"Kurt Ullman" wrote in message
"Robert Green" wrote:
"Kurt Ullman" wrote in message news:3v-
"Malcom \"Mal\" Reynolds" wrote:

From the fines imposed on those that don't meet the law

SInce the fines as currently structured are less than the likely
premiums, how is that supposed to work?

"Currently structured" answers your own question. If too many companies
decide to pay the fine but not provide health care, the fines can be
adjusted until they do. This law *should* have been passed when so many
businesses *began* ditching health care and the problem hadn't become a
nationwide epidemic.

But then, they wouldn't have had to move large numbers of
people to the government plans. Interestingly enough, the same problem
show in the MA plan, more or less the template for much of reform. And
many people go in and out of insurance plans as needed since they can't
be kept out due to pre-existing conditions.
The REALLY scary part about MA is that, since inception of their
reform, annual increases in premiums have gone from well below the
national average to above it. Their general spending also has
accelerated in a similar matter.

When one state alone does it, there are too many extra forces working
against success. Just like legislators discovered that despite their
draconian gun laws, DC was impossible to keep free of guns because it shared
a border with Virginia, where getting guns in some counties is very, very
easy. That's why the healthcare pool should include *everyone* since that's
the only way to avoid the fervent desire of for-profit insurers to not
insure sick or likely to be sick people. Who knows how many people came to
MA looking for a freebie like so many immigrants flock to the US to have
anchor babies? When you offer a benefit that nearby people don't have,
they're going to move.

People will always pay more for their healthcare in a profit-based system
than under a Medicare/Medigap system unless the latter is mis-managed to the
hilt - and it may be. The government can use its enormous purchasing power
to strike the kind of 40% Big Pharma discounts that only the Europeans get
(on OUR medicine!!!!). They supply a basic formulary excluding experimental
treatments. If you want that, you pay extra, just like if you feel you need
flood insurance.

What's gumming up the works is the basic fact that commercial health
insurers have no interest in *really* caring for the seriously ill. Payouts
= lost profits. It's that simple. Anyone whose dealt with them knows that.
That's why "pre-existing" crap started and the "recission game" came into
being. Commercial insurers DO NOT WANT to insure sick or even likely to be
sick people. Medicare evolved because some people over 55 couldn't buy
health insurance at any price. People forget that it was the for-profit
insurers refusomg to insure retirees that basically forced the birth of
Medicare.

In a non-profit situation, there is no conflict between a patient's health
and a for-profit corporation's need to pay huge salaries to the CEO and big
dividends to the stockholders. Lots of people have to get their cut of my
premium payment before I see a penny of benefits in the for profit system.
I am still in awe of how many people believed that government health care
meant "death panels." I was even more amazed to realize that so many people
didn't know those "death panels" were already in full operation at
for-profit insurers. People really seemed unaware that for profit insurers
have teams that review the week's major claims and how to "stop-loss" them.
For profit health insurance is a dirty, miserable business that does not
operate in the interest of the customer's health (for which they are paid)
but in the interests of their stockholders. That conflict alone is driving
healthcare to unaffordable levels for a lot of people.

Fixing healthcare is going to be a tough, ugly job because too many
people
make oodles of money with things just the way they are. MRSA is a
perfectly
example of the built in lack of incentives to actually *improve*
healthcare.
With 30 years experience, Kurt, surely you can tell us how hospitals
made
buckets of blood money making sick people even sicker from iatrogenic
MRSA
infections. At least until the Feds stepped in, that is. And even that
will be a long, uphill battle.

Yeah, those evil hospitals who made a killer disease just to
increase revenue.

Those evil hospitals that refused to do the minimum required to keep a known
killer infection at bay because they got MORE income for treating the
patient for the disease THEY gave him. Tell me where the incentive IS for
hospitals to keep the patient from acquiring MRSA? Nowhere. Giving a
patient that came in for a routine surgery MRSA merely means guaranteeing a
very expensive return visit. Is that evil? Is it criminal negligence? Is
it stupidity? Or is it something that keeps the bucks flowing into a profit
center and it won't be dislodged until it *doesn't* represent a lucrative
($50K per patient) followup business? They didn't invent it, but they sure
have taken advantage of it and I think that makes them evil. YMMV.

For most countries badly affected by methicillin-resistant Staphylococcus
aureus (MRSA) there have been many years of debate about its relative
virulence compared with methicillin-susceptible S. aureus (MSSA) and whether
it could be controlled. Now that it is endemic in the majority of hospitals
around the world, it is clear that it is at least as virulent as MSSA and is
an additional burden of healthcare-acquired infection. There is increasing
evidence that, despite this endemicity, control efforts can be successful,
although they are often perceived as expensive. In reality, there is a large
body of consistent evidence that control is highly cost effective,
particularly in the context of the huge societal costs of MRSA and the
future ever-greater threats that it poses. Source:
http://www.sciencedirect.com/science...24857906003499

And yet it took the Federal threat to withhold payment for iatrogenic
(medically caused) MRSA infections that the patient acquired previously at
that hospital. A lot of people died A LOT of people. Twenty thousand a
year according to some reports. Lots more people are horribly maimed by the
"flesh eating bacteria" MRSA.

When a report says "cost effective" it should mean for the payers: the
patient and insurers. Infecting people with a disease that guarantees a
return visit brings is very cost effective for HOSPITALS because of the
incredible extra revenue it represents. They're not about to cut off a
revenue stream unless forced at financial gunpoint - and that's exactly what
it took and the hospitals are finally responding. W i t h a l l d e l i b
e r a t e s p e e d. I'll bet they're looking for loopholes as I write
this.

How many people does MRSA kill?

http://www.medicinenet.com/mrsa_infection/article.htm says:

"Statistical data suggest that as many as 19,000 people per year die from
MRSA in the U.S.; current data suggest this number has declined by about
25%-35% in recent years, in part, because of prevention practices at
hospitals and home care."

By definition the free market cannot operate fairly in a system where
you're
buying a future service of unknown quality that can KILL you if poorly
performed. What are your free market options when the market has killed
you? To not buy THAT insurance again?

The insurance isn't going to kill you though.

You're a funny guy, Kurt. Bad insurance certainly CAN kill you if it denies
you urgently needed medical care by stalling approvals for procedures and
treatment long enough for you, the patient to die. Or are you going to
really try to deny that those cases are not a dime-a-dozen to find? Do I
*really* need to review the thousands (maybe tens or hundreds of thousands)
of cases where people who died wrapped up in their medical insurer's red
tape?

With your three decades in the business you HAVE to know all the tactics
insurers use to keep premiums but avoid payouts. I'd hate to think you were
"HeyBubbing" us. But you're dodging the question. How can the free market
work when a bad choice in insurers can kill you? So in light of what I just
wrote, perhaps you can explain why you believe "insurance isn't going to
kill you" by denying you treatment that they deem "too expensive" or "not in
our formulary." Unless, of course, you're playing silly word games with us
as in "insurance doesn't kill people, diseases do." Freemarket rules don't
work when it comes to a commodity that you may not need until 20 years after
you've been paying for it.

Most people don't know they have bad health insurance until they get a
denial in a life-threatening case. So where's the built-in competition and
the freemarket buyer's ability to reject inferior goods? I have read over
and over that people with advanced degrees in medical fields can't properly
compare plan benefits because they are so complex. So I believe it's a
given that people don't really know exactly what they are buying, or what it
will really cover. It's a commercial gold mine and no wonder they are
fighting Obamacare so hard. It might derail the gravy train for private
insurers.

A basic Federal minimum
Medicare-like plan for everyone who's a citizen with the ability to buy
all
the Cadillac "gap" insurance for those who feel that the minimum is not
good
enough for them is where we are headed and will end up. It will just
take a
while.

Well under those indications, we should probably then federalize
car makers (well MORE federalize carmakers) because a bad brake pad
could kill me.

That's a bit non-sequitur, a bit specious and quite a leap of logic. We've
come close to Federalizing carmakers - no, wait, we actually DID Federalize
carmakers - literally. The point is that at least in safety areas like
brakes the Feds specify what safety equipment is supposed to do and they do
it with far more detail than what your health insurance will and won't pay
for.

Brake pads have to be manufactured to stringent Federal specifications
because your bad brakes may not only kill you, but may also kill many other
people when you can't stop your car. So I ask again, if your health insurer
stalls your treatment long enough to kill you how does the free market
protect you when their self-interest (profits) collide with your
self-interest (staying alive)? Remember, I will spank your ass rosy red if
you keep denying such things happen with a dozen examples of people dying
before their insurer decided if they'll pay. (-:

I read the LAT too often to have missed the antics of California's medical
insurers, the absolute leaders in weaseling out of paying for their
insured's medical care just with two nuclear options: recissions and
pre-existing condition denials. A private insurer can renege on a payout
for nearly any reason, and if you're too sick to fight and don't have family
capable of fighting for you, you're likely to get stomped. To death.
That's why Obamacare is here. Too many private insurers have figured out
too many ways to rip off policyholders and refuse to pay what they promised.
Other countries handle universal health just fine. We're beginning to look
like the world's knuckleheads with all the unsolved problems we're facing.

From the savings to the health care system because they
catch/diagnose
cirrhosis
of the liver earlier thus preventing unnecessary liver transplants

I ahve followed these things professionally for nearly 3 decades
and
the next study that shows this will be the first. Even in insured
populations this doesn't show up.

But the concept is sound. The current structure of the health care
system
does very little to prevent ill health because that would rob them of
expensive "Hail Mary" procedures downstream. Mal's point is still valid
even if the example is not - and I don't even know if that's true.
Just
because something isn't studied doesn't make it false. It's just
unstudied.

The concept is sound but there is no evidence of its usefulness so
we should go ahead and do it anyway.

Nonsense. The MRSA data alone indicates that when there's a clear benefit
in prophylactic care, hospitals STILL refuse to get on board. It appears to
take a much bigger hammer than clearly better patient outcomes to get them
off their asses to do it right. And that's wrong. Or are you going to now
claim there's no benefit to be gained by NOT infecting people with the flesh
eating bacteria MRSA?

On the other hand, I can direct you to old journals full of studies
showing
ulcers were stress induced (they're not - they are bacterially caused).
So
even a study showing X is cause by Y has to be taken with a grain of
salt -
or some antibiotics.

which of course makes my point rather nicely, the concept of stress
was sound (actually it still is but research has shown you need this
other thing, too) until it wasn't.

Say what? It proves MY point. Australians proved antibiotics cured the
disease, but the best our US drug makers could come up with was expensive
drugs that merely treated the symptoms. That's endemic of our current
system. Don't cure - treat over a lifetime with expensive drugs.

If the fact that the medical establishment had proof up the wazoo that
something was true when it wasn't makes your point then your point is
perhaps pretty pointless. What is it you're trying to prove, anyway? That
preventative care is meaningless? Doctors kept pushing useless treatments
for ulcers that didn't cure the problem but were highly profitable to Big
Pharma - who fought the Australian studies tooth and nail. That's MY point.
Good health outcomes are secondary to the profits of the medical industries.
When was the last time medicine cured something as serious as smallpox or
polio? A long, long time ago.

That's especially true when so darn many studies are
funded by the drug makers themselves with the express intent to prove a
product's efficacy or non-lethality. Common sense tells us that there
are
likely to be some conflicts of interest in those studies.

Well known and well discussed.

Great. I'll take that as an admission that studies that show preventative
care is useless were likely to be funded by drug companies who profit more
from "treating for life" than they do curing or preventing..

Looking for myself, it seems to be now "common wisdom" that early
detection
and treatment of cirrhosis can reduce the need for transplants:


http://www.google.com/search?q=cirrh...+for+l iver+t
ransplants

Makes sense to me, too, studied, unstudied, understudied or overstudied.
Is
your objection simply that no studies have confirmed this? Or are you
actually saying that catching liver diseases earlier than where we tend
to
catch them now would have NO effect on the liver transplant rates?

No, I am saying that no studies show that insurance status has an
impact on catching these things earlier. Even with insurance that covers
annual physicals, the rates at which people take the time to actually do
them is low. The magic behind preventive medicine is largely not
supported by reality.

First of all, I don't believe Mal restricted himself to "insurance status"
but regardless, when you're forced to admit that "reality" is determined by
studies sponsored by drug companies that have a vested interest in selling
more drugs, then it's clear that they would not be interested in proving
that preventative care is worthwhile. Here's an interesting "study of past
studies" by the NEJM (who assures us this report is bias free - although all
the reports they're aggregating could be as biased as hell). It says that
preventative measures can work:

Some preventive measures save money, while others do not, although they
may still be worthwhile because they confer substantial health benefits
relative to their cost. In contrast, some preventive measures are expensive
given the health benefits they confer. In general, whether a particular
preventive measure represents good value or poor value depends on factors
such as the population targeted, with measures targeting higher-risk
populations typically being the most efficient.

http://www.nejm.org/doi/full/10.1056/NEJMp0708558

The way these cost-benefit analyses are set up, there's a lot of fudge to
factor in. I believe it was you who pointed out how subjective a concept
like a QALY (quality adjusted life year) turns out to be.

When you factor in the newness of prevention as a tool in the medical
toolkit, it's very likely we don't quite yet know *how* to best prevent
disease. So I would expect prevention numbers to improve substantially as
more feedback is acquired. Monitoring a hard drinker for signs of cirrhosis
seems to be intuitive and perhaps as diagnostic imaging improves, we'll be
able to catch liver failure and even more untreatable things like pancreatic
cancer faster. AFAIK, pancreatic cancer is almost always fatal because it's
so notoriously difficult to catch early and people only survive more than a
few months if surgeons discover it, usually looking for something else.

New gene-based tests that can detect even a few pancreatic cancer cells are
destined to come to market (although many have failed dismally) and
eventually prevention studies like the NEJM's are going to show substantial
shifts. It's really as common sense an idea as routine auto maintenance and
inspection to detect small problems from becoming bigger. Only in the wacky
world of medical statistics does that simple, time-proven idea get turned on
its head.

--
Bobby G.