On Sun, 07 Jun 2009 11:25:53 -0500, HeyBub wrote:

Larry Blanchard wrote:

We'll never know unless we try the alternative, will we?

We have tried it. Both Medicare and Medicaid are both, essentially,
single-payer.

I don't know about Medicaid, but I'm on Medicare with a supplement and it
works fine for me. I pay about $300 a month for the pair. Before I was
eligible for Medicare I paid about the same for major medical coverage
only. I still pay that for my wife as she isn't 65 yet.

There is a problem with fraud, but that exists for private insurance as
well.

On my last endoscopy I still had to pay $36, but that's miniscule
compared to what the doctor charged - of course Medicare didn't pay
anywhere near what he charged.

No, it's not perfect, but I'm fairly confident I won't lose my retirement
fund and/or my home from exorbitant medical bills.

--
Intelligence is an experiment that failed - G. B. Shaw

On Thu, 04 Jun 2009 17:41:36 -0500, dpb wrote:

Tim Douglass wrote:
...
The rationale behind electronic medical record keeping is not, and
never has been, about cost reduction. The entire reason behind it is
to reduce errors, improve diagnostics, speed administrative functions
and make records more accessible where they are needed. Any cost
factors are merely incidental.

I spent several years involved in the medical software industry about
20 years back. Even then all of these same issues were being
discussed, although not on the national stage. The goal was to find a
way to give better service, not necessarily cheaper service.
...
One wonders how many of these same players (and new ones) are making
large contributions to push the current agenda and did so during the
campaign...

Could well be, although few of those players had the kind of size and
reach to do any political activism.

Just an odd anecdote relating to electronic medical records. I have a
friend whose husband is a GP. He was actually voted state doctor of
the year a while back. The clinic he works in recently went to an
electronic system and he hates it. A big part of the problem is that
he is now expected to enter into the computer (something he is not
skilled at) all of the patient notes he previously scribbled on a
chart or dictated to a recorder. The result is that he only sees about
2/3 as many patients a day as previously.

OTOH, my personal GP, a younger (OK, still probably in his 50s) doctor
in a different clinic went to a computerized system at about the same
time. He absolutely loves it. He claims he sees more patients in a day
and gives better service. I will attest to the latter because he
always sees something now on the computer that prompts him to ask
about certain conditions that previously only got brought up if I
brought them up. Their billing is still sometimes a bit messed up,
but I like that all the lab orders and prescriptions are sent out
paperlessly and immediately.

The real point is that the human factor in the doctor's office may
have more to do with the effectiveness of any electronic system than
all the other factors.

Tim Douglass

http://www.DouglassClan.com

Two Down - Two to Go!

"Tim Douglass" wrote in message
The real point is that the human factor in the doctor's office may
have more to do with the effectiveness of any electronic system than
all the other factors.

Funny you mention this as there's currently an active money scandal
involving the Ontario government's conversion of medical records to an
electronic system. It seems the problem is there's too many government
people throwing public money around and too many people without ethics
willing to take it.

Anyone else getting the equivalent of a $114,000 bonus on top of a $380,000
salary after just a few months on the job?

http://www.citynews.ca/news/news_35148.aspx

Lew Hodgett wrote:
"dpb" wrote:

But the sidebar was about LT care and not dumping oneself onto the
gov't.

"Dumping".

Great choice of words, it says a lot.

What would you have a person do who has played by the rules, saved for
a "rainy day", provided insurance coverage, then as a result of an
unforeseen illness or accident, find themselves in debt in the 6
figure range and has to declare bankruptcy?

That's what catastrophic policies are for...you don't have one???

--

"dpb" wrote:

That's what catastrophic policies are for...you don't have one???

And after it gets maxed out, then what?

Lew

Tim Douglass wrote:
On Thu, 04 Jun 2009 17:41:36 -0500, dpb wrote:
....
One wonders how many of these same players (and new ones) are making
large contributions to push the current agenda and did so during the
campaign...

Could well be, although few of those players had the kind of size and
reach to do any political activism.

Well, the particular one(s) w/ which you were associated may not; the
former outfit I worked thru is $2B annual sales and are/were _VERY_
adept at having folks on the inside who knew the current hot-button
agenda items of every key player in Congress as well as close contacts
in all the pertinent agencies. I've not kept close tabs, but I'm sure
they (and all the other of their ilk) haven't been idle. That's not
_all_ necessarily bad; it's how things happen, but one shouldn't pretend
all of this is happening merely as a goodwill gesture.

Just an odd anecdote relating to electronic medical records. I have a
friend whose husband is a GP. He was actually voted state doctor of
the year a while back. The clinic he works in recently went to an
electronic system and he hates it. A big part of the problem is that
he is now expected to enter into the computer (something he is not
skilled at) all of the patient notes he previously scribbled on a
chart or dictated to a recorder. The result is that he only sees about
2/3 as many patients a day as previously.

OTOH, my personal GP, a younger (OK, still probably in his 50s) doctor
in a different clinic went to a computerized system at about the same
time. He absolutely loves it. He claims he sees more patients in a day
and gives better service. ...

My brother is a veterinarian w/ a tie-in to a nationwide group. They
went to digital recordkeeping system as well a number of years ago. It
had the same effect as the former above--initially it required him to
spend several additional hours every evening after closing the doors to
transcribe the daily records. Eventually he managed to get
adequately-trained technicians who could do most of the transcription
but it is still an additional labor cost that he doesn't see made up for
in increased productivity or other offsetting cost avoidance.

The system has improved over the years but so have the associated
hardware and maintenance costs as the processor power requirements have
gone up drastically. As well, it has on occasion become a bottleneck
when there have been server/network failures either local or, more
often, remote that have kept the system unoperational. Unfortunately in
those cases, the business model has move to where they are essentially
shutdown if the 'puters are down--that was never the case before.

I think the point about individuals is valid; however, and certainly
virtually everyone who is growing up today has far better computer
skills than most of the present geezer generation. That combined w/
improving systems themselves probably will make the success rate go up;
however, I'm still far more interested in my physician actually knowing
some medicine than in him being an expert IT guy and relying on a remote
neural net to prod him w/ answers a la the service tech in a far away
call center...

--

Lew Hodgett wrote:
"dpb" wrote:

That's what catastrophic policies are for...you don't have one???

And after it gets maxed out, then what?

Call Uncle Barak, I guess. Seems your answer to everything else; ask
somebody else to take care your responsibilities.

--

In article
dpb writes:
Lew Hodgett wrote:
"dpb" wrote:

That's what catastrophic policies are for...you don't have one???

And after it gets maxed out, then what?

Call Uncle Barak, I guess. Seems your answer to everything else; ask
somebody else to take care your responsibilities.

In designing critical systems (and I think health care qualifies),
it is important to consider the failure points before they occur.
So I think it was not only a fair question, but an essential one.

Then what? Some *will* be in over their heads. Is there a lifeguard
or do they drown?

Both are acceptable answers (ultimately, all resources have limits),
but avoiding the question definitely doesn't lead to good solutions.

Governing isn't about finding the easy 90% of the answer.

--
Drew Lawson

I only came in search of answers, never planned to sell my soul
I only came in search of something left that I could call my own

Drew Lawson wrote:
In article
dpb writes:
Lew Hodgett wrote:
"dpb" wrote:

That's what catastrophic policies are for...you don't have one???
And after it gets maxed out, then what?
Call Uncle Barak, I guess. Seems your answer to everything else; ask
somebody else to take care your responsibilities.

In designing critical systems (and I think health care qualifies),
it is important to consider the failure points before they occur.
So I think it was not only a fair question, but an essential one.

Then what? Some *will* be in over their heads. Is there a lifeguard
or do they drown?

Both are acceptable answers (ultimately, all resources have limits),
but avoiding the question definitely doesn't lead to good solutions.

Not according to Lew, apparently.

The problem I see is that the proposed solutions don't actually address
the questions but only provide another unfunded mandate similar to the
several that are already in place that we haven't yet figure out how to
continue to pay for.

I have no problem w/ the idea of somehow making alterations; I simply
would like to see the actuarial bases behind the changes a priori as
well as how various things such as the electronic records that is being
touted as a cost-savings tool (of apparently almost unlimited benefit to
hear it sold) is actually going to defray which specific costs to offset
the implementation, operation and continuing maintenance costs.

I've heard much rhetoric; little what I would classify as solid information.

--

"dpb" wrote:

Call Uncle Barak, I guess. Seems your answer to everything else;
ask somebody else to take care your responsibilities.

I'm not sure what the answer is, but the system is broken.

If you are wealthy you can afford to pay for health care.

If you are poor, then the government provides you with health care.

However, if are in the middle, you are SCREWED.

You get to purchase health care insurance that may or may not cover
your particular problem when you need it most or have such a large
copay that coverage becomes impossible to use.

An unfortunate situation such as an accident or a disease such as
cancer, and the next thing you know, it's bankruptcy time, even with
the best laid plans of financial advance planning.

There are lots of middle class families that planned ahead, but ended
up with copay debt in the 6 figure class and bankruptcy, the only way
out.

Allowing the private sector to be the fox guarding the hen house has
developed a hodge podge safety net with far too many holes in it to be
considered safe.

I'm not in favor of having the government being in the health
insurance business, but I am in favor of government being the
oversight business which probably does include having government
provide "super high catastrophe" coverage and basic low end coverage.

That leaves a lot of room for the private sector to operate; however,
some retooling of how they operate will be required.

Lew

Lew Hodgett wrote:
"dpb" wrote:

Call Uncle Barak, I guess. Seems your answer to everything else;
ask somebody else to take care your responsibilities.

I'm not sure what the answer is, but the system is broken.

If you are wealthy you can afford to pay for health care.

If you are poor, then the government provides you with health care.

However, if are in the middle, you are SCREWED.

You get to purchase health care insurance that may or may not cover
your particular problem when you need it most or have such a large
copay that coverage becomes impossible to use.

An unfortunate situation such as an accident or a disease such as
cancer, and the next thing you know, it's bankruptcy time, even with
the best laid plans of financial advance planning.

There are lots of middle class families that planned ahead, but ended
up with copay debt in the 6 figure class and bankruptcy, the only way
out.

Allowing the private sector to be the fox guarding the hen house has
developed a hodge podge safety net with far too many holes in it to be
considered safe.

I'm not in favor of having the government being in the health
insurance business, but I am in favor of government being the
oversight business which probably does include having government
provide "super high catastrophe" coverage and basic low end coverage.

That leaves a lot of room for the private sector to operate; however,
some retooling of how they operate will be required.

Lew


I'm one of your "in the middle" people. I planned ahead - invested 10%
of gross for 35 years and have insurance that I carefully shopped for.
The wife had two major medical events in '05 and '06 and I had surgery
for colon cancer in '05, all adding up to a large 6 figure billable
total. The insurance copays weren't overly burdensome. The insurance
company didn't try to get out of anything and there are no max coverage
issues. The insurance premiums run a little over $800/month which is
easily doable if you plan ahead.

My and SWMBO's folks are gone now, but both of our parents planned ahead
and had insurance and were treated well by the medical and insurance
folks. We had SWMBO's mom with us for her last four years, but it
wasn't because of any financial problems on her part, rather dementia.
My mom spent her last years living with my sister and BIL, again not for
financial reasons, but debilitating conditions caused by a stroke at age 93.

So, I'm having a difficult time wondering why these folks you mention
are in such tough shape if they have planned ahead financially and have
good insurance (they looked carefully at the coverage before buying).

$800/month may be doable for you, but there may be people for whom it is
not. Example: 40-odd year-old couple (no kids, no more parents). Both
lost full-time jobs. One of them can retain the job, but is only paid 50%
as a part-time person. No benefits. Cobra costs over $1000/month.

That can be tough in NY City.
--
Best regards
Han
email address is invalid

Han wrote:
$800/month may be doable for you, but there may be people for whom it
is not. Example: 40-odd year-old couple (no kids, no more parents).
Both lost full-time jobs. One of them can retain the job, but is
only paid 50% as a part-time person. No benefits. Cobra costs over
$1000/month.

That can be tough in NY City.

A forty year old couple with no health problems shouldn't have to pay
anything like $1000/month. I pay $170 a month. The trick is to not expect
insurance to pay for every checkup and the like. I have a high deductible
indemnity policy--the deal is that they don't pay a cent until I accrue more
than $2000 expenses in a single year, then they pay _everything_. It's old
fashioned _insurance. The medical insurance business has moved away from
that model to one in which the insurance company pays for every checkup and
the like and on that basis there is no way for such a system to cost less
than the patient simply paying the doctor for routine checkups.

Han wrote:
$800/month may be doable for you, but there may be people for whom it is
not. Example: 40-odd year-old couple (no kids, no more parents). Both
lost full-time jobs. One of them can retain the job, but is only paid 50%
as a part-time person. No benefits. Cobra costs over $1000/month.

That can be tough in NY City.

Well, I lost my job in 1998 and my wife didn't work. It was still
easily doable because I planned ahead and invested 10% of my gross from
the time I started working. 10% is less than what you and your employer
contribute to SS, yet if invested wisely, it will provide much more
income and not be drained even over a lifetime. Compound
interest/earnings are wonderful things.

"Doug Winterburn" wrote:


I'm one of your "in the middle" people. I planned ahead - invested
10%
of gross for 35 years and have insurance that I carefully shopped
for.
The wife had two major medical events in '05 and '06 and I had
surgery
for colon cancer in '05, all adding up to a large 6 figure billable
total. The insurance copays weren't overly burdensome. The
insurance
company didn't try to get out of anything and there are no max
coverage
issues. The insurance premiums run a little over $800/month which
is
easily doable if you plan ahead.


Consider yourself lucky you had 35 straight years to build a nest egg.

In many cases a lengthily undisrupted period to build a nest egg was
not a possibility for many reasons.

For a family earning say $48K/annum or $4,000/month gross, an
$800/month health care premium or 20% of gross is probably a real
stretch to handle, especially if you throw in say 35% for ALL taxes,
and 30% for housing.

That leaves only about 15% or $600/month to cover all other living
expenses.

Highly unlikely that scenario is going to fly.

BTW, the 6 figure unpaid bill referred to previously, was an
accumulation of the remaining copay after the insurance company had
paid.

Lew

On Tue, 09 Jun 2009 07:17:35 -0700, Doug Winterburn
wrote:

Han wrote:
$800/month may be doable for you, but there may be people for whom it is
not. Example: 40-odd year-old couple (no kids, no more parents). Both
lost full-time jobs. One of them can retain the job, but is only paid 50%
as a part-time person. No benefits. Cobra costs over $1000/month.

That can be tough in NY City.

Well, I lost my job in 1998 and my wife didn't work. It was still
easily doable because I planned ahead and invested 10% of my gross from
the time I started working. 10% is less than what you and your employer
contribute to SS, yet if invested wisely, it will provide much more
income and not be drained even over a lifetime. Compound
interest/earnings are wonderful things.

Shame on you for being self sufficient. That is *not* allowed in
Obamanation.

Lew Hodgett wrote:
"Doug Winterburn" wrote:


I'm one of your "in the middle" people. I planned ahead - invested
10%
of gross for 35 years and have insurance that I carefully shopped
for.
The wife had two major medical events in '05 and '06 and I had
surgery
for colon cancer in '05, all adding up to a large 6 figure billable
total. The insurance copays weren't overly burdensome. The
insurance
company didn't try to get out of anything and there are no max
coverage
issues. The insurance premiums run a little over $800/month which
is
easily doable if you plan ahead.


Consider yourself lucky you had 35 straight years to build a nest egg.

"Luck is where preparation meets opportunity."


In many cases a lengthily undisrupted period to build a nest egg was
not a possibility for many reasons.

For a family earning say $48K/annum or $4,000/month gross, an
$800/month health care premium or 20% of gross is probably a real
stretch to handle, especially if you throw in say 35% for ALL taxes,
and 30% for housing.

That leaves only about 15% or $600/month to cover all other living
expenses.

Highly unlikely that scenario is going to fly.

BTW, the 6 figure unpaid bill referred to previously, was an
accumulation of the remaining copay after the insurance company had
paid.

Why would anyone buy an insurance policy with a 6 figure copay,
deductible or a ceiling which would leave you that unprotected? One
needs to examine the terms and conditions before selecting a policy.


Lew

"Doug Winterburn" wrote:

Why would anyone buy an insurance policy with a 6 figure copay,
deductible or a ceiling which would leave you that unprotected?

From what I was told, it was an accumulation of several events.

Lew

Doug Winterburn wrote:
Lew Hodgett wrote:
"Doug Winterburn" wrote:


I'm one of your "in the middle" people. I planned ahead - invested
10%
of gross for 35 years and have insurance that I carefully shopped
for.
The wife had two major medical events in '05 and '06 and I had
surgery
for colon cancer in '05, all adding up to a large 6 figure billable
total. The insurance copays weren't overly burdensome. The
insurance
company didn't try to get out of anything and there are no max
coverage
issues. The insurance premiums run a little over $800/month which
is
easily doable if you plan ahead.

Consider yourself lucky you had 35 straight years to build a nest egg.

"Luck is where preparation meets opportunity."

In many cases a lengthily undisrupted period to build a nest egg was
not a possibility for many reasons.

For a family earning say $48K/annum or $4,000/month gross, an
$800/month health care premium or 20% of gross is probably a real
stretch to handle, especially if you throw in say 35% for ALL taxes,
and 30% for housing.

That leaves only about 15% or $600/month to cover all other living
expenses.

Highly unlikely that scenario is going to fly.

BTW, the 6 figure unpaid bill referred to previously, was an
accumulation of the remaining copay after the insurance company had
paid.

Why would anyone buy an insurance policy with a 6 figure copay,
deductible or a ceiling which would leave you that unprotected? One
needs to examine the terms and conditions before selecting a policy.
....

All it would take in total liability w/ a fairly typical 80% copay would
be otoo $500K in billings to leave $100K.

That's why one indeed needs that catastrophic policy that does cover the
big ticket items that ordinary/routine policies leave wanting.

Unfortunately, it's all too easy any more to reach upper 6 or 7-digit
expenses for extensive treatments (and Lew, before you start, I've never
disagreed that costs need some sort of containment, only that I don't
see how anything so far proposed is going to help in that regard other
than transfer one form of cost for another disguised one).

--

"dpb" wrote:


(and Lew, before you start, I've never disagreed that costs need
some sort of containment, only that I don't see how anything so far
proposed is going to help in that regard other than transfer one
form of cost for another disguised one).

As I see it the only way to get a handle on cost containment is to
change the focus of how medicine is practiced.

We need to focus on the lower cost preventative medicine rather than
the higher cost therapies required after someone gets ill.

To do this requires early like preventative care(prenatal, pediatric,
etc) of all the population.

Producing a healthier young population that requires fewer high cost
procedures later in life is the easiest way to reduce what are now a
totally runaway costs to a more manageable level while at the same
time improving over all health of the nation.

Lew

Upscale wrote:
"Lew Hodgett" wrote in message
Producing a healthier young population that requires fewer high cost
procedures later in life is the easiest way to reduce what are now a
totally runaway costs to a more manageable level while at the same
time improving over all health of the nation.

Essentially, that's the same as saying the entire county population has to
undergo a complete lifestyle change. What are the chances of that happening?
Sounds good in theory and in practice, but it ain't going to happen in a
dozen lifetimes.

Nor ime is it likely to make any real difference in EOL outcomes as
technology continues to improve to extend life and the expectation is
that everyone is entitled to receive every possible treatment to extend
life as long as possible irregardless of eventual outcome (in the near
term sense, obviously). With that increasing technology and the use of
it are inherent higher costs.

--

On Jun 10, 5:56*pm, "Upscale" wrote:
"Lew Hodgett" wrote in message
Producing a healthier young population that requires fewer high cost
procedures later in life is the easiest way to reduce what are now a
totally runaway costs to a more manageable level while at the same
time improving over all health of the nation.

Essentially, that's the same as saying the entire county population has to
undergo a complete lifestyle change. What are the chances of that happening?
Sounds good in theory and in practice, but it ain't going to happen in a
dozen lifetimes.

The governments WANT people to die young, 70 tops. No pensions to pay,
no long-term care facilities. Keep the hospitals open for those who
can be put back to work so they can be milked for taxes. An aging
population, a sick population is bad for harvesting taxes.
So smoke'm if you got'm.

"Upscale" wrote:

Essentially, that's the same as saying the entire county population
has to
undergo a complete lifestyle change. What are the chances of that
happening?
Sounds good in theory and in practice, but it ain't going to happen
in a
dozen lifetimes.

No, not at all.

What I am saying is that a significant portion of the 6 and under
population are not receiving adequate preventative health care in
their formative years which leads to higher cost medicine in later
years.

As far as a change in lifestyles is concerned, a healthier population
may want to live a healthier lifestyle, but it isn't something you can
quantify.

Lew

Lew Hodgett wrote:
....
What I am saying is that a significant portion of the 6 and under
population are not receiving adequate preventative health care in
their formative years which leads to higher cost medicine in later
years.
....
You're back to the same problem you didn't want to hear earlier--the
bulk of those are in that fix because of either sorry parenting or that
they're in the part of the society that isn't covered currently and
extending that care to them is going to cost more in additional services
than it can bring in.

I'd be surprised if it could be showed by tracking cohort studies that
most of that same population are the ones actually getting the very high
cost extensive care at or near EOL.

Either way, they're not the ones who will bring any resources into the
system to help defray expenses.

--

"dpb" wrote:

Nor ime is it likely to make any real difference in EOL outcomes as
technology continues to improve to extend life and the expectation
is that everyone is entitled to receive every possible treatment to
extend life as long as possible irregardless of eventual outcome (in
the near term sense, obviously). With that increasing technology
and the use of it are inherent higher costs.

As I said earlier, it is the real elephant in the room.

It is THE issue that society must face.

When do you say, "Enough is enough"?

Do we require everybody to have a "Living will"?

At least then, the desires of the person most affected are known.

Do we nationally adopt the procedures that are in place in Oregon?

Do we empower the government to make these decisions?

I think NOT.

What part does a persons religion have in this process?

Tough questions, but it now is the time to face up to what are not
only tough, but uncomfortable questions to answer.

Lew

"Lew Hodgett" wrote in message
Producing a healthier young population that requires fewer high cost
procedures later in life is the easiest way to reduce what are now a
totally runaway costs to a more manageable level while at the same
time improving over all health of the nation.

Essentially, that's the same as saying the entire county population has to
undergo a complete lifestyle change. What are the chances of that happening?
Sounds good in theory and in practice, but it ain't going to happen in a
dozen lifetimes.

"Lew Hodgett" wrote in message
What I am saying is that a significant portion of the 6 and under
population are not receiving adequate preventative health care in
their formative years which leads to higher cost medicine in later
years.

Ok, my mistake. I thought you were referring to the entire lifeline, not
children in their formative years. And, what you say does make sense, but
why are they not receiving adequate preventative health care? Is it solely a
financial reason?

Lew Hodgett wrote:
....
The politicians, if nothing else, astute at reading the tea leaves and
responding to what the public wants.
....

Polls should as many as 80% were against bailouts; no poll showed
anything at all approaching a majority in favor--how did that come out
if the above were the primary driving force?

--

"dpb" wrote:

Polls should as many as 80% were against bailouts; no poll showed
anything at all approaching a majority in favor--how did that come
out if the above were the primary driving force?

Am clueless what polls you are referring to.

Been watching any C-Span lately?

Lew

Lew Hodgett wrote:
"dpb" wrote:

Polls should as many as 80% were against bailouts; no poll showed
anything at all approaching a majority in favor--how did that come
out if the above were the primary driving force?

Am clueless what polls you are referring to.

Been watching any C-Span lately?

No TV other than OTA networks. All stories in every paper I saw
indicated general public was highly opposed.

Just an observation that the pol's don't always do the expected and
other political factors come into play besides public opinion.

Certainly the current administration/congress leaders have intentions;
what they actually get incorporated is yet to be determined.

And, of course, there's the old saw of "careful what you wish for; you
just might get it".

--

"Lew Hodgett" wrote in message
...
"dpb" wrote:

Polls should as many as 80% were against bailouts; no poll showed
anything at all approaching a majority in favor--how did that come out if
the above were the primary driving force?

Am clueless what polls you are referring to.

DAGS: poll bailout

Lots to clue you.


Been watching any C-Span lately?

Lew