Welch wrote:- Profit-making insurance companies have an interest in reducing the care that is given. That is how they make a profit.
- a for-profit insurance company is more likely than a non-profit to cut care.
Which is more likely to cut costs and improve care; a free market or Government control?
When was the last time you can remember the Government EVER cutting the costs of anything?
Walmart, an evil capitalist corporation dropped most prescription drug prices to $4 for a one month supply. Giant Food, another evil capitalist company offered free antibiotics. Why did they do this? Simple; greed.
These companies both knew that if they took a hit on the cost difference between what the drug actually cost, and what the consumer actually paid for it, that the consumer was much more likely to come to their stores for ALL of their other needs.
Could you see the Govt doing this? Sure, they may force a company to lower it’s prices by simply refusing to pay more than x amount, but the company will combat that through malicious compliance. They will not give you any more than they are required to by law, and will cut corners everywhere they can.
Welch wrote:- The US model ought to be more like Medicare, which is available to older people. Medicaid is intended to punish whoever uses it: it intentionally forces people down to poverty before it covers them. Otherwise, the argument goes, Medicaid would be a handout, and people would take advantage of it.
You mean the bankrupt? Medicare has been operating in the red as far back as I can remember and even though we all pay for it dutifully out of our checks each week, we are being told that it won’t be available by the time we are old enough to qualify.
Medicare currently attributes to our National debt, even though an overwhelming majority of American are employed and paying into the system. The National Unemployment level is, what, 10% now? That means there are 90 of the population paying into a system that is currently operating in the red.
Maybe if we give the Govt full control of our healthcare they’ll do a better job with their finances?
The big difference between the Govt and a “for profit” company is that a “for-profit” company cannot continually run itself into the red the way the Govt does.
Welch wrote:- Further examples, just like Bob's brother, are all around: one brother-in-law of mine who came down with leukemia and had to stop work as a truck driver. When he stopped, he lost his company insurance, but Medicaid did not kick in until they had sold off almost everything. Another who was mis-diagnosed by a hospital in Greensboro that also provided his insurance. Their internal medicine group boasted that they had "helped" him to lose 70 pounds in six months by changing a medication for high-blood pressure. He had stomach cancer; the hospital-owned insurance company insisted on stopping his blood transfusions because it was a waste of money.
And you think the Govt isn’t going to come to the same conclusions when they are the ones footing the bill?
Now Govt could regulate this. They could require or encourage Insurance companies to cover people with “black-hole” diagnosis’s (people who cannot return to the public workforce, and will need continual care) through tax incentives and law changes, but I am not quick to believe that the Govt is going to step in and become more charitable than a for-profit company would.
Welch wrote:- Uninsured people use hospital emergency rooms as family doctors because the ER, ultimately, must treat everybody. I have seen that since I worked at a city hospital 40 years ago; the biggest change has been that hospitals have cut their ER waiting rooms to the size of my living room just to discourage walkin-in emergency treatment.
If the Govt is paying for all of these uninsured people, than why are ER’s so much more expensive? Everything you get in an ER costs you nearly 1000 times what it would cost you on the street? Asprin costs $800 a pill when you can buy a whole bottle of it for less than $25 dollars.
Nobody would voluntarily pay for such a thing, but an insurance company will, and most insurance providers fully cover an ER visit. So, the Hospital has figured out that they can recoup their expenses for those without health insurance, by gouging those with it.
Govt run healthcare won’t stop people from going to an ER for unnecessary reasons. There are many people with health insurance who are just as guilty as those without. What do they care how much it costs, they aren’t footing the bill, the insurance company is.
Think they’ll feel any different when the Govt is paying for it?
Welch wrote:- Regarding government in general, Medicare seems adequately run...I suspect because we all hope to become old enough to use it. The Amtrak Acela is always full and the Delta shuttle, NYC-DC, has cut prices to try to compete. The rest of Amtrak runs to stations that are kept open as a public service, in the same way that the US Postal Service must deliver mail everyplace. Still, there are probably lots of runs that would be profitable if the government built high-speed lines rather than added lanes to interstate highways. Offhand, I've also found that a first class mail package gets from New York to California in three days for about $1.50; FEDEX and UPS cost about 10 times that for the same delivery speed. Schools? My public schools in DC and PG County were better than today's private schools. Whatever the problem, it does not come from the public in public schools, anymore than public money makes public libraries inferior to bookstores.
Medicare seems adequately run? Are you kidding me? They’ve been saying that it is steadily losing money, and that the whole system will be in default by the year 2015.
Sure, Acela seems full on certain routes. New York to DC was a great trip, but the company is still operating at a loss because it is running routes that aren’t profitable. The Govt can’t/won’t shut them down becuase it would be bad publicity for whatever senator has to go back and explain to his constituency why they really don’t need a train.
I found going from DC to New York a great way to travel. We were there in 5 hours, and it was a comfortable ride for less than half what the air-fare would be. I tried to get one to go from DC to Miami and it was going to cost me twice as much, and was going to take me 24 hours to get there.
If public schools are so great, then why are there private schools at all? Have you seen what “No Child Left Behind” is doing? It was designed to increase test scores by not allowing anybody to fail. In practice, all it’s done is lower the passing grades so that more kids pass. That hasn’t improved their education and really brings down the education of the rest of the class. They don’t have to go back and re-study a test because they failed when 47% is the passing grade!
Sure FedEx and UPS are more expensive, but if the U.S. mail charged what things actually cost, they’d be more expensive too. Is it any wonder why stamps have increased in price so many times over the past couple of years and they are talking about ending Saturday delivery? If the services between FedEx, UPS and the Post Office are all comparible, and the only difference is in cost, than why does anyone use the more expensive companies at all?
Welch wrote:- Regarding overall efficiency, I can't see how a profit-making insurance company can be as efficient at paying for health care when its business interest is in denying payment.
You’ve probably never heard of a company called Logisticare before. Logisticare is a private company that bids on state contracts to provide transportation to Medicare/Medicaid recipients. Why do they use a private company? Because when the state Govt tried to run the transportation by themselves, they found that they weren’t getting what they were paying for. One guy submitted over a million dollars in bills to Medicaid over the course of a year, and skipped the country before the state realized that he had never provided a single trip to any passengers.
So, the Govt did what it usually does when it needs to hire from the outside, it put the whole job up for bid to a private company. The company that bid the least won the contract. Now, this company cannot provide any transportation on it’s own, and is required to contract with local carriers to do all of the medical transportation for the state.
Know how they make money? They shortchange the companies that provide the transportation!
They routinely deny10-20% of their invoiced receivables.
They also “create” companies that are willing to operate illegally and put the onus on these other “companies” to make sure they have the proper insurance, or qualifications (such as even having a driver’s license). These companies are usually have no business office and no expenses, and if they find themselves in some sort of litigation, they simply disappear.
Logisticare protects themselves from litigation by having a contract that holds them harmless.
So, what happens when a legitimate provider complains about these illegal companies, or if someone is killed in an auto accident riding with an illegal, uninsured operator? Nothing. There is no interest at a state or local level to stop Logisitcare from doing these things because to interfere would only cost the state more money.
The state turns a blind eye to everything Logisitcare does because it knows it can’t do it themselves.
Welch wrote:- Regarding the essece of public insurance, the fundamental spirit of the thing, it seems as American as John Winthrop and the Massachusetts Bay "puritans". In Winthrop's sermon "A Model of Christian Charity", he says that "we shall be knit together in bonds of love". (Approximately...I haven't gone over to check the reference). Winthrop, the first governor of Massachusetts Bay, spoke those words during the voyage here...about 1630, or almost as deep into the American foundation as you can get.
Charity has many defenitions, but in this context, I would have to say that Winthrop was referring to “a kindly or lenient attitude towards people.
Sure, charity is where the many help the few, or the one, but the essence of charity is it’s “voluntary” nature. Income taxes are considered “voluntary” by the Govt (because otherwise, they are prohibited by the constitution) but what happens when you don’t pay them? You are arrested; thrown in jail. Doesn’t seem voluntary to me, but that’s what they are called.
When you “donate” you are considered to be charitable, when something is taken from you by force it is called theft.
If you give up something because you feel you have no other choice it is called surrender.
Govt healthcare will limit our options. We will surrender our freedoms to choose how we wish to be treated in a medical sense.
Welch wrote:- We have governments in the US to do things that individuals cannot do separately. The Constitution begins, "We the people": not we the states, or the guilds, or the medieval town "corporations", or the landholders...just "the people".
And most especially, not “We the Government entity…”
The constitution is about individual freedoms. Most of them specify what specifically the Government is allowed to do, and in any place where it doesn’t specify EXACTLY what the Government is allowed to do, than it is by default up to the individuals.
Welch wrote:- We have seen, as have other countries, that individuals cannot work out a private health insurance system. From the '30s onward, many companies made health insurance part of a benefit package that included a guaranteed pension plan, and an assumption of a permanent job. My dad worked for PEPCO for 37 years. That does not happen anymore: MBA managers boast that "you don't have tenure in your job now-days".
We have seen the same about Govt healthcare as well. The Canadian Supreme court ruled that it is unlawful for that Government to shut down “for-profit” clinics which are popping up all over the place out there. If the Govt program is so good, why would these things even be necessary? Why would people pay for something they could already get for free?
Welch wrote:- Why shouldn't "we, the people" provide ourselves health insurance just as we provide schools, libraries, fire departments, police departments, an army / navy / air force?
Yes, we THE PEOPLE should be responsible for our own healthcare. Not we the elected few, or we the Government of the United States. We THE PEOPLE.
“If you grow up in metro Washington, you grow up a diehard Redskins fan. But if you hate your parents, you grow up a Cowboys fan.”-Jim Lachey
