Riddle me this - Gingrich: Republicans have 'zero' health care ideas

[Cancel 2016.2]

Hey, you know what would be awesome. Not having any caps on out-of-pocket costs ever. That would be sweet.

actually that would be pretty fucking retarded.

It should be the exact opposite. High deductibles with complete coverage beyond the deductible. Then subsidize the deductible for the lower income (or no income) families. That way you know your max out of pocket for a given year and can plan accordingly.

 

[Bonestorm]

The problem with that is it does not address the rising health care costs. Add to that the fact that it is already trillions of dollars in unfunded liabilities and I don't think that can work. We must address rising costs before changing (or at least at the same time) the way we pay for the system.

Single-payer would certainly address costs.

 

[Cancel 2016.2]

Single-payer would certainly address costs.

How so?

 

[Bonestorm]

How so?

The government could simply set prices like Medicare does now.

 

[Cancel 2016.2]

The government could simply set prices like Medicare does now.

Yeah, price caps... that should work well. Do you think the (costs - Medicare caps) get passed on to private payers right now?

Does the government caps reduce obesity, smoking, cancer etc...??? Does it cover all new tech and drugs available? Or will the price have to keep going up to cover the increasing costs associated with them?

 

[blackascoal]

The problem with that is it does not address the rising health care costs. Add to that the fact that it is already trillions of dollars in unfunded liabilities and I don't think that can work. We must address rising costs before changing (or at least at the same time) the way we pay for the system.

Sure it does.

“If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage” (“Canadian Health Insurance: Lessons for the United States,” 90 pgs, ref no: T-HRD-91-90. Full text available online at http://archive.gao.gov/d20t9/144039.pdf).

Single Payer System Cost?
http://www.pnhp.org/facts/single-payer-system-cost

How do you think they control costs in the rest of the developed world?

 

[Bonestorm]

Yeah, price caps... that should work well. Do you think the (costs - Medicare caps) get passed on to private payers right now?

Does the government caps reduce obesity, smoking, cancer etc...??? Does it cover all new tech and drugs available? Or will the price have to keep going up to cover the increasing costs associated with them?

This isn't really debateable, SF. This is how every other country contols their health care costs much better than we do.

 

[Bonestorm]

Since you might have missed it, SF:

Looking at that write up of the Cornell study, I'm not sure what figure they're using for total U.S. health care costs, but whatever it is it is way way way too low. I mean, 190 billion as 20.6% of total health care spending would put total spending at abut $950 billion. Actual total U.S. health care costs are almost three times as high.

This is what I'm using for total health expenditures:

http://www.cms.gov/Research-Statist...onalHealthExpendData/downloads/highlights.pdf

 

[Cancel 2016.2]

Sure it does.

“If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs [10 percent of health spending] would be more than enough to offset the expense of universal coverage” (“Canadian Health Insurance: Lessons for the United States,” 90 pgs, ref no: T-HRD-91-90. Full text available online at http://archive.gao.gov/d20t9/144039.pdf).

Single Payer System Cost?
http://www.pnhp.org/facts/single-payer-system-cost

How do you think they control costs in the rest of the developed world?

If that were the case, then why is Medicare so dramatically unfunded right now?

The administrative costs are lower vs. private because private has to deal with 50 different sets of rules and regulations. I agree that the elimination of 50 and in place one set of rules and regs would lower admin costs. But that does nothing for the increasing costs elsewhere.

Note... I have not had a change to read the 90 page one yet... I will try to do so and then respond to that... which could negate what I stated above...

 

[blackascoal]

The government could simply set prices like Medicare does now.

Absolutely.

You Contain Health Care Spending With Price Controls

To me far and away the most frustrating aspect of the health care debate in the United States is failure to acknowledge this point. All around the world you see lots of different models of health care finance, but one thing that all the systems have in common is that the systems where spending is low have very stringent price controls. That's even true of Singapore, which is often perversely touted as an example of a successful market-based approach.

To get an example of how this works, you don't even need to go any further than the United States of America. We have a single-payer health care program called Medicare that provides insurance to old people. Since there are a lot of old people and old people see the doctor a lot, Medicare is a big chunk of the market for health care services. Since Medicare is such a big chunk of the market, it can offer health care providers lower payment rates than the private sector and many providers will accept Medicare patients anyway. But we dare not allow the gap between Medicare rates and private rates grow too large lest more providers stop accepting Medicare patients. Normally Congress chooses to prevent the gap from growing too much by means of passing "doc fix" legislation that increases payment rates. But Congress could choose to act on the other end and just apply Medicare rates further across the board.

more
http://www.slate.com/blogs/moneybox...health_care_spending_with_price_controls.html

 

[tekkychick]

The problem with that is it does not address the rising health care costs. Add to that the fact that it is already trillions of dollars in unfunded liabilities and I don't think that can work. We must address rising costs before changing (or at least at the same time) the way we pay for the system.

Of course, the ACA is attempting to do that... there are panels to review "best" treatment methods, which includes analyzing the cost/benefit...why does a particular treatment cost much more in one area than another? Why are there more (%agewise) c-sections in one area than another? etc; and if everyone has insurance they should be going to doctors for care more, ER less, which will cut costs.

I do agree there is more to be done to address costs. It's a real shame the ACA didn't allow medicare to negotiate prescription costs with drug companies, for example.

If we went to singlepayer, a lot of the administrative overhead would be gone as well. For example - that one provision that is being postponed re out of pocket costs - that's being postponed because they don't have all the systems in place to calculate that. With single payer, centralized administration, that should be easier. Of course, we don't have that.

There are other things that can be done; right now, if you go into hospice care, you don't get access to treatment of your disease, just palliative care. So people are reluctant to go to hospice, which tends to lead to expensive end of life care. I read a study that when people were allowed to get treatment when they went in to hospice - they actually lived longer than expected; they did not demand much treatment; and it was cheaper than not going to hospice would have been. But that disincentive around going into hospice drove up costs for not better results.

 

[Cancel 2016.2]

This isn't really debateable, SF. This is how every other country contols their health care costs much better than we do.

it actually is debatable. Show me another country with our geographic size and similar population density that does this... if you could find one that has similar obesity problems as well, I would appreciate that.

 

[Cancel 2020.1]

Yeah, price caps... that should work well. Do you think the (costs - Medicare caps) get passed on to private payers right now?

Does the government caps reduce obesity, smoking, cancer etc...??? Does it cover all new tech and drugs available? Or will the price have to keep going up to cover the increasing costs associated with them?

You can chew gum & walk at the same time. There is no reason you can't cap prices, and also try to address obesity & the rest as well.

I agree w/ you on obesity, but there is so much waste & gouging in the industry. If we didn't have insurance, and everyone had to pay out of pocket for everything, the cost structures would be radically different.

 

[Bonestorm]

If that were the case, then why is Medicare so dramatically unfunded right now?

Because it doesn't bring in sufficient revenue.

The administrative costs are lower vs. private because private has to deal with 50 different sets of rules and regulations. I agree that the elimination of 50 and in place one set of rules and regs would lower admin costs. But that does nothing for the increasing costs elsewhere.

Note... I have not had a change to read the 90 page one yet... I will try to do so and then respond to that... which could negate what I stated above...

Getting rid of the various insurance companies and their various forms and various reimbursement rates and various plans and various coverages various administrators and managers and employees and cetera are using one insurance company (the government) with one set of forms, codes, rates, plans, coverages, employees and cetera would dramatically reduces adminstative expenses in healthcare as a general matter.

 

[tekkychick]

In terms of price controls - on another msg board a couple years ago - there was a drug that cost $100 a dose in Mexico; most hospitals in the US charged about $4,000 a dose. A woman went to the hospital ; they recommended this drug - I think it was for a particular kind of insect poison or something - and the hospital charged over $40,000 a dose. And gave her two doses. And then her insurance wouldn't pay it.


so a) govt can keep hospitals from charging ten times what they should for a drug and
b) in this case there were other, cheaper drugs that could have been used - govt can require that hospitals fully inform patients of their options.

Apologize for not remembering more details...

 

[Cancel 2016.2]

Of course, the ACA is attempting to do that... there are panels to review "best" treatment methods, which includes analyzing the cost/benefit...why does a particular treatment cost much more in one area than another?

Demographics for one. If you put a new MRI machine in a major metro area with a population of 4mm people, it is going to be more efficiently used than an MRI put in a small town of 50k. Thus the cost scale shifts.

Why are there more (%agewise) c-sections in one area than another? etc; and if everyone has insurance they should be going to doctors for care more, ER less, which will cut costs.

I agree we should seek preventative care more and the ER less.

I do agree there is more to be done to address costs. It's a real shame the ACA didn't allow medicare to negotiate prescription costs with drug companies, for example.

I can get most drugs generic versions via WalMart for $4. For those that have to have name brand... well, let them pay more. Those drugs still under patent to prevent generics... goes back to your point of everyone thinking they should have access to the newest tech and newest drugs.

If we went to singlepayer, a lot of the administrative overhead would be gone as well. For example - that one provision that is being postponed re out of pocket costs - that's being postponed because they don't have all the systems in place to calculate that. With single payer, centralized administration, that should be easier. Of course, we don't have that.

No question we could reduce admin costs by eliminating 50 sets of regulations the private companies have to go through. We could also do that without going to single payer. Have one set of federal rules and not 50 sets of state rules. Then resume competition on the private side.

There are other things that can be done; right now, if you go into hospice care, you don't get access to treatment of your disease, just palliative care. So people are reluctant to go to hospice, which tends to lead to expensive end of life care. I read a study that when people were allowed to get treatment when they went in to hospice - they actually lived longer than expected; they did not demand much treatment; and it was cheaper than not going to hospice would have been. But that disincentive around going into hospice drove up costs for not better results.

No question there are many situations like the one you describe. Which is what we should be focusing on rather (again my opinion) than simply trying to shift how we pay for healthcare.

 

[blackascoal]

If that were the case, then why is Medicare so dramatically unfunded right now?

The administrative costs are lower vs. private because private has to deal with 50 different sets of rules and regulations. I agree that the elimination of 50 and in place one set of rules and regs would lower admin costs. But that does nothing for the increasing costs elsewhere.

Note... I have not had a change to read the 90 page one yet... I will try to do so and then respond to that... which could negate what I stated above...

Easy .. because it's underfunded.

How Medicare for All would be funded is what you pay politicians to figure out .. just as they would have had to figure out with any healthcare plan, including the ACA.

There are several funding options considered in HR676, the Expanded and Improved Medicare for All Act

 

[anatta]

Obama’s unconstitutional steps worse than Nixon’s
George F. Will, Published: August 14

http://www.washingtonpost.com/opini...-11e3-9259-e2aafe5a5f84_story.html?tid=pm_pop

nowhere near as bad as Nixon, but an interesting read

 

[Cancel 2016.2]

Because it doesn't bring in sufficient revenue.

and you think putting more people into that system will help that?

Getting rid of the various insurance companies and their various forms and various reimbursement rates and various plans and various coverages various administrators and managers and employees and cetera are using one insurance company (the government) with one set of forms, codes, rates, plans, coverages, employees and cetera would dramatically reduces adminstative expenses in healthcare as a general matter.

again, I agree that admin costs could be reduced dramatically if we went to one set of rules instead of fifty. We can do that without having to go to a government cookie cutter plan.

 

[Cancel 2016.2]

Easy .. because it's underfunded.

How Medicare for All would be funded is what you pay politicians to figure out .. just as they would have had to figure out with any healthcare plan, including the ACA.

There are several funding options considered in HR676, the Expanded and Improved Medicare for All Act

Exactly... they have to raise taxes to pay for it. So how does that help people? You are simply shifting HOW they pay for it. You are not reducing their costs.