Shouldn't there have been healthcare reform before Obamacare is implemented?

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   c mark walkerposted 11 years ago

   Shouldn't there have been healthcare reform before Obamacare is implemented?
   
   Healthcare reform would mean looking into a countless number of things wrong with the system.Yet now we are getting a new insurance that there are so many concerns about. It's like rebuilding an engine without taking it apart first.

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   Larry Wallposted 11 years ago

   The word reform is often misused. Most people see the word reform as meaning change, and I would not argue with that, but there are subtle differences. Sometimes reform means to improve or to eliminate, and sometimes it is just the wrong word to use.
   
   In my opinion, health care needs an overhaul. Medical schools are too expensive, forcing potential doctors to go into deep depth before graduating, and they work as interns or residents before they earn the big money. My doctor works from 7 a.m., to at least 6 p.m. and has called me at home as late as 8 p.m. with test results.
   
   Medicare needs to be reform. Medicare needs to pay a decent amount to the doctors, so doctors will not be forced to increased prices in the hopes that Medicare will pay a little more and private insurance will not complain and the uninsured will find some way to pay. The lab I used for blood work offers an injured rate and a non-insured rate. Their net revenue is the same regardless of which rate is used.
   
   I am looking forward to Obamacare. I am 62. I am a Type II diabetics, who takes no medication for it and have it completely controlled with diet and limited exercise. However, that is an automatic turndown by the major insurance companies. My wife has a form of arthritis in her back. One company said they would insure her, but there would be an $85,000 deductible for back problems (that is 85 and three zeros--not a typo). Causing more people to be insured, especially the young, who do not use it as much as we old folks should increase revenues for insurance companies and possibly lower rates.
   
   Thus this is one step in health reform. I have been to the emergency room many times over the years (had seven surgeries, three of them major, a dog bite and something so long ago I cannot remember. However, people are in the ER for headaches, toothaches, etc. Migraine headaches hurt--Been there. Toothaches are horrible--had my share. However, I went to my Doctor or Dentist or an after-hours clinic and today, even with lousy insurance and no job, I pay my medical bills.
   
   We need to reform Medicare and establish realistic reimbursement levels. We need to make it cheaper to become a doctor and encourage more doctors to become family physicians. HMOs need to be reformed. Many pediatricians will not belong to an HMO because a single ear ache might result in six visits to the doctor while the HMO only pays for two. Reform is going to have to be gradual and one step at a time.

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      Gawthposted 11 years agoin reply to this

      If the goal of universal health care is to keep people from going bankrupt over medical bills, I would think it would be prudent to provide everyone with a simple dread disease or costly accident policy.   Government and people alike could be protect

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      Larry Wallposted 11 years agoin reply to this

      A dread disease policy would be good--as soon as you can define dread disease. Cancer is a dreaded disease, but skin cancer and liver cancer are very different. I think a policy that kicks in when your medical bills in a year top $100,000 would help.

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   My Esotericposted 11 years ago

   I really like Larry's answer, but to add my two cents, I think Obamacare, something that 80 years of presidents have been trying to get through Congress (well maybe Reagan and Bush 2 didn't) is healthcare reform, or at least a start.
   
   With all of the problems you and Larry mention, the biggest one, in my mind, facing America is the basically immoral stance of those who purposefully would keep 40 million people unnecessarily uninsured, thereby costing themselves (shooting themselves in the foot, in other words) and the rest of insured America billions of dollars, but even worse, making sure a large percentage of those 40 million, most of them working, live a life of misery.

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      Larry Wallposted 11 years agoin reply to this

      I would have to agree with you. Good health care should be made available to everyone. Some people do refuse--lack of trust, fear, etc., but we still need to keep trying.

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      JON EWALLposted 11 years agoin reply to this

      Obamacare, GOVERNMENT HEALTHCARE.Ryan and Van Hollen Debate Medicare Proposals 6/3/11
      http://www.youtube.com/watch?v=o_SHUELJci4
      Medicare is WAISTING . $8 billion http://www.kaiserhealthnews.org/Daily-R … ogram.aspx

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      My Esotericposted 11 years agoin reply to this

      Another big problem with health care in America is the delivery of it is driven by the profit motive.  The true goal of healthcare today, as opposed to the 1960s, is the bottom-line and not the health of the patient; patients are a means to an end.

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      LandmarkWealthposted 11 years agoin reply to this

      Really because Dr's are making far less today on a relative basis than  in the 60's.The median pay for an General Internist is about 150k.  My HVAC contractor makes more than that. Profit is not the problem.  Market distortions are the problem.

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      My Esotericposted 11 years agoin reply to this

      Yep, I am certain you are right, Drs are one of the casualties of all of the mergers by corporations who don't give a damn about your health, the Walmarting of non-profits who actually delivered real healthcare, the HMOing of private practices, etc.

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      LandmarkWealthposted 11 years agoin reply to this

      The only problem with that argument is that life expectancy has gone up dramatically from all of these profit driven medical advancements.  The problem is economic. As I said earlier.  Cost is distorted by Govt intervention dislocating markets.

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      My Esotericposted 11 years agoin reply to this

      When healthcare was delivered without the profit motive, life expectancy increased 3 and 3.6 years per decade for men and women, respectively (1900 - 1980), but only 1.9 and 1.1 years/decade from 1980 to 2010 when profit motive was involved.  Next?

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      LandmarkWealthposted 11 years agoin reply to this

      Healthcare always had a profit motive.  And I wouldn't put much stock solely in the rate of change in expectancy as many mortalities never come in contact with care. Murder etc.  Look at survival of specific diseases Cancer etc. Exp is much better.

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      My Esotericposted 11 years agoin reply to this

      I used your example. As to profit motive, you are technically correct, but not in practice.  Before 1980, or when ever it was deregulated, Drs had private practices and delivered personal care as did hospitals; now they dont, it costs too much.

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       LandmarkWealthposted 11 years agoin reply to this

       I was referring to exp in treatment of illness. And it's the regulations that are preventing them from personalized practices.Delivery of medicine is anything but deregulated. It is more regulated today and controlled by Gov't than ever before.

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   JON EWALLposted 11 years ago

   In 2009, the American people voted for a Democrat President and elected a super majority Democrat control of Congress hence the government was 100% controlled by one party.Obamacare law even after it was passed is still being written today, REALLY? The Constitution with the checks and balances were not followed due to one party rule.2/27/10   GOVERNMENT HEALTHCARE REFORM ? http://jon-ewall.hubpages.com/hub/GOVERNMENTHEALTREFORM
   5/1/13 Train Wreck Ahead
   http://www.creators.com/opinion/john-st … 05-01.html
   details of President Obama's Affordable Care Act Obamacare’ Regulations Printed and Stacked High
   http://www.theblaze.com/stories/2013/03 … all-it-is/
   Time will tell if Obamacare will be repealed before the country will go broke.

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      My Esotericposted 11 years agoin reply to this

      I think they said the same thing about Social Security and Medicare., look how much worse the people are with those programs around.

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      LandmarkWealthposted 11 years agoin reply to this

      A lot worse...healthcare would be a lot cheaper if not for medicare.  They've distorted prices upward for decades making it less accessible.

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      Larry Wallposted 11 years agoin reply to this

      Jon Ewal you seem to be complaining that the people elected a Democratic president and congress. The people made a choice. If a Republican President and Congress, do you really think we would be better off today. The people picked the Democrats.

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      JON EWALLposted 11 years agoin reply to this

      Larry Wall
      Stating fact is not complaining.March 23, 2010 President Barack Obama is applauded after signing the health care bill
      http://www.foxnews.com/politics/2012/04 … z1t4xDoibt

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      My Esotericposted 11 years agoin reply to this

      Healthcare might be cheaper (very debatable) but I am talking about quality of life.  How many people on Medicare today could afford that "cheaper" healthcare; how many people on social security today would be dead or in soup lines?

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      LandmarkWealthposted 11 years agoin reply to this

      All of them...Since medicare doesn't pay the dr. he would have to provide the service for less.  And SS the same is true.  the return is a guaranteed loss, which also helps to supress wages of the lower income employee. And both are unsustainable

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      My Esotericposted 11 years agoin reply to this

      I don''t understand "all of them".  There would be no Medicare or Social Security in your world, it seems.  People would fend for themselves as best they can.  Multitudes of more people would be (and were) begging in the streets again.

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      LandmarkWealthposted 11 years agoin reply to this

      Healthcare has become more expensive relative to broad inflation & even less available for the masses since the creation of these programs.  As is the case with any area in which the gov't has moved beyond regulation and become a market participa

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      Larry Wallposted 11 years agoin reply to this

      If Medicare reimbursements were raised to reasonable levels, Doctors & hospitals could lower rates for others instead of trying to makeup the difference Medicare fails to cover. Enhancing Medicare, with rules that other prices are adjusted = prog

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       LandmarkWealthposted 11 years agoin reply to this

       That's only part of the problem with Medicare.  http://www.aapsonline.org/index.php/sit … _and_facts

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       Larry Wallposted 11 years agoin reply to this

       All the alleged myths are not correct. I have no other decent insurance. Cannot buy it because of Pre-Existing conditions. I know drs. are underpaid. I know Medicare, is cash in-cash out. I am looking at a possible surgery--cannot afford it now.

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       LandmarkWealthposted 11 years agoin reply to this

       If we had the ability to negotiate, you could afford the surgery. You would pay what you can afford.  And the cost of surgery would be much less without 3rd party interference.  Why is cosmetic surgery so much cheaper....NO INSURANCE

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       Larry Wallposted 11 years agoin reply to this

       I would like to see the proof on that last statement and cosmetic surgery is usually not an absolute necessity. We are widening the discussion to a whole new area.

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       LandmarkWealthposted 11 years agoin reply to this

       You can look up the average rates per procedure. The MOST expensive procedure is about 10k. The point is Cosmetic surgery has price discovery. Why is auto insurance so much cheaper when the liability is just as great. No claims for basic maintenance.

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       Larry Wallposted 11 years agoin reply to this

       I question your numbers. However, what about the hospital, which has a fixed overhead, Is it going to charge a different price to each patient. Will the radiologists, nurses, etc. do the same. The Dr. bills for his services--not the total cost.

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       LandmarkWealthposted 11 years agoin reply to this

       It's not A&O's.  It's economics.  The cost has gone up faster since we created these programs and stopped negotiating with Drs. The laws of supply and demand do not cease to exist in the field of medicine. And they can be done for as little as 10

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       Larry Wallposted 11 years agoin reply to this

       You lost me, on what is A&O. Medicare has been around for 50 years. Medicaid helps the poor, who often have nothing .Stockholders of private hospitals will not allow  negotiated rates. It would be illegal for public hospitals--discrimination..

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       LandmarkWealthposted 11 years agoin reply to this

       Apples & Oranges.  And the rate of increase in the cost and availability of healthcare has gone up much faster since the creation of those programs than before them.And the lack of ability to negotiate is precisely the problem.Without it prices g

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5. 67

   LandmarkWealthposted 11 years ago

   Nothing about "Obamacare" is a reform.  It is designed to make it impossible for private insurers to operate. The problem with healthcare is the price, which often makes it hard to obtain for lower income individuals.  This is because we don't allow markets to operate and haven't for decades.  Healthcare no longer has the use of price discovery.  Insurance is there as a "contract of indemnity" to replace a loss of an unpredictable nature.  That is how it works best.  Like auto insurance we don't submit bills to the insurance carrier for new windshield washer fluid.  We do when our car is totaled.  The maintenance of the car allows for price discovery.  We shop for places to have our oil changed or brake jobs completed.  We negotiate directly with the provider of the service with no third party intermediary.  Hence we get much more efficient pricing and costs stay lower.  Which is why the cost to maintain a car has not gone up nearly as dramatically as health care.  The cost to insure the car and the person driving it has also remained much more reasonable...yet car accidents can also cause catastrophic financial losses.   
   
   Prior to Obamacare, the largest insurer in the nation was already the Federal gov't.  Their solution to solve the cost problems was not implement price discovery, but rather to not pay the Dr's.   So now we have large numbers of Dr's who will either limit or no longer take on new Medicare patients.  And virtually no Dr will take on Medicaid patients as they are paid next to nothing.   This actually drives up cost for those attempting to buy it privately, and does a lot to discourage people to enter the field.  Start asking Dr's how many of them want their kids to follow in their footsteps these days.   Insurance does not mean services are rendered.  And this problem will get worse...not better.  At least until the people stop listening to politicians who promise them free things.  Free things are the most expensive in the long run.  And until there are true market reforms that encourage competition and price discovery, the cost will remain a serious problem.    And contrary to popular opinion, their was more accessibility to healthcare prior to the creation of this gov't intervention.  Dr's actually came to the house and negotiated prices.  An interesting chart on impact of gov't interference and prices is list below. 
   
   http://globaleconomicanalysis.blogspot. … price.html

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      JON EWALLposted 11 years agoin reply to this

      LandmarkWealth
      An excellant comment regarding healthcare. the ideologies are different in todays politics. Private  verus public, one type will not work.Ryan and Van Hollen Debate Medicare Proposals 6/3/11
      http://www.youtube.com/watch?v=o_SHUELJci4

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      LandmarkWealthposted 11 years agoin reply to this

      Private options haven't been and won't be permitted to function properly by the gov't because it limits the power and scope of authority of elected officials.

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      My Esotericposted 11 years agoin reply to this

      Tell me, how did private options not work in the gov't health program I belonged to?  Seemed to work fine to me.  The gov't created a pool with minimum rqmt's, companies put in their bids, I made a choice.

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      LandmarkWealthposted 11 years agoin reply to this

      Each insurer overcharges for the plan to account for the lack of price discovery.  The premiums still went up faster than the cost of a new car for all the reasons I stated.  Your employer just happened to be the Gov't. The problem is the same.

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      Larry Wallposted 11 years agoin reply to this

      If  lost your group policy after being laid off and found that you could not buy insurance because of "pre-existing" conditions, then Obamacare is indeed reform. I am having Cataract surgery--my 'insurance" will pay nothing to the outpatient clinic.

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      LandmarkWealthposted 11 years agoin reply to this

      Our you could pay or outpatient services out of pocket, which with proper price discovery would be a lot less than 15k a year in premiums for a family.Insurance should be for catastrophic needs and not linked to employers to begin with as it once was

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      Larry Wallposted 11 years agoin reply to this

      I had an obstruction in my throat--$1,500
      Wife had bone density scan $125
      Annual Lab Work $350 (per person)
      And the list goes on and who decides when something is catastrophic. Is a hernia in that group--About $2,500--had five in last 13 years.

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      LandmarkWealthposted 11 years agoin reply to this

      The cost of those procedures would be dramatically less if the population of consumers could negotiate freely.  And you would set the guidelines for what is catastrophic through high deductibles.  Or at least you should if we ran the system sensibly.

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      My Esotericposted 11 years agoin reply to this

      Private health insurance seems to be doing just fine, thank you, in spite of two years of Obamacare; no weaknesses are yet appearing other than they are having to clean up their act.

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       LandmarkWealthposted 11 years agoin reply to this

       Law has barely been implemented until Jan.  But ultimately their margins are so low to begin with that the consumer will pay the cost of this upsurd legislation.  The lack of price discovery will get transferred on to the consumer as always.

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       My Esotericposted 11 years agoin reply to this

       If their margins are that terrible, why are they paying such exorbitant salaries to senior management?  Of course, I just answered my own question.

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       LandmarkWealthposted 11 years agoin reply to this

       Define exorbitant...contrary to popular opinion running a company is not that easy to do.  If it were then everyone would start one and pay themselves these exorbitant salaries. It takes talent to squeeze out those margins which average about 3.5%

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       My Esotericposted 11 years agoin reply to this

       Up until the 80s senior mgnt earned say 50 times the regular workforce and that had been stable for decades.  After 1980, that ratio increased dramatically to where it is more like 150 to1 today.  Did management get suddenly become better or greedy?

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       LandmarkWealthposted 11 years agoin reply to this

       Most of their pay has become more incentive driven over the decades.  And that ratio is not entirely a reflection of pay increases as much as it is decreased wage increases for an increasingly unskilled labor force.

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       My Esotericposted 11 years agoin reply to this

       Hmmmm, your unskilled comment is going to cause me to research that.  My stereotype is that it is the reverse, but then I haven't looked at any data to verify that; I need to now.

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       LandmarkWealthposted 11 years agoin reply to this

       You'll also find that CEO's often receive as much 70% of their comp through stock options,which links them to the success of the company and can be theoretically worthless In the future.By unskilled I mean, lack of engineers and antiquated skill sets

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       Larry Wallposted 11 years agoin reply to this

       The more people that are insured, means more premiums will be collected. If the young, who use insurance less, pay a reasonable premium, we will benefit. I think many dislike Obamacare because of partisan views and possibly not using insurance before

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       LandmarkWealthposted 11 years agoin reply to this

       Cost will never go down without proper price discovery.  Until you can negotiate directly with a medical provider and eliminate the cost of gov't, prices will remain high and quality will weaken.  Obamacare does nothing to increase price discovery.

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       Larry Wallposted 11 years agoin reply to this

       Please explain how we are going to negotiate with hospitals, laboratories and physicians. They cannot give one price to one person and one price to another. Please explain your negotiation process and theory. I do not understand it.

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       LandmarkWealthposted 11 years agoin reply to this

       They can if they are allowed to.My bro-inlaw is a surgeon and does not accept any form of insurance. He is paid by the patient directly and they get reimbursed by Ins Co.He dropped his rates by 2/3 rds when he opted out of insurance from his savings.

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       Larry Wallposted 11 years agoin reply to this

       Your brother-in-law does not accept insurance assignments. The individual pays the entire cost, insurance pays 80 percent at best and the patient is left to pay the other 20 %,  There is still the hospital, lab work, physical therapy, medication, etc

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       LandmarkWealthposted 11 years agoin reply to this

       No he takes nothing.  He is paid before a claim is ever submitted in advance based on what the patient can afford.  They get what they get. The reduced overhead allowed him to drop rates.  And all those services can also be negotiated.

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       Larry Wallposted 11 years agoin reply to this

       I should had said insurance pays 80 percent at best, of whatever the doctor charges, back to the patient. So if the Doctor agreed to $20,000, the patient would get $16,000 from his ins. company and have to eat the rest, since he already paid the doc.

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       LandmarkWealthposted 11 years agoin reply to this

       You negotiate that with him in advance. Does everybody pay the same price for the same car...Ofcourse not.  Why should medicine be any different.  That's why insurance should be high deductible catastrophic plans, not for basic maint.

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       Larry Wallposted 11 years agoin reply to this

       I think we have beat this horse enough. We cannot say much in the short space available at one time. So, let's agree to disagree and call it a night. You make an interesting argument. I just do not agree. You disagree with ne, I can accept that.

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       LandmarkWealthposted 11 years agoin reply to this

       As you are free to.  Have a read on how healthcare inflation has correlated with CPI before and after these interventions.
       
       http://www.americanthinker.com/2009/09/ … f_hea.html

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   Admiral Murrahposted 11 years ago

   I do not think that government intervention is the solution to healthcare.In answering your question, first you have to define your terms. Healthcare is very different than medical care. Confusing the two leads to some major problems. Health care deals with providing preventative and routine care to people, not the management of major medical issues or conditions, which is seen as 'medical care'.
   
   In terms of reform, it is not clear what needs reforming. If it is the rising cost of care, then tort reform is needed. It is a great first step in reducing costs. When the malpractice and business cost of providing health care is so high, it is only natural that those costs are passed onto the public. The public does not realize the full extent of how they will be the ones paying for all the major reforms in healthcare.
   
   It may also help reduce costs if the public were allowed greater freedom of choice when it comes to care. Many non-traditional treatments are limited by government regulations of either their practice, or advertising.Removing government interference would mean that it would be up to the public to do their own homework. It would be a 'buyer beware' market. Many people want to have their cake and eat it to. They want low cost, no risk, health services with a wide range of choices.
   
   The public would also have more choices if the medical profession allowed other health providers to provide health services as well. The turf wars where the MD's dominate the health care field have artificially restricted access to health care services. If the monopoly enjoyed by the medical establishment was broken up, the public would benefit from a wider range of services at lower costs. The monopoly keeps the supply of physicians tight so that the demand is artificially high. This could be changed by allowing universities to build medical schools and allowing other health care providers to treat conditions they are trained to treat. Presently the medical profession operates with an attitude that they are the only ones qualified to treat many disorders that could easily be treated by others.
   
   If your idea of reform means that more medical conditions be covered, the answer lies with making changes to insurance companies, I do not have the space to cover all the ways that changes could be made in those areas.
   
   Reform could have been done before Obamacare, but many parties were protecting their turf and keeping from happening.

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      Larry Wallposted 11 years agoin reply to this

      I agree with you in part. I liked trained Drs. I have a friend who is a nurse practitioner, she knows her limits. With my eyes, I go to an ophthalmologist and not an optometrist. When my son needed brain surgery, we had a neurosurgeon.

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      My Esotericposted 11 years agoin reply to this

      Tort reform - Do you have statistics on what percentage of malpractice suits weren't legitimate?  Do you see that as the silver bullet?  If the vast majority were legitimate, then what is the problem with taking bad Drs to task?

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      Abby Campbellposted 11 years agoin reply to this

      I couldn't agree with your more, Admiral Murrah! Thank you for a well educated answer.

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   Abby Campbellposted 11 years ago

   Mark, I would think healthcare reform would mean looking into all that is wrong with the system before implementing a new system. Unfortunately, I believe we are creating a bigger problem.
   
   I'm in North Carolina, and I personally buy my family's insurance. My husband's employer offered the exact same insurance through Blue Cross Blue Shield. However, It would cost us about $1,000 more in premiums per month, and that included paying 75% for his premiums. It seemed crazy to me, but my husband's employer has many employees over the age of 60. Thus the reason for higher premiums.
   
   I've been happy with Blue Cross and Blue Shield, and my premiums have always been below $400 per month for a family of four. I could have chosen plans for a higher monthly premium to reduce my deductibles and co-insurance. However, I felt it unnecessary as we practice healthy lifestyles in my family. One year, I did have to pay for emergency costs for one of my children that did meet the $5,000 deductible plus co-insurance. However, that was my choice in picking the plan I did. Since then, I changed my plan to a lower deductible as my husband and I aren't getting any younger. My premiums increased approximately $35 per month when I changed, though the new changes increased my premiums another $75 for 2013 due to changes (i.e., free birth control due to ObamaCare), bringing premiums up to approximately $500 per month.
   
   Just last week, I received a letter from Blue Cross regarding the changes that will take effect in 2014 with ObamaCare. It included 8 changes. However, some of them weren't really changes as Blue Cross already provided those benefits (including 100% covered preventative care... physicals, mammograms, gynecological exams, lab work, vaccines, etc.). However, one of the added benefits is maternity care. Currently, private insurers have the option to deny that coverage which saves on premium. It saved me approximately $600 per month as my daughters and I don't plan to get pregnant. When I decided to opt out of maternity care, I knew the risk of extra costs if any pregnancies do come about. That was my choice though. Now that I don't have a choice on opting out of maternity care, I can only imagine how much my premiums will rise in the coming 2014. It's scary and definitely not my choice!
   
   Just as with any other insurance (auto, home, umbrella), I have had a choice when it comes to benefits. I've worked hard to make those choices. Why should I pay for others?

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