dagblog - Comments for "Mandates: a Rube Goldberg solution"

Think about how much

hcberkowitz — Mon, 17 Dec 2007 06:24:39 +0000

In reply to Mandates: a Rube Goldberg solution

Think about how much information on human health we could be gathering and analyzing with such a system. What we could be learning. We have three times their population and it is much more diverse.

With a combination of universal access to health care, and properly privacy-protected electronic medical records, perhaps we should justify this under the terrorism budget: finding early patterns in medical records is probably the mechanism best suited to detecting covert bioterrorism.

I am only guessing about the malpractice situation in France, but remember, they are Civil Law, not Common Law. Their judges and magistrates are not referees between opposing sides as we have here, but, even in criminal matters, charged with finding truth. An expert panel, then, would fit quite well into French legal culture.

Howard

*equal opportunity offense to both extremes*

"Those who cannot remember the past are condemned to repeat it" [George Santayana]

Germany's system sounds very,

Emma Zahn — Mon, 17 Dec 2007 06:09:51 +0000

In reply to Mandates: a Rube Goldberg solution

Germany's system sounds very, well, um, German. Efficient and effective.

Think about how much information on human health we could be gathering and analyzing with such a system. What we could be learning. We have three times their population and it is much more diverse.

But back to France. One of the articles I read said that they pay for doctors' tuition so they get more doctors who don't have to make as much because they have no student loans. They also don't have to worry so much about malpractice suits. Not sure how they handle that.

IMO, we will need lots more doctors, nurses, lab techs etc. before healthcare costs will come down. I don't know where we are going to get them. Maybe Cuba. I read a review of SICKO that said Cuba has one doctor for every 75 people.

Maybe I am more comfortable

Emma Zahn — Mon, 17 Dec 2007 05:23:28 +0000

In reply to Mandates: a Rube Goldberg solution

Maybe I am more comfortable with the idea because I spent most of my life working in the investment community -- most of it when it was more about investing than speculation. Believe it or not, there are people in the industry who take their fiduciary responsibilities seriously. Those who don't, the operators, are problematic but I think their glory days may be ending. From David Ignatius's column today:

"What scares the central bankers now is the evaporation of trust from the system. Banks don't believe each other's numbers..."
""The basic problem is that banks don't trust each other. "

I imagine many in the finance industry will be shedding a lot of their hot shot creative accountants in favor of some duller but more trustworthy bean counters if for no other reason than to find out where they stand. Maybe I should dust off my resume.

As for the fees, they are always negotiable.

but they will most likely be

jollyroger — Mon, 17 Dec 2007 03:16:27 +0000

In reply to Mandates: a Rube Goldberg solution

but they will most likely be more than $100 per month.

quite true.

The imponderable is the extent to which the general fund will subsidize (as it already does) each additional new medicare beneficiary.

Where that tipping point is put will determine the competitive advantage of medicare over for profit insurers.

"Note that the present

Emma Zahn — Sun, 16 Dec 2007 17:31:38 +0000

In reply to Mandates: a Rube Goldberg solution

"Note that the present medicare premium deducted from individual social security checks is less than $100.00 per month."

That is the premium only for Medicare Part B. It is a deceptive number because it along with the premium for Part A are subsidized with a 2.9% federal payroll tax and maybe from the general fund as well. According to Wikipedia:

Medicare-eligible persons who do not have 40 or more quarters of Medicare-covered employment may purchase Part A for a monthly premium of:
$226.00 per month (2007) for those with 30-39 quarters of Medicare-covered employment, or
$410.00 per month (in 2007) for those with less than 30 quarters of Medicare-covered employment and who are not otherwise eligible for premium-free Part A coverage.

There are additional premiums for Part D as well. Medicare's financing is complicated.

Premiums for a basic single payer plan should logically be less than what most people pay now for similar private coverage but they will most likely be more than $100 per month.

No purchase mandate. I favor

Joe Monster — Sun, 16 Dec 2007 14:45:45 +0000

In reply to Mandates: a Rube Goldberg solution

No purchase mandate. I favor a single-payer we'd be free to opt out of in favor of voucher-style portable HMO eligibility.

Whatever it is, it should be done by and for people, not by industry. Done as a national program, we could weigh and budget things to give a boon to the companies presently underwriting the healthcare economy. That's appropriate- they should continue to get paid for their work.

It's their work that should change. Why did my insurance plan (group plan, I'm self-employed with my wife) go up 10% this year, despite me opting for higher copays? And the previous year, when I did the same? And the previous year? Because they're public, for-profit companies who hire secretaries and lawyers to grow their business, not shrink their market.

Invest in health.

There's no question that any

hcberkowitz — Sun, 16 Dec 2007 06:43:25 +0000

In reply to Mandates: a Rube Goldberg solution

There's no question that any practical approach will require transition, and that things will be fought. While France's system has been mentioned tonight, and there are many references to Canada and Britain, I'm a little surprised the German system is not better known here. Japan's system is also quite close to Germany's.

Both are multi-payor with a government safety net. I'm more familiar with the German system, so I'll focus on that.

Germany passed its first medical insurance plan in 1883. Originally, it was 1/3 employer paid and 2/3 employee, administered by local committees elected by the employees (as the major contributors).

Over time, the employee contributions started to go into not-for-profit "sick funds", often administered by unions. Yes, there are employer contributions, but no "insurance companies" in our sense (there are some special cases, mostly for the wealthy). A government safety net handles the unemployed.

One of the interesting things is that they don't micromanage or preapprove, but still have a national quality control organization. Providers, in fact, are paid (I'm simplifying a bit) for the effort of collecting statistics.

Roughly quarterly, provider costs and outcomes are evaluated statistically by medical professionals and analysts. Good outcomes and low costs are investigated, as are bad ones.

When a provider is doing well, the investigators try to learn if it was statistically random, or if they are doing something especially well. If it does turn out they have improved techniques, this is disseminated to the medical community by the national quality organization. IIRC, if a provider stays above the norm for two years, they can list this in marketing materials.

For providers that do not do well, and again on a statistically significant sample, the investigators visit. In the journals I've seen, the term most often used for the flavor of the visit is "collegial". No threats to cut out of network, not reimburse, etc., to start, but an honest attempt to understand what happened.

Perhaps Dr. Schmidt had a practice of 85 year olds, whose bodies gave out at the same time. Perhaps there was an epidemic in Darmstadt. If there's a decent explanation for the outlier, there may be increased surveillance for a time, but nothing drastic.

If there is a problem with quality, the reviewers, again acting collegially to start, try to fix the problem. If the practitioner ignores the advice, there indeed may be consequences -- after reason has failed.

Howard

*equal opportunity offense to both extremes*

"Those who cannot remember the past are condemned to repeat it" [George Santayana]

You are correct on the

TheraP — Sun, 16 Dec 2007 06:33:40 +0000

In reply to Mandates: a Rube Goldberg solution

You are correct on the number. Exact figure is $96.40 for 2008.

The purchase mandate on one

jollyroger — Sun, 16 Dec 2007 06:19:32 +0000

In reply to Mandates: a Rube Goldberg solution

The purchase mandate on one hand, and the regulatory mandate that carriers take on all comers without regard to pre existing conditions at a community price, both appear to be obtrusive attempts by the government to force a "market based outcome" different from that produced by a free market.

In reality this is a (virtuous) scam, because, when coupled with the proviso that individuals of whatever age may fulfill their purchase mandate by buying into medicare , the resultant competition will crush for profit insurers into the dust.

Note that the present medicare premium deducted from individual social security checks is less than $100.00 per month (disclaimer:number pulled from ass, correction solicited.)

Consider this: Some

TheraP — Sun, 16 Dec 2007 05:18:27 +0000

In reply to Mandates: a Rube Goldberg solution

Consider this: Some insurance companies insured such bonds - the ones that are going bust! I.E. some who bought the bonds also bought insurance on them!! And some of those insurance companies are now going to have to declare bankruptcy... as the bonds go bust and the holders of insurance on them seek to get reimbursed! It's a cascade of problems.

This whole mortgage thing is such a mess! I honestly see the economy sinking in a very bad way over this.

So many things have gone wrong under bush. I am pretty discouraged. I know one person who lost her house a year ago. They were 8 years from paying off the house when they fell on hard times - with one spouse on disability and the other unable to work for about 6 months (and 3 teenagers). A home equity scam left them unable to pay, when the rates went up. ... That's only one story, but I am truly worried that we now live in a society full of scavengers, people preying on the weak, ignorant, or poor.

Back to your comment. I am a psychologist. It is so annoying to be "under the thumb" of managed care - and while most insurance companies now have gotten away from managed care for "medical care," that is now the norm for mental health. Which is often reimbursed at a much lower percentage (even in Medicare, mind you). I have gotten out of all networks for that reason. But get this, even if you write them saying "take me off your network," they won't do it sometimes!!! Very annoying! They get you coming and going!