Proposal to help control health care costs:
 

This is bipartisan, so let's not make it political.

The idea is to let the states take the lead in controlling health costs. To curb the growth of health care, states would set their own spending targets. Then states would pocket their share of federal Medicare and Medicaid savings, which could be up to 1 billion or more.

This plan would be called "Accountable Care States", as described in a recent article, and would be voluntary.

How will the states control costs?

What would you do to control costs if you were in charge?

I would try to reduce demand by promoting self reliance through education.
Of course the powerful food industry would be against it so there's little chance of that happening.

The answer to lowering health care is certainly not in going to a state by state list of covered services. You did not link to the article you reference, so I cannot see if you have actually explained what the original writer suggested. The most efficient health care insurance in the US is Medicare, which is Federally run with a single list of covered services uniform for the entire country. Why would someone, knowing that, suggest we go in the exact opposite direction and incentivize states to cut costs and pocket the dollars? I can just see the race to the bottom that would bring.

I really do not understand the new heath care packages. The poor people were already getting free health care (medicaid) and the only ones this has hurt is people trying to stay covered.

Education and healthy lifestyle has never stopped one person from ultimately dying. The majority of healthcare spending for any person is during the last 2 years of their life when they are at the end of the disease process that will eventually end their life. Mortality is still 100% and treatment of the dying is expensive even if it's only palliative. The expense will not be impacted just by switching the burden to the state level. Medicare has been the most efficient health care delivery system in the world. Quick payment for service providers and nearly immediate approval for services for Patients. The problem is private insurance. Take a look at the profit of the 10 largest private insurance providers. WellPoint had a profit of 38%. Anthem was higher! If Medicare received all the premiums that the top 10 insurance providers enjoyed, the system would be the most stable in the world. No one should make profit from administrating insurance coverage. The only profit should be at the provider level. Go to a single payor system with Medicare and wipe out the insurance companies profits and the cost of healthcare would be instantly manageable.

So fun to have thousands dying waiting for treatment. One visit to the VA, IRS, the motor vehicle office/tag… court house, any civic government function… heck, they all require the entire day(s) to just work your way through the system.

If given any choice between private enterprise and govt, I will always choose private enterprise for faster, friendlier, more comprehensive service.

I'm always concerned about the ulterior motives of those pushing for an inferior single-payer system.

Make that "I'm always concerned about the ulterior motives of those pushing for an inferior single-payer system MONOPOLY."

As bad as you might think insurance companies are, they are regulated by the state insurance departments/commissioners and are cited, prosecuted, fined, and sometimes ordered to Cease & Desist if they or their agents commit fraud, do not pass tests of financial solvency and ability to pay all claims, or if they do not pay claims on time or in the amount stated in the policies/contracts.

Also, the consumer or employer can fire them and go with another company and package. With a government single-payer monopoly, do you really think you're going to be able to get them to cite, prosecute, fine or order themselves to cease and desist? And if you could fire them or get them prosecuted and fined, who would you go to for insurance when it's a single-payer monopoly?

Its interesting that the majority of people on Medicare like Medicare.

It would be interesting to hear from some Canadians who are on a single payer system similar to Medicare w/o the requirement to be 65 years old. The Canadians I have talked to would not think of becoming residents in the US because of the their access to that healthcare. It appears that some companies are even moving to Canada so taxes can't be too abhorrent to support such a system.

Our taxes are high, but it's well worth it.
I am extremely happy with the Canadian health care system.


Canuck Bare

It would be interesting to hear from the elderly about how anxious they would be about firing their insurance company and going with another company at age 80, 90, or 100 plus. Any centenarians care to comment?

The VA healthcare delivery system is not comparable to the Medicare system. The VA is a socialized system where every person delivering the care is employed by the government. That is why they are under such scrutiny for long waiting lists for care in some regions. A Single payer system with Medicare in the United States could never be compared to a single payer system in another country. In the United States, the vendors such as Physicians, Hospitals, Clinics, Home Health, DME will always be privatized which gives incentive for more vendors to enter the market. The more eligible Patients, the more vendors eager to provide the care. Regarding regulation of private insurance companies, it's minimal. They are taken to task once in a while over high profile cases ,but, for the most part they have found ways to skirt around the regulations. Some are so reluctant or slow to pay claims that entire hospital systems have stopped accepting their insurance. Medicare always pays. I've been in healthcare delivery for 40 years and I have never witnessed one person FIRE Medicare.

"In the United States, the vendors such as Physicians, Hospitals, Clinics, Home Health, DME will always be privatized which gives incentive for more vendors to enter the market. The more eligible Patients, the more vendors eager to provide the care."

Really?

The Mayo Clinic stopped accepting Medicare at its five-physician practice in Glendale, Ariz., two years ago. Officials said at the time they would analyze financial results of the move early this year.

No results yet. Mayo spokesman James McVeigh said in an e-mail: “Our plan is to continue to study the program, collect data and review the impact on our patients.”

Mayo officials, who were unavailable at deadline, need more time to analyze how the Arizona clinic's decision to drop Medicare affected its finances, patient satisfaction and the overall number of patients, he said.

Mayo officials faulted Medicare for the move when they first announced plans to stop accepting the insurance.

“Mayo Clinic in Arizona loses a substantial amount of money every year due to the reimbursement schedule under Medicare, a loss we cannot continue to sustain,” the health system said on its news blog. “The discrepancy between what Medicare pays and our cost of providing services is particularly acute for our primary-care practices.”

Mayo also told the Bloomberg news service the clinic's finances would be examined under the pilot “to see if it could have implications beyond Arizona.”

Mayo Clinic operates in Arizona, Iowa, Florida, Minnesota and Wisconsin."
http://www.modernhealthcare.com/arti...GS01/301209984

SO. Medicare payments less than the costs of providing the care is going to "incentivize more vendors to enter the market"??

Why? So they can go bankrupt and be unable to pay themselves and their employees who need jobs?

I would be interested in a more detailed response on the Health Care system in Canada.

Interesting. Any updates in the last 2-1/2 years since your cited article about this one clinic?

Really?!?
 

LoriAnn, you wrote: WellPoint had a profit of 38%.

I question the veracity of your informational source. In 2008, WellPoint had an after-tax profit of 4.1% of revenues. That same year the healthcare insurance industry as a whole ranked 35th (out of the 53 identified industries) with a profit of 2.2% of revenue. They were surpassed by both the healthcare facilities industry (34th) and the pharmaceutical industry (ranked 30th) with a meager 3.0% of revenue profit, hardly an enviable number. The before -tax profit of WellPoint in 2013 was 5.4% of revenue, down from 6.2% in 2012. Those numbers seem quite modest to me.

You are proposing a single-payer system. Allow me to offer the following example as one of dozens that could have been chosen: the Department of Energy was formed in 1977, in a large part to reduce our dependence on foreign oil. At that time we imported around 40% of our oil needs. 35 years later, in 2012 we still imported about 35% of those needs and yet, that year, for the first time ever, we produced as much oil as we used. Our oil industry has been able to create those kinds of resources in spite of the government’s contrarian attempts to slow production down.

So I must ask you: do you really want your healthcare needs to be handled by such incompetence? And we must never forget that the efforts driving us to a “single-payer system” are being orchestrated and propagandized by that same inefficient and ineffective bureaucracy.

Remember a few years ago when a politician thought that Exxon’s $40 billion profits were obscene and should be turned over to the government for redistribution? What was never mentioned was that Exxon had paid over 110 billion dollars in taxes that same year or nearly 3 times as much as they made in profit, but that important fact was ignored. That was politics and it was dirty because it misled those who were unaware.

This is not a political statement. Instead it is a statement of facts. It is a statement based on real numbers and it is intended to show that propaganda pieces only sell to those who are unaware.

As Ayn Rand said, “we can ignore reality, but we cannot ignore the consequences of ignoring reality”.

Really indeed. You are being exceedingly misleading.
"Mayo Clinic follows an established fee schedule based on the federal guidelines for Medicare patients, which allows health care organizations to charge up to 15 percent above the Medicare allowable fee. You're financially responsible for the portion above the Medicare allowable amount."

Medicare information for Mayo Clinic in Arizona - Arizona Patient and Visitor Guide - Mayo Clinic

:BigApplause::BigApplause: I totally agree with you. All of it.

There are a lot of misconceptions about the Canadian Health Care System.
I find the US System confusing .. "free" health care seems to involve some type of monthly charge?
In Canada, we don't have any monthly fees to pay.
I have my choice of doctors. I can a specialist with a referral from my family doctor.
In Emergency Rooms, as in the USA, the critically ill are seen first. Others must wait their turn.
I've heard you have to wait four years for elective surgery. Not true.
Last year I had a knee replacement, without any cost to me.
Recently I had cataract surgery without any cost to me, other than I chose an upgraded lens.
Dental is not covered. Drugs are covered after the age of 65.

I'd be happy to answer any questions you have.

Sounds like the Mayo clinic needs to implement some cost controls since other facilities can provide services under the MediCare fee schedule. I know for example, a MRI can run from $1500 to $5000. Why is there that much variation in cost?

My biggest concern with Medicare is FRAUD - seems to run rampant in the government run program - not so much in private insurance - maybe that's why private companies make a profit!

It seems the issue here in the USA is who pays for what and how much through our taxes. In Canada you may be paying more taxes but perhaps it is more efficiently spent.Why do Canadians not seem upset with their healthcare system and the government that provides it?

Don't quite remember this exactly. Perhaps some documentation would help. Thanks.

[QUOTE=gomoho;935302]My biggest concern with Medicare is FRAUD - seems to run rampant in the government run program - not so much in private insurance - maybe that's why private companies make a profit![/QUOTE
The fraud comes from the doctors and the hospitals and is perpetrated on the insurance companies.

In any case, I don't agree that fraud should bring Medicare down in favor of privatizing insurance, who were denying coverage to people who needed it the most, or making it so expensive they couldn't afford it. Every year private insurance rates hike.

Anybody with a pre-existing condition is happy to have Medicare.

How Do They Do It?
 

The French have one of the most advanced, extensive and overall best health care systems in the world. Complete coverage is available to every French citizen.
Yet, if healthcare costs per procedure here in the US were the same as those in France, we would currently be currently enjoying a budget surplus.

In Need of a New Hip, but Priced Out of the U.S.
http://www.nytimes.com/2013/08/04/he...anted=all&_r=0

Here ya go!
 

BTW, congrats on an even 600 posts!!

Taken from a 2/2/07 article --

Yesterday Exxon declared the biggest profit in the entire history of capitalism — $39 billion — and that did not escape Hillary's notice. Today she promised to tax Exxon on those huge profits, and tax those greedy capitalist pigs big time. Here's her quote:

"I want to take those profits and put them into an alternative energy fund that will begin to fund alternative smart energy alternatives that will actually begin to move us toward the direction of independence."

She referred to those profits as the highest in the history of the world, and she said: "I want to take those profits..." Not I want to take PART of those profits. "I want to take those profits," she said.

Great job of taking words out of context! Pass the salt shaker, please. :1rotfl:

Her complete statement IN CONTEXT...

"Exxon Mobil and other oil giants continue to run up record profits to maintain the status quo even as Americans struggle to pay the high costs of heating their homes, fueling their cars, and meeting the mounting challenges of a growing economic crisis. And too many in Washington have stood in the way of the changes we need to chart a new energy strategy for our nation that breaks our dependence on foreign oil, reduces global warming pollution, and creates millions of new green collar jobs. I have proposed that we eliminate the tax breaks for big oil companies like Exxon Mobil and use that money to establish a Strategic Energy Fund to speed development of clean energy technology, put more efficient cars on the road, create new jobs, and provide immediate energy relief for the middle class as we head into what could be a difficult winter."

Read more: Clinton Blasts Exxon Mobil's Record Profits | TheHill
Follow us: @thehill on Twitter | TheHill on Facebook

It wouldn't be "misleading" if one actually reads and considers the points in bold in my post, that Medicare pays less than costs of running the place. Mayo was reacting to that reality.

So here is a more current article on what major hospitals across the country are doing to compensate for that problem: buying physician practices and adding "hospital" "facilities fees" onto procedures and services done at 1/4 the cost in a private practice office.

The result of this and the higher deductibles new ACA policyholders have mean that people are choosing to not go to the dr. when they need to for routine care, because they cannot afford a former $150 charge at the office now being $400 because the same office is now "in a hospital", and they now have a $5,000 deductible to pay before getting any use out of their insurance.

As hospitals buy physician practices, costs rise, Medicare report finds | Tampa Bay Times

[QUOTE=Rags123;935363]Her complete statement IN CONTEXT...

"Exxon Mobil and other oil giants continue to run up record profits to maintain the status quo even as Americans struggle to pay the high costs of heating their homes, fueling their cars, and meeting the mounting challenges of a growing economic crisis. And too many in Washington have stood in the way of the changes we need to chart a new energy strategy for our nation that breaks our dependence on foreign oil, reduces global warming pollution, and creates millions of new green collar jobs. I have proposed that we eliminate the tax breaks for big oil companies like Exxon Mobil and use that money to establish a Strategic Energy Fund to speed development of clean energy technology, put more efficient cars on the road, create new jobs, and provide immediate energy relief for the middle class as we head into what could be a difficult winter."

Thank you for that good researching. Eliminating tax breaks for big oil is a lot different than "I want to take those profits" as a direct quote, isn't it? It also sounds like a very good idea when you think of the percentage of income tax they pay when compared with the percentage you and I pay.

Sorry, 1) I thought the heading of the article sounded too political 2) I'm not good at providing links unless the address is short and 3) I figured someone would recognize the issue and eventually provide a link.


If it might help the conversation stay focused, I'll provide the proper search phrase now so that someone can provide the link:

This is it: Democrats borrow a GOP idea in proposal to help control health care costs

You do realize that since 1965 you have been paying into Medicare as part of your FICA taxes? Don't you think that you should get your money back?

If the government had invested all of the money that they have taxed out of us for SS and Medicare into the right places and not stolen it for other programs, these programs would be solvent for ages.

Z

"Borrowing a Republican idea, a group including former senior Obama and Clinton advisors is unveiling a novel proposal to let states take the lead in controlling health costs"



Democrats Borrow a GOP Idea on Health Care Costs - ABC News

I believe Vermont is having great success with its single payer state run programs. Having lived by the Canadian boarder for many years and having had a child who spent 6 years going to school there, I can say that I knew a lot of people who preferred that system to ours. Especially when it came to catastrophic care. ie pregnancy or birth complications and cancer. Canadians sure don't want to get rid of their medical system for ours. I'm benefiting from Obama Care now that I'm here in Florida and know many others who are as well. My attitude was and is still a wait and see how it works one. And so far so good. So I'm willing to entertain a state by state single payer system as a possible improvement. With so many more people now having coverage I'm looking forward to the reduced costs of the now preventative health care vs the more costly emergency care.

Thanks again, you're on the ball!!! :clap2:

I want to be able to go to the top of the line Mayo Clinic. I do not want a Government at any level control where I or my wife can go for treatment. If cost exceeds Insurance levels, we should be able to pay the difference if we want.

The Canadian Single Payer does not allow it. In Germany, socialized and Private Insurance are both available.

If Canadian so good, why do they come to US for treatment. There are hospitals and clinics built right along the US Canadian border. They must pay cash as we would do out of US, but we can put in a claim for some reimbursement later, can the Canadians? What do you do when you are in US and need a Doctor?

The same thing we do when we're living in Europe and need a doctor--either take out medical insurance or pay cash. And believe you me, the cost for the same medical care in France and Spain, where I've had experience, is a helluva lot cheaper than it is in the US.

And I would like to see some facts to back up your statement about Canadians flocking to the US for medical care. Because according to this site, that is the #1 myth about Canadian healthcare. Canada vs. US Health Care Systems - Debunking Canadian Health Care Myths - AARP

I will quote part: 99.39% of Canadians do not come to the US for medical care.

I read the ABC news few paragraphs describing this suggestion. My summary would be that as the Federal Government is paralyzed and that now that the economy is improving there seems to be an upswing in health care expenses we "need" to do something. That something cannot be divert dollars from some other aspect of government toward healthcare nor can it be increase taxes to provide for those services. As DC can't perhaps each state would decide what to do to control costs. If the Federal Government saves money on whatever plan the state invents, they will share the savings with the state. There will be measurement of costs to include both public and private insurance. There will be a list of essential services which cannot be cut. Costs could not be shifted to patients.

On its face who could object to such a plan? How would a state decrease costs with things they control? The easiest ways are to make getting care less convenient but still available. You want an MRI? Those are expensive, definitely overused and sadly often contribute more to the income of the provider than to the management of the patient. So let's do 2 simple things. All MRI's must be approved by an agency. No new MRI's will be installed in the state without a certificate of need to limit the use of these machines. Does every orthopedic doctor need his own MRI and CT? Does she order those tests because it is really needed or because they own the machine? If only hospitals had MRI machines there would still be some in every county and I guarantee a whole lot fewer MRI's would be done. Multiply this kind of thinking which does not deny services, does not shift costs to patients, and likely does not lower the quality of care and the state saves millions every year. Now apply that process to lots of medical high cost procedures. Does this sound good to you?

The OP asked members opinion of state run vis a vis federally run health care. Health care is one of those issues that can never be covered here.

First everyone seems to be talking about the payer system and not health care itself. This country is not doing a good job of dealing with this critical issue. I believe the remedy is to let the market settle it. I believe the government and private insurance companies need to take a step back and give the medical community room to do their jobs. Far top many doctors are losing their passion for medicine.

I was never one for central planning and bureacuracy because such a system is too big too clumsy. Our government is so large that departments are tripping over one another especially issuing conflicting or redundant regulations

I'm Canadian, and I don't know anyone who goes to the USA for treatment.
I suppose there are people who want to have a knee replacement in two weeks rather than wait two months.
In that case, if they are wealthy, perhaps they have the surgery done in the US?
Please see CFrance's information below.

When we are living in our Villages home for six months, we buy a comprehensive travel insurance policy to cover us for critical illnesses.
If I were able to travel, I would fly back to Canada for treatment.
If I need to see a doctor for a minor problem, or have an allergy shot, I pay cash (rates are much lower for self-payers).

you are correct
 

She did indeed say exactly what you said, however those were not the only words that she has ever spoken with regards to Exxon. The statements I quoted were not made up, in fact, they were copied from my referenced article. BTW, here are some other facts about Exxon in 2011 and I copy: Often ignored fact: ExxonMobil makes pennies per gallon on gasoline, diesel and petroleum products it refines and sells in the United States. In the first and second quarters of this year, ExxonMobil made 7 cents and 8 cents, respectively, on the gasoline, diesel and other petroleum products it refined and sold in the United States. Comparatively, local, state and federal gasoline taxes average nearly 49 cents per gallon nationally, with a high of 67 cents in states such as California and New York.

Another way of saying it is that Exxon pays more in local, state and federal gasoline taxes to the tune of 6 to 7 times as much as is their profit. With that being the case, this question must be asked: Who is the greedy one, the one who makes 7 cents per gallon in profit or the entity who takes 49 cents a gallon from you and me in taxes?

A correction here -- Exxon does not pay more in taxes than is its profit, instead you and I pay those taxes to the tune or 6 to nearly 10 times (in some cases) what Exxon's profits are. Sorry for my mis-statement. But, who is greedy?