what is Romney Care?

[c1ue]

Re: Global arbitrage vs US health care!

Price transparency is a major issue. But grocery stores and radio shack offer it without the presence of competing government services.

But no one buys a stereo or banannas using insurance.

Grocery stores and Radio Shack sell standardized products which people use relatively often.

Medical procedures are tremendously varied, non standardized and specific ones employed by individual people are generally not repeated.

[dcarrigg]

Re: what is Romney Care?

They never explain why a person who pays for thier own care should be required to pay for premiums. We are subsidising poor people
through general taxes anyway. So why should I pay an "insurance premium" on top of my taxes? Because that's what the insurance companies want. They have national political reach. I don't by my cars, houses, or food using insurance, so there is no reason I should purchase medical care that way either. If a big expense comes up, I pay it out of savings, or by borrowing. I can use insurance for catastrophic rare events, analogous to fire insurance on a house.

At least in the states, I think the insurance market is more pervasive than you illustrate here. In all but NH you must buy car insurance. Then there's the required PMI (for low down payments) / homeowners insurance that comes with houses (not to mention flood where it's needed). In the case of PMI, you really do buy a house with insurance in a way. Food has swaps etc. but no direct retail market. Although, I can see how it would work for direct customer purchases.

If ever I lose my mind and my morals, I'd be happy to start a food-born illness insurance business with you. We'll lobby the state departments of health to require it as a public good to offset costs for state insurance exchange rates, lest a large food-born illness outbreak slam the budget one year. Then we'll subsidize it with the cigarette excise tax, require cheap $15 annual premiums from the consumer, and collect them through the DMV at registration time. Then we leverage up and start snapping up the downtown real estate. Money in the bank.

[Polish_Silver]

Doctors are more mechanic than artist!

Medical procedures are tremendously varied, non standardized and specific ones employed by individual people are generally not repeated.

I disagree strongly with this. Japan publishes a book with a price for every medical procedure, and doctors are not allowed to charge more. Massachusetts also has a price list.

Doctors are expected to follow established protocols in treating illness. That means others have worked out the methods, doses, etc, ahead of time. Medicine is analytical, but it is not supposed to be creative. Competency consists of correct diagnosis and following the relevant protocols. (ie. what shot treats what infection)

Novel treatments are "research" not clinical practice. About 98% of treatable ailments have been diagnosed, and treated countless times before.

Prices could certainly be established in a competitive transparent market, to a much greater extent than they are, but the system works against this to keep costs high.

Comparing a private sector treatment to a public sector alternative only works if costs can be established in advance.

A vet once told me how long it takes to spay a dog. That is a fairly complex procedure and they can predict +/-5 min how long the surgery takes.

We need to stop treating medicine like a mystery religion and subject it to a rational incentive structure!

[lektrode]

Re: what is Romney Care?

Reporting for duty.
...

thanks dc - we appreciate it greatly - more later
(and hows yer leg doin?)

[lektrode]

Re: Romney care and what's really wrong

Price transparency is a major issue.

If a single clinic were to post prices on the internet, it would attract business from all the uninsured people.

Eventually, that will happen. However, I am not holding my breath. (Blood tests are falling rapidly in price, due to

competition over the internet.)

What we need is something to introduce more competition!

People haggle with car dealers over $300 on a $15k car. The Dealers are bending over forwards to create 2% of price opacity in thier products.

+1
one would think there'd be more independent operators of such clinics that specialize in narrowly defined areas of practice - so there must be something about the regulatory or tax systems that prevent or discourage this?

could it be the insurance industry colluding with the regulatory buracracy that does it? (by pricing coverage of typical perils prohibitively high or by zoning/licensing/reporting/hiring regs chasing them from locations that would incent their establishment)

again referring back to the cost of malpractice insurance and it causing more docs to either throw in the towel and go with the big hospital/hmo systems or simply retire rather than be milked/gouged by the insurance/tort 'conspiracy' ???

[lektrode]

Re: what is Romney Care?

At least in the states, I think the insurance market is more pervasive than you illustrate here. In all but NH you must buy car insurance.

and is it any wonder that auto ins in NH is MUCH cheaper than in neighboring states with mandatory coverage laws?
the old/overused argument that the uninsured motorists cause rates to be higher is pure BS, for the simple reason that uninsured operators dont file claims (but if you cause damage in NH and cant immed pay for it, you is screwed and will pay for years into the future by having to file an SR22 just to have a license to drive)

and by same token, why would we expect mandatory med ins to lower the rates?

why methinks we're headed for single payer, no matter what happens, short of the .gov getting into med services as provider of last resort, which i think would be the answer to skyrocketing med services, as i DONT believe the insurance model works anymore.

[shiny!]

Re: Doctors are more mechanic than artist!

I disagree strongly with this. Japan publishes a book with a price for every medical procedure, and doctors are not allowed to charge more. Massachusetts also has a price list.

Doctors are expected to follow established protocols in treating illness. That means others have worked out the methods, doses, etc, ahead of time. Medicine is analytical, but it is not supposed to be creative. Competency consists of correct diagnosis and following the relevant protocols. (ie. what shot treats what infection)

Novel treatments are "research" not clinical practice. About 98% of treatable ailments have been diagnosed, and treated countless times before.

Prices could certainly be established in a competitive transparent market, to a much greater extent than they are, but the system works against this to keep costs high.

Comparing a private sector treatment to a public sector alternative only works if costs can be established in advance.

A vet once told me how long it takes to spay a dog. That is a fairly complex procedure and they can predict +/-5 min how long the surgery takes.

We need to stop treating medicine like a mystery religion and subject it to a rational incentive structure!

YES! Why can't my own care be purchased as transparently and directly as my dog's veterinary care? God knows, the vets I've known have been better doctors than the ones I've had to see for myself, and they have to know how to treat multiple species!

With my vet the transaction is between me and him. He gives me a printout of options (with prices) showing the different ways to treat a problem. I decide what to do with full information in front of me. For expensive treatments they let me pay them out over time.

[c1ue]

Re: Romney care and what's really wrong

I disagree strongly with this. Japan publishes a book with a price for every medical procedure, and doctors are not allowed to charge more. Massachusetts also has a price list.

Japan has a fully national health care system with pricing restrictions not only on public but also private care - or at least anything paid by insurance.

Thus it isn't the existence of the price list which keeps costs down, it is the law preventing anyone from charging insurance more than what is negotiated by government.

I have no information on Massachusetts so cannot comment on it. Pretty sure the 'price list' in Massachusetts hasn't had any effect on actual prices though.

[dcarrigg]

Re: what is Romney Care?

thanks dc - we appreciate it greatly - more later
(and hows yer leg doin?)

Alright - second surgery helped a lot. I'm back on it now. It'll be a couple of months until I'm 'right' (whatever the new normal will be). All things considered, I'm doing pretty good. I haven't even received any 4+ figure bills from the second operation...yet.

[shiny!]

Re: what is Romney Care?

and is it any wonder that auto ins in NH is MUCH cheaper than in neighboring states with mandatory coverage laws?
the old/overused argument that the uninsured motorists cause rates to be higher is pure BS, for the simple reason that uninsured operators dont file claims (but if you cause damage in NH and cant immed pay for it, you is screwed and will pay for years into the future by having to file an SR22 just to have a license to drive)

and by same token, why would we expect mandatory med ins to lower the rates?

why methinks we're headed for single payer, no matter what happens, short of the .gov getting into med services as provider of last resort, which i think would be the answer to skyrocketing med services, as i DONT believe the insurance model works anymore.

A friend of mine from South Africa tells me that there, liability insurance is paid for by a tax on gasoline at the pump. The more you drive, the more you contribute to the insurance pool. If you want collision or comprehensive coverage you pay for it yourself.

The Road Accident Fund

************

Here in Arizona the uninsured/underinsured motorist coverage is very high, especially for underinsured. I asked the rep at GEICO why it cost more for underinsured vs uninsured coverage. She told me it's because the minimum required liability is so low in this state ($15,000) that most drivers actually do have insurance, but they don't carry enough insurance. If we required a higher minimum liability, then the cost for un/under insured motorist coverage would be less. It only costs a few more dollars a month to pay for $30,000 to $50,000 liability.

Un/under-insured driver coverage for motorcycles is so ridiculously expensive here that we dropped that part of our coverage- three months before my husband was hit by TWO under-insured drivers. The first driver that cut him off and knocked him down carried the minumum, $15,000. The second driver, the one that ran over and killed him and also hit the Good Samaritan who was with him, also carried the minimum. Split 50/50 with my stepson, I got a whole whopping $15,000 for the loss of a great man, my best friend and my provider.

[dcarrigg]

Re: Romney care and what's really wrong

Japan has a fully national health care system with pricing restrictions not only on public but also private care - or at least anything paid by insurance.

Thus it isn't the existence of the price list which keeps costs down, it is the law preventing anyone from charging insurance more than what is negotiated by government.

I have no information on Massachusetts so cannot comment on it. Pretty sure the 'price list' in Massachusetts hasn't had any effect on actual prices though.

MA does not have a "price list" short of those provided as part of Medicare/Medicaid. That being said, they are looking at cost control.

They are opting for a "global payment system" rather than a price list. It is somewhat like a bundled payment system - but different in a few key ways. It entails a fixed payment per patient per time period per health issue rather than simply per procedure. This is ostensibly to de-incentivize ordering unnecessary procedures for the purposes of profit. It also is to incentives wellness, as sick patients now cost physicians and hospitals more, rather than make them money. It functionally shifts financial risks onto physicians and may incentivize taking on as many patients as possible, as today, but there are those who argue it would not. Since it has never been done, there is no way to say for sure one way or the other.

If you are interested in the global payment system, here's the synthesis document that led to its recommendation. It is somewhat technical and hard to explain. That may be a major drawback in-and-of-itself. But here's a graphic that attempts to illustrate the differences in payment methodologies:





To zoom out a little, one must be clear about purpose when discussing "Romneycare" in MA. It was never sold as cost control. Its purpose was only to extend insurance universally. It is at about 98%, which is probably as close to universal as one can get with a scheme like this. Since its stated goal was to expand insurance coverage, it is hard to argue that it was anything but successful. Costs are another story.

They are talking about a global payment system in MA, however. Gov. Patrick and the legislative leadership seem to be for it, but there has been much studying and hand-wringing about it. Its purpose is to control costs. Unfortunately, the latest study/survey of physicians there, showed that they are far from ready to adopt a 'global payment' model. It was supposed to happen by 2013. I'm doubtful at the moment, but perhaps a few years down the line we will have a new Massachusetts experiment in healthcare. It's global index to the CPI should keep costs down.

The questions will be first asked by hospitals, some of whom may shut down. The Japanese system interestingly spends considerably more on ambulatory care and first response than the rest of the world. With hospitals further away, and no more money for first response, one must ask what, if anything, happens to quality of healthcare. Quality overall may end up being an issue compared to those who do not keep costs down over time. My guess would be relatively little, as there is little evidence that the increased costs improve U.S. health rates overall compared to other nations. Plus Boston has some of the best teaching hospitals period. But we may see.

[BK]

Re: Romney care and what's really wrong

An interesting article on Romney- Kennedy and MA Healthcare was in NYTimes on Sunday.
http://www.nytimes.com/2012/03/25/us...haunts-it.html

My big objection to Romney Care was the creation of a Government Authority - with great salaries and defined Pension benefit retirement plans that is yet another patronage tool for the Political Class of Massachusetts. Governor Romney seems like a trustable and honest politician - TheConnector reminds me the an honest and trustable politician is an oxymoron........when will I learn.
check out the current leadersthip of the connector... https://www.mahealthconnector.org/po...iShown=default
Here is a story on the Salaries and benefits for the Connector...
http://www.boston.com/yourlife/healt...ers/?page=full

[Raz]

Re: what is Romney Care?

A friend of mine from South Africa tells me that there, liability insurance is paid for by a tax on gasoline at the pump. The more you drive, the more you contribute to the insurance pool. If you want collision or comprehensive coverage you pay for it yourself.

The Road Accident Fund

************

Here in Arizona the uninsured/underinsured motorist coverage is very high, especially for underinsured. I asked the rep at GEICO why it cost more for underinsured vs uninsured coverage. She told me it's because the minimum required liability is so low in this state ($15,000) that most drivers actually do have insurance, but they don't carry enough insurance. If we required a higher minimum liability, then the cost for un/under insured motorist coverage would be less. It only costs a few more dollars a month to pay for $30,000 to $50,000 liability.

Un/under-insured driver coverage for motorcycles is so ridiculously expensive here that we dropped that part of our coverage- three months before my husband was hit by TWO under-insured drivers. The first driver that cut him off and knocked him down carried the minumum, $15,000. The second driver, the one that ran over and killed him and also hit the Good Samaritan who was with him, also carried the minimum. Split 50/50 with my stepson, I got a whole whopping $15,000 for the loss of a great man, my best friend and my provider.

Perhaps we should have a provision in the law where in such cases (negligence, vehicular manslaughter, etc.) the court could order restitution instead of imprisonment.

If you read the Pentateuch (especially Deuteronomy) you'll see that no one was locked up in a cage for any crime. They were either (a) ordered to make restitution - four-fold for stealing, or (b) executed or (c) judged not guilty and set free. It would be a daily reminder of guilt to the man who ran over your husband when he had to work and turn over 25% of his earnings to you and your stepson for the next fifteen+ years.

[shiny!]

Re: what is Romney Care?

Perhaps we should have a provision in the law where in such cases (negligence, vehicular manslaughter, etc.) the court could order restitution instead of imprisonment.

If you read the Pentateuch (especially Deuteronomy) you'll see that no one was locked up in a cage for any crime. They were either (a) ordered to make restitution - four-fold for stealing, or (b) executed or (c) judged not guilty and set free. It would be a daily reminder of guilt to the man who ran over your husband when he had to work and turn over 25% of his earnings to you and your stepson for the next fifteen+ years.

That was a good system.

Financial restitution would be nice since my income, which wasn't great before, has dropped 80%. Unfortunately we live in a world where most people try harder to escape responsibility than take ownership of it. This guy doesn't have much going for him... twenty-seven years old and living with his parents. If the court were to order him to pay restitution, he could have it discharged in a bankruptcy or work under the table for cash to show a minimal income.

So I'd like to see him do volunteer work for the rest of his life. I'd like the court to order him to speak to people about distracted driving. I'd like him to be a regular blood donor, if he's qualified. My husband donated blood every eight weeks; he was on his 20th gallon. He was O-neg and they gave his blood whole to preemies in the NICU. Maybe if this guy did these things it would help him become a better person. Maybe it would help make up for the good things my husband would have done, but can't now.

This guy needs to step up, be a man, but so far all he's done is make excuses and try to get out of it.

[Polish_Silver]

Medical insurance not like auto insurance

I only need auto insurance to operate a car on a public roadway. Many people in large cities don't own a car and aren't required to buy insurance. Every car on a roadway is some risk to the other cars.


As for mortgage insurance, we had to pay it when our loan to value ratio was high. When we lowered the LTV, we stopped paying it. There may be some other insurance hidden in the monthly payment, but I've never been able to figure that part out.
I am not required to borrow money ---I can pay cash for the house or rent. So I find mortgage insurance much less intrusive.
If interest rates were rational, they would just price in the borrowers risk, with no need for "insurance".