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Postby Common Sense Al » Thu Jul 02, 2009 12:02 pm

Op-Ed Contributor: Shifting America from sick care to genuine wellness

The fact is, we currently do not have a health care system in the United States; we have a sick care system. If you’re sick, you get care, whether through insurance, Medicare, Medicaid, SCHIP, community health centers, emergency rooms, or charity. The problem is that this is all about patching things up after people develop serious illnesses and chronic conditions.

We spend a staggering $2.3 trillion annually on health care – 16.5 percent of our GDP and far more than any other country spends on health care – yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia.

We spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease.

How can this be so? The problem is that we have systematically neglected wellness and disease prevention. Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur. But we spend peanuts on prevention.
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Postby josh » Thu Jul 02, 2009 1:00 pm

Al wrote:Op-Ed Contributor: Shifting America from sick care to genuine wellness

The fact is, we currently do not have a health care system in the United States; we have a sick care system. If you’re sick, you get care, whether through insurance, Medicare, Medicaid, SCHIP, community health centers, emergency rooms, or charity. The problem is that this is all about patching things up after people develop serious illnesses and chronic conditions.

We spend a staggering $2.3 trillion annually on health care – 16.5 percent of our GDP and far more than any other country spends on health care – yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia.

We spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease.

How can this be so? The problem is that we have systematically neglected wellness and disease prevention. Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur. But we spend peanuts on prevention.


Just curious...how much money from my paycheck do you think I need to fork over to try and convince the sloth down the street that he really, really needs to get up and exercise so that he doesnt develope diabetes or heart problems which will cost money to treat? Just curious. Isnt that part of what Obama-care is about?

I'm actually of the school of thought that says that the sloth down the street has an individual responsibility to get off the couch to get healthy and that making me pay for some educational program that the sloth is never going to take advantage of is just a weee bit different from the type of America that I was under the impression the Founder's had in mind. You know, the one based on individual liberty and all. But what do I know.
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Postby Common Sense Al » Thu Jul 02, 2009 1:05 pm

josh wrote:Just curious...how much money from my paycheck do you think I need to fork over to try and convince the sloth down the street that he really, really needs to get up and exercise so that he doesnt develope diabetes or heart problems which will cost money to treat? Just curious. Isnt that part of what Obama-care is about?

I'm actually of the school of thought that says that the sloth down the street has an individual responsibility to get off the couch to get healthy and that making me pay for some educational program that the sloth is never going to take advantage of is just a weee bit different from the type of America that I was under the impression the Founder's had in mind. You know, the one based on individual liberty and all. But what do I know.


I think you miss the bigger picture. There are MANY people who would get more preventative care but they don't because they don't have suitable access (no insurance coverage, limited money (too expensive), etc). It's not about taking care of the sloth. The sloth will still not go to the doc, but many others would be more concerned about prevention if they could do so without significant consequence to their pocketbooks.
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Postby esemerson » Thu Jul 02, 2009 1:43 pm

According to Rush people who excercise and play sports are the ones driving up healthcare costs.
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Postby josh » Thu Jul 02, 2009 2:24 pm

esemerson wrote:According to Rush people who excercise and play sports are the ones driving up healthcare costs.



Good think I dont let Rush think for me.
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Postby admin » Thu Jul 02, 2009 2:48 pm

From Rep. Michael C. Burgess, M.D.:


Current legislative efforts to reform health care have focused solely on cost and coverage, that is, making sure all Americans are covered at the lowest acceptable cost. It's a legitimate goal, but it oversimplifies the problems of our health care system. The number of Americans without health care is unacceptably high, but the problems with American health care are complex, extending much further than simple lack of insurance. Congress' policy decisions should reflect this complexity.

Unfortunately, much of the current debate has ignored many problems that are fundamental to comprehensive health care reform. For example, our current medical workforce is shrinking each year as fewer students are completing medical school and more doctors are retiring early. Extending coverage to all Americans won't make much of a difference in our current situation if there are not enough doctors to go around. Additionally, denying patients with government health insurance is often a necessary business decision for doctors to make given the low reimbursement rates. Physicians nation-wide are already staring down a 20% cut in Medicare reimbursement from the government this year. Coverage becomes irrelevant if the patient cannot find a doctor willing to accept the program.

Further, government-administered health care puts Americans who have employer-based health coverage at risk. President Obama assured us during his campaign that anyone who already had their own health care would be allowed to keep it; they would not be forced to accept government health care. Yet most individuals don't truly have their own health insurance-they get it from their employers. If the coverage provided in the government-administered plan is cheaper than what employers are paying now, logic suggests that employers will go for the thriftier option and drop the private plans. Estimates from independent actuaries at the Lewin Group suggest that as many as 75% of all Americans currently with employer-sponsored health insurance - nearly 120 million individuals - would find themselves switched over from their private plans to the government plan without consent. This is unacceptable.

I recently created a Health Care Caucus in the House of Representatives to find solutions to our health care problems. We need alternatives that will expand access to affordable, quality health care. We also know that we need to keep doctors and patients, not the bureaucracy, at the center of health care.

Please be assured that I will give my full effort in the coming months to find valid, working solutions, and I will not fall prey to paltry partisanship. We must fight against a silver-bullet answer that will leave gaps in our reform efforts, and instead work in favor of thoughtful, comprehensive reform.
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Postby Common Sense Al » Thu Jul 02, 2009 2:54 pm

Sad that the "world's only superpower" can't figure out how to "fix" healthcare in this country when so many other countries do it better.

If the private insurance companies go out of business because of a gov't plan, it's probably a good thing. If they really have such a superior product/service and people want it then they'll stay in business.

Maybe more people would want to get into medicine if major problems (like insurance and payment) were fixed (so they know they'd get paid)... and of course wouldn't be sued into oblivion.
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Postby josh » Thu Jul 02, 2009 3:05 pm

Al wrote:Sad that the "world's only superpower" can't figure out how to "fix" healthcare in this country when so many other countries do it better.

If the private insurance companies go out of business because of a gov't plan, it's probably a good thing. If they really have such a superior product/service and people want it then they'll stay in business.


You didnt read a single word he said did you? You keep going back to the same old thing over and over again (others do it better, cheaper, etc). How many horror stories from people in the English and Canadian systems do you have to read to convince you?

Did you read the "myths" posted in the opening post? Those seem to address pretty much all of the healthcare "monsters" you have been talking about. No response to those? The other thing that you and others are confusing is insurance vs health care. They are not the same thing. As the Rep points out, it doesnt do you much good to have full medical coverage when you cant find a doctor to treat you...or if you can find one, you have to wait 6 months to be seen.

If the private insurance companies go out of business and everyone is completely covered by the govt, how do you imagine the govt pays for such a plan? Spare me the myth about how digital medical records will save the day (and the dollar). The only way that works is to drastically raise taxes or significantly ration health care.

Again - read the opening article. Maybe you have good responses to those issues raised. Just dont keep repeating the same "myths" over and over again hoping that eventually they will become facts.
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Postby Common Sense Al » Thu Jul 02, 2009 3:17 pm

josh wrote:You didnt read a single word he said did you?


Yeah, I read it.

josh wrote:You keep going back to the same old thing over and over again (others do it better, cheaper, etc). How many horror stories from people in the English and Canadian systems do you have to read to convince you?


You can find horror stories for anything... but I'll bet you can find many more US horror stories!

josh wrote:Did you read the "myths" posted in the opening post? Those seem to address pretty much all of the healthcare "monsters" you have been talking about. No response to those?


I read it, but didn't delve deep into it. I think there's some truth in them, but if you think those "myths" mean that the US healthcare system is fine, then you must be living in the clouds.

josh wrote:The other thing that you and others are confusing is insurance vs health care. They are not the same thing. As the Rep points out, it doesnt do you much good to have full medical coverage when you cant find a doctor to treat you...or if you can find one, you have to wait 6 months to be seen.


Which is more reason why we need to fix the system... so more people will want to be doctors. If the private system was so great, then why aren't we seeing an overflow of doctors???? Instead we are supposedly seeing declines. Remember, we are still under the "private system" as we have been for decades and it's still getting worse. If it was so great, we wouldn't be in the "crap" we are now and there would be an abundance of doctors and specialists... but, there's not.

josh wrote:If the private insurance companies go out of business and everyone is completely covered by the govt, how do you imagine the govt pays for such a plan? Spare me the myth about how digital medical records will save the day (and the dollar). The only way that works is to drastically raise taxes or significantly ration health care.


Yes, taxes, but the net effect of a good, efficient healthcare system would be positive to people's bottom lines, as well as their health. And as I explained before, "rationing" is a scare tactic. We already ration care... many don't get it due to various reasons... they are "rationed" out of the system. It's a myth to think that there is no rationing already. There can only be no rationing when there is much more supply than demand, and obviously that's not the case as there is much more demand than supply. People can't get care because they don't have the $$$. And those that do get care are often ripped-off.

josh wrote:Again - read the opening article. Maybe you have good responses to those issues raised. Just dont keep repeating the same "myths" over and over again hoping that eventually they will become facts.


The fact is the system is still broken. That's not a myth.
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Postby josh » Thu Jul 02, 2009 3:37 pm

Al wrote:
josh wrote:You didnt read a single word he said did you?


Yeah, I read it.

josh wrote:You keep going back to the same old thing over and over again (others do it better, cheaper, etc). How many horror stories from people in the English and Canadian systems do you have to read to convince you?


You can find horror stories for anything... but I'll bet you can find many more US horror stories!

josh wrote:Did you read the "myths" posted in the opening post? Those seem to address pretty much all of the healthcare "monsters" you have been talking about. No response to those?


I read it, but didn't delve deep into it. I think there's some truth in them, but if you think those "myths" mean that the US healthcare system is fine, then you must be living in the clouds.

josh wrote:The other thing that you and others are confusing is insurance vs health care. They are not the same thing. As the Rep points out, it doesnt do you much good to have full medical coverage when you cant find a doctor to treat you...or if you can find one, you have to wait 6 months to be seen.


Which is more reason why we need to fix the system... so more people will want to be doctors. If the private system was so great, then why aren't we seeing an overflow of doctors???? Instead we are supposedly seeing declines. Remember, we are still under the "private system" as we have been for decades and it's still getting worse. If it was so great, we wouldn't be in the "crap" we are now and there would be an abundance of doctors and specialists... but, there's not.

josh wrote:If the private insurance companies go out of business and everyone is completely covered by the govt, how do you imagine the govt pays for such a plan? Spare me the myth about how digital medical records will save the day (and the dollar). The only way that works is to drastically raise taxes or significantly ration health care.


Yes, taxes, but the net effect of a good, efficient healthcare system would be positive to people's bottom lines, as well as their health. And as I explained before, "rationing" is a scare tactic. We already ration care... many don't get it due to various reasons... they are "rationed" out of the system. It's a myth to think that there is no rationing already. There can only be no rationing when there is much more supply than demand, and obviously that's not the case as there is much more demand than supply. People can't get care because they don't have the $$$. And those that do get care are often ripped-off.

josh wrote:Again - read the opening article. Maybe you have good responses to those issues raised. Just dont keep repeating the same "myths" over and over again hoping that eventually they will become facts.


The fact is the system is still broken. That's not a myth.



We are NOT under a private only system. We operate in a system in which the govt influences rates by way of medicare reimbursement rates. Every year the govt dials back what they are going to reimburse and how much, which is why doctors are leaving the practice. That, along with rising malpractice premiums. So your conclusion about why doctors are leaving seems to be completely misinformed. You should actually "delve" in a bit more about how rates are set, who sets them, how the private insurance companies react to those govt rates, the impact those rates have on doctors, etc, etc before claiming that the way to "fix" the system is to hand the keys over to the very same entity responsible for a massive portion of the breakage! Thats like me telling my 6 year old he is now in charge of making sure nobody messes up the game room when the only one who messes up the game room is him!

Don't read words that I didnt type. I never said the system doesnt have problems. The "mtyhs" posted earlier made no such claim either. They do a good job of refuting the notion that the only solution or even that a good solution is to let the govt run the whole thing.

By the way. I will take your "bet" and challenge you to go find more horror stories about the US.

Regarding your last point - about rationing and people not getting care I would point you back to the opening post. That myth is addressed head on.
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Postby Common Sense Al » Thu Jul 02, 2009 3:54 pm

josh wrote:We are NOT under a private only system.


I know, but we are primarily under a private system.

josh wrote:We operate in a system in which the govt influences rates by way of medicare reimbursement rates. Every year the govt dials back what they are going to reimburse and how much, which is why doctors are leaving the practice.


Why would they leave their practice? Why don't they just drop medicare patients and go private if the private portion of our system is so great? Could it be because not enough people have the "luxury" private insurance, and of those that, many still can't pay the ever increasing co-pays and deductibles?

josh wrote:That, along with rising malpractice premiums. So your conclusion about why doctors are leaving seems to be completely misinformed. You should actually "delve" in a bit more about how rates are set, who sets them, how the private insurance companies react to those govt rates, the impact those rates have on doctors, etc, etc before claiming that the way to "fix" the system is to hand the keys over to the very same entity responsible for a massive portion of the breakage! Thats like me telling my 6 year old he is now in charge of making sure nobody messes up the game room when the only one who messes up the game room is him!


You're blaming the gov't instead of the private insurance companies? You don't think the private insurance companies set rates too? While the gov't certainly does screw up, the private system can screw up big-time too. I do blame the gov't for not helping doctors with frivolous lawsuits, but I blame the private insurance companies for a great deal of the big problems in the system. Remember, their PRIVATE which means they are only there for their BOTTOM LINE!

josh wrote:Don't read words that I didnt type. I never said the system doesnt have problems. The "mtyhs" posted earlier made no such claim either. They do a good job of refuting the notion that the only solution or even that a good solution is to let the govt run the whole thing.


Whatever happens, there needs to be a lot more gov't involvement. I didn't say they need to run the whole thing either, but in other countries like ours, there's a lot more gov't involvement and the system is better.

josh wrote:By the way. I will take your "bet" and challenge you to go find more horror stories about the US.


I'm pretty busy and shouldn't be spending more time on this, but google will provide many US horror stories! Tons of them!

josh wrote:Regarding your last point - about rationing and people not getting care I would point you back to the opening post. That myth is addressed head on.


You mean waiting times? That's a great example of how numbers can be fudged. Why not add to the US waiting times the number of people in the US who want a procedure but can't get it? They're not even on the list because they may not ever be getting it. Don't you'd think they'd rather wait a bit than to never have it? So put those people on the list and you'll see the US waiting times explode. It seems you'd rather deny care to some people so that other people don't have to wait as long.... because that's how it works in the US.
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Postby josh » Thu Jul 02, 2009 4:19 pm

Al wrote:
josh wrote:We are NOT under a private only system.


I know, but we are primarily under a private system.

josh wrote:We operate in a system in which the govt influences rates by way of medicare reimbursement rates. Every year the govt dials back what they are going to reimburse and how much, which is why doctors are leaving the practice.


Why would they leave their practice? Why don't they just drop medicare patients and go private if the private portion of our system is so great? Could it be because not enough people have the "luxury" private insurance, and of those that, many still can't pay the ever increasing co-pays and deductibles?

josh wrote:That, along with rising malpractice premiums. So your conclusion about why doctors are leaving seems to be completely misinformed. You should actually "delve" in a bit more about how rates are set, who sets them, how the private insurance companies react to those govt rates, the impact those rates have on doctors, etc, etc before claiming that the way to "fix" the system is to hand the keys over to the very same entity responsible for a massive portion of the breakage! Thats like me telling my 6 year old he is now in charge of making sure nobody messes up the game room when the only one who messes up the game room is him!


You're blaming the gov't instead of the private insurance companies? You don't think the private insurance companies set rates too? While the gov't certainly does screw up, the private system can screw up big-time too. I do blame the gov't for not helping doctors with frivolous lawsuits, but I blame the private insurance companies for a great deal of the big problems in the system. Remember, their PRIVATE which means they are only there for their BOTTOM LINE!

josh wrote:Don't read words that I didnt type. I never said the system doesnt have problems. The "mtyhs" posted earlier made no such claim either. They do a good job of refuting the notion that the only solution or even that a good solution is to let the govt run the whole thing.


Whatever happens, there needs to be a lot more gov't involvement. I didn't say they need to run the whole thing either, but in other countries like ours, there's a lot more gov't involvement and the system is better.

josh wrote:By the way. I will take your "bet" and challenge you to go find more horror stories about the US.


I'm pretty busy and shouldn't be spending more time on this, but google will provide many US horror stories! Tons of them!

josh wrote:Regarding your last point - about rationing and people not getting care I would point you back to the opening post. That myth is addressed head on.


You mean waiting times? That's a great example of how numbers can be fudged. Why not add to the US waiting times the number of people in the US who want a procedure but can't get it? They're not even on the list because they may not ever be getting it. Don't you'd think they'd rather wait a bit than to never have it? So put those people on the list and you'll see the US waiting times explode. It seems you'd rather deny care to some people so that other people don't have to wait as long.... because that's how it works in the US.


Waiting times, too. But I was talking primarily about the myth that so many millions are without coverage. When you take away those that can afford it but decide not to take it, ilegal aliens, those covered by medicare, medicaid, then you are down to a much, much smaller portion of the population. A portion that is small enough that they can be addressed with targeted reform, not sweeping reform at the expense of the 95%.

Yes. And Google provide lots of horror stories on the socialist system as well. And now we are right back to where we both started, again.


"Whatever happens, there needs to be a lot more gov't involvement. I didn't say they need to run the whole thing either, but in other countries like ours, there's a lot more gov't involvement and the system is better."

Well, thats the whole point of this argument, isnt it? Two faulty assumptions in my opinion: 1. there needs to be a lot more govt, and 2. their system is better. I have yet to see compelling evidence for either point.

Thats all for me...off leaving for home to start this 4th weekend early. Have a good one!
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Postby Common Sense Al » Thu Jul 02, 2009 4:20 pm

josh wrote:Thats all for me...off leaving for home to start this 4th weekend early. Have a good one!


Yeah, enough for me too. Have a good one too! Stay safe and don't end up in the hospital with all those copays, deductibles, fighting the insurance company, mounds of paperwork, bureaucracy, overcharging, etc! :wink:
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Postby neighbor » Fri Jul 03, 2009 8:38 am

admin wrote:From Rep. Michael C. Burgess, M.D.:

... denying patients with government health insurance is often a necessary business decision for doctors to make given the low reimbursement rates... Coverage becomes irrelevant if the patient cannot find a doctor willing to accept the program.


Very good point. I'm sure this has happened to many of us. We have to change doctors because our current one has dropped insurance company X because they don't pay out enough. I can only assume doctors will do the same with bargain basement government insurance.

admin wrote:From Rep. Michael C. Burgess, M.D.:

Yet most individuals don't truly have their own health insurance-they get it from their employers. If the coverage provided in the government-administered plan is cheaper than what employers are paying now, logic suggests that employers will go for the thriftier option and drop the private plans.


Makes the point above more of an issue.
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Postby Lantana07 » Fri Jul 03, 2009 11:07 am

Al, doctor's do get paid (almost always on time) by the insurance carriers and have few complaints. The issue from the physician perspective has zero to do with the insurance providers.

It has to do with the fact that Washington continues to lower the Medicare reimbursement fee schedule. All contracts with insurance carriers are based on a percent of Medicare (typically 125-140% of Medicare). As that number continues a somewhat shockingly steep decline from year to year, the reimbursements fall proportionally. That's where the doc's get into pain. Just keeping you straight :wink:
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