Obama Care

saden1 · 11-11-2009, 01:11 AM

Quote:

Originally Posted by JoeRedskin

By increasing demand for Physicians but not increasing their supply, the cost to use them will increase. As costs increase, people will be forced to buy less coverage. Some will make sacrifices to maintain the same coverage, others will not be able to. Several weeks ago, you posted a link demonstrating the upcoming Dr. shortages. Do you expect fewer doctors to provide more services for less money?

Sure, you can keep what you have, but, as costs increase due to increased demand, fewer and fewer people will be able to keep what they have. Do you expect costs to stay the same even though you are increasing demand by at least 10-15% without increasing the supply? Do you believe premiums for private insurance will not increase? If not, why not? If so, do you believe that rising costs won't force many families into poorer coverage?

As for the public option, 1) If it offers competitive pricing to private insurers, it will eventually drive out these companies as it has an innate market advantage of not needing to be profitable. It can offer the same services, lose money and still draw from the public teat; 2) If it is not competitive and truly an insurer of last resort with a bare bones package, only those who are absolutely uninsurable, and thus the most costly to insure, will purchase it and, as they inevitably cost more to insure - and, of course, the horror stories of insufficient coverage will continue.

Your assumption is that we're already at 100% capacity utilization of our health-care system and those 47 million new patients will utilize the capacity all at once. I don't believe this to be the case across the country. Furthermore you aught to be familiar with H. Res 903, which allocated 100 million dollar annual grant to organizations/institutions to develop medical schools in areas experiencing medical professionals shortage, was passed along with the Healthcare Bill (note that all your boys voted against it).

There's also the expectation on your part of perfection from this bill which I think is ludicrous. You also seem to completely ignore the law of demand. Revamping the healthcare system is an incremental process and there's lots of good stuff in the bill and the kinks will get worked out. You can have a doom and gloom attitude but I don't think the substance of this bill warrants it.

I have no love for the insurance industry. Frankly they're going to reap what the sawed. They need to compete with the government and if they can't then their business model is dated. Honestly, I can not muster the emotion required to feel sorry for them or care for their wellbeing, kinda like how I don't give a shit what happens to a child molesters in prison.

p.s. Those of you that complain about the number of pages in the bill but can't be bothered to read it you're in no position to complain about it. Well, you can but you'd sound, like, kinda like, umm, you know, dumb.

JoeRedskin · 11-16-2009, 03:46 PM

Quote:

Originally Posted by saden1

Your assumption is that we're already at 100% capacity utilization of our health-care system and those 47 million new patients will utilize the capacity all at once. I don't believe this to be the case across the country. Furthermore you aught to be familiar with H. Res 903, which allocated 100 million dollar annual grant to organizations/institutions to develop medical schools in areas experiencing medical professionals shortage, was passed along with the Healthcare Bill (note that all your boys voted against it).

If there will be no increase in demand for health care services, then why was this bill needed? Isn't the presumption that demand for HC outstripped its supply so we needed to artificially mandate supply?

My assumption is that we are already experiencing a shortage of medical providers that will be excerbated as fewer doctors enter the system (again, per your own earlier citation - and a couple of my own: http://www.nytimes.com/2009/04/27/he...e.html?_r=2&em; http://www.reuters.com/article/reute...6M14E20090723). At the same time, the same system is expected to provide care to more individuals. Based on these two events: generally, an increase in the demand for services and, generally, no increase in the supply of providers, I assert that physicians will charge more for there services in conjunction with the law of supply and demand (Supply and demand - Wikipedia, the free encyclopedia - which, by the way, incorporates your "Law of Demand", but see my discussion below).

Will the additional incentives assist in creating appropriate supply? Perhaps. That is one I just don't know the stats for and would be very suspect of anyone claiming that they did as it is simply speculative. Further, to be clear, I believe the physician shortage to be only one basis for the increased premiums (and thus decreased care) we should all expect w/in the next 4-8 years.

As for "my boys", let's get something straight - I don't believe any one was "my boy" in this past debate b/c no one exhibited real leadership and said "There are no sacred cows." Pharmaceuticals, Malpractice Lawyers and Insurance Companies have too much money to be ignored and were essentially untouched in this litigation. Only someone with political charisma and leadership could have pulled off real reform. No one - Republican or Democrat demonstrated this leadership.

Quote:

Originally Posted by saden1

There's also the expectation on your part of perfection from this bill which I think is ludicrous. You also seem to completely ignore the law of demand. Revamping the healthcare system is an incremental process and there's lots of good stuff in the bill and the kinks will get worked out. You can have a doom and gloom attitude but I don't think the substance of this bill warrants it.

1. I did not expect perfection. I expected reform. This bill is not reform, it is a mandatory expansion of the existing system. A system that was market challenged from its inception and has become more so in the last 20 years with the growth of HMO's, medical malpractice litigation, and the increased expectation of full coverage from employer based insurance. You cannot "incrementally" untie Gordian's Knot and this bill does not even begin to do so.

2. I do not see how my assertion that increasing the number of insureds will cause a rise in cost ignores the "Law of Demand", please enlighten me. I assert that demand will increase due to the mandatory expansion of insureds, because of increased demand, costs will rise. As costs rise, people will be forced to pay more for their current coverage or choose a lesser coverage. Where am I ignoring the Law of Demand and how?

As people are forced to purchase lesser coverages, will demand decrease and thus, again, force prices down? Possibly - However, I believe it is more likely that the "incremental legislative" approach will cause legislative changes to the minimal coverage provide by the Public Option ("There are too many under insureds, the Govt. needs to ensure a better base coverage"). As more services are legislatively mandated, demand is artificially inflated and costs again rise, etc., etc. As insurers are unable to create profitable pools because they must provide unprofitable coverages under the expanded "basic" services, fewer insurers will opt for that market and only the very wealthy will be able to afford the rich coverage provided to the vast majority of current insureds.

Quote:

Originally Posted by saden1

I have no love for the insurance industry. Frankly they're going to reap what the sawed. They need to compete with the government and if they can't then their business model is dated. Honestly, I can not muster the emotion required to feel sorry for them or care for their wellbeing, kinda like how I don't give a shit what happens to a child molesters in prison.

Neither do I. It is why I advocate reform, not expansion, of the current system. Insurers have a very simple business plan - collect as much as you can in premiums, pay out as little as possible in HC costs. Obviously, this plan is in direct conflict with the consumer purchasing insurance who would like the reverse to be true.

Unlike a standard arms length agreement, and due to pooling, however, the insurers have a distinct advantage inherent to the product being sold. We need them, they do not need any one of us. Hell, they don't really need any small group of us. Further, we need several of them so that no one of them can set the market.

On one hand, the Public Option addresses this inherent market flaw - individually, we no longer need them - "You cost too much, I will go to the Public Option". On the other hand, and at odds with this, however, the Public Option addresses the second need only if it ensures the insurers continued existence which it can only do by offering an inherently uncompetitive product. If it does not ensure the continued existence of insurance companies, the Public Option becomes the only option and the already flawed system becomes completely divorced from the market process. Once that occurs, a government entity, unconcerned with profitability, determines what services will be provided at what cost. You apparently trust such a system to be relatively cost efficient and sufficiently consumer friendly. I do not.

As for private companies competing with the govt., to me that is a ludicrous statement. In light of the surcharge and tax support, the Public Option is essentially given 50 yard head start in a 100 yard dash. What's your business? If your competitor receives an anually subsidy of 100M from the Govt. and you receive nothing, do you think your company could devise a plan that would compete with that? Or would it be driven into bankruptcy as, even at its most efficient, it can't generate 100M in cost cutting to remain competive?

Real reform would have attacked the market dichotomy presented by the current employer insurance based system, addressed the anti-market effects of pharmaceuticals R&D development/production costs, and the rising costs of malpractice (all the costs - litigation, premiums, excessive defensive medicine, etc.).

No one, not the President, not the Democrats, not the Republicans offered real HC reform with long term sustainability. Rather, the Dems & Obama protected the sacred cows and simply expanded the current system, costs be damned, and the Republicans adopted an opposition stance that simply said "No - Do Nothing". As I said earlier, each side has guilt and this act represents a massive fail for the people of America. We were ill-served.

Real leadership was needed. None was demonstrated.

12thMan · 11-16-2009, 06:12 PM

Quote:

Originally Posted by JoeRedskin

If there will be no increase in demand for health care services, then why was this bill needed? Isn't the presumption that demand for HC outstripped its supply so we needed to artificially mandate supply?

My assumption is that we are already experiencing a shortage of medical providers that will be excerbated as fewer doctors enter the system (again, per your own earlier citation - and a couple of my own: http://www.nytimes.com/2009/04/27/he...e.html?_r=2&em; http://www.reuters.com/article/reute...6M14E20090723). At the same time, the same system is expected to provide care to more individuals. Based on these two events: generally, an increase in the demand for services and, generally, no increase in the supply of providers, I assert that physicians will charge more for there services in conjunction with the law of supply and demand (Supply and demand - Wikipedia, the free encyclopedia - which, by the way, incorporates your "Law of Demand", but see my discussion below).

Will the additional incentives assist in creating appropriate supply? Perhaps. That is one I just don't know the stats for and would be very suspect of anyone claiming that they did as it is simply speculative. Further, to be clear, I believe the physician shortage to be only one basis for the increased premiums (and thus decreased care) we should all expect w/in the next 4-8 years.

As for "my boys", let's get something straight - I don't believe any one was "my boy" in this past debate b/c no one exhibited real leadership and said "There are no sacred cows." Pharmaceuticals, Malpractice Lawyers and Insurance Companies have too much money to be ignored and were essentially untouched in this litigation. Only someone with political charisma and leadership could have pulled off real reform. No one - Republican or Democrat demonstrated this leadership.

1. I did not expect perfection. I expected reform. This bill is not reform, it is a mandatory expansion of the existing system. A system that was market challenged from its inception and has become more so in the last 20 years with the growth of HMO's, medical malpractice litigation, and the increased expectation of full coverage from employer based insurance. You cannot "incrementally" untie Gordian's Knot and this bill does not even begin to do so.

2. I do not see how my assertion that increasing the number of insureds will cause a rise in cost ignores the "Law of Demand", please enlighten me. I assert that demand will increase due to the mandatory expansion of insureds, because of increased demand, costs will rise. As costs rise, people will be forced to pay more for their current coverage or choose a lesser coverage. Where am I ignoring the Law of Demand and how?

As people are forced to purchase lesser coverages, will demand decrease and thus, again, force prices down? Possibly - However, I believe it is more likely that the "incremental legislative" approach will cause legislative changes to the minimal coverage provide by the Public Option ("There are too many under insureds, the Govt. needs to ensure a better base coverage"). As more services are legislatively mandated, demand is artificially inflated and costs again rise, etc., etc. As insurers are unable to create profitable pools because they must provide unprofitable coverages under the expanded "basic" services, fewer insurers will opt for that market and only the very wealthy will be able to afford the rich coverage provided to the vast majority of current insureds.

Neither do I. It is why I advocate reform, not expansion, of the current system. Insurers have a very simple business plan - collect as much as you can in premiums, pay out as little as possible in HC costs. Obviously, this plan is in direct conflict with the consumer purchasing insurance who would like the reverse to be true.

Unlike a standard arms length agreement, and due to pooling, however, the insurers have a distinct advantage inherent to the product being sold. We need them, they do not need any one of us. Hell, they don't really need any small group of us. Further, we need several of them so that no one of them can set the market.

On one hand, the Public Option addresses this inherent market flaw - individually, we no longer need them - "You cost too much, I will go to the Public Option". On the other hand, and at odds with this, however, the Public Option addresses the second need only if it ensures the insurers continued existence which it can only do by offering an inherently uncompetitive product. If it does not ensure the continued existence of insurance companies, the Public Option becomes the only option and the already flawed system becomes completely divorced from the market process. Once that occurs, a government entity, unconcerned with profitability, determines what services will be provided at what cost. You apparently trust such a system to be relatively cost efficient and sufficiently consumer friendly. I do not.

As for private companies competing with the govt., to me that is a ludicrous statement. In light of the surcharge and tax support, the Public Option is essentially given 50 yard head start in a 100 yard dash. What's your business? If your competitor receives an anually subsidy of 100M from the Govt. and you receive nothing, do you think your company could devise a plan that would compete with that? Or would it be driven into bankruptcy as, even at its most efficient, it can't generate 100M in cost cutting to remain competive?

Real reform would have attacked the market dichotomy presented by the current employer insurance based system, addressed the anti-market effects of pharmaceuticals R&D development/production costs, and the rising costs of malpractice (all the costs - litigation, premiums, excessive defensive medicine, etc.).

No one, not the President, not the Democrats, not the Republicans offered real HC reform with long term sustainability. Rather, the Dems & Obama protected the sacred cows and simply expanded the current system, costs be damned, and the Republicans adopted an opposition stance that simply said "No - Do Nothing". As I said earlier, each side has guilt and this act represents a massive fail for the people of America. We were ill-served.

Real leadership was needed. None was demonstrated.

Your analysis is pretty exhaustive, if not exhausting

I just wanted point out, if it hasn't been already, that the public option will initially be funded with $2 billion government money to cover initial costs and claims. This is expected to be paid back over a ten year period. Then the operation becomes a self-sustaining entity paid for with premiums by those who want coverage just like any other insurance company. So in that regard, there's no unfair advantage.

Trample the Elderly · 11-16-2009, 06:44 PM

Quote:

Originally Posted by 12thMan

Your analysis is pretty exhaustive, if not exhausting

I just wanted point out, if it hasn't been already, that the public option will initially be funded with $2 billion government money to cover initial costs and claims. This is expected to be paid back over a ten year period. Then the operation becomes a self-sustaining entity paid for with premiums by those who want coverage just like any other insurance company. So in that regard, there's no unfair advantage.

You bought that?