NYT article about Medicaid

tr_ wrote:
No, they aren't. In particular, Medicare has an administrative overhead of something like 2-5%, compared to the whopping 20-30% seen in the private insurance industry. This is because Medicare doesn't expend time, effort, and money trying to figure out how not to pay claims. It just pays the claim. Granted, it doesn't pay *enough* of the claim, but again, this is related to the fact that it carries the bulk of the high-cost patients while private insurance companies cherry-pick the cheap ones.

I've never had problems with insurance payments as a therapist. Medicare/aid I had the worst problems. When you talk about overhead, what exactly are you including? And do you realize that public programs in theory *should* have lower overheads because of taxpayer money?

I'm also curious where you got your overhead numbers. Some resources I'm finding also peg Medicare/aid with higher fraud amounts, and the majority of those costs are not because of the company, but because of patients and doctors engaged in fraudulent activity.

And yes, private insurance plans can pick who they insure, to a degree. It's called risk management. The whole idea behind insurance is to prepare you for catastrophe, not to start paying out immediately. That's not insurance.

No, the insurance business sucks because insurance is inherently a stupid way to handle a service that is needed by everyone. Insurance is based on risk pooling. It makes sense for fires and natural disasters. It does not make sense for health care.

sure it makes sense for health care. Especially for younger populations. Health care is not the sole responsibility of the gov't or an insurance company to provide. Your number one health care provider should be yourself with your diet, exercise, etc. Buying a policy for unforeseen illness is very appropriate. Otherwise, going to the doctor for your yearly or every other year checkup costs how much? And how much are people spending on luxury and excess in that year or 2? But that argument comes down to whether one considers healthcare a right or not, and I do not.

An unregulated insurance industry would simply go even farther in the current direction of improving profits by reducing product quality (i.e., refusing to insure the ill, and refusing to pay legitimate claims).

With what reasoning would this happen? What model do you have to base it on? The model I'm looking at is insurance provision in the last 40-50 years. And the way it looks to me is that the more it's been regulated and governed, the worse it's gotten.

However, there are 3 big examples of gov't healthcare programs that are failures: Medicare, Medicaid, Social Security. If they were such successes, we wouldn't be scrambling with meetings about the debt ceiling and having our president threaten our elderly that they're not going to receive their checks next month (while he and Congress would still get paid, of course).

I've never had problems with insurance payments as a therapist. Medicare/aid I had the worst problems.

That's fascinating. I've had the exact opposite experience. I find private insurers meddle endlessly in treatment decisions. I've never ever gotten a demand for prior authorization from Medicare.

When you talk about overhead, what exactly are you including? And do you realize that public programs in theory *should* have lower overheads because of taxpayer money?

No, why should they? Usually people make the opposite argument - that governmental administration results in bloated budgets.

I'm also curious where you got your overhead numbers.

Originally from an Op-Ed series by Paul Krugman some years ago, but before I posted I googled around and found corroboration from multiple sources.

And yes, private insurance plans can pick who they insure, to a degree. It's called risk management. The whole idea behind insurance is to prepare you for catastrophe, not to start paying out immediately. That's not insurance.

So it's okay with you if only healthy people, and not sick people, can get care?

Health care is not the sole responsibility of the gov't or an insurance company to provide. Your number one health care provider should be yourself with your diet, exercise, etc. Buying a policy for unforeseen illness is very appropriate. Otherwise, going to the doctor for your yearly or every other year checkup costs how much? And how much are people spending on luxury and excess in that year or 2? But that argument comes down to whether one considers healthcare a right or not, and I do not.

I don't think this is a philosophical matter, but a pragmatic one. It is to the benefit of all of us to live in a society where all members have their basic health care needs taken care of. If laissez-faire, fee-for-service healthcare were in practice to result in sufficiently low costs that everyone could afford basic care, I would be all for it. However if in practice it resulted in lots of people spreading measles and TB on public transport because they couldn't afford preventative care, I'd say we'd need another system.

I am against private insurance because in practice it has resulted in wasted resources, nonprovision of care, and bureaucratic interference with care that is provided by physicians. Not because of any theoretical position on health care as a right or not.

An unregulated insurance industry would simply go even farther in the current direction of improving profits by reducing product quality (i.e., refusing to insure the ill, and refusing to pay legitimate claims).

With what reasoning would this happen? What model do you have to base it on? The model I'm looking at is insurance provision in the last 40-50 years. And the way it looks to me is that the more it's been regulated and governed, the worse it's gotten.

On the fact that it is happening now, and that the government regulation is mostly aimed at preventing it from going even further in that direction. I think you've reversed the causality: the more insurance goes in the natural direction of improving profits at the expense of providing care, the more the government tries to rein in those tendencies. By what reasoning would you expect that getting rid of the regulation would suddenly cause the insurance companies to start implementing strategies that would improve health care at the cost of their own profit margin?

However, there are 3 big examples of gov't healthcare programs that are failures: Medicare, Medicaid, Social Security. If they were such successes, we wouldn't be scrambling with meetings about the debt ceiling and having our president threaten our elderly that they're not going to receive their checks next month (while he and Congress would still get paid, of course).

Again, when you try to apply an insurance model to health care, you end up with a lot of people who are too expensive to be profitable to private insurers. Those people end up on the government rolls. Obviously the system that is forced to take all the unprofitable patients is going to end up... unprofitable.

Gov't debt doubled during the Bush years, and I don't once recall most of that being attributable to the costs of sustaining medicare, medicaid, and SS. So unfortunately, it looks like we have another pathetic "Pee Baggers" theory at play here.

TR, you present a d*mn compelling argument that seems pretty useful for prepping for med school interviews. Thanks!

That's fascinating. I've had the exact opposite experience. I find private insurers meddle endlessly in treatment decisions. I've never ever gotten a demand for prior authorization from Medicare.

I always had to have prior authorization from the State of IL and Medicaid, my biggest payor sources. I'd say I billed insurance about 25% and gov't programs 75%.

No, why should they? Usually people make the opposite argument - that governmental administration results in bloated budgets.

In theory, gov't programs should be as cost-effective as possible, because it isn't private capital being placed for business, rather public tax dollars. Unfortunately, yes, gov't programs are bloated for a variety of reasons.

Originally from an Op-Ed series by Paul Krugman some years ago, but before I posted I googled around and found corroboration from multiple sources.

That's why I hadn't heard of it. Krugman is too biased for me to take seriously.

So it's okay with you if only healthy people, and not sick people, can get care?

That really doesn't have anything to do with what I stated. As it stands, the really sick have emergent care available despite payor source. The indigent have Medicaid.

I don't think this is a philosophical matter, but a pragmatic one. It is to the benefit of all of us to live in a society where all members have their basic health care needs taken care of. If laissez-faire, fee-for-service healthcare were in practice to result in sufficiently low costs that everyone could afford basic care, I would be all for it. However if in practice it resulted in lots of people spreading measles and TB on public transport because they couldn't afford preventative care, I'd say we'd need another system.

I never said I was against public health in general, especially vaccines. I'm absolutely pro-vaccine. However, your position is also philosophy, and no matter how nice you present it, I don't want the gov't telling me how to live my life, taking my income (which is property) and distributing it to others vis a vis telling them how to live their lives.

I can give you examples of insurance plans that are very affordable, and cover more than Medicaid allows. Assurant health, BCBS have some, just to name a few. They cost less than a case of beer or a carton of cigs a week. Or a big screen TV...

I am against private insurance because in practice it has resulted in wasted resources, nonprovision of care, and bureaucratic interference with care that is provided by physicians. Not because of any theoretical position on health care as a right or not.

By this position, you should also be against any past and present gov't healthcare program as well. Nothing is more bloated, more bureaucratic, or wasteful than this.

On the fact that it is happening now, and that the government regulation is mostly aimed at preventing it from going even further in that direction. I think you've reversed the causality: the more insurance goes in the natural direction of improving profits at the expense of providing care, the more the government tries to rein in those tendencies. By what reasoning would you expect that getting rid of the regulation would suddenly cause the insurance companies to start implementing strategies that would improve health care at the cost of their own profit margin?

There would be more competition, especially from smaller companies that have been forced out of existence thanks to regulation. In addition, someone in CA could purchase a policy from even the same insurer in IL for a cheaper rate. Can't do that now.

Again, when you try to apply an insurance model to health care, you end up with a lot of people who are too expensive to be profitable to private insurers. Those people end up on the government rolls. Obviously the system that is forced to take all the unprofitable patients is going to end up... unprofitable.

Medicaid is not a bona fide insurance model. Taxes are compulsory for every taxpayer into this system. Not so for private insurance. People that end up on the gov't dole are growing, but not because of healthcare issues. More related to current failed economic issues.

I appreciate you taking the time to explore the different ideologies with me. I would like to hear more of your views, but I may not be able to check back in until later this week. I start my general surgery service tomorrow and I have no idea when I'm even going to sleep again LOL.

pathdr2b wrote: Gov't debt doubled during the Bush years, and I don't once recall most of that being attributable to the costs of sustaining medicare, medicaid, and SS. So unfortunately, it looks like we have another pathetic "Pee Baggers" theory at play here.

TR, you present a d*mn compelling argument that seems pretty useful for prepping for med school interviews. Thanks!

Thank you for that compelling, mature, adult description to your stance at play here :sleep: . Debt did go up under Bush, and I was quite vocal about him as well, but none moreso than under Obama, a convenient fact you ignore.

Back to the ignore list for you, since you are more about ad hominem than intelligence for topics you disagree with, as evidenced above.

megboo wrote: Thank you for that compelling, mature, adult description to your stance at play here :sleep: . Debt did go up under Bush, and I was quite vocal about him as well, but none moreso than under Obama, a convenient fact you ignore.

Back to the ignore list for you, since you are more about ad hominem than intelligence for topics you disagree with, as evidenced above.

ROTFLMBAO!!!!

Perhaps if Obama didn't have to spend so much cleaning up Bush's mess, you'd have NO argument at all, LOL!!!

As for the fact that Obama has spent more than Bush, my VERY visceral response is that I supported McCain, a fact I'm sure makes you crap your "Pee Party" pants.

Oh crap, you didn't read one line of that did you?