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Tags health care issues , health care reform , health insurance issues , health insurance reform

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Old 10th October 2011, 10:51 AM   #401
BenBurch
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So what? Corporation is just a way to group together a collection of properties, rights, and responsibilities into a package that can be addressed by law in a uniform way.
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Old 10th October 2011, 11:11 AM   #402
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Originally Posted by BenBurch View Post
So what? Corporation is just a way to group together a collection of properties, rights, and responsibilities into a package that can be addressed by law in a uniform way.
Right. Let's move on.
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Old 10th October 2011, 01:41 PM   #403
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Originally Posted by Drachasor View Post
Also, here's two links you missed:
Good catch. I liked that Urban Institute paper:...
Originally Posted by page 6,7
Quality of care for certain acute conditions
Studies of diverse conditions ranging from heart disease, hip fracture and vision impairment also are mixed in terms of their findings as to how U.S. quality compares to that of other countries.
...higher rates of invasive and revascularization procedures in United States and Brazil were associated with lower rates of refractory angina or readmission for unstable angina, no apparent reduction in cardiovascular death or myocardial infarction, but higher rates of stroke. ...
short-term, but not long-term, cardiac outcomes were better in the United States than Ontario.
..inpatient hip fracture mortality was higher in Canada (Manitoba and Quebec) than in the United States (California and Massachusetts). Canadians had longer waits for surgery, ...
The United States had fewer adverse intra-operative events than the other three sites studied but, along with Manitoba, had higher rates of early postoperative events.
Quality of cancer care
the United States as one of several world leaders in providing high-quality cancer care.
...The United States had the highest survival rates for cancer of the colon, rectum, lung, breast, and prostate. U.S. survival rates were also among the highest for melanoma (fourth), uterine (second) and ovarian (fifth) cancer, cervical cancer (sixth), Hodgkins disease (third) and non-Hodgkins lymphoma (fourth).
The study also looked at cross-country differences by population group, finding that survival rates for colon, breast and uterine cancer were similar in the United States and Europe for patients under 45 years, but were much better in the United States for patients age 65 or older at diagnosis. In the case of stomach cancer, the U.S. survival rate for patients under age 45 was below those of many European nations, but similar among the older patients....
... U.S. survival rates for certain cancers, particularly prostate cancer, are among the best. Among 30 OECD countries, the United States had one of the best five-year survival rates for patients with breast or colorectal cancer.27 There is an important link between survival rates and screening rates for many cancers (e.g., melanoma, prostate cancer, breast cancer, colorectal cancer). Many cancers are more amenable to treatment when caught early. But it is also true that in countries with higher screening, more cancers will be diagnosed early, and survival rates in those countries will be higher simply because there are more patients in the denominator with less advanced disease. Thus, Gatta et al.28 found that those countries with the highest breast cancer incidence rate (share of population newly diagnosed with the disease in a given year) also had the highest survival rates. Differing national commitments to screening becomes an issue, particularly, in the case of prostate cancer, where U.S. incidence rates are double those of Europe because aggressive screening uncovers cancers at a very early stage.
Differences across countries in access to diagnostic and treatment services explain most of the observed differences in cancer survival rates.30 Better survival rates are associated with higher national income levels, higher levels of expenditure on health, and higher investment in health technology, as proxied by indicators such as the rate of CT scanners per person.
Note that Drachasor has argued that a socialized system would not waste money on those expensive CT scanners.
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Old 10th October 2011, 01:47 PM   #404
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Originally Posted by Malcolm Kirkpatrick View Post
..Note that Drachasor has argued that a socialized system would not waste money on those expensive CT scanners.
that is a gross misinterpretation of drachasor's position.
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Old 10th October 2011, 04:25 PM   #405
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Originally Posted by bikerdruid View Post
Originally Posted by Malcolm Kirkpatrick View Post
Good catch. I liked that Urban Institute paper:...
Quote:
...Differences across countries in access to diagnostic and treatment services explain most of the observed differences in cancer survival rates.30 Better survival rates are associated with higher national income levels, higher levels of expenditure on health, and higher investment in health technology, as proxied by indicators such as the rate of CT scanners per person.
Note that Drachasor has argued that a socialized system would not waste money on those expensive CT scanners.
that is a gross misinterpretation of drachasor's position.
Please explain. What do you understand to be Drachasor's position on CT scanners and other expensive diagnostic machinery (MRI, PET scaners, etc.)?
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Old 10th October 2011, 04:29 PM   #406
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Originally Posted by Malcolm Kirkpatrick View Post
Please explain. What do you understand to be Drachasor's position on CT scanners and other expensive diagnostic machinery (MRI, PET scaners, etc.)?
you have been arguing with him.
if you are unsure of his position, perhaps you should ask him, rather than misrepresent it.
btw...countries that have socialized medicine also utilize expensive diagnostics.
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Old 10th October 2011, 04:36 PM   #407
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Originally Posted by Malcolm Kirkpatrick View Post
Please explain. What do you understand to be Drachasor's position on CT scanners and other expensive diagnostic machinery (MRI, PET scaners, etc.)?
I explicitly said MRIs, because MRIs are more expensive and in the vast majority of cases do not provide any better information than cheaper scanning technologies. There's no need to buy a whole bunch if cheaper technologies will do. That said, I admit that Japan manages to do pretty well with its system despite a large number of MRIs, so it isn't wholly unfeasible. Certainly, the point of what you were talking about is that aggressive preventative medicine can stop problems before they become very expensive.

As for the rest of what you said, you are cherry picking as usual. You ignore the overall conclusion of the studies in order to point at the extremely small number of areas where the US is SLIGHTLY better. Then you ignore everything else, such as the fact Europe has fewer incidences of prostate cancer (meaning marginally better survival rates in the USA don't count for much).

You then say things like the above, where you act like they are doing something very expensive, when it is blatantly the case that their medical care costs a LOT less than ours.

All this causes you to draw conclusions that contradict the evidence in a vain attempt to show that the US system is somehow superior, when study after study shows it to be more expensive and less effective (with only very slight exceptions).

Let me ask you a question here. Would you support socialized medicine if you knew for a fact that it was cheaper and more effective? Or would you still be against it?

Last edited by Drachasor; 10th October 2011 at 04:42 PM.
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Old 11th October 2011, 04:04 AM   #408
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Originally Posted by bikerdruid View Post
Originally Posted by Malcolm Kirkpatrick View Post
Originally Posted by bikerdruid View Post
Originally Posted by Malcolm Kirkpatrick View Post
...Note that Drachasor has argued that a socialized system would not waste money on those expensive CT scanners.
that is a gross misinterpretation of drachasor's position.
Please explain. What do you understand to be Drachasor's position on CT scanners and other expensive diagnostic machinery (MRI, PET scaners, etc.)?
you have been arguing with him.
if you are unsure of his position, perhaps you should ask him, rather than misrepresent it.
Druid made the claim of "misrepresentation", so I ask Druid: "where do you (Druid, not Drachasor), see "misrepresentation"?
I sense another...
Originally Posted by bikerdruid View Post
whatever....
...moment coming.

Last edited by Malcolm Kirkpatrick; 11th October 2011 at 04:06 AM. Reason: typo: "."=>"?".
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Old 11th October 2011, 08:51 AM   #409
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Originally Posted by Malcolm Kirkpatrick View Post
Druid made the claim of "misrepresentation", so I ask Druid: "where do you (Druid, not Drachasor), see "misrepresentation"?
I sense another......moment coming.
speaking of gross misrepresentations.......
is it not possible for you to present your position honestly?
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Old 11th October 2011, 08:59 AM   #410
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I think the argument is 'Socialized Medicine is bad because socialism is evil, thus, people should die if they cannot afford insurance or medical care.'
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Old 11th October 2011, 09:52 AM   #411
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Originally Posted by bikerdruid View Post
speaking of gross misrepresentations.......
is it not possible for you to present your position honestly?
Is it possible for Druid to make an argument out of anything but insults and inuendo? Show us. What does Druid understand Drachasor's position to be on acquisition of expensive diagnostic machinery and where have I "misrepresented" that position?
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Old 11th October 2011, 10:04 AM   #412
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Originally Posted by Malcolm Kirkpatrick View Post
Is it possible for Druid to make an argument out of anything but insults and inuendo? Show us. What does Druid understand Drachasor's position to be on acquisition of expensive diagnostic machinery and where have I "misrepresented" that position?
http://www.internationalskeptics.com...&postcount=407
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Old 11th October 2011, 10:04 AM   #413
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Originally Posted by Malcolm Kirkpatrick View Post
Is it possible for Druid to make an argument out of anything but insults and inuendo? Show us. What does Druid understand Drachasor's position to be on acquisition of expensive diagnostic machinery and where have I "misrepresented" that position?
Again, it is overacquisition. Note that the website there concludes there might be a scarcity, but the studies that I provided, and you yourself have quoted, show that is not the case in regards to scan. In fact, with fewer machines other countries scan still can more aggressively.

Last edited by Drachasor; 11th October 2011 at 10:05 AM.
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Old 11th October 2011, 12:22 PM   #414
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Originally Posted by Shalamar View Post
I think the argument is 'Socialized Medicine is bad because socialism is evil, thus, people should die if they cannot afford insurance or medical care.'
You clearly have not been paying attention.
Originally Posted by Malcolm Kirkpatrick View Post
Here.
(Malcolm): "Health care (other than traditional 'public health' services like vector control and pollution control) is not the State's business. The taxpayers of one medium-sized US State could provide health care for everyone on the planet if "health care" means one aspirin tablet and one bandaid per person per year. The world's GDP is insufficient to keep even one person alive forever. You are going to die. Most of us, before we die, will get sick. Inevitably, for each person, someone decides if X additional days of life is worth $Y more dollars in treatment costs. In any system, for every person, the answer will be 'no', eventually."

Originally Posted by Malcolm Kirkpatrick View Post
Here.
(Malcolm): "Try this:..."
Eduardo Zambrano
Formal Models of Authority: Introduction and Political Economy
Applications
Rationality and Society, May 1999; 11: 115 - 138.
Quote:
Aside from the important issue of how it is that a ruler may economize on communication, contracting and coercion costs, this leads to an interpretation of the state that cannot be contractarian in nature: citizens would not empower a ruler to solve collective action problems in any of the models discussed, for the ruler would always be redundant and costly. The results support a view of the state that is eminently predatory, (the ? MK.) case in which whether the collective actions problems are solved by the state or not depends on upon whether this is consistent with the objectives and opportunities of those with the (natural) monopoly of violence in society. This conclusion is also reached in a model of a predatory state by Moselle and Polak (1997). How the theory of economic policy changes in light of this interpretation is an important question left for further work.
(Malcolm): "The problem with the 'public goods' argument for State (government, generally) provision of charity (medical care, education, welfare) is that oversight of corporate functions is a public good and the State itself is a corporation. Therefore, oversight of State functions is a public good which the State itself cannot provide. State assumption of responsibility for the provision of public goods transforms the free rider problem at the root of public goods analysis but does not eliminate it."

Originally Posted by Malcolm Kirkpatrick View Post
Here
(Malcolm): "...Everybody dies...a policy which leaves medical decisionmaking to patients and physicians and which leaves insurance decisions to customers and actuaries will outperform a policy which displaces voluntary arrangements in a competitive market for a State-monopoly system. "
Originally Posted by Malcolm Kirkpatrick View Post
Here.
(Malcolm): "Two questions:...
I. From State control (or subsidization) of what industries does society as a whole benefit? You may imagine either a dichotomous classification: A={x:x is an unlikely candidate for State control}, B={x:x is a likely candidate for State operation} or a continuum:...
(highly unlikely) -1______.______+1 (highly likely).
II. What considerations determine an industry's classification or position on the continuum?

Devout Marxists will put every industry in B. Devout Libertarians will put every industry in A. To most of us, most industries fall somewhere in between, with "control" being itself a continuum, defined by the degree of regulation. I suggest that an industry's classification or position on the continuum depends upon the degree to which the industry exhibits economies of scale and the relative contributions which detailed local knowledge and general expertise make to performance.

Seems to me both the education industry and the medical treatment industry are highly unlikely candidates for State (government, generally) control.
"

Originally Posted by Malcolm Kirkpatrick View Post
Originally Posted by Drachasor View Post
Originally Posted by Malcolm Kirkpatrick View Post
"Profit" is a bookkeeping term: the difference between total costs and total revenues. An organization which has no line in its balance sheet for "profit" must attribute all revenues to costs. This says nothing about the motives of the people in that organization. Doctors can be greedy and crooked. Patients may become complicit in fraud by physicians.
Motives matter, and profit as a prime motivating force in health care objectively doesn't work well. At least if you compare America's system to any other first world country. The profit motive makes health care cost more and cover less and provides zero advantages.
We disagree.
Joel Fried
Pots and Kettles: Governance Practices of the Ontario Securities Commission
Quote:
2. The Government’s Principal – Agent Problem
The principal-agent problem for the private sector is well known: the owner/principal delegates to a manager/agent the responsibility to provide some services for the principal.
The problem is one of structuring contracts and institutions to insure that, in carrying out her duties, the agent acts in the principal’s interest rather than her own.
Citizens of a country also face a principal – agent problem. Citizens “own” the machinery of government and employ bureaucrats to act as their agents in running this machinery. To reduce the costs of monitoring, the principals choose a legislature/board of directors to oversee the agents. Monitoring mechanisms are similar to those in the private sector: there are financial accounting standards that are met for each budgetary unit, and an external auditor checks these internal accounts. Transparency is maintained, in part, through freedom of information regulations. Compliance with procedures and other regulations are met both through internal monitoring and checks by units external to the bureau. Finally, contracts are structured, at least in a limited manner, to align the incentives for agents with those of the principals.
There is, however, an additional problem in the public sector that does not exist for private firms. The firm has a well defined objective function – the maximization of profits – whereas the apparent objective for the government is the maximization of some index of a (weighted) level of welfare of the electorate. An unambiguous index of social welfare has been impossible to construct and, in its absence, monitoring the public sector is further complicated because data is generally lacking on whether or not the objective was actually approached and/or achieved and what the costs are that are linked to any specific objective. In effect, because of distribution issues and public goods, the cash flows measured with traditional accounting procedures will be, at best, only superficially correlated with that objective. Thus, looking at cash flows will provide the principals an extremely poor method of monitoring their public sector agents.
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Old 11th October 2011, 12:46 PM   #415
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Originally Posted by Drachasor View Post
Let me ask you a question here. Would you support socialized medicine if you knew for a fact that it was cheaper and more effective? Or would you still be against it?
Let me ask you a question here: would you convert to Islam if you knew for a fact that Allah was the One True God and Mohammed (pbuh) was his Prophet?
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Old 11th October 2011, 01:06 PM   #416
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Originally Posted by Drachasor View Post
I explicitly said MRIs, because MRIs are more expensive and in the vast majority of cases do not provide any better information than cheaper scanning technologies.
Not according to this.
Originally Posted by Drachasor View Post
Again, it is overacquisition. Note that the website there concludes there might be a scarcity, but the studies that I provided, and you yourself have quoted, show that is not the case in regards to scan.
Ummm...Drachasor provided a link to this Urban Institute study:...
Quote:
Quality of cancer care
the United States as one of several world leaders in providing high-quality cancer care.
...The United States had the highest survival rates for cancer of the colon, rectum, lung, breast, and prostate. U.S. survival rates were also among the highest for melanoma (fourth), uterine (second) and ovarian (fifth) cancer, cervical cancer (sixth), Hodgkins disease (third) and non-Hodgkins lymphoma (fourth)...There is an important link between survival rates and screening rates for many cancers (e.g., melanoma, prostate cancer, breast cancer, colorectal cancer). Many cancers are more amenable to treatment when caught early. But it is also true that in countries with higher screening, more cancers will be diagnosed early, and survival rates in those countries will be higher simply because there are more patients in the denominator with less advanced disease...Better survival rates are associated with higher national income levels, higher levels of expenditure on health, and higher investment in health technology, as proxied by indicators such as the rate of CT scanners per person.
CAT machine cost
Quote:
A basic MDCT scanner (6 or 8 detector rows) costs about 2 to 2.5 crore rupees here in India (INR 20 to 25 million = US $ 500,000 to 630,000). I learnt from a source in the industry that the cost of the scanner is about 40% subsidized for the Indian market (compared to its cost in the North American & European markets). So the same basic multislice CT scanner would cost about $ 900,000 in the US.
MRI machine cost
Quote:
MRI's are expensive because of the price of the equipment. With the average MRI machine costing over $1 million dollars they have to charge enough per test to cover the expense of the machine.

Last edited by Malcolm Kirkpatrick; 11th October 2011 at 01:32 PM. Reason: Delete " In fact, with fewer machines other countries scan still can more aggressively."
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Old 11th October 2011, 02:33 PM   #417
Shalamar
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Originally Posted by Malcolm Kirkpatrick View Post
You clearly have not been paying attention.

(Malcolm): "Health care (other than traditional 'public health' services like vector control and pollution control) is not the State's business. The taxpayers of one medium-sized US State could provide health care for everyone on the planet if "health care" means one aspirin tablet and one bandaid per person per year. The world's GDP is insufficient to keep even one person alive forever. You are going to die. Most of us, before we die, will get sick. Inevitably, for each person, someone decides if X additional days of life is worth $Y more dollars in treatment costs. In any system, for every person, the answer will be 'no', eventually."


(Malcolm): "Try this:..."
Eduardo Zambrano
Formal Models of Authority: Introduction and Political Economy
Applications
Rationality and Society, May 1999; 11: 115 - 138.
(Malcolm): "The problem with the 'public goods' argument for State (government, generally) provision of charity (medical care, education, welfare) is that oversight of corporate functions is a public good and the State itself is a corporation. Therefore, oversight of State functions is a public good which the State itself cannot provide. State assumption of responsibility for the provision of public goods transforms the free rider problem at the root of public goods analysis but does not eliminate it."


(Malcolm): "...Everybody dies...a policy which leaves medical decisionmaking to patients and physicians and which leaves insurance decisions to customers and actuaries will outperform a policy which displaces voluntary arrangements in a competitive market for a State-monopoly system. "

(Malcolm): "Two questions:...
I. From State control (or subsidization) of what industries does society as a whole benefit? You may imagine either a dichotomous classification: A={x:x is an unlikely candidate for State control}, B={x:x is a likely candidate for State operation} or a continuum:...
(highly unlikely) -1______.______+1 (highly likely).
II. What considerations determine an industry's classification or position on the continuum?

Devout Marxists will put every industry in B. Devout Libertarians will put every industry in A. To most of us, most industries fall somewhere in between, with "control" being itself a continuum, defined by the degree of regulation. I suggest that an industry's classification or position on the continuum depends upon the degree to which the industry exhibits economies of scale and the relative contributions which detailed local knowledge and general expertise make to performance.

Seems to me both the education industry and the medical treatment industry are highly unlikely candidates for State (government, generally) control.
"
Yes. You are claiming that Socialized Medicine is evil. The system being used in the US right now, does not work. It is bloated, it is expensive, and leaves those with little ability to pay with even fewer ways to get treatment for treatable diseases.

It results in hospitals not getting paid for services, which drives up costs for those of us who do pay. And the for profit insurance system is encouraged to not pay for needed treatment so they can make even more money.

It only works if you have the money to pay for everything yourself.
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Old 11th October 2011, 02:44 PM   #418
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Here's a link I found that states part of the problem with hospitals in the past couple years:

http://www.ama-assn.org/amednews/200...6/bisb0126.htm

Hospitals are laying people off, support staff, and doctors both. While there are a number of factors in the reasons, a big one is that in a recession, people lose jobs. They lose insurance, but they don't stop getting sick.

So either they a: don't go the hospital. Or b: They do go to the hospital, but cannot pay for services. Costs of services go up, or people get laid off.

In pretty much every other first world country on this planet, people have insurance, provided by the government regardless of employment, and the hospital and doctors get paid.
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Old 11th October 2011, 03:55 PM   #419
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Originally Posted by Malcolm Kirkpatrick View Post
Not according to this
That link doesn't work.

Originally Posted by Malcolm Kirkpatrick View Post
.Ummm...Drachasor provided a link to this Urban Institute study:...
We already went over this. You yourself quoted how America has higher rates of these cancers to begin with, significantly so. That study also points out that America's "lead" is not even statistically significant compared to a number of other first world countries.

So we have more people getting those cancers and are not statistically better at treatment compared to same. Even the ones we are better with treatment, we still have more cancers to begin with, so they have fewer problems.

Originally Posted by Malcolm Kirkpatrick View Post
Yes, I should have included CAT machines in that. There are other ways of doing tests and imaging than just a CAT or MRI. We DO have too many (note, however, that generally CAT machines are significantly cheaper than MRIs, on average, but this isn't an essential point).

Like the link I posted says, we have too much of both. Like the section of a study I quoted earlier says, other countries still manage aggressive scanning and screening for cancers and other problems better than the USA despite significantly fewer scanners. We have more than is needed.

Originally Posted by Malcolm Kirkpatrick View Post
Let me ask you a question here: would you convert to Islam if you knew for a fact that Allah was the One True God and Mohammed (pbuh) was his Prophet?
Given that the idea of an all-good, all-powerful, all-knowing god is impossible due to things like earthquakes...I'd probably not follow such a god if I somehow could know one existed. I certainly wouldn't be servile to any entity...Islam is a lot of work and genuflecting.

Last edited by Drachasor; 11th October 2011 at 04:00 PM.
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Old 11th October 2011, 04:29 PM   #420
Malcolm Kirkpatrick
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Originally Posted by Drachasor View Post
Given that the idea of an all-good, all-powerful, all-knowing god is impossible due to things like earthquakes...I'd probably not follow such a god if I somehow could know one existed. I certainly wouldn't be servile to any entity...Islam is a lot of work and genuflecting.
That's how I feel about government.
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Old 11th October 2011, 07:48 PM   #421
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Originally Posted by Schrodinger's Cat View Post
This entire post is just so insulting and filled with strawmen. I.E. "boo hoo, work for another industry if you think yours is especially bad." Uh, yeah, never said that what we deal with was unique. I was only responding to your skepticism that denials exist.
Let me explain -that "strawmen argument" is when one MISCHARACTERIZES the opponent s argument then argues against the false characterization.

We were discussing legitimate and covered medical services covered by insurance that were not paid by the insurer. That is contract violations by the insurer. YOU falsely characterized the argument by citing cases where your institution rendered services without proper documentation and without medical necessity. That is NOT the topic under discussion.

In your rebuttal you strawman again claiming I suggested you change jobs if it was so bad ... I did no such thing. I clearly stated the YOU need broader perspective on you off-topic claims. It is common to not be paid unless you meet the contrctual requirements includng documentation and case condition. That you complain that your institute doesn't keep proper records and so doesn't get paid is off topic and shows an ignorance of common business practice.


Quote:
]My problem is not your skepticism. My problem is your skepticism is completely based on your personal experience and not on any actual knowledge about how the industry works. Again, that would be like me saying I am skeptical that domestic abuse exists because my husband never beats me. It's a impractical and self absorbed way to come to an opinion.
Why wouldn't anyone be skeptical of self-serving claims by people who want more than their contracts allow ? Again - my case is not the sole basis for skepticism, nor do we need a basis for skepticism. The complete lack of evidence that this is a regular pattern of contract violation is more than sufficient. Your domestic domestic abuse analogy fails. People have social reasons to hide abuse. No one has a social reason to hide that their insurance contract was violated.

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If an insurance doesn't agree with medical necessity, it's because we're too bad a hospital to prove it? ...
Your point is OFF-TOPIC. If your institution can't successfully meet the insurance contractual obligations (including paperwork and showing necessity) and can't make a strong enough case to win the contract point - then obviously you've failed to meet the contract terms. That is NOT what this is about.

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You keep saying we should sue the insurers. Sue them for what? They get to decide medical necessity, not us. Their medical directors have that authority ....
So now you claim that your institution is providing services without any contract ? That's ridiculous as a business model. It also prevents market forces from correcting insurers who would make bad decision egregiously.


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Now sure, there are times in which the patient can and does successfully sue the insurance company, but an insurance company saying it's not medically necessary when our MDs think it is is not in and of itself grounds for a lawsuit.
If a service is denied that is covered under contract then it's a contract violation and is actionable. Apparently you provide services without any contract - that's the problem.

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There are only certain kinds of policies that patients are allowed to sue by law for denied services. In many cases, the insurance only is required by law to let the patient appeal their denial. There is not a law requiring them to overturn the denial on appeal, only allowing the patient to appeal.
Of course an appeal can be denied - what part of that isn't clear and obvious to a child.

Binding 3rd party arbitration is a sort of conventional alternative to tort, but I don't understand your other claim about "can't sue". Please detail your point with evidence.

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For some types of insurance policies, there are actually laws on the books that disallow patients from suing if they are denied. What types of policies these apply to depend upon the state.
Please detail. these laws Evidence.

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But sure, Steve, you're right. The reason our sarcoma patient just got denied is because his oncologist, one of the top ranked specialists in the world, has no idea what he's doing and ....
Strawman - I never suggested the problem was medical competence - I clearly said your experts should be able to make the case for necessity, or else you shouldn't be performing non-emergency procedures without contractual agreement.

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On what do you base your belief that if an insurance says a service is not medically necessary and we can't sue them successfully, and the patient's doctor (or doctors) say it is, it is always the hospital who is wrong, and the insurance is always right on whether or not the treatment actually is medically necessary?
That was never my argument - strawman ? BTW you can still sue for breech of contract or bad faith compliance even if there is a conflict resolution clause.

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Now look, maybe you're fine with insurances having the decisions over whether or not something is medically necessary, rather than the patient's doctor - or in many cases, .....
I'm not completely happy with insurance, but I'm not some moron expecting more than a contract calls for (or doing business without a contract), and whining when I don't get it. Also - what's to prevent me paying when the insurance doesn't cover ? Of course your institution is busy billing insurers perhaps ~1/3 of the rate the bill the uninsured too - right ?

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I never claimed there was a pattern. I specifically stated that when compared to the amount of services that are approved, denials are definitely a small minority (at least to my knowledge). I never argued denials make up X% of services. Only that they exist.
You so far have failed to show that insurers fail to meet their contractual requirements except on in exceptional cases. Maybe people need to read and understand their insurance contracts(duh). If there is no pattern then all you are saying is that there are exceptional or extraordinary cases at issue, that's very believable. These exceptions are not a basis for making radical changes to the nations health care system.


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Did you not see my other post where I pointed out that Medicare and Medicaid are a big problem because they pay us far less than private insurers, and that I feel that universal healthcare would not work unless we developed a system with a higher compensation rate for government sponsored insurance. We do lose a lot of money on these patients. I specifically said that.
This goes to the MAIN point of the thread. I have read that ~13% of US physicians currently do not accept medicare assignment. The plan for Obamacare is to decrease payment amounts if funding is insufficient. I don't see this is a practical plan either, however once O'care destroys private insurance then you will have no choice but to take less. You won't be able to cost-shift onto insurance. So when your institution is underpaid by government plans - then who makes up the shortfall. Obviously you are passing the unpaid costs onto insured or the uninsured - right ? Isn't that a huge part of the problem - that the amount billed to insurance and the uninsured is already a market distortion due to government underpayment ? The amount billed vs the "negotiated amounts" are another vast market distortion.

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No, I said the opposite. I said denials are far outweighed by paid claims. Obviously if I am saying that health insurances typically do pay far more often than they deny, then on average we would not be losing money on claims. Do we lose a lot of money every year on denials? Sure. But on average, as I clearly stated, insurers do pay and we do not lose money on their claims.
So you charge everyone cost + a reasonable profit, and then you don't lose money when some bills aren't paid ..... nope - doesn't answer my question. WHO is the cost burden shifted to ? To insurance, I'll bet. Perhaps even some to some few of the uninsured who can pay. The important point here is that insurance is underwriting the cost of the government programs underpayments already. What happens when there are few privately insured ? Then obviously you can't continue to do procedures.

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All I said is that denials exist. That was the only point of my post, that denials exist, and I listed you examples of some reasons why denials happen.
Right - and my point has always been that the only denials of concern to me are the ones where the insurer violates their contract. If YOU don't have a contract agreement or YOU don't keep documentation - that's not a cause to blame insurers.

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Yeesh, that was a weird post, Steve. The majority of your arguments were not only against things I never said, and in fact, things I explicitly said were not true (i.e. me clearly saying that we typically do not lose money on private insurers, they usually do pay....and then ask if I'm really claiming that we lose money on average). Or claiming that I think this doesn't happen in other industries and that this is somehow a unique burden hospitals face.
I think you missed the points at several turns. I want to see evidence that either insurers are violating their contracts, or else I'll reject the whining about insuraners. Your arguments, that you don't have a contract and yet provide service on "hope", or that you don't keep documentation and dn't get paid is NOT an issue where we can blame the insurer. *IF* as you imply the insurer is really 'jerking you around' for paperwork, that's bad-faith contract compliance and you can sue.

Someone pays 100% for EVERY expense of your institution plus some profit or else you don''t exist. That's a fiscal fact. The question is, and remains, who pays for these denials and government underpayments you talk about ? Obviously the costs is shifted to other sources of income. Who is being overcharged to make up for the underpayments ? Then the next question is - how long does your institution last when the numbers of government under-payers increase and the insured over-payers decline ?

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I have very little respect for people who come to an opinion, even if it's just "I'm skeptical of this" based on a survey sample of one.
That your misunderstanding. Skepticism doesn't require any basis - it's a call for evidence. I'm still seeking evidence that there is any pattern of insurers violating their contract terms, and I don't see any so far. I might agree that people want more than their contracts call for, or that people don't bother to read their contracts - but that's a different topic too.


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Whar does cherry picking have to do with anything? That would imply I'm trying to make some claim other than denials exist. Here is my statement from post #260:
Cherry picking is selectively choosing data for a case, and asking someone who only handles claim-denials is a selection of evidence.

Last edited by stevea; 11th October 2011 at 08:15 PM.
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Old 15th October 2011, 11:09 PM   #422
oddball
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Originally Posted by Travis View Post
My dad got prostate cancer. It took several procedures but they eventually beat it and he's been cancer free since.

But the cost? $120,000

How is charity alone going to provide over a hundred grand to help one person live?
In the case of someone who can't pay, hospitals usually end up settling for about 10% of what they bill.
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Old 16th October 2011, 11:17 AM   #423
bikerdruid
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Originally Posted by oddball View Post
In the case of someone who can't pay, hospitals usually end up settling for about 10% of what they bill.
to a great many people, even 12000 bucks is a monumental amount of money.
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Old 16th October 2011, 01:11 PM   #424
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Originally Posted by bikerdruid View Post
to a great many people, even 12000 bucks is a monumental amount of money.
The original argument was that no charity would be able pay $120k. My response was to that statement.
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Old 16th October 2011, 01:14 PM   #425
bikerdruid
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Originally Posted by oddball View Post
The original argument was that no charity would be able pay $120k. My response was to that statement.
cool.
great avater, btw.
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