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Bloggingheads 06-21-2011 04:14 PM

Quality Control (Conn Carroll & Noah Kristula-Green)
 

Don Zeko 06-21-2011 04:33 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Conn, this is ridiculous. The Doc Fix situation was exactly the same before the ACA passed and would be exactly the same if it had not. It is absolutely not part of the cuts to Medicare included in the ACA and wasn't counted as a part of its savings. This also means that your assertion that the ACA's cuts come out of payments to physicians is essentially bullshit as well.

Don Zeko 06-21-2011 04:41 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Oh, and this is ridiculous too. Medicare already pays much less than private insurance, but plenty of doctors still see Medicare patients because Medicare's pay rates are still high enough to make treatment profitable and Medicare patients are an enormous market that doctors can't afford to leave sitting on the table. If everybody's coverage paid at Medicare's rates then doctors absolutely would not refuse to see you. If they did that, they'd have no patients. Instead, doctors would make less money and everybody else would spend less on health care. That stinks for doctors, but it's what medical cost control means: making the same care cheaper by making it somewhat less profitable to be a provider.

operative 06-21-2011 04:58 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213407)
Oh, and this is ridiculous too. Medicare already pays much less than private insurance, but plenty of doctors still see Medicare patients because Medicare's pay rates are still high enough to make treatment profitable and Medicare patients are an enormous market that doctors can't afford to leave sitting on the table. If everybody's coverage paid at Medicare's rates then doctors absolutely would not refuse to see you. If they did that, they'd have no patients. Instead, doctors would make less money and everybody else would spend less on health care. That stinks for doctors, but it's what medical cost control means: making the same care cheaper by making it somewhat less profitable to be a provider.

A growing number of doctors do not participate in Medicare due to the artificially low rates paid:
http://www.usatoday.com/news/washing...medicare_N.htm

If the government forced everyone into a statist, Medicare style model, many doctors would simply go into medical research and stop treating people. They may also consider moving abroad. If the state suddenly issued wage controls on my profession, I would move to a different country.

Don Zeko 06-21-2011 05:00 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by operative (Post 213408)
If the government forced everyone into a statist, Medicare style model, many doctors would simply go into medical research and stop treating people. They may also consider moving abroad. If the state suddenly issued wage controls on my profession, I would move to a different country.

Please, please tell me that you know the difference between the government changing the level at which it subsidizes a product and the government instituting wage controls on the providers of that product.

operative 06-21-2011 05:02 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213410)
Please, please tell me that you know the difference between the government changing the level at which it subsidizes a product and the government instituting wage controls on the providers of that product.

I'm talking about the Single Payer model, as well as its stalking horse, the 'Public Option.' If you lower the rate of Medicare payment in our existing model, you will simply further limit the number of doctors who participate in Medicare.

Don Zeko 06-21-2011 05:04 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Why, it's almost as if Tea Partiers are completely incoherent on health care!

Don Zeko 06-21-2011 05:05 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by operative (Post 213411)
I'm talking about the Single Payer model, as well as its stalking horse, the 'Public Option.' If you lower the rate of Medicare payment in our existing model, you will simply further limit the number of doctors who participate in Medicare.

That still doesn't make what you describe wage controls. Similar in effect, perhaps, but we're talking about an industry in which demand is created by a government program. Cut the program and you cut demand, leading to a decrease in wages for providers, but that's absolutely not the same thing as wage controls.

operative 06-21-2011 05:08 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
I'll expand further:

Your presumption that lower Medicare wages would not result in a net reduction of the number of doctors who participate in the system fails due to at least two reasons:
1) Medicare involves more paperwork, which is an added burden on doctors. This is added to the cost of seeing a Medicare patient and makes seeing one more costly.
2) (and more importantly) Your analysis fails to take into account market psychology. Say you give music lessons for $40 an hour--a reasonable rate probably around the market rate for decent music lessons. Say you have five students a day. A sixth student comes to you and says that he would like lessons, but he is only willing to pay $28 an hour. You have the time free, and it would mean a net increase in your pay. But you will in all likelihood not take the student. Why? Because that is not the market wage, and you will feel insulted that someone is wanting to pay you substantially less than what you deserve for your service, which the market has set. You will turn down the offer and simply not work that extra hour, until someone comes along and offers you the market wage.

operative 06-21-2011 05:10 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213413)
That still doesn't make what you describe wage controls. Similar in effect, perhaps, but we're talking about an industry in which demand is created by a government program. Cut the program and you cut demand, leading to a decrease in wages for providers, but that's absolutely not the same thing as wage controls.

I don't see where demand is created by Medicare. Regardless of the existence of Medicare, there is demand where people need treatment. Maybe participation in Medicare leads to a net increase in the amount of medical services demanded--is this what you are claiming?

Don Zeko 06-21-2011 05:10 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by operative (Post 213414)
I'll expand further:

Your presumption that lower Medicare wages would not result in a net reduction of the number of doctors who participate in the system fails due to at least two reasons:
1) Medicare involves more paperwork, which is an added burden on doctors. This is added to the cost of seeing a Medicare patient and makes seeing one more costly.
2) (and more importantly) Your analysis fails to take into account market psychology. Say you give music lessons for $40 an hour--a reasonable rate probably around the market rate for decent music lessons. Say you have five students a day. A sixth student comes to you and says that he would like lessons, but he is only willing to pay $28 an hour. You have the time free, and it would mean a net increase in your pay. But you will in all likelihood not take the student. Why? Because that is not the market wage, and you will feel insulted that someone is wanting to pay you substantially less than what you deserve for your service, which the market has set. You will turn down the offer and simply not work that extra hour, until someone comes along and offers you the market wage.

As usual, I'm talking about existing health care systems and my libertarian interlocutors are talking about thought experiments and the magic of the free market. If you don't already think that health care is so full of market failures that it makes this dogma nonsense, then I won't convince you. I'm done with this argument.

operative 06-21-2011 05:11 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213416)
As usual, I'm talking about existing health care systems and my libertarian interlocutors are talking about thought experiments and the magic of the free market. If you don't already think that health care is so full of market failures that it makes this dogma nonsense, then I won't convince you. I'm done with this argument.

Rats and I was having fun, too :(

Don Zeko 06-21-2011 05:12 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by operative (Post 213415)
I don't see where demand is created by Medicare. Regardless of the existence of Medicare, there is demand where people need treatment. Maybe participation in Medicare leads to a net increase in the amount of medical services demanded--is this what you are claiming?

Do I really have to tell you that Demand, as used in economics, means desire for a good and the willingness and ability to pay for it, not just desire for a good?

Don Zeko 06-21-2011 05:16 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Holy false dichotomy Batman! Are you really so sure that a bunch of cranks and wackos are useful in pushing a legitimate issue that is tangentially related to their idiocy? Would you say the same thing about, say Code Pink?

operative 06-21-2011 05:16 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213418)
Do I really have to tell you that Demand, as used in economics, means desire for a good and the willingness and ability to pay for it, not just desire for a good?

One does not generally need Medicare for that. Thus Medicare provides for a negligible increase in the consumption of services, moreso just a distributed payment for them.

chiwhisoxx 06-21-2011 05:30 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213405)
Conn, this is ridiculous. The Doc Fix situation was exactly the same before the ACA passed and would be exactly the same if it had not. It is absolutely not part of the cuts to Medicare included in the ACA and wasn't counted as a part of its savings. This also means that your assertion that the ACA's cuts come out of payments to physicians is essentially bullshit as well.

I haven't listened to the DV yet (and can't listen to the clip right now) to see what Conn's point is, but he could still have a plausible point. The doc fix was being used to assume roughly 200 billion in savings, at least for a while. I don't know if it was counted towards saving in the final CBO score, but it definitely was for a while. Not to mention, if you're going to do healthcare reform, it would be nice to address something widely recognized as an obvious flaw in the system, rather than ignore it and pretend like it doesn't exist. If the people who wrote the bill actually were interested in paying doctors less money, as "that's what part of cutting costs is!" then they would have just done this. Except it would have been honest and transparent, so it didn't happen.

Don Zeko 06-21-2011 05:31 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
OK, after hearing the rest of the Ron Paul/Federal Reserve discussion, I'm curious to hear Conn's thoughts about Buckley's famous repudiation of the John Birch Society. The arguments he's putting forward could justify essentially any faction at all, no matter how radical or nonsensical their policy views, being considered a member in good standing of the coalition. What's was wrong with the Birchers that's not wrong with the Paulites?

Don Zeko 06-21-2011 05:36 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
What is so hard about the concept of incremental improvement? Conn is really in full apparatchik mode for this DV. It's very disappointing.

Don Zeko 06-21-2011 05:43 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by chiwhisoxx (Post 213422)
I haven't listened to the DV yet (and can't listen to the clip right now) to see what Conn's point is, but he could still have a plausible point. The doc fix was being used to assume roughly 200 billion in savings, at least for a while. I don't know if it was counted towards saving in the final CBO score, but it definitely was for a while.

No, no, no, it wasn't ever counted towards savings in the ACA. It was temporarily counted against the ACA's savings. CBO scores are relative to a baseline of spending, but there are a couple different ways of defining that baseline. One is against current law, which means no Doc Fix, so Medicare reimbursement rates fall 30% next year, no extension of the Bush Tax cuts, things like that. This baseline is unrealistically rosy, as we know full well that politicians have no intention of cutting spending and raising taxes in those ways, so the CBO also has an alternative baseline that takes those changes into account.

In the early stages of the ACA's journey through Congress, it included the cost of making the Doc Fix permanent, i.e. taking a cost that everyone knew we were going to incur, whether or not the ACA passed, and putting it on the books. This would have made our overall fiscal accounting more honest, but would have saddled the ACA with a sticker price that reflected more costs than were actually included in the bills changes to current policy. Because they were concerned about how expensive the ACA was perceived to be, Democrats took it out (this is also why they made the bill's expenditures, taxes, and cuts wait until 2014 to take effect). But the fact that they were considering doing this doesn't mean that the Doc Fix had anything to do with the ACA, and taking it out certainly doesn't mean, as Conn implies, that the Doc Fix won't be passed and that reimbursement rates are going to crater next year.

Quote:

Originally Posted by chiwhisoxx (Post 213422)
Not to mention, if you're going to do healthcare reform, it would be nice to address something widely recognized as an obvious flaw in the system, rather than ignore it and pretend like it doesn't exist. If the people who wrote the bill actually were interested in paying doctors less money, as "that's what part of cutting costs is!" then they would have just done this. Except it would have been honest and transparent, so it didn't happen.

The Doc Fix isn't even a flaw in the system. It's an accounting fiction that will have no effect on anything besides CBO projections.

look 06-21-2011 06:21 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
lol

Great pairing. I'd like to see these two appear regularly. Noah, examine this diavlog carefully. Conn's a wascally wabbit.

Noahkgreen 06-21-2011 07:00 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by look (Post 213427)
lol

Great pairing. I'd like to see these two appear regularly. Noah, examine this diavlog carefully. Conn's a wascally wabbit.

Thank you! Apologies about the atrocious video and audio from my end!

sugarkang 06-21-2011 07:01 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213407)
If everybody's coverage paid at Medicare's rates then doctors absolutely would not refuse to see you. If they did that, they'd have no patients. Instead, doctors would make less money and everybody else would spend less on health care. That stinks for doctors, but it's what medical cost control means: making the same care cheaper by making it somewhat less profitable to be a provider.

Okay, I'm going to be charitable and just assume that I don't have all the assumptions that you're working with here. So, please tell me what they are. Based on the information I have at hand, your position is that by capping the pay rates to doctors, we'd essentially just get the same amount of health care, but it would be cheaper for everyone. Is that right?

Even if we did what you're suggesting, which is politically impossible, and even if it worked like you're suggesting, the best case scenario would be that it works for a short period of time. In a few short years, there would be no doctors. The reason for that is quite simple:

PEOPLE WOULD STOP GOING TO MEDICAL SCHOOL.

Yes, in the short run doctors would still be doctors and they'd still show up for work. But do you think that by lowering the price of services, college grads are going to take on SEVEN FUCKING YEARS OF DEBT to be a doctor that doesn't make any money? Why the hell would anyone go to medical school? People go to Wall Street to make a killing and it causes a brain drain in all of our other industries. What is it about self-interest that is so fundamentally difficult to understand?

There's an obvious solution to this, though. We could just subsidize medical school through tax payer money. Just make it cheaper for students to get their doctor's licenses by giving them a free ride. Right? But then you'd get many more doctors, but they'd be less qualified. We get lower nominal wages, lower pay rates and that makes everyone "feel" like they're getting cheaper health care. But, the REAL (not nominal cost) would be the same, only we'd get a REAL decline in health care quality.

This all leads me to ask: why are you flirting with half measures? While you're at it, why don't you let the government take over our computer industry too? Is Moore's Law not working fast enough? Yes, the government could mandate One Laptop Per Child and we can subsidize the program with taxpayer. Oh wait, what? What do you mean the free market makes laptops cheaper than OLPC?

Markets aren't perfect. Stop making them worse.

chiwhisoxx 06-21-2011 07:08 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Don Zeko (Post 213426)
No, no, no, it wasn't ever counted towards savings in the ACA. It was temporarily counted against the ACA's savings. CBO scores are relative to a baseline of spending, but there are a couple different ways of defining that baseline. One is against current law, which means no Doc Fix, so Medicare reimbursement rates fall 30% next year, no extension of the Bush Tax cuts, things like that. This baseline is unrealistically rosy, as we know full well that politicians have no intention of cutting spending and raising taxes in those ways, so the CBO also has an alternative baseline that takes those changes into account.

In the early stages of the ACA's journey through Congress, it included the cost of making the Doc Fix permanent, i.e. taking a cost that everyone knew we were going to incur, whether or not the ACA passed, and putting it on the books. This would have made our overall fiscal accounting more honest, but would have saddled the ACA with a sticker price that reflected more costs than were actually included in the bills changes to current policy. Because they were concerned about how expensive the ACA was perceived to be, Democrats took it out (this is also why they made the bill's expenditures, taxes, and cuts wait until 2014 to take effect). But the fact that they were considering doing this doesn't mean that the Doc Fix had anything to do with the ACA, and taking it out certainly doesn't mean, as Conn implies, that the Doc Fix won't be passed and that reimbursement rates are going to crater next year.



The Doc Fix isn't even a flaw in the system. It's an accounting fiction that will have no effect on anything besides CBO projections.

ok, but at the point where the doc fix wasn't being counted against ACA savings (and that's what I meant, perhaps I wasn't clear enough) then that's essentially the same thing as using the assumption that the doc fix would be cleared. if you're not counting against it, you're assuming it will continue to exist. that seems like a distinction without a difference to me. if you were making an exact point about when it was being counted and when it wasn't, I simply don't remember.

piscivorous 06-21-2011 08:04 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Actually fro the CBO scoring the doc fix by law had to be considered in their guesstimates; even if reality and legislative history says that it will never be enacted. It is one of the primary reasons for the administration's claim that it this boondoggle piece of crap legislation, which went unread before passage, will produce savings from thin air.

look 06-21-2011 08:13 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by Noahkgreen (Post 213429)
Thank you! Apologies about the atrocious video and audio from my end!

Your image was fuzzy, but I had no audio problems.

bkjazfan 06-21-2011 08:43 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Noah's mention of a quality control system for republican candidates was provocative. Is he suggesting a Dodge Romig sampling system? If so, 8 running is not enough for a accurate measure. Being pro defense they would easily pass a Mil-Q-9858 inspection. When it comes to the overall populace it's hard to say if they could do the same with the ISO 9000.

I know Ron Paul is a quixotic politician but think it's beneficial to have someone on the stage who is against the banksters and American Imperialism. His stances there are worth their weight in gold.

badhatharry 06-21-2011 09:01 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by sugarkang (Post 213430)
This all leads me to ask: why are you flirting with half measures? While you're at it, why don't you let the government take over our computer industry too? Is Moore's Law not working fast enough? Yes, the government could mandate One Laptop Per Child and we can subsidize the program with taxpayer. Oh wait, what? What do you mean the free market makes laptops cheaper than OLPC?

Markets aren't perfect. Stop making them worse.

Here's the thing. Some people want to keep the medical system we have (had) and some people don't. I am in the first camp but I'd like to see some needed changes. The thing about the other camp is that in order for the US to get to where Europe is there are going to have to be a whole lot more changes than ACA.

You mentioned medical school. As you probably know, France and the UK subsidizes medical school for doctors. So in addition to the added cost of ACA (which does exist) the American taxpayer will also be paying for medical schools. Will we still be able to pay for top notch schools or will they go down in quality? I am also pretty confident that our drug companies will be affected. If the prices of drugs are controlled as they are in Europe, will research be as vigorous and will Europe continue to enjoy the benefits we are currently subsidizing? And of course our insurance providers will eventually go out of business, but they're evil so who cares.

This thing is huge and may be impossible to stop. However, I don't think people realize how much in this country is going to change. As you said in another thread, you don't know what you've got until it's gone.

or as Biden said, "this is a big fucking deal!"

badhatharry 06-21-2011 09:05 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by bkjazfan (Post 213444)
I know Ron Paul is a quixotic politician but think it's beneficial to have someone on the stage who is against the banksters and American Imperialism. His stances there are worth their weight in gold.

I agree that his presence has been a big influence on the Party. I'm pretty sure he knows he hasn't a chance in hell but is using the exposure to get his ideas heard.

badhatharry 06-21-2011 09:18 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by chiwhisoxx (Post 213431)
ok, but at the point where the doc fix wasn't being counted against ACA savings (and that's what I meant, perhaps I wasn't clear enough) then that's essentially the same thing as using the assumption that the doc fix would be cleared. if you're not counting against it, you're assuming it will continue to exist. that seems like a distinction without a difference to me. if you were making an exact point about when it was being counted and when it wasn't, I simply don't remember.

You obviously have no grasp of the intricacies of higher level accounting. You should read Ezra Klein more. I prefer Peter Suderman myself.

Quote:

If you presume that the doc fix will be funded somehow—even if it means more short-term extensions and deficit spending—then you have to think of this as irresponsible on the part of President Obama and the Democratic members of Congress who voted for the health care overhaul. They had a $380 billion problem to fix within Medicare, their existing system. But after coming up with changes that they believed would reduce the cost of that system by about $500 billion, they ignored the problem they already had and spent the money on a new entitlement instead.
Just remember these are accounting tricks, smoke and mirrors and you get to pay for the show.

Shall we now speak of waivers? whether the CBO taken those into account? and whether anyone keeping track of this stuff?

sugarkang 06-21-2011 09:44 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by badhatharry (Post 213445)
And of course our insurance providers will eventually go out of business, but they're evil so who cares.

You gotta love these premises.

There is one liberal argument that I find compelling, though. The fundamental conflict of interest between insurance providers and beneficiaries is problematic. The former has a profit motive to not pay out on a valid claim and we can easily see where lines are blurred by ambiguous laws the insurance companies might do their best to not pay out on the most expensive ones.

I have to say that I'd much prefer overhaul the whole damn thing. As a bloggingheads guest mentioned before, there's a difference between health care and health insurance, but we've completely screwed up the distinction between the two. I think a more reasonable socialist approach would be to provide basic health care for kids and screw everyone else. Of course, there's that anchor baby problem, but as long as we're talking about crap that's not going to happen, I might as well pretend that we can easily amend the Constitution.

timba 06-21-2011 10:09 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
The artificial layer of profit-taking that's inserted into our health care system is ruining the country, the economy and everyone's lives.

Listening to this dual-right-wing diavlog is like listening to two people talking about life on Mars - rich morons in ivory towers who have no clue what life is like for the majority of people.

operative 06-21-2011 10:10 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by timba (Post 213458)
The artificial layer of profit-taking that's inserted into our health care system is ruining the country, the economy and everyone's lives.

What do you mean by "artificial layer of profit-taking"

graz 06-21-2011 10:15 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by operative (Post 213459)
What do you mean by "artificial layer of profit-taking"

A rigged deck.
An unleveled playing field.
A fixed outcome.
A cornered market.

You know. The opposite of a free market.

operative 06-21-2011 10:16 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by graz (Post 213460)
A rigged deck.
An unleveled playing field.
A fixed outcome.
A cornered market.

You know. The opposite of a free market.

Those are talking points. Care to elaborate on some or all of them?

timba 06-21-2011 10:34 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
>What do you mean by "artificial layer of profit-taking"

When a public company whose duty is to maximize profits for its shareholders takes a cut of every health care transaction, amounting to billions of dollars, and games the system, in collusion with other for-profit corporations, to maximize the amount they rake off the top - which is enough to ruin the country.

The trouble with the one sided diavlog is that you've created a straw dog in this nonsense about doctors and medicare. You're deflecting attention away from the elephant in the room - the organized crime protection racket that Republicans have set up to bleed everyone dry.

The person who needs health care has to pay and the people who provide the actual care need to be paid. Because health care is usually not needed until it's needed in unaffordable amounts, there has to be a way to pay one affordable amount over the long haul and then be guaranteed care. The fair way to do this is through taxes and single payer. If an insurance model has to be used, IT HAS TO BE NON-PROFIT! As long as a corporation's profits are determined by how badly they screw over the Ämerican public this is going to keep happening. Why is that so hard for rich people to understand? You all sound like Marie Freaking Antoinette.

badhatharry 06-21-2011 10:38 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by sugarkang (Post 213453)
You gotta love these premises.

There is one liberal argument that I find compelling, though. The fundamental conflict of interest between insurance providers and beneficiaries is problematic. The former has a profit motive to not pay out on a valid claim and we can easily see where lines are blurred by ambiguous laws the insurance companies might do their best to not pay out on the most expensive ones.

Usually conflict of interest means that one is more amenable to an entity than you would normally be because you want them to succeed for your own nefarious reasons. This, I imagine, isn't what you mean when you say there is a conflict of interest between insurance providers and beneficiaries. Instead you are saying that insurance companies don't have the proper incentives to pay out.

Somewhere back in the anals of history people thought insurance companies could be trusted to pay what they promised. I have carried individual insurance for a very long while and have never had a problem, but that doesn't mean it can't happen. I think HSA's would go a long way to incentivizing everyone from patients to providers to insurers... that and letting insurance carriers compete across state lines and removing government mandated coverage.

Yadda, Yadda, Yadda... that's a tired old song. We're doomed.

sugarkang 06-21-2011 10:50 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by graz (Post 213460)
You know. The opposite of a free market.

I like how one answers for the other, y'know, like a Liberal Hive-Mind. Certain things are just true, e.g., trickle down economics doesn't work.

Like, you friggin rich people with your expensive $20,000 big screen plasma TVs. You don't know what it's like for.... What do you mean they're only $600 now?

badhatharry 06-21-2011 11:04 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by timba (Post 213466)
>What do you mean by "artificial layer of profit-taking"

so you don't really mean an artificial layer of profit taking. You just mean plain old profit taking and you don't think this concept works for health insurance.

Quote:

The person who needs health care has to pay and the people who provide the actual care need to be paid. Because health care is usually not needed until it's needed in unaffordable amounts, there has to be a way to pay one affordable amount over the long haul and then be guaranteed care.
That's kinda the way health insurance works. I've never been without insurance even when I was young and poor and had to pay for it myself.


Quote:

The fair way to do this is through taxes and single payer. If an insurance model has to be used, IT HAS TO BE NON-PROFIT!
Ya know that's kinda funny. Blue Cross is supposedly non-profit.

Quote:

As long as a corporation's profits are determined by how badly they screw over the Ämerican public this is going to keep happening.
What's going to keep happening?

Don Zeko 06-21-2011 11:21 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by chiwhisoxx (Post 213431)
ok, but at the point where the doc fix wasn't being counted against ACA savings (and that's what I meant, perhaps I wasn't clear enough) then that's essentially the same thing as using the assumption that the doc fix would be cleared. if you're not counting against it, you're assuming it will continue to exist. that seems like a distinction without a difference to me. if you were making an exact point about when it was being counted and when it wasn't, I simply don't remember.

My problem is that Conn was saying that the ACA's cuts to Medicare consisted of the reductions in the Medicare reimbursement rate that are averted by the doc fix every couple of years. Those cuts won't happen and have nothing to do with the ACA's savings.

sugarkang 06-21-2011 11:29 PM

Re: Quality Control (Conn Carroll & Noah Kristula-Green)
 
Quote:

Originally Posted by badhatharry (Post 213467)
Usually conflict of interest means that one is more amenable to an entity than you would normally be because you want them to succeed for your own nefarious reasons. This, I imagine, isn't what you mean when you say there is a conflict of interest between insurance providers and beneficiaries. Instead you are saying that insurance companies don't have the proper incentives to pay out.

Oh, I think I see what you mean.

This relates back to the meshing of two systems that were traditionally distinct: care vs. insurance. If health care services were limited to routine checkups, prescriptions, X-rays, etc., then cost projections for these types of things would be calculable from a quarter to quarter basis. Removing uncertainty and allowing free competition should allow for basic services to get better and cheaper over time, just like in the electronics / computer industry.

However, because our system combines care and insurance markets, routine costs and insurance payouts end up being one and the same: the former being more readily calculable, the latter being more volatile. I'd imagine any bad insurance year means less money goes to provide good routine services, then. In that sense, I think there's a conflict of interest. It's more like a triangle in this example, rather than two parties where you quoted me.

It's the same problem I have with Too Big to Fail banks and why I want Glass-Steagall to return. Because, theoretically you can mix investment banking and consumer level banking. In practice, money gets shifted between these concerns. One side may expose the other side to risks they never signed up for.

I don't mean to suggest that the companies and their officers wake up each morning saying, "How many people do I have the privilege of fucking over today?" Rather, these conglomerates operate too many different businesses under the same roof to be acting in the best interests of all.

Now, that makes it sound like I'm against conglomerates and, theoretically, I suppose I am. But I heard the guys at engadget talking about Samsung, a huge Korean conglomerate with many hands in many pots. According to them, one division (say phones) will not automatically accept parts from another Samsung division (say memory chips) just because they are part of the same umbrella. That is, the Samsung phone division forces the Samsung chip division to compete with all other chip companies in the world on price. Isn't that some cold ass shit? And it fucking works.


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