Yet another reason to despise the ambulance chaser

[IJ]

I went looking for medicare tales to learn more about how the program was started etc. I found this (on a sketchy site, I might add, and written by people who want medicare for all):

"Civil rights activists had targeted segregation in Southern hospitals. But with the passage of Medicare, hospitals and nursing homes that wanted to receive federal funding would no longer be able to discriminate. A staff of 1,000 SSA and Public Health Services staff people were immediately trained and sent throughout Southern hospitals to inspect hospitals for discrimination, according to Jill Quadagno and Steve McDonald in The New Deal and Beyond.

Undersecretary Wilbur Cohen said 20 years later:

"On the day before Medicare went into effect, every hospital in the South, over every drinking fountain, over every bathroom, over every cafeteria, there were signs reading "Whites" and "Colored" for separate and presumably equal facilities. On the day that Medicare went into effect in the South, all those signs and separate facilities began to come down. In one day, Medicare and Medicaid broke the back of the segregated health services.""

http://socialistworker.org/2009/08/06/t ... f-medicare

Again, sketchy site. I wasn't looking for sketchy sites. But this neatly illustrates my point about how government buying power can change behavior overnight. And behaviors need to change.

[Bill Glasheen]

Again, sketchy site. I wasn't looking for sketchy sites. But this neatly illustrates my point about how government buying power can change behavior overnight. And behaviors need to change.

I agree. I'm all for government buying as little as possible. The least we can do is stop all this nonsense the day government runs out of money in the bank. Oh wait...

Thomas Jefferson:
“I would rather be exposed to the inconveniences attending too much liberty than to those attending too small a degree of it.”

When is someone going to parade the Nazi flag? Either that or the KKK. Isn't that the usual way these things go?

It's kind of like my youth. As my Exeter friends used to say, "All conversations eventually degenerate into discussions about either sex or drugs."


Turn your head and cough, sweetie!

- Bill

[Van Canna]

Hey bill,

Send that cutie over my way...will you

[Bill Glasheen]

Too much brown sugar is bad for you, Van. And that, my friend, is too much!

That young lady is quite the study of human potential, isn't she? Seriously... if ever there is a prototype of the classic African beauty queen, you're looking at her. Waist-to-hip ratio means perfect health. Thighs suggest she could either outrun you or kick your arse. Face suggests she'd wrap you around her little finger before kicking your arse.

All in a single picture!

- Bill

[IJ]

"I agree. I'm all for government buying as little as possible. The least we can do is stop all this nonsense the day government runs out of money in the bank. Oh wait..."

So just to clarify: Medicare, Medicaid, gone? Hmm? If you'd like to cite that popular rebellion, as in Mass, you'll be hard pressed to find a majority interested in ending these programs. While they're not perfect, I'm particularly fond of the way some of their policies (like not funding expensive inadequately proved tests like CT colography; ceasing to pay for avoidable complications to incentivize hospitals to improve care) set and raise national standards.

[Van Canna]

Too much brown sugar is bad for you, Van. And that, my friend, is too much!

That young lady is quite the study of human potential, isn't she? Seriously... if ever there is a prototype of the classic African beauty queen, you're looking at her. Waist-to-hip ratio means perfect health. Thighs suggest she could either outrun you or kick your arse. Face suggests she'd wrap you around her little finger before kicking your arse.

All in a single picture!

- Bill

LOL... I have a bit of brown sugar in my oat meal or is it 'hot meal' every morning...

The trick is a 'sugar continuum'

[Bill Glasheen]

So just to clarify: Medicare, Medicaid, gone?

I want to know what happened to all my Medicare money, Ian.

That's somewhat of a rhetorical statement. We all know that it's gone, and that Medicare is a Ponzi scheme. A properly run Medicare system relies on a growing population, and we all know how much you love that. When the generation that's supposed to support me comes on board to pony up their contribution, there won't be enough of them to support all of us. So we're screwed. Please tell me what's good and/or rational about that.

Perhaps we can gut it and start over? Or at least allow for a system where I put my money aside for a lifetime and then I can draw from it when I retire. The government doesn't seem to be able to do that.

Remember Al Gore's "lock box" mantra? He was on to something.

I'm particularly fond of the way some of their policies (like not funding expensive inadequately proved tests like CT colography; ceasing to pay for avoidable complications to incentivize hospitals to improve care) set and raise national standards.

Then you should step up and defend commercial insurance companies when they do the exact same thing, Ian. This isn't new. The issue is that the government can be a bully while private insurance companies have to put up with azzholes like Michael Moore.

- Bill

[Bill Glasheen]

is it 'hot meal' every morning...

The trick is a 'sugar continuum'

Or... I recall one RBSD expert promoting the concept of a "sugar wheel." In other words, you don't have to work UP to any one level. Whenever any particular level is appropriate, well then you just go straight for it!



- Bill

[IJ]

I wasn't around when Medicare was formed. And no one can fix the fact that it and SS went by a pay as you go rather than plan for the future model. But we still need to make decisions now. One of those decisions is: Medicare, Medicaid, gone, or not? So I'm still curious. (Incidentally, I do agree with the lock box. Everyone agrees that you don't raise taxes or slash spending too much in a big recession. You are supposed to prop the economy up. The problem is no one ever seems to put the money away when times are good (think: massive tax cuts during our surplus) which is the other half of the equation. I would have put that money towards our debt, or reserves).

As for Michael Moore, huh, what? He's had no significant impact on private insurance other than to point out a few egregious examples of insurance company abuse, and make up a few false ones to further his argument. He's only part of the larger media that's been doing such things, just a bit more dishonestly, and I'm glad that when an insurance company does something especially nasty, they risk public exposure. I don't believe for a moment Sicko or similar reporting has impaired the private insurance companies one iota. They have less ability to change the way things are done because there are a zillion of them and they don't act together. And they're generally for profit, which impairs their credibility. When NICE takes heat in the UK for denying care, no one has to wonder why; executive pay isn't tied to denying care over there.

http://www.healthcare-now.org/denial-of ... iring-ceo/

http://blogs.webmd.com/mad-about-medici ... re-is.html

It's not like they needed much help to come up with bad PR taking home these salaries. I'm really not sure what I would do with $73 million, but some would say it's easier to get an elephant through the eye of the needle than a CEO who's massively rewarded for containing spending on people with healthcare problems. Charity, anyone? Take home $72 million, maybe?

[Van Canna]

[Bill Glasheen]

One of those decisions is: Medicare, Medicaid, gone, or not?

It's effectively gone for me, Ian, so the discussion is moot. One way or another, I'll have to deal with the fact that all my dollars were spent and there aren't going to be any for me. Private insurance it is.

I'll just take a chapter out of the book of my father. At age 88, he still works full time. He EARNS his BCBS Medicare extended; he pays every cent of it.

It's OK. If I had to sit around all day, I think I'd kill myself. (No exaggeration) "Retirement" for me will be a transition to things I've always wanted to do, but couldn't while the kids were in school.

The problem is no one ever seems to put the money away when times are good (think: massive tax cuts during our surplus) which is the other half of the equation.

Not true. Virginia does this; it's the Rainy Day Fund. These days it amounts to just short of a billion and growing.

That's one of many reasons why I want less money going to the federal government.

And they're generally for profit, which impairs their credibility.

Wrong on two accounts, Ian.

• Most commercial insurance companies are NOT for-profit. Certainly a good part of the Blues aren't.
• Credibility is NOT impaired by going for-profit. On the contrary, shareholders don't invest in companies which are likely to abuse their customers. Would you invest in Toyota today? I wouldn't. Share price was $91.78 at its peak in January. It's now trading at $73.55. Karma happens in the free market - as it should.[/quote]
• In my book, things run by the government lack credibility. Take VDOT (the Virginia Department of Transportation). When we had one to three feet of snow in December, they and the local counties did a perfectly abysmal job of clearing the roads. I commented to my family (online) that with the last 2 mega storms this month (record-setting by the way), the road cleaning (from Interstates to neighborhoods) has been exemplary. Why? Our new Republican governor got ticked off, and contracted the services out to private companies. THEY are responsive; government often is not.

It's not like they needed much help to come up with bad PR taking home these salaries.

Why do you have a problem with the best-of-the-best taking home mega dollars? If they are doing something GOOD, then I'm all for it. If they are parasites on an otherwise productive system, well that's another story altogether. The key is actually PRODUCING something.

Want to know why the AL East dominates baseball these days? Because the Yankees and the Red Sox budgets are the first and third highest. They pay for the best talent, and end up with the best teams.

I rest my case.

If you made $20 million a year, I'd be very happy for you. I'd brag to everyone that I remembered when you were a wet-behind-the-ears karate student who barely could fill his gi. And look at you now!

If you quit medicine and become a trial attorney, I'm personally going to kick yer azz.

- Bill

[IJ]

Still not answering the Medicaid / Medicare question I see. I wonder what you'd say if Obama thought dealing with our healthcare mess was all moot. Anyhoo, if the programs are better managed, there's no reason they're not sustainable. One has to gradually increase the age of eligibility (they picked the average life expectancy, previously), stop paying for waste, stop paying for unnecessary care, stop paying for errors, and incentivize good behavior. We know how to do each of these things. On the other hand, if we eliminate these programs, we end up back in the day when death panels decided who would and would not get dialysis (since dialysis = qualifying for these programs). Maybe it's weird to pick individual diseases for qualifying, but as for those losers who've distorted the evil government's intentions, the fact is that government intervention eliminated the death panels, instead of creating any. Go figure.

I plan to work a long time to keep active and be productive myself. Enjoy.

I'm glad Virginia is the exception that proves the rule I identified with regard to saving for the future. *I'm* one too-saved tons for who knows what, but America still spends money she doesn't have. Anyway, we could just do what Virginina did on a larger scale. Don't see why that's impossible, other than the endless bickering and obstructionism in Washington, but hey, that's what we're discussing changing.

I'm not saying for profit companies are necessarily lacking in credibility. I am saying that when someone who really believes in a mission is taking care of people who can't get adequate medical care, they don't go home with 73 million in cash. Because it's wrong. Maybe it's not wrong that a system permits that to occur, as an incentive for good work [although we see over and over that companies give crazy bonuses for bad work, or for cash producing work that while successful, isn't maximally successful at what should be the real purpose: generating health, not (just) profits] but it is wrong to take that much home. Case in point would be Bill Gates. He's rich. Fabulously so. Over spends in my book. But he gives sooo much back, and that was when his job was to make dollars, not make healthcare. You say you support great rewards for doing something "good." I think that great rewards aren't necessarily financial, and that being a care-limiting insurance CEO isn't necessarily "good." What if these yahoos were incentivized based on risk adjusted mortality of their customers, or % preventive care received, or for ratio of EBM to total care received? You mention a system actually "producing" something, and health is what I'm interested in producing, not dollars, not moving paperwork around, not an entire segment of our society the size of most countries economies created just to move paper around and fight claims and argue about fees. I DO produce healthier and happier patients now, I DO produce smarter med students and residents, I DO produce (a bit of sloppy) medically relevant literature, and I think that's a lot more to brag about that pulling in 20 million dollars a year. But work with any success scales you want!

Your VDOT example is great. Sorta. Of something. The government contracted something out, and the result was exemplary. You sound like the guys who yell, "no government intervention and kep your hands off my medicare!" The government collected taxes, made decisions, and contracted with the best provider to get the job done. It's still government provided snow shoveling. Think outside the box here: why can't we do something like that with healthcare? At least have competing offices offering the same services with real benefits for the winners and real risks for the underperforming state service? Or go all the way and contract out the health plans.[/i]

[Bill Glasheen]

Still not answering the Medicaid / Medicare question I see.

Medicare is going to be gone when it's my turn, and MY Medicare contributions are gone. So it IS moot to me.

Medicaid is pretty much a state enterprise.

I wonder what you'd say if Obama thought dealing with our healthcare mess was all moot.

I'd say GOOD!!! Why? Because he, Pelosi, and Reid scare the schit out of me. Essentially they were about to throw a whole bunch of people on a system under stress with no improvement in quality. Methinks there's a Machiavelian element to this. Since they couldn't get their public option, they were going to break what we have and then use it as an excuse down the road to get the single-payer, socialized system they wanted all along.

I say keep your fuking public hands off my private health-care.

On the other hand, if we eliminate these programs,...

It's already on the path to self destruction.

I am saying that when someone who really believes in a mission is taking care of people who can't get adequate medical care...

ON AVERAGE, two thirds of consumers are very or completely satisfied with their private health plan. I fail to see how people can't get adequate medical care.

If you don't have health insurance, well that's another story altogether. But don't blame the CEO of a health plan for that.

Considering how consumer oriented we are, these kinds of approval ratings are REALLY good. Saying "no" to THE PAYMENT OF care you don't need doesn't make you very popular. But if you follow the contract and stick with evidence-based care guidelines, it's the right thing to do.

I don't have a problem with a CEO going home with $73 million in cash. Very few people can do that kind of job. And if you don't pay that kind of money, you won't get the kind of person you need to operate such a company. It's the going rate for CEOs.

Considering the billions these health plans manage, that's a drop in the bucket. Very few in management make that kind of money.

Or go all the way and contract out the health plans.

I wish someone had done that with MY Medicare dollars. Meanwhile... the government already is doing that (to some extent) with both Medicare and Medicaid. Obamacare was going to eliminate many of these programs, and save it for the government.

- Bill

[Glenn]

Medicare is going to be gone when it's my turn, and MY Medicare contributions are gone. So it IS moot to me.

People have been predicting that doom and gloom for Medicare and Social Security for decades and yet it's still going strong. There is no reason for it to go away, nor any indication it will.

ON AVERAGE, two thirds of consumers are very or completely satisfied with their private health plan. I fail to see how people can't get adequate medical care.

If you don't have health insurance, well that's another story altogether. But don't blame the CEO of a health plan for that.

Considering how consumer oriented we are, these kinds of approval ratings are REALLY good.

Two thirds of people with health insurance are satisfied with the plan they're on and that is a good approval rating? As long as we aren't setting our standards too high. i wonder how many of them haven't actually had to use it yet.

[Bill Glasheen]

People have been predicting that doom and gloom for Medicare and Social Security for decades and yet it's still going strong.

People HAVE been predicting Medicare's troubles for decades because it really is headed there, Glenn. And it has absolutely nothing to do with today, so your comment is irrelevant.

The boomers haven't all retired yet. But that day of reckoning will come.

The result? There will be means testing. If you have any assets, well it'll be "Sorry, Charlie!" It's the only solution, Glenn. In other words if you were smart enough to save for your future, then you aren't going to be one of the ones to benefit from social security or Medicare. It's perverse, but it's the only solution.

From Wikipedia

According to the 2008 report by the board of trustees for Medicare and Social Security, Medicare will spend more than it brings in from taxes this year (2008). The Medicare hospital insurance trust fund will become insolvent by 2019.[41][42][43][44] Shortly after the release of the report, the Chief Actuary testified that the insolvency of the system could be pushed back by 18 months if Medicare Advantage plans that provide more health care services than traditional Medicare and pass savings onto beneficiaries were paid at the same rate as the traditional fee-for-service program. He also testified that the 10-year cost of Medicare drug benefit is 37% lower than originally projected in 2003, and 17% percent lower than last year's projections.[45] The New York Times wrote in January 2009 that Social Security and Medicare "have proved almost sacrosanct in political terms, even as they threaten to grow so large as to be unsustainable in the long run."[46]

Two thirds of people with health insurance are satisfied with the plan they're on and that is a good approval rating?

Please don't misquote me. I said what I meant and I meant what I said. A little survey methodology research on your part might be in order.

i wonder how many of them haven't actually had to use it yet.

It depends upon the type of health plan. But here are the facts/

• On average, about 80 percent of people use their health benefit in any given year.
• Because of the wellness/prevention philosophy, more people in HMO plans use their benefits than folks who have PPO plans. The higher the deductible in a PPO or a "traditional" plan, the fewer the percentage of people who use it.
• The "sweet spot" for satisfaction (most highly satisfied) is the vast majority of people in the middle range of utilization. Satisfaction tends to drop a bit on both tails - people who don't use their plan in a year and people who use it far more than most.

- Bill