Health-Care Reform: Pocketbook or Portfolio?

• Report this Comment On September 28, 2009, at 4:52 PM, BMFPitt wrote:

  Aside from shenanigans regarding trumped up unrelated preexisting conditions (which to the best of my knowledge is a pretty rare occurrence) I have no problem with the way insurance companies operate. My problem is with the current plans to staple another pile of administrative overhead onto our already duct-taped together system. Anything that preserves the current employer-based system is only perpetuating the problem.

  The patient is bleeding out from a gunshot to the stomach, but the "cure" that is being proposed is to amputate both arms.

  In an ideal world, there's be a nationalized entity that covers 95% or so of catastrophic and childhood care, individual tax-free health savings accounts, and the AMA wouldn't prevent nurses from doing simple things that they can easily do at a much reduced cost. There's probably about as good a chance of that as there is of the Pittsburgh Pirates goign undefeated next year.

• Report this Comment On September 28, 2009, at 4:57 PM, dad2four wrote:

  Us americans are driven by profit and incentive

  people who develop and research are not stupid

  If there is no incentive to advance medicine, they are smart enough to move on to a more lucrative line of work

  Profit and financial stability is what brought all of my readers to the "Fool" to begin with

  think about it!

• Report this Comment On September 28, 2009, at 5:03 PM, spinindog wrote:

  Democrats spend tons of money to find those rare instances of an insurance company has denied legitimate claims. They love to haul out the .000005% of claims that should have been paid. It makes for a great speech to people dumb enough to buy it.

• Report this Comment On September 28, 2009, at 5:15 PM, Smithtenn wrote:

  No one likes being ill and all like it even less to pay for it. There probably is not enough money in the world to give everyone the best of everything in medical care -- and that's assuming we could determine what the best care is. We have to accept the fact that universal health care requires rationing of health care. No on over 65 gets dialysis or heart bypass. Instead we spend that money on babies so we get a greater return on our investment. Oregon several years ago listed the procedures the State could provide for everyone and the diagnoses that would be trteated. All the rest had to be paid by the patient. You want more things treated, pay more taxes. It isn't free! I'm a retired physician who was 30 years old before he could actually earn a decent living.

• Report this Comment On September 28, 2009, at 5:17 PM, Beecharmer13 wrote:

  Government run health care is still dealing with a profit margin system.. Don't let them kid you. If there not getting enough taxes to pay for services they will simply be denied. Ex Europe's healthcare plan says it's too expensive for advanced breast cancer meds. So the patients have been denied these medicines.

• Report this Comment On September 28, 2009, at 5:22 PM, mtracy9 wrote:

  The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO.

  Provincial single-payer plans in Canada have an overhead of about 1%.

• Report this Comment On September 28, 2009, at 5:23 PM, mtracy9 wrote:

  Interesting that France's health care system is rated #1 in the world. And the French pay only half of what Americans (ranked #37) pay. No wonder the neo-cons at Faux News don't like the French.

• Report this Comment On September 28, 2009, at 5:26 PM, parcheymex wrote:

  In my early years, as a progressive professional I was

  a health planner ostensibly to prevent duplication of

  major hospital services and facilities where possible so that the public funded Medicare/medicaid could

  prevent taxpayer dollars from abuse in private hospitals and other health care facilities.

  If .000005% of the claims received by private health insurance were all that we have to worry about I doubt seriously there would be a problem with the present system. That figure is woefully miniscule in comparison to the actual denied claims figures.

  In fact, claims are routinely denied whenever it is felt that payment wouls jeopardize profits realised. The real peril in fully servicing the health care needs of this country is the staggering accummulation of unmet need that has built up over the years we have been deluding ourselves that private health insurance adequately covers the need. Enough said about private health insurance (ie you are a boob if you believe otherwise).

• Report this Comment On September 28, 2009, at 5:32 PM, 777091 wrote:

  1. Having lived and suffered under national health care in another country, I do not look forward to having it here in the US.

  2. If the profits of insurance companies are too high, it is only because government rules limit competition. Let them compete across state lines, and the profits will end up "normal."

  3. From my 40+ years in private and government organizations (not health care), I can testify that the private profits are in general much lower that the losses from government inefficiencies. These inefficiencies are in reality much higher than what is officially measured.

• Report this Comment On September 28, 2009, at 5:33 PM, Marvelous52 wrote:

  My question is whether anyone out there actually believes that government employees, with no incentive to work efficiently or to innovate, could run an insurance program as efficiently as a for-profit insurer. The less efficient the program the greater the cost, and in a competitve environment, the inefficient, more expensive program would lose to the competition. A government program, without competition and no incentive to run more efficiently, would undoubtedly cost the taxpayer more.

  Why does anyone think it will be different this time?

• Report this Comment On September 28, 2009, at 5:33 PM, PoundMutt wrote:

  mtracy9 wrote: "Interesting that France's health care system is rated #1 in the world. And the French pay only half of what Americans (ranked #37) pay."

  I am going to be 71, HOW MUCH health care do 71s get in France? All those OTHER 35 countries ranking above the USA?

• Report this Comment On September 28, 2009, at 5:37 PM, PoundMutt wrote:

  mtracy9 wrote:

  "Interesting that France's health care system is rated #1 in the world. And the French pay only half of what Americans (ranked #37) pay."

  I am going to be 71 in October. HOW MUCH health care do 71s get in France and the OTHER 35 countries ranked above the USA?

• Report this Comment On September 28, 2009, at 5:39 PM, PoundMutt wrote:

  OOPS! I looked too soon for my comment and sent it again!

• Report this Comment On September 28, 2009, at 5:40 PM, leenapaivikki wrote:

  Not claiming knowledge of all health care systems in the world, but I have understood that many come to US to get the care they feel they need and cannot get in their own country with government lead health care system. It has also been reported that in US you can get the best and the latest that is possible in health care. If all that is true - how should one think of this "voting with one's feet"? Should we get into a system that limits research spending and regulates the amount of care one gets based on age?

  I recognize the need to do something with the health care system we presently have, but to go onto government regulated one? Not liking that much at all. There's gotta be a better way. Shouldn't US be motivated to be a world leader rather than follower. US is the most innovative (based on patents issued) and most productive country in the world. We have got to be able to get together a more innovative solution to the health care problem than the government regulated one. There has to be a better solution - but - is anyone really looking for it?

• Report this Comment On September 28, 2009, at 5:44 PM, thunderbob wrote:

  thunderbob

  For the person who wants everything nationalized check these links:

  http://www.dentistry.co.uk/news/news_detail.php?id=15

  http://blog.mises.org/archives/005021.asp

  Do you want your health care to be just like the UK?

• Report this Comment On September 28, 2009, at 5:46 PM, themoment wrote:

  Those that are in favor of rejecting those that haven't the money to pay the hospital fee's, haven't had a family member die, due to being turned away, or lose a leg or hand due to an infection that the hospital wouldn't treat because they had no way to pay. Also, if a family making minimum wage can't afford to buy insurance now, how will they do it when the goverment fines them and then demands they pay? The people I speak of are born citizens that do work that most people wouldn't consider doing. So they do it for you, for next to nothing. Then can't afford to buy insurance. Who will do your dirty work once they have all passed on?

• Report this Comment On September 28, 2009, at 5:49 PM, harrymax wrote:

  If the fire department ran like insurance companies, the firefighters would not put out a kitchen fire if the cook didn't have a fire extinguisher because being prone to a kitchen fire was a pre existing condition. The fire department wouldn't want to put out a fire that was already out of control, or on the upper floor and would capitate their effort to put out the fire. They would leave the scene early before the fire was out. The fire department wouldn't put out a fire of anyone who didn't pay them in advance. The fire department would gladly put out fires for the well connected but not for the rest of us. Thank God the firefighters don't work for profit.

  Health insurance should not be for profit. It ends lives.

• Report this Comment On September 28, 2009, at 5:49 PM, Wyeth027 wrote:

  There is no single solution that would add coverage to everybody all those now insured plus those that are now not seeking insurance, but a step in the right direction would be for health experts to design several types of policies that would form the basis of coverage for all economic levels or perceived levels of need. Then, standardized forms coupled with open borders for purchase of these same policies would not eliminate profit but it would lead to considerable streamlining and competition, thus squeezing cost our of the delivery of healthcare across the board. The second step would be to create a national catastrophic fund using a small tax levied on all insurance policies to serve as reinsurance of the entire insured populace. Such a fund should be held "in trust" and possibly run by the Social Security Administration. Tort reform should follow and juries replaced with medical boards of qualified experts approved by the state medical societies of those certifiably eligible to serve. Inherent is this new system would be the separation of coverage from employment thus requiring each potential insured to price his own policy and be required to maintain it just as drivers are required to maintain auto insurance.

• Report this Comment On September 28, 2009, at 5:51 PM, retiredmd wrote:

  Drug companies are able to market their products at different prices in different countries and stil turn a profit. I am not comfortable with the idea that we should be shouldering the R&D costs unequally with the rest of the world.

  Innovation is great, but the result has often been the over use of technologies due to the lack of careful evidence medical research to establish their validity as tools that improve health. Another factor is the liability force that drives testing that is otherwise statistically not indicated.

  As for the fear of socialized medicine, it already exists as Medicare and Medicaid. Unfortunately like most government efforts they are fraught with inefficiencies since they are run as burocracies and not as businesses. That is not to say they should be businesses, but they would benefit by being held accountable to business standards.

  A leveling of reimbursement for various medcal professions would go a long way toward encouraging primary care as a commitment by physicians. Primary care physicians are seldom paid anything close to that of those in surgical specialties. It is shameful that those who work to keep patients well are paid a small fraction of those in other branches of medicine. Is their effort really of that much value? Should the reimbursements be tempered some?

  I believe we need to be forthright in our efforts to finance healthcare. We should be willing to pay for the care, goods, and services provided. But this should not be accomplished by cost shifting to those who are insured, or charging outrageously those who seek care, want to pay, but are uninsured. Perhaps an affordable tax supported program that was elective for those who are able to afford insurance either through group plans or independently, and a subsidized but mandatory program with fees proportionate to gross income. This coupled with on going evidence based review of therapies and diagnostic proceedures, and negotiated prices of drug and medical consumables. Opening of the import border to the purchase of drugs from evaluated providers in other countries.

  Just a beginng....but the time I think has come for us to afford healthcare for our citizens. It happens and is paid for by taxation in many countries. It will require some financial sacrifices, however I feel we owe it to our society to come to terms face on with the costs of healthcare and afford what is of proven value and worth.

• Report this Comment On September 28, 2009, at 5:52 PM, jc09058 wrote:

  Nationalized health care? No, I don't think so and first hand experience tells me this is a very bad idea.

  I spent a total of 10 1/2 years living in Germany and my sister has spent 19 years living in England. Both of us have experienced national health programs in those countries and we both agree it is a great way to play lotto suicide by doctor.

  Sounds funny? No, it isn't because my sister damn near died due to national health programs that use doctors that they hire as cheaply as possible. They tend to be the worst educated and over worked.

  Consider how every government program is run in the US and ask yourself if you would be willing to have yourself treated by the lowest bidder? I'm not joking about that and that was never meant to be funny.

  I am willing to pay the extra and incur debt to know that the doctor I will see is capable and competent at his/her's profession. Where I have a good chance of living a full and productive life.

• Report this Comment On September 28, 2009, at 5:54 PM, healthcare41 wrote:

  I have been a healthcare provider for 41 years. Insurance companies are not healthcare providers. They are businesses that have an average 30% administrative cost as opposed to Medicare that operates on a 3-7% administrative cost. We are not talking "allowing them to make a profit". We are talking about the multi-millions that the top administrative people take home. When you see your insurance company stock split 2-4 times per year, I do not think we need to worry about them. I think we need to bring them into balance with the rest of the economy. (And yes I do own some insurance company stock, but I also have a conscience. The cost of private insurance continues to rise out of proportion to inflation or the status of the economy. The benefits do not increase. A "pre-existing" condition of mumps as a child that you did not think to include on your application form can cause them to deny your claim or drop your coverage when you become seriously ill even though they have gladly accepted your premiums for years. Denials are NOT rare. Just because you have insurance does not mean you will have coverage when you need it. Rates are going up every year. Copay and maximum payable by patient go up every year. There has recently been lobbying for a 35% payable by patient of any medical expenses. Most people filing bankruptcy due to healthcare expenses have insurance.

  Even moderate sized companies are struggling to continue to provide insurance coverage for their employees (not family coverage).

  Medicare is the most reliable coverage around. If we could offer Medicare to younger people (the ones who do not usually have a lot of medical expenses) at a reasonable rate, it would help to provide funding for our basic Medicare coverage for those 65 and over.

  It would be better if those in Congress who accept millions of dollars from the Insurance industry were not allowed to vote on this issue, since they do not seem to be able to put the needs of those who voted them into office above their personal needs.

  Healthcare providers are in favor of true reform-competition for the private insurance providers, and tort reform to limit the outrageous judgements that are sometimes awarded.

• Report this Comment On September 28, 2009, at 6:00 PM, thunderbob wrote:

  thunderbob

  The US could welcome people from other countries to come here for their health care. Charge them a fair price for round trip air fare, hotel rooms, etc, provide their treatment and spread the cost for our health care among many more people. That would also help the airlines, the hotels, rental cars and other service industries. Las Vegas does it, why cant the US do it also?

• Report this Comment On September 28, 2009, at 6:13 PM, Cal77 wrote:

  There's nothing fundamentally wrong with healthcare companies making a profit, as long as people can afford health care.

  If getting health care insurance costed the same as insuring a car for instance (as it does in other western civilized countries), everything would be fine, and people would be minding their own greedy business.

  It's only when one realizes that things have gotten out of hand in every aspect of health care costs, that it should become obvious to anyone in a civilized society that the rules of the game must change. Even if that means going against some deeply engraved beliefs that all out Capitalism is the ultimate Darwinian good.

  Now I can almost understand that the average ignorant American can be easily lead to fear the boogie man. What I cannot understand is that he/she cannot be as easily lead to appreciate the reality in every other civilized-ish country where health care costs are affordable to everybody, to the point that they are not even a factor in people's budgets.

  And I mean both public (subsidized) and private (unsubsidized) health care.

  The whole US system is broken, and fundamental changes must be made. Accept that, or die denying it.

• Report this Comment On September 28, 2009, at 6:17 PM, 7t52day wrote:

  We're not questioning the fact that there are bright people in R & D...and the brighter they are (with a little luck) they come up with better solutions to problems, whether it's health care, engineering, whatever. If the company's really smart they provide an incentive for these R & D geniuses....then they build ROI into their costs. That would seem to be a pretty good incentive.

  Low percentage of denials???.....Try asking some veterans who have found out that the "manual" says to automatically deny at least the first health claim,.. no matter what.

  Unfortunately, medicines are still released for human treatment with sometimes deadly side effects, because of an inefficient monitoring bureau. Yes, the system needs changing. but, while profit is natural...greed, when it concerns human suffering, is NOT, (no matter what Michael Douglas says from his cinematic, Wall Street ivory tower).

• Report this Comment On September 28, 2009, at 6:30 PM, Kassym wrote:

  Note that the new system would NOT put the health insurance companies out of business. Those who think their insurance company is so wonderful can keep them. Then, when you are dropped you will have an OPTION available. Note that one problem with selling across state lines is that each state has their own set of rules and regulations regarding health care insurance. Talk about red tape. We must have insurance to drive a car now - thank goodness. Tax breaks for small business and individuals to pay for insurance premiums will be made available that were not previously available. The present system is hurting small business more than any requirements to help out their employees ever would. Oh, and someone made a remark that Medicare would not pay for a heart bypass. My mother had a valve replacement and three bypasses on Medicare at 85. She is now 90 and occasionally plays tennis. There may be problems with the health insurance option but it will be worked out and everyone will be healthier so that we won't have to pay for uninsured people who show up at emergency rooms like we are paying now in our regular premiums that have more than doubled since they killed the Clintons' health care reform attempt in the early 90's. This is not England, Germany or Canada. This will be a unique American Insurance Program.

• Report this Comment On September 28, 2009, at 6:35 PM, amt77 wrote:

  Brian Orelli - I think you blew your point and your article. You start out with 3 quotes from readers. 2 are specifically about Health Insurers should/shouldn't be profiting (one even said he didn't mind his health provider/doctor making money) and one didn't specify who they thought shouldn't be making money on our sickness.

  You then take the liberty of going into Drug Companies and Research and their need for profit. You succumbed to the classic apples and oranges. Health Insurers do NOTHING to promote our health and that is who your readers said shouldn't be profitting from our sickness. That 3rd quote that didn't specify, could have been saying Insurers shouldn't make money on our illnesses. But since you brought up big pharma, you know there are only 2 countries in the world that allow pharma to do Direct to Consumer advertising, the U.S. and New Zealand. They spend 2.5 billion each year on this dubious practice and it comes out of the money we give them for our medicines! I don't object to drug companies profiting but explain to me what the purpose of DTCA, what do all the other countries besides US and New Zealand know??

• Report this Comment On September 28, 2009, at 6:41 PM, gardy3 wrote:

  Somewhat surprising that with a group like this there has been so little discusion of the cost of medical malpractice on the healthcare industry, Every facet of the industry spends much more of the Insurance Co $ than would be spent if Med Mal was not such a big problem. Check the reduction in costs in states like Alabama where there has been meaningfull tort reform. While you are checking on Alabama check to see how many states have totaly lost doctors of specialties like gynacology due to rising costs of Medical Malpractice.

  Insurance rates are set by the state insurance departments. These folks preserve their control of the industry and have prevented development of federal insurance regulation which in Health insurance could be a way to lower costs.

  I know why Obama and his attorney minions have so little respect for the "public". They have been demonizing the insurance companies (some of whom may deserve it). The media and many posting here gobble it up and spit it out like trained seals.

• Report this Comment On September 28, 2009, at 6:44 PM, perobin wrote:

  Mtracy you must get your info from nancy pelosi, and the french let their aged dehydrate, the tax rate is double what it is here and now they have to pay a fee of about $30.00 every time they visit the Dr. 3% overhead on Medicare, I believe you left off a zero, but that would still be a horrible amount of money. Doctors by the droves are refusing to take medicare and it it breaking our hospitals. You have evidently never worked around healthcare are visited with someone that has lived under nationalized medicine. Why do you thing so many come to the U.S. for healthcare, I guess they want substandard care i fi thought you had any idea whay really goes on.

• Report this Comment On September 28, 2009, at 6:49 PM, jill2004 wrote:

  Part of the problem may lie with how insurance administration is evaluated. If it is evaluated on how much it "saves the plan" in terms of money, then the incentive is to deny as many claims as possible. Under this system, the weak who can't fight back lose. And we all lose. A healthy me depends partly on a healthy society. Thus, evaluation of health insurance administration should be based on how well the administration serves the client--both by denying unqualified claims and by facilitating (not impeding) the payment of expenses that are necessary and reasonable.

• Report this Comment On September 28, 2009, at 7:05 PM, Gayle914 wrote:

  I do not have a problem with doctors, hospitals or anyone directly involved with health care making a profit.

  I do have a problem with health insurance dictating what my doctor and I decide we want to do for my health. And I have to pay them for the privilage!

  I would like to have major medical insurance only and get the insurance companies out of the health care business.

  People are talking about insurance companies making a profit but you also have to realize that we are also paying for them to be in business plus a profit!

  Tort reform is also necessary to help lower the cost health care.

  There is no Value Added with the way the system is now set up!

• Report this Comment On September 28, 2009, at 7:59 PM, rjp123 wrote:

  How does an insurance company aid in the longevity of its subscribers?

  I do not see the correlation between processing bills and longer life.

  Insurance companies do not produce a product, they do not make a diagnosis, they do not perform life saving services and they certainly do not help lower blood pressure or cure depression.

  I am not keen on the idea of the govt taking the place of an hmo and making the call whether a procedure is worthy or not but if there can be a middle ground that includes getting rid of or severely limiting an insurance companies motivation (profits) I would be willing to listen.

  The govt screws everything it touches so we would also need some protections from them built in as well.

• Report this Comment On September 28, 2009, at 9:50 PM, jm7700229 wrote:

  I am amazed at the way in which the health insurer opponents get all their information from each other. For instance, mtracy9 repeats the figure of 3% for Medicare overhead. Sounds important until you learn that Medicare outsources ALMOST ALL processing to the private sector. Medicare's 3% is on top of all of the other processing costs.

  Here's a list of the major dollar exchangers in health care:

  1. Hospitals

  2. Doctors

  3. Pharmas

  4. Health insurers

  5 Lawyers

  6. Government

  Question: which of these entities is working to reduce health care costs (there is only one)? Hint: it's not the government, which caps its own expenditures and passes the rest on to the private sector while adding mandates like adoption expenses that have nothing to do with health care.

  As has been pointed out, health insurance is not a particularly profitable business. Many of the pioneers, like Met Life, have gotten out of the business altogether.

  I think the primary reason we consider the insurers to be the problem has to do with lobbyists. The AMA spends far more that the entire insurance industry (including property, liability and life). So do the trial lawyers. So do the hospitals. So do the Pharmas. Our Congressmen, who are the beneficiaries of these lobbyists' largess, become very prone to attack the people who aren't greasing their fingers.

  As far as denials, I think they are rare and greatly exagerrated. Or maybe you guys all have lousy insurance companies. I have had Blue Cross in four states and have never had a claim denied or questioned improperly, and I've had a lot of them. On the other hand, when I broke my neck a couple years ago, I was overcharged $4,000 by the doctors and $22,000 by the hospital. Thank God for Blue Cross, which straightened them out. In fact, I always call BC first when I have a question because a person answers the phone and almost always can answer without putting me on hold. They can tell me what the doctor or hospital did wrong and will help me fix it. A couple times, they even paid things they shouldn't have instead of leaving me caught in the middle.

  Those of you who are prepared to trust your health care to the post office and look to the DMV for compassion are welcome to move to Canada. In the meantime, I would like someone somewhere to give me a single example in which the government has been able to do something as well and for the same or less cost than the private sector. Those of you who own investments in FedEx and UPS should be able to answer that one.

• Report this Comment On September 28, 2009, at 9:57 PM, Vynch wrote:

  The way I see it, the role of the govt is to provide services that ensure the safety of the people. They collect taxes and spend the money on infrastructure, defense, education etc in a relatively transparent way, and we have ample opportunities to change the government.

  And so it seems to me that insurance premiums are essentially a tax, in that they are an inevitable levy collected by an entity that spends the proceeds to manage the healthcare infrastructure.

  But their spending is absolutley nontransparent, and we have no say in who is collecting and spending.

  They offer taxation without representation or accountability. They are imperialists.

• Report this Comment On September 28, 2009, at 9:58 PM, themoment wrote:

  Talked yourself right into that, didn't you. Glad you could sell yourself.

• Report this Comment On September 28, 2009, at 10:09 PM, Pharonic wrote:

  Ok Jm77,

  I believe the U.S. Marines do a better job for about 1/10th the price of a private army like Blockrock. So there are some gov services that work well and we all depend on.

  As for the comments on France I have to say. My family and I visit Paris as often as we can and twice my 80+ yr old father in law has needed to be treated while in Paris. The first time he was ill and called a doctor to come to our place. They treated him at home and the cost to him was 40 euros, for a house call. The second time he fell. We took him to the hospital, he had xrays and was evaluated. Turns out he broke a few ribs. The cost, zero. That's right nothing.

  That's what being first in health care in the wourld is like.

  I know people say the tax rate is so high in Europe. It's 35-40% for most people. Well guess what, living in NYC after paying the fedral tax the state tax and the city tax, I pay 35 % now, and that does not include sales tax.

• Report this Comment On September 28, 2009, at 10:14 PM, irapm wrote:

  With all the talk of rationing health care how is it that many of these commentators don't seem to get it that health care is at this very moment rationed by the insurance companies. I presently send my insurance company almost $1k a month and this is without, at the time of original enrollment, a diagnosed pre-existing condition. I am 72 and aside from four stents in very good physical condition. Does anyone think that in my present condition I would stand a snowball's chance of getting coverage for any amount of money? Yes I qualify for medicare now but at the time of my diagnosis and first stent over 14 years ago, I would have been driven to bankruptcy or simply planted. We as a nation maintain the largest military in the world which is a far greater drain than the cost of healthcare for our whole hemisphere and perhaps for the world. Lets wake up, stop posturing about "realpolitik" and understand that nothing lasts. We have one opportunity at life and I cannot comprehend, beyond an overwhelming fear of death, why anyone with a right mind finds any solace in the form of military might. Women give their children to feed the caskets, the priests bless their sacrifice and promise another life and the politicians along with the generals beat the drums of war. Nothing lasts and nobody gets out alive. I would rather work to live in peace than prepare to die in fear.

• Report this Comment On September 28, 2009, at 11:10 PM, DougScorpio wrote:

  ET69 suggests that everyone integral in health care delivery should be a government employee. End any kind of compensation based on degree of training, or years spent improving ones skills. Just pay everyone the same; let 'big-brother' coddle us from birth to dust. So where are medical and scientific innovations coming from; perhaps Michael Moore can provide ET69 some guidance. I would submit that it is not from Cuba, Russia or Venezula.

• Report this Comment On September 28, 2009, at 11:19 PM, jm7700229 wrote:

  OK, Pharonic, I take nothing from the Marines, but Blackrock is not in competition with them; rather it's doing their dirty work. On the other hand, I'll bet that Blackrock doesn't pay $600 for a hammer.

  Let's talk about enterprise, though. Fifty years ago, almost all road building was done by government workers. Today that only happens in highly corrupt environments like Rhode Island. Everyone else has figured out that private companies that have to bid on work keep costs down and don't need to be paid for not working. And can still make a profit at it. Fifty years ago, all residential package and mail delivery was done by the government. Without the statutory monopoly, the government would have long since been put out of business. The rest of the world, including Japan and Europe, those classy people, are saturated in cell phones compared to the United States. Why? Inefficient state run telecoms make cell phones a no-brainer there. So come on: tell me how government employees are going to be busting their butts to be efficient and compassionate and to have some other goal than their traditional long term one of doing the least work for the most money while whining constantly about how the hate their jobs and making sure they never leave them..

• Report this Comment On September 28, 2009, at 11:20 PM, hupgwu wrote:

  I recommend reading "Consumer-Driven Health Care" by Regina E. Herzlinger (Harvard Business School).

  See: http://www.businessweek.com/magazine/content/08_51/b41130663...

  Third parties distort the market. Equalize the tax treatment and permit all citizens to purchase plans that "fit their individual needs" with pre-tax dollars through defined contribution plans. Allow market forces to work with some government oversight to protect citizens. Permit insurance companies to offer plans across state lines. Stop allowing policy wonks to tell us what we need and can and cannot have.

• Report this Comment On September 28, 2009, at 11:20 PM, donq70 wrote:

  As my son, an Air Force Officer, comments, " The military is the most efficient part of the government. That should scare all of your to death." My experience dealing with the government in research and development for 50 years is that of the nearly 1000 "government managers" only about a dozen were someone I would trust to understand what they were supposedly in charge of. Government hiring policies for the level of personnel that would staff medical management issues would make whatever you have now look like heaven.

• Report this Comment On September 28, 2009, at 11:47 PM, robertf36009 wrote:

  Why rush into a lot of measures that are bound to have unintended consequences? Start with the free stuff like tort reform and pooling insurance resources. By streamlining regulation across state lines and letting groups of individuals/businesses group together to expand risk pools prices would be driven down. Place a small excise tax on all policies to create a fund for indigents and we will achieve much at minimal cost to tax payers. These can be done as individual single bills with no need for broad sweeping cumbersome legislation

• Report this Comment On September 29, 2009, at 12:10 AM, mabar2000 wrote:

  First Pharmaceutical companies are not the same as Health providers.

  PFE and ABT have just engaged in multibillion expansions and their dividends are about 5% not their earneanings!!

  Most (90%) health care research (and some drugs) is supported by NIH.

  So start with facts not speculations.

  What percentages of each health care dollar goes to insurers, providers,and drug companies?.There you will find how to tackle the problem!!.

• Report this Comment On September 29, 2009, at 12:13 AM, topsecret09 wrote:

  The two most Important Issues of this generation are the Federal Budget Deficits,and Social security. It would also help If there was a HINT of JOB CREATION. Health care has been made a priority of the SPECIAL INTEREST GROUPS that are IN control of Congress. Until the AMERICAN PEOPLE wake up,and quit listening to the MEDIA that Is bought and paid for,nothing good will EVER come out of Washington... TS

• Report this Comment On September 29, 2009, at 12:26 AM, topsecret09 wrote:

  Heres the real reason the Democrats are trying to shove healthcare through so fast.... And why PELOSI and REID say there MUST be a "PUBLIC OPTION". First you get the ILLEGALS covered with healthcare,then you give them AMNESTY,then you collect MILLIONS of votes for all the future elections In the UNITED STATES. And If this happens..... You WILL end up with a SOCIALIST UNITED STATES that Is TOTALLY CONTROLLED by your U.S (REPRESENTATIVES).... And if you don't think that this Is true,that means that you listen to the MAINSTREAM NEWS MEDIA TOO MUCH..... TS

• Report this Comment On September 29, 2009, at 12:30 AM, topsecret09 wrote:

  You can sit back and let this happen,or you can ask your REPRESENTATIVE In Congress why they Insist on aiding and abetting ILLEGALS In this country,which Is against FEDERAL LAW...

  Federal Immigration and Nationality Act

  Section 8 USC 1324(a)(1)(A)(iv)(b)(iii)

  "Any person who . . . encourages or induces an alien to . . . reside . . . knowing or in reckless disregard of the fact that such . . . residence is . . . in violation of law, shall be punished as provided . . . for each alien in respect to whom such a violation occurs . . . fined under title 18 . . . imprisoned not more than 5 years, or both."

  Section 274 felonies under the federal Immigration and Nationality Act, INA 274A(a)(1)(A):

  A person (including a group of persons, business, organization, or local government) commits a federal felony when she or he:

  * assists an alien s/he should reasonably know is illegally in the U.S. or who lacks employment authorization, by transporting, sheltering, or assisting him or her to obtain employment, or

  * encourages that alien to remain in the U.S. by referring him or her to an employer or by acting as employer or agent for an employer in any way, or

  * knowingly assists illegal aliens due to personal convictions.

  Penalties upon conviction include criminal fines, imprisonment, and forfeiture of vehicles and real property used to commit the crime. Anyone employing or contracting with an illegal alien without verifying his or her work authorization status is guilty of a misdemeanor. Aliens and employers violating immigration laws are subject to arrest, detention, and seizure of their vehicles or property. In addition, individuals or entities who engage in racketeering enterprises that commit (or conspire to commit) immigration-related felonies are subject to private civil suits for treble damages and injunctive relief.

  Recruitment and Employment of Illegal Aliens

  It is unlawful to hire an alien, to recruit an alien, or to refer an alien for a fee, knowing the alien is unauthorized to work in the United States. It is equally unlawful to continue to employ an alien knowing that the alien is unauthorized to work. Employers may give preference in recruitment and hiring to a U.S. citizen over an alien with work authorization only where the U.S. citizen is equally or better qualified. It is unlawful to hire an individual for employment in the United States without complying with employment eligibility verification requirements. Requirements include examination of identity documents and completion of Form I-9 for every employee hired. Employers must retain all I-9s, and, with three days' advance notice, the forms must be made available for inspection. Employment includes any service or labor performed for any type of remuneration within the United States, with the exception of sporadic domestic service by an individual in a private home. Day laborers or other casual workers engaged in any compensated activity (with the above exception) are employees for purposes of immigration law. An employer includes an agent or anyone acting directly or indirectly in the interest of the employer. For purposes of verfication of authorization to work, employer also means an independent contractor, or a contractor other than the person using the alien labor. The use of temporary or short-term contracts cannot be used to circumvent the employment authorization verification requirements. If employment is to be for less than the usual three days allowed for completing the I-9 Form requirement, the form must be completed immediately at the time of hire.

  An employer has constructive knowledge that an employee is an illegal unauthorized worker if a reasonable person would infer it from the facts. Constructive knowledge constituting a violation of federal law has been found where (1) the I-9 employment eligibility form has not been properly completed, including supporting documentation, (2) the employer has learned from other individuals, media reports, or any source of information available to the employer that the alien is unauthorized to work, or (3) the employer acts with reckless disregard for the legal consequences of permitting a third party to provide or introduce an illegal alien into the employer's work force. Knowledge cannot be inferred solely on the basis of an individual's accent or foreign appearance.

  Actual specific knowledge is not required. For example, a newspaper article stating that ballrooms depend on an illegal alien work force of dance hostesses was held by the courts to be a reasonable ground for suspicion that unlawful conduct had occurred.

  IT IS ILLEGAL FOR NONPROFIT OR RELIGIOUS ORGANIZATIONS to knowingly assist an employer to violate employment sanctions, REGARDLESS OF CLAIMS THAT THEIR CONVICTIONS REQUIRE THEM TO ASSIST ALIENS. Harboring or aiding illegal aliens is not protected by the First Amendment. It is a felony to establish a commercial enterprise for the purpose of evading any provision of federal immigration law. Violators may be fined or imprisoned for up to five years.

  Encouraging and Harboring Illegal Aliens

  It is a violation of law for any person to conceal, harbor, or shield from detection in any place, including any building or means of transportation, any alien who is in the United States in violation of law. HARBORING MEANS ANY CONDUCT THAT TENDS TO SUBSTANTIALLY FACILITATE AN ALIEN TO REMAIN IN THE U.S. ILLEGALLY. The sheltering need not be clandestine, and harboring covers aliens arrested outdoors, as well as in a building. This provision includes harboring an alien who entered the U.S. legally but has since lost his legal status.

  An employer can be convicted of the felony of harboring illegal aliens who are his employees if he takes actions in reckless disregard of their illegal status, such as ordering them to obtain false documents, altering records, obstructing INS inspections, or taking other actions that facilitate the alien's illegal employment. Any person who within any 12-month period hires ten or more individuals with actual knowledge that they are illegal aliens or unauthorized workers is guilty of felony harboring. It is also a felony to encourage or induce an alien to come to or reside in the U.S. knowing or recklessly disregarding the fact that the alien's entry or residence is in violation of the law. This crime applies to any person, rather than just employers of illegal aliens. Courts have ruled that "encouraging" includes counseling illegal aliens to continue working in the U.S. or assisting them to complete applications with false statements or obvious errors. The fact that the alien is a refugee fleeing persecution is not a defense to this felony, since U.S. law and the UN Protocol on Refugees both require that a refugee must report to immigration authorities without delay upon entry to the U.S.

  The penalty for felony harboring is a fine and imprisonment for up to five years. The penalty for felony alien smuggling is a fine and up to ten years' imprisonment. Where the crime causes serious bodily injury or places the life of any person in jeopardy, the penalty is a fine and up to twenty years' imprisonment. If the criminal smuggling or harboring results in the death of any person, the penalty can include life imprisonment. Convictions for aiding, abetting, or conspiracy to commit alien smuggling or harboring, carry the same penalties. Courts can impose consecutive prison sentences for each alien smuggled or harbored. A court may order a convicted smuggler to pay restitution if the alien smuggled qualifies as a victim under the Victim and Witness Protection Act. Conspiracy to commit crimes

• Report this Comment On September 29, 2009, at 1:15 AM, Howard1ii wrote:

  Brian, you need to do a little more research before you make a statement like "Sen. John Kerry seems to get it. He's concerned that a tax on medical device companies such as Boston Scientific (NYSE: BSX) and Medtronic. Boston Scientific is headquartered in his backyard and most likely has paid his campaigns millions (not to mention a couple of thousand employees/voters in the state. Plus, Kerry is recommending a higher tax on insurance companies (which we all know will REALLY help bring down the cost of healthcare).

• Report this Comment On September 29, 2009, at 1:27 AM, topsecret09 wrote:

  I guess you just have to live In Caleeeeeeeefornia to truly understand the astronomical costs associated with ILLEGALS and all of their family members ALREADY getting free medical care here In the once Golden State.. Wait until they Invade YOUR neighborhoods.... as Bachman Turner Overdrive once said "You Ain't seen nothin yet"

• Report this Comment On September 29, 2009, at 1:50 AM, Gratta wrote:

  Concerning health insurance:

  even according to people working for the World Bank it is clear that the only possible way to have an efficient health sector is ONE paying agency who sets the health providers in competition for better cost/effective services.

  But keep in mind that this is NOT enough. The agency must also work effectively. We have in Europe good examples (like scandinavian countries) and bad ones (like Italy).

  Gratta

• Report this Comment On September 29, 2009, at 7:15 AM, dagrman wrote:

  Dear Fools,

  I have to ask how much WE are responsible for higher health costs. I've read some comments about how government involvement would stiffle innovation, but I have to ask, who is more concerned about making a profit - the innovators or those who fund them?

  I like capitalism as much as the next Fool, but I'm not sure we need to chase 15% + profits on everything.

• Report this Comment On September 29, 2009, at 7:40 AM, fish4uinmd wrote:

  The bottom line on healtcare IS the bottom line...regardless of the profits, Americans cannot afford this overwhleming expenditure. Small business owners will be the ones that will take it on the chin (they are, after all, responsible for 70% of the new jobs created) Someone has to pay for it, and it will be the hard working middle class...again!

• Report this Comment On September 29, 2009, at 7:51 AM, Jedermann wrote:

  Another misinformed conclusion to one of your articles. I just moved home from living in Europe for years. The medical technology is way ahead. I even found this to be true when I lived in Colombia. COLOMBIA!

  Stop spouting these gov't kills technology falsehoods. Why did Boeing go after Airbus in the world courts. Because their "subsidized" technology was beating on Boeing. And as always, would you rather drive a BMW or a Chevy? Come on! The evidence is there. Your line of thinking is bogus.

• Report this Comment On September 29, 2009, at 7:56 AM, topcatman wrote:

  Seriously, MF treats subscriber as if we actually are fools, by using the whining, simpering tone with every use of the word "profit". No one, not even the government, is against "profit" ("profit", after all, is ultimately what funds the tax base.), but MF costantly refrains the wounded, trapped kitten, when someone questions the delivery of the promised product that is generating the profits, instead of reneggin on the promised treatment and care.

  Didn't see any whining from MF when the hated control government boarded busses to deprive seniors of the opportunity to purchase needed medications in Canada at a price they could afford. I have to wonder how the companies providing those drugs at much lower costs, are surviving without making any profit. Tell me how that works?

  TC

• Report this Comment On September 29, 2009, at 8:34 AM, jeeads wrote:

  The question isn't about profit and lose or about government run health care it is about the society we want to live in and the society we want to pass on to our childern. Currently our society seems to regard war more important than health care for our citizens? We continue to let Washington get us into these "War powers act" wars that are never declared so industry is not nationalized, there is no exit strategies, our citizens are being killed daily and there seems to be an unlimited pocket book to keep these going. I was brought up believing that the USA was number 1 well since our major debt holders have become our enemies, China and Russia, it might not be long before they dictate our foriegn policy. Ike was right, beware of the Military-Industrial complex. I for one am willing to shift the emphasis from war to health care.

• Report this Comment On September 29, 2009, at 8:47 AM, spendamony wrote:

  Profit should not enter the process at all when we talk about the actual care giving by hospitals and clinics. If a sick individual enters a hospital or doctors office they should receive immediate attention without having to worry about going bankrupt. How much of the 6% profit is enabled by those who were refused health care? The illegal alien thing is not a health care problem it is an immigration problem, fix that and you have fixed the issues regarding their health care.

• Report this Comment On September 29, 2009, at 10:52 AM, StateCollegeGuy wrote:

  This is why I believe Foolish editors should stick to just making money and analyzing stocks.

  "Making bucks off of sick people" ? Are you serious ? Then Walmartis making money off of hungry people ? JC Penney is making money off of naked people ?

  I believe the writers and editors of FOOL are a wealthy lot and hence to make the stereotype complete they have decided to behave like falming libs.

• Report this Comment On September 29, 2009, at 10:53 AM, ozzfan1317 wrote:

  Mystic stocks I agree completely it would be a the right step in the right direction if we could accomplish those four.

• Report this Comment On September 29, 2009, at 11:01 AM, topsecret09 wrote:

  On September 29, 2009, at 8:47 AM, spendamony wrote: The illegal alien thing is not a health care problem it is an immigration problem, fix that and you have fixed the issues regarding their health care. Unfortunately AMNESTY will only make OUR HEALTHCARE SITUATION WORSE TS

• Report this Comment On September 29, 2009, at 12:05 PM, FreddyWhite wrote:

  Has anyone been to a Country with free health care? I live in Germany and they have free health care here and it is retarded. I'm American by the way. The Doctors are hardly ever at work because they get paid no matter what and then they are on strike every other week. They Docs have no motive to work because they don't make a profit. My wife has had back problems for a while now and the doctors here basically blow her off every time because they just don't care here about the patients. If the patient complains or leaves that doctors office he still gets paid. Lastly the hospitals here look like they are from the 80's because they don't make as much money as US hospitals...I really want to see this in America because everyone who says they want free health care are going to be the ones saying "where is my fancy doctors or where is the TV in my room?" Keep the health care system we have now just lower the cost of what insurance companies charge.....

• Report this Comment On September 29, 2009, at 1:14 PM, mtopper wrote:

  @healthcare41

  "Medicare is the most reliable coverage around. If we could offer Medicare to younger people (the ones who do not usually have a lot of medical expenses) at a reasonable rate, it would help to provide funding for our basic Medicare coverage for those 65 and over."

  This sounds a LOT like how Social Security is supposed to work, a system which as we all know, is due to go bankrupt in the not too distant future. Not a good model for any new program. Especially one that will increase the national debt by as much as has been projected.

• Report this Comment On September 29, 2009, at 1:50 PM, pickerupper wrote:

  My, oh my, oh my. I’ve been reading many of the comments here and it’s hard to know where to start. So many facts. So many opinions. And everybody thinks they’re right. Can we all just step back for a minute and look at the bigger picture? Full disclosure: I’m fundamentally a conservative and generally believe government should be as small as possible and only do what must be done be government. That said, liberals shouldn’t tune me out just yet. I might actually agree with you on some points! I probably have more questions than answers, anyway.

  I think we need to ask what is the reason for all this and why are we in this discussion in the first place? Well, President Obama started it, but someone had to because people, and the government thru Medicare, are going broke trying to pay for health care. The President put it well when he said we need to “bend the cost curve” back down.

  My first question then would be: Why is the cost curve pointed so dramatically up? In other words, why are the costs increasing so fast beyond general inflation? Well, where do our health care dollars go? They go (in NO PARTICULAR ORDER) to:

  • Insurance Companies ( and all their staff)

  • Doctors (and all their staff)

  • Hospitals (and all their staff)

  • Various testing labs (and all their staff)

  • Manufacturers of all the (very expensive) devices used in the above 3 places ( and all their staff).

  • Lawyers (and all their staff)

  • Probably some others I’ve overlooked

  First, insurance companies. I’ve read lots of opinion and see lots of data (some of which contradicts others) about the Insurance companies. They’re in business to make money. Gasp. Of course they are! There’d be no incentive for them to exist if they couldn’t make money. For publicly owned companies, their first goal has to be to make money for their stockholders. I don’t think I’ve ever seen the Fool recommend any stock that expected to return no money on an investment, either on appreciation or dividends. Would any of you buy such a stock? OK. It’s a given they have to make a decent profit. Do they make too much? Maybe. It depends on whose numbers you trust. Do they even belong in the health care business? Maybe, maybe not. That’s maybe even a moral question, but that’s not why the cost curve is bending up at such an alarming rate. Even if we grant that the health insurance companies’ profits are too high, I don’t think their profits have been INCREASING at such a phenomenal rate as to explain why costs are increasing so fast. It seems to me that they’re doing all they can to minimize costs, not increase them, by doing such things as denying coverage, using pre-existing conditions creatively, negotiating lower rates with providers (have you ever compared what a Dr. gets paid from an insurance company vs. what you’d pay with no insurance?), etc. Some of these practices are awful and maybe should be outlawed, but let’s be clear: That will increase costs, not decrease them.

  Next, doctors. Most doctors make a pretty nice living, especially the higher-paid specialists. I think my GP does well, but he’s not making millions. Many years ago my first doctor was in practice by himself. He had a nurse who also handled stuff like answering the phone, scheduling appointments, etc. That’s it. Just the two of them. When we went to see him, we paid him. (Disclaimer: this was some 40 years ago). Now, my doctor is in a practice with 4 other doctors. They have at least 5 or 6 people working behind the scenes. Doing what? Well, I assume interfacing with insurance companies, making appointments with specialists, updating records, etc. All I know is that they’re all busy typing away or talking on the phone or helping a patient. That’s a lot of people to be paying. I don’t know how doctors’ salaries have fared relative to inflation, but there are certainly more people in the loop now. That’s an increase in cost.

  Now hospitals. Some are for-profit, some not. They all have TONS of expensive equipment and are constantly upgrading and beautifying to keep patients and doctors from going somewhere else. There are many, many people working in the typical hospital. We’re paying them all. We’re buying all that equipment. It seems to me (without any data) that we’re paying for constantly increasing costs here.

  Labs? Well, we’re buying all their equipment and paying all their people too. There are more tests and more sophisticated tests being run all the time. MRI tests are run now at the drop of a hat and they are VERY expensive. New geneting testing and other tests (all requiring more sophisticated equipment) are being ordered, often with no regard to costs.

  Manufacturers of all this equipment mentioned above also need to make a profit and pay all their people.

  Lawyers? Well, we certainly do need a way for people to redress grievances but my doctor friends say that they have to pay the equivalent of a fairly high-salaried person each year to cover insurance against malpractice lawsuits. Hospitals must do the same. Presumably, so do labs, etc. We have become an increasingly litigious society and it’s reflected in these increasing costs.

  So, finally to the real question. Why the cost increases? Well, we certainly expect much more from health care than we used to. We expect an MRI every time our knee hurts. We expect the most sophisticated tests. We expect medications for everything. And we want it all at no cost to us individually. This simply HAS to be a large reason for the increases. Are many of the reasons mentioned by others in there? Probably, at least to some extent. If anyone has the temerity to suggest that services have to be curtailed, though, they are immediately tarred with the “rationing” brush. Another big (no pun intended) reason for increases in costs as a nation is that we’re fat (Pardon me. Obese.) . It’s well known that obesity leads directly to many diseases and conditions. Our health care system barely addresses this situation. In fact, our “health care” system is geared almost totally to fixing things after they go wrong, not preventing them in the first place. When was the last time your doctor asked what your were eating and how much exercise you got? If s/he did, you’re lucky. Most doctors either don’t have much knowledge about diet since they’re not educated that way or they simply don’t have the time for such discussions.

  So I expect you’re looking for a grand conclusion about now. I don’t have any. I don’t know if a public plan is a good idea. I don’t even know that this is a problem the government can solve. I do know one thing, that the Law of Unintended Consequences is very real and we should be very, very careful. I think trying to change our whole system dramatically can have effects, some undoubtedly negative, which will last for decades. Every thing we change will change other things in ways we may not have anticipated. I think that’s an excellent argument for going slowly and deliberately. Let’s pick out the areas which can be clearly identified as reasons that costs are increasing so rapidly and go after them first, making other changes only as the effects from the first changes become more clear.

• Report this Comment On September 29, 2009, at 2:03 PM, marketjunkie08 wrote:

  ok html disabled lol

  http://www.youtube.com/watch?v=VPADFNKDhGM

  watch for yourself!

• Report this Comment On September 29, 2009, at 4:13 PM, dodge1026 wrote:

  OK...nobody is saying the obvious. The reason for this discussion is that private health insurance companies have failed. They had their chance. What, they are going to say, "Just kidding...we really didn't mean to raise insurance premiums 35% while offering less coverage! We take it all back!" A public option is the only sane alternative. If you don't want it...don't buy it. But don't tell me I can't have it!

• Report this Comment On September 29, 2009, at 9:57 PM, wolfman225 wrote:

  One thing I have not seen in any of the comments, or in the article itself is any mention of the effect of government mandated coverages on the costs of health care. The closest I've seen is a passing comparison of health insurance with auto insurance.

  Federal and State Insurance Regulators each have their own (not so) little lists of Things Which Must Be Covered. Why? Guess. Votes, people. Politicians live to get re-elected and to that end they offer an endless array of promises that they will make your life better/easier. Get rid of the mandates and you get rid of a large part of the increase in costs (it doesn't matter if they are "funded" or "un-funded") who do you think ends up paying for their largesse?

  I've said it in other places before, but I'll repeat it here because I haven't seen it yet. There is no reason for a woman to have to subsidize prostate screening, hair transplant surgery and ED drugs for middle-aged (and older) men; similarly, there is no reason for a man to have to subsidize expenses for breast augmentation, lipo, plastic surgeries of all kinds, or "fertility treatments"; and there is NO reason for ANYONE to have to subsidize "gender re-assignment" surgeries for the sexually confused.

  If we're gonna have government in our healthcare (and it seems likely, at least in some form), limit it to major medical/catastrophic care ONLY. Let those who want policies that cover routine care or other forseable event chose from a menu of options ala carte. Those wanting truly elective proceedures (which covers nearly all plastic surgery, excepting reconstruction) should pay for them out of pocket (or learn to age gracefully) and the rest of us should be allowed to put aside pre-tax money in HSA/MSA's and to choose our own insurance coverages without restriction to state-approved "providers".

  Just look at the results over at Costco. They provide great coverages at substantially less cost. When you give people a direct stake, costs come down and results improve dramatically. Please, quit looking to someone else to cover your life. NO one has a crystal ball, and NO one has a responsibility to take care of your future. No one---and no government---can.

• Report this Comment On September 29, 2009, at 10:44 PM, bigbubba49 wrote:

  Some things are inherently better handled by government than by individual entrepreneurs. Obvious examples are criminal justice, military forces, highways, and airports. Some things such as news, consumer products, music and movies are better left to the free market. Utilities and schools often fall into a middle zone, with a combination of private and public influences and funding. These types of activities are handled much the same across a broad range of societies, though there are some outliers such as private militaries in Somalia and government control of movies in Cuba.

  In most countries, health care is generally regarded as either a public service like highways, or as a semi-public service like schools. Compared to the rest of the world, the United States is clearly an outlier in health care financing.

  I have made my living in the health care industry for the last 35 years. I have worked for governments, not-for profits, for-profits, and have been in business for myself. The inefficiencies of for-profit health care are not apparent from the bottom line. United Health Care, the largest private insurer, for the trailing twelve months had net income of $3.5 million on revenues of 84 million, and a cost of goods sold - medical care provided - of 64 million. Do the math: 4% of the money goes to the investors and 76 % goes to doctors, hospitals and big pharma. This leaves 20% going to advertising, lobbying, selling policies, denying claims, and funding mergers and acquisitions.

  It has been reported that Medicare has administrative overhead of only 2 to 4%. This is probably too low. I am on the board of directors of a small local health insurance company set us as a non-profit employee benefit trust and our administrative overhead runs 6 to 8%. We aren't getting rich, but we can pay our childrens' college tuition.

  The people who actually provide health care don't go into it for the money. Research scientists are smart and fairly well-paid, but the ones I know are not retiring to private islands in the Caribbean. Doctors are plenty smart too. But if they want to make the most money possible, they quit seeing patients and go to work for a health insurance company, or become investment bankers. Family doctors make about as much as nursing home administrators. Even in the highest-paying specialties it's hard to make more than half a million a year.

  Money is not the major motivator for those who actually provide medical services. To be sure, if we didn't get paid at all, we would have to find other jobs. Most of us are closet bleeding-hearts who actually like saving lives and relieving misery. We often spend our vacations traveling to foreign countries to practice our professions without pay for the underserved. Lately we have been able to save on airfare by simply staying in the US and caring for the underserved.

  Guess what? Health insurers know this about us! They know that if they deny the occasional claim for no particular reason, we usually won't fire our patients who happen to have their insurance. And we won't sue them, because they have bigger lawyers. And once a company gets a sizeable percentage of the business in an area, they just start paying the doctors and hospitals less. Free market or monopoly? Is it any surprise that a sizeable majority of doctors favor a government-funded health care system? With the government, at least there is an appeal process, however convoluted and cumbersome it may be. You can always call your congressman, or demand an inquiry into how taxpayer dollars are being spent. If a single, dominant company sets a price, that is the market at work. Take it or leave it. If doctors or hospitals join together to collectively bargain with an insurer, that's price fixing and triple damages for anti-trust.

  Lest I be accused of socialist tendencies, I might mention that I own and operate a small business with revenues of several million dollars a year. I invest often and enthusiastically in equities. I have a competitive streak and relish making a good deal in the stock market, diagnosing an obscure condition, or beating you to the bottom of the hill on my snowboard.

  Having a public option will move health care to more closely resemble education. There is a publicly-funded program which provides a fairly comprehensive, reasonable-quality system open to all. This does not spell the end for the private sector, since lots of people pay extra for their children to take violin lessons, play football, or go to Yale. Several for-profit education companies have been recommended by Motley Fool newsletters. A public option will move private health insurance into other market niches, but will no more eliminate it than the University of California has eliminated Stanford.

  The founding fathers recognized that having an educated population was essential to a functioning capitalist democracy. Considering the state of the medical arts in the 1770s, it is no surprise that they ignored health care. Two hundred and forty years later, health care has improved to the point that it makes a difference both for individuals and countries. Now, having a healthy and educated population is essential to a functioning capitalist democracy. The excessive costs of the health care sector undermine our ability to compete in the global marketplace.

  Death is cheap, health care is expensive. Dead patients file no claims, so restricting care to patients with serious illnesses always helps the bottom line for a private insurer. Government employees get paid the same regardless of how the budget at their agency fares; they will simply try to administer the law and have no financial incentive to deny claims. It is both hilarious and disgusting that public funding is held up as leading to "death panels". Under our present system people die from the decisions of an administrative assistants to deny their claims without even getting a panel to review the "medical necessity" of their situation.

  Competition does not always reduce costs and lead to a better product; that is why we let the government build roads instead of having private, competing corporate road networks. A public healthcare system, or at the least an option, will temporarily dampen profits for a few companies, but will improve the efficiency of the overall system, and thus of the US economy. This is a simple fact that every other civilized country has recognized. It is time to stop putting the short-term interests of a few override the long-term health of all of us.

• Report this Comment On September 30, 2009, at 5:16 AM, ollyish wrote:

  Supporting health-care companies does NOT increase your life expectancy, if you suffer from the disease that is the biggest killer.

  It is not health-care companies that invest in malarial research, rather trusts such as bill gates and the wellcome Trust.

  But health-care companies are happy to develop viagra

• Report this Comment On September 30, 2009, at 6:22 PM, tmduffy5 wrote:

  So let me get this straight, some of the commentators to this article are amazed that health insurance companies make a profit from people who are sick. Let's analyze this for a moment; drug companies sell drugs to sick people for profit; commercial hospital organizations make a profit on sick people; medical device manufacturers make a profit from sick people; pharmacies make a profit from sick people; you bet the picture. Here is one question: How many foolish idiots (no pun intended), who are upset with health insurance companies making a profit, would be willing to give me a $10 bill for every $5 bill I give them? The problem is that these individuals don't understand underwriting risk. In States like New York or New Jersey, health insurance companies who want to sell policies there are required to accept all buyers, regardless of their health status. So if an individual is healthy they won't purchase a policy. Once they become sick, than the insurance company is required by law to sell them a policy. Even if the policy has a premium is $600 per month, the insurance company has a potential liability up to the lifetime limits of the policy, which in many cases can be as high as $5,000,000. If the purchaser requires surgery that will cost $100,000, including all pre and post operative care, the insured can cancel the policy when they have recovered and no longer need care. During this time the insurance company may only collect $7,200 in premium, leaving them upside down to the tune of over $90,000. How many of the foolish idiots would be willing to underwrite these risks? Try calling phoning State Farm when your house is on fire and ask to purchase a policy.

  So before we crucify health insurance companies, remember there are many entities who make a profit off of sick people. This includes non-profits as their executives just pay themselves a larger salary and bonus. Blue Cross Blue Shield of Michigan just paid $168,000,000 in bonuses but supposedly lost $250,000,000.

  Tim D, Michigan

• Report this Comment On October 01, 2009, at 12:20 AM, bs1934 wrote:

  Pre-existing conditions aren't the norm. So what. You who says that won't complain until it affects you. How about 62K for a dying woman in a hospital for 5 days. 31K billed for the room alone. over 30K for the rest. Oh, it's O K since we only had to pay $800. So whadda we care huh? My neighbor works in construction. No insurance although he owns his own home. His wife refused to go to a doctor-no insurance. Now she is dead. When she finally was dragged to a hospital, they gave her 30 days. She died in 5. That's two cases I know of in 5 months. Que sera. I'm over 65 and happy with medicare. I can afford my supplemental and don't have many drugs to worry about. Nontheless, I'd like to see some of the less fortunate get a break somehow.

• Report this Comment On October 01, 2009, at 12:27 AM, Geesix wrote:

  Insurance companies are NOT subject to anti-trust laws and therefore will not compete. If a new company forms and offers terms that are favorable to the insured then the established companies will run them out of business openly and legally. Regardless of any changes made in our 'healthcare system' the costs will continue upward until legitimate competition can occur which will require subjecting insurance companies to anti-trust laws. When this occurs then costs will rapidly decline.

• Report this Comment On October 01, 2009, at 11:32 AM, 1hammer2 wrote:

  comeon folks, get a clue, when has the goverment done anthing right! I don't what anyone to go with out, but I resent the fact that congress whats to steal MY money again. read the constution. congress is not ot do this stuff !!!!!!!!!!!!! If we want stimulus we need to rebuild our infistructure, its falling down around or ears!

• Report this Comment On October 01, 2009, at 2:28 PM, metinmsm wrote:

  I recommend you read T .R. Reıd book on health care. If as a moral socıety we do not want people to be left to dıe because they can not pay for health ınsurance we have to make health INSURANCE nonprofıt but allow profıt for health provıders. By doıng that all other wealthy counrıes have been able to provıde health care at half of our cost. In hıs book as well as hıs talk at the Commonwealth Club (avaılable on ınternet) he compares dıfferent health plans. How can we allow 18 to 25 cents of each dollar to be spent on admınıstratıon!! Nonprofıt, nongovermental ınsurance companıes ın europe as well as Japan do ıt for 4 to 6 cents! Lısten tohıs comments or read hıs book. Our ınsurance company lobby ıs too powerful for the congress to stand up to them. Even though the doctors and a mojorıty of Amerıcans want to get rıd of the profıt motıve ın the health ınsurance, not necessarıly drug companıes or hospıtals or doctors.

• Report this Comment On October 02, 2009, at 1:12 PM, actuary99 wrote:

  - jm7700229

  THANK YOU for your post. Ditto.

• Report this Comment On October 02, 2009, at 2:52 PM, actuary99 wrote:

  For those of you citing the 2% medicare admin cost, read this: http://www.cahi.org/cahi_contents/resources/pdf/CAHI_Medicar...

• Report this Comment On October 02, 2009, at 6:51 PM, JustSomeFacts wrote:

  Some numbers to compare the quality and $-efficiency of the US health care system with "socialized" systems:

  Life expectancy at birth for 2009 in years from CIA fact book (high is good):

  USA 78.1

  Canada 81.2

  UK 79

  France 81

  Germany 79.2

  Sweden 80.9

  Infant mortality rate 2007 from UNICEF (high is bad):

  USA 7

  Canada 5

  UK 5

  France 4

  Germany 4

  Sweden 3

  Health expenditures per capita 2003 from OECD (high is bad)

  USA $5711

  Canada $2998

  UK $2317

  France $3048

  Germany not determined

  Sweden $2745

  Seems to me like the US is not spendings its $ very wisely even if its "private" $

• Report this Comment On October 03, 2009, at 12:49 AM, wolfman225 wrote:

  JustSomeFacts--

  I'm afraid that all of your numbers and comparisons are meaningless. You have to account for all differences in lifestyles between the countries. For instance, how do the different diets in each affect longevity? In the U.S. we have had a decades-long love affair with fast food and "super-sized" portions. Not to mention our drug use, extreme sports, sedentary lifestyle, etc.

  Infant mortality? Is this rating taking into account #'s of babies born to drug addicted mothers? Teens who dump their newborns?

  Expenses per capita; again, we need to put these numbers into context. Most other countries who provide "health care for all" control costs by rationing access, sometimes denying drugs based on cost benefit analysis. Canada and some other countries keep the costs of drugs down by simply refusing to pay fair market prices, thus forcing the U.S. Pharmaceutical Industry to absorb the costs of R&D for the world, or pass them on to clients in the U.S.

  Statistics are slippery things. You should be careful to provide context and to be sure you are comparing "apples to apples".

• Report this Comment On October 03, 2009, at 12:57 AM, wolfman225 wrote:

  I will agree that in the U.S. we aren't spending our healthcare dollars very wisely, but that is more a factor of our individual failure to take responsibility for our own health and lifestyle choices than a failure of government to provide for us. As long we insist on believing we can eat, drink, smoke, etc. as much as we want, (while spending the majority of our time on the couch) and be sheltered from the consequences, costs will never come down.

• Report this Comment On October 03, 2009, at 7:37 AM, Bobxy wrote:

  Profit for companies that actually DO something to provide or improve health care is fine (ie; drug companies, equiptment manufacturers, hospitals, doctors, nurses, etc).

  I object to profits for insurers.

  They DO NOTHING but move money around--accept premiums and pay vendors and providers.

  And in the process add about 30 percent (or lose it depending on your point of view) to profit and overhead. Note that Medicare has about 3 percent overhead.

  Further-- in the name of "saving money" or "reducing health care costs", insurers often deny essential patient services on a regular basis. In fact, insurers often base employee compensation upon savings produced by denials of service.

• Report this Comment On October 04, 2009, at 8:54 PM, EarthDoctor wrote:

  This is something to never forget. It is the private medical insurance industry that cancels YOUR medical insurance AFTER taking YOUR MONEY for years.

  Smart Medicare Insurance for All will not only improve our quality of life but also our wallets. Yes we would have more expendable cash for birthdays,Christmas, vacations and investments.

  Smart Medicare Insurance for All cannot be cancelled

  One more thing to never forget... there is no such as free medical insurance. Paying with tax dollars is not free because those are YOUR tax dollars.

  National Health Insurance does not remove competition from the actual health care industry. It will be alive and well. Profits will be based on customer service and clinic performance based on the clients experience. This is my perception of competition.

  How many of the vocal minority out there supporting the most expensive medical insurance in the world are employees and/or shareholders?

  How many are receiving corrupt campaign dollars?

  Some of our reps on all sides of the aisle say “Let's slow down a bit”. I say consumers have been waiting for more than 60 years for fiscal responsible medical insurance how much slower can it go?

  What could possibly be more american? Providing americans with the choice of National Health Insurance. HR 676 is the only equitable approach that includes all of us.

  Shouldn't taxpayers have the choice of Medicare Insurance For All? Absolutely!

  HR 676 would cover every person for all necessary medical care including:

  *long term care such that cancer demands

  *prescription drugs

  * hospital

  * surgical

  * outpatient services

  * primary and preventive care

  * emergency services

  * dental

  * mental health

  * home health

  * physical therapy

  * rehabilitation (including for substance abuse)

  * vision care

  * hearing services including hearing aids

  * chiropractic

  * durable medical equipment

  * palliative care

  * long term care.

  A family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs.

  HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

  National Health Insurance for All

  http://www.healthcare-now.org/

• Report this Comment On October 05, 2009, at 5:21 PM, Beanfarmer wrote:

  Hurrah for "GaryCCB"

• Report this Comment On October 08, 2009, at 4:08 PM, jersey44 wrote:

  I have sold health insurance for many years and found that the people that make the most "choose" to be self-insured, except when the bills come due.

  I have also witnessed a huge shift in doctors using MRI, Ultrasound, CAT scans, etc. to diagnose everything (of course the doctors own the imaging centers), Recently I went to the doctor for a sinus infection and he wanted to order a CAT scan - he could not diagnose a simple sinus infection and order antibiotics without it - I insisted I would not have the scan; reluctantly he gave me antibiotics and it cleared up in 5 days. Some companies are getting smart and require preapproval for scans.

  The abuse in this area (supposedly because of Malpractice Insurance Claims) costs the insurance companies and patients millions. I hear the stories every day when clients bring in their bills for me to explain.

  I am not opposed to health reform, if it is done in the correct format to benefit the consumer. There is always room for improvement.

  In over 25 years of business I have never had a client's insurance cancelled by any of the companies I represent because of usage or illness.

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