"A government big enough to give you everything you want, is big enough to take away everything you have"
Thomas Jefferson

Monday, August 17, 2009

Q and A of the week

This gentleman raised the question and put the Great One on the spot where he had to admit he plans to raise taxes in order to pay for his health plan. We need more questions from average people because it obvious the MSM is in the tank and will not ask the tough questions.

Also, drill down into the answer. He plans on paying for part of the plan by insurance companies, which means 1 of 2 things - insurance companies will raise premiums or people will be forced out of the private plans and into the government plan causing an increased need for funds.


Bob Johnson, MD said...

Mr. Grey -- I rarely venture on to blogs, but what do you think has to happen. Healthcare is labor intensive and it has to be paid for. The idea is how to cover everyone and yet save money.

The low hanging fruit to save money are the insurance companies, the drug companies and the trial lawyers.

Why do we want to pay insurance companies exorbitant premiums when they keep 20 - 25% to pay for their administrative cost to deny care and pay their CEO obscene salaries. Not one of those CEOs provide healthcare.

Medicare, while not perfect -- nothing is -- uses only 3-4% to run the program. I don't see them denying much healthcare unless one of the private firms is contracted to administer a plan.

The drug companies charge twice as much to Americans than anywhere else and the civil tort system costs us nearly one tenth of the healthcare dollar.

We are overpaying for healthcare as it is. Why not make a healthcare insurance system efficient and fair and base it on the "government run" Medicare insurance.

I have never had Medicare tell me how to practice surgery, whereas private insurance companies are continually denying and delaying care.

What's wrong with everyone pays and everyone is covered. I'll tell you what's wrong: nobody wants to pay. The young don't want to pay because they don't get sick, the old because they think they have paid already, the poor because they say they can't, the rich because they will pay too much and labor because someone already paying for them.

So everyone is trying to get a good deal for themselves instead of a fair deal for everyone.

Yes, the Medicare withholding will increase under a national health insurance plan, but the exorbitant premiums that we are now paying will go away. More money in everyone's pocket.

The logic is inescapable. The only thing left is to overcome the ideology.

Anonymous said...

This is all the fault of George Bush and Republicans.

Anonymous said...

Dr Johnson - I am not defending the insurance execs here, but, should the same line of thinking apply to everyone in the system? For instance Doctors such as yourself might have their pay capped or how about hospital CEOs - do you not think it is a bit exorbitant to be paying Samaritan CEO Carmen a half million dollars a year with perks? Do you not think that is excessive for NNY?

Earthbob said...

How do we provide Health Care versus Health Cost.

Insurance companies are for profit, and to be profitable means they must "cherry pick" those that they cover.

Their premise is to make income for their shareholders by reducing risk. Nothing wrong with that.

But, that does not relieve the human barrage on our Emergency Rooms.

This ER cost permeates into all of our hospital bills.

The number of uninsured has been reported to be about 42 million people.

How do those in that number access Health Care at a lower cost to us that have Health Care.

Preventive and Catastrophic Care would be useful, and reduce ER visits. Avoiding a problem is easier than cleaning up after the problem.

Pre-existing conditions, like Diabetes, are systematically precluded from coverage by insurance companies. Simply put, it is unprofitable. Yet educating a Diabetic can avoid a Diabetic Shock.

Wouldn't providing a Diabetic that kind of education cost less than treating a Diabetic Shock in an ER?

I heard an interview that approximately 70% of a person's health care expenses occurs in their last year of life.

If that is a known expense, how can the uninsured and Health Care System absorb that?

The federal government does have a role, if it can provide insurance companies the ability to have interstate pools.

Cooperatives are just another form of a corporation and, in reality, can not resolve the problem of the uninsured.

A new cooperative would have difficulty penetrating the health insurance marketplace that is presently served by existing firms.

Affixing the cost of providing preventive and catastrophic care to the uninsured would resolve the problem.

Coverage for pre-existing conditions is another problem that may have a state level solution. Family Health Care Plus is an example.

The benefit of the August Debate is that we all have an opportunity to kick the tires.

(A note to my anonymous friend: I did not use the word proce...oops!)

Dan Francis said...

Anonymous 11:44... mix in the topic of CEO salaries - which is NOT exactly what Dr. Bob was addressing, but nice try anyway.

Runaway health care costs (all the costs associated with health care when you need it) relates directly to the economy. In a word it is helping sink the economy.

Simple math: x-number are out of work, no health care coverage (a growing number); they must use ER for Primary Care; others without insurance (the poor, the unemployed, and yes, low-wage earners who work but w/o care) all use the ER.

That cost is passed along to all insurance policy holders.

New Rx costs; new equipment fees, etc. etc. all add to the cost.

And these days, according to most stats, we live longer and due to more Rx and fancy equipment and stuff... but living longer is pretty good, isn't it?

As a Wise Ruler once said in the single most-important sentence he wanted to leave his people, and after years of study and writing was:

"There ain't no free lunch."

Dan Francis said...

My last point (food for thought):

* As many, if not most, GOPers are against the "public health care option," then:

1. Get rid of the FEHP (Fed program).

2. Get rid of the VA.

3. Get rid of TRICARE.

4. Get rid of Medicare and Medicaid.

5. Don't fund SSI.

6. Stop giving money to supplement Children's clinics and SCHIP, et al.

7. Stop giving members of Congress preference at military hospitals in the DC area.

Okee, dokee?

Anonymous said...

DR Johnson, your comment about who pays is well put. Thank you for some clarity.

People don't want to be forced into a gov't plan, but what happens at 65?

Anonymous said...

Dan - a hospital CEOs salary is damn sure part of it, what is the debate about cost, coverage and competition for insurers.

What drives premiums? Cost and experience ratings, what drives cost a lot of factors including paying a CEO half million bucks in Watertown.

Anonymous said...

A few years the UAW had a study conducted showing the savings with investigating Medicare Fraud, the amount was staggering, I also wonder why precriptions are so expensive, considering you can go north of the border, for cost savings, also retirees also flock to Mexico for their precriptions.

Bob Johnson said...

Anon 3 --

Your point is wall taken. I turns out that physician's income has decreased 20% from 1996 to 2006. That's a fair figure to quote, since it does not take into account, hopefully, the temporary effects of the current recession. The problem is that the primary care doctors in the trenches are not paid sufficiently. As a result, more young doctors are going into highly paid specialties instead of primary care (pediatrics, internal medicine, family practice). That choice is now being driven by the debt in which students now find themselves. It is not unusual for students to finish medical school $250K - $400K in debt. They have to make that up and the only way of doing so is to abandon primary care for high paid specialties.

The fix to that problem is to underwrite medical education but in return, a requirement to participate in the national health insurance program.

As far as CEO salaries are concerned you are preaching to the choir. No hospital CEO is worth more than the lowest paid primary care doctor. It should be remembered that CEOs do not provide one jot of healthcare. Their worth should therefore reflect that.

If I had my way, I would tie hospital Medicare payments to CEO salaries. A hospital's life blood is Medicare, and if hospitals were denied payments because of obscene CEO salaries, we would save millions bringing CEO and their executives salaries to reasonable limits.

Anonymous said...

Bob Johnson MD. It is disappointing that you do not represent us in someway politically. I believe that your take on the system is well demonstrated by you. And Danny Francis you are well versed also. Your problem is the very fact that you are willing to take on the system.

Corporate American will never back you in donations to fund the campaign that you need to win.

We are all hostage to big brother including our current president.

When all is said and done we will not have health care reform. Hilary did not accomplish it, and Barrack will not, and that is truly a shame.

I hurt for the children in this country and in the world that cannot get the healthcare they deserve. It is a true health care genicide in my book and it should make us all feel guilty.

Dan Francis said...

Anonymous 9:13. I appreciate your comments, really I do. I would add this (as strongly as I can):

* Unless and until we stand up against big money, inside and outside the beltway (that buys our members of congress - and yes, that's precisley what they do) ... NOTHING WILL CHANGE.

First, our attitude has to change and then any action that follows will stick -- I guarantee it.

But, the public is so jaded that that is tough to do, I know, I've tried.

But, I firmly believe that if we can take away the big money, then moe Reps. will go home to spend more time with their families and not in DC screwing up our families.

— dmf

Anonymous said...

1;26 Danny Francis really those who try to take on the system
( locally, state or nationally) usually do not get anywhere. Locally the people want change, but they consider the change maker a rebel. State or nationally you will not get the funds to run from corporate america who you usually are challanging for reform.( encumbents become hostages to them) And everyone loves an incumbent as a general rule.

We have created our own monster. IT will change when people become extremely desperate!!!!! It is coming.

Anonymous said...

No problems with Doc Johnson's identification of three major areas of concern, insurance companies, drug companies, and trial lawyers. But then his rant conveniently omits any corrections to the lawyers and their contribution to the problems. Just like a donkey. Very predictable, Doc. Could it be because the lawyers are the single biggest contributer to the Democratic party? Even you can't bring yourself to talk about the need for tort reform.

And why does it is cost a rural customer in PA half what it costs a rural customer twenty miles away in NY for the same health insurance? That imbalance is because we don't allow the same policies to be sold in all states. I have no idea why, but these numbers are true.

I know I'm just a simple guy, but our government gave us this stupidity. I don't have a lot of confidence allowing them to run the entire operation. And Doc, you need to learn something about sleazy lawyers. You may have the money to pay for these guys but I don't.

Anonymous said...

That imbalance is because we don't allow the same policies to be sold in all states. I have no idea why,

It is because our polititions made a deal with the insurance companies to force NYers to only buy in state. I am sure there was no $$$$$$$$$ involved it was to insure we got the very best of insurance coverage. I think I remember Schumer having a hand in this rule and Mario Coumo .

Anonymous said...

Well, Doc, what do you have to say about that? Please comment about the insurance companies being regulated as they are. I would also appreciate hearing what you have to say about changes that you think are necessary regarding the lawyers and their effect on healthcare costs. I realize you're a Dem and are reluctant to discuss it, but please, give us your point of view.

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