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What works in other countries, such as Canada, is that the govt system tells medical providers what they will be paid except for those providers who stay out of the system and remain private. Thus these providers are paid much less than that which is paid US medical providers. Medical providers are defined as non-administrative such as MDs, pharma, hospitals, etc. So how can this be done except by govt fiat ? There can be cost efficiencies in a really large pool but if medical costs are not significantly reduced, the savings pale when compare to medical costs. All other countries pay their MDs, hospitals, etc much less than the US so, again, how do we significantly reduce the majority of these healthcare costs except by reducing what medical providers are paid, which is what these other countries, including Canada, did ?.
Scott, Since the vast majority of healthcare costs are medical (80%) and not administrative, how specifically do you propose to lower these costs. You only address non-medical costs such as associations banding together. How much will your plan reduce current charges made by medical personnel, pharma, hospitals, medical equipment mfgs, etc. How will you arrange to pay medical personnel, hospitals, etc. less? Specifics please.For example, will you pay using Canada's payment schedule for MDs ? Or do you propose a blanket reduction on what all medical personnel will be paid and, if so, how much ? And how do you propose to do this ? Your response within a week to the SB Pilot with specifics such as costs and timelines will be appreciated as we need answers. Specific answers. So far all have avoided the 80% gorilla in the room - medical cost reductions, which are mandatory if healthcare costs are to be reduced.
To improve ACA, all agree costs must be lowered. Julie, Nancy, anyone - Since 80% of healthcare is medical and not administrative, how do you specifically propose reducing what is paid to MDs, RNs, hospitals, pharma, and all other medical providers? Please do no go back to administrative ( ins cos or office staff) which comprise the vast minority of healthcare costs. For the moment, let us all agree that a single payer system or ACA is best. I cannot get any proponent of these plans to answer the above question with specific answers. For example, Canada's MDs make much less than US MDs. Do you propose US MDs make what Canada, UK, France MDs make ? Buy pharma as Canada pays ? To lower healthcare costs, these costs must be lowered. Julie, most insurance companies left exchanges because they lost a lot of money. Like all companies, if more money is paid out than earned, the losses have to be stopped. Insurance companies are in business to make a profit but their rates (premiums) are State regulated so is their profit which is 7% compared to the S&P 500 10% and they are part of the minority costs - the administrative (20%) If one magically deleted all administrative costs leaving only medical costs, we'd still be higher than Canada etc. So again, does any single payer/ACA proponent have a specific answer to how medical providers will be reduced to what single payer systems now pay in other countries ? And answers such as a single payer system will produce savings is not specific nor does it answer the above questions. Changes are needed. If ACA is to be improved, specifically how and what ? Need a timeline, costs, estimates, and much more. You bring up good points. Perhaps we can receive comments with specific suggestions showing how we can lower MEDICAL costs - the majority of healthcare costs. My thoughts are to repeal the anti-bidding of ACA, Medicare, and Medicaid pharma, restrict equipment so all hospitals do not have the same as all others leaving each to specialize and be more efficient, vastly increase use of PAs which has already started. Perhaps reduce the number of urban hospitals. What do you think ?
A single payer system cannot lower costs unless the majority of costs , medical, are significantly reduced because these account for about 80% of healthcare costs. So do you, Lock and Dan S, suggest reducing MDs, RNs, hospitals, etc. income imposed by a new government run plan ? Single payer systems control these costs by paying much lower payments than our current system so s p e c i f i c a l l y how do you propose cutting all MDs income and I am not talking about a small reduction in office (administrative-the 20% of healthcare) but medical cost reductions ? Same question for hospital expense ? Med equipment mfgs ? Etc. ? Do you propose simply telling providers that they'll be receiving a specified amount after your new plan goes into effect ? Simply saying something will address the costs of health care is akin to saying we're going to have world peace. When a statement is backed by facts, it becomes credible so if we were to create a single payer system, show a time line, payment schedule, benefits,premiums or healthcare tax, administration, costs, and anything else I may have missed. Please.
Shouldn't we also look at what we receive that does NOT leave our community such as our school property tax, huge federal funds sent to YValley Hospital for uninsured care, medicaid and CHIPs payments,highway maintenance, non-local law enforcement, Airport funding, and the list goes on and on. Maybe the question should be "how much of our taxes actually do leave and do not come back ?
Christine, FYI - Please call the Colorado Dept of Insurance and you will find that unlike your totally incorrect statement, insurance companies are highly regulated. Each State has a Dept of Ins to enforce and carry out each State's regulations of which there are many. Unlike most industries, insurance companies cannot just charge what they want. The rates, which create premiums must be approved by the CO Dept of Ins -regulated. Did you know a stock market fund cannot take a hit as it is an inanimate object but the fund owners, teachers, pension funds,farmers, your neighbors, etc who own the fund can suffer losses and gains ? Did you know that insurance companies' returns are 30% LESS than the S&P500 ? If you owned a restaurant and the price of food went up 25%, wouldn't you have to increase your prices and pass along that food price increase? If you didn't , you'd be out of business in a very short time. Guess what ? When healthcare costs increase, those increased costs cause an increase in insurance premiums but unlike a restaurant, the increase is highly r e g u l a t e d. Do you understand that insurance companies cannot arbitrarily increase premiums unlike almost any other industry ? It is because they are regulated.
Lock, Thank you for responding and helping start a dialog about cost reductions.We agree that it'd be good if pharma prices could be negotiated but I asked you how that could be specifically achieved since current law prohibits it. According to 20/20, every word of the pharma section of ACA was written by pharma lobbyists. How would you specifically prohibit their power from again influencing a new law, which would be required to change the current process of buying pharma. How would you specifically suggest getting a new law passed ? Again,I asked only for suggestions to lower medical costs and you mentioned possible medical office staff cost reductions from a single payer system, which is a good result, but you failed to mention how to reduce the huge majority of medical costs arising from MD charges, and all other medical providers. If we were to have the costs of the Canadian med system, our MDs would have to incur a huge reduction in income as Canadian MDs are paid much less. If medical providers costs are not reduced, the 80% cost of healthcare cannot be reduced much. For fun, take the salaries of the top 20 health insurance companies CEOs, divide that sum by total healthcare costs, and see how a 70% reduction in their salaries ( or even their total current salaries ) would barely measure on a chart. I, purposely, did not provide these figures because I wanted everyone to be comfortable with the accuracy of the comparison. So now we can go back to the real problem - medical costs need to be reduced and how to do that. In Canada, medical providers are told what they'll be paid. Is that our solution. In single payer systems, pharma is told what they'll be paid, whatcha think ? Loch, significant changes are needed but we all need specifics , without emotion or error ridden data, such as was put out by A69, which completed ignored that an increase of medical costs would obliterate the possible small savings in administrative costs. With factual information, we can hopefully work toward an acceptable solution but, I believe, painful changes may be necessary. Thank you for contributing.
Loch, Please specifics. Comments such as single payer systems would reduce costs because of their buying power is not specific but another generalization. Do you mean to abolish the prohibition against bidding ? If so, when. And replace it with what ? To reduce medical costs (the 80%of healthcare) do you advocate reducing payments to medical providers ? If so, how so ? Please--For the moment, try to stick with medical costs and not the minority of administrative costs, the 20% (ins cos and self directed plan's staff). For a single payer system, or any system , a reduction of medical costs must occur in order for total costs to be reduced. Proponents of a single payer system and A69 would not answer this question. They always veered back to the bad old ins cos and would not venture into the massive majority of healthcare costs (medical at 80%) and then they couldn't answer basic questions, such as what would the personnel costs be, but would simply answer that they'd be lower. A69 proponents could not even answer what the CEO of CFO salaries would be. To support a plan, one must know the basics of that plan such as detailed costs and timeline. A single payer system may absolutely be the better solution but how can it be supported with "it has to be cheaper than insurance companies " comments with no basis. Federal employee costs compared to private industry costs provide higher, not lower, costs. But if 50% less employees were needed ,there could be a personnel cost reduction but we'll never know UNLESS and UNTIL that information is provided to the public. Why hide it ? If one doesn't have it, say so but don't say it'll be cheaper - just because I said it would. Again, detailed specifics are needed and required, please.
Christine, Can we look at facts. About 80% of healthcare cost is medical leaving 20% administrative. Under a federal single payer system, the total staff (federal) would be paid more than insurance companies pay, receive a defined pension that private industry cannot afford, receive more paid holidays, accrue sick day pay not offered by private industry, receive very expensive and comprehensive health insurance plus have dependents partially paid for, etc. so personnel costs cannot be lower than insurance company's costs. Now let us delete all insurance companies. We end up with a savings of up to ( underline up to ) 15% of ADMINISTRATIVE costs only. To significantly reduce single payer costs, medical costs must be reduced. I repeatedly asked Nancy Spillane, an admirable advocate of A69 or any other proponent to specifically state how our medical costs were to be significantly reduced. No one answered with specific data. None from any single payer proponent. I am not against this idea. I see a lot of merit. I am not interested in hyperbole and would appreciate factual specific concepts such as allowing bidding on pharma, not having every hospital in large metropolitan areas duplicate medical services, limit price increases on pharma, - others must have better ideas that I. The emphasis on those horrible insurance companies who do not try to screw people out of legitimate claims or they'd lose their ass in Court daily and whose stock market return is 30% below the S&P 500 should move on to the 80% majority of healthcare cost - doncha think ?
Please everyone read the 4/2/17 Pilot about MEDICAL costs with more to come. Insurance simply pays high and higher costs. Got it ? Insurance premiums are high because of HIGH medical costs and not because of high profits, which are regulated and 30% lower than the S&P 500.Medical costs amount to about 80% of healthcare costs so unless they are lowered insurance premiums cannot be lowered. No one is going to pay out more than they take in or they'd be out of business quickly. Could not get A69 proponents to understand the simple 4th grade math that a massive increase in the 80% (medical) cannot produce lower healthcare costs even if administrative costs were lowered. It appears that more columns will be forthcoming.
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