Politics As Usual

[Tyrone Slothrop]

Originally posted by Greedy,Greedy,Greedy
Ah, the intermoderator power struggle.

When do you guys come up for re-election?

It's more a question of sucking up to Slave. I really haven't figured how to keep up with the Spartan in that department, but I'm happy to be #2 and trying harder so long as there are two mods. But thank you again for your support!

Apropos of nothing, has anyone noticed what a powerhouse the Yankees are this year? Such power and skill.

[sgtclub]

Originally posted by Atticus Grinch
Boo-hoo. You are the pussiest pussy that's ever pussed out on this board. Go back to Walnut Creek and have dull, distracted missionary sex with your dental hygienist trainee wife, ya pussy.

I'm going to let this petty little comment go by

[Tyrone Slothrop]

Originally posted by sgtclub
I'm going to let this petty little comment go by

No, don't do that -- you can take him. Just remember: It's not the size of the dog in the fight, it's the size of the fight in the dog.

[Shape Shifter]

Originally posted by sgtclub
I'm going to let this petty little comment go by

Your just going to stand there and let him call you a pussy? Are you French?

[Greedy,Greedy,Greedy]

Originally posted by Replaced_Texan
So the testimony starts today in Congress about not-for-profit hospitals and billing practices, the class action lawsuit was amended yesterday to include more hospitals, and it looks like the very shaky system that we've been operating under for the last fifteen or so years is about to collapse.

What do we do?

Yes, I agree, people who don't have health insurance get screwed and they are probably the people who can least afford to get screwed. Yes, I agree, insurance companies negotiate very low rates, lower than the average rates. Yes, I've seen the bills for someone who has no insurance against the bill for someone who is insured, and yes, the rates charged to the uninsured is higher than the rates charged to the insured. BUT. Managed care screwed everything. The negotiated rates for the insurance companies are so low that 1.) the marginal revenues have fallen significantly for the insured and 2.) there's very little wiggle room to give away care or deeply discount it.

I don't see how it's possible to keep managed care contracts in place and not charge uninsured or out of network patients a higher rate than the rates negotated by the insurance companies. It's not just the not-for-profit hosptials, it's also the public hosptials and the for-profit hosptials that operate this way.

I'm generally pissed off at the entire situation. I'm pissed off at the plaintiffs lawyers for bringing up this suit, which is going to be expensive to defend (thus deferring funds that could go to, say, charity care). I'm pissed off at the government for ignoring the problem of the uninsured for so long while scaring every hosptial in the country with EMTALA. I'm pissed off at the insurance companies for taking so much control over health care. I'm pissed off that somehow or another we've gotten to the point that the quality and quantity of health care that we get is entirely dependent on who your employer is.

The plaintiff suit doesn't really make sense though. The underlying problem is that health care is expensive and no one wants to pay with it. Whether an uninsured patient gets a $50,000 bill or a $25,000 bill doesn't really matter if the patient can't pay for any of it. No one wants to pay for these people's care. Not Congress, not the patients, not the insurance companies, and not the hospitals.

This has always been a shaky system.

I would like to divorce employment from health care. I would like to give everyone in the country very basic coverage (similar to those crappy plans you could get in college for about $400 a year), and set up a system where people can buy (through an MSA) more comprehensive coverage if they wanted to. The insurance companies would have to market their products to individuals, not the companies, and individuals would be responsible for deciding what kind of care they want. A kid in her 20s with no real health problems doesn't need anything more than disaster coverage and maybe a yearly physical. The HMO product would be fine for her. The 40 year old accountant who hasn't been eating right for years may think about getting more a comprehensive indemnity policy.

I'm irritated that they're reducing this underlying problem to how hospitals price their products. That ignores the larger problem that isn't going away any time soon.

I have no idea how either candidate for president feels about this issue, though I haven't seen Tommy Thompson running to take charge of the problem of the uninsured.

Ah, so much to deal with.

You can always try the Massachusetts solution -- once the insurance companies become sufficiently concentrated so that they have effective monopoly power in the negotiating game (take my price or your beds are all empty), just concentrate your hospitals sufficiently so that the two are on par. Then we have dueling monopolies, which is really significantly better than just one monopoly (Burger take note, some anti-trust issues in here).

Here, the problem of the uninsured is pushed heavily on to the Hospitals, and since they are all basically non-profits, they don't resist much, just negotiate carefully the details of their surrender. But most of their pricing is not driven so much by the ability of the uninsured to pay, but instead by the willingness of the governmental payors to pay -- once the Medicare/Medicaid rates are set, most of the rest seems to follow, including the relative imporance of one service versus another in the negotiations with the insurers. The exception here is the foreign payors, where there actually is something that looks more like a market, but not really big enough to have a big impact on pricing.

So effectively there are three negotiating monopolies: (1) hospitals; (2) insurance companies; (3) government, and the uninsured are then an after-thought.

What do I take from all of this? That the health care system has the flaws of partial regulation; unless we can find a way to fully regulate, all we're doing is trying to referee a street fight. And if we don't regulate, we are at this point leaving it to the monopolies, the strongest of which are insurance companies and government.

[Replaced_Texan]

Originally posted by Greedy,Greedy,Greedy
Ah, so much to deal with.

You can always try the Massachusetts solution -- once the insurance companies become sufficiently concentrated so that they have effective monopoly power in the negotiating game (take my price or your beds are all empty), just concentrate your hospitals sufficiently so that the two are on par. Then we have dueling monopolies, which is really significantly better than just one monopoly (Burger take note, some anti-trust issues in here).

Here, the problem of the uninsured is pushed heavily on to the Hospitals, and since they are all basically non-profits, they don't resist much, just negotiate carefully the details of their surrender. But most of their pricing is not driven so much by the ability of the uninsured to pay, but instead by the willingness of the governmental payors to pay -- once the Medicare/Medicaid rates are set, most of the rest seems to follow, including the relative imporance of one service versus another in the negotiations with the insurers. The exception here is the foreign payors, where there actually is something that looks more like a market, but not really big enough to have a big impact on pricing.

So effectively there are three negotiating monopolies: (1) hospitals; (2) insurance companies; (3) government, and the uninsured are then an after-thought.

What do I take from all of this? That the health care system has the flaws of partial regulation; unless we can find a way to fully regulate, all we're doing is trying to referee a street fight. And if we don't regulate, we are at this point leaving it to the monopolies, the strongest of which are insurance companies and government.

That's the same exact situation in Houston, except we have three not-for-profit hosptials controlling the show instead of two. (Four if you count the sisters for chairty, but after the elevator decapitation last year, they've had issues filling their beds.) The problem is that we as a people have a problem shoving sick and/or dying people out on the street and we have requirements about taking care of people who show up on the threshold (or 50 feet from the campus, whichever is closer), but we steadfastly maintain the illusion that we're operating some sort of capitalist enterprise here.

[Atticus Grinch]

I wonder if there's any single position officially taken by the Democratic party that is as fundamentally embarrassing to its core values (as professed here) as H.J. Res. 56 is fundamentally embarrassing to the GOP's core values (as expressed here, and by all GOP candidates before Reagan --- except Nixon).

Guys, your original core values can't win elections, but at least they had honorable intentions. "Republicans' only coherent notion, family values, is a euphemism for collectivism. Individual rights have no place in the Republican Party.". Your recent praise of Reagan does no honor to the dead libertarianism you profess --- rather, it honors the cynical pragmatism that has resulted in the manipulation of the out-of-control religious zealotry now informing our nation's foreign and domestic policy. Reagan had the guts to ignore the reactionary wingnuts after he got elected. That made him a hypocrite, but at least he was a leader.

[Hank Chinaski]

Originally posted by Atticus Grinch
I wonder if there's any single position officially taken by the Democratic party that is as fundamentally embarrassing to its core values (as professed here) as H.J. Res. 56 is fundamentally embarrassing to the GOP's core values (as expressed here, and by all GOP candidates before Reagan --- except Nixon).

Guys, your original core values can't win elections, but at least they had honorable intentions. "Republicans' only coherent notion, family values, is a euphemism for collectivism. Individual rights have no place in the Republican Party.". Your recent praise of Reagan does no honor to the dead libertarianism you profess --- rather, it honors the cynical pragmatism that has resulted in the manipulation of the out-of-control religious zealotry now informing our nation's foreign and domestic policy. Reagan had the guts to ignore the reactionary wingnuts after he got elected. That made him a hypocrite, but at least he was a leader.

you want to talk about bowing to perceived pressure? What the fuck did Teddy think voting for the decency law? more senators voted against going into Iraq, so don't blame fear of political backlash. Shoot, it was 99-1 which means Kerry voted for it.

[Tyrone Slothrop]

Originally posted by Atticus Grinch
I wonder if there's any single position officially taken by the Democratic party that is as fundamentally embarrassing to its core values (as professed here) as H.J. Res. 56 is fundamentally embarrassing to the GOP's core values (as expressed here, and by all GOP candidates before Reagan --- except Nixon).

Guys, your original core values can't win elections, but at least they had honorable intentions. "Republicans' only coherent notion, family values, is a euphemism for collectivism. Individual rights have no place in the Republican Party.". Your recent praise of Reagan does no honor to the dead libertarianism you profess --- rather, it honors the cynical pragmatism that has resulted in the manipulation of the out-of-control religious zealotry now informing our nation's foreign and domestic policy. Reagan had the guts to ignore the reactionary wingnuts after he got elected. That made him a hypocrite, but at least he was a leader.

Apparently the Republicans in Congress are too libertarian (in the sense of having principles, as opposed to the sense of having run a different cost-benefit analysis) to want to push this, but the White House wants it out there to help with the election.

[SlaveNoMore]

sgtclub
I'm going to let this petty little comment go by

Still battered from the Fresno comment I take it?

[SlaveNoMore]

Tyrone Slothrop
It's more a question of sucking up to Slave. I really haven't figured how to keep up with the Spartan in that department, but I'm happy to be #2 and trying harder so long as there are two mods. But thank you again for your support!

Apropos of nothing, has anyone noticed what a powerhouse the Yankees are this year? Such power and skill.

Shhhh. No need to tip-off the IRS.

But just so you know, Darcy would love a mink and a new set of Pings would really make a difference in my short game.

[SlaveNoMore]

Atticus Grinch
I wonder if there's any single position officially taken by the Democratic party that is as fundamentally embarrassing to its core values (as professed here) as H.J. Res. 56 is fundamentally embarrassing to the GOP's core values (as expressed here, and by all GOP candidates before Reagan --- except Nixon).

I don't disgree with you.

Here's former congressman Bob Barr, testifying on the Hill yesterday. At least some of us still have it right:

• I am not new to my conservative principles. No one has ever tried to accuse me of being a liberal Republican or a moderate Republican; I have only been a conservative Republican. And, as a conservative Republican, I have never compromised my basic principles - limited government, the free market, steadfast adherence to civil liberties including the right to keep and bear arms and the rights of the states - in the search for higher office. I appear before you today in that spirit of consistency with conservative ideals... I, along with many other conservative opinion leaders and lawmakers, strongly oppose the Federal Marriage Amendment for three main reasons. First, by moving what has traditionally been a state prerogative - local marriage laws -- to the federal government, it is in direct violation of the principles of federalism. Second, in treating the Constitution as an appropriate place to impose publicly contested social policies, it would cheapen the sacrosanct nature of that document, opening the door to future meddling by liberals and conservatives. Third, it is unnecessary so long as DOMA is in force.

Originally posted by SlaveNoMore
Shhhh. No need to tip-off the IRS.

But just so you know, Darcy would love a mink and a new set of Pings would really make a difference in my short game.

Friends don't let friends wear mink. Or any fur. Try to keep your mistresses straight.

[sgtclub]

Originally posted by SlaveNoMore
Still battered from the Fresno comment I take it?

No, just don't want to deal with a repeat of the thought police around here.

[SlaveNoMore]

catrin_darcy
Try to keep your mistresses straight.

I do.

But they still seem to end up in bed with other chicks.