Healthcare Reform

[Merge]

1. It's all about supply and demand. You have to increase the supply so price drops. Stop agricultural conservation and allow farmers to grow good crops on that land. Stop farm raising seafood. Do a google search for what those fish are fed.

We do not have a supply problem. Supermarkets toss billions of dollars in fresh produce per year.
Not to mention the billions wasted because Americans want to eat pretty fruits and vegetables. Increasing supply will not lower the costs at all. Government can lower the costs by placing incentives on healthy eating - Subsiding healthy foods further and taxing unhealthy foods. Even then, you have to change unhealthy habits before people jump into buy

Now to be fair you'll never see 100% healthy population but these industries will be less than 25% of what they are today if the focus was on preventing being sick, not what to do after being sick.

There are actually some studies about the impacts on economic growth from the health of the population.
Sure some industries would not do as well, but overall it would be better for economic growth if we were healthier.

 

[Merge]

The government shouldn't tell you what to eat nor should the government be responsible for your shitty choices.

They shouldn't tell you what to do, but they should aim to educate as much as possible and I am not opposed to penalizing unhealthy behaviors because those unhealthy behaviors have an impact on how much I have to pay for my health insurance.

 

[SHUHoopsFan]

Organic fruits and vegetables are more expensive because without chemicals, yields and consistency are lower making prices higher. More land may or may not solve the problem, unless you are implying the government should subsidize organic farmers.

You would like to increase the supply of wild seafood? How? It is not an easy fix.

I'm sure someone with much more knowledge in agriculture and fishing industries have answers. This country survived the majority of it's first 200 years without putting chemicals in their food and farm raising seafood.

 

[SHUHoopsFan]

They shouldn't tell you what to do, but they should aim to educate as much as possible and I am not opposed to penalizing unhealthy behaviors because those unhealthy behaviors have an impact on how much I have to pay for my health insurance.

That's why I hope they get rid of the ACA. It's all robin hood based getting working people and young people to help reduce the costs of unhealthy and poor. I have no problem contributing for hard working people or people who just have bad luck with disease. But people who drink soda non stop or people who haven't attempted to get a job in 10 years, it's ridiculous to ask people to pay for those people.

 

[knowknow456]

I'm sure someone with much more knowledge in agriculture and fishing industries have answers. This country survived the majority of it's first 200 years without putting chemicals in their food and farm raising seafood.

And people in Pittsburgh lived their whole lives and never ate a lobster. We live in a much larger and more interconnected world. I have little desire to live in the 1800's.

 

[knowknow456]

They shouldn't tell you what to do, but they should aim to educate as much as possible and I am not opposed to penalizing unhealthy behaviors because those unhealthy behaviors have an impact on how much I have to pay for my health insurance.

Much like the crusade to reduce smoking, this will take two generations to show results. It is a process. Interestingly enough, both pepsi and coke are deriving less revenue and profit from soda than before. The things being discussed here are starting to take hold, at least on the margins.

 

[Merge]

That's why I hope they get rid of the ACA. It's all robin hood based getting working people and young people to help reduce the costs of unhealthy and poor. I have no problem contributing for hard working people or people who just have bad luck with disease. But people who drink soda non stop or people who haven't attempted to get a job in 10 years, it's ridiculous to ask people to pay for those people.

Again, that is what insurance is. Healthy people pay for the sick people.
If you reduce the amount of healthy people in the pool, the price goes up for the remaining healthy people and sick people.

If you want to penalize people who drink soda their whole lives, you can accomplish that by taxing soda.... Your idea would penalize people who never had soda in their life but want health insurance. Just not a good idea from my view.

 

[SHUHoopsFan]

Again, that is what insurance is. Healthy people pay for the sick people.
If you reduce the amount of healthy people in the pool, the price goes up for the remaining healthy people and sick people.

If you want to penalize people who drink soda their whole lives, you can accomplish that by taxing soda.... Your idea would penalize people who never had soda in their life but want health insurance. Just not a good idea from my view.

Yes but how many types of insurances are mandatory? People may want life insurance but can't afford it. People may want renters insurance but can't afford it. It's not Bill Gates responsibility to help pay for those people. Nor should you or I have to pay for other people's health insurance. Again I don't object to contributing and helping out people, but the number of people that milk the system it is ridiculous. People who haven't looked for a job in 10 years can't afford it and we're all supposed to chip and get it for them?

 

[Merge]

Yes but how many types of insurances are mandatory? People may want life insurance but can't afford it. People may want renters insurance but can't afford it. It's not Bill Gates responsibility to help pay for those people. Nor should you or I have to pay for other people's health insurance. Again I don't object to contributing and helping out people, but the number of people that milk the system it is ridiculous. People who haven't looked for a job in 10 years can't afford it and we're all supposed to chip and get it for them?

So your problem isn't young people, it's poor people?

There are other things we can try to limit the number of people milking the system, but that isn't really going to impact our healthcare system.
Two separate issues and we can address both.

Health insurance is unlike anything else because you have access to healthcare the day you are born until the day you die.
Similar to if a house is burning down, the firemen will show up and try to put it out. Police will try to save you when your life is in danger... they will not check your tax records first. With health insurance, if you have a heart attack on the side of the road. You will be treated.

Getting healthy people out of the pool is a incredibly poor decision that will just kill our current system faster.

 

[SHUHoopsFan]

No my problem is people who milk the system

 

[Pirata]

I'd like to see tobacco test, body mass criteria, drug tests. If an unhealthy threshold is detected, penalties and surcharges are levied. No medicaid if you do drugs or are overweight, etc. Medicare surcharges for that cohort.

Work out the details for the exceptions and odd circumstance but the principle stands.

Call me draconian, I don't care. If you are shoving ice cream and soda into an obese frame, you are going to run up major prescription bills and other treatment costs. It is a no brainier.

 

[knowknow456]

No my problem is people who milk the system

That's why I hope they get rid of the ACA.

So your issue isn't specifically the ACA, it is people who game the system.

 

[Merge]

No my problem is people who milk the system

Pretend they all disappear tomorrow.
Healthcare still isn't fixed.

I am not saying we can't address people who milk the system, but it has very little to do with the problems in healthcare.

 

[SHUHoopsFan]

So your issue isn't specifically the ACA, it is people who game the system.

We live in a capitalistic society. In a perfect world everybody would have food, shelter, health insurance, etc. Some people have a ton things, others lack necessities. Maybe you want to open your home for those without shelter and hungry. I understand the system and even if a younger healthy person doesn't need insurance they purchase it for themselves for security purposes. Overall the money may pay for the others but they purchased it for themselves. The approach of just giving people stuff is so far left and socialist it's not our system which is what the ACA is.

 

[knowknow456]

We live in a capitalistic society. In a perfect world everybody would have food, shelter, health insurance, etc. Some people have a ton things, others lack necessities. Maybe you want to open your home for those without shelter and hungry. I understand the system and even if a younger healthy person doesn't need insurance they purchase it for themselves for security purposes. Overall the money may pay for the others but they purchased it for themselves. The approach of just giving people stuff is so far left and socialist it's not our system which is what the ACA is.

For the record, Milkers should always be removed. If my premium goes up because fat people drive up the rate as a capitalist I get annoyed. But you know what? If a healthy guy gets cancer and drives up the rate, as a capitalist I get annoyed.

 

[SPK145]

They shouldn't tell you what to do, but they should aim to educate as much as possible and I am not opposed to penalizing unhealthy behaviors because those unhealthy behaviors have an impact on how much I have to pay for my health insurance.

Get rid of community ratings.

 

[Merge]

Get rid of community ratings.

I don't want to penalize people who happen to get sick. I'd rather subsidize healthy and tax unhealthy behaviors.

 

[Pirata]

I don't want to penalize people who happen to get sick. I'd rather subsidize healthy and tax unhealthy behaviors.

I agree.

The penalties however should not be on taxing the source, i.e cigarettes and soda.

The penalty should be at the point of sale of the treatment. You would pay more for insurance, pay a surcharge for medicare, reduced benefit for medicaid.

Rationale: If I chose to drink soda as my treat, but hen work out and otherwise take care of myself, I my treat should not penalized nor should the tax on treat subsidize those who drink soda and are otherwise unhealthy, overweight etc.

The other aspect is where to you draw the line on what products are unhealthy and who makes the choice. Do we start taxing chocolate, whipped cream, half & half, etc?

 

[Merge]

I agree.

The penalties however should not be on taxing the source, i.e cigarettes and soda.

The penalty should be at the point of sale of the treatment. You would pay more for insurance, pay a surcharge for medicare, reduced benefit for medicaid.

Rationale: If I chose to drink soda as my treat, but hen work out and otherwise take care of myself, I my treat should not penalized nor should the tax on treat subsidize those who drink soda and are otherwise unhealthy, overweight etc.

Obviously I don't agree. I haven't really taken the time to think out the exact details on how I think it should work. It would take more hours than I have available, but generally healthcare is too expensive for most people. Adding a penalty to something people already can't afford is not tre direction I would want to go. At that point it is too late.

To actually reduce healthcare costs, we must change the poor lifestyle choices that we make every day.

As far as what to tax, people smarter than I am can work on that... but again, the general idea is that if you tax soda - healthy people who drink relatively small amounts of soda would be paying a relatively small amount of tax. People who drink more soda would pay more.

 

[Pirata]

 

[Pirata]

To actually reduce healthcare costs, we must change the poor lifestyle choices that we make every day.

Couldn't agree more.

Adding a penalty to something people already can't afford is not tre direction I would want to go.

Not sure I understand your comment. For the millions with employee health insurance, they already have it. Our company has penalties if you smoke. The also have incentives if you lose weight, exercise, and take care of yourself.

In principle I don't like subsidizing bad life styles.

As far as what to tax, people smarter than I am can work on that... but again, the general idea is that if you tax soda - healthy people who drink relatively small amounts of soda would be paying a relatively small amount of tax. People who drink more soda would pay more.

I agree in principle but where to you draw the line? Do we tax pizza? alocohol? Butter? Chocolate? Bagels? White bread? Pasta? (And lets not forget donuts!)

I don't want the government levying more taxes and controlling my life. My view is let people have choice but let there be consequence for their choices.

If you are overweight, you pay more insurance. If you smoke, you pay more. if you do drugs, you pay more.

 

[Merge]

Not sure I understand your comment. For the millions with employee health insurance, they already have it. Our company has penalties if you smoke. The also have incentives if you lose weight, exercise, and take care of yourself.

You said penalty at the point of sale on treatment. I was assuming you meant treating a heart attack for an obese person would carry a penalty?

I don't want the government levying more taxes and controlling my life. My view is let people have choice but let there be consequence for their choices.

On principal I want to agree with you. In practice, decades of poor decisions are destroying our healthcare system.
If you want to bend the cost curve in healthcare, you have to go after the drivers. Our diets are a huge cost driver.
Also, it's not just the individual who suffers. My healthcare is more expensive because of them which is why I would have no issue with taxing bad behaviors.

 

[HALL85]

I don't want the government levying more taxes and controlling my life. My view is let people have choice but let there be consequence for their choices.

If you are overweight, you pay more insurance. If you smoke, you pay more. if you do drugs, you pay more.

This is the crux of the matter where I agree. We do the same thing for our healthcare insurance. If an employee signs up and participates in bi-annual biometric screening, signs a non-smoking affidavit and commits to quarterly coaching calls, we give them a 10% reduction on their contribution. After here years, we are seeing some very encouraging anecdotal cases (significant weight loss, smoking cessation, etc.). Incentives/penalties, but more important creating a culture of healthy lifestyle choices.

 

[Pirata]

You said penalty at the point of sale on treatment. I was assuming you meant treating a heart attack for an obese person would carry a penalty?

Very wrong assumption. Clearly, The ER and heart attack is not the time to do anything but take care of the patient.

At a high level, I am saying don't tax the sin. Let people have the freedom to live their lives as they choose but also bear the consequences.

Provide ROI incentives for better lifestyle and penalties for those that choose to be unhealthy. I use penalties in the abstract sense. Charging more for a copay, a higher deductible, or no coverage at all depending on the circumstance.

Our company does (We are self insured, 5,000 employees) and apparently Hall85's company does also.

It works by the way.

Auto insurance does it. You get speeding tickets, you pay more. You cause accidents, you pay more.

 

[Merge]

Auto insurance does it. You get speeding tickets, you pay more. You cause accidents, you pay more.

Not the best analogy for your point. The sin is taxed. If you get speeding tickets you pay for speeding, as well as getting a higher insurance rate.

To prevent the sin, we penalize it.

What I am suggesting has about an incredibly slim chance of becoming law, so this is really just a thought exercise anyway.
I am all for promoting good behaviors, but would also be in favor or penalizing bad behaviors.

 

[Pirata]

If you want to bend the cost curve in healthcare, you have to go after the drivers.

Agreed.

Toss in tort reform. Huge need to address that.

There is also a huge nut available on efficiency, workflow, etc. We are doing work in an urban ER in our area. Docs and nurses have historically focused solely on care. We discovered incredible inefficiencies that could be mitigated but it is a delicate tightrope to walk with the caregivers.

One of my clients is a Hospital Network CFO. From his lips (paraphrase: Payers, Providers, and Patients. Payers are insurance companies and the government. We use to break even on the government and make our money with the insurance companies. We were fat dumb and happy. Recent years and ACA has taken away the juice in the insurance companies and so we must now address the cost and efficiency if we are to stay in business.

 

[Merge]

Recent years and ACA has taken away the juice in the insurance companies and so we must now address the cost and efficiency if we are to stay in business.

I'd like to know what he was talking about specifically but There were provisions in a the ACA to improve efficiency. That's a good thing.

 

[knowknow456]

I'd like to know what he was talking about specifically but There were provisions in a the ACA to improve efficiency. That's a good thing.

Patient Outcomes?

 

[HALL85]

I'd like to know what he was talking about specifically but There were provisions in a the ACA to improve efficiency. That's a good thing.

The big one was giving hospitals an incentive to invest in EHR systems. The thought being that those systems will ultimately improve patient care through better access information.

Now I am a big supporter of this technology, however, in addition to giving your money (taxes) to hospitals, what it did was accelerate hospital M&A activity since smaller hospitals just didn't have the ability to invest in the systems surely with the incentive. it created an uneven playing field that picked the winners.

 

[HALL85]

Somebody here might be better equipped to answer this (what's happening today), but in terms of education, why not have compulsory health education every semester K-12 that teaches, reinforces, etc. proper eating choices, lifestyle, exercise, etc. (not just four food groups and dodge ball...lol). 45-60 minutes every day...educating adults with a government program is a waste of money...need to drill it into the children when they are more apt to absorb the material.

 

[Merge]

The big one was giving hospitals an incentive to invest in EHR systems. The thought being that those systems will ultimately improve patient care through better access information.

Now I am a big supporter of this technology, however, in addition to giving your money (taxes) to hospitals, what it did was accelerate hospital M&A activity since smaller hospitals just didn't have the ability to invest in the systems surely with the incentive. it created an uneven playing field that picked the winners.

Sorry should have clarified. I'm wondering what that CFO would have been referring to as far as the ACA talking away the "juice" from insurance company payments. Wasn't sure if he was talking about "bundled payments" or what. Hospitals were incentivized to reduce readmission rates and there was a general trend of readkission rates declining when I was auditing hospitals, but I am 2 years removed from that industry.

Those payments to hospitals for tech systems certainly did not slow m&a but that trend started before the ACA. Everyone would have gotten there eventually anyway.

 

[HALL85]

Sorry should have clarified. I'm wondering what that CFO would have been referring to as far as the ACA talking away the "juice" from insurance company payments. Wasn't sure if he was talking about "bundled payments" or what. Hospitals were incentivized to reduce readmission rates and there was a general trend of readkission rates declining when I was auditing hospitals, but I am 2 years removed from that industry.

Those payments to hospitals for tech systems certainly did not slow m&a but that trend started before the ACA. Everyone would have gotten there eventually anyway.

Reducing readmission rates is a good thing but hospitals do game the system. It also creates a ton of administrative reporting...more cost and overhead, while also not moving the needle much.

 

[Pirata]

The short of it was that insurance companies have reduced the amounts they will pay the Providers. The reduction was in response to complying with ACA. Insurance companies push on both ends, squeezing the employers and Patients and squeezing the providers.

Reductions can come in different ways. One example is reducing in-patient reimbursement. For argument's sake let's say the insurance company used to reimburse two days recovery for gallbladder. Now they will only reimburse for one day. Instead of the hospital keeping the patient for 2 days and trying to collect the money they discharged the patient after one day because they know they will never collect. This causes a loss of revenue for a full day of inpatient charges.

We can discuss and argue all kinds of details around that example but the essence of it is they (Payers) have cut back on what they're willing to reimburse for and it is affecting the revenue of the hospitals (Providers).

 

[Pirata]

Regarding EHRs, I don't think the jury is out on that one. Our local network spent $750 million converting from one to another. I do not know how much of that they were able to suck out of the feds but I am not certain that the efficiencies gained will offset $750 million for quite a while. The anecdotal word in the medical community is that the staff is spending more time sitting in front of computer terminals than they are in front of patients. Any new system and change in general always causes discontent and so it may be a few years before we fully understand whether anything was achieved.