Obama Returns to End-of-Life Plan That Caused Stir

[sweetpea17]

I see this whole thread boils down to
doctors will continue to advise and assist patients with their end of life decisions. Some here agree they should be able to be paid for it, others do think that there should be reimbursement for those whose insurance coverage consists of governmental plans. Because that is the only issue at hand springing from the recent announcement. Some doctors may refuse to this without compensation, but I would bet most will.

Someone referenced attorneys and implied that they would just advise based upon the law and not their own views. I do not think that is true. I think many attorneys, arguably most, would not interject their own personal opinions into the advice they give. But some do.

Ultimately, I think most patients when faced with end of life decisions want to get their affairs in order, want to maintain a quality of life, and do not want endless suffering. Yes they do want medical care, but I have yet to talk to someone who wants to be kept alive indefinitely on machines when they are no longer conscious and have no hope of recovery. No doubt there are some who feel that way- I have yet to hear someone say that to me.

 

[Ridgerunner]

I see this whole thread boils down to
doctors will continue to advise and assist patients with their end of life decisions. Some here agree they should be able to be paid for it, others do think that there should be reimbursement for those whose insurance coverage consists of governmental plans. Because that is the only issue at hand springing from the recent announcement. Some doctors may refuse to this without compensation, but I would bet most will.

Someone referenced attorneys and implied that they would just advise based upon the law and not their own views. I do not think that is true. I think many attorneys, arguably most, would not interject their own personal opinions into the advice they give. But some do.

Ultimately, I think most patients when faced with end of life decisions want to get their affairs in order, want to maintain a quality of life, and do not want endless suffering. Yes they do want medical care, but I have yet to talk to someone who wants to be kept alive indefinitely on machines when they are no longer conscious and have no hope of recovery. No doubt there are some who feel that way- I have yet to hear someone say that to me.

Oddly enough, I have had someone tell me that very thing; that she would want to be kept alive no matter what. But I’ll grant she is exceptional in saying that.

I don’t want to quibble pointlessly, but I, at least, never said doctors should not be paid for assisting patients in their life decisions. My point was that they already are…when there is actually something specific to say; some known and serious condition to address. What I think is pointless at best, pernicious at worst, is the government paying for physician (much more likely outsourced) advice and information when there really ISN’T anything specific to say. And so, perhaps that will galvanize perfectly well (but older) people to say…what? What a person might say as a well person is inherently uninformed precisely because he/she has no idea what his “end of life” condition will actually be. “No machines” perhaps? Well, what about the machines that keep your blood circulating when you’re having coronary artery surgery? Would that include kidney dialysis under all circumstances? What about those pumps some cancer patients live with for years? Hyperbaric machines like the one that saved my 74-year-old diabetic friend’s feet and legs?

And finally, the government has already demonstrated with that (later withdrawn) VA “informational” pamphlet, what its approach is. And when a very liberal congress shrinks from this, yet the administration enacts it anyway? One finds it hard to be sanguine about it.

 

[seekerz]

Where did you specifically refer to another post?

In the first paragraph of what was a two paragraph post.

 

[bbarrick8383]

In the first paragraph of what was a two paragraph post.

I was addressing specific views

What truly amazes me is how many** theories and ideologies**

I see you still haven’t responded to what (in your estimation) constitutes the “most local level” at which medical care should be paid for. Would that not be in fact be, not the state or the insurance company, but the individual pocket? Then if individual pockets are empty…too bad?

Not very specific to me. You’re first paragraph had very little to do with the broad brush tangent you started in the second.

Care to be more specific? Care to answer my previous question you probably forgot to answer?

 

[Roselle]

I thought Charles Krauthammer has a great article out today. It’s about Obama’s plans to use regulatory agencies to achieve political goals since he lost badly during the mid-term election ~ as with end of life, EPA regulating green house gases, etc.

Dems Now Try Quiet Defiance Via Regulation

investors.com/NewsAndAnalysis/Article/558258/201012301905/Dems-Now-Try-Quiet-Defiance-Via-Regulation.htm

 

[seekerz]

Not very specific to me. You’re first paragraph had very little to do with the broad brush tangent you started in the second.

Care to be more specific? Care to answer my previous question you probably forgot to answer?

The theories and ideologies I referenced were in the poster’s previous comments and no, I do not care to be more specific than that. If the cap fits, any reader is welcome to wear it…if not, there shouldn’t be a problem.

This thread is a discussion of end of life plans (and imaginary death panels) - not a dissection of my posts.

 

[bbarrick8383]

The theories and ideologies I referenced were in the poster’s previous comments and no, I do not care to be more specific than that. If the cap fits, any reader is welcome to wear it…if not, there shouldn’t be a problem.

This thread is a discussion of end of life plans (and imaginary death panels) - not a dissection of my posts.

You made a comment earlier that you were being tag teamed, now you are upset that I am dissecting your posts. Maybe a public forum where discussion and debate is not your avenue. You sound more like you want a monologue where you are the only one voicing your opinion, or do you just not like others jumping in the conversation? In that case you should just PM people and not post on the open threads.

In order for us to discuss the original topic we must to a certain extent pay attention to each others posts, at least those that we find interesting. So your complaining about your posts being dissected is kind of funny in a way.

 

[Scott_Lafrance]

I see you still haven’t responded to what (in your estimation) constitutes the “most local level” at which medical care should be paid for. Would that not be in fact be, not the state or the insurance company, but the individual pocket? Then if individual pockets are empty…too bad?

What truly amazes me is how many theories and ideologies have been thought up to justify the kind of selfishness (me, mine, my over you and yours) that is totally opposed to anything Christ taught in the Gospels.

The party receiving the service should be the one paying for it. If they are incapable of paying for it, that is the purpose of private charity. There, subsidiarity. And this is not about selfishness, it is about personal responsibility, and by extension, the responsbility to care for one’s neighbors. I laugh at your attempt to equate resistance to intrusive government with selfishness. Sounds exactly like Obama on the campaign trail.

 

[Scott_Lafrance]

I thought Charles Krauthammer has a great article out today. It’s about Obama’s plans to use regulatory agencies to achieve political goals since he lost badly during the mid-term election ~ as with end of life, EPA regulating green house gases, etc.

Dems Now Try Quiet Defiance Via Regulation

investors.com/NewsAndAnalysis/Article/558258/201012301905/Dems-Now-Try-Quiet-Defiance-Via-Regulation.htm

and the GOP (I hope) will quite loudly stiffle the socialists and their attempt to end-run Congress by starving those regulatory agencies of money. I hope they defund Cas Sunstein’s office by 100%. Make him work for free. We all know that ruling class elites don’t work for free.

 

[ishii]

And now the backpeddling:

"Rep. Earl Blumenauer (D-Ore.) is distancing himself from a memo sent by his office that urged health reform advocates not to advertise new end-of-life counseling regulations to avoid reviving talk of “death panels.”

The weeks-old memo recommended that end-of-life advocates celebrate a “quiet” victory out of concern that Republican leaders would “use this small provision to perpetuate the ‘death panel’ myth.”

Blumenauer now says he regrets the letter’s secretive language, which has only bolstered conservatives’ claims that the Obama administration tried to sneak the provision in under the radar."

Amazing. Notice how Blumenaur seems to regret that they didn’t disguise their true intentions better and were exposed. What Obama and the Democrats are doing can only be done secretively, without the public knowing. Whenever the light is shined on what they’re proposing, the public opposition increases. Any Catholic who is interested in the sanctity of life, and any person who is interested in transparency and open debate of ideas, ought to be very concerned about the Democrats and Obama.

Ishii

thehill.com/blogs/healthwatch/health-reform-implementation/135523-democrat-regrets-language-in-memo-on-death-panels-that-reignited-debate

 

[TheTrueCentrist]

The party receiving the service should be the one paying for it. If they are incapable of paying for it, that is the purpose of private charity. There, subsidiarity. And this is not about selfishness, it is about personal responsibility, and by extension, the responsbility to care for one’s neighbors. I laugh at your attempt to equate resistance to intrusive government with selfishness. Sounds exactly like Obama on the campaign trail.

Subsidiary is a principle which dictates how we should deal with needs in the world. It is easy to see that there is a need for health care which is not met currently. It therefore seems like subsidiary should apply. This, however, is slightly shortsighted.

Say some organization gained a monopoly on food. They charged 10x the price food currently is because they could. Would you expect private charities to make up the difference for all the new people who could no longer afford to feed their families? Maybe in the short term, but in the meantime, you would expect the government to break up the monopoly so that companies would have to charge competitively.

This is the second reason why subsidiary is not relevant (I mentioned the 1st earlier). Health care providers, especially in rural areas, typically have geographic monopolies on various services. For example, the hospital near me may have high end cardiac services. If I wanted comparable cardiac care, my choices would be to go to that hospital or travel a prohibitive distance for care somewhere else. If pricing were left up to the health care providers, they could set exorbitant prices for any services not offered elsewhere.

Unfortunately, the government cannot “break up” a geographic monopoly by mandating people make more hospitals.
Also, we would not expect charities to pay exorbitant rates for every uninsured person’s broken arm for example (let alone more complicated surgeries.) How then can we ensure that more people can receive the health care they need? In the old system, the mechanism by which prices were kept competitive was collective bargaining on the part of the insurance companies. While some of the proposed ideas (e.g. government option, single payer) would have changed this mechanism, the new system largely maintains the status quo.

“How does an individual mandate help?” you may ask. The answer is not overly complicated. When everyone has insurance, two relevant things will happen. Firstly, health insurers will wield even greater collective bargaining clout, allowing them to negotiate lower rates which will in turn drive increased efficiency on the health care provider side. Secondly, when everyone has access to insurance-negotiated rates, private charities can actually afford to help the needy with their health care.

 

[TheTrueCentrist]

Article I, Section 8, Clause 7 of the United States Constitution, known as the Postal Clause or the Postal Power, empowers Congress “To establish Post Offices and post Roads”.

It doesn’t. Therefore they, not being expressed, enumerated powers, are both unconstitutional.

I was thinking of this government takeover of the mail when I mentioned mail:
en.wikipedia.org/wiki/Private_Express_Statutes
en.wikipedia.org/wiki/American_Letter_Mail_Company
“The American Letter Mail Company was started by Lysander Spooner in 1844, competing with the legal monopoly of the United States Post Office (USPO) (now the USPS) in violation of the Private Express Statutes. It succeeded in delivering mail for lower prices, but the U.S. Government challenged Spooner with legal measures, eventually forcing him to cease operations in 1851.”

The problem with your position on social security and medicare is the resounding roar of legal challenges that we don’t hear. There have been precious few actual challenges to either since they were enacted (3 or 4 to social security back in 1937 and none for medicare.) In other words, if the constitutionality of either program were truly dubious then it is likely people would consistently challenge them. Since they have not, I can only conclude that such claims are the product of a sort of constitutional fundamentalism which appears to be in vogue among the more conservative circles.

 

[Scott_Lafrance]

I was thinking of this government takeover of the mail when I mentioned mail:
en.wikipedia.org/wiki/Private_Express_Statutes
en.wikipedia.org/wiki/American_Letter_Mail_Company
“The American Letter Mail Company was started by Lysander Spooner in 1844, competing with the legal monopoly of the United States Post Office (USPO) (now the USPS) in violation of the Private Express Statutes. It succeeded in delivering mail for lower prices, but the U.S. Government challenged Spooner with legal measures, eventually forcing him to cease operations in 1851.”

The problem with your position on social security and medicare is the resounding roar of legal challenges that we don’t hear. There have been precious few actual challenges to either since they were enacted (3 or 4 to social security back in 1937 and none for medicare.) In other words, if the constitutionality of either program were truly dubious then it is likely people would consistently challenge them. Since they have not, I can only conclude that such claims are the product of a sort of constitutional fundamentalism which appears to be in vogue among the more conservative circles.

I know that insisting that the government and the ruling elites in power show a great deal of disdain for the Constitution, and that there is a small 9but growing) group of citizens that are actually demanding that our so-called “public servant” abide by the rule of law and uphold their oath to protect and defend the Constitution. Abiding by the rule of law, what a novel and faddish concept.

 

[TheTrueCentrist]

I know that insisting that the government and the ruling elites in power show a great deal of disdain for the Constitution, and that there is a small 9but growing) group of citizens that are actually demanding that our so-called “public servant” abide by the rule of law and uphold their oath to protect and defend the Constitution. Abiding by the rule of law, what a novel and faddish concept.

While I’m sure that “small but growing” group feels very righteous coming out in favor of the rule of law when everyone else is against it, their tactics are somewhat less than admirable. Creating controversy over “death panels” when there is no such thing is at best ignorant and at worst dishonest. I believe seekerz has done a pretty good job of explaining why the government’s plan should not be even remotely controversial.

Panels determining standards of care already exist:

You have the answer within your own post. Doctors do that right now, as part of ongoing care - which means they don’t get compensated to do it. If I went to a doctor for diabetes complications, he would get paid the same whether he took the time to counsel me on end-of-life care or not (diabetes counseling is a different story - here, compensation would depend on how much time he took). If provision is made for end of life counseling reimbursement, then proper time can be allotted to it.

As for panels that determine standards or care and compensation, those already exist (that’s the hypocrisy of this whole fear strategy) and I don’t really see what prevents good, life-respecting Christians from making sure to take their places on them.

And are scientifically informed:

You’re welcome to your opinion but not to your own facts. HHS does not set standards of care arbitrarily. It has to be based on a summary of relevant research. Any and every body in the world of medicine has an opportunity to perform and submit sound scientific studies. If people of good moral character choose not to become active in research, then that is their failing, not the government’s.

All doctors counsel people about thousands of things everyday and they do it without a teleprompter. Without a sound medicolegal grounding, anyone practicing medicine is taking a foolish risk as there is hardly an area of medicine not impacted or regulated by the law in some way.

As for “paint by the numbers” medicine, as you call it - I have a healthy respect for it. It might irk those who are unwilling to take the time to familiarize themselves with relevant data or to contribute to it, but it in no way precludes the practice of the art of medicine. What it does do is set a minimum standard of what should be done (or what is definitely not acceptable in some cases). Practicing medicine in this day and age, without due regard for the scientific basis of one’s actions, is like surveying a field by pacing it instead of using scientific measuring instruments. The length of your legs, the size of your feet, your energy level and whether you quarreled with your wife at breakfast, are all more likely to affect the former measurements rather than the latter.

 

[Ridgerunner]

Subsidiary is a principle which dictates how we should deal with needs in the world. It is easy to see that there is a need for health care which is not met currently. It therefore seems like subsidiary should apply. This, however, is slightly shortsighted.

Say some organization gained a monopoly on food. They charged 10x the price food currently is because they could. Would you expect private charities to make up the difference for all the new people who could no longer afford to feed their families? Maybe in the short term, but in the meantime, you would expect the government to break up the monopoly so that companies would have to charge competitively.

This is the second reason why subsidiary is not relevant (I mentioned the 1st earlier). Health care providers, especially in rural areas, typically have geographic monopolies on various services. For example, the hospital near me may have high end cardiac services. If I wanted comparable cardiac care, my choices would be to go to that hospital or travel a prohibitive distance for care somewhere else. If pricing were left up to the health care providers, they could set exorbitant prices for any services not offered elsewhere.

Unfortunately, the government cannot “break up” a geographic monopoly by mandating people make more hospitals.
Also, we would not expect charities to pay exorbitant rates for every uninsured person’s broken arm for example (let alone more complicated surgeries.) How then can we ensure that more people can receive the health care they need? In the old system, the mechanism by which prices were kept competitive was collective bargaining on the part of the insurance companies. While some of the proposed ideas (e.g. government option, single payer) would have changed this mechanism, the new system largely maintains the status quo.

“How does an individual mandate help?” you may ask. The answer is not overly complicated. When everyone has insurance, two relevant things will happen. Firstly, health insurers will wield even greater collective bargaining clout, allowing them to negotiate lower rates which will in turn drive increased efficiency on the health care provider side. Secondly, when everyone has access to insurance-negotiated rates, private charities can actually afford to help the needy with their health care.

I don’t agree with this. At one time in my life I negotiated insurer rates with providers. In thinking about all of this, one first has to realize how competitive healthcare providers really are relative to one another. They’ll undercut each other in a heartbeat if they think it will get them on the provider list. Possibly the worst thing about “monopolies in healthcare” is Medicare rates. But that’s not a provider monopoly, it’s a government monopoly. Because Medicare rates are supposed to be deeply discounted, providers simply do what stores do when they advertise sales or discounts. They jack up a bogus rate that is called “reasonable an necessary” and “discount” to medicare (and Medicaid) from that. If you walk in off the street with no Medicare and no insurance, they have no choice but to charge you “reasonable and necessary”; the bogus rate, like it or not, though they might “compromise” it later after dunning you a bit (or if you offer greenbacks) to convince the government that they actually tried. It’s a fraud, and the government is a knowing participant in the fraud. It is, in fact, the creator of the fraud.

Now, understanding how things vary from place to place, and not arguing against the proposition that they do, I will also say that Medicare rate is actually a pretty good rate. Never, ever, ever did I fail to negotiate less than Medicare rate for my client, particularly when it came to services and specialists whose calendars are not always full. Sometimes I needed to switch from an overused specialty to an underused one that does the same thing. (e.g., underutilized plastic surgeons without a big cosmetic following as substitutes for orthopaedic surgeons for some things, or new orthopaedic surgeons as substitutes for a long-established neurosurgery group for things either one could do). Some things are needlessly duplicated in medical groups. MRIs are perhaps the worst example, though there might be others. MRI for $300? That was exceptional. But they would still rather get $300 than nothing during slack times. And the government paid five times that and didn’t care, because negotiated deals with insurers don’t count when it comes to “reasonable and necessary”. Only self-pay people or “out of the area” insurers without a provider agreement do. That government-induced fraud is precisely why your insurer doesn’t approve “out of network” procedures readily. It’s worse if you want care out of state. There is a very good chance they don’t have a provider deal with somebody several states away. It’s not greed, exactly. It’s that they have to have time to negotiate pricing if they can. Remember, they have based their premiums on their provider deals. More on that below.

And when you see the breathtaking gold plating in some of those facilities and realize most of it is built on Medicare rate for which that gold plating is factored in, it just amazes. Government monopoly at work.

(continued)

 

[Ridgerunner]

One specialist, the head of his department for a large group, opined to me one time that one of the biggest causes of high medical costs is the fact that everybody who utilizes it wants somebody else to pay for it. An enormous amount of money, time and energy is devoted to that phenomenon. People who could easily pay for minor things absolutely won’t do it because “the insurance should pay for it” or “the government should pay for it”, or whatever, and half the cost is the trouble and paperwork involved in “getting somebody else to pay for it”.

In the rural areas around my town there are a fair number of Amish. Amish don’t mind “modern” when it comes to medical care. Not at all. It’s amusing to observe them at the cashier’s window. Amish don’t use insurance or government healthcare at all. It’s against their religion. But they pay immediately and in cash-greenbacks. And they almost always get a discount without much resistance. Why? Because all the cashier has to do is register it in and give a receipt. No billing and re-coding when it comes back, and hassling with an insurer or the government (which also means insurers, because Medicare and Medicaid are “farmed out” to private insurers) about the way bills are constituted,and getting paid weeks or months after the service. Cash on the counter. It talks. But we all want to just pay that $10 “co-pay” instead of the $100 charge (or the $50 or $60 it would be if it was all done in cash) and somehow we seem to think it’s nearly “free”, (truly free if it’s Medicaid) never realizing that it’s all costing us in one way or another. We’re fools to think we have shifted the burden to “somebody else”.

But the doctors have to have all this expensive software and computer equipment and personnel to keep track of all that, and they absolutely hate it.

So, I don’t necessarily disagree that decentralization could help with the cost of healthcare. But the government itself is largely responsible for the centralization and for the overpricing. Also the overutilization that’s rampant in “care somebody else pays for”. But that’s another story. Well, briefly, know who the big users of very expensive ER care are? Medicaid people. It’s “free” to them. So if they have an earache at midnight, it’s off to the ER. You and I have to sweat it out until the doctor’s office opens in the morning.

One more thing. I have had occasion now and then to work with annuities. It’s astonishing how much money market rates influence what insurers can charge and pay. Insurers collect premiums and invest them, and figure out what they have to have at available rates to pay for healthcare costs for a given person or population. It’s not easy, and just figuring it out requires significant and expensive talent. But just a little downturn in return rates makes a big difference in the premiums they have to charge to stay even.

So here we are, in an economy in which housing-based securities, supposedly safe, collapsed, and interest rates have been kept artificially low, all due to political decisions, and nobody sees the connection between those events and the cost of health insurance. The effect is big, very big.

And somehow, people manage to convince themselves that the government is the cure for it all.

 

[seekerz]

The party receiving the service should be the one paying for it. If they are incapable of paying for it, that is the purpose of private charity. There, subsidiarity. And this is not about selfishness, it is about personal responsibility, and by extension, the responsbility to care for one’s neighbors. I laugh at your attempt to equate resistance to intrusive government with selfishness. Sounds exactly like Obama on the campaign trail.

Let me see private charity pay 10 times Medicare’s contracted fees (yes, that’s what some docs real fees are outside of their contracts with insurance carriers). Then we would have donors with varying degrees of medical knowledge (or none at all) deciding whether to give to this or that charity based on whether or not they think the care provided to poor people is medically necessary/deserved/in line with their beliefs etc. Or worse yet, poor people might find it more convenient to get sick at Christmas and not so much throughout the year. Actually that kind of health care plan should take care of the sticky problem of death panels quite nicely, I would think…

 

[TheTrueCentrist]

I don’t agree with this. At one time in my life I negotiated insurer rates with providers. In thinking about all of this, one first has to realize how competitive healthcare providers really are relative to one another. They’ll undercut each other in a heartbeat if they think it will get them on the provider list. Possibly the worst thing about “monopolies in healthcare” is Medicare rates. But that’s not a provider monopoly, it’s a government monopoly. Because Medicare rates are supposed to be deeply discounted, providers simply do what stores do when they advertise sales or discounts. They jack up a bogus rate that is called “reasonable an necessary” and “discount” to medicare (and Medicaid) from that. If you walk in off the street with no Medicare and no insurance, they have no choice but to charge you “reasonable and necessary”; the bogus rate, like it or not, though they might “compromise” it later after dunning you a bit (or if you offer greenbacks) to convince the government that they actually tried. It’s a fraud, and the government is a knowing participant in the fraud. It is, in fact, the creator of the fraud.

No, what you have said is fundamentally flawed. You essentially repeated what I said but claimed without reason that it is the government’s fault. Medicare does not cause health care providers to act as a geographic monopoly. Health care providers can charge “bogus rates” because they are local monopoly. It is the nature of their business, just like utilities typically have geographic monopolies on their particular service (e.g. it doesn’t make sense to argue for competition for tap water.) The only way the government is at fault for this is that they have not engaged in price fixing, mandating that all health care providers charge specific rates for specific services.

In order to actually mandate lower rates, governments typically implement a single payer system, which causes the health care market to become a monopsony in which the government can dictate the terms of health care services.

Now, understanding how things vary from place to place, and not arguing against the proposition that they do, I will also say that Medicare rate is actually a pretty good rate… negotiated deals with insurers don’t count when it comes to “reasonable and necessary”. Only self-pay people or “out of the area” insurers without a provider agreement do. That government-induced fraud is precisely why your insurer doesn’t approve “out of network” procedures readily. It’s worse if you want care out of state. There is a very good chance they don’t have a provider deal with somebody several states away. It’s not greed, exactly. It’s that they have to have time to negotiate pricing if they can. Remember, they have based their premiums on their provider deals. More on that below.

And when you see the breathtaking gold plating in some of those facilities and realize most of it is built on Medicare rate for which that gold plating is factored in, it just amazes. Government monopoly at work.

It seems to me that you are saying this:
“Health care providers charge very high rates to the uninsured (or people with insurance they don’t except), and it is the government’s fault”

I agree with you except for the “it is the governments fault part.” Please explain specifically how it is the government’s monopoly (on what?) that causes health care providers charge a lot to the uninsured.

 

[TheTrueCentrist]

I don’t agree with this. At one time in my life I negotiated insurer rates with providers. In thinking about all of this, one first has to realize how competitive healthcare providers really are relative to one another. They’ll undercut each other in a heartbeat if they think it will get them on the provider list. Possibly the worst thing about “monopolies in healthcare” is Medicare rates. But that’s not a provider monopoly, it’s a government monopoly. Because Medicare rates are supposed to be deeply discounted, providers simply do what stores do when they advertise sales or discounts. They jack up a bogus rate that is called “reasonable an necessary” and “discount” to medicare (and Medicaid) from that. If you walk in off the street with no Medicare and no insurance, they have no choice but to charge you “reasonable and necessary”; the bogus rate, like it or not, though they might “compromise” it later after dunning you a bit (or if you offer greenbacks) to convince the government that they actually tried. It’s a fraud, and the government is a knowing participant in the fraud. It is, in fact, the creator of the fraud.

No, what you have said is fundamentally flawed. You essentially repeated what I said but claimed without reason that it is the government’s fault. Medicare does not cause health care providers to act as a geographic monopoly. Health care providers can charge “bogus rates” because they are local monopoly. It is the nature of their business, just like utilities typically have geographic monopolies on their particular service (e.g. it doesn’t make sense to argue for competition for tap water.) The only way the government is at fault for this is that they have not engaged in price fixing, mandating that all health care providers charge specific rates for specific services.

In order to actually mandate lower rates, governments typically implement a single payer system, which causes the health care market to become a monopsony in which the government can dictate the terms of health care services.

Now, understanding how things vary from place to place, and not arguing against the proposition that they do, I will also say that Medicare rate is actually a pretty good rate… negotiated deals with insurers don’t count when it comes to “reasonable and necessary”. Only self-pay people or “out of the area” insurers without a provider agreement do. That government-induced fraud is precisely why your insurer doesn’t approve “out of network” procedures readily. It’s worse if you want care out of state. There is a very good chance they don’t have a provider deal with somebody several states away. It’s not greed, exactly. It’s that they have to have time to negotiate pricing if they can. Remember, they have based their premiums on their provider deals. More on that below.

And when you see the breathtaking gold plating in some of those facilities and realize most of it is built on Medicare rate for which that gold plating is factored in, it just amazes. Government monopoly at work.

It seems to me that you are saying this:
“Health care providers charge very high rates to the uninsured (or people with insurance they don’t except), and it is the government’s fault. It is the governments fault because they negotiate rates that cause health care providers to operate at a loss, a loss that they recoup by charging higher rates to the uninsured”

The problem with that statement is this: the majority of the uninsured are uninsured because they cannot afford insurance. The health care providers are not going to recoup any losses by charging someone who lives paycheck to paycheck $12,000 per MRI for example. Quite simply, that person doesn’t have that much money to give them.

Moreover, if everyone has health insurance, the health care providers will not have any customers left to charge “bogus rates.”

 

[seekerz]

The problem with that statement is this: the majority of the uninsured are uninsured because they cannot afford insurance. The health care providers are not going to recoup any losses by charging someone who lives paycheck to paycheck $12,000 per MRI for example. Quite simply, that person doesn’t have that much money to give them.

Moreover, if everyone has health insurance, the health care providers will not have any customers left to charge “bogus rates.”

Thank you. Those who charge bogus rates, do so because they can - simple. I have something you need (not want, but need) - I can charge whatever I like and unless there is some entity advocating on behalf of those who need my services, I can get away with it too! It’s not that doctors do not deserve to be paid for their services, it’s simply that allowing free market principles to dictate the provision of health care equates very simply to survival of the richest. If we truly believe that all men are created equal, than that is a situation which just cannot fly.