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Author Topic: How the "death panel" thing works
vulture
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quote:
Originally posted by NobleHunter:
quote:
Notice in the NHS plan does not allow the patient or their family to be involved. It's solely up to the medical team to make the cost/benefit analysis and implement the guidelines. This is a predicable and entirely plausible result and is something that should be a concern with any attempt at government run care.
I don't see anything in the information you provided where it was a cost/benefit analysis. The alleged "panel" is basically a bunch of doctors deciding that death is immediate and inevitable. Accordingly, they undertake efforts to make the process less uncomfortable. There are no government officials or productivity experts involved.

So this doesn't seem to be the infamous death panels, but rather an insensitive implementation of passive euthanasia.

What actually happens in the NHS:

In 2004, the National Institute for Clinical Excellence (NICE) was set up. One of the jobs of NICE (not the only one) is to evaluate available treatments in terms of effectiveness and use of resources (money, access to limited medical equipment, man hours to administer treatment). Not just for life threatening conditions, but for all possible medical treatments and conditions. NICE then decides what treatments will be available on the NHS based on those criteria. And yes, inevitably they have to decide for drugs whether the cost per day of keeping someone alive is finanically viable (somehow I doubt that anyone would argue that a treatment costing $10,000,000 per day should be available to anyone who isn't paying it for themselves).

I imagine that all health insurance companies have similar processes to decide whether the benefit is worth the resource utilisation and cost. It is impossible, unless you have infinite resources, to avoid making those kinds of decisions about how much you can afford to spend to keep someone alive per week, or month.

(NICE also has a number of other roles including investigating the effectiveness of treatments, reviewing new research and recommending best practice).

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Pyrtolin
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quote:
Originally posted by Gina:
quote:
Originally posted by JoshCrow:

2)"Others who are voluntarily uninsured will be forced by the individual mandate"
... ok, you don't seem to understand that "mandate" is an obligation, which is the very opposite of the idea of an "option".

And you apparently don't understand that every proposal now on the table contains an individual mandate to purchase health insurance? Private insurance companies are not going to be able to compete with an "option" that is U.S. taxpayer-subsidized, backed by the confiscatory power of the IRS. So by circumstance, some of those voluntarily uninsured are going to have to go into Uncle Sam HMO whether they want to or not.
Which option is that? None of the options being proposed have any provision for tax payer subsidies; in fact they have to be actuarily sound- their revenue has to come from premiums and their rates have to be based on risk factors just like the rest of the industry. The only difference is that they won't have to pay dividends to investors, so there will be no pull to put profit over product.

Low income people will get credits, sure, but those credits can be applied to _any_ plan on the exchange, not just the public one. This would actuall let the government encourage some portion ofthe people on Medicare or Medicaid to move to private plans using subsidies instead of continuing to draw on the existing public plans.

There's a much better chance of this representing a net move away from government sponsored care than to it.

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Gina
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quote:
Originally posted by TomDavidson:
quote:
if you are forced to buy a dog and one of the kennels is backed by the bottomless pit of a government willing to borrow itself into oblivion and thus can undercut those who have to play fair...
You know, I understand this sentiment, but it's worth noting that we've recently handed billions of taxpayer dollars to a number of insurance companies willing to borrow themselves into oblivion. So I'm a bit less sympathetic to this scare tactic than I used to be.
If we're both pro-business and anti-bailout, we might actually be getting somewhere, Tom. [Wink]
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vulture
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quote:
Originally posted by Gina:
If we're both pro-business and anti-bailout, we might actually be getting somewhere, Tom. [Wink]

I'll arrange a date for the two of you then [Smile]
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Pyrtolin
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quote:
Originally posted by Gina:
quote:
Originally posted by JoshCrow:
It's a total non-sequitur. You're talking about people who willfully don't have a plan being forced into one. It doesn't exist, in ANY version of the bill.

Is that you, Arlen?

The individual mandate to purchase health insurance is in every single proposal on the table- Obama's, the House's, the Senate's. It is one of the few things they all have in common. Yes, you will have to buy a dog. The proposals do not say which kennel you have to go to, but if you are forced to buy a dog and one of the kennels is backed by the bottomless pit of a government willing to borrow itself into oblivion and thus can undercut those who have to play fair, you're going to have to go to Uncle Sam's Kennel unless you're rich enough to truly have an option. And that is my point: The only ones who will have an "option" will be the rich.

Except that those poor people will have subsidies to bring the costs of the plans down. And under no proposal is the public option directly subsidized.

So the only way that it will be the the cheapest option, after the first year or so while the private companies take time to respond to actual competition, is if the private companies cannot match government efficiency and beat its overhead costs.

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The Drake
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So... any reform made to health care is a step on the slippery slope to the LCP and death panels, but the status quo continues to increase the uninsurable.

Our choice is between a hellscape where all ERs cease to exist, because they are increasingly buried under the "dead weight" of the uninsured, or a futuristic Logan's Run where people are killed off earlier every year to save money under a National Health Plan?

Clearly, middle grounds do exist. Anyone who thinks that any change in national health policy will inevitably lead to death panels has not really evaluated the situation accurately

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Pyrtolin
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quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Gina:
quote:
Originally posted by JoshCrow:
It's a total non-sequitur. You're talking about people who willfully don't have a plan being forced into one. It doesn't exist, in ANY version of the bill.

Is that you, Arlen?
The individual mandate to purchase health insurance is in every single proposal on the table- Obama's, the House's, the Senate's. It is one of the few things they all have in common. Yes, you will have to buy a dog. The proposals do not say which kennel you have to go to, but if you are forced to buy a dog and one of the kennels is backed by the bottomless pit of a government willing to borrow itself into oblivion and thus can undercut those who have to play fair, you're going to have to go to Uncle Sam's Kennel unless you're rich enough to truly have an option. And that is my point: The only ones who will have an "option" will be the rich.

Except that those poor people will have subsidies to bring the costs of the plans down. And under no proposal is the public option directly subsidized.

So the only way that it will be the the cheapest option, after the first year or so while the private companies take time to respond to actual competition, is if the private companies cannot match government efficiency and beat its overhead costs.

And, I'll note, employers will be welcome to offer to pay part of the premium as well, but again, they won't be able to require any particular plan- employees will be free to pick any provider they want, giving them more choice than previously negotiated deals with only a few companies did. This will also mean that the coverage is implicitly portable, since it's not tied to employer specific deals.

[ September 03, 2009, 04:00 PM: Message edited by: Pyrtolin ]

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kenmeer livermaile
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Ooh! Tom D intrudes the 'reality' factor! Oooohhh...!!! Dirty, Tom, dirty. Like pro-wrestling.
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Pyrtolin
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quote:
Originally posted by NobleHunter:
quote:
Notice in the NHS plan does not allow the patient or their family to be involved. It's solely up to the medical team to make the cost/benefit analysis and implement the guidelines. This is a predicable and entirely plausible result and is something that should be a concern with any attempt at government run care.
I don't see anything in the information you provided where it was a cost/benefit analysis. The alleged "panel" is basically a bunch of doctors deciding that death is immediate and inevitable. Accordingly, they undertake efforts to make the process less uncomfortable. There are no government officials or productivity experts involved.
In nationalized healthcare the doctors ARE, essentially, government officials. That's part of why the leap, even from single payer never mind from an excahnge with competeing private companies, to a NHS is completely illogical. The government is the provider, not a watchdog, in NHS.
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kenmeer livermaile
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"So the only way that it will be the the cheapest option, after the first year or so while the private companies take time to respond to actual competition, is if the private companies cannot match government efficiency and beat its overhead costs. "

Ooh! Good logic, bad precedent, for it is widely believed, whether true or not (sometimes it is, some it isn't), that having taxpayers float the capital means endless cash flow for the guv side!

Why, we're saying this every day in state guv bankruptcies forestallments.

Repeat after me: THERE ARE NO MARKET CORRECTIONS FOR GOVERNMENT PROGRAMS BECAUSE THEY ARE IMMUNE TO MARKET FORCES, BEING public, SEE?!?!?

P.S. The government allows NO acknowledgment of what does and doesn't work.

None. Nada. Zip.

COnclusion: No way providing options to private care through public funding will ever worlk

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kenmeer livermaile
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"So the only way that it will be the the cheapest option, after the first year or so while the private companies take time to respond to actual competition, is if the private companies cannot match government efficiency and beat its overhead costs. "

Ooh! Good logic, bad precedent, for it is widely believed, whether true or not (sometimes it is, some it isn't), that having taxpayers float the capital means endless cash flow for the guv side!

Why, we're saying this every day in state guv bankruptcies forestallments.

Repeat after me: THERE ARE NO MARKET CORRECTIONS FOR GOVERNMENT PROGRAMS BECAUSE THEY ARE IMMUNE TO MARKET FORCES, BEING public, SEE?!?!?

P.S. The government allows NO acknowledgment of what does and doesn't work.

None. Nada. Zip.

COnclusion: No way providing options to private care through public funding will ever work. It's all turtles go down, down, down from there. Always. Forever. (and amen)

Ladeez and gennulmennz, Kenmeer's vernacular tinfoil yarmulke has now left the building...

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JoshCrow
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quote:
Originally posted by Gina:
quote:
Originally posted by JoshCrow:
It's a total non-sequitur. You're talking about people who willfully don't have a plan being forced into one. It doesn't exist, in ANY version of the bill.

Is that you, Arlen?

The individual mandate to purchase health insurance is in every single proposal on the table- Obama's, the House's, the Senate's. It is one of the few things they all have in common. Yes, you will have to buy a dog.

No, you won't, but you will be expected to pitch in for a community dog park whether you want a dog or not. There's a serious distinction to be made there.

[ September 03, 2009, 04:31 PM: Message edited by: JoshCrow ]

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Gina
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quote:
Originally posted by JoshCrow:
No, you won't, but you will be expected to pitch in for a community dog park whether you want a dog or not. There's a serious distinction to be made there.

God, I give up. Read the proposals, JoshCrow. An individual mandate is in all of them.

You and Arlen need to get a clue.
Looky here.

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G2
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Actually Josh the mandate to buy insurance does exist in at least the house bill, I provided the relevant section on another thread. You'll have to provide proof of approved insurance on your tax form every April under that bill.

Obama's is not out yet, he's just now getting around to it after farming it out to Congress blew up in his face. I'm not sure about the Senate but I thought they had this requirement, pretty sure they did.

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Gina
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quote:
Originally posted by vulture:
quote:
Originally posted by Gina:
If we're both pro-business and anti-bailout, we might actually be getting somewhere, Tom. [Wink]

I'll arrange a date for the two of you then [Smile]
Happily married, thank you. To a sexy conservative. [Smile]
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Pyrtolin
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quote:
Originally posted by Gina:
quote:
Originally posted by JoshCrow:
No, you won't, but you will be expected to pitch in for a community dog park whether you want a dog or not. There's a serious distinction to be made there.

God, I give up. Read the proposals, JoshCrow. An individual mandate is in all of them.

You and Arlen need to get a clue.
Looky here.

Josh is mincing the point that, for a small price, you can indeed choose to forgo any actual health insurance. I think that falls well into the realm of semantic quibbling, though.
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G2
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quote:
Originally posted by Gina:
quote:
Originally posted by JoshCrow:
No, you won't, but you will be expected to pitch in for a community dog park whether you want a dog or not. There's a serious distinction to be made there.

God, I give up. Read the proposals, JoshCrow. An individual mandate is in all of them.

You and Arlen need to get a clue.
Looky here.

Excellent link, there it is. The Senate:
quote:
Require all individuals to have insurance that meets minimum coverage standards. Enforced through an excise tax equal to a percentage of the premium for the lowest cost option available through the Health Insurance Exchange in the area where the individual resides. Exemptions will be granted for financial hardship; if the lowest cost plan option exceeds 10% of an individual's income; and if the individual has income below 100% of the poverty level.
The House:
quote:
Require individuals to have “acceptable health coverage”. Those without coverage pay a penalty of 2.5% of modified adjusted gross income up to the cost of the average national premium for self-only or family coverage under a basic plan in the Health Insurance Exchange. Exceptions granted for dependents, religious objections, and financial hardship.
And Obama's announced policy:
quote:
The plan must put the country on a clear path to cover all Americans.
So yes, individual mandate is in there.
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MattP
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The coverage has to be available to all, but you don't have to use it. It's a dog park and you don't want a dog, so don't bother going there.

In this form it's a tax, plain and simple and taxes don't always pay for things you want or intend to utilize. I paid for a bridge in another neighborhood but no one is going to force me to drive over it.

The argument here should be (and perhaps thread drift means that it now is) that you object to paying the tax, not that you are concerned about the quality of health care or think you are going to be euthanized by a death panel.

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G2
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quote:
Originally posted by Pyrtolin:
quote:
Originally posted by G2:
quote:
Originally posted by TomDavidson:
quote:
As Morrisey says, "When government controls all the resources and makes all the decisions, the “death pathway” is an entirely predictable result. Patients and their families no longer control the decisions made in health care, because they no longer control the compensation."
But patients and their families don't control those decisions now. Do you not realize that private insurers already have "death panels?"
That is wildly inaccurate. Do you really think a group from an insurance company could come into a hospital and tell the doctors to sedate a patient and deny further care? It's laughable, absurd in the extreme.

Perhaps you're trying to say is an insurance company could potentially claim they won't cover any more care? They could do that I suppose. But you know who would then have the decision to actually continue care? The patient or their family. Would you rather make that call yourself with your family or rely on government guidelines?

I'd rather have the insurance company legally prevented from denying care that it had previously been paid to provide as needed. Otherwise there is no real choice, or you have situations like I referenced in another thread, where people are forced to divorce or go to other irrational extremes to prevent themselves from being compeltely financially destroyed because of such issues.
When you get insurance, there is a contract that spells out what is and is not covered. If they refuse to cover something they say they would, they are in breach of contract and the issue can go to litigation. There are lawyers all of the US chomping at the bit to get one of these cases. So the things you'd rather have is something you already have.

quote:
Originally posted by Pyrtolin:
The only enforcable government guidelines that are being proposed in such situations are ones that require the insurance companies to be honest up front about what will and won't be covered so that they can't pull such tricks and leave people with no real choice when it comes to care.

The contracts spell that out, usually in brutal detail. The only thing is, if the government does not hold up their end of the contract you have no recourse.
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MattP
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quote:
The only thing is, if the government does not hold up their end of the contract you have no recourse.
People sue the government all the time. There are only certain specific circumstances where the government is immune from being sued and I doubt health insurance would qualify for that immunity.
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G2
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quote:
Originally posted by MattP:
The coverage has to be available to all, but you don't have to use it.

That's not what it says, let me re-quote the senate and versions: "Require all individuals to have insurance that meets minimum coverage standards" and "Require individuals to have “acceptable health coverage”".

That's pretty straightforward and plain. It requires individual coverage. I don't see how you can rad those two lines and say it doesn't mean what it says.

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G2
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quote:
Originally posted by MattP:
quote:
The only thing is, if the government does not hold up their end of the contract you have no recourse.
People sue the government all the time. There are only certain specific circumstances where the government is immune from being sued and I doubt health insurance would qualify for that immunity.
Yes, it does happen but do you know how? The federal government has to waive its sovereign immunity. It's called the Federal Tort Claims Act and it limits government's exposure to law suits significantly. It's not like suing a private entity at all.
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Gina
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quote:
Originally posted by Pyrtolin:
Josh is mincing the point that, for a small price, you can indeed choose to forgo any actual health insurance. I think that falls well into the realm of semantic quibbling, though.

Oh, so he is saying you could just flout the law and pay the fine? We don't know yet how much it will be, but the numbers I've heard have been pretty hefty.

Yeah, I guess all laws are "optional" by that definition. [LOL]

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Daruma28
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quote:
Repeat after me: THERE ARE NO MARKET CORRECTIONS FOR GOVERNMENT PROGRAMS BECAUSE THEY ARE IMMUNE TO MARKET FORCES, BEING public, SEE?!?!?
This is one of the biggest fallacies I've ever seen you contribute here, ken.

GOVERNMENT PROGRAMS ARE NOT IMMUNE FROM MARKET FORCES...THEY DISTORT THEM AND CAUSE ALL SORTS OF UNINTENDED (and in some cases definitely intended) CONSEQUENCES.

Half the problems this country has on an economic level is precisely due to Government interventions that distort the market forces and prevent market forces from working as they would under true free market conditions.

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MattP
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quote:
That's pretty straightforward and plain. It requires individual coverage. I don't see how you can rad those two lines and say it doesn't mean what it says.
Right. You have to have coverage. You don't have to actually *use* it though. Appendix bursts? You may a) Take advantage of the coverage. b) Pay for it yourself. c) Stay home and die. Options b) and c) are already available now. They are just adding a) as a third option and requiring that everyone who doesn't have another plan to pay for it to exist.
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Pyrtolin
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quote:
Originally posted by G2:
When you get insurance, there is a contract that spells out what is and is not covered. If they refuse to cover something they say they would, they are in breach of contract and the issue can go to litigation. There are lawyers all of the US chomping at the bit to get one of these cases. So the things you'd rather have is something you already have.



Expecpt that all of those contracts currently allow them to deny coverage for treatments that they don't feel is necessary, or believe to be part of a pre-existing condition, or because you didn't report that you stubbed your toe when you were 5. They also allow them, if they can't explicitly deny coverage, to raise your rates to unaffordable levels instead, effectively dumping you from the plan.

quote:
quote:
Originally posted by Pyrtolin:
The only enforcable government guidelines that are being proposed in such situations are ones that require the insurance companies to be honest up front about what will and won't be covered so that they can't pull such tricks and leave people with no real choice when it comes to care.

The contracts spell that out, usually in brutal detail. The only thing is, if the government does not hold up their end of the contract you have no recourse.
You have far more recourse when the contract is explicitly written to protect your interests than the profits of the investors. And if it's a public plan itself that you have problems with, your first fallback is a completely free letter to your reprsentative and senators, who will almost always bring their influence to bear for the promise of a large number of greatful voters.
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PSRT
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quote:
Yes, it does happen but do you know how? The federal government has to waive its sovereign immunity. It's called the Federal Tort Claims Act and it limits government's exposure to law suits significantly. It's not like suing a private entity at all.
It isn't like suing a private entity at all.

But you know what? The government pays out tens of millions if not hundreds of millions per year to people who sue the government. Saying, as you did, "The only thing is, if the government does not hold up their end of the contract you have no recourse" is an outright lie.

Can you please explain why you are lying on this thread?

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G2
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quote:
Originally posted by The Drake:
So... any reform made to health care is a step on the slippery slope to the LCP and death panels, but the status quo continues to increase the uninsurable.

Our choice is between a hellscape where all ERs cease to exist, because they are increasingly buried under the "dead weight" of the uninsured, or a futuristic Logan's Run where people are killed off earlier every year to save money under a National Health Plan?

Clearly, middle grounds do exist. Anyone who thinks that any change in national health policy will inevitably lead to death panels has not really evaluated the situation accurately

No, there is a way to reform the system without taking it over although I strongly doubt there is a middle ground. We've been in the middle ground for some time now and you can see what that got us. For example, do you know what it costs to treat a broken arm? How about to treat an infection? Just for physical? I don't. I know what I'd pay but I have no idea what it costs. Almost nobody really does. Government policies have distorted the market such that we only know what we'll pay instead of what it actually costs. We only know what we can bill and because we've hidden the costs under copays and insurance schemes and inflated it with outrageous legal bills from lawsuits and government mandates, we don't know the actual bottom line cost of treatment. Allowing the government to take it over will only further hide those costs. Any reform should include a way to get these distortions out of the marketplace.
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MattP
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We don't know what it will cost because insurance companies negotiate discounted rates with health care providers and those rates vary between insurance companies. I imagine the "list price" is jacked up to begin with so that providers can negotiate *down* to a payment that they'll still make money on.

Most people that actually see a doctor have insurance so there is no need to advertise these bogus prices ahead of time.

That's a situation created by insurance companies and health care providers, not the government.

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G2
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quote:
Originally posted by PSRT:
quote:
Yes, it does happen but do you know how? The federal government has to waive its sovereign immunity. It's called the Federal Tort Claims Act and it limits government's exposure to law suits significantly. It's not like suing a private entity at all.
It isn't like suing a private entity at all.

But you know what? The government pays out tens of millions if not hundreds of millions per year to people who sue the government. Saying, as you did, "The only thing is, if the government does not hold up their end of the contract you have no recourse" is an outright lie.

Can you please explain why you are lying on this thread?

Look:
quote:
Generally, a sovereign government cannot be sued unless it allows itself to be sued. In the United States, Congress has passed the Federal Tort Claims Act (FTCA) allowing the U.S. government to be sued for the tortious negligence of its employees that causes personal injury or property damage.

Prior to bringing a lawsuit under the Federal Tort Claims Act, it is required that a written claim be presented to the offending government agency. After the written claim is presented, six months must pass before a lawsuit may be filed in United States District Court. If the claim is denied in writing by the agency, the claimant must file suit within six months of the date of denial.

Generally, a written claim must be presented within two years of reasonable knowledge of the cause and existence of the injury, even for minors and incompetents. There are numerous other details and restrictions under the FTCA and it is advisable to have an attorney represent you in this potentially complicated area of the law. Other laws that allow claims to be made against the United States government, but do not allow a lawsuit may also apply such as the Military Claims Act (MCA) and Foreign Claims Act (FCA).

See how that works, you can sue the government but it's not like suing a private entity. You don't need permission to sue a private entity, just go to court and do it. You have to get permission from the government to in order to sue it. Yes, sometimes that permission is granted but it is up to the government if they want to allow themselves to be sued. You present a claim to the agency you want to sue, then wait at leasts 6 months before you can file. Note the part where it says, "There are numerous other details and restrictions under the FTCA ... ". Hey, what do you think that process is like? You think it's easier to sue the government or harder? Think ... it may hurt a bit but it'll be worth it.

I realize your ignorance has made you angry, that's understandable and I'll let it pass - see how generous I am? Next time, spend a few minutes with google before you decide to prove you're a fool.

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PSRT
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I ask once again, G2, why did you lie?

If you knew ahead of time about the process of suing the government then you knew that the statement "you have no recourse," is factually false. Stating something that you know is false is a lie.

I never said that suing the government is not different than suing a private entity, you are assuming I wrote something I did not. So I am also wondering, why are you lying about what I wrote?

Is it perhaps because your sole purpose in posting on ornery is to score partisan political points? I think it probably is. Someone with even a passing interest in the truth would not behave as you do.

So, why did you lie about suing the government?

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Gaoics79
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quote:
See how that works, you can sue the government but it's not like suing a private entity. You don't need permission to sue a private entity, just go to court and do it. You have to get permission from the government to in order to sue it. Yes, sometimes that permission is granted but it is up to the government if they want to allow themselves to be sued. You present a claim to the agency you want to sue, then wait at leasts 6 months before you can file. Note the part where it says, "There are numerous other details and restrictions under the FTCA ... ". Hey, what do you think that process is like? You think it's easier to sue the government or harder? Think ... it may hurt a bit but it'll be worth it.
Ummm... you didn't say that it was "harder" to sue the government, you said that there was "no recourse" and that the government could only be sued if you get "permission" from it.

With respect, the excerpt you posted does not seem to be saying what you say it says...

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OpsanusTau
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quote:
Government policies have distorted the market such that we only know what we'll pay instead of what it actually costs
This is mostly a tangent unrelated to the real argument going on, but there is a way to figure out what actual procedures actually cost, at least in a ballpark sense.

Take a look at veterinary medicine. There's no insurance; you know up front what things cost, and you generally pay for it at the time of service.

Physical exam = median, $40 or $50, depending on where you are.
If anyone actually cares, I could think about some medical services for which I know the cost on a dog or a cow and tell you about them.

But even if nobody does care, it's an interesting piece of information.

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The Drake
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And suing a massive insurance company is

oh

so

easy!


Cancer Joe: May I please have my chemo treatments?

Ace Insurance: No. Go fish.


Cancer Joe: Can you bill me?

Hospital: Sorry, no chemo on credit.


Cancer Joe: Will you sue the insurance company, and get me my chemo?

Lawyer #1: You don't have a case.

Lawyer #2: I don't sue big companies with staff lawyers on credit.

Lawyer #3: Sure, I'll sue them for you. At best it will take you 18 months to get a judgement.

Cancer Joe: But I'll be dead by then!

ACE Insurance: (rubs hands together and laughs diabolically.)

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Daruma28
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quote:
Originally posted by OpsanusTau:
quote:
Government policies have distorted the market such that we only know what we'll pay instead of what it actually costs
This is mostly a tangent unrelated to the real argument going on, but there is a way to figure out what actual procedures actually cost, at least in a ballpark sense.

Take a look at veterinary medicine. There's no insurance; you know up front what things cost, and you generally pay for it at the time of service.

Physical exam = median, $40 or $50, depending on where you are.
If anyone actually cares, I could think about some medical services for which I know the cost on a dog or a cow and tell you about them.

But even if nobody does care, it's an interesting piece of information.

This is actually a good point, Ops. I'd also like to point out that veterinary medicine also provides an opportunity to study how monopoly cartel-ization can be effected in what is essentially still a good example of a free market.

More specifically, I'm talking about frontline anti-flea & tick medication and HeartGuard heartworm chewable pills.

At least as far as here in Hawaii is concerned, frontline & heartguard appears to have a working agreement with veterinarian clinics here in Hawaii. You CAN buy Frontline and heartguard at pet supply stores, but is prohibitively expensive...like $100 or so for a six pack.

Or, you can go to a veterinarian clinic where they will typically sell it to the consumer for $30 or so.

The catch is most all vet clinics will not sell a pet owner frontline or heartguard, unless the pet owner makes an appointment for an overall physical, a heart worm test and whatever else a vet deems as a requirement before they are willing to "prescribe" frontline and/or heartguard for the pet owner.

And that usually results in a vet bill equal to or higher than the cost of the high prices for frontline at the pet stores.

It's certainly a good example of how a cartel can be created to control prices and distort the market.

It also creates a black market demand...and as a long time owner of a lot of dogs, I must say, I'm a "hub" for "black market" frontline and heart guard distribution. I have a long time friend whose sister is a mobile veterinarian. She sells me frontline and heartguard at vet clinic wholesale cost, and I get it for all of my friend's and families that own dogs...at cost. I don't profit from it, but I do it to help the people I know save some $$.

It is completely unnecessary for a dog owner to have to give their dogs a full checkup just to administer heartguard or frontline. All that is required is the correct weight of the dog to know the correct dosage.

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OpsanusTau
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You know there are alternative products, right? It's not a real monopoly.

Frontline is an over-the-counter and should not be sold as a prescription. If it requires a prescription in Hawaii, that's a little strange.
I've never seen it retail for less than $15 or $20 a dose; I forget how many doses are in the box, but it does add up.
If the vets are selling it for less than that in Hawaii, it is because they are getting an extra special good deal on the wholesale price compared to what the pet stores are getting, which is plausible.

Heartworm preventive is a slightly different story. If there is a negative heartworm test as the animal is on the preventive at the proper dosage and without missing doses from that point on, there's no reason not to keep giving it.
However, sometimes when an animal is infected with heartworm and is given ivermectin, the animal dies.
So veterinarians often will refuse to sell heartworm preventive to owners with animals of unknown heartworm status, out of concern for liability.
Some vets do not so refuse, and that's their choice; I have to say that I see both sides of that.

I tell you what, I have fielded more than my fair share of phone calls from angry people who don't understand why a vet might be unwilling to refill a prescription without seeing the animal, or unwilling to give a vaccine without doing a physical exam first. All I can say is, it's not good medicine.
The summarized and simplified reason why a doctor will not always just give a patient (or an animal owner) what he or she wants is that the patient (or owner) does not always know about or fully understand potential complications and contraindications, and the doctor does; that's her job.

[ September 03, 2009, 06:45 PM: Message edited by: OpsanusTau ]

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Gina
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Sure, you'll have recourse. The way you have recourse with the IRS. Anyone ever tried to fight the IRS? Uh huh. That's how I want my health care appeals process to work.
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MattP
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quote:
That's how I want my health care appeals process to work.
As opposed to how? Do you think it's *not* an uphill battle to fight a denial of service with an insurance company.
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Daruma28
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quote:
You know there are alternative products, right? It's not a real monopoly.
True...but none are near as effective...especially with frontline.

quote:
Frontline is an over-the-counter and should not be sold as a prescription. If it requires a prescription in Hawaii, that's a little strange.
Your right, I'm merely pointing out the general practice...vet clinics here will not sell frontline to pet owners unless the pet owner becomes a vet client...i.e. the pet must receive a physical, and be a "regular" checkup patient to be able to purchase frontline at the much "cheaper" prices they sell it for in comparison to pet stores.

quote:
However, sometimes when an animal is infected with heartworm and is given ivermectin, the animal dies.
I don't deny this...but you do have to concede that this is pretty rare. Doesn't the animal have to have a significant heartworm infection for this to actually happen?

Anyhow, I'll say this: the majority of people I get the heartguard for, all got it from me either for their puppies, or their dogs to which they've been paying through the nose for annual checkups just to keep buying it.

Aside from that, one could buy injectable ivermec from feed and grain stores without a prescription either. It's just that most pet owners are squeamish about administering shots to their pets.

quote:
I tell you what, I have fielded more than my fair share of phone calls from angry people who don't understand why a vet might be unwilling to refill a prescription without seeing the animal, or unwilling to give a vaccine without doing a physical exam first. All I can say is, it's not good medicine.
Another good point...but what about a pet owner who is more than willing to take the risk that a there is a very minute chance of their pet dying from an ivermec dose? Especially a dog owner that has religiously given their dog ivermec it's entire life? I've had probably 20+ dogs over the years, and I've never taken any of my dogs in for a physical. I've always gotten any and all meds from my friend's sister and done it myself...and never had a single bad thing happen yet.
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OpsanusTau
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Well, that's fine for you. You should keep right on doing that!

But regardless, it's not that Frontline jacks the price for non-vet-clinics. It seems to be that some vet clinics either get special deals and pass on the deal to their loyal customers
OR
offer an expensive product at a discount to their loyal customers and eat the loss, as an incentive to come in and have their pets checked out for the pets' own health.

The idea that animals should get a physical every year or two was NOT concocted so that doctors could rake in the money; it's actually just good medical practice. Doing a physical on a healthy pet does not really make a vet much money.

I am going to suggest that it's possible that if you had taken your pets in for physicals, they might have lived longer and healthier lives. It's also possible that they wouldn't have; and it's also possible that this would not have been a net benefit. I have severely mixed feelings about the proper extent of companion animal medicine anyways that I will not get into here.

Have you actually TRIED the alternative products and found them to be less effective, or are you just saying that?
Frontline is a Merial product; Bayer, Novartis, Elanco and Pfizer all have competing products and they all work well enough.
They are also all roughly comparable in price; one might be somewhat cheaper but I can't remember which.

(And yes, the reasons that you state are exactly the reasons that many vets feel fine selling ivermectin products as over-the-counter; that's their choice. It's not a controlled substance.)

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