The butt stops here!

jpanhalt said:

You have to make money, or you can't live. Regulation adds to costs without much quantifiable benefit. Competition generally leads to a better, more efficient, and less costly outcome.

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It seems you read what was on your mind rather than what I wrote

An HMO is mostly just an insurance company the contracts for care.
That is not the same as the care and insurance coming from the same company.

Health care provider would make their money on health care as they do now. Think of the in house insurance people in the same light as the building maintenance people. You have to have them, but they are not expected to turn a profit. They are a part of cost of doing business, overhead.

With the current system the health care people have no economic reason to keep costs down. Things would be different when they were spending their own money!

I would expect hospitals to compete for clients by offering bang for the buck. That does not exist with the current system.

I do agree that lawyers are a large part of the problem. It needs attention. Caps are often suggested but difficult to legislate for the obvious reasons.

Not all regulation is bad. Currently it exists for both the health care people and the insurance people.

hi 3v0,

According to the documentary I saw, it is the free medicare and pensions thats going to be the main problem for the States.

Thats a problem we are facing in the UK.
Many companies have been using employees contributions to help their cash flow, leaving a short fall.

The retired population percentage in the UK is rising year on year,.
In the not distant future I expect to see serious problems.

There is already talk of raising the pensionable age level.

A few years ago many millions of pounds was injected into the health service, with little effect, most was used on raising the administrators salaries.!

Some of our Doctors are on 6 figure salaries.

Regards

3v0 said:

It seems you read what was on your mind rather than what I wrote

An HMO is mostly just an insurance company the contracts for care.
That is not the same as the care and insurance coming from the same company.

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I don't think I misread what you wrote. I was addressing the history of one failed attempt at a provider-controlled health plan. HMO's initially (1980's, excluding Kaiser) were often formed by large medical practices, like Mayo, Geisinger, Cleveland Clinic, etc. and university medical centers. Thus, they were provider-controlled insurance. Many of those HMO's have been sold since to insurance companies because of the economics. Those that remain independent are in somewhat protected environments.

One driving force for the change was how to pay for out of system care. If a patient was out of the service area and got care, the HMO paid essentially list price for that care. (It is another story about how list price got disconnected from actual reimbursement.) Thus, the HMO's needed to expand their service area to avoid loosing huge amounts of money on such care. That led to regionalization and eventual take over by insurance companies.

Second, the larger the HMO (now just an insurance company), the more effectively it could "negotiate" price concessions from providers, even ones that weren't enrolled.

Finally, the large HMOs could afford marketing to attract younger and more healthy patients. Even if one excludes out of system care, the economics of an HMO just don't work, unless there is a continuous supply of young, healthy enrollees.

So today, although the HMO conceptually had some attractive aspects, it has become just another type of insurance. One example of which is/are the Medicare HMO(s), which remain physician controlled in name only (NB: HMOs still have Medical Directors).

John

I think one would have to look into the larger picture. The failures may have been due to laws which favored insurance companies.

3v0 said:

Health care is an interesting animal. When public it does not generate money for research, and services can be hard to get. If it is private some can not afford it.

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Here in the UK we have a mixture of both.

Nearly all hospitals and doctor's surgeries are state owned and provide their services completely free, even foreign nationals get free emergency care. This highly socialist system, generally provides reasonably decent quality care for everyone. It isn't perfect, we have had problems with long waiting lists for certain procedures and substandard hygiene in some hospitals which has lead to some deaths but on the whole it isn't too bad.

Earlier on I said we don't pay anything for our healthcare, this isn't entirely true. Ophthalmology and dentistry are not free but heavily subsidised; children and students get this for free though. There's also flat-rate prescription charge which makes all drugs the same price.

I've spoken to heath care workers who have worked in the US and they generally think our system is more fair even though they get paid less.

Drugs companies remain privately owned which in itself remains controversial due to the large profits they make, often from the NHS.

Medical research is paid for by both the government and private companies and a lot is done in universities which often make breakthroughs.

I think the US should move closer to our system, it will be cheaper, more efficient and fair.

The US spend the same as us on healthcare but they're only just above Cuba who sped one tenth of the amount of money on thier socialist system.
The World Health Organization's ranking of the world's health systems

I used to consider myself non-socialist but come to think of it I'm a bit of a lefty as far as healthcare is concerned - our NHS is a similar system to that of Cuba and the former Soviet Union and I back it 100%.

I made a reply about stupid smoking and about a military jet crash told on the same web news page. Then I clicked submit reply and got a web error. My reply is gone. I can't save text here anymore because I allow smilies now.

Too late now but, sometimes if you click the refresh button in your browser, you'll get your text back.

I've found, the back button more effective than the refresh.

Hero999 said:

Earlier on I said we don't pay anything for our healthcare, this isn't entirely true. Ophthalmology and dentistry are not free but heavily subsidised; children and students get this for free though. There's also flat-rate prescription charge which makes all drugs the same price.

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Ophthalmology and dentistry are only free under certain circumstances, and apart from that are completely unsubsidised these days.

It's almost impossible to find an NHS dentist who will take you, unless you're under 18, unemployed, or pregnant.

In the US there is a distinction between opthalmology and optometry. Opthalmology is practiced by physicians (MD's and DO's); optometry is not. It is basically fitting of glasses.

If that same distinction holds in GB, it is hard to imagine a compassionate government that would ignore diseases of the eye and retina, including diabetic retinopathy, detached retinas, bacterial and viral infections of the eye, pink eye, retinitis pigmentosa, Tay-Sach's, glaucoma, cataracts, penetrating injuries, etc.

John

5 years ago when I got tri-focal glasses, I rejected the first pair because they weren't perfect so my optometrist gave me another test and another prescription. The glasses manufacturer did not charge me twice and the second set was perfect. Then my optometrist knew that I am a perfectionist and when he discovered that I have cataracts he sent me to cataracts specialist surgeon instead of to an ordinary hospital with ordinary surgeons.

In my part of Canada the government pays for the cheapest cataracts lenses and the surgery. I was told that the lenses are huge and therefore the eyes take a long time to heal, the lenses are free to rotate a little which affects vision, the surgery causes astigmatism which requires glasses to fix and that the lenses have poor night vision.

The best lenses and surgery are very expensive (over $6000CAN) for new lenses that focus. But sometimes they get stuck and they have poor night vision.

The "middle" lenses are small so the eyes heal quickly, are fixed in position in 4 places and have excellent clarity day or night. Additional high-tech tests and surgery correct astigmatism that all older people get.
I selected this one but I paid $3240CAN for both eyes which is half the cost of the focussing lenses. My government paid the surgeon $500CAN. I can claim a small amount on my income tax.

dknguyen said:

Wouldn't you rate health to be more important than the economy?

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Depends who's health I'm deeming as important?

Mine? YES
Yours? MAYBE
Osama been Hidin? NO
Nancy Pelosi? NO
Ted Kennedy? DEFINITELY NOT
Alec Baldwin? NO
My pet dog? YES
Barbie Griffin? A BIG YES!
Who's Barbie Griffin you ask?

Barbie Griffin has huge you-know-whats.

HiTech said:

Barbie Griffin? A BIG YES!
Who's Barbie Griffin you ask?

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Holly Transistors HiTech!
Don't click on the link unless you are over 18.
There's something good about being 40+

Does anybody need to be over 18 to look at bare you-know-whats?

Nigel Goodwin said:

Ophthalmology and dentistry are only free under certain circumstances, and apart from that are completely unsubsidised these days.

It's almost impossible to find an NHS dentist who will take you, unless you're under 18, unemployed, or pregnant.

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Yes I agree and I think it needs sorting.

I would even agree with increasing taxation to support it. Perhaps there should be a sugar tax to give us free dental care.

EDIT:

jpanhalt said:

If that same distinction holds in GB, it is hard to imagine a compassionate government that would ignore diseases of the eye and retina, including diabetic retinopathy, detached retinas, bacterial and viral infections of the eye, pink eye, retinitis pigmentosa, Tay-Sach's, glaucoma, cataracts, penetrating injuries, etc.
John

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I'm also reasonably sure that surgery for cataracts and glaucoma are free on the NHS, it's just things like glasses and laser corrective surgery that you have to pay for.

Hero999 said:

I'm also reasonably sure that surgery for cataracts and glaucoma are free on the NHS.

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Yes they are.

kchriste said:

Holly Transistors HiTech!
Don't click on the link unless you are over 18.
There's something good about being 40+

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Barbie Griffin, or Michelle McCurry (real name) is absolutely, positively, most assuredly, damn skippy, and without a doubt in my little pea brain one of the best looking women walking on this planet!! A Florida native, 26yr. old blue-eyed blonde with 34D breasts.... that's the only thing I need in life! And to think I once leaned towards Carmen Elektra .... fffft!
If you like pretty faces here's a real beauty to gaze upon -- oh dear, just look at those eyes:

**broken link removed** **broken link removed**

audioguru said:

Barbie Griffin has huge you-know-whats.

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They're called "lungs". Now aren't you glad you went through with the cataract surgeries? Look at what you've been missing out on.
You can take away my speech,
You can take away my hearing,
You can take away my sense of touch,
You can take away my sense of smell,
Just don't take away my vision,
'Cause life would be hell.

When I was blind I went around "feeling" my way along. "OOPS, sorry madam. I didn't mean to feel up your you-know-whats".

Now I can gawk and feel at the same time.