I will also note that shopping for doctors and healthcare is very different than shopping for other items. My brother, who is a doctor, noted that in his area (a major metropolis area with around 5 million people), doctors who advertised lower prices actually got less business. Though not entirely clear why, one theory was that people don't want to pay cheap for healthcare versus other items. This was even the case when much or most of the cost came either out of pocket or through a health savings account.
My Ex had some health issues a few years ago. She started seeing a Doctor who we came to truly dislike. After she'd been to him a few times, I started noticing how much advertising he did.
My conclusion from that experience is that good doctors get business by word of mouth - not advertising.
And I don't EVER recall - other than plastic surgery - seeing any type of pricing in a Doctor's advertisements.
Healthcare really is much different than shopping for a lot of other goods and services.
I would like to point out something else. The insurance companies are there for both health insurance and medical malpractice. From what I hear is that medical malpractice insurance really drives up cost too. It is just kind of funny how they make money off both ends. A doctor may want test "x" done just to cover his butt in this sue everybody world. But he can not get approval from the insurance company because they think it is not needed. I do not think there should be a middle man in between my doctor and what ever choice I make. How do you get rid of that? Government run would be the same.
An example I have is this. My son jumped off a swing, landed hard, and broke his arm. He broke it at a bad spot...his growth plate. He required two surgeries and pins. It was very important that things were set correctly or his arm would not grow any longer. He was 6 at the time. From the X-ray things were not clear enough as to exactly what needed to be done. He needed a high res scan. The insurance company said no. Doctor came to me said sorry but the insurance company will not let us do the scan. I was like "f them do the scan I will pay it." After it was all said and done the scan cost me very little. I was like what the H was the big deal?
At this time I was on my companies plan. Paying $1200.00 a month for it. Another thing that happened is that I got a prescription and when I got it filled they told me "I am sorry but I can not fill this for you, your insurance company does not cover this drug." Again I was like so what just give it to me, here is the piece of paper with the doctors signature. That is when I decided to dump the insurance and look for my own plan. It all just ticked me off.
The rules were strange though. I could not just dump them a pick up a new plan. There was a few months that I did not have insurance at all. That is when I found out that it is all a numbers game and everything is negotiable. I was paying cash for everything. I found out how little my expensive plan paid out in the past. But I also knew that I could not have afforded the two operations on my sons arm. So that is how I ended up getting my high deductible plan. I don not sweat the small stuff. I am just worried about the big things lurking down the road.
I would like to point out something else. The insurance companies are there for both health insurance and medical malpractice. From what I hear is that medical malpractice insurance really drives up cost too. It is just kind of funny how they make money off both ends. A doctor may want test "x" done just to cover his butt in this sue everybody world. But he can not get approval from the insurance company because they think it is not needed. I do not think there should be a middle man in between my doctor and what ever choice I make. How do you get rid of that? Government run would be the same.
An example I have is this. My son jumped off a swing, landed hard, and broke his arm. He broke it at a bad spot...his growth plate. He required two surgeries and pins. It was very important that things were set correctly or his arm would not grow any longer. He was 6 at the time. From the X-ray things were not clear enough as to exactly what needed to be done. He needed a high res scan. The insurance company said no. Doctor came to me said sorry but the insurance company will not let us do the scan.
This is what I was talking about earlier in this thread. Rationing is already being done via utilization management. This is what happened with your son's case. It's only going to get worse. The guidelines these insurance companies adopt to decide what test/drug/treatment is "medically necessary" or "appropriate" in any given situation get updated yearly. Most people are aware of the guidelines that make the news due to being high-profile (e.g. the fairly recent U.S. Preventive Services Task Force suggestion that screening mammograms are not necessary for women under age 50). However, most people are not aware of the hundreds of others that are updated and adopted by Medicare and insurance companies every year.
Utilization management is a growing business. I mean seriously booming. Medicare and insurance companies are trying to save money any way they can, so it will continue to grow by leaps and bounds. A single payer government-run health care system would just speed up the process and give us no other options. That's a recipe for disaster. Medicare is government-run, after all, and they are always the first to grab onto these guidelines and turn them into very specific formulas that your medical case MUST fit exactly into.... or else, "too bad, so sad, we're not paying for it."
The way they're going about it is very clever. They very deliberately steer clear of terminology that makes it sound like they're rationing care (no, seriously, there is literally a list of words/phrases I'm prohibited from using at work because of this), but they are.
Then I have a question for our legal minds: Provided that the Supreme Court ultimately does throw out "Obamacare" on those particular grounds, would it be fair to say that new legal challenges to other similar insurances might soon come to fruition, i. e. the compulsary buying of auto insurance that is mandated/required by nearly all of the states?
If this were to occur, the insurance industry would be totally reeling!
Then I have a question for our legal minds: Provided the Supreme Court throws out "Obamacare" on those grounds, would it be fair to say that new legal challenges to other similar businesses might soon come to fruition, i. e. compulsary buying of auto insurance that is mandated by nearly all of the states.
If this were to occur, the insurance industry would be totally reeling!
I keep thinking that if universal healthcare is unconstitutional - then isn't Social Security also unconstitutional?
Then I have a question for our legal minds: Provided that the Supreme Court ultimately does throw out "Obamacare" on those particular grounds, would it be fair to say that new legal challenges to other similar insurances might soon come to fruition, i. e. the compulsary buying of auto insurance that is mandated/required by nearly all of the states?
If this were to occur, the insurance industry would be totally reeling!
There is a reason that compulsory auto care is a state-managed issue - ITS CONSTITUTIONAL when it is managed by the state.
The tenth amendment lists a very few things that the federal government can manage. It says that all other powers are kept by the state or the individual. Auto insurance, medicaid and other items, like Romney care are state issues because the US constitution forces them out of the realm of the federal government. I don' know which justice talked about it, but one said that the federal government can use the commerce clause to open up interstate health markets, but it can't manage health care itself, and it can't mandate health care.
There is another aspect of car insurance - if you don't like the intrusive nature of the law, you can take a bus instead. You don't have to drive or own a car.
Through the whole debate, as Dean noted, there were many solutions being presented from within the health care community. Congress ignored these for partison reasons.
Any Libertarian will tell you, however, that social security was vetted constitutionally through political discourse, lengthy discussions that didn't even take place with the health care law. There are multiple arguments that can support its constitutionality, in my opinion, since it is tax driven, and there is a constitutional amendment passed in the early 1900's for federal taxes. What bothered me more about the out of control federal government, beyond the blatant disregard for our personal rights, are other scenarios that congressional think tanks are discussing. Despite the recent downturn, I've worked my butt off to save for my retirement. Unlike those in my community, I avoid buying fancy cars, nice houses or exotic vacations every year. I've saved a few million in the retirement portfolio. Since some congressman have already talked about it, I feel like the odds are pretty high that the federal government will seize this money (tex deferred 401k's and retirement funds) and put it into a federally managed fund, once social security inevitably begins to go bankrupt.
According to the heritage foundation, in 2009, less than 50% of working amercians paid federal taxes after refunds from the earned income credits and others. 70% of all revenue is brought in from only 20% of the top earning workers. Yet nearly 70% of the population gets some sort of government help, in one form or another. They surely need it, a fact that I will not argue. The problem is that Jefferson and others talked about the tyrany of the Federal government that will result when more people are receiving benefits than not, and voting people into office to give themselves even more.
Although I worked for the U.S. Treasury/IRS for several years as a tax law analyst, I've always been a personal proponent of either a "flat tax," or better yet, a "national sales tax." But we all know that the accountants lobby would fight both tooth and nail to obviously sustain the status quo. And that's the primary reason that we will never live to see them come to any semblance of fruition!
Although I worked for the U.S. Treasury/IRS for several years as a tax law analyst, I've always been a personal proponent of either a "flat tax," or better yet, a "national sales tax." But we all know that the accountants lobby would fight both tooth and nail to obviously sustain the status quo. And that's the primary reason that we will never live to see them come to any semblance of fruition!
Yes to a flat tax! But would that put a lot of people like you out of work? It is too simple. No more paying people to do your taxes.
But would that put a lot of people like you out of work? It is too simple. No more paying people to do your taxes.
CrazyGuy: No sweat; I'm retired! So are you saying that we need to keep fostering a complex national tax system in order to keep a certain couple of related industries afloat? Wouldn't that be tantamount to some form of welfare in order to preserve those folks jobs at the expense of American tax dollars?
The flat tax would virtually do away with CPA's participation in the tax code not to even mention a vast proportion of the U. S. Department of Treasury/IRS bureaucrats within the Fed. Conversely, the national sales tax would still need to be largely supervised by the DOT/IRS with the CPA's primary focus then shifted over to the business sector. Either way, it would aid in some small way in helping to reduce the Federal budget deficit!
This is what I was talking about earlier in this thread. Rationing is already being done via utilization management. This is what happened with your son's case. It's only going to get worse. The guidelines these insurance companies adopt to decide what test/drug/treatment is "medically necessary" or "appropriate" in any given situation get updated yearly. Most people are aware of the guidelines that make the news due to being high-profile (e.g. the fairly recent U.S. Preventive Services Task Force suggestion that screening mammograms are not necessary for women under age 50). However, most people are not aware of the hundreds of others that are updated and adopted by Medicare and insurance companies every year.
Utilization management is a growing business. I mean seriously booming. Medicare and insurance companies are trying to save money any way they can, so it will continue to grow by leaps and bounds. A single payer government-run health care system would just speed up the process and give us no other options. That's a recipe for disaster. Medicare is government-run, after all, and they are always the first to grab onto these guidelines and turn them into very specific formulas that your medical case MUST fit exactly into.... or else, "too bad, so sad, we're not paying for it."
The way they're going about it is very clever. They very deliberately steer clear of terminology that makes it sound like they're rationing care (no, seriously, there is literally a list of words/phrases I'm prohibited from using at work because of this), but they are.
I just do not get how insurance companies think they can control other industries. That is not how they sell there line of crap. I worked in the automotive field for a few years. Somebody put gravel in an engine as a prank. Insurance was handling the situation. I gave them a fair price for the job. The insurance company told me that they would pay a lot less. I told them the cost is what I told them. If you do not like that get the car out of here. I will start charging for storage if you do not get the car out of here. I have so much more work to do with customers that pay me for my time. They ended up paying me for the original estimate.
As you can tell I dislike the insurance industrie. But it is a needed service.
Hey - Accountant here! Don't blame us for the complex nature of the tax code! That's ALL politics from where I sit!
True Accounting follows logic and reason. We don't like loopholes and exceptions. All that stuff comes about when politicians are trying to give "breaks" and "incentives."
We want people to own homes - so we make mortgage interest deductible. But we don't want to give rich people with 2 mansions and a summer home a big break - so we end up with some crazy negotiated cap on what can be deducted.
I just wonder how long a flat tax would stay "pure." I almost guarantee we would still end up with politically driven incentives and breaks.
There is another aspect of car insurance - if you don't like the intrusive nature of the law, you can take a bus instead. You don't have to drive or own a car.
Thinking back to High School days - driving a car is actually closer to a privilege than a right.
Quote:
Originally Posted by Halien
According to the heritage foundation, in 2009, less than 50% of working amercians paid federal taxes after refunds from the earned income credits and others. 70% of all revenue is brought in from only 20% of the top earning workers. Yet nearly 70% of the population gets some sort of government help, in one form or another. They surely need it, a fact that I will not argue. The problem is that Jefferson and others talked about the tyrany of the Federal government that will result when more people are receiving benefits than not, and voting people into office to give themselves even more.
Even people who don't pay federal income tax still pay taxes in other ways (sales tax). And every citizen benefits from government services (National defense).
If its even remotely true that the richest 20% in this country owns about 80% of the nation's wealth, then the stats quoted above regarding federal taxes and government benefits seem fairly reasonable to me.
What I don't understand - why can France do this - but we can't?
Hey - Accountant here! Don't blame us for the complex nature of the tax code! That's ALL politics from where I sit!
True Accounting follows logic and reason. We don't like loopholes and exceptions. All that stuff comes about when politicians are trying to give "breaks" and "incentives."
We want people to own homes - so we make mortgage interest deductible. But we don't want to give rich people with 2 mansions and a summer home a big break - so we end up with some crazy negotiated cap on what can be deducted.
I just wonder how long a flat tax would stay "pure." I almost guarantee we would still end up with politically driven incentives and breaks.
Hey, Nice! It was not my intent to step on your toes per se. Lord only knows how many hard-working CPA friends that this ex-revenuer has. I absolutely love you people. In fact, one still does my taxes because there's still way too much confusion in the tax code for me to try to figure out. In either a FT or NST scenario, I still can't quite envision CPA's getting left out in the cold except for individual income tax return preparation. I'm thinking that the monsterific bureaucracy that is the IRS can be cut way back, helping to make a small dent or even a ding in the federal deficit.
So from an ex-revenuer to all of the CPA community, I absolutely love you guys!
I just do not get how insurance companies think they can control other industries. That is not how they sell there line of crap. I worked in the automotive field for a few years. Somebody put gravel in an engine as a prank. Insurance was handling the situation. I gave them a fair price for the job. The insurance company told me that they would pay a lot less. I told them the cost is what I told them. If you do not like that get the car out of here. I will start charging for storage if you do not get the car out of here. I have so much more work to do with customers that pay me for my time. They ended up paying me for the original estimate.
As you can tell I dislike the insurance industrie. But it is a needed service.
The story about you telling them to get the car out of there or pay up made me grin
If doctors and health care providers could do the same on a large scale, it might have an effect. If enough doctors really did stop taking new Medicare patients because they can't give those patients the care they need, don't you think there would be enough of an uproar about it to catalyze a change in the system? But because they're already too dependent on Medicare payments, they can't or won't do that. They'll keep threatening it, but few will do it.
Similarly, if enough doctors offices, imaging sites, etc. would stop accepting the insurance plans that are the worst-offending (refusing to pay for needed services, getting in between the doctors and their patients, etc.), insurance companies would have to change or they'd no longer have a business.
We don't have enough competition, IMO. Right now, almost all insurance companies follow Medicare's and each other's leads. This is sort of like your local gas station raising its gas prices to match the gas station's down the road. If there's nowhere else nearby to buy your gas, what else can ya do but suck it up and pay the higher price?
If we privatized Medicare and opened the state lines so people could buy their insurance anywhere in the US, we'd have more choices and more competition. I'm not naive enough to think this would solve everything, but it would be a great start.
Even people who don't pay federal income tax still pay taxes in other ways (sales tax). And every citizen benefits from government services (National defense).
If its even remotely true that the richest 20% in this country owns about 80% of the nation's wealth, then the stats quoted above regarding federal taxes and government benefits seem fairly reasonable to me.
What I don't understand - why can France do this - but we can't?
You are referring to Pareto's economic theory. I had a senior project in finance to solve the formula and show modern applications that have watered it down a bit. Unfortunately, you are mixing wealth with taxable income, just like our president often does when he talks to the masses. Unfortunately, our tax systems primarily taxes income, that which fits its definition, which tends to mean that those of us who make between $80,000 and $350,000 are paying the largest share for all federal programs. Those with real wealth have plenty of avenues to avoid taxes. Even where I work, our health care is going to be taxed now, while our union counterparts got a free pass based on their political affiliation. I've never met one of the autoworkers whole will say that he/she makes less than $100k with overtime, either. Their benefit/pay scale is almost as good as federal workers....
In my opinion, your France comment is now a big part of the national discourse. Look how easy it is to say that we should model the socialist basis of other countries. Problem is, we never have been a socialist country mindset until recent years. Its not how this country was created. Plenty of people say we should do things like France, Greece, and Germany. That's their prerogative, but we, unfortunately live in a country where individual liberty trumps federal power. Its so easy for people to knock our country, yet our unique system has virtually created the modern medical science, technology, and standard of living. I recognize that this is just my opinion, and the opinion of a guy who grew up poor, but I think our country is spending entirely too much intellectual energy trying to argue about how to take what is legally other people's money. They think that they are picking on the ultra wealthy in doing so, but the tax system isn't even set up that way. The ultra wealthy are just laughing at the irony of it all.
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Re: Any thoughts on the health care crisis? 
