# Competition lacking among private health insurers



## R y a n (Apr 4, 2005)

> *Competition lacking among private health insurers*
> 
> http://www.seattlepi.com/national/1151a ... ition.html
> 
> ...


If you are wondering .. here is one of the many reasons to support a public option for healthcare...

-Ryan


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## Plainsman (Jul 30, 2003)

> Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.


That's true, and the monopolistic conditions were created by the government. There are about 60 good size companies out there, but Blue Cross and Blue Shield run the show here in North Dakota. This country and free enterprise were built on the idea of competition. Make our states open the borders to all companies and the competition will exist. Dorgan was told this at the town hall in Jamestown last Friday evening.


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## Chuck Smith (Feb 22, 2005)

Ryan great post. And yes the reason for the monopoly type in states is because of state mandates. Lift the mandates or reconfigure them.

So if you lift state mandates it would give these company's a chance to expand. Again I am tired of bringing it up but there are over 60+ health insurance companies doing business in the USA. So if they are making record profits some would want to re-invest and make even more profit by expansion. I mean when other insurance companies make $$$ they try to expand its market base. Why wouldn't the health industry if state mandates where lifted and they could use the same business model in each state.

*"About 1,300 carriers operate across the country, although many only have a small share of the market in their states." - quoted from above posted article...*

So for a good debate.....would lifting or reconfiguring state mandates be a better option because two or three more companies could go into a state instead of just a public option? Also how would a public option be cheaper than lifting state mandates?[/quote]


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## Chuck Smith (Feb 22, 2005)

> Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn't have to turn a profit.


This is a big problem. So a Goverment option can go bankrupt and still provide service? How will they keep paying for things if they don't make $$$? How will the standard of care stay the same if it is not making $$$? Who would will this effect.....tax payers.



> "The fear and concern is that the public plan could become the market-dominant plan," said Dr. James Rohack, president of the American Medical Association. "*When you've got the federal government involved, it can infuse money into a plan to keep it solvent even if the premiums are lower than its actual costs."*


This is what the huge problem with a public option!!!!!!


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## Chuck Smith (Feb 22, 2005)

> "Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."
> 
> "The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan.'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."


Could this also push or force more people to be put into the public plan?


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## Chuck Smith (Feb 22, 2005)

> The basic framework lawmakers are looking at would encourage competition, even without a government plan. It calls for setting up a big insurance purchasing pool called an exchange. It would be open, at least initially, to individuals and small businesses. The government would offer subsidies to make premiums more affordable.
> 
> Consumers would find it much easier to shop for a plan through the exchange. For one thing, they would be able to readily compare benefits and premiums in different plans. Also, participating insurers would have to take all applicants and not charge higher premiums to those in poor health.


Wouldn't this be better than a public option? This would not cost tax payers 1 penny.


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## Plainsman (Jul 30, 2003)

Chuck, there is one easy answer to this whole thing. In a free market, capitalist economy government is not supposed to compete with private industry. Private industry can not compete because they have no tax dollar support behind them when they run in the red. People will not like this statement, but it is socialist.
Even as a conservative I will accept a small amount of socialism. Social Security is socialist, but we need it so that those to childish to save on their own have something when they retire. I will accept that amount of socialism. 
There is a balance point where to much socialism takes away the liberty of society. It is replaced with government control which becomes tyrannical by nature. The further we fall into socialism the more liberty we give up. Weak people are willing to sacrifice freedom for security, but in the end get neither. I think socialised medicine controls to much of the economy and would tip the scales to far towards socialism. So far that we never would recover as a capitalist economy and we have done pretty good with that for the past 200+ years. Those who push for socialised medicine think they are wiser than the men who formed this nation. I disagree.


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## swift (Jun 4, 2004)

What a screwy path of logic you took here Ryan. You say we should have a government controlled health insurer because there isn't enough competition. That makes no sense at all. The public option would dissolve the little bit of competition that is out there. Abolish the stateline rule as Chuck says and allow competiton to flourish. Don't go with a single payer public option.


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## hunter9494 (Jan 21, 2007)

swift said:


> What a screwy path of logic you took here Ryan. You say we should have a government controlled health insurer because there isn't enough competition. That makes no sense at all. The public option would dissolve the little bit of competition that is out there. Abolish the stateline rule as Chuck says and allow competiton to flourish. Don't go with a single payer public option.


i suppose ryan's plan is OK, if you don't mind bumping your dog's appointment with the vet for yourself! :lol:


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## barebackjack (Sep 5, 2006)

You cant lift the state mandates, that would negate the whole purpose of the health care reform as they want it,......which is to eliminate individual choice.


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## Plainsman (Jul 30, 2003)

barebackjack said:


> You cant lift the state mandates, that would negate the whole purpose of the health care reform as they want it,......which is to eliminate individual choice.


bbj I think a person has to have serious socialist tendencies to want this health care public option. More and more people want the government to guarantee them security and happiness. The right to Life, liberty and the pursuit of happiness isn't enough for them. Today the weak are willing to sacrifice liberty for security. Some want security and the right to lazyness.


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## TK33 (Aug 12, 2008)

Healthcare is the epitomy of what is wrong with the entire economy. No competition. If the gov't gets their hands on it will be like the mega corporations of the business world. They will monopolize it whether intentionally or not and then things will get ugly. The problem is we cannot outsource very much of the healthcare industry.

I agree that government should not be allowed into any private sector but they need to regulate it better. Take a look the de-regs in energy and the lending industry. Government should set the rules and strictly enforce them.



> Social Security is socialist, but we need it so that those to childish to save on their own have something when they retire.





> Weak people are willing to sacrifice freedom for security, but in the end get neither


This is another one of the conservative hypocrisies that I love. These people who rely on social security often times are people who have worked a blue collar job for a company that didn't offer benefits or a retirement plan. Meanwhile the owners or execs of these companies laughed all the way to the bank. They are the people who are in favor of this not because they are weak but because they are screwed right now. A lot of these people are in your generation (60+) and are or have lost most of everything. Should they have saved more, obviously. Could anyone have predicted this, I don't know. There are so many companies in the Dakotas and MN that pay crap and offer nothing for their employees. If there were some mandates a long time ago some of this could have been avoided. The part that gets interesting is that in the near future a lot of white collar types are going to, or are already in this boat. God only knows what will happen if this doesn't get fixed soon.

Taxes on the wealthy, socialism, etc are all the fruits of what greedy, corporate righties (mostly righties anyways) planted over the last 30 years.


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## Plainsman (Jul 30, 2003)

> Taxes on the wealthy, socialism, etc are all the fruits of what greedy, corporate righties (mostly righties anyways) planted over the last 30 years.


I was with you on much of that, and split on this statement. A few years ago they published the ten richest senators. Nine were democrats. It would appear that the greedy corporate are not necessarily righties. Look at Microsoft and Bill Gates. The man and the company are far left. How about George Soros? How about all those rich Hollywood people. How about Ted Turner? Who in the senate has more illegal aliens, pays poor, and diverts millions to her husband? 
I think the rich are the liberals. They keep saying they want to help the poor, and they have been saying it for 80 years, but the poor are still poor.
I worked for a salary all my life so I am not one of the rich. However, I am also not a jealous person. Rather than wanting the rich to loose what they have I wish I had more, but I don't. That doesn't mean I would be happy punishing the rich. They provide jobs, pay way more taxes than I do etc. Some were once poor and took chances that paid off. Good for them, I am happy for them. I wish that would have happened for more of us.


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## Plainsman (Jul 30, 2003)

Here is a good video on health care.


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## R y a n (Apr 4, 2005)

Wow! I checked back this AM, and there are alot of good comments in here...

I'll take a stab at a few.. just a moment..


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## Bowstring (Nov 27, 2006)

To lower insurance rates for individuals we need competition. The answer to more competition isn't bigger Insurance companies. They just buy out the competition when its necessary. To get insurance costs under control is to "Prohibit" employer paid health insurance. You will see competition like never before when the insurance companies are trying to sign up individuals instead of taking the easy money from the large companies.

You would get an increase in your pay and you could take the responsibility of providing health care insurance and shop for the coverage and price you want.

Give the individuals the tax break on their 1040 as a deduction similar to their home interest deduction.

You keep your insurance if you are laid off or change jobs.

Create a Health Insurance Savings account similar to the Health Care Savings account to let individuals to fund a cushion if they lose their job to pay for their insurance premiums.
Keeping the same insurance company reduces the problem with pre-existing conditions.

Create a "risk insurance pool" similar to car insurance, requiring all insurance companies to cover high risk individuals, those with pre- existing conditions in a lottery type selection..

Keep the 11 million who don't have insurance and need it on Medicaid, instead of cutting the program. Medicare is deducted from each senior's social security check, deduct Medicaid from the individuals public assistance check each month. Medicaid only cost 226 billion in 2008. Offer a Medicaid "part B" as a gap for coverage above what Medicaid covers. Similar to part B offered to cover the gap in coverage with Medicare. A part D drug program could work the same way.

I almost forgot, prohibit paid health insurance for federal, state, county, city and municipal employees too. Increase their pay and let them shop for the best deal Congress and the President too. That should help increase competition.

Mandatory open state borders for all insurance companies to do business. In instead of one "public option" we would get 60 major insurance companies and all of the other small insurance companies looking for our $$$.

As a last resort break up the large insurance companies into regional competing insurance companies. Similar to the break up of North Western Bell years ago.

Mandatory 10 years cleaning bed pans for health care fraud!!

Seriously health care and insurance can be reformed or tweaked with out a public option if only the people we send to DC would take care of business instead of trying to hang the other party from the tallest tree.

To lower healthcare costs by lowering insurance rates to doctors, hospitals, clinics, Tort reform is necessary and congress doesn't want to touch it.

Offer a "Patients comp" insurance policy to doctors, hospitals, etc. similar to Worker's Comp. to eliminate frivolous and mega lawsuits by trial attorneys.

Man was that simple, I should have thought of this months ago!

:beer:


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## R y a n (Apr 4, 2005)

Chuck Smith said:


> Ryan great post. And yes the reason for the monopoly type in states is because of state mandates. Lift the mandates or reconfigure them.
> 
> So if you lift state mandates it would give these company's a chance to expand. Again I am tired of bringing it up but there are over 60+ health insurance companies doing business in the USA. So if they are making record profits some would want to re-invest and make even more profit by expansion. I mean when other insurance companies make $$$ they try to expand its market base. Why wouldn't the health industry if state mandates where lifted and they could use the same business model in each state.
> 
> *"About 1,300 carriers operate across the country, although many only have a small share of the market in their states." - quoted from above posted article...*


Just consider Chuck that Blue Cross (for example) does as much to KEEP that monopoly going in North Dakota thru political influence. It isn't the states being resistant, as much as all of them working together to keep the status quo. The insurance commissioner's job is far easier with less irons in the fire.

And just consider that if they are all making "record" profits, it is because their rates are high(er) than they might be because of those very monopolies.

And consider that Health Insurance lobbyists have spent $250,000,000.00 + lobbying and pocketing Congressman, and putting ads on the air under misleading names, in order to influence you into hating the public option.



> So for a good debate.....would lifting or reconfiguring state mandates be a better option because two or three more companies could go into a state instead of just a public option? Also how would a public option be cheaper than lifting state mandates


My answer would be BOTH. I still want a public option, because of the collusion going on with private Health insurers. The public option will keep them more honest. If they are _truly_ forced to compete and play ball fairly with Joe Common Citizen, only then will they bring their prices down in line.

And the answer is NOT as simple as you think. There are plenty of states that are protectionist, that *don't want* to bring down their artificially imposed barriers to entry. Trying to get 50 states to fully and wholly agree on a framework will be impossible. Hence the need for the Federal government to step in over the top and imposed a national solution (e.g, the public option) Trying to implement a framework like that will take a decade. We don't have a decade for the foot draggers to agree to the best terms they can stall and try and achieve.


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## R y a n (Apr 4, 2005)

Chuck Smith said:


> > Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn't have to turn a profit.
> 
> 
> This is a big problem. So a Goverment option can go bankrupt and still provide service? How will they keep paying for things if they don't make $$$? How will the standard of care stay the same if it is not making $$$? Who would will this effect.....tax payers.


No Chuck. That is not the implication. Rather that as a "non profit", they don't have to slash services or dump customers to achieve positive numbers for shareholders.

Understand how a non profit works, and you wouldn't make that claim. They can essentially run as a break even institution, achieve their goals, and remain solvent and functional.



Chuck Smith said:


> > "The fear and concern is that the public plan could become the market-dominant plan," said Dr. James Rohack, president of the American Medical Association. "*When you've got the federal government involved, it can infuse money into a plan to keep it solvent even if the premiums are lower than its actual costs."*
> 
> 
> This is what the huge problem with a public option!!!!!!


No.... what is a problem is that the AMA president is insistent on maintaining the status quo for his constituency (e.g. doctors), who make huge salaries relative to other doctors across the world. His paying membership expects him to keep their current cash cow operating by the same rules, that ensures them bank.

He is using a rhetorical fear tactic to scare citizen sheep.

It would be much more honest of the good Dr., to take a look at what makes those premiums high in the first place, grow a pair of balls to confront the escalating costs in the system he currently is a proponent of, and take some leadership to stand up to his constituency and propose genuine reform, that might end up costing his membership a percentage of their salaries, in return for the good of the American people.


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## R y a n (Apr 4, 2005)

Chuck Smith said:


> > "Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."
> >
> > "The private plans would come back to the providers and say, 'If you don't negotiate with me, you're going to be left with only the public plan.'" Blumberg continued. "Suddenly, you have a very strong economic incentive for them to negotiate."
> 
> ...


You are misunderstanding his point Chuck. The private providers would have to play ball to stay afloat. They would be forced to compete and bring down their cost structure in order to remain competitive with cheaper plans. As soon as the first one would play ball, all the rest would be forced to follow, as citizens would stay with a Private insurer they like, provided they are trying to remain cost competitive with the low(er) competition.


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## Bowstring (Nov 27, 2006)

The congress regulates commerce now. They could make it happen if they weren't bought off. We need a new congress in 2010 and 2012.


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## Chuck Smith (Feb 22, 2005)

> My answer would be BOTH. I still want a public option, because of the collusion going on with private Health insurers. The public option will keep them more honest. If they are truly forced to compete and play ball fairly with Joe Common Citizen, only then will they bring their prices down in line.
> 
> And the answer is NOT as simple as you think. There are plenty of states that are protectionist, that don't want to bring down their artificially imposed barriers to entry. Trying to get 50 states to fully and wholly agree on a framework will be impossible. Hence the need for the Federal government to step in over the top and imposed a national solution (e.g, the public option) Trying to implement a framework like that will take a decade. We don't have a decade for the foot draggers to agree to the best terms they can stall and try and achieve.


How can an private company compete with a public option or a goverment run option? Because businesses fail because they don't make money. How can you compete against a company that has an unlimited budget?

Ryan I agree to a certain extent that you can't have a public option unless you de-regulate/regulate state mandates. because like I have stated in other threads. look at ND and blue cross is the only carrier. Now if they go out of business or pull out of the state....who will compete with the public option....NO BODY. Does it mean that it is the best option for people...NO.

Here is the deal. They can take what would be covered in the Public option and then that is the regulation for all states. It is not that difficult.

Look how the Goverment regulates the Auto industry. They say what will be covered by Tort Laws. Then people can choose the amount of coverage on liability limits, full coverage, auto glass, collision, pet care, road side assistance, deductibles, etc. More of A La Carte type policies.

They can do the same on the medical side.....say every policy out there has to cover major medical.....then you can choose the policy limits. If you only want $10,000 a year limits you pay for it. If you want $100,000 limits, then you pay for it. If you want limits of 2,000,000 you pay for it. Then if you want high deductible, low deductible, etc. If you want co-pay, medicine/pill coverage, eye ware, pregnancy, etc.

You see now states will say if you want to do business in our state you have to have $100,000 major medical, co pay on medicines, etc. They dictate what the policy minimums are. Let the feds set that and go from there.

Because lets say you are 25 and healthy as a horse you can say I only want the federal minimum. Then as you age and your family status changes.....Now that person is 30, married and 2 kids and still healthy as a horse. They can say....I need more coverage so I don't drain my family. They can up it.

Basically it is the same as it is now but the State does not dictate what is covered so more insurance companies will do business because they may have awesome rates on basic coverage but get kicked by the other coverage mandated by that said state so they don't do business in that state. This way they can save people $$$ if all they want is the basic coverage.


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## R y a n (Apr 4, 2005)

swift said:


> What a screwy path of logic you took here Ryan. You say we should have a government controlled health insurer because there isn't enough competition. That makes no sense at all. The public option would dissolve the little bit of competition that is out there. Abolish the stateline rule as Chuck says and allow competiton to flourish. Don't go with a single payer public option.


It isn't my logic. It is the logic of the public option. This is precisely why many are demanding that a public option remain a part of the overhaul.

There isn't enough competition. period.

If it was so simple to remove state barriers, that idea would have been passed years ago. The corporate lobbyists have ensured this will not happen. Therefore the government is coming in to trump the lobbyists.


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## Bowstring (Nov 27, 2006)

> Understand how a non profit works, and you wouldn't make that claim. They can essentially run as a break even institution, achieve their goals, and remain solvent and functional.


Also understand that non profit has nothing to do with cutting costs! Blue Cross is non-profit and your not to crazy about them.


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## R y a n (Apr 4, 2005)

Bowstring said:


> To lower insurance rates for individuals we need competition. The answer to more competition isn't bigger Insurance companies. They just buy out the competition when its necessary. To get insurance costs under control is to "Prohibit" employer paid health insurance. You will see competition like never before when the insurance companies are trying to sign up individuals instead of taking the easy money from the large companies.
> 
> You would get an increase in your pay and you could take the responsibility of providing health care insurance and shop for the coverage and price you want.
> 
> ...


We agree! I'd take this compromise in a heartbeat! :beer:

This idea has been floated for a few weeks now.. I haven't heard if is gaining momentum.

It was mentioned on ABC Sunday with George Stephanopolous last Sunday...


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## Chuck Smith (Feb 22, 2005)

Lots of good post and it will take a few for me to answer all....



> No Chuck. That is not the implication. Rather that as a "non profit", they don't have to slash services or dump customers to achieve positive numbers for shareholders.
> 
> Understand how a non profit works, and you wouldn't make that claim. They can essentially run as a break even institution, achieve their goals, and remain solvent and functional.


Ryan....I understand how non profits work. But you are missing the point I am trying to make and you are saying it is fear i am playing on. It is a valid fear. The goverment can infuse money into any system to help it out....look what just has happened. Now if the public option is losing money or if they want to drive out competition they can. They can keep cutting costs at a loss because they have an unlimited bank roll. Is that "Fair Market"....NO.


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## Chuck Smith (Feb 22, 2005)

> Chuck Smith wrote:
> Quote:
> "Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."
> 
> ...


You are missing the point again. What if the companies don't want to play ball in every state. They will just stick to a select few states and pull out of others. So people will only be left with the public option. Look at all the states that only have one carrier. If that carrier leaves who is there to play ball???


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## Chuck Smith (Feb 22, 2005)

> Bowstring wrote:
> To lower insurance rates for individuals we need competition. The answer to more competition isn't bigger Insurance companies. They just buy out the competition when its necessary. To get insurance costs under control is to "Prohibit" employer paid health insurance. You will see competition like never before when the insurance companies are trying to sign up individuals instead of taking the easy money from the large companies.
> 
> You would get an increase in your pay and you could take the responsibility of providing health care insurance and shop for the coverage and price you want.
> ...


Agreed this is better than a public option!!!


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## TK33 (Aug 12, 2008)

The last thing we need is more "non-profits". What a scam. Most of them are not fluent. Their (our) revenues go to way overpaid execs and board members and also to attorneys and accountants who have to spend countless hours and money finding ways to misconstrue the laws and regulations to keep them at a non-profit status.


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## Ron Gilmore (Jan 7, 2003)

R y a n said:


> swift said:
> 
> 
> > What a screwy path of logic you took here Ryan. You say we should have a government controlled health insurer because there isn't enough competition. That makes no sense at all. The public option would dissolve the little bit of competition that is out there. Abolish the stateline rule as Chuck says and allow competiton to flourish. Don't go with a single payer public option.
> ...


But the fallacy of the PO is that it somehow is going to lower costs!!!!!! The harsh reality is that it simply shifts who is paying for the premiums to others.

Reform to the American public is about getting costs under control, not about anything else. The backlash to the current proposals amount to none of the options provided address that. They can paint a skunk pink, but it still remains a skunk.

Ryan one question, how does a PO lower costs of services and drugs, to those who are charged with paying the bills?

Without controls or changes that affect the cost of services, it is all white wash that looks good until the first rain!!!!!!!!

There are and have been a good deal of ideas put forward that address all or most of the issues surrounding costs. From competition to services, but because they do not include the sacred cow of Public Option, which is a code word for increase our potential voting block, the Dems including Nobama are ignoring them. The public have not!!!!

*Waterloo! Waterloo! Will health care be my Waterloo!!!!!!!! The thought that goes through Nobama's mind everynight!!!!!!! Waterloo!Waterloo!*


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## zogman (Mar 20, 2002)

Ryan, this is a long interesting read from a primary care doctor. I hope you read it. I think it fits in under this thread.

By Vance Harris
Special to CNN

Editor's note: Dr. Vance Harris is a primary care physician in Redding, California. An earlier version of this commentary was posted on SERMO.com, a private, physicians-only online community.

Dr. Vance Harris says primary care doctors get minuscule payment for saving the system huge sums of money.

(CNN) -- Health policy experts agree that any reform in our health care system must include a well-educated, caring primary care doctor who is able to manage the health of his or her patients with an eye to using resources optimally to keep costs down.

That's a tall order and it seems that few policy makers realize the value of primary care physicians.

People are making a huge assumption in this reform effort that as we extend coverage to millions who don't have health insurance, there will be doctors there to actually provide the health care. Fewer and fewer medical students are choosing primary care and many primary care doctors are leaving the field.

Let me share with you why we are losing so many primary care doctors. What follows are a few examples I experience each week.

How many dozens of chest pain patients have I seen in the last month for whom I didn't order an EKG, get a consult, set up nuclear imaging or send for a catheterization?

Only I have the advantage of knowing how anxious some are and that they have had similar symptoms over the last 20 years. After a history and exam, I am willing to make the call that this is not heart disease. In doing so, I save the system tens of thousands of dollars.

Most of these patients are worked into a busy day, pushing me even deeper into that mire of tardiness for which I will be chastised by at least six patients before the end of the day. My reward for working these people in and making the call is at most $75.

How many times has an anxious patient come in demanding an endoscopy who I examined and then decided to treat less invasively for three to four weeks first? Few of these patients are happy no matter how many times I explain that it is reasonable to treat their reflux symptoms for several weeks before endoscopy.

This delay in referral has led to many tense moments in the last 20 years. The cost savings to the system is thousands of dollars each and every time I am willing to make the call and go with the treatment. My reward is about $55 from Medicare and private health insurers.

How many low back pain patients have come to the office in agony knowing that there has to be something serious to cause this kind of pain? A good history and exam allows me to reassure the patient that there is nothing we need to operate on and that the risk of missing anything is low.

This takes a lot of time to explain as I teach them why they don't need an MRI. If someone else ordered the MRI, guess who gets to explain the significance of bulging disks to an alarmed patient? Setting realistic expectations on recovery and avoiding needless imaging helps saves the system thousands of dollars. My reward is another $55.

How many diabetics do I struggle with, trying to get them to take better care of themselves? How many hours have I spent with teenage diabetics who will not check their blood sugar and forget half of their insulin doses?

Hundreds of hours seem wasted until one day they open their eyes and want to take care of themselves. My reward for years of struggle is a few hundred dollars at best. The savings to society for my hard work and never-give-up attitude is in the tens of thousands of dollars.

I am in my 22nd year in practice, now caring for 3,600 patients. Having me in the system has resulted in savings in the hundreds of thousands of dollars each and every year. My financial incentive to hang in there and work harder is that I now make less than half what I did 20 years ago. This year I will make even less.

These are the reasons so many physicians have left medicine entirely and most of us who are left wonder how long can we continue to work like this? I have always served my fellow man out of a sense of love and compassion. That's why I went into medicine.

I have been richly rewarded by my patients over the decades as they have appreciated my judgment and skills. Isn't it a shame that after all this time and with skills honed by decades of experience, many of us can no longer afford to work as a physician?

No one is talking about this on the national level. If they don't address these issues, then good luck having physician assistants provide the safety net with two years of training. Good luck getting newly trained physicians once they see our salaries. Good luck finding internists in your community with only 1 percent of medical students going into internal medicine.

Good luck recruiting primary care specialists when we are projected to be short 39,000 by 2020, according to the American Academy of Family Physicians. And nearly half of all doctors surveyed by the Physicians' Foundation have said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

I know this is true because I am struggling to find a primary care doctor to take care of my wife and myself. Now that is ironic. Anyone know who is taking new patients in California?


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## R y a n (Apr 4, 2005)

zogman said:


> Ryan, this is a long interesting read from a primary care doctor. I hope you read it. I think it fits in under this thread.


Interesting read Zogman. It sorta fits in this thread... but we may need to split this off onto it's own thread if we go too far offtrack.

His story is interesting, but he also assumes alot, makes a broad asssertation as to his value in saving the "system" money, and tries to gain sympathy for all the poor doctors in the U.S.

A couple things I found in a brief search on the interweb:









This image is a Poll Question: "How much do you expect to make as a physician (after residency)?" sent to a bunch of residency students..

You can then go and input in the Doctor Speciality and get a range of *actual salaries*...

For example for a* Family Practice Doctor* (just like he is):

Lowest Reported --> Average Reported --> Highest Reported

$128000 --> $204000 -->	$299000

http://www.studentdoc.com/family-practice-salary.html

Now.. we need to take into account that these results are provided for different medical and surgical specialties based on surveys of physicians in different medical specialities, and are publically available on the web (see the Physicians Search website). This information can be used in several ways, specifically in evaluating different physician job possibilities.

And being a GP is on the lower end of the specialties if you will... so other specialties pay significantly more...

I'm not calling the Doctor a complete liar, but he is full of bull scat if he is going to try and blow sunshine up my browneye that we should believe he is not making a sufficient salary relative to the rest of the country.

If he genuinely has 20+ years of experience, and was practicing in California.. he likely made over $200,000 a year with "3,600" patients. What a jackass..

Sorry. He gets no sympathy from me, except in the area of tort reform.

-Ryan

edit:

some other graphs I found:


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## Ron Gilmore (Jan 7, 2003)

Yup!!!!!! Sure looks as if the only issue on the table to fix the HC issues is a Public Option!!!!!!

In case Ryan you do not know it, the above statement is laced heavily with sarcasm!!!

Which brings me back to my point regarding HC reform, until and unless the areas which affect prices,service and cost of insurance are addressed, nothing changes and we are better off leaving the system as it stands right now for the majority of the public!!!!!!!!!!

So Ryan or anyone else touting the PO as the fix, let's have an honest debate on what is involved in the HC issue. Doctors,Ins companies, drug companies, service providers, Gov affects e.g. mandates reimbursement schedules etc.., fraud, tort reform, patients etc... You get the picture?

The only winner of a Public Option is the politicians who now have another voter base to chase with promises of more through the entitlement program it just created!!!!!!!


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## R y a n (Apr 4, 2005)

Ron Gilmore said:


> Yup!!!!!! Sure looks as if the only issue on the table to fix the HC issues is a Public Option!!!!!!
> 
> In case Ryan you do not know it, the above statement is laced heavily with sarcasm!!!
> 
> ...


Ron.

I never claimed the PO was the only magic bullet. The idea is total reform, and everything you mention here I'm completely in favor of. I have never stated otherwise.

The PO is one lever in the fix. It is not exclusive, but it is needed as a lever to rein in out of control Health Insurance companies who have spent in excess of $250 Million in the past couple of months trying to influence you and the Congressman they own into passing legislation that keeps them rolling in $$$$$$$$

Follow the money. I've said it before. Follow who makes the biggest profits out of the current system, and that is who is trying to keep the status quo. (including the AMA and its doctors, Big Pharma, the HealthCare cabal, and the lobbyists who make big salaries pimping for their hired bosses)

Start asking yourself honest questions with that in mind, and you'll arrive at the right solutions.


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## zogman (Mar 20, 2002)

Ryan oh king of the search.......
What does the Med Malpractice cost the gp and each specialty.
I bet it's not cheap. As pp in the civil engineering/surveying business I know what our e and o costs. It's NOT cheap.


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## R y a n (Apr 4, 2005)

zogman said:


> Ryan oh king of the search.......
> What does the Med Malpractice cost the gp and each specialty.
> I bet it's not cheap. As pp in the civil engineering/surveying business I know what our e and o costs. It's NOT cheap.


What part of tort reform didn't you understand in my typed words? With tort reform you will have a drastically reduced need for carrying extra high malpractice insurance! Right?

Ummm.... :huh: :homer:


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## Chuck Smith (Feb 22, 2005)

> Ron Gilmore wrote:
> Yup!!!!!! Sure looks as if the only issue on the table to fix the HC issues is a Public Option!!!!!!
> 
> In case Ryan you do not know it, the above statement is laced heavily with sarcasm!!!
> ...


YOu agree that all the stuff Ron has stated is needed and a public option. Hmmm....If drug companies charge less, hospitals can charge less because of a more stream lined data processing, tort reform so malpractice insurance goes down, operations cost less, etc.....shouldn't insurance go down as well? Because if it costs the insurance companies less to pay for something then the insurance companies can charge less to get more clients which also intrun makes more profit. So again isn't a public option like putting the cart before the horse?


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## Ron Gilmore (Jan 7, 2003)

Ryan this may be easier to understand. If you have a flat tire with multiple holes in it and fix only one, the tire still will go flat!!!!!!!!

That is why starting a PO without fixing the other holes still leaves you with a flat tire. Because driving the flat tire is going to ruin the tire anyway. So why bother putting on a patch!!!!!!

Either fix the tire completely or drive it flat!!!!!!! Same result!!!!!

Your fix, causes no relief at all to rising costs, it simply shifts as I said who is paying for it. No benefit in that!

Your fix, also takes away from seniors, puts more strain on existing services! No benefit in that!

Your fix as presented by the Dem's is full of mandates! This will increase costs to those who have private insurance! No benefit to that!!!!

Do you get the picture! We are not talking about HC reform in any way shape or matter. We are talking only about increasing the level and number of people who are receiving an entitlement!!!!!! Only the politician's benefit when entitlements grow and someone else is picking up the tab!!!!!!!


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## R y a n (Apr 4, 2005)

Chuck Smith said:


> > Ron Gilmore wrote:
> > Yup!!!!!! Sure looks as if the only issue on the table to fix the HC issues is a Public Option!!!!!!
> >
> > In case Ryan you do not know it, the above statement is laced heavily with sarcasm!!!
> ...


My response:

1. They won't unless forced to, and they won't because the proposed Pharma reform originally touted, (in order to have the gvmt buy common meds, and reduce markup) has been yanked off the table. Why has it been yanked off? Ask yourself that.

2. Hospitals are streamlining data processing of information now. It isn't causing any reduction in costs passed on to consumers.

3. agreed.

4. They should but they won't. They will keep those markups as an additional profit cushion for themselves. There is not mandate or incentive to pass that cost reduction down to the consumer.

No it is not putting the cart before the horse. The insurance companies have had the free market incentive to do many of these things for years. Some things (like streamlining data processing) have already happened with no reduction in costs to consumers.


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## R y a n (Apr 4, 2005)

Ron Gilmore said:


> Ryan this may be easier to understand. If you have a flat tire with multiple holes in it and fix only one, the tire still will go flat!!!!!!!!
> 
> That is why starting a PO without fixing the other holes still leaves you with a flat tire. Because driving the flat tire is going to ruin the tire anyway. So why bother putting on a patch!!!!!!
> 
> ...


Wow. That is so full of misinformation, I can't even start breaking it down. If you believe this is only about the above, there is nothing I can say that will change the fundamental flaws in your beliefs.

I won't even try to start.


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## zogman (Mar 20, 2002)

Ryan, please define tort reform. No one has done that yet. Does that mean instead of a 50 mil award it will be limited to 15 mil? That won't save much of anything.


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## Chuck Smith (Feb 22, 2005)

> 4. They should but they won't. They will keep those markups as an additional profit cushion for themselves. There is not mandate or incentive to pass that cost reduction down to the consumer.


So when peoples homeowners insurance goes down because of cost of materials to "rebuild" go down.... Why wouldn't health insurance do the same?

So if one company is saving money and wants to go grab a bigger market share they can invest in going out and getting that market.

One thing you are not thinking of is Medicare sets most of the prices these companies pay right now. So if medicare can lower its prices because of the cost effectiveness of cutting costs then the other prices will also go down. Correct??



> 2. Hospitals are streamlining data processing of information now. It isn't causing any reduction in costs passed on to consumers.
> 
> 3. agreed.


You are telling me the data sharing is done? How come the tests my grandmother did in Florida did not transfer back to her doctor in MN and they had to redo all the tests? This is tort reform and data sharing. So then the private insurance company had to pay for two tests.


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## Chuck Smith (Feb 22, 2005)

Ryan and others....

You keep saying that you want insurance premiums to go down. I agree 100%. The best way for this to happen is to have them compete against each other and not a goverment option. Just like auto/homeowners insurance companies.

Another way to lower premiums is to help stream line costs or cut costs in the Health Care world....ie tort reform, data sharing, drug costs, etc.

If these things happen premiums will decrease or become stable all on its own.

Adding a Public/Goverment Option will do nothing if these other things don't happen. all it will do is drive out companies from competition and all that will be left is a goverment option.


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## Ron Gilmore (Jan 7, 2003)

Ryan there is no misinformation in what I said. What you cannot do is address the fact that fixing only one part does nothing to the overall problem and the solution being offered is not really a fix anyway!!!!!

Why is it that the Dem's have focused solely on PO? Why is it the drug companies are getting a pass? Why is it that to balance it out, the services to the Medicare recipient's are to be cut?

Ryan, why is it?

It is as I have said all along simply a smoke screen Ryan, and one you have allowed to be blown up your pant leg!!!


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## Ron Gilmore (Jan 7, 2003)

Chuck cost control measures do not create entitlement programs that can be manipulated to garner votes!!!!!

Plain and simple! All the BS poor Ryan is trying to use have no economic basis for working! GAO,CAO have proven that, just as they did with the stimulus!

A public option garners more votes for Dem's in many districts! That part of the equation cannot be overlooked in this debate as well.


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## R y a n (Apr 4, 2005)

zogman said:


> Ryan, please define tort reform. No one has done that yet. Does that mean instead of a 50 mil award it will be limited to 15 mil? That won't save much of anything.


Sure..

In it's most simplistic terms, tort reform as it relates to the Medical profession seeks to reduce the exposure doctors face when practicing medicine. It seeks to do that by establishing a legal framework that, instead of encouraging waste, encourages doctors to focus on what's really needed. One pillar in the new legal framework is a system of justice that is trusted to reliably distinguish between good care and bad care. Reliable justice would protect doctors against unreasonable claims and would expeditiously compensate injured patients. _The key is reliability_. Traditional "tort reform" -- merely limiting noneconomic damages -- is not sufficient to end defensive medicine, because doctors could still be liable when they did nothing wrong.

But we need to stop the practice of ordering tests and procedures that aren't needed to protect a doctor from the remote possibility of a lawsuit, and to that end, we need to setup guidelines that strictly define how/when/for how long (statute of limitations) on if a lawsuit can be brought. So the question becomes, how do make this happen? For example, we can start with the use of electronic medical records, to review and research and develop result-based best practices just like every other industry uses to limit. their exposure. If you stay within best practices, and deviate only when you can articulate a good reason for doing so, you're safe. You do something stupid, you're not.

Check out these two great articles on tort reform.. I apologize in advance for their length, but they do a great job of putting it in perspective.. and they hammer Obama pretty good too... 



> http://www.investors.com/NewsAndAnalysi ... ?id=504246
> 
> Tort Reform Is Key To Health Reform
> By TIGER JOYCE
> ...


and



> http://www.americanthinker.com/2009/06/ ... eform.html
> 
> 6/17/09
> President Obama was booed this week at the annual meeting of the American Medical Association in Chicago. He was booed by an audience that included America's leading medical experts for declaring he was "not advocating caps on malpractice awards." Many the experts know something that Obama doesn't.
> ...


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## R y a n (Apr 4, 2005)

Chuck Smith said:


> > 4. They should but they won't. They will keep those markups as an additional profit cushion for themselves. There is not mandate or incentive to pass that cost reduction down to the consumer.
> 
> 
> So when peoples homeowners insurance goes down because of cost of materials to "rebuild" go down.... Why wouldn't health insurance do the same?
> ...


It is apples to oranges. Two different industries, that don't operate or have similar political influence. This is somewhat at the root of my point, is that the HealthCare Insurance industry is an animal onto itsself without rival or peer. Don't expect to see similar behavior or results based on something you extrapolate from another industry.

Regarding the statement about Medicare, yes you are correct. That is precisely how we will see reductions in cost, once you have governmental regulation and/or a PO that sets a min/max floor/ceiling on most basic procedures, and certain common ones.



Chuck Smith said:


> > 2. Hospitals are streamlining data processing of information now. It isn't causing any reduction in costs passed on to consumers.
> >
> > 3. agreed.
> 
> ...


We are talking two different things. It appears you are talking about a national database. I was talking about regional or provider specific data processing.


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## R y a n (Apr 4, 2005)

Ron Gilmore said:


> Ryan there is no misinformation in what I said. What you cannot do is address the fact that fixing only one part does nothing to the overall problem and the solution being offered is not really a fix anyway!!!!!
> 
> Why is it that the Dem's have focused solely on PO? Why is it the drug companies are getting a pass? Why is it that to balance it out, the services to the Medicare recipient's are to be cut?
> 
> ...


Ron you took a broad brush stroke and tied several general themes together, that noone in a brief typed reply could ever begin to address with sufficient clarity or comprehensiveness.

I did address your earlier question, telling you that the PO is only one piece of a bigger pie on overall healthcare reform.

I have no idea why Big Pharma is getting a pass, as I said in my earlier reply they are part of the big puzzle too...

Do you read my replies?

There is no smokescreen Ron. I've been very consistent in my feelings on the issue. The real smokescreen has been applied by Big Health Insurance and Big Pharma as their paid lobbyists have mounted an effective web campaign targeting under-educated Republican citizens to distract America and Congress from having a comprehensive honest debate about the source of the issues, and how to effectively control those issues, without undue influence from corporate lobbyists.

Until you start understanding how much "news" that is being fed to you has been carefully sculpted and disseminated to you via email, internet, talk shows etc... until such time as you start considering that you are being influenced by BIG $$$ corporate interests, you will continue to be swayed by those having interests that are not in the best interests of you and your family....

Or so it seems to me..

-Ryan


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## Plainsman (Jul 30, 2003)

I know a doctor that makes $200K a year, but his insurance is nearly half that. They don't make the big profit you think. Everyone is simply jealous of everyone else. Ask those who hate profit if they want a raise. I can tell you the answer right now.

You mentioned tort reform reducing ridiculous settlements. We need tort reform in many areas, or brain transplants in some of the judges. Some guy who smoked for 45 years was just awarded something in the billions today. Idiots.

Government is not supposed to compete with private business in a free market system. Impose some controls, but compete, that's socialism, and a capitalist country can only withstand so much socialism before it fails. There is a threshold, and I fear we may already have crossed it.


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## Chuck Smith (Feb 22, 2005)

> We are talking two different things. It appears you are talking about a national database. I was talking about regional or provider specific data processing.


I am talking about data sharing between facilities. ie....a person takes a test in one part of the country that same test does not need to be done. example you go into one hospital take a test. It says you have a heart condition. You go to a different hospital back home and go to your doctor tell them you had a test done and they found a heart defect. Guess what that doctor will have you take the same test so they have it on there system. You pay for the same test twice or the insurance company pays for that same test twice. One way to help cut insurance costs.



> It is apples to oranges. Two different industries, that don't operate or have similar political influence. This is somewhat at the root of my point, is that the HealthCare Insurance industry is an animal onto itsself without rival or peer. Don't expect to see similar behavior or results based on something you extrapolate from another industry.


Not in the way they do business or the insurance business model.

The premiums are based on risk factors. Example if a company has 500 - 30 year old males insured and it will cost the company $1 million in payouts (health care, billing, staffing, agents, etc) they will charge it accordingly like $2000 a year. Now in that year those 500 - 30 year old males only costs them $900,000 they made profit in that category. But the figures for the nation still show that 500- 30 year old males will still cost them $1 million a year. So the premium stays the same. But if costs goes up then those 500 - 30 year old males premiums will go up.

So with out cutting costs premiums will keep rising. Adding another insurance company (public option) won't do a darn thing.

A public option will turn this country into this......Healthy people will be the only ones with private insurance and sick people will be in the Public option.

Again....A person is healthy. Goes to the private sector and gets insurance. They get sick....premiums will go up. They move to public option and will not have to pay inflated premiums. So where is the $$$$ going to come from with that new sick person in the public option? Where is the $$$ going to come from to pay for all the medical costs?


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## Chuck Smith (Feb 22, 2005)

> There is no smokescreen Ron. I've been very consistent in my feelings on the issue. The real smokescreen has been applied by Big Health Insurance and Big Pharma as their paid lobbyists have mounted an effective web campaign targeting under-educated Republican citizens to distract America and Congress from having a comprehensive honest debate about the source of the issues, and how to effectively control those issues, without undue influence from corporate lobbyists.
> 
> Until you start understanding how much "news" that is being fed to you has been carefully sculpted and disseminated to you via email, internet, talk shows etc... until such time as you start considering that you are being influenced by BIG $$$ corporate interests, you will continue to be swayed by those having interests that are not in the best interests of you and your family....
> 
> Or so it seems to me..


This could be said about both sides of this issue. Both are trying to smokescreen a nation.


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## Ron Gilmore (Jan 7, 2003)

See Ryan I am not naive! It is the lobbyist that are driving this. Phrma paid off the Dem Congress to be left alone. So that fix cannot take place! AMA has refused to pay off in the same manner so they are on the chopping block. So are Insurance companies!!!!!

That is the whole point Ryan!!!!!!! You cannot fix HC by only attempting to take a stab at one area!!!!!!!!!

You live in some sort of fantasy world where you think the Gov is going to provide some form of efficiency that will bring down costs of premiums. I on the other hand see the reality that as an entitlement program, we will never control costs, and that the Insurance industry just happens to be the boogie man this time around!!!!!!!!!

Not overly complex, not hard to follow, but dead on accurate. None of the above mentioned areas can go unattended if we want any real impact to happen.

So it remains very clear, doing nothing, is better than creating another entitlement program that is all about political payoff. You have to factor into this legislation the reason why they are pushing it. It is not about what is good for American and the US! The staggering debt load alone tells all of us that is a farce. So it boils down to what do they have to gain?

You nor anyone that supports a PO can with any integrity produce anything that disputes the increased debt load this will create. You nor anyone else has produced anything that remotely shows cost of services coming down, they have shown that they will cut costs by paying less or paying for less services!!!!

Are you starting to understand this now Ryan?

To me this is all about what this country can sustain! We simply cannot afford a new entitlement program period. Reform is not a PO, and never has been! Reform is doing substantial things to control costs, which encompass not only premiums, but all the other aspects that are connected to HC!

It is almost silly to think a PO in of itself is a move forward without bringing along the rest of the family.

This attitude and idealism I have comes from watching over and over the inablity of the Gov to get things right or fix them when they go wrong. FEMA is improved, but still a shambles compared to what it could and should be. SS has been portrayed as being a trust fund of money set aside to meet future needs. When from the start of the program it has been a pay as you go program where they actually took in more than they should to fund the outlay.

We have Medicare Part A&B and D! Why do we need separate parts? Put it all under one heading, but once again the shell game continues!!!!!

Ryan you are naive and that is being generous if you truly believe what you are promoting.


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## Plainsman (Jul 30, 2003)

> Big Pharma as their paid lobbyists have mounted an effective web campaign targeting under-educated Republican citizens


 :rollin:

I'm not going to get into the education of republican vs. democrat, but I think it's funny as heck. What I will get into is this. You said the youth put Obama in office. Now the youth are running from him faster than anyone else. Most have caught on to it's them getting screwed. However, Obama is still counting on the under experienced youth to help him on health care. And that can't be argued. A person 80 years old has more experience than one 20 years old. The 80 year old doesn't think the worst is past like Obama wants everyone to believe. The 20 year old although he is running from Obama now perhaps still believes things are getting better. 
Then there is the media. The left doesn't really need lobbyists with the media in their pocket. When the market hit and Clinton was president the media nearly called for a national celebration. When it passed 12,000 when Bush was in we heard how bad the economy was. Now we are still down and the media is talking about how we are recovering. We will see. Pass Obama's health care and I predict under 6000 for the market.

When I was at Dorgan's town hall he really hit hard against speculators. Guess what if you have a 401k, or some stocks your speculator. Some of you without knowing it have health insurance stocks. Ya, go for the government health care and shaft yourself in more than one way.


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## TK33 (Aug 12, 2008)

Plainsman said:


> I know a doctor that makes $200K a year, but his insurance is nearly half that. They don't make the big profit you think. Everyone is simply jealous of everyone else. Ask those who hate profit if they want a raise. I can tell you the answer right now.
> 
> You mentioned tort reform reducing ridiculous settlements. We need tort reform in many areas, or brain transplants in some of the judges. Some guy who smoked for 45 years was just awarded something in the billions today. Idiots.
> 
> Government is not supposed to compete with private business in a free market system. Impose some controls, but compete, that's socialism, and a capitalist country can only withstand so much socialism before it fails. There is a threshold, and I fear we may already have crossed it.


My wife is a nurse, she knows two doctors that use to practice in Fargo but now practice overseas. They go out for a month or whatever at a time, then come home, repeat. They make less in salary but pay less in insurance, in the end they make more. Tort reform has to be one of the focal points of not only healthcare but the general economy.



> zogman Posted: Tue Aug 25, 2009 2:52 pm Post subject:
> 
> --------------------------------------------------------------------------------
> 
> Ryan, please define tort reform. No one has done that yet. Does that mean instead of a 50 mil award it will be limited to 15 mil? That won't save much of anything


that 35 million happens very frequently, add that to the legal fees, the civil court costs that we all pay and it adds up. Tort reform is an easy way to get things moving in the right direction quickly. The other reforms may very well take a while to be effective. As Chuck, Ron, and others have said we all know how effecient gov't operates.


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## Bowstring (Nov 27, 2006)

R y a n said:


> Bowstring said:
> 
> 
> > To lower insurance rates for individuals we need competition. The answer to more competition isn't bigger Insurance companies. They just buy out the competition when its necessary. To get insurance costs under control is to "Prohibit" employer paid health insurance. You will see competition like never before when the insurance companies are trying to sign up individuals instead of taking the easy money from the large companies.
> ...


 .COOL!!!!

:beer:


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## Plainsman (Jul 30, 2003)

Anything that changes the mess we are in now, but keeps the government out of it so we don't become socialist. Maybe a bunch of us are coming close to agreeing on something for a change.


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