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  1. #41
    Senior Member alexx's Avatar
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    Quote Originally Posted by Halla74 View Post
    Kind of like the Republicans passed controversial legislation for 8 years?
    [YOUTUBE="http://www.youtube.com/watch?v=AN8yu9M1anc"]interesting[/YOUTUBE]

  2. #42
    pathwise dependent FDG's Avatar
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    Quote Originally Posted by Babylon Candle View Post
    Think of it this way. The Germans know how to run a bank. Given the Italian and Greek history, would you necessarily trust them to run a German bank as well as the Germans?
    Well, banking in the western world was born in Italy, actually... (the word itself comes straight from vulgar italian). Our state finance are absolutely awful, our banks however are pretty good, they were not extremely impacted by the crisis, and Unicredit is one of the biggest in Europe - in fact, Unicredit does run two German-speaking banks, Bank of Austria and HVB. We've always lacked natural resources, we had to make up for that by inventing a way to create nonexistant money

    California (a cluster fuck of a government) should stand as a testament to the fact that American Government is probably not as efficient as European government. If thats the case, who thinks we will be able to run a European entitlement program?
    Yeah, I understand your point about homogeneity of population, that will obviously work against any type of universal policy. Still, without universal policies, there will be progressively less and less homogeneity; it seems to be a positive feedback cycle, which probably needs to be stopped somehow.
    ENTj 7-3-8 sx/sp

  3. #43
    Artisan Conquerer Halla74's Avatar
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    Quote Originally Posted by alexx View Post
    [YOUTUBE="http://www.youtube.com/watch?v=AN8yu9M1anc"]interesting[/YOUTUBE]
    It's back and forth, like tennis, alexx. The only difference is who's fraternity buddies are going to reap the spoils of war.

    Quote Originally Posted by FDG View Post
    Well, banking in the western world was born in Italy, actually... (the word itself comes straight from vulgar italian). Our state finance are absolutely awful, our banks however are pretty good, they were not extremely impacted by the crisis, and Unicredit is one of the biggest in Europe - in fact, Unicredit does run two German-speaking banks, Bank of Austria and HVB. We've always lacked natural resources, we had to make up for that by inventing a way to create nonexistant money
    LOL!

    Quote Originally Posted by FDG View Post
    Yeah, I understand your point about homogeneity of population, that will obviously work against any type of universal policy. Still, without universal policies, there will be progressively less and less homogeneity; it seems to be a positive feedback cycle, which probably needs to be stopped somehow.
    Hey there FDG, I don't understand the angle on homogeneity of population. Could you please clarify? Are you speaking of:

    (1) Similar demographic traits in high density across a nations people?

    OR

    (2) Similar political beliefs in high density across a nations people?

    If (1) then that only works for a health care system if the life cycle of the people of the given demographic all adhere closely to a similar and predictable pattern of health related events that make it easier to manage the chronic and or expected high-cost conditions assumed to occur as the aging process moves forward.

    In the U.S., I worked on a Medicaid Reform project that utilized risk adjusted rates for the HMOs that participated in the pilot project. There are two models of rsik adjustment used in the U.S. for risk adjusting pre-paid (capitated) rates: (a) CDPS (Chronic Disability Payment System, using historical physician and hospital claims) and (b) Medicaid Rx (Pharmacy claim analysis identifies high cost ailments via historical claims analysis). At the time the project was implementing here in Florida, the base of people used to assign an individual risk score to each enrollee was from other states (California, Georgia, and Ohio I think).

    Management asked the actuaries from Mercer if there was an issue using historical risk score assumptions from citizens of other states as the base of the first year of our project. The actuaries said "No. In high enough numbers people are people." Ultimately our claims were added to the risk adjustment base, but homogeneity was not an issue for us or other states using that model, as having an extremely heterogenous base of people seemed to level unnatural spikes in ailments incurred by certain groups of people, and thus normalized the weights that affected plan payment.
    ---------------

    If (2) this only affects the likelihood universal health care is passed as policy, and liked after implementation, right?
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  4. #44
    Senior Member Lateralus's Avatar
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    Quote Originally Posted by Babylon Candle View Post
    We'll see what happens. My biggest problem with health care is that Nebraksa support was "bought" with extra "pork". I also dont think it makes me an angry old republican to ask for some baby steps (a few smaller bills) rather than a huge 2000 page cluster fuck of a bill. The republicans definitely had some ideas that could be implemented at no cost (tort, cross state competition etc).
    Taking baby steps could (probably would) make things worse. If you allow cross state competition without repealing anti-trust exemptions, you could see premiums rise. If you were to eliminate pre-existing conditions clauses without mandating coverage for every individual you would be allowing people to game the system.

    So many of the so-called individual issues are interconnecting. That's why a piecemeal solution will probably fail.
    "We grow up thinking that beliefs are something to be proud of, but they're really nothing but opinions one refuses to reconsider. Beliefs are easy. The stronger your beliefs are, the less open you are to growth and wisdom, because "strength of belief" is only the intensity with which you resist questioning yourself. As soon as you are proud of a belief, as soon as you think it adds something to who you are, then you've made it a part of your ego."

  5. #45
    Artisan Conquerer Halla74's Avatar
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    Quote Originally Posted by Lateralus View Post
    Taking baby steps could (probably would) make things worse. If you allow cross state competition without repealing anti-trust exemptions, you could see premiums rise. If you were to eliminate pre-existing conditions clauses without mandating coverage for every individual you would be allowing people to game the system.

    So many of the so-called individual issues are interconnecting. That's why a piecemeal solution will probably fail.
    And thus a total overhaul a better option. This makes sense.

    The proposition on the table is a big patch instead of several little ones implemented piecemeal.
    So it is at best a middle of the road solution, right?
    I think a total overhaul would be the way to go, but no one has the balls to even propose it, let alone make it happen without being a clusterfuck.

    New thought:

    COMMON SENSE THINGS TO CONSIDER to
    IMPROVE PUBLIC HEALTH CARE SYSTEMS:


    (1) Use of non-profit HMOs instead of for-profit HMOs in public healthcare systems. The providers will be the same corporations as in the private market, there will be no exclusion of participation from the private market, they just won't be able to suck up the premiums for shareholder profit. Even if the plans can only pay their staff, execs, and operating costs, the cash flow from the premiums would still be very beneficial to the holding company/mother corporation.

    (2) Real feedback loops must exist for their to be equity and sanity in premium costs at the indivdual level. Smokers pay more for life insurance, and I wager they should for health insurance too. Furthermore, if I eat well and workout three times per week, I should get a break in my premiums. Health club memberships are paid for up to $150 by HMOs in my area, so that is a step in the right direction.

    Gratuitous efforts have been made in awarding $5-$15 credits (not money, spending power available for use in approved pharmacies on approved items) if "healthy behaviors" are performed, such as getting a flu-shot or successful completion of a smoking cessation program, but the end result is that the money sits in the trust account and is not utilized for a whole lot.

    (3) HMOs must be held accountable for performance. Typically plans in public health care systems are held to the minimum contract standards, and ultimately the quality of care erodes and is scrutinized by enrollees and advocates alike. There should be performance benchmarks to persuade the plans to do the right things on a quarterly basis.

    For instance, there is a historical propensity for HMOs to withhold the encounter data (equivalent of an X12 fee-for-service claim, but with the "PTE indicator" checked marking it as an encounter claim) from their plans. HMO rates are set via analysis of fee-for-service claims; typically a two-year base period is used. Once plan enrollment is complete, which can occur within 6 months if the program enrollment is voluntary as can be done in Medicaid programs with a B-waiver, then the state begins to lose the granular, detail level claims information used to set the initial rates, because the plans got their money up front, and they are not compelled to submit the encounter claims to allow the states to accurately monitor the program and set future rates. It is a big shell game.

    So, I'll wager that if a plan did not submit of full and accurate encounter data and it affected release of an upcoming capitation payment, that they would quickly get their shit in order. Typically, because of elitist politics, states only have a carrot, but no stick in affecting their provider's business behaviors.
    --------------------
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    "Enneagram is psychological underpinnings. Cognitive Functions are mental reasoning and perceptional processes. -Sanjuro

  6. #46

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    One of the things I'd say about the whole entitlement and demographic whines is that its a bit of a side step, how is a private system going to solve these problems? Health isnt like soda or beer if people neglect to buy it their neighbours could well share their consequences.

  7. #47
    Senior Member Lateralus's Avatar
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    Quote Originally Posted by Lark View Post
    One of the things I'd say about the whole entitlement and demographic whines is that its a bit of a side step, how is a private system going to solve these problems? Health isnt like soda or beer if people neglect to buy it their neighbours could well share their consequences.
    They do share the consequences, through higher insurance premiums.
    "We grow up thinking that beliefs are something to be proud of, but they're really nothing but opinions one refuses to reconsider. Beliefs are easy. The stronger your beliefs are, the less open you are to growth and wisdom, because "strength of belief" is only the intensity with which you resist questioning yourself. As soon as you are proud of a belief, as soon as you think it adds something to who you are, then you've made it a part of your ego."

  8. #48
    Senior Member lowtech redneck's Avatar
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    Quote Originally Posted by Lateralus View Post
    Taking baby steps could (probably would) make things worse. If you allow cross state competition without repealing anti-trust exemptions, you could see premiums rise. If you were to eliminate pre-existing conditions clauses without mandating coverage for every individual you would be allowing people to game the system.
    Only the first combination involves gradualist measures; either aspect of the second combination qualifies as radical change lacking political consensus at this time, so you don't have to worry about doing one thing but not the other in a bi-partisan, piece-meal scenario. As for the first combination, does a majority of either political party endorse the first measure while opposing the second (or vice-versa)?

  9. #49
    Senior Member lowtech redneck's Avatar
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    Quote Originally Posted by Lark View Post
    One of the things I'd say about the whole entitlement and demographic whines is that its a bit of a side step, how is a private system going to solve these problems? Health isnt like soda or beer if people neglect to buy it their neighbours could well share their consequences.
    We can start by finding out what an actual free market health-care system in the United States would look like, and then take it from there. After that, less intrusive, expensive, and unsustainable measures such as tax credits, cooperatives, and carefully targeted regulations can be utilized to cut costs and increase coverage.

    Also, the entitlement and demographic "whine" was an answer to your own tangential question, and neglecting to address how existent public health programs can be sustained under future demographic conditions (not to mention attempting to dismiss the whole thing as "whining") is a side-step in itself.

  10. #50
    Senior Member Lateralus's Avatar
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    Quote Originally Posted by lowtech redneck View Post
    Only the first combination involves gradualist measures; either aspect of the second combination qualifies as radical change lacking political consensus at this time, so you don't have to worry about doing one thing but not the other in a bi-partisan, piece-meal scenario. As for the first combination, does a majority of either political party endorse the first measure while opposing the second (or vice-versa)?
    I've listened to a lot of debate on this issue (on CSPAN radio) and I have yet to hear any politician mention anti-trust exemptions. It's possible that it has been mentioned and I missed it.
    "We grow up thinking that beliefs are something to be proud of, but they're really nothing but opinions one refuses to reconsider. Beliefs are easy. The stronger your beliefs are, the less open you are to growth and wisdom, because "strength of belief" is only the intensity with which you resist questioning yourself. As soon as you are proud of a belief, as soon as you think it adds something to who you are, then you've made it a part of your ego."

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