Sharp as a Marble - Why Senator Bill Nelson is an idiot

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Just got a health-care related email from Bill Nelson. The following line informs me the man is not qualified to clean up dog poop, much less write bills that affect millions of Americans

The bill will hold insurers' feet to the fire by requiring them to cover everyone and preventing them from dropping individuals who get sick. Additionally, it will contain several measures aimed at reducing overall medical and prescription drug costs and eliminating waste and fraud in the system.

Bolded parts mine. If this guy cannot grasp why those two parts are mutually exclusive, then it's time to find another senator.

Now, I'm totally ok with requiring insurance companies to continue covering people who get sick. It's risk management and the fact that they crapped out on the deal is what their business is all about. But to require them to insure people who are already sick is like requiring State Farm to accept the new client whose house has already burned down.

posted @ 9/15/2009 9:29:37 AM

Comments

Caleb says:

on 9/15/2009 12:15:29 PM

I don't think your categories are working. I just noticed that all your posts have "Politics" or "Guns, Lots of Guns", etc inserted inline with the text.

Dixie says:

on 9/15/2009 12:25:40 PM

"... then it's time to find another senator."

I said that for a long time about Martinez. Now I have LeMieux, and if Rubio doesn't win in the primaries, it'll be Senator Crist in 2010. Now that's scary.

Robb Allen says:

on 9/15/2009 12:28:02 PM

Caleb, what browser are you using?

Senatorial Cheap Tricks? says:

on 9/15/2009 12:44:09 PM

Rick Nelson is your Senator? Awesome!

If he's not getting the job done, perhaps you should oust him and elect Rick Nielsen.

Sailorcurt says:

on 9/15/2009 1:43:18 PM

Also keep in mind that insurance companies don't generally drop people for "getting sick", what they drop people for is misrepresenting their situation when they applied for the policy to begin with.

If you fail to disclose a pre-existing condition, you committed fraud and SHOULD be dropped.

That's not to say that protections against insurance companies dropping people when they shouldn't would be a bad thing, but I don't think it's a pervasive problem.

UBU52 says:

on 9/15/2009 6:40:28 PM

"But to require them to insure people who are already sick is like requiring State Farm to accept the new client whose house has already burned down."

I'm only going to mention this because you may not realize it: Your chances of being covered by the same insurance company from birth to death are nil. At some point, insurance companies get bought out, go out of business, change their business plans, or do other things that enable them to stop covering people like you. At that point you have to find new insurance. As you get older, you will have pre-existing conditions. Everyone does. It could be something as mundane as warts or it could be something bigger like heart disease, diabetes or cancer.

Also, as you get older, your premiums go up so you no longer get the cheapie insurance young healthy people get. Try paying over $1k a month just to insure yourself with good (not an HMO) insurance.

"Also keep in mind that insurance companies don't generally drop people for "getting sick", what they drop people for is misrepresenting their situation when they applied for the policy to begin with."

Ha! Trying telling that to someone who has lost their insurance for getting something like cancer where the insurance company says "Well, you SHOULD have known you had cancer. You don't get cancer overnight." This has never happened to me, but it has happened to people I know.

Young people seem to think they will never get sick. I know this because I thought so too once upon a time. Now I know better. Life happens. Very few people will live to be old without experiencing a few bad medical things.

Robb Allen says:

on 9/15/2009 7:25:43 PM

UBU, you might want to invest in a book on basic economics. I suggest Dale Frank's book Slackernomics. Even the most basic understanding of managing scarcity should help alleviate the delusion you have that it is possible to get something for nothing.

Insurance companies work by pooling risks. They need the healthy people who never use it to have it (or the drivers who never get into accidents or home owners who don't live in flood zones) in order to cover those who get sick.

Home and car insurance is a safer bet because the vast majority of people simply do not total their cars nor do most houses burn down. However, if Geico was forced to sell Dwane the DUI guy insurance at the same cost as someone like me who doesn't have a speeding ticket to his name, Geico would not have enough money to cover all the claims.

Health insurance is no different. In fact, it's harder because unlike cars and houses that generally stay put, people always get sick.

You don't use your car insurance to pay for gas, new tires, to fix the headliner, or for a kickin' new sound system, you use it when there's been a major accident that leaves the car in an unworkable /unsafe condition. Nobody feels sorry for the guy who was trying to save a buck by skimping on his car insurance and is now left with a totaled vehicle and no way to repair it.

We abuse insurance and use it like insulation. Need a flu shot? INSURANCE! Need the doctor to listen to your lungs because you've got a cough? INSURANCE! Need a $12 prescription? INSURANCE!

Oh, but I hear you now "Nobody could afford a $300 doctor visit!!". Bullshit. Most people would prefer a cell phone, a computer and internet connection, and cable TV, all combined could pay for a visit a month. Plus, since insurance pays top dollar (at a discounted rate that, due to the government, they're not allowed to offer to you), doctors will accept the most money for the least amount of work, just like every other human on the planet.

Because a doctor's visit is $20 for most people, they'll go regardless if it's necessary or not. The doctor then has to also raise his or her prices to compensate for the increased usage (supply / demand. It's in that book!). You can easily lower demand by making it more expensive.

I don't mind paying more for something I use (and that my family has to use) if it betters the quality. But what you're suggesting will LOWER the quality while raising my price. And I'm going to fight that tooth and nail.

UBU52 says:

on 9/15/2009 8:18:51 PM

I suggest you reread what I wrote before you suggest I get a book on economics. I fully understand how risk management works. The problem is: Everyone over a certain age has a "pre-existing condition." Are we simply not going to insure people over the age of 40 or 50? I'm not talking about "paying more," I'm talking about "not available at any price."

I had a "minor" pre-cancerous condition over 20 years ago. I had surgery back then and never got it back. That's considered a pre-existing condition.

All I can say to you is "Karma, baby! Karma!" I read your post where you mentioned going in for an MRI. I don't know why you are doing this but whatever you are doing it for is now a "pre-existing condition" to any insurance company other than the one you have now.

Also, regarding paying out of your pocket for doctor visits: I had a doctor who stopped taking all forms of insurance about 15 years ago. He simply didn't want to deal with it anymore. He would only take cash. He was an excellent doctor, chief of a department at a local hospital, and had a huge wealthy clientelle (who could afford to lay out the cash). His prices didn't go down a dime. He's still one of the best in town but if you want to see him, you better bring $$$$.

Robb Allen says:

on 9/15/2009 8:50:49 PM

Well, UBU, I'm glad you have a single example of a doctor who can ask as much as he wants because there is a market for his services. You can read a lot more about those kinds of price signals in that book, or even some Milton Friedman.

You see, that doctor provides a one of a kind service for your area. If there was only one guy in your town who could mow yards, you bet he'd charge a lot of money. Once every Tom, Dick, and Harriet can mow yards, the price comes down. The guy who mows the yard the best still can command a higher price than his competitors who don't edge or clean up, but only if people are willing to pay for the service. Again, economics.

And to your friends who couldn't buy insurance, well, dunno what to tell you. My 92 year old grandmother just had all kinds of heart surgery. My 72 year old father in law just had a hip replacement. My mother has gone through chemotherapy. All of them STILL have insurance. And if my mother's employer does close down (which it's amazing they haven't yet), she's going to have to rely on charity and her savings to keep her medicines coming. I'll do what I can, but what I won't do is put a gun to YOUR head and demand YOU pay for it.

You should trumpet the names of the insurance companies your friends were dropped from. That way others know not to use them. See, if I knew my insurance company was the kind of company that failed to live up to their end of the deal, I'd find another. And if the contract which I signed (and read, in detail, right?) was broken by them, I'd have a lawsuit.

If you really wanted things to get better, you'd DEMAND the government get out of the way when it comes to insurance. I should be able to buy a policy written in Wyoming. My employer shouldn't get a tax break by providing me the cheapest plan possible (which I pay for through a lower salary). There is no place in the Constitution that grants the federal government the means to manage health care. None. If you think that the vast majority of Americans feel this is required, I suggest you get an amendment added to say so.

UBU52 says:

on 9/15/2009 10:01:34 PM

Don't your grandmother, father-in-law and mother have Medicare? They are old enough to have it. What charity would your mother go to? Is that charity "taxpayer funded"?

That doctor (the one I mentioned above) is only one of many around here, though most of them accept insurance. My primary doctor offers "concierge medicine" (look it up - you might like it because it doesn't involve insurance). It's hard for me to compare medical care around here to medical care other places since most other places don't have the things available here.

Are you familiar with the "lifetime cap" on medical insurance policies? Once you reach that, they quit paying. My mother got sick three years before she passed away and she reached the lifetime cap in just a few months -- and she had two insurance policies plus Medicare covering her.

Kaiser is one insurance that drops people even though they say they don't. You can sue them but they have attorneys on staff while you will have to pay for yours out of your pocket. They DO go to court over this and I guess they win often enough that it is worth their while to keep dropping people and going to court.

Anyway, the USA can keep spending all of it's money on medical care, or they can try to fix it. If you don't want the government getting involved and you want the very best doctors, you should move here because you can have that, regardless what the government decides to do.

UBU52 says:

on 9/15/2009 10:28:40 PM

I guess there are a lot of doctors providing "concierge medicine" in Los Angeles. Here's an article in the LA Times about another one: http://articles.latimes.com/2008/apr/16/opinion/oe-fuchs16

And more: http://www.latimes.com/business/la-fi-lazarus10-2008aug10,0,1208323.column

From what I have seen, cutting out insurance doesn't lower the cost. If anything, some of these doctors are actually making more money.

UBU52 says:

on 9/16/2009 4:13:12 AM

The more I read about this "medical concierge" idea, the more I see it as applying to your libertarian philosophy.

You pay to have a physician on retainer and then you pay when you use him. No insurance required (or accepted).

Does this not fit into your libertarian ideals? It seems you would love this!

Robb Allen says:

on 9/16/2009 8:00:37 AM

Well, UBU, if Obamacare gets passed, you might not have much of a choice about going to doctors.

Seem a lot of them would simply quit if it was enacted

Two of every three practicing physicians oppose the medical overhaul plan under consideration in Washington, and hundreds of thousands would think about shutting down their practices or retiring early if it were adopted, a new IBD/TIPP Poll has found.
...
It also calls into question whether an overhaul is even doable; 72% of the doctors polled disagree with the administration's claim that the government can cover 47 million more people with better-quality care at lower cost.

Who am I going to believe? Some pencil necked lawyers who wouldn't know an IV from a Splint or doctors who work on this stuff daily... Man, that's a tough call.

Sailorcurt says:

on 9/16/2009 9:55:39 AM

Isn't it interesting how everyone who claims insurance companies drop people for no reason always qualify the statement with "it didn't happen to me, but to someone I know..."

Criteria for qualification as a "pre-existing condition" vary from company to company. The claim that having pre-cancerous cells removed 20 years ago uniformly constitutes a "pre-existing condition" is specious on it's face because that determination depends completely upon the insurance company you're applying for insurance with.

When I was applying for supplemental health insurance, I was instructed to inform them of ALL prior medical conditions. I did so. That's called "full disclosure". None of them are currently active conditions though, so they were not treated as "pre-existing conditions" and my insurance application was approved.

That doesn't prove anything except that the company I applied with is a good one. Your anecdotal experiences prove nothing except that you aren't very good at choosing insurance companies.

Are you familiar with the "lifetime cap" on medical insurance policies? Once you reach that, they quit paying. My mother got sick three years before she passed away and she reached the lifetime cap in just a few months -- and she had two insurance policies plus Medicare covering her.

And what, specifically, leads you to believe that there won't be lifetime caps under Obamacare?

Kaiser is one insurance that drops people even though they say they don't.

Thanks for the information, I'll avoid Kaiser for my health insurance needs.

"Concierge Coverage" is actually a great idea, but it doesn't have to be restricted to the rich...as long as the government stays out of the way.

I can't find it now, but several months ago there was a story in the news about a doctor in a less affluent area of an inner city who had started a program where people could pay a set amount per month and receive basic health care. It was a relatively small fee...like $30 a month or so...the government shut it down because it didn't conform to some arbitrary reporting requirements.

The government isn't the solution to our problems with either medical care or insurance...the government is the CAUSE of many of those problems.

Sailorcurt says:

on 9/16/2009 9:57:21 AM

Isn't it interesting how everyone who claims insurance companies drop people for no reason always qualify the statement with "it didn't happen to me, but to someone I know..."

I shouldn't have said "always". I'm sure it does happen from time to time...but every time I've run across someone making that claim, either in person or on the internet, it's always been a second-hand story...which means that the teller of the story may not have been privy to all the details and circumstances.

UBU52 says:

on 9/16/2009 4:38:23 PM

Robb,

Why would doctors shut down? Wouldn't Obamacare be just like Medicare? Doctors don't have to take Medicare if they don't want to.

Taxpayers already pay for those who don't have insurance.

emdfl says:

on 9/16/2009 9:46:20 PM

UB -
Just exactly where is "here"? The place where you can get the very best doctors regardless of what the government decides to do.

UBU52 says:

on 9/16/2009 10:21:07 PM

Los Angeles, particularly the area around Beverly Hills (Cedars Sinai, UCLA) or Burbank/Sherman Oaks (St. Josephs Medical Center). St. Joe's and Cedars both have excellent doctors they can recommend to you.

Sailorcurt says:

on 9/16/2009 11:09:46 PM

Wouldn't Obamacare be just like Medicare?

Sort of...except much larger and impacting many more people.

Why do doctors accept medicare? Well, because some doctors actually care about patients and will care for them if at all possible.

Right now, even though Medicare doesn't pay the total cost of treatment and care, and is slow to pay even when they decide to do so, doctors that accept medicare make up the difference in overcharging other payers. There ain't no such thing as a free lunch...and that's one of the many reasons that private insurance is so expensive.

One of the problems with a "public option" is that, the way HB3200 is written, private insurers will eventually be forced out of business.

Just like is done now with medicare, the government will set the amount that it will pay for any treatment or service and it will be way below what it actually costs to provide the service.

Private insurers can't compete with an entity that can decide what it's going to pay for services and force the payee's to accept it. They don't have that power. The costs to private insurers will continue to go up and up, resulting in more and more people being forced onto the "public option" until private insurance simply disappears for all but the extremely wealthy. Once that happens, how are the shortfalls that result from the government plans lowballing going to be made up?

A prime example. Although this doctor didn't have Obamacare to contend with (yet), his clinic is in an area with a high number of people on Medicare and medicaid. He can't make up the shortfalls with other payers, because there just aren't any...end result: he's leaving the clinic with no doctor because he simply can't make ends meet.

That's exactly what will happen to ALL doctors when there are no deep pocketed insurance companies to make up the shortfalls with.

It really doesn't matter how badly a doctor wants to treat patients, if they can't make enough money to feed themselves and keep a roof over their heads they're going to have no choice but to find other lines of work.

My doctor is already working on his fall back position...he's well into the process of opening a gun range in Suffolk. The last time I was in for an appointment, he told me that they're in construction right now and should be opening by next spring at the latest. He's going to continue working in medicine as long as he can afford to because he really enjoys it...but he's already decided that as soon as it becomes unfeasible, he'll get out and run his gun range full time.

I'm gonna miss him when he's not doing the doctor thing any more. It's nice not to have to worry about the doc freaking out when he sees my carry piece when I have to take my shirt off so he can listen to my heart or whatever.

Another doctor I can speak with personal knowledge about is my best friend's wife. She's a pediatric research physician at a major hospital in a major city. She's also researching alternate careers.

The thing is, someone with the education level, intelligence and drive it takes to be a doctor, won't have any trouble at all finding an alternate career field in which they can make a very comfortable living.

UBU52 says:

on 9/17/2009 2:44:26 AM

The American Medical Association is backing Obamacare, so it must not be that bad for doctors.

http://www.latimes.com/news/nationworld/nation/healthcare/la-na-lobbying-ama15-2009sep15,0,2022381.story

I read a story today about the rising cost of medical insurance. It's getting so expensive now that I don't know how employers are able to offer coverage. I know my last employer quit covering families several years ago and would only offer insurance for the employee.

If your doctor can replace his salary owning a gun range, he must not be making much money.

Sailorcurt says:

on 9/17/2009 9:07:11 AM

Yes...after initially opposing the plan, the AMA leadership was convinced, in a "closed door" meeting, to all the sudden begin supporting it.

But I'm SURE it's just because the AMA was convinced that the plan is actually good for it's member doctors, in spite of its earlier opposition...not because the leadership itself stands to gain anything.

That's the problem with top-down special interest groups versus grassroots groups...the leadership of the top-down groups, over time, become more interested in maintaining their own status, power and perks than in protecting the interests of hte people they're supposed to be representing.

Witness the fact that AARP also supports the plan, in spite of the fact that the vast majority of its members do not.

Until you can address the specific points made above, I find the support of a special interest group who "opposed it before they supported it" to be less than convincing.

If your doctor can replace his salary owning a gun range, he must not be making much money.

Very observant of you.

UBU52 says:

on 9/18/2009 3:55:12 AM

I suddenly remembered something tonight that I had forgotten.

You know the doctor I talked about first? The one who stopped taking insurance around 1995? Well, I've tried to recommend other patients to him and when they've called, they've been told that his practice was closed and he was no longer accepting new patients.

Then, I suddenly remembered, the first time I called his office, I was told the same thing: He was no longer accepting new patients. It's a really long story which I won't repeat here, but he felt sorry for me and he found a way to let me become one of his patients.

There are doctors who will still treat patients no matter what happens to insurance, Obamacare, Medicare, etc. Maybe it will be cash up front for services but there will still be doctors.

Sailorcurt says:

on 9/18/2009 10:27:49 AM

Except for one minor detail of the proposed health care "reform" plans:

The government is going to fine people who don't have health insurance.

That means that the only people who will be able to afford "cash and carry" healthcare are those who can afford to pay for their health care twice by either carrying insurance in addition to paying cash for their care, or paying the multi-thousand dollar fines levied for not having insurance.

Not many people will be willing to do that, so the clientele of these cash and carry doctors will necessarily be limited to the very wealthy. And because the doctors who practice this kind of medicine will be raking in the bucks, the statists will inevitably cry about how unfair it is that people are making a profit by providing something that is a "right", and that the poor can't afford the same level of care.

Which leads to the next inevitable step...the outlawing of "cash and carry" health care programs.

Which won't eliminate it of course...where there's a demand, there WILL be a supply...it will just drive it underground, make it even more expensive and more elite.

It definitely won't be accessible to your average joe.

nursebetty says:

on 9/18/2009 10:37:03 PM

I never post to these things, but cannot help myself!!
Who do you think pays for all of the uninsured NOW??? They can still go to any ER and get treatment, even get admitted, even get CHEMO and SURGERY, all with no way to pay. If you don't think that all of us already pay for the uninsured, you are living under a rock! Why do you think healthcare is already so expensive? At least by having more Americans with some kind of coverage, they can go to the doctor when they are "just a little sick" instead of waiting until they are half dead to go to the ER. They can get checkups and immunizations. Any bonehead can understand that is a GOOD thing.

"Just like is done now with medicare, the government will set the amount that it will pay for any treatment or service and it will be way below what it actually costs to provide the service.

Private insurers can't compete with an entity that can decide what it's going to pay for services and force the payee's to accept it. They don't have that power."

Actually, most insurance companies DO decide what they will pay for services, and doctors and hospitals must agree to take what they are paid if they are going to accept that company's insurance. Yes those fees are negotiated, but the insurance companies have plenty of power. My doctor recently tried to bill ME for the portion of my bill that my insurance did not cover. My insurance company told me that my Dr. was "charging me too much for that service, it is not allowable to charge that much and you are not required to pay this bill."
Most Dr.s must accept insurance in order to survive financially. They are not all as lucky to be able to take cash for services and survive. Note those MDs are in affluent areas. Most of the country is not so affluent.
The idea that most doctors will "quit" praciticng if healthcare reform passes is quite ridiculous! I wish I could quit my job--for one reason or another-- daily. But I can't!! I haven't hit the lotto, and most MDs are not wallowing in cash and do not have the ability to "just quit" any more than I do.

Sailorcurt says:

on 9/19/2009 10:43:41 AM

Any bonehead can understand that is a GOOD thing.

In other words, I'm stupid if I don't agree with you?

The first refuge of someone who'd rather the opposition would just shut up.

Be that as it may...

You are completely missing the point. Of COURSE we already pay for the uninsured...which gives lie to the idea that this is about health care. It's not about health care, anyone can get that...it's about health insurance.

I would argue that a major portion of the people who go to emergency rooms without health insurance do so because they are illegals.

I have no problem with them receiving treatment for bona fide emergencies...turning them away would be inhumane...followed immediately by a call to the INS and, if they actually are determined to be illegally in the country, deportation proceedings.

Sort of like when someone shows up with a gunshot wound, a stab wound, or is obviously the victim of a beating...you don't just treat them and let them go on their way. If there is suspicion that a crime has been committed, you call the proper authorities and have it investigated.

But I digress.

Your assertion completely discounts the simple numbers. Sure, there are people that go to the emergency room because they don't have medical coverage. But how many go when they really don't need to? How many people go sit for hours in an emergency room just because they have a cold or sore throat? Some, for sure, but most? Many? Even a large minority? I don't think so.

So...we add 20 to 40 million people to the numbers who will now be making regular doctor's appointments. What will that do to the schedule? It currently takes me between 1 and 3 weeks to get an appointment with my doctor. If I need care quicker than that, I have to go to the emergency room.

Now add another few hundred patients to his rolls. When it takes a month or two (or three, or four) to get an appointment, do you really think people are going to wait? The emergency room visits are going to get WORSE not better, because now, people like me who would normally make an appointment with my doc for a sore throat or the flu, will not be able to get a timely appointment and will be forced to the emergency room for ANYTHING other than routine care.

Emergency room visits are much more expensive than doc office visits...and who's paying for those emergency room visits now? And somehow this is going to reduce costs?

The idea that preventative care reduces medical costs is a fallacy. The proposal that Obamacare will reduce costs is also a fallacy and for many of the same reasons.

doctors and hospitals must agree to take what they are paid if they are going to accept that company's insurance.

That's called a "contradictory statement". Either they must accept insurance, or they have a choice. The two possibilities are mutually exclusive.

Yes those fees are negotiated

Exactly. If a doctor doesn't agree to the negotiated fees, he doesn't have to accept them.

but the insurance companies have plenty of power. My doctor recently tried to bill ME for the portion of my bill that my insurance did not cover. My insurance company told me that my Dr. was "charging me too much for that service, it is not allowable to charge that much and you are not required to pay this bill."

That's not a function of the insurance companies having "power" over the doctors, that's a function of the insurance companies holding the Doctor to a legally binding contractual agreement which the doctor voluntarily entered into. The Insurance company was protecting your legal rights, not being a bully. The Doctor was wrong and should have been held accountable for it. You should be thankful that the insurance company was there to watch your back.

Most Dr.s must accept insurance in order to survive financially.

Of course most doctors have to accept SOME insurance...the vast majority of their potential customer base has some sort of insurance coverage. The idea that they must accept SUBSTANDARD insurance...insurance coverage that doesn't pay enough to even cover their costs...is the problem. Medicare and Medicaid, in most cases, doesn't even cover the expenses of the doctors. If they stopped accepting it, they would make MORE money...not less...or would be able to negotiate lower payment schedules from the private insurers, thereby reducing insurance costs for the rest of us.

It is the private insurance plans that they can "overcharge" for services that make up the shortfall. That's the only reason they CAN accept substandard insurance plans.

The only other options are fraud (which is rampant), and "making it up in volume"...giving substandard care to a large number of people so that any minuscule profits realized from each individual patient add up to enough to maintain operations.

Most Dr.s must accept insurance in order to survive financially. They are not all as lucky to be able to take cash for services and survive. Note those MDs are in affluent areas. Most of the country is not so affluent.

I agree with you on that one...cash and carry medical care will only be available to the affluent, as I pointed out before.

But after the "public option" takes over the marketplace and the doctors have no way of making up the shortfalls through their patients on private insurance (which will be few if not nonexistent), they will simply not be able to make ends meet.

The idea that most doctors will "quit" praciticng if healthcare reform passes is quite ridiculous!

The idea that most doctors will be able to NOT quit when they can't pay their overhead costs is what is ridiculous.

And even discounting that, your point is a strawman. It won't take "most" doctors to quit to cause a massive crisis. Adding 20 to 40 million new patients to the roles of the insured will already place huge burdens on the existing "system". Remove even a small percentage of health care providers from that "system" and you've got a major problem on your hands.

"Most" doctors probably are not considering hanging up their stethoscopes at the moment, but there are enough of them doing so to indicate that this is going to be a major problem if this passes. And many who aren't considering it right now, will have no choice but to close up shop when they simply can't make ends meet any more.

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