Monday, November 9, 2009

More on the Health Scare Debacle and AOTW

I'm going to start with AOTW, because, very simply, the list below detailing the contents of the POS health care "reform" is really damned long. It's also a clear illustration of how to sickeningly fuck up something that needs fixed.  And since the House passed the bastard, my Asshat is already chosen, because I'm betting on the Senate to kill this travesty and I was waiting for its passage to do this.  So...

Satyavati Devi Dasi is Asshat of the Week!

Satyavati and I have mixed it up on almost every subject.  That shit happens when you get a near-libertarian carnivore and a socialist Hare Krishna in the same chat.  But out of the myriad of conversations, I know we have something in common:  We want the best for everyone, including each other.  For example, she's starting a new (and good) nursing job today.  Happy happy joy joy.  The problem is that we often violently disagree on the way to solve the problems.

On the health care debacle, for example, she's an advocate of the single[government]-payer system, whereas I advocate the absolute opposite, what I will term the individual-payers system, because the solution to our mess is to cut out the third-party payers as much as possible.

But what the House passed Saturday night will do everything we don't want.  It grows government control and mandates over the individual to the point that choice will be rubbed out.  It adds layers of bureaucracy to every transaction.  It hobbles any innovation by tying up more and more of our system into a political process.

And yet, in an attempt to achieve something like the government-payer system she seeks, she's willing to go for the bloat bill.  She's willing to accept tons of mandates to empower special interests.  And she's willing to turn over control of health care to a Republican-led government (which will happen at some point in the future). The result of this is that, inevitably, the levels of health care in this county can only get worse for all in the quest to help some.

So for being the most knowledgeable of my blogger buddies on the subject of actual health care and somehow not understanding that increasing size decreases health care quality (like BIG INSURANCE has done according to everything from the left I've heard), no matter how good the nurses are (intentional asskiss insert), asshattery doesn't begin to cover it.  But asshattery is what I have to give.

And now, back to the Obama/PelosiScare bill:

The following is a list of 'bureaucracies' created by the travesty that the House cursed us with, as compiled by the House Republican Conference.  And while we can probably debate on the purpose, size and scope of individual items on the list, it's still a list of 111 items!  I'm still waiting for someone who supports government health care to come along and tell me how this bill will do anything good.

Seriously. Try to justify it.  I need a laugh.  I'd laugh now if it weren't for the list below (and the Saturday passage of it).

Some gems I noticed.  There are 7 "pilot programs," 6 "funds," 3 "Ombudsmans," 3 "advisory committies," and 31 "grant programs."

The most ridiculous is #4: Program of administrative simplification. You've got to be shitting me. Is this a joke? Coming in second is #58: Center for Quality Improvement.  Because government run has always been soooooo synonymous with "quality."

And now, boring-ass reading.

1. Retiree Reserve Trust Fund (Section 111(d), p. 61) 
2. Grant program for wellness programs to small employers (Section 112, p. 62) 
3. Grant program for State health access programs (Section 114, p. 72) 
4. Program of administrative simplification (Section 115, p. 76)  You've got to be shitting me. Is this a joke?
5. Health Benefits Advisory Committee (Section 223, p. 111) 
6. Health Choices Administration (Section 241, p. 131) 
7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138) 
8. Health Insurance Exchange (Section 201, p. 155) 
9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191) 
10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194) 
11. Health Insurance Exchange Trust Fund (Section 307, p. 195) 
12. State-based Health Insurance Exchanges (Section 308, p. 197) 
13. Grant program for health insurance cooperatives (Section 310, p. 206) 
14. "Public Health Insurance Option" (Section 321, p. 211) 
15. Ombudsman for "Public Health Insurance Option" (Section 321(d), p. 213) 
16. Account for receipts and disbursements for "Public Health Insurance Option" (Section 322(b), p. 215) 
17. Telehealth Advisory Committee (Section 1191 (b), p. 589) 
18. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" (Section 1222, p. 617) 
19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648) 
20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653) 
21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672) 
22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681) 
23. Independence at home demonstration program (Section 1312, p. 718) 
24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734) 
25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738) 
26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753) 
27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784) 
28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786) 
29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796) 
30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804) 
31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859) 
32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933) 
33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978) 
34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000) 
35. Medical home pilot program under Medicaid (Section 1722, p. 1058) 
36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073) 
37. Nursing facility supplemental payment program (Section 1745, p. 1106) 
38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149) 
39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162) 
40. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid in the case of dual eligibles" (Section 1905, p. 1191) 
41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198) 
42. Public Health Investment Fund (Section 2002, p. 1214) 
43. Scholarships for service in health professional needs areas (Section 2211, p. 1224) 
44. Program for training medical residents in community-based settings (Section 2214, p. 1236) 
45. Grant program for training in dentistry programs (Section 2215, p. 1240) 
46. Public Health Workforce Corps (Section 2231, p. 1253) 
47. Public health workforce scholarship program (Section 2231, p. 1254) 
48. Public health workforce loan forgiveness program (Section 2231, p. 1258) 
49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272) 
50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275) 
51. Prevention and Wellness Trust (Section 2301, p. 1286) 
52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295) 
53. Community Prevention Stakeholders Board (Section 2301, p. 1301) 
54. Grant program for community prevention and wellness research (Section 2301, p. 1305) 
55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305) 
56. Grant program for community prevention and wellness services (Section 2301, p. 1308) 
57. Grant program for public health infrastructure (Section 2301, p. 1313) 
58. Center for Quality Improvement (Section 2401, p. 1322) 
59. Assistant Secretary for Health Information (Section 2402, p. 1330) 
60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352) 
61. Grant program for nurse-managed health centers (Section 2512, p. 1361) 
62. Grants for labor-management programs for nursing training (Section 2521, p. 1372) 
63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382) 
64. "No Child Left Unimmunized Against Influenza" demonstration grant program (Section 2524, p. 1391)
65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398) 
66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402) 
67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410) 
68. Grant program to implement medication therapy management services (Section 2528, p. 1412) 
69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422) 
70. Grant program for State alternative medical liability laws (Section 2531, p. 1431) 
71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437) 
73. Grant program for community-based collaborative care (Section 2534, p. 1440) 
74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457) 
75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462) 
76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464) 
77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478) 
78. Council for Emergency Care (Section 2552, p 1479) 
79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480) 
80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487) 
81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494) 
82. National Medical Device Registry (Section 2571, p. 1501) 
83. CLASS Independence Fund (Section 2581, p. 1597) 
84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598) 
85. CLASS Independence Advisory Council (Section 2581, p. 1602) 
86. Health and Human Services Coordinating Committee on Women's Health (Section 2588, p. 1610) 
87. National Women's Health Information Center (Section 2588, p. 1611) 
88. Centers for Disease Control Office of Women's Health (Section 2588, p. 1614) 
89. Agency for Healthcare Research and Quality Office of Women's Health and Gender-Based Research (Section 2588, p. 1617) 
90. Health Resources and Services Administration Office of Women's Health (Section 2588, p. 1618) 
91. Food and Drug Administration Office of Women's Health (Section 2588, p. 1621) 
92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624) 
93. Grant program for national health workforce online training (Section 2591, p. 1629) 
94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632) 
95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717) 
96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719) 
97. Program of Indian community education on mental illness (Section 3101, p. 1722) 
98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754) 
99. Office of Indian Men's Health (Section 3101, p. 1765) 
100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774) 
101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775) 
102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809) 
103. Urban youth treatment center demonstration project (Section 3101, p. 1873) 
104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874) 
105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877) 
106. Mental health technician training program (Section 3101, p. 1898) 
107. Indian youth telemental health demonstration project (Section 3101, p. 1909) 
108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925) 
109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927) 
110. Native American Health and Wellness Foundation (Section 3103, p. 1966) 
111. Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)\

If you're still here, and you read the whole list, why the fuck?  Don't have anything better to do, like watching paint dry?  I resorted to searching to come up with most of my info, and that was so I could find something funny in the chaos.

32 comments:

Satyavati devi dasi said...

I'd be flattered and think this was all really cute and launch into a huge melee over it except I'm (as you likely know) too stressed out to be more than an evil bitch lately. So:

So for being the most knowledgeable of my blogger buddies on the subject of actual health care and somehow not understanding that increasing size decreases health care quality

I'd love to know exactly W.T.F. you know about healthcare quality or how to achieve it. Everybody's a damned armchair quarterback who thinks they know better, even if they don't know the first f'n thing about a given topic, and somehow think they're qualified in some miraculous way beyond people who actually have a legitamate clue about what the situation is, and I am ever so tired of it.

And on that note I'm going to try to start this new job. And yes, happy happy joy joy, I hope.

TAO said...

Look at all the JOBS this bill will create!

Oh, and everyone says the government doesn't create jobs!

If these 111 new 'job creating' entities create 30 million jobs then we have also solved the issue of providing healthcare for everyone!

WOW!

Think positive!

Patrick M said...

Saty: It's a general principle. As size of any business increases, it allows for greater efficiency. But it also allows for more bloat without noticing it. And when it's a monopoly (government, for example), the bloat piles on with no need to clean it out.

In general, health care works best when it's just provider and patient and as little hanging over them as is necessary. Bureaucracy upon bureaucracy is not that.

Tao: I'm going to assume you're not serious, because if I do, I have to insult you.

When we talk about creating jobs, it's the kind of job that produces something, drirectly or indirectly, and that, as a result, grow the economy. Government DOES NOT DO THAT. They create make-work jobs, in some cases create infrastructure jobs that allow jobs that add value to multiply.

Creating jobs that suck productivity in the pursuit of shuffling cash and micromanaging said productivity usually leads to a loss of jobs.

Here's positive: If we're lucky. the Senate will kill this piece of shit. That's why I decided to give Satyavati the AOTW today rather than take the chance on the Senate.

Satyavati devi dasi said...

The monopoly (or oligopoly or whatever fucking opoly word it is, I hate semantics and you know it) is the INSURANCE INDUSTRY.

Please let's get past the idea that somehow the GOVERNMENT is the enemy here.

The ENEMY, if there is one, is THE INSURANCE INDUSTRY, who uses something like 85% of every premium dollar for administrative bullshit, as opposed to Medicare, who I believe is using some ridiculously small fraction of that to administer, by itself, to a vast number of people.

And as far as your general principles go: I've worked in a 55 bed hospital and in a 1100 bed hospital. Would you like me to evaluate which hospital gave superior quality of care and list all the reasons why?

Or would you rather guess?

Healthcare is not like running a Family Dollar, okay?

Beth said...

You give Saty way too much credit, Patrick. She may know how to start a line or change a bedpan, but she obviously has no clue how a free market works and why it works so well. Which is fine, to a point, because not everyone needs to be a financial expert, however, the basic ideas of economics are important for everyone to know and understand. After all, we are all part of our economy.

The basic idea behind the free market is having motivations and being rewarded for it. Why does Saty go to work? To make money. Why does a company exist? To make money. Will someone hire her if she has a poor work record? Probably not. So, Saty works hard and gets a brand new job, good for her, but she has to keep working hard to keep that job. So, there is motivation, BUT it gets rewarded.

Specifically with the health care business, doesn't it behoove a doctor, nurse or hospital to get it right, or they'll lose patients (sometimes literally!!)? Even if you think hospitals cut services to make more profits, they will be forced to shut down if service is very poor or if people are dying in large numbers under their care. They do have a motivation to not suck a lot.

Patrick is right, it makes no sense to have insurance companies managing our health care costs. We don't have car insurance companies taking care of regular maintenance in our cars, or even things that break on our cars. We only use insurance for the BIG out-of-the-ordinary car expenses, like a tree falling on it. So why doesn't health insurance work the same way? Doesn't that make sense?

Then, we'd have the MOTIVATION (oh there's that word again!) to be as healthy as we can be, so that we don't have to use that health insurance, unless it's for things beyond our control (apendicitis for example).

So there is a basic economic lesson for you. Maybe sometime you can teach us how to use those neat new thermometers that go across your forehead to read a person temperature, Saty, that would be great!

Satyavati devi dasi said...

Fuck you, Beth.

You have no idea of what I do or what I know and least of all why I do it.

I hope that if you ever get sick and need a nurse you have one who's not in it just for the money.

And I repeat, because it behooves repeating, fuck you.

dmarks said...

SDD said: "The monopoly (or oligopoly or whatever fucking opoly word it is, I hate semantics and you know it) is the INSURANCE INDUSTRY."

So, you see monopoly and concentration as a problem, right? Then why do you want to make it much much worse and advocate single-payer, which takes the monopoly idea to an extreme?

"I hope that if you ever get sick and need a nurse you have one who's not in it just for the money."

There are plenty of those in this area, unfortunately. A few years ago we had a nasty nurses strike in which the nurses (now thankfully former nurses: they all got replaced) held patient care hostage to their greed.

TAO said...
This comment has been removed by a blog administrator.
Patrick M said...

Tao: Different Beth. This one's the ok one.

And we're not stirring the abortion debate up. Here's the redacted version of your comments. I'll comment next:

Hey Beth, aren't you the one that flutters all over the internet doing drive by postings about abortion wherever you can?

[redacted]

I say lets end medicare and medicad, and the employer tax deduction for providing healthcare insurance to their employees.

Right now employers can write off the full cost of premiums and in turn they get another tax deduction, on employer payroll taxes, when employees have their fringe benefits deducted from their pay on a pretax basis.

That should bring billions of dollars in additional revenue to the government, considerably reduce the deficit and....

Probably cut the number of Americans with insurance in half! Which in turn would force health insurers, hospitals, and doctors to declare bankruptcy and or go out of business...

Oh, but we could rely on the charity of others...but that is also tax deductiable and I wonder how much charity there would be in this country if it also wasn't a tax deduction.

Considering how charitable giving drops during recessions people are not making donations for anything other than the tax deduction!

But we have to have free markets! So lets bring free markets to the...[redacted]

Patrick M said...

Saty: So you have issues with the oligopoly of insurance. So do I. But consider why they have so much administrative cost (and I seriously question that percentage, but...).

They have to comply with a myriad of state and federal mandates, regulations, hipaa (I remember forms doubling for me after THAT passed), in addition to trying to eke out a profit (they get about 3.6% on average). Obviously, the industry is a mess. But taking a few companies and slapping them together into the mess of a federal administration (layer upon layer upon layer upon layer, etc).

As for specific examples, there's always an exception to the rule. But I can look at any company, and as they grow larger and larger, they accumulate problems, bad habits, inefficiencies, etc. And the result is that they become inefficient. Either way, size means inflexibility.

Beth: I think you just stood on her last nerve on that. Especially since you are wrong about many of Satyavati's motivations.

Dmarks: Sadly, you can't replace striking governmnet workers for the most part. Ah, the future.

Tao: You're ignoring pretty much everything that's been said about free market solutions and taking it to the ridiculous. It's expected that there will be some portion of the population that we will have to take care of that the free market can't (I think I did a whole post on that).

The point is that to fix this mess we have now, we either have to centralize everything under the kind benevolence of our big government or we have to unleash the power of individuals to solve their own problems, and only using government to address those points that CAN'T be addressed in the private sector.

So taking it to the ridiculous adds nothing but a reason to scream things about Pelosicare being designed to kill people and feed Nancy's belly with fresh babies. Shall I get the New World Order bullshit going while I'm at it? After all, they're probably behind hiding Obama's REAL birth certificate.

Want to keep up the exaggeration?

Toad734 said...

If only the Republicans would have put this much time and consideration into Iraq, we would have plenty of money to fund this health care bill now with some left over.

Patrick M said...

Toad: That still leaves the Social inSecurity and Mediscare funding problems. And if you're believing any numbers in the bill without using multiplication, then you're nuts.

Satyavati devi dasi said...

By the way, you must have forgot that while single-payer is in my opinion the way to go, my goal is to get as many people access to healthcare as possible, meaning I'm more concerned with getting them insurance coverage, more concerned with getting rid of preexistings, more concerned with reducing the number of people in this country that have no insurance and thus no real access to any kind of care. If this means something other than a single payer system so be it, because the pay source is less important to me than the care delivery.

Toad734 said...

With a single payer we could reduce overhead costs by 30%. That means everyones healthcare bill would decrease by 30% over night. How's that for fiscal conservatism?

Patrick M said...

Saty: How we get as many people health care as possible is just as important as the act of doing so. Because mistakes affect quality and choice and sustainability (greater problems if we go with the government-payer model vs individual payment).

Toad: I call BS on the 30%. That's about as believable as the total cost staying under the trillion mark, and produced from the same orifice.

dmarks said...

Toad said: "With a single payer we could reduce overhead costs by 30%. That means everyones healthcare bill would decrease by 30% over night. How's that for fiscal conservatism?"

Why not apply this to all industries? The Stalin plan, really. Wouldn't that decrease overhead costs by a few hundred percent?

dmarks said...
This comment has been removed by the author.
dmarks said...

SDD said: "Please let's get past the idea that somehow the GOVERNMENT is the enemy here."


Sounds like someone here forgot to read their Constitution, and decided to ignore many hundreds of years of progress made in protecting human rights from the rapaciousness of the ruling class.

(This is not an appeal to the militia or terrorist line of wanting to overthrow the enemy government. Rather, it is an open-eyed recognition of the facts of the problems of trusting government too much.)

------------

Toad said: "If only the Republicans would have put this much time and consideration into Iraq, we would have plenty of money to fund this health care bill now with some left over."

Actually, in such a scenario, it would still not be a good idea to waste money on such a program (which as defined ruins the healthcare system). Such savings, if realized, could be better spent.

Satyavati devi dasi said...

The rapaciousness of the ruling class...

..those would be the small fragment of our population that hold the vast majority of the wealth, right?

The large corporations that make their money screwing people out of services they contracted for?

Like healthcare?

dmarks said...

"those would be the small fragment of our population that hold the vast majority of the wealth, right?"

It's those who actually rule. The real mighty people who make even Bill Gates and Warren Buffet shell out bazillions of dollars in monetary tribute.

"The large corporations that make their money screwing people out of services they contracted for? Like healthcare?"

And you seem to think that the way to fix it is to replace these hundreds of corporations with one corporation. Then we'd all be screwed.

Satyavati devi dasi said...

And you seem to think that the way to fix it is to replace these hundreds of corporations with one corporation. Then we'd all be screwed.

So rather than have just ONE entity to watch, monitor, regulate and observe, it's better to have dozens or hundreds, all working just as hard as they can to make an often unethical buck at your expense.

We spend so much time clinging to the chains that bind us in the name of 'freedom'. In reality, all we're doing is supporting those who would exploit us for their own profit.

Cause that's the American way.

dmarks said...

"So rather than have just ONE entity to watch, monitor, regulate and observe,"

And guess who does the regulation and observing? The exact same corporation that is running the monopoly: the government.

"it's better to have dozens or hundreds, all working just as hard as they can to make an often unethical buck at your expense."

But by competing, they hold each other accountable. You'd rather have just one company doing this. No choice.

" In reality, all we're doing is supporting those who would exploit us for their own profit."

That is all that socialism is. That is all you are doing, but you are completely blind to the fact of abuse by government monopolies.

Satyavati devi dasi said...

You are so obsessed with 'abuse by government monopolies' and 'competition'.

In reality, the abuse has been by the insurance 'oligopoly' (Patrick and his f'n semantics) and the fact that they've successfully, amongst themselves, completely eliminated any real and actual competition in the industry.

Government didn't have anything to do with that.

So you propose that the solution is to let the abusers continue to abuse, and pretend it's 'competition' and something that isn't the oligopoly (f'n Patrick again) it is currently?

Riiiiiiiiiiiiiiiiiiiiight.

dmarks said...

"You are so obsessed with 'abuse by government monopolies' and 'competition'."

Actually, I dislike any business monopoly. This includes government monopolies.

"In reality, the abuse has been by the insurance 'oligopoly'"

Of course. Why? Because of the concentration of power in a few companies, and the lack of competition caused by unnecessary regulations.

The only reason the abuse here is by private industry and not the government is because there is no single payer. Replace an oligarchy with a monopoly (private sector or government) and the problems will get worse.

"and the fact that they've successfully, amongst themselves, completely eliminated any real and actual competition in the industry."

How is this done? Through regulation. Government policy.

And... AGAIN... you would make the problem worse by reducing competition even more.

"Government didn't have anything to do with that."

It has everything to do with it. The states have artificial walls of regulation put up that prevent all 1200 or so insurance companies from offering services to every American in every state.

"So you propose that the solution is to let the abusers continue to abuse"

I have never proposed that. But you have proposed making the abuse worse by getting rid of all competition.

"and pretend it's 'competition' "

I am not pretending anything. I have a rather clear view of what is going on now. And I recognize that the solution isn't to intentionally make the problems worse by narrowing the members of the oligarchy to one.

Satyavati devi dasi said...

Insurance companies are prohibited from selling across states.

People love to toss this out.

However, in just one example I can cite off the top of my head before I have to get to work, Blue Cross Blue Shield operates in more than one state, including NY, MD, NC and many others that I don't actually have personal knowledge of.

I've also personally carried policies with Cigna and United in more than one state. And when I worked for Maxim, which is a national company, my insurance was carried by BCBS in MD, despite the fact that I live in NC. Colonial Penn also has insurance in at least NC and NY if not in other states as well.

So all this about companies being so restricted and not being able to sell across state lines may be true in some cases but is obviously not the inviolable rule.

Again, there is no real and actual competition in any true sense, which allows the insurance industry to basically do whatever they like.

And through the delusional thinking brought on by unceasing, blatantly false propaganda (like that 3.6% profit rate, which would mean 3.6% AFTER you pay your CEO $24 MILLION dollars salary, in whatever case that was, and have outsourced the bulk of your labour costs to the Phillipines, like Cigna did).... people still continue to defend the industry and somehow, in a twist of logic resembling a Mobius strip or an Escher illustration, blame it on the government.

Because in America, it couldn't possibly be evil companies.. this is a capitalist nation and the heart of everything we do and stand for.. right?

dmarks said...

"However, in just one example I can cite off the top of my head before I have to get to work"

There are different Blue Cross, Blue Shield's in each state. Different companies.

"I've also personally carried policies with Cigna and United in more than one state"

Thanks for providing examples that prove what I am talking about. I went to Cigna's sight, and they only offer policies in 10 states.

United is even worse. From their home page: "We sell insurance only in Missouri, Arkansas and Kansas."

"Again, there is no real and actual competition in any true sense, which allows the insurance industry to basically do whatever they like."

Yes. And this is because of the unnecessary anti-competitive regulations which bar or discourage complete across-all-states competition. In many cases, states raise the regulatory bar so high that companies can offer in these states, but they are discouraged from doing so.

"and have outsourced the bulk of your labour costs to the Phillipines, like Cigna did"

What is wrong with that if it means that costs are lower?

"you pay your CEO $24 MILLION dollar"

This is a perfect example of something that you don't make better, and might even make worse by turning something into a government monopoly: there are federal agencies where the people running them make far more than that!

I'm open to changes in how the insurance companies are handled. One interesting idea is to make them all nonprofits. It's the type of change that involves no bad ideas like creating new government agencies or federal monopolies to make the government even more rich and powerful.

Satyavati devi dasi said...

What is wrong with that if it means that costs are lower?

Lower for who? Premiums have gone up by hundreds of percent in the last few years.

dmarks said...

And they might be higher if not for the Phillipines center. That was all I meant.

Satyavati devi dasi said...

Tell that to the hundreds of people (my sister included) who lost their jobs.

All glories to capitalism. Go America!

dmarks said...

A lot of people lose their jobs to others who are better at the job, or due to changes and evolution in technology. They key is to turn around and find something they are better at.

(now I sing the requiem for the laid-off horse-buggy maker).

Satyavati devi dasi said...

So once again, we celebrate the wonderfulness of businesses who ship off jobs to third world countries for pennies on the dollar, and at the same time berate the large hole China has chewed into our GNP.

That's what real Americans do, right?

dmarks said...

"Pennies on the dollar" sounds like a huge difference. Let's assume several; like, about 7.

So, that's a choice of paying 100% for something, or a mere fraction, 7% for something.

"and at the same time berate the large hole China has chewed into our GNP."

You can blame the US for its own internal policies (such as overregulation and overtaxation to encourage businesses to flee, buy, or invest elsewhere) for this. Not China.

Besides, you named the Philipines earlier, not China.