surreal and more surreal

[Winstonm]

Well, in that case they show on the balance sheet as expenses. By "profits" I mean strictly those dollars which leave the organization for enrichment of the owners/stockholders. Hospitals are very good at keeping the money in - they can't have too much profit, and still maintain their non-profit tax status. So the successful ones keep building and expanding, which can indeed be good for care. Insurers are a different animal however. Those (large) profits provide little towards care.

 

Salaries and business spending can be ridiculously high in a non-profit as long as the monies are shown on paper to be plowed back into the "non-profit" business.

[barmar]

In a healthcare system where the majority of fees are paid by insurance companies rather than out of pocket, high list prices aren't unexpected. It's similar (but to an absurd extent) to the high prices for business class airfares and hotels at conference sites: they know that the costs will be passed on to the employer, who can afford higher prices.

 

BTW, don't forget that study that found vast differences in prices for the same procedures in different hospitals, sometimes an order of magnitude. So if she shopped around, maybe that $125K procedure could have been done for $50K elsewhere (but probably not $6500).

[mikeh]

In a healthcare system where the majority of fees are paid by insurance companies rather than out of pocket, high list prices aren't unexpected. It's similar (but to an absurd extent) to the high prices for business class airfares and hotels at conference sites: they know that the costs will be passed on to the employer, who can afford higher prices.

 

BTW, don't forget that study that found vast differences in prices for the same procedures in different hospitals, sometimes an order of magnitude. So if she shopped around, maybe that $125K procedure could have been done for $50K elsewhere (but probably not $6500).

In fairness, I should have mentioned that we did 'shop around' and the cheapest we found was in Oklahoma, where the price was $12,500. In addition, the bios of the doctors at Cleveland Clinic were very impressive, while all the Oklahoma doctors either had their degrees and speciality designations from Oklahoma or, in the case of one of them, from New Delhi. Make no mistake: I understand that the standards of training in India are pretty good and I wouldn't have any qualms about having that doctor be the one doing the procedure...I mention it only as what seemed to me to be a partial explanation for the price discrepancy. The CC could rip people off because they could claim to have the best, and the best expect and are entitled to be well paid, while Oklahoma would be less competitive for a host of reasons.

[y66]

Why do some posters say that Obamacare represents a government takeover of healthcare? Do you know something Politifact does not know? What are your information sources?

 

Myth #5: The Affordable Care Act Is "Socialized Medicine" And A "Government Takeover" Of Health Care

 

Fox News' Monica Crowley: "You Don't Surrender The Nation To Socialized Medicine Just Because You Think That You Can't Win The PR Battle." Fox News' Monica Crowley pushed the idea that Congress should consider a government shutdown unless a resolution funding the government included defunding the Affordable Care Act. When faced with opposition to that opinion from a Fox colleague, Crowley explained that, "You don't surrender the nation to socialized medicine just because you think that you can't win the PR battle." [Fox News, Happening Now, 9/20/13, via Media Matters]

 

Fox Quotes Heritage Foundation's Jim DeMint: Politicians Need To Stop "The Government Takeover Of Healthcare." According to a September 20 piece on FoxNews.com by Fox News Radio reporter Todd Starnes, Heritage Foundation president Jim DeMint defended a decision to cause a government shutdown over funding the Affordable Care Act claiming it was worth it to"take a risk" in order to stop "the government takeover of healthcare":

 

"If there's ever been a time for politicians to take a risk on their next election, it's stopping the government takeover of healthcare," said Jim DeMint, president of the Heritage Foundation. "This is not about political party or political calculation." [FoxNews.com, 9/20/13]

 

FACT: The Affordable Care Act Is Not Socialized Medicine Or A Government Takeover Of Health Care

 

PolitiFact Named "Government Takeover Of Health Care" As Its 2010 "Lie Of The Year." In its article declaring "a government takeover of health care" to be the Lie of the Year, PolitiFact explained how the law "relies largely on the free market" and "private companies":

 

"Government takeover" conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:

 

Employers will continue to provide health insurance to the majority of Americans through private insurance companies.

 

Contrary to the claim, more people will get private health coverage. The law sets up "exchanges" where private insurers will compete to provide coverage to people who don't have it.

 

The government will not seize control of hospitals or nationalize doctors.

 

The law does not include the public option, a government-run insurance plan that would have competed with private insurers.

 

The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.

 

PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. We have concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.

 

It's true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.

 

Republicans who maintain the Democratic plan is a government takeover say that characterization is justified because the plan increases federal regulation and will require Americans to buy health insurance.

 

But while those provisions are real, the majority of Americans will continue to get coverage from private insurers. And it will bring new business for the insurance industry: People who don"t currently have coverage will get it, for the most part, from private insurance companies. [PolitiFact, 12/16/10]

[y66]

Why do some posters characterize the current health care market as a free market? Have you not read your Milton Friedman or Kenneth Arrow? Have you not heard of the AMA? Do you think price differentials of the types mentioned by mikeh can persist in a free market? Come on. And how come free market people are not calling for a repeal of the tax code exemption for employer provided medical care?

[Winstonm]

In a healthcare system where the majority of fees are paid by insurance companies rather than out of pocket, high list prices aren't unexpected. It's similar (but to an absurd extent) to the high prices for business class airfares and hotels at conference sites: they know that the costs will be passed on to the employer, who can afford higher prices.

 

BTW, don't forget that study that found vast differences in prices for the same procedures in different hospitals, sometimes an order of magnitude. So if she shopped around, maybe that $125K procedure could have been done for $50K elsewhere (but probably not $6500).

 

The problem is this is actually backwards from reality - it is the insurance companies because of their purchasing power who get the discounted rates. The person who pays his own way is penalized. The reason this happens is for write-off purposes - the uninsured loss to the hospital is charged at the highest rate possible to lower tax liabilities.

 

I had this experience myself - the bill for a CT was shown to be over $3000 but discounted to $900, a negotiated price with the insurance company. Without the collective purchasing power of the insurance company, there would have been no discount.

[Winstonm]

Btw, isn't it odd that the Republicans are against a law that: a) encourages free market competition, b) lowers taxes by way of healthcare tax credits, and c) is a market-based, rather than government-based solution to healthcare problems

[mike777]

Btw, isn't it odd that the Republicans are against a law that: a) encourages free market competition, b) lowers taxes by way of healthcare tax credits, and c) is a market-based, rather than government-based solution to healthcare problems

 

 

yes surreal

[mike777]

"While I can empathize with a distrust of government, and a fear that government controlled health care will waste billions of dollars and often be mismanaged, where you and I part company is with respect to the notion that private enterprise does a better job:

 

 

I wish I could write as clear as MikeH does.

 

 

in two sentences he makes his key point. He does not trust in private markets to do better much better.

 

What is unclear is what he thinks is better.

 

fwiw I strongly agree that ocare is not socialized medicine...just a step forward

 

I note Canada is not just a single payer system. It would be nice to hear from others who do not get a check from the govt. anyone?

[ArtK78]

The problem is this is actually backwards from reality - it is the insurance companies because of their purchasing power who get the discounted rates. The person who pays his own way is penalized. The reason this happens is for write-off purposes - the uninsured loss to the hospital is charged at the highest rate possible to lower tax liabilities.

A common misconception. The "write-off" does not lower tax liabilities. If you don't receive the income, it is not subject to tax. There is no "write-off." Only if you have already included the billed amount as income before the write-off is there a deduction.

 

For tax purposes, the difference between the amount billed and the amount received is a non-event.

 

 

[kenberg]

I woke up this morning and realized that I am totally fed up with this game of road chicken with the nation's future. Wheter we are speaking of the Weather Underground or the Tea Party, enough is enough. I think of myself as open to duscussion on most points, but if the Republican Party cannot or will not bring their extreme wing under control then that's it for me, I will happily sign a pledge to not vote for any Republican anywhere under any circumstances, regardless of his good qualities, regardless of the defects of his opponent, regardless of anything. Bring it to an end or be gone.

[y66]

The path forward is glaringly obvious even to a growing number of House Republicans: a clean continuing resolution to fund the government for a few weeks or months, and an unconditional increase in the debt limit.

 

If Mr. Boehner continues to refuse to put those measures on the floor, Republicans and Democrats should join together to sign a discharge petition to force a vote, which would undoubtedly pass. And then the talks about what would be good for the country’s future can begin. -- NYT Editorial Board

 

Updated 10/9/2013 at 8:00 a.m.

 

Washington (CNN) – There appeared to be enough votes in the House on Wednesday to approve legislation to reopen the federal government, according to an ongoing CNN survey of House members.

 

CNN's vote count

 

All 200 Democrats and 19 Republicans support passing a continuing resolution with no additional legislative strings attached that would reopen the federal government, which has been partially closed for a week over a bitter policy dispute between Republicans and Democrats on health care. With three vacancies in 435 member House, 217 votes are currently the minimum needed for the measure to win approval in the House.

 

The 19 Republicans who support a government funding bill with no strings attached are:

 

Walter B. Jones, R-North Carolina: Said during an interview with MSNBC that he wished the House "would pass a clean CR."

 

Mike Coffman, R-Colorado: Announced he supported a government funding bill with no strings attached in a Denver Post opinion-editorial.

 

Tim Griffin, R-Arkansas: "Tweeted the he would support a clean government funding bill."

 

Bill Young, R-Florida: A spokesman tells CNN that Young would support a clean government funding bill.

 

Dennis Ross, R-Florida: A spokeswoman told CNN Ross would support a one-year government funding bill at sequestration levels with no strings attached.

 

Mike Simpson, R-Idaho: Statement: "Similar to Sen. Rand Paul, I could support a very short-term clean CR, perhaps one or two weeks, while we continue to negotiate on a longer-term bill."

 

Frank LoBiondo, R-New Jersey: LoBiondo penned an editorial in the Philadelphia Inquirer that said he supported a clean government funding bill.

 

Jon Runyan, R- New Jersey: Runyan penned an editorial in the Philadelphia Inquirer that said he supported a clean government funding bill.

 

Pete King, R-New York: Told CNN he supports passing a clean government funding bill.

 

Michael Grimm, R-New York: Grimm told CNN he would support a clean government funding bill.

 

Jim Gerlach, R-Penn.: A spokesman told CNN that Gerlach would support a clean government funding bill if it came to the floor.

 

Pat Meehan, R-Penn.: Statement on October 1: "I believe it’s time for the House to vote for a clean, short-term funding bill."

 

Michael Fitzpatrick, R-Penn.: Fitzpatrick penned an editorial in the Philadelphia Inquirer that said he supported a clean government funding bill.

 

Lou Barletta, R-Penn.: A spokesman told CNN that Barletta would vote yes if a clean government funding bill came to the floor. On Tuesday morning, the spokesman said while Barletta is now focused on passing a compromise that includes repealing of the medical device tax, it is fair to include him as a yes vote for a funding bill with no strings attached.

 

Charles Dent, R-Penn.: Told CNN he supports a clean government funding bill. "I think now it's imperative that we just fund the government," he said.

 

Robert Wittman, R-Virgina: A spokeswoman tell CNN Wittman would vote yes on a clean government funding bill.

 

Scott Rigell, R-Virginia: Told CNN on October 1 that he supported passing a clean government funding bill.

 

Frank Wolf, R-Virginia: A spokesman tells CNN that Wolf will support a clean government funding bill.

 

David Reichert, R-Washington: October 7 statement: "I will continue to vote for any legislation that keeps the federal government open."

[Winstonm]

A common misconception. The "write-off" does not lower tax liabilities. If you don't receive the income, it is not subject to tax. There is no "write-off." Only if you have already included the billed amount as income before the write-off is there a deduction.

 

For tax purposes, the difference between the amount billed and the amount received is a non-event.

 

Thanks for the correction - then why the discrepancy?

[blackshoe]

Like Ken, I'm fed up with this nonsense. I am, and have been most of my adult life, a registered Republican. The reason for that is that the stated goals and I ideals of no other party matched my own as closely as theirs. But stated goals aside, what the Republican Party is now showing, by their actions, their goals and ideals to be, no longer matches mine, not even close. That would make me a Democrat, I suppose, if that were my only other choice. Fortunately, it's not. I can be a Libertarian, or an Independent, or even a Communist, if I so desire. Or I can have no political party at all. I can be a party of one.

 

I suppose that registering as a Republican gives some "support" of some kind to the Party - they can say "see? look how many Republicans there are". If we want to express displeasure with what they're doing, one way is to to de-register. If enough Republicans do that, maybe the ones remaining will wake up. Or maybe not.

 

There is a danger, I think, in "I'll never vote again for a Republican, even if I think he's the best candidate for the job". Many decry the two party system, saying it's not flexible enough. It seems to me that whether or not that's true, a one party system would be worse.

[Winstonm]

The fairy dust is flying fast and furious around Washington as some Republican lawmakers are now claiming that a debt default would be a positive for the country, and others are claiming the money is there in tax revenues to pay our debts (just not enough for debt service and a federal government is something they don't mention.)

 

This, IMO, is the inherent danger from putting people in positions of authority who are subject to holding unverifiable beliefs. This small group is so firmly convinced that their way is the only true path for government that they cannot imagine being wrong, so no argument can sway them. But it is only the safety net provided by youthful ages, health, money and jobs, or imagination that gives this group the shield from reality to hold to their faith. The sadly ironic twist to this tale is that if you took any one of them out of his circumstances and could magically make him a 65-year-old with no family wealth, who relies solely on social security and medicare to survive, his distaste for government interference would evaporate.

[PassedOut]

There is a danger, I think, in "I'll never vote again for a Republican, even if I think he's the best candidate for the job". Many decry the two party system, saying it's not flexible enough. It seems to me that whether or not that's true, a one party system would be worse.

I agree. For the foreseeable future at least we in the US find ourselves effectively locked into a two-party system, so whether or not a there are better alternatives (and there might well be), it's important to me to have sensible republican candidates to vote for once again. So I'd never preclude voting for a republican that I thought would be best for the job (and I'm pretty sure that Ken would not actually do so either).

 

For the time being though, it is really hard for me to vote for a national republican (local is a different story, of course). Not only do I disagree with the national republicans on "social issues," but on my big issues as well. My big issues are (a) staying out of stupid wars and (b) maintaining fiscally responsible policies. On both those issues, the democrats these days are head-and-shoulders above the republicans.

[ArtK78]

.....

 

Frank LoBiondo, R-New Jersey: LoBiondo penned an editorial in the Philadelphia Inquirer that said he supported a clean government funding bill.

 

.....

 

Woo Hoo! My Republican representative is a rational human being! I knew I liked him, even if he was a Republican.

 

:)

 

I also note that Jon Runyan, a second term Republican representative from my parent's district, is also on board. Jon Runyan is a former offensive lineman for the Philadelphia Eagles, and was once voted the second dirtiest player in the NFL. Apparently he is not suffering from post-concussion syndrome. That can't be said about many Republicans.

[ArtK78]

I will happily sign a pledge to not vote for any Republican anywhere under any circumstances, regardless of his good qualities, regardless of the defects of his opponent, regardless of anything. Bring it to an end or be gone.

Be careful about pledges. There are a lot of Republicans out there who took Grover Norquist's pledge that may regret it now.

 

But I have to admit, voting for a Republican is certainly something that I have rarely been accused of doing. There have been a couple of exceptions, but I can't think of what they were at this moment.

[ArtK78]

Thanks for the correction - then why the discrepancy?

Perhaps there are some people rich enough to be willing to pay full freight regardless of the circumstances. The list price certainly doesn't have anything to do with tax planning.

[Winstonm]

Perhaps there are some people rich enough to be willing to pay full freight regardless of the circumstances. The list price certainly doesn't have anything to do with tax planning.

 

Let me ask this, then: an uninsured comes into the ER and must be treated until stable. His condition is such that he needs to be hospitalized for 4 days. He is sent a bill for the full amount and cannot pay it, so files bankruptcy. How does the hospital determine its loss on that patient's care, and does that loss show on its balance sheet?

[ArtK78]

Let me ask this, then: an uninsured comes into the ER and must be treated until stable. His condition is such that he needs to be hospitalized for 4 days. He is sent a bill for the full amount and cannot pay it, so files bankruptcy. How does the hospital determine its loss on that patient's care, and does that loss show on its balance sheet?

 

There is no loss for tax purposes. Only income not realized. The hospital has its expenses, which it deducts in the usual course. As far as the income lost because the patient cannot pay its bill, there is no loss for income tax purposes. The only reason there would be a deductible loss would be if the hospital were to recognize the amount billed as income, which is not the case for a business (or an individual) reporting under the cash-basis method of accounting.

 

Many years ago, when I was a teenager, I worked for my father in his dental practice, handling the books. He would often ask me why he couldn't deduct the fees charged but not paid by some patients that did not pay their bills. I told him it was because there was no loss. If you don't receive the income, there is nothing to deduct.

[blackshoe]

Let me ask this, then: an uninsured comes into the ER and must be treated until stable. His condition is such that he needs to be hospitalized for 4 days. He is sent a bill for the full amount and cannot pay it, so files bankruptcy. How does the hospital determine its loss on that patient's care, and does that loss show on its balance sheet?

As I understand bankruptcy, it's the court-appointed Trustee who determines what the hospital gets. I would guess then that the hospital's loss is the difference between what it gets and what it charged. Of course, since the charge is severely overinflated bullshit in the first place, so is the "loss".

[bd71]

Btw, isn't it odd that the Republicans are against a law that: a) encourages free market competition, b) lowers taxes by way of healthcare tax credits, and c) is a market-based, rather than government-based solution to healthcare problems

 

I think your empirical claims in (a) and (b) are wrong, and while © may be right it's misleading.

 

(a) You suggest health reform "encourages free market competition"

 

Point 1: "heavily-regulated competition" is not the same as "free market competition"...through the exchanges, the health reform law is consistent with the former but definitely not the latter.

 

Point 2: I think being "consistent with" competition is a better description than "encourages" competition. Competition is already happening in the markets for individual and small group insurance. In some markets, that competition is limited due to significant monopoly advantages of some Blue Cross plans, but that is also going to be true on the Exchanges. Other than goosing the market with subsidy dollars, the health reform bill is doing nothing else to really "encourage" competition.

 

(b) You suggest health reform "lowers taxes" through the credits/subsidies.

 

There are lots of new tax changes coming through the health reform bill; the tax credits through subsidies is only one part. In net, this bill is adding significantly to the national tax burden rather than diminishing it....and it's not even close.

 

© You suggest health reform is "market-based" rather than "government-based."

 

Slippery words. I guess this may be accurate in a vague sort of way if your point is that it's not actual government confiscation and ownership of the health care industry. It all depends on your benchmark. The post-health reform health system may be "more" market-based than many other nations' approaches to health care. But I think this is incredibly misleading...the full extent of local, state, and federal rules and taxes that touch health care make it one of the most-regulated industries in the United States. That was actually true even BEFORE the health reform bill, which adds a significant amount of new rules. So sure, it's still a "market", but to suggest that it's NOT also "government-based" as well is misleading. For what it's worth, the government pays/finances well more than 50% of all health care bills through Medicare, Medicaid, CHIP, and current/former government employees health benefits (including veterans). Still care to describe our health system as NOT "government-based"?

[Winstonm]

I think your empirical claims in (a) and (b) are wrong, and while © may be right it's misleading.

 

(a) You suggest health reform "encourages free market competition"

 

Point 1: "heavily-regulated competition" is not the same as "free market competition"...through the exchanges, the health reform law is consistent with the former but definitely not the latter.

 

Point 2: I think being "consistent with" competition is a better description than "encourages" competition. Competition is already happening in the markets for individual and small group insurance. In some markets, that competition is limited due to significant monopoly advantages of some Blue Cross plans, but that is also going to be true on the Exchanges. Other than goosing the market with subsidy dollars, the health reform bill is doing nothing else to really "encourage" competition.

 

(b) You suggest health reform "lowers taxes" through the credits/subsidies.

 

There are lots of new tax changes coming through the health reform bill; the tax credits through subsidies is only one part. In net, this bill is adding significantly to the national tax burden rather than diminishing it....and it's not even close.

 

© You suggest health reform is "market-based" rather than "government-based."

 

Slippery words. I guess this may be accurate in a vague sort of way if your point is that it's not actual government confiscation and ownership of the health care industry. It all depends on your benchmark. The post-health reform health system may be "more" market-based than many other nations' approaches to health care. But I think this is incredibly misleading...the full extent of local, state, and federal rules and taxes that touch health care make it one of the most-regulated industries in the United States. That was actually true even BEFORE the health reform bill, which adds a significant amount of new rules. So sure, it's still a "market", but to suggest that it's NOT also "government-based" as well is misleading. For what it's worth, the government pays/finances well more than 50% of all health care bills through Medicare, Medicaid, CHIP, and current/former government employees health benefits (including veterans). Still care to describe our health system as NOT "government-based"?

1) The health insurance exchanges offer competition among the providers - it is irrelevant that the health industry is regulated - we are only talking about competition among the companies selling payments for health services.

2) Prices in California and NY are substantially lower than expected because of increased competition for those large markets. If this is not an example of encouraged competition, I suggest you need a new dictionary.

3) Medicare projected payouts are already estimated to be falling as a direct result of the Affordable Care Act. Your claim of higher costs is simply that: an unfounded claim.

[blackshoe]

AFAICS, any time the government says "you will buy X product, or you will be fined," however that fine is implemented (a tax penalty in this case), and whatever choices you may have as to versions of X, you can throw any claims of "free market" right out the window. Not to mention any of the hundreds of other ways in which the government ensures that the health care market is not free.