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January 25, 2007

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The movement on the topic in the last 13 years provides hope. When Republican governors in Massachusetts and California believe it's time to take action about the problem, you know that the range of opinion and politically possible solutions are much broader than before.

as each day goes by, i'm liking this Obama fellow more and more.

OT: Retelling the Iraq war story, entirely in lies.

boo ya.

Hate to be a cynic, but I'll believe it when I see it. Six months is a very ambitious goal...and one that might not be achievable. Will Obama continue to work on the problem if he misses his goal?

Six years, Dianne (really four years from the beginning of his presidency, since the six years is starting now).

yes yes yes! maybe we finally have someone to get excited about.

Kevin Drum is not impressed.

"legislation to make health care available to every child in America"

I have seen this recommended around(eg, a comment at the end of MY's "Leninism" thread), on the grounds that it can get done, will actually help in huge ways (increase job mobility for parents who are terrified of losing a group plan), is a foot in the door, etc.

This connects to the Dingell thread, and why I oppose increased CAFE stds and Carbon taxes. If you oppose incrementalist rhetoric and tactics on Health Care, how can you support it on Global Warming?

You may not want to make thing worse so they can get better. But you have to be very careful not to make things a little better and foreclose or postpone the possibility of radical change.

Six years,

Gah. That sounds much more reasonable, though still overly ambitious. And I'm going to blame my misreading on having a temp of 101 at the moment.

When Republican governors in Massachusetts and California believe it's time to take action about the problem, you know that the range of opinion and politically possible solutions are much broader than before.

It will be interesting to see how Romney plays this in his campaign for the nomination. Universal health care is not going to be popular with the Republican base.

Of course, even for a politician, Romney is capable of enormous inconsistency.

I'll believe it when I see it

of course.

but, he is at least talking about the problem, and about what the real solution needs to be. he's make it acceptable for Dems to talk about this stuff. and that's a big step in the right direction.

and if Clinton and Edwards and Obama are going to get into a competition over who has the best UHC proposal, even better!

Ezra Klein is unimpressed.
Atrios shrugged.

Mark Kleiman:

If I seem to be picking on Obama for making a no-worse-than-usual politician's speech about health care finance policy, it's because I hold him to a higher-than-average standard. I have the strong impression that Obama is an intellectual superstar among politicians, someone with sheer brainpower, creativity, and willingness to work hard to get things right equal to the best public-policy academics. That would rank him alongside LBJ and Bill Clinton — and no one else — among Presidents and Presidential nominees in my lifetime. This was not the health-care speech I would have expected from someone at that level; I hope it was just an off-day.

I looked around for the text of the speech before I posted, but couldn't find it. Silly me, not to check Greg Sargent.

Like Ezra, I wish it had more specifics. Like Atrios, I don't mind their absence that much at this stage of the campaign, which according to me should not have so much as started by now. I find some of Mark's comments perplexing: the amount of paperwork and non-medical expenses (e.g., administration) is high, but electronic data isn't going to deal with the majority of that (I don't know whether Obama's figures are right, but Mark's idea that he meant to say 'billion', not 'million', is not in the right ballpark at all.) It will help -- and will also help with other things, like making a patient's complete history much easier to access, which in turn helps with quality of care -- but the main problem, as far as administrative costs are concerned, is the fragmentation of the health care system.

I'm wondering if transparency of data could be a soft underbelly for some sort of defacto unification of the health care system, rather than simply a rhetorical device as Kleiman suggests. If it were mandated (and enforced) that histories include specific data, and that those records had to be available to other health care providers within a set period, and efficiencies could be generated, it would then pave the way to linking them up in some way that makes a bit more sense. Of course, some may recoil in horror at this prospect ('how sneaky!) but there seems to be general agreement that something has to be done, and if you don't want health care leninism, you have to find a way to move towards this.

We recently received a bill for (the not covered portion of) Rilkekind's "room and board" while in the hospital following his birth seven months ago. We've been back recently (nothing awful, fortunately) - will (parts of) the bill for those visits show up in August? We've also had to physically transport records from one hospital to the other and back - hospitals that are in effect the same organization.

It's astounding to me that there are people not clamoring for a vastly simplified system.

We recently received a bill for (the not covered portion of) Rilkekind's "room and board" while in the hospital following his birth seven months ago. We've been back recently (nothing awful, fortunately) - will (parts of) the bill for those visits show up in August? We've also had to physically transport records from one hospital to the other and back - hospitals that are in effect the same organization.

It's astounding to me that there are people not clamoring for a vastly simplified system.

I can easily see SOME savings from this. And it's a pretty rational thing to demand in and of itself.

Is there some reason why it ISN'T being done right now?

We recently received a bill for (the not covered portion of)

If Obama is pushing transparency, it would reveal a lot of creative accounting by hospitals and insurance companies. Hospitals generally overcharge, and large insurance carriers negotiate it down. This allows hospitals to take big tax breaks when they treat indigents who can't pay, allowing them to deduct the overinflated charges, which often allows them to say they are non-profit, if I understand the system correctly.

Interestingly, on Kleiman's blog, there is an earlier post by Zasloff discussing this.

"Hospitals generally overcharge, and large insurance carriers negotiate it down."

Our bills reflect that - they're records of negotiations.

Being insured meant the experience of having a child was "Wow, this isn't free, and we have to pay how much?" instead of "We have to sell off our assets" (though maybe the hospital would have charged us less). I think California has a program to provide some coverage for poor uninsured pregnant women - just a patch, though.

gwangung: various reasons, including a lack of incentives to pay the non-trivial costs of conversion, institutional inertia, and so forth. Also included: the always baleful fragmentation of the system, which means that some of the possible benefit from hospital X's upgrade would accrue to hospital Y, which would be the one having the much easier time when a patient previously at hospital X showed up.

I'm in a community college medical assistant program and taking my second class in billing and coding as we speak.
I have the impression that non-treating medical personnel are indeed clamoring for a simplified system. Doctors, right now, tend to think magically about money: it's just supposed to come to them due to their virtuous behavior as medical providers. I don't mean to be snarky about doctors--it's just that they don't become doctors out of a desire to run a business. Accounts receivable is not an area of interest to them.
I remember awhile back (months)Kevin Drum had a quote from a doctor who wanted the US to go to a single payer system because such a system would reduce his overhead so dramatically. The doc estimated that under single payer he would only need to have one biller, whereas under the current system he needed four.
I don't know how much billing collections annd outstanding accounts receivable has to do with the upward trend in medical costs, but my guess is that it is significant. Doctors write off a lot of money as uncollectible. It has become such a complex process to collect money from insurance companies that many doctors not only employ a biller, but they pay a fee to a clearinghouse to edit the bills as well. (It is possible to get a clearinghouse that doesn't bill the doctor).
BTW there are quite specific requirements for charting medical histories. Charts are written in an agreed upon jargon with agreed upon standards so that the info in the chart can be translateed into the codes required by insurance companies. For example, the amount of money that can be charged for an office visit depends on the type of visit (one of four types) and each type has specific requirements for what the doctor does during the visit which much be documented in the chart.

"I'm in a community college medical assistant program and taking my second class in billing and coding as we speak."

Is that "for platform x" or "covering the usual programs X, Y, and Z"?

mind you, LBJ had immense influence in congress, to a degree that is perhaps unrepeatable in the modern era. maybe it's a pipedream to hope for someone like Obama to actually be able to implement anything particularly meaningful on the domestic agenda.

Rilkefan, for those of us with good jobs that provide decent health insurance, navigating the USA's nonsensical health care system is merely frustrating. For those with poor or no insurance, it can be a nightmare.

My mom got sick last year and once she realized that the chemotherapy would soon make her too sick to work, one of her first concerns was that she's lose her health insurance once she was fire. She had money to pay for COBRA, but that would expire almost a full year before she could qualify for Medicare.

We contemplated the task of finding medical insurance for a 64 year-old breast cancer survivor to cover that interim year. She spared us that by passing away on Thanksgiving.

Mom was luckier than most, really. She had money in the bank and three reasonably successful sons to take care of her. But what kind of civilized society has a sick, old woman worrying about the intricacies of the COBRA system in this sort of situation?

I'd suggest an open thread with horror stories about negotiating the medical payment maze, not simply to get things off of chests, but because it actually might help other people. I wish I had known what I know now.

my wife's a cancer survivor. so, like all cancer survivors, that puts her in a pretty tricky situation w.r.t. insurance - she can't get individual coverage, and she can't go a single day without employer-based coverage (including COBRA), because that counts as a 'lapse'. and if her insurance coverage lapses, there's a very good chance the next company will refuse to cover her at all, or refuse to cover her for cancer-related issues.

it's horrific and indefensible. and yet, conservatives, and there is a group of people here who try to defend the current system, every time they get a chance. fools.

(i apologize for the stupid sloppy editing... but you get the point)

Oh but the free market is holy annd must be worshipped. It doesn't solve everything but the things it doesn't solve are within the realm of personal responisblity and the free marketers aren't going to be mommy statists and rob you of your opportunity for initiative. And everyone knows the Canadian system is Socialist so it must be worse. I mean you have to wait for elective surgeries up there! Remember, reality isn't as important as ideology.

Sarcasm off now. I'm a member of Group Health and I am very satisfied with them. The right hand knows what the left hand is doing and the customer service is great. I love the eye doctor. She is the only eye doctor I've ever had that took eye pain seriously.

Wait, you mean your health plan actually believes people have eyes? Next you'll be telling me they think people have teeth, or even minds!

Yes, my primary care doctor referred me to an eye doctor (right down the hall)who recommended some medicine, set me up with a consultant (same office), and got me an appointment to get a contact lens (right across the hall). All of these people actually talk to each other.
No help with teeth, however.

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