[Trinidad]

mike777, on Dec 25 2009, 12:05 AM, said:

As for your point about not checking up on health insurance claims, if other countries do not check and double check, how do they avoid massive fraud claims?
With our single payer system, medicare, we check and double check and still have massive fraud and waste.

By keeping the health care system simple and transparent. That way it is easy to find fraud. But in a system that is complicated where no one has any overview of what is paid for what, fraud is easy to commit and hard to detect.

mike777, on Dec 25 2009, 12:05 AM, said:

In any event you guys do claim  to get great health care at about 50% of our cost, somehow.

I don't know the exact numbers, but I will say this: Simpler is cheaper.

(And yes, the USA is the only country in the world that my standard, 13 in a dozen health insurance doesn't cover. Guess why.)

Rik

[Trinidad]

Winstonm, on Dec 25 2009, 01:31 AM, said:

I am in a catch-22.  I am in favor of a single payer system yet I do not trust this government to run it.  Perhaps we should outsource single payer to a country who knows how to do it.

That's probably the most costly in the USA: The fundamental lack of trust in the government.

I will not judge whether this lack of trust is justified or not, but it does cost you an awful lot of money.

Rik

[mike777]

Trinidad, on Dec 24 2009, 09:02 PM, said:

mike777, on Dec 25 2009, 12:05 AM, said:

As for your point about not checking up on health insurance claims, if other countries do not check and double check, how do they avoid massive fraud claims?
With our single payer system, medicare, we check and double check and still have massive fraud and waste.

By keeping the health care system simple and transparent. That way it is easy to find fraud. But in a system that is complicated where no one has any overview of what is paid for what, fraud is easy to commit and hard to detect.

mike777, on Dec 25 2009, 12:05 AM, said:

In any event you guys do claim  to get great health care at about 50% of our cost, somehow.

I don't know the exact numbers, but I will say this: Simpler is cheaper.

(And yes, the USA is the only country in the world that my standard, 13 in a dozen health insurance doesn't cover. Guess why.)

Rik

Simple and transparent.....you mean the health care bill in our Congress?



Whatever Sweden, etc do to make health care simple and transparent seems impossible in real life or beyond us.

One does wonder how these simple and transparent country plans avoid massive fraud and waste, I have no idea how.


I mean in the headlines today there are claims that Russian hackers are stealing millions and millions from our banks via computers. If we cannot keep money safe in banks..then....how do we protect a multi trillion health care system from hackers?

[andrei]

cherdanno, on Dec 24 2009, 11:18 AM, said:

andrei, on Dec 24 2009, 10:16 AM, said:

cherdanno, on Dec 23 2009, 04:02 PM, said:

In Germany, we pay a little bit more in taxes ...

is it twice more "a little bit" ?


ok, maybe twice more is as exaggeration, but "a little bit more" it is too.

edit again: it seems that twice more might be quite accurate:

a 75000 euros/year will pay 33% income tax
a 75000 US/year will pay 20% income tax

if you factor in the sales tax, 19% versus 4%-8% you are getting there ...

Lol, maybe you should start by comparing similar incomes, instead of comparing a 75k $ salary with a 105k $ salary.

I am wondering if you try to be sarcastic, but whatever ...

cherdanno, on Dec 24 2009, 11:18 AM, said:

You might also be aware that the German income tax offers a lot more tax exemption. And if you start factoring in VAT, you might also want to add in corporate taxes.

what exactly is the connection between corporate taxes and personal taxes?
I am only trying to compare how much Fritz is paying versus Jim.

and "twice more" was wrong, I meant to say "double the amount".

[cherdanno]

When you go to a store in Germany, and buy s.th. for 20 Euros, then the store pays the VAT as part of the 20 Euros. Is that so different from the store taking all of the 20 Euros, then paying corporate tax from that revenue?

[spwdo]

What fraud are you talking about?

if health insurance is there for everyone how can one fraud. there's never any money paid to the sick people so the only fraud possible is doctors claiming to have given care that they haven't and receive money for it.

Again in most developed country's most money spend on healthcare goes to actual healthcare. If the USA was to cut administration cost in half every single person in the US without healthcare would get it and get it for free at the same cost.

they way it goes with you is like this

Person A wants insurance and goes to firm B
Firm B opens a dossier, checks the history of person A and decides whether or not person A gets insurance. if yes person A gets sick, another person( A doctor!!!) in firm B investigates if person A should receive financial support for that sickness. If yes cost are taking care off. if not bankruptcy lies ahead for the sick person and the doctor saying No might receive a bonus for denying healthcare. That is sick!!!!!!!!!!

Over here everyone gets automatically insurance, only extra insurance is possibil. you can buy the option you get a single room when hospitalised and those cost are covered or a insurance for pay check lost when sick. Stuff like that, none is discussing/insuring the basic health need , everyone gets that for free....


As for having to get insurance when ones to visit usa beeing cheap....

I been to India and my healthcare was never an issue, yes india. While there i heard storys about usa folks visiting india to get treatment , treatment combined with the travel was at a lower cost then receiving the same treatment in de states. Thats sick!!!!!!!

[spwdo]

something else .

overhere if we go to a doctor we pay for that visit, then we get most of that money back from the healthcare organisation. So it means that medical cost is actualy forced into a marketsystem where the clients(sick people) checks up on the bill.
If doctor A was to ask double for the same as Doctor B then doctor A would not be in business long.

paying for medical care is only the lower bills, its to keep some folks to see a doctor/dentist/spychiatrist every day. Hospital bills are paid for a large portion from the goverment direct and the sick people receive a small (own portion) later on.

Then theres the annual maximum bill, means once you spend over a certain amount a year(people with a ongoing condition) the goverment takes care of eevry bil.
then there are the people who cant afford even the annual bill, well they get it for free. Noone wants to be in that situation since it means you are very poor , but at least you have healthcare.

[mike777]

[quote name='spwdo' date='Dec 25 2009, 03:40 AM'] What fraud are you talking about?

if health insurance is there for everyone how can one fraud. there's never any money paid to the sick people so the only fraud possible is doctors claiming to have given care that they haven't and receive money for it."


Yes fraud, you talk as if there is no fraud in these systems...geez


Fraud here in the USA runs tens of billions, tens and tens of billions of bucks for health care claimed but not given.

Yes that means, doctors, patients, medical equip companies, pharmicies, and just plain fake companies with fake invoices etc etc are involved


Common example,,,,a fake company sets itself up, bills millions in bills. They get the money. They move and start a new company.

The patients get their copy of bills months later and medicare follows up even more months later. They are overwhelmed.

[kenberg]

I am not sure of the extent of fraud, I certanly can see opportunities for it here. To some extent, it depends on definitions. Smoe examples:

1. My father died in 1977 aafter a stay in one hospital and then a stay at the ICU in another hospital. I took care of the bills, I received bills from doctors whom i had never met for services that I was unaware of. I paid them without tracking down the validity. At the time, I thought that it would be better if one doctor, or one administrator, submitted one bill with the charges of every doctor on it. That doctor, or that administrator, would take legal responsibility for the bill being correct.



Of course 1977 is a while ago. Much more is covered by insurance now. We move on to



2. A couple of years back, I awoke around 3 am with severe pains throughout my back and chest. I called the doc, he told me to go to the hospital. We had recently moved, we went to the one hospital that we knew the location of. A pretty decent one, as it turned out. Anyway, they did lots of tests. Lots and lots. After a while, the pain subsided some and was predominantly in my back. All of the written records emphasize chest pain. They did lots of tests on my heart, and I assumed (possibly wrongly but I don't think so) that if you are going to do tests for the heart it is better if the patient has chest pains instead of back pains. Fraud? Or just knowing how to write a report so that it gets covered by the insurance? The problem was a slightly worn out neck disk that has given me no trouble since. At any rate, I have a very thoroughly examined heart.

3. Last summer I had a rash. The dermatologist checked that I had prescription insurance and gave me a prescription for a lotion, a small tube for $250. I eventually needed a refill so that's $500. There would normally be a co-pay. Not to worry. Along with the prescription I got a coupon entitling me to a discount. The discount covered the copay. So actually the lotion was not $250, but rather $250 minus the value of the coupon. Let's say $210, although I an not sure. So I got a $210 lotion, arranged to avoid the co-pay. Fraud? Or just a nice coupon to help sales?





Here is where, I am coming to think, the fundamental problem lies: In this country at least, we have a strong belief in the wisdom of the marketplace. This ideology won't be changing anytime soon. But in medical care, we have circumvented this. I got a little embarrassed with all the heart tests they were doing in item 2. It was tempting to say "Guys, get real, it's not my heart!" But then, hell, I'm not getting the bill and maybe the tests will find something interesting. I guess they did, there was some follow-up, but nothing serious, rather just things that your average guy walking down the street might have.



With health care we seem to be neither fish nor fowl. We believe in market discipline, we have set things up so there is no discipline. Whatever the merits of the expanded coverage in the bills being put together, it's not clear to me that this aspect is being addressed at all.


Yes I know that not everyone agrees with market discipline but most of us, even those who know nothing of Glenn Beck, do.

[PassedOut]

kenberg, on Dec 25 2009, 09:58 AM, said:

With health care we seem to be neither fish nor fowl. We believe in market discipline, we have set things up so there is no discipline. Whatever the merits of the expanded coverage in the bills being put together, it's not clear to me that this aspect is being addressed at all.

Of course we won't know for sure what is included until after reconciliation (presuming that happens), but my understanding is that the bill will contain seed money for a fairly large number of initiatives that the legislators believe might increase the efficiency of US health care services and cut the waste that exists today. The intention (as I understand it) is to measure and evaluate the effectiveness of each and then to go with what works best.

This is most certainly not the approach I would have preferred because I think much of what should be done is obvious, and I hate unnecessary dithering. But I'm not a politician and often have a devil of a time figuring out what they think they are looking at.

I do believe that the healthcare bill contains some very important provisions, and I can see that it's very important for (most) businesses that it pass. It at least makes it possible to get a handle on the ballooning federal deficit, but it is only the first step of many that will be needed.

I can't help but note that the republicans are again 100% against getting control of the federal deficit as they were in 1993, and as they have mostly been since Reagan was elected. (Yes, I'm still irritated that the party I once supported has flipped on so many issues.)

[andrei]

cherdanno, on Dec 25 2009, 01:07 AM, said:

When you go to a store in Germany, and buy s.th. for 20 Euros, then the store pays the VAT as part of the 20 Euros. Is that so different from the store taking all of the 20 Euros, then paying corporate tax from that revenue?

the store collects sales tax from shoppers and pass it to the government, so a sale tax is basically an indirect way to tax the consumer.

why is almost everything cheaper in US than Germany? gas - food - clothes - cars? it's the amount of taxes included in the price.

when the sale tax is 4-8% compared with 19%, when the income tax is quite sensibly higher, how is the german not paying at least double the amount of taxes an american is paying?

sure germans might get better EI and social programs, it is cheaper when you get your car impounded, but it has a cost, and a very high cost at that.

EDIT: and to answer your question, when you pay 20 euros to buy something at a store, the store is keeping 16.8 euros. if sales tax would be 0, why would the store sell for 20 euros and not for 16.8?

[hrothgar]

andrei, on Dec 25 2009, 07:29 PM, said:

cherdanno, on Dec 25 2009, 01:07 AM, said:

When you go to a store in Germany, and buy s.th. for 20 Euros, then the store pays the VAT as part of the 20 Euros. Is that so different from the store taking all of the 20 Euros, then paying corporate tax from that revenue?

the store collects sales tax from shoppers and pass it to the government, so a sale tax is basically an indirect way to tax the consumer.

why is almost everything cheaper in US than Germany? gas - food - clothes - cars? it's the amount of taxes included in the price.

when the sale tax is 4-8% compared with 19%, when the income tax is quite sensibly higher, how is the german not paying at least double the amount of taxes an american is paying?

sure germans might get better EI and social programs, it is cheaper when you get your car impounded, but it has a cost, and a very high cost at that.

EDIT: and to answer your question, when you pay 20 euros to buy something at a store, the store is keeping 16.8 euros. if sales tax would be 0, why would the store sell for 20 euros and not for 16.8?

The "incidence" of a tax describes what portion of a tax gets paid by the consumer as opposed to the seller. Tax incidence is a very basic concept in economics. (First semester, Econ 101 type stuff). You might want to read up on it.

As a preview of coming attractions, the incidence of a tax varies dramatically between different types of goods. (This division is related to the price elasticity)

[Winstonm]

I believe I have found in The Denver Post the reason we ended up with the health care bill as written:

Quote

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead.

Myth: The Canadian system is significantly more expensive than that of the

U.S.Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's

Read more: http://www.denverpos...7#ixzz0aivmGbLY


A $14 trillion economy x 17% x 31%= A shitload of bucks.->political power->no public option, no single payer, no medicare buy in->A $14 trillion economy x 17% x 31%=A shitload of bucks.

[kenberg]

I have a visceral dislike for an author who announces that she, the wise person, finds herself called upon to correct the myths that we, the uniformed, are still clinging to in our stupidity. If she has something to say, she can say it straight out. Skip the crap about how the rest of us are thinking in myths. Anyway, reading her arguments, I am not impressed. I gather my view is shared, since no one jumped on the bandwagon.

[spwdo]

[quote name='mike777' date='Dec 25 2009, 02:18 PM'] [quote name='spwdo' date='Dec 25 2009, 03:40 AM'] What fraud are you talking about?

if health insurance is there for everyone how can one fraud. there's never any money paid to the sick people so the only fraud possible is doctors claiming to have given care that they haven't and receive money for it."


Yes fraud, you talk as if there is no fraud in these systems...geez


Fraud here in the USA runs tens of billions, tens and tens of billions of bucks for health care claimed but not given.

Yes that means, doctors, patients, medical equip companies, pharmicies, and just plain fake companies with fake invoices etc etc are involved


Common example,,,,a fake company sets itself up, bills millions in bills. They get the money. They move and start a new company.

The patients get their copy of bills months later and medicare follows up even more months later. They are overwhelmed. [/quote]
impossible here.


Hardly possible here to start overnight a company and starting billing total strangers for services not given and receive money for it. One goes through years and years before being able to write a bill . 7 orr more years of education, several years of trainee , then assistant. then your own practise , why risk having all that time and money invested become useless since they take away your medical license . This all when you have a better then decent income makes the incentive to commit fraude small. Either its made almost impossible to commit fraud over here or we as citizens are that honest its not in our nature to commit fraud. i believe its the first.

yes, it happens on very rare occasion that a medical degree starts over billing. Lets say doing ten patients a day, but billing 25. they lose their license to ever practise medicine again .

But lets look at a simple doctor: you as a patient pay him 20 Euros, when you go to healthcare you get 18 Euros back so a homepractising doctor cant fraud since he receives only money directly from patients.

So its only some professions that can actually fraud but its soo rare that it is big big news whenever something naughty happens.

Whenever a system of fraud comes known administration fixes that way of doing things.

Fraud isnt a issue here, nor i hear it being a issue in country's neighbouring mine so maybe looking at other places and adept a better way of handling those problems works better.

[andrei]

hrothgar, on Dec 25 2009, 12:36 PM, said:

andrei, on Dec 25 2009, 07:29 PM, said:

cherdanno, on Dec 25 2009, 01:07 AM, said:

When you go to a store in Germany, and buy s.th. for 20 Euros, then the store pays the VAT as part of the 20 Euros. Is that so different from the store taking all of the 20 Euros, then paying corporate tax from that revenue?

the store collects sales tax from shoppers and pass it to the government, so a sale tax is basically an indirect way to tax the consumer.

why is almost everything cheaper in US than Germany? gas - food - clothes - cars? it's the amount of taxes included in the price.

when the sale tax is 4-8% compared with 19%, when the income tax is quite sensibly higher, how is the german not paying at least double the amount of taxes an american is paying?

sure germans might get better EI and social programs, it is cheaper when you get your car impounded, but it has a cost, and a very high cost at that.

EDIT: and to answer your question, when you pay 20 euros to buy something at a store, the store is keeping 16.8 euros. if sales tax would be 0, why would the store sell for 20 euros and not for 16.8?

The "incidence" of a tax describes what portion of a tax gets paid by the consumer as opposed to the seller. Tax incidence is a very basic concept in economics. (First semester, Econ 101 type stuff). You might want to read up on it.

As a preview of coming attractions, the incidence of a tax varies dramatically between different types of goods. (This division is related to the price elasticity)

you might not believe me, so I am quoting from wikipedia:

"The theory of tax incidence has a number of practical results. For example, United States Social Security payroll taxes are paid half by the employee and half by the employer. However, economists think that the worker is bearing almost the entire burden of the tax because the employer passes the tax on in the form of lower wages"


No matter of the incidence, more taxes in any economy means higher prices for the consumer, who eventually ends up paying all of them.

[Winstonm]

kenberg, on Dec 25 2009, 03:33 PM, said:

I have a visceral dislike for an author who announces that she, the wise person, finds herself called upon to correct the myths that we, the uniformed, are still clinging to in our stupidity. If she has something to say, she can say it straight out. Skip the crap about how the rest of us are thinking in myths. Anyway, reading her arguments, I am not impressed. I gather my view is shared, since no one jumped on the bandwagon.

The Great American Pastime: Shoot the Messenger.

[mike777]

Winstonm, on Dec 25 2009, 12:54 PM, said:

I believe I have found in The Denver Post the reason we ended up with the health care bill as written:

Quote

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead.

Myth: The Canadian system is significantly more expensive than that of the

U.S.Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's

Read more: http://www.denverpos...7#ixzz0aivmGbLY


A $14 trillion economy x 17% x 31%= A shitload of bucks.->political power->no public option, no single payer, no medicare buy in->A $14 trillion economy x 17% x 31%=A shitload of bucks.

Overhead costs run at only 1%...nonsense. This is just nutty accounting.


"In business, overhead, overhead cost or overhead expense refers to an ongoing expense of operating a business (also known as Operating Expenses - rent, gas/electricity, wages etc). The term overhead is usually used to group expenses that are necessary to the continued functioning of the business, but do not directly generate profits."

[Winstonm]

Quote

Overhead costs run at only 1%...nonsense. This is just nutty accounting.

This was an opinion piece from a Canadian citizen - she used poor word choice - so sue her.

Let's try another one:
Healthcare costs as a percent of GDP runs 10.1 in Canada and 16.0 in the U.S. according to Wikipedia.

There is no doubt that administrative costs of health care are substantially higher in the U.S. than Canada - a report I read showed about 3 times as high.

[kenberg]

I don't wish to shoot her, I doubt anyone plans to sue her. But you posted the piece, so it's fair to observe that there is no reason to take her seriously. That there may other more solid arguments on the subject is not in dispute.