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Peter
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Peter

Posted by: John Fembup “I understand that some/most members of Congress are whores on social issues.” No, just “whores” will do. The second original “Fee For Service” profession. John, the tax code is a political document that is created for special interests, not a need for income statement. Being able to deduct mortgage interest from your income is social engineering that does not help renters and also supports the building, real estate, develoment industry. The 50 cent per gallon subsidy on ethanol production allows money to be made on growing corn and giving ADM a good ROI but is I… Read more »

John Fembup
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John Fembup

Barry, I think we generally agree on the directions in which we’d like to see our nation move, but it looks like we disagree on the means to get there. That seems to be the crux of my exchanges with Peter as well. “taxes can sometimes be used to make the price of a particular product more closely reflect the full social cost of producing it” If by “social cost” you mean a tangible and demonstrable expense (such as the cost of avoiding or cleaning up environmental pollutants), I have no objection. On the other hand if taxes are adjusted… Read more »

Barry Carol
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Barry Carol

John, I agree with your primary thought regarding tax policy – that government’s objective should be to raise the revenue it needs in a way that does the least economic harm and without social engineering. Unfortunately, Congress cannot seem to resist social engineering, and the tax code is, as a result, riddled with provisions that attempt to encourage or discourage various behaviors. On the other hand, I also think taxes can sometimes be used to make the price of a particular product more closely reflect the full social cost of producing it or accomplish some other worthwhile objective. For example,… Read more »

John Fembup
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John Fembup

PS, Peter you nail this one:
“if you visit the AMA’s web site, their issues are income protection, not healthcare. DUCK -Incoming!!”
Regards,
Fembup

John Fembup
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John Fembup

Peter, I am notoriously poor at reading a person’s intent instead of their words, and I apologize if I have misread your intent. “What we need to look at is shifting tax policy so that those making personel decisions are informed by a tax that there are consequences to society.” At the risk of again misreading your intent, may I say that I disagree with your view of tax policy. Taxes are the means by which governments raise money to operate. The more this simple goal is diluted by the addition of one after another social “messages” the less I… Read more »

TomH
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TomH

My point is not to recommend capitation per se, but to point out that insurers are unlikely to invest heavily in a cost-control approach unless employers are rewarding them for it. In the mid-1990s, employers rewarded HMOs for deploying an array of strict cost-control measures which included capitation. When the backlash hit, HMO market share dropped. No private insurer looking at the dramatic rise of PPO/POS market share could fail to catch the market signal: lay off of strict cost-control measures. Barry’s ideas for using retrospective utilization review mechanisms for catching unwarranted practice variation are interesting. I’d like to see… Read more »

Peter
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Peter

John, I think you misinterpret my intent. I don’t want any body, gov or private, saying I or you can’t eat this or that. What we need to look at is shifting tax policy so that those making personel decisions are informed by a tax that there are consequences to society. I would also pay the tax as a person with more personal responsibility who chose to eat crap. People can then make their own decision. The money collected should then be invested in the health delivery system or more healthy food supplies, not general funds, as happens with liquor… Read more »

Barry Carol
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Barry Carol

TomH, I don’t know how Wellpoint challenges practice variations, but I can envision a couple of approaches. First, in the c-section example, if a doc is performing c-sections on, say, 50% of his patients when the national average is 30%, he could be asked for an explanation. Assuming the practice does not specialize in high risk pregnancies, and there is no other valid explanation, the insurer could threaten to remove him from its network after giving him a reasonable chance to bring his practice pattern into closer alignment with peers. Just knowing that someone is looking at this and is… Read more »

TomH
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TomH

> The private sector, is, in fact, making an effort to > identify significant vairances in practice patterns. What will insurers do once they “identify” these practice variances, which they could have easily identified 15 years ago? How will Wellpoint “challenge” a doctor with a higher-than-usual c-section rate? Each individual case will fall within the range of reasonable medical judgement. Jawboning is a low-yield approach to medical variance. Talk to me instead about how Wellpoint and other private insurers will shift payment policy to incentivize prudent clinical choices. As it happens, there used to be a payment policy that did… Read more »

Barry Carol
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Barry Carol

Peter, The private sector, is, in fact, making an effort to identify significant vairances in practice patterns. Wellpoint, for example, if it finds an OBGYN performing C-Sections at a significantly higher rate than his or her peers, it will be challenged. There may be a legitimate reason for it like a practice that specializes in high risk pregnancies, but the insurer will not just blindly pay the bills. The software is gradually getting more sophisticated and probably has quite a way to go. However, at least there is an attempt being made to address it. If the government sector, through… Read more »

John Fembup
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John Fembup

“I don’t eat junk food, I watch my weight, I drink very little, I exercise . . . ” I see. Good for you. So I take it you view responsibility as voluntary for SOME people – those who are already responsible, like you – and involuntary for others, that is “. . . a whole bunch of other people . . . ” “. . . that sector of society . . . ” “. . . don’t have health insurance or much income . . .” whom you apparently consider irresponsible, and have no problem dragging them, kicking… Read more »

Peter
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Peter

Posted by: Barry Carol | Aug 24, 2006 12:09:11 PM “Instead, it seems that both Medicare and Medicaid are perfectly content to blindly and mechanically pay these bills and then brag about their low administrative costs as a percentage of outlays. We’re not even talking fraud here which is a significant but separate issue. It looks like government entitlement programs like Medicare and Medicaid are just checkwriting machines with precious little oversight. No wonder costs are out of control.” Barry, in my reading of Matt’s piece I didn’t see medicare/caid/government mentioned once althought I’m sure they are victims of the… Read more »

Peter
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Peter

Well John, we see those dragged kicking and screaming into personal responsibility ever day in the court system, if you want one example of a system of “draggers”. Single moms suing for child support is all about imposing personal responsibility on the other half of a decision. The state of healthcare and health in this country IS a result of misdirected (to put it politely without a rant) government policy. I don’t eat junk food, I watch my weight, I drink very little, I exercise, but a whole bunch of other people, many of which don’t have health insurance or… Read more »

John Fembup
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John Fembup

“People don’t just FIND personal responsibility, they are shown it with legislation and dragged into it kicking and screaming.” “Personal responsibility is about taking action, not just saying it and walking away while you count your money earned from the lack of personal responsibility and misdirected government policy.” Well then, is personal responsibility involuntary (dragged into it kicking and screaming)? Or is it voluntary (taking action, not just saying it)? If personal responsibility is involuntary, who appoints the draggers and may a kicker & screamer appeal? Anyway who decides if legislated public policy is misdirected? If personal responsibility is voluntary,… Read more »

Peter
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Peter

Posted by: Eric Novack | Aug 25, 2006 6:39:19 AM “Of the $2 trillion spent on healthcare, less than 25% goes to physician salaries…” Everytime this argumant is discussed we see only this % is earned by insurance, X% by docs, X% by drug companies, X% by equipment manufacturers, ands so on. If all the little parts are looked at then this must be the best, most cost effecient, most affordable system in the world that will never implode; well somethings not smelling right. “Decreasing costs by arbitrarily reducing physician reimbursement is the equivalent of printing more money and thinking… Read more »