Health Care Reform or Cap-and-Trade CO2: Which Should Take Priority?

[Andre]

What decision to make?

http://thehill.com/leading-the-news/dem-centrists-press-pelosi--to-shelve-climate-change-bill-2009-05-06.html

Dem centrists press Pelosi to shelve climate bill

Democratic centrists are pressing House Speaker Nancy Pelosi to set aside a flagging climate change bill to focus on what they think is a more achievable goal: overhauling the nation’s healthcare system.

But those close to Pelosi (D-Calif.) say she is charging forward on cap-and-trade legislation, despite the potential defections of Democrats who represent states with industries that would be adversely affected by the bill...cont'd.

James Hansen, NASA climatologist has an outspoken opinion about cap and trade:

Temple of doom

...Cap-and-trade is the temple of doom. It would lock in disasters for our children and
grandchildren. Why do people continue to worship a disastrous approach? Its fecklessness was proven by the Kyoto Protocol.

So what would save more lives? reforming health care or cap and trade CO2?

 

[turbo]

Reforming health care is the BIG one and it needs to be done. Despite the whining of the insurance companies and the lies spread by the neo-cons, universal health care coverage will benefit us all. It will allow at-risk people to receive preventative care currently denied them, and control conditions before they are serious enough to require ER visits. In addition, universal health care will take a huge burden off businesses. Years back, businesses (urged on by unions and by competition for labor in the case of non-union shops) started offering health insurance coverage to their employees and their families at rates lower than the individuals could get. Now the cost of the insurances has exploded, and companies are trying to get out of those agreements without losing their work-forces. Universal health insurance would remove one of the most nagging (and fastest-growing) labor expenses. It would also help put companies with international markets on a more level playing field with their foreign competitors. For instance, all but one of Maine's large saw-mills has shut down in the recession and housing bust. Still, truckloads of logs go to Canada every day, and truckloads of finished lumber return. How can the Canadian sawmills remain profitable? In part, it may be because they don't have to purchase and administer health-insurance plans for their employees, reducing their overhead. Right-wingers rant about "socialism" whenever universal health coverage is mentioned, as if the US (by joining the rest of the industrialized world) is sliding into communism or worse.

 

[mgb_phys]

How can the Canadian sawmills remain profitable? In part, it may be because they don't have to purchase and administer health-insurance plans for their employees, reducing their overhead.

But they and their employees pay more tax making them uncompetitive with their lower taxed ( ie. subsidized) US competitors (at least that's what the politicians up here were claiming!)

The big advantage of the US system is that you can reduce pay and conditions. Here's a pay cut - don't like it you can leave. Of course your kid's medical problems will be a pre-existing condition at your next employer and not covered so 'do as we say or the kid gets it'.

 

[turbo]

I don't buy that mgb_phys, unless you have some pretty serious graft and corruption somewhere between the tax collections and the expenditures.

Although nearly 46 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.3

http://www.nchc.org/facts/cost.shtml

In fact, I read recently that even though the US has so many millions of uninsured, we spend 30% more than EU countries per capita on health care.

 

[chemisttree]

Where is your information regarding the high cost of healthcare as it applies to the cost of a board foot of lumber. If you actually do an analysis you will find that the cost of health care is a vanishingly small component of the cost of that board foot of lumber.

Isn't is more likely that the reason that Canada can outcompete US lumber companies is because http://en.wikipedia.org/wiki/United_States-Canada_softwood_lumber_dispute"

Health care costs? Gimme a break!

 

[turbo]

Let's see what the Big 3 automakers AND the UAW had to say about the value of the Canadian health-care system in regard to the viability of their Canadian plants.

http://www.house.gov/mcdermott/sp051215a.shtml

Well, I will enter into the RECORD a letter that sets the record straight and give us a chance to finally confront America's health care crisis. This letter was sent separately to the Canadian government by the Ford Motor Company, General Motors, Daimler Chrysler and the union representing auto workers in late 2002.

The so-called big three U.S. car companies put their full support behind publicly, publicly, funded health care in Canada. Let me read some excerpts. "Canada's publicly funded health care system provides essential and affordable health care services for all Canadians, regardless of their income. For both employers and workers in the auto industry, it is vitally important that the publicly funded health care system be preserved and renewed."

The letter sent by GM, Ford, and Daimler Chrysler, concludes: "In addition to reinforcing the quality and accessibility of health care for all Canadians, these measures would also help to ensure the long-run success of the Canadian auto industry." There is a business reason to do it. That is the U.S. auto industry acting outside the United States. It is time for them to act inside the United States and for us to act.

 

[mgb_phys]

A national health care system isn't an advantage because it's a subsidy - it's just vastly cheaper because of scale efficencies.
I pay around $50/month for healthcare in Canada + whatever proportion of my taxes go to health. I paid several times that in the US just to upgrade my work HMO to whatever the better scheme was called.
I do remember that my single doctor visit in the US resulted in months of bills, rebates, queries, letters and starements.

 

[Al68]

Reforming health care is the BIG one and it needs to be done. Despite the whining of the insurance companies

Any evidence of insurance companies whining?

They benefit from all the regulation by gov't forcing people to pay for insurance provisions they don't want or need (because Dems think they "should have it").

And we're expected to believe that insurance companies just hate it when people are forced to buy more insurance coverage than they would otherwise buy voluntarily. Poor, poor insurance companies.

Gimme a break.

 

[turbo]

A national health care system isn't an advantage because it's a subsidy - it's just vastly cheaper because of scale efficencies.
I pay around $50/month for healthcare in Canada + whatever proportion of my taxes go to health. I paid several times that in the US just to upgrade my work HMO to whatever the better scheme was called.
I do remember that my single doctor visit in the US resulted in months of bills, rebates, queries, letters and starements.

Not only that. Insurance companies all enforce their own coding standards, and when a small private practice gets denied coverage for a covered procedure because the coding wasn't perfect, they either have to re-code, and resubmit, hoping to get paid another month or so down the line, eat the cost, or go back on their own patients to recover "denied coverage" costs. This is a HUGE drain on private practices. The primary money-making strategies for large insurers are outright denial of claims or interminable delays in paying claims.

 

[Al68]

The primary money-making strategies for large insurers are outright denial of claims or interminable delays in paying claims.

Generalizations like this benefit those companies that fraudulently deny claims, while hurting "good" insurance companies, and the consumers of both.

 

[chemisttree]

Wow, you found a business that wants to shift one of it's expenses onto the backs of the US citizens. Gee, it must be true.

The cost of health care per car at GM is $1,525 (2004 data) while that for Toyota in the US is only $201. The cost of retirees benefits is the culprit. Recently GM has cut the healthcare retirement benefit and may eventually eliminate it. If that happens and universal health care is enacted, everyone else will pay for their benefits. An increasingly small part of our population (those that work) will be saddled with that and all of the other debt we are incurring. It will be too much for those workers and deficit spending will skyrocket even higher.

There's no end to this ponzi scheme.

 

[Coin]

I don't see it as "pick one", I see it as "what do we do first?". Given what the Congress has to work with it really just does not seem believable that they can get to both of these two things this year.

And it makes sense to do health care first, because the economic downturn both means (1) more people will be having trouble affording their health care and (2) industrial output and thus carbon output will be down naturally for the duration of the recession.

In fact I think it will actually be easier to pass cap and trade if they get health care addressed first-- Congress will have more leeway to act if they can present themselves to the public as having sensible priorities, and conservative Democrats will be easier to pressure once activist resources are freed up from working on health care.

 

[turbo]

Generalizations like this benefit those companies that fraudulently deny claims, while hurting "good" insurance companies, and the consumers of both.

I was the Network Administrator for a very large (by Maine's standards) ophthalmic practice with offices and treatment centers in 5 cities and some smaller towns, and I can assure you that ALL health insurance companies use denial/delay of claims to pad their profits. The denial/delay is automatic and very cheap on their part, and trying to get past their obstructionism is very costly to medical practices. Trying to streamline the coding, electronic resubmission, and accounting and reduce the aging of receivables (accounting jargon) was my most valuable day-to-day contribution to that large practice. Health-care in the US would be a lot cheaper if the insurance companies payed claims that they had agreed to, and didn't tie up untold man-hours chasing them for well-documented treatments.

 

[Al68]

I was the Network Administrator for a very large (by Maine's standards) ophthalmic practice with offices and treatment centers in 5 cities and some smaller towns, and I can assure you that ALL health insurance companies use denial/delay of claims to pad their profits. The denial/delay is automatic and very cheap on their part, and trying to get past their obstructionism is very costly to medical practices. Trying to streamline the coding, electronic resubmission, and accounting and reduce the aging of receivables (accounting jargon) was my most valuable day-to-day contribution to that large practice. Health-care in the US would be a lot cheaper if the insurance companies payed claims that they had agreed to, and didn't tie up untold man-hours chasing them for well-documented treatments.

Well, then it must be ALL insurance companies, except all the ones I have ever dealt with.

Your "assurance" just doesn't outweigh my direct knowledge to the contrary from personal experience, experience of friends and family members, and general knowledge of the subject.

Have you considered that if denies/delays are common with a particular practice that the problem is with that practice? Since the problem is obviously not universal with other practices around the country.

 

[turbo]

Well, then it must be ALL insurance companies, except all the ones I have ever dealt with.

Your "assurance" just doesn't outweigh my direct knowledge to the contrary from personal experience, experience of friends and family members, and general knowledge of the subject.

Have you considered that if denies/delays are common with a particular practice that the problem is with that practice? Since the problem is obviously not universal with other practices.

The highest-paid non-professionals in medical practices are coding specialists. Any idea why? If they understand the coding requirements (very arcane!) of all the insurance plans that the practice honors AND they can code treatments accurately much of the time, the insurance companies don't bounce as many claims and the practice gets paid fairly promptly with fewer partial payments or denials. And it is ALL insurance companies. If the claim trips any flag, now matter how minor, it is denied. The coding specialists for the practice then have to figure out what flagged the claim, re-code, and re-submit and hope for payment. This is a huge industry that can be eliminated by the establishment of a single-payer system with a single set of coding requirements. If you have not worked in a medical practice on the business side, you have no idea how much the insurance companies cost Americans.

Let's say that you run a health insurance company, and by denying or delaying claims you can capture and invest a "float" of several billions of dollars to invest at your will. Do you pay valid claims promptly or do you throw up enough roadblocks to maintain and increase the size of your float until you start losing "participating practices"? I think you're smart enough to answer that. Most people don't see it in action enough to estimate the magnitude of the drag it causes on private practices and on health care in general. I have seen it first hand, and it is ugly.

 

[Coin]

Al68, it sounds like you are discussing claims being denied from the customer's perspective, whereas turbo-1 is speaking from the medical practice's perspective. It also sounds like turbo-1 is alleging that the customer's perspective would be unreliable, since there would be frequent payment denials which the customer would never even be aware of because the medical practice would handle them internally. Is this about right?

 

[Al68]

Al68, it sounds like you are discussing claims being denied from the customer's perspective, whereas turbo-1 is speaking from the medical practice's perspective. It also sounds like turbo-1 is alleging that the customer's perspective would be unreliable, since there would be frequent payment denials which the customer would never even be aware of because the medical practice would handle them internally. Is this about right?

Nope.

 

[turbo]

Al68, it sounds like you are discussing claims being denied from the customer's perspective, whereas turbo-1 is speaking from the medical practice's perspective. It also sounds like turbo-1 is alleging that the customer's perspective would be unreliable, since there would be frequent payment denials which the customer would never even be aware of because the medical practice would handle them internally. Is this about right?

This is exactly right. The very last resort of a medical practice is to go back on the patient for collections. They will typically try at least 1-2 rounds of re-coding and re-submission to try to get paid, and if the insurance company still denies payment, and they are looking at receivables that are now aged 90 days or so (considered high-risk or uncollectable by banks) the practices have to try to fall back on the patients for payments. Like any other businesses that have unexpected expenses (surgical retinal laser dies at an inconvenient time) high-tech medical practices need to keep their receivables in a healthy (no more than 60-day aging in most cases) situation to maintain their lines of credit with the local banks in case they need big $$$ fast. As the network administrator, it was my job not only to keep stuff running smoothly, but to keep the coding, claim submissions, accounting functions running as smoothly as could be. It was a really hot-seat job.

People who listen to politicians' and lobbyist hacks' sound-bites have no idea how big and expensive the problem really is.

 

[Coin]

Nope.

...nope that is not an accurate summary of your position, or nope you don't agree with turbo-1's position? I am just trying to make sure I understand what you are trying to say.

 

[Al68]

The highest-paid non-professionals in medical practices are coding specialists. Any idea why? If they understand the coding requirements (very arcane!) of all the insurance plans that the practice honors AND they can code treatments accurately much of the time, the insurance companies don't bounce as many claims and the practice gets paid fairly promptly with fewer partial payments or denials. And it is ALL insurance companies. If the claim trips any flag, now matter how minor, it is denied. The coding specialists for the practice then have to figure out what flagged the claim, re-code, and re-submit and hope for payment. This is a huge industry that can be eliminated by the establishment of a single-payer system with a single set of coding requirements. If you have not worked in a medical practice on the business side, you have no idea how much the insurance companies cost Americans.

Let's say that you run a health insurance company, and by denying or delaying claims you can capture and invest a "float" of several billions of dollars to invest at your will. Do you pay valid claims promptly or do you throw up enough roadblocks to maintain and increase the size of your float until you start losing "participating practices"? I think you're smart enough to answer that. Most people don't see it in action enough to estimate the magnitude of the drag it causes on private practices and on health care in general. I have seen it first hand, and it is ugly.

Well, you are mixing together two different issues. Now you're just claiming that all insurance companies delay claims that have something wrong with them (flags) as any (respectable) insurance company would do.

Obviously I would prefer to buy insurance from a company that doesn't pay a claim until they know it's legit. The more people that believe that all insurance companies are the same, the more likely it is for some companies to fraudulently deny claims, since the blame is spread around. When people believe that, there is no reason for a company to care about their reputation for prompt payment.

And the idea that this practice as a whole would increase insurance company profits as a whole is just a gross misunderstanding of free market economics.

 

[Al68]

...nope that is not an accurate summary of your position, or nope you don't agree with turbo-1's position?

Both.

 

[Al68]

This is exactly right. The very last resort of a medical practice is to go back on the patient for collections.

This may be true of some medical practices, but is definitely not true of all. It has never taken anywhere near 90 days for me to get a statement showing what was paid by my insurance company and what wasn't. And I get a separate statement from my insurance company explaining any denials.

One common misconception is that an insurance company has an obligation to the medical provider. No such obligation exists in a normal insurance policy.

The obligation is to the policy holder regardless of who the payment is sent to. Medical practices file insurance claims on behalf of their patients as a convenience to their patients. The medical practice is only owed money by the patient, who is owed money by the insurance company.

 

[turbo]

Well, you are mixing together two different issues. Now you're just claiming that all insurance companies delay claims that have something wrong with them (flags) as any (respectable) insurance company would do.

Obviously I would prefer to buy insurance from a company that doesn't pay a claim until they know it's legit. The more people that believe that all insurance companies are the same, the more likely it is for some companies to fraudulently deny claims, since the blame is spread around. When people believe that, there is no reason for a company to care about their reputation for prompt payment.

And the idea that this practice as a whole would increase insurance company profits as a whole is just a gross misunderstanding of free market economics.

You miss the point. The insurance companies will not standardize coding requirements because it would reduce their ability to deny claims and cost them a great deal of money that they get from investing the "float" on unpaid claims. They could have gotten right in bed with Alcon and other medical specialty companies that provide practice-management software and standardized coding requirements, but they will not because the status quo makes them a lot of money.

Years back, congress required banks to process personal checks in a more timely manner because the banks were withholding transfers long enough to ensure them a huge rolling "float" that they could invest and make money from. Congress has never required the same of the health insurance companies. It is a huge money-maker for them - even more than it was for the banks, because while a bank might establish a "float" fund on a 7-day rolling balance, the health insurance companies can establish a "float" on at least a couple of months worth of denied or delayed payments.

 

[Al68]

You miss the point.

I think you miss the point. There are insurance companies that fraudulently deny/delay claims and are getting by with it because people believe they're all the same instead of dumping their insurance company.

Insurance companies used to use their good reputation to make money by getting and keeping customers. Now, people don't even bother to notice the name of the company. After all, they're all the same, right?

Not for me. Any insurance company that took 90 days to pay my claim (either to me or to my medical provider on my behalf) without good reason would be dumped immediately.

As far as medical providers, they are simply not a party to the policy contract, they file claims only as a service to their patients. Maybe they shouldn't. Or maybe they should just ignore the insurance company's coding requirements, use their own, and send the patient a bill for whatever is not paid.

 

[Al68]

Congress has never required the same of the health insurance companies.

Congress is not a party to the contract (insurance policy). It's an agreement between me (for example) and a private company.

Only when that contract is violated and a party to it files a complaint is it an issue for government. This is a consequence of the basic human right to contract, traditional common law right of citizens to make private agreements with each other without government "approval". Is it safe to assume you don't believe in any such right?

 

[russ_watters]

...universal health care coverage will benefit us all.

I'm 33, in excellent health, and for the past few years have enjoyed very low health insurance costs. Universal health care will certainly increase my health care costs and almost certainly reduce my health care quality. It most certainly will not benefit everyone.

Regarding the question in the OP, I think the democrats are drawing an artificial conflict. If both issues are important to them, they should pursue both issues. What this really says is they are abandoning cap and trade either because they've decided it is a bad idea (and want to save face by not admitting it) or don't think it can pass (and want to save face by not backing a losing cause).

 

[turbo]

Congress is not a party to the contract (insurance policy). It's an agreement between me (for example) and a private company.

Only when that contract is violated and a party to it files a complaint is it an issue for government. This is a consequence of the basic human right to contract, traditional common law right of citizens to make private agreements with each other without government "approval". Is it safe to assume you don't believe in any such right?

The right for people to establish checking accounts with local banks was a private agreement. Congress stepped in when banks started delaying check transfers in order to generate rolling "float" funds on which they could get large short-term profits. The Federal government should examine health insurance companies it the same way - their offenses are more egregious, and more blatant.

 

[Al68]

The right for people to establish checking accounts with local banks was a private agreement. Congress stepped in when banks started delaying check transfers in order to generate rolling "float" funds on which they could get large short-term profits. The Federal government should examine health insurance companies it the same way - their offenses are more egregious, and more blatant.

That's a requirement for Federally insured banks, as a condition for doing business with the gov't. Gov't is free to impose any condition it wants as a condition of doing business. A private institution that doesn't do business with the gov't is under no such obligation. Private insurance companies in general are not asking to do business with the gov't.

Anyone is free to impose any condition they want as a condition of doing business with anyone else. They are not free, however, to use force against them. You just can't equate the use of coercive force to voluntary agreements between people. There's an obvious big difference.

But I notice you didn't answer my question.

 

[mheslep]

Reforming health care is the BIG one and it needs to be done. Despite the whining of the insurance companies and the lies spread by the neo-cons, universal health care coverage will benefit us all.

I assume this means universal care provided by the government. What example around the world do you have in mind here that we should emulate? Keep in mind that the US already has universal government paid care for at least the poor(Medicaid), the elderly(Medicare), and the military.

It will allow at-risk people to receive preventative care currently denied them, and control conditions before they are serious enough to require ER visits. In addition, universal health care will take a huge burden off businesses. Years back, businesses (urged on by unions and by competition for labor in the case of non-union shops) started offering health insurance coverage to their employees and their families at rates lower than the individuals could get. Now the cost of the insurances has exploded, and companies are trying to get out of those agreements without losing their work-forces. Universal health insurance would remove one of the most nagging (and fastest-growing) labor expenses. It would also help put companies with international markets on a more level playing field with their foreign competitors. For instance, all but one of Maine's large saw-mills has shut down in the recession and housing bust. Still, truckloads of logs go to Canada every day, and truckloads of finished lumber return. How can the Canadian sawmills remain profitable? In part, it may be because they don't have to purchase and administer health-insurance plans for their employees, reducing their overhead.

In general I agree with the point illustrated by the anecdotes, except that universal whatever would 'remove' the cost. It would move the cost from the employer to the taxpayer in general - it doesn't go away. There are better ways to move the cost off the employer IMO, namely kill the payroll based health deduction. Sen Conrad is the latest to advocate this.

Right-wingers rant about "socialism" whenever universal health coverage is mentioned, as if the US (by joining the rest of the industrialized world) is sliding into communism or worse.

I think they rant that government based care is a slide into socialism. What do you call it?

 

[mheslep]

... What this really says is they are abandoning cap and trade either because they've decided it is a bad idea (and want to save face by not admitting it) or don't think it can pass (and want to save face by not backing a losing cause).

It's definitely the latter (can't pass) in the minds of the leadership. Midwestern congressmen are not going for it.

Even industry is weighing in and saying they prefer a straightforward carbon tax over cap & trade. Exxon's Tillerson and Chevron's O'Reilly favor a straight tax because its transparent; C&T would be all about 'moving money around' with a million hands out. It has so far had a poor showing in Europe.
http://blogs.wsj.com/environmentalcapital/2009/01/08/exxons-tillerson-give-me-a-carbon-tax-not-cap-and-trade/"
http://www.bloomberg.com/apps/news?pid=20601072&sid=atXJzegtJUGg&refer=energy"

 

[drankin]

I've been watching C-Span and the committee discussions about how to go about universal health care. In general, they don't know where to start. Which means they will throw vast amounts of tax-payer money at it until it floats itself and then more money at it to keep it from capsizing.

I think we should simply look at supplementing the system we have where required for both preventative and "life & death" (cancer, transplants, etc.). Look at plugging the holes in our society and moving on. Anything beyond that is going to suck for everyone. More taxes, less quality health care. One day I'll see this incredible pay-cut, except they will call it health care tax and it won't do me a bit of good.

In general, do we not have better health care available in the US compared to countries that have a nationalized system?

 

[turbo]

In general, do we not have better health care available in the US compared to countries that have a nationalized system?

Other industrial nations have better outcomes, lower infant mortality, and better longevity while spending less money on a per-capita basis. We have close to 60 million people with NO health insurance, not just inadequate or high-deductible coverage, so our health care spending should be lower than that of other industrialized countries. It is not.

 

[Proton Soup]

how will Al Gore power his mansion if we don't buy his carbon credits?

 

[drankin]

Other industrial nations have better outcomes, lower infant mortality, and better longevity while spending less money on a per-capita basis. We have close to 60 million people with NO health insurance, not just inadequate or high-deductible coverage, so our health care spending should be lower than that of other industrialized countries. It is not.

Like I said, we could do more to plug the holes but as far as infant mortality and longevity alone, we aren't that far off. And as far as that goes there may be other factors that skew the averages (I'm thinking our prevailent gang/drug culture may be a detriment to our numbers) that more or less puts us on par health care wise. As far as the money spent on it, well, you get what you pay for. Better care costs more.

Infant Mortality 2006 per 1000 births
US - 6.26
Canada - 5.04
UK - 4.85

Longevity
US - 77.1
Canada - 79.4
UK - 77.7

 

[mgb_phys]

how will Al Gore power his mansion if we don't buy his carbon credits?

Interns + giant hamster wheels

http://weeklyvolcano.typepad.com/spew/images/hamsterguy.jpg