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A score to bet your life on: medFICO

Have you ever been denied for a home loan because your FICO score was too low? How about being denied for medical treatment because your medical credit score was too low? Don’t laugh; it’ll be here by summer. (link)

A new credit score called medFICO is being developed by the health care industry in an effort to judge a patient's ability to pay. The new medFICO score is slated to be up and operation in 2Q08. Healthcare Analytics, a health-tech company is developing the score with the financial support of Tenet Healthcare, Fair Issac Corp (credit industry megalord) and venture capital money; they each put in $10 million for the development of the score.

Many believe that this score will be used to deny medical treatment or offer lower quality care to those with a low score.

The line from Healthcare Analytics' CEO Stephen Farber is that the score will only be used after the patient has been discharged.

Well now…that just doesn't make sense.

  • If you're taking money from VC and other companies with significant skin in the game then there's a return on that investment that all interested parties want to see. VCs aren’t charitable organizations; they want significant return. ROI needs to come from somewhere and writing off bad debt isn't going to make the VC fund yield a greater return.
  • Tenet told the Dallas Morning News it had $433 million in bad debts as of the third quarter of this year, one-fourth of it in the form of insurance deductibles patients wouldn’t or couldn’t pay. Since Tenet is putting up $10MM to help fund this system, they, like the VCs, expect return. It's a pipe-dream to think that Tenet's shareholders are going to approve $10MM investment into something to identify writing off bad-debt earlier.

  • According to a recent interview Farber said: “Hospitals lack a tool to determine who is deserving of a discount. ” (link). That means that this system is designed to produce different pricing models for different patients. It also appears that they will determine the pricing model before the patient is discharged not after.

  • In the attached article, "Mr. Mooney, of Tenet Healthcare, says the hospital business has changed over the past 30 years to take on characteristics of the retail industry. With patients expected to pay a larger share and do more comparison shopping, they soon will be able to purchase health care much like an automobile, he said." This is crap. Yes, the health care industry has changed its way of doing business and yes they are beholden to their shareholders first and their patients second, but alleging that people will shop from hospital to hospital looking for a deal is absurd. People buy their homes with the knowledge of where the local hospital is with relation to their home. People are not going to compare hospitals when their loved one is lying unconscious on the kitchen floor.
  • For me, this is just more evidence that we need a socialized health care solution, like the heath care solution that our service men and women get.

    When you put a corporation in charge of your health care decisions, people will die; it's guaranteed.

    Posted by john trevisani at January 7, 2008 11:31 AM
    Comments
    Comment #242457
    Mr. Mooney, of Tenet Healthcare, […]

    Mr “Mooney”.

    8-)

    Posted by: Philippe Houdoin at January 7, 2008 12:14 PM
    Comment #242460
    When you put a corporation in charge of your health care decisions, people will die; it’s guaranteed.

    Scare tactic aside, they will if the government is in charge as well. We can have a private healthcare industry that is regulated and monitored by government or a self-monitoring governmentally run healthcare industry that is not regulated at all, other than by politics.

    We all know that as soon as government controls healthcare 100% it will start using that to control behavior and deep certain medical procedures as not covered or even illegal. This is evidenced by every other governmental program in existence.

    This is crap. Yes, the health care industry has changed its way of doing business and yes they are beholden to their shareholders first and their patients second, but alleging that people will shop from hospital to hospital looking for a deal is absurd.

    Hospitals yes, doctors no. And having an incentive to go back after the fact and argue $100 aspirins at hospitals is a good first step IMO.

    The new HSAs that roll over and provide a person with basically a Medical 401k is a better solution that keeps liberty and choice for individuals intact.

    Posted by: Rhinehold at January 7, 2008 12:25 PM
    Comment #242465

    John
    Although I do not disagree on principle,an entirely socialized system is not politically and possibly economically practical at this point. I do thank you for suggesting it as perhaps the idea will make some opponents of universal care realize that single payer IS the compromise.
    The investment to purchase the facilities and the bereaucracy that would be needed to hire every healthcare provider is just too big a nut to swallow. Single payer would accomplish the main goals of assureing care for all and price control.Under single payer private providers would still be in competition but the would be forced to compete in terms of care quality and convenience.
    A place where the government should assume near total responibility in the healthcare system is in provider education and certification. The enormous cost for medical schooling not only saddles new doctors and nurses with an onerious debt burden but also attracts those who’s interest in the professions is based on potential financial gain as opposed to a desire to serve in that field.As you point out, a large investment calls for a large return.
    As for certification,the AMA is a private monopoly that acts to keep rates high for the financial benefit of its members.Its policy of forbidding physicians to advertize prices etc. should come to an end and their anti-trust exclusion should be eliminated.

    Posted by: Bills at January 7, 2008 12:54 PM
    Comment #242467

    Rhinehold:
    i’m not comfortable with the current ‘private’ health care system as it is. There’s far too much control in the decision making process for my health by corporate managers rather than the doctors themselves. Having medFICO in place only gives more control to those corporations and less to the doctors that treat their patients.

    Posted by: john trevisani at January 7, 2008 1:17 PM
    Comment #242468

    JimS:
    Single Payer Private may be better than our current, but i’m of the belief (and probably in the minority) that health should not be a for profit industry.

    For me, corporations are beholden to their stockholders and stockholders want profit. As with any industry, to increase profit and affect the P&L you must increase revenues and reduce cost. Both options for increased profit, with regards to health care, are problems for patients.

    Posted by: john trevisani at January 7, 2008 1:24 PM
    Comment #242469

    John
    How is the pay of healthcare providers affected by socializing the field?

    Posted by: kctim at January 7, 2008 1:35 PM
    Comment #242471

    kctim:
    Sorry; i don’t understand the question. Can you elaborate?

    Posted by: john trevisani at January 7, 2008 1:43 PM
    Comment #242473

    Sorry about that John, I’ll try again.
    Healthcare employees; doctors, nurses, hospital staff etc… make pretty good money right now. How is their pay determined when govt is paying them instead of who pays them now?

    Posted by: kctim at January 7, 2008 1:52 PM
    Comment #242474

    John-


    For me, this is just more evidence that we need a socialized health care solution, like the heath care solution that our service men and women get.

    If a tree falls over in the woods somewhere you’d be advocating for socialized healthcare. No need to bring this boogie man into the game.

    Neither the linked article nor your fine words mention the EMTALA or any other existing Medicaid/Medicare regulation preventing the “death by corporation”, or more likely, “death by non profit”, that you guarantee.

    Many believe that this score will be used to deny medical treatment or offer lower quality care to those with a low score.

    More than that believe that Elvis is still alive.

    If you want to advocate socialized medicine that’s fine; I’d actually be interested in your thoughts on how it would work and what it would look like. Probably won’t share your view, but that’s why I like to read all three columns here. But a scare piece like this gives your cause a bad name and is no different than the tactics used by Bush Administration that I’m sure you’ve railed against.

    As this thread is starting to show, debate on the subject of to socialize or to not socialize is much more interesting. How bout leading with some ideas instead of emotions.

    Posted by: George in SC at January 7, 2008 1:59 PM
    Comment #242475

    Kctim:
    i’ll buy it that Drs are paid well (by some measure); i’m not convinced the nurses and hospital staff are paid as well.

    But if i understand your point: how can a government funded system pay private wages? i can’t say.

    It used to be that going into the medical profession was a noble way of life. Dedicating yourself to healing the fellow man and all that. But now it’s about the P&L. It’s about how to increase revenue and reduce costs. IMO this sea change comes at a cost.

    Posted by: john trevisani at January 7, 2008 2:01 PM
    Comment #242479

    George in SC:

    But a scare piece like this gives your cause a bad name and is no different than the tactics used by Bush Administration that I’m sure you’ve railed against.

    If you’re comfortable with the current corporate health care industry creating and managing a credit score that will directly affect the type of care that you receive; that’s your prerogative.

    i didn’t realize that the piece would be construed as a ‘scare piece’; i viewed it as an informative piece. Were you aware of medFICO before you read the piece?

    If you want to advocate socialized medicine that’s fine; I’d actually be interested in your thoughts on how it would work and what it would look like.
    i acknowledge that the current corporate, for-profit, system is broken. i think a possible remedy is a socialized health care system (or government run, whatever you want to call it). Modeling Canada or France could be a start. Yes that would require more taxes, but i would offer that my yearly health care costs have gone up significantly in the last 10 years. With monthly contributions and co-pay, my personal percentage from my salary totals about 4-5%. i would think this were a socialized program my contribution wouldn’t be any more than that. i’m probably wrong; it’s all supposition.


    Posted by: john trevisani at January 7, 2008 2:18 PM
    Comment #242480

    John
    When you compare them to similar jobs outside the healthcare industry, many are paid pretty good.

    I understand the “noble way of life” thing, but the profession has never really been one that lacked in pay and I can’t say they don’t deserve it either.
    I would hate to see people of such quality take a different route in life because of pay.

    Anyway, was just curious about it, thanks for your answer.

    Posted by: kctim at January 7, 2008 2:32 PM
    Comment #242500
    i didn’t realize that the piece would be construed as a ‘scare piece’; i viewed it as an informative piece. Were you aware of medFICO before you read the piece?

    How exactly did you think your hyperbolic statement “When you put a corporation in charge of your health care decisions, people will die; it’s guaranteed.” would be taken, exactly?

    Posted by: Rhinehold at January 7, 2008 4:46 PM
    Comment #242502

    This MedFICO score merely serves to punish those whose health problems leave large amounts of bills they can’t pay. If it becomes a determinant of healthcare, be prepared to see every category of healthcare problem become worse.

    Given that consequence, why not be afraid? There are things worth fearing. Things like losing a generation of workers and their experience because they got sick and couldn’t pay all their bills.

    The situation we’re setting up here is making something that is already hard to afford more difficult to afford, and more difficult to impossible to access.

    This is a predatory system, and there’s no good reason for the American public to put up with it. Stuff like this will hasten, not prevent, the socializing of medicine. People already die so that insurance companies and healthcare corporations can profit more.

    People work hard all their lives in this society, and these industries reward them and their families with pain and suffering.

    Posted by: Stephen Daugherty at January 7, 2008 5:15 PM
    Comment #242503

    Rhinehold:

    How exactly did you think your hyperbolic statement “When you put a corporation in charge of your health care decisions, people will die; it’s guaranteed.” would be taken, exactly?

    In the same manner that Tom Ridge told everyone to hide behind plastic sheathing and duct tape when he put his Mr. Rogers stoplight to LEVEL ORANGE. :)

    Posted by: john trevisani at January 7, 2008 5:20 PM
    Comment #242505

    So you’re validating the tactic by adopting it yourself?

    Posted by: Rhinehold at January 7, 2008 5:59 PM
    Comment #242512

    Rhinehold says “Scare tactic aside, they will if the government is in charge as well. We can have a private healthcare industry that is regulated and monitored by government or a self-monitoring governmentally run healthcare industry that is not regulated at all, other than by politics.”

    George in SC says “But a scare piece like this gives your cause a bad name and is no different than the tactics used by Bush Administration that I’m sure you’ve railed against.”

    Exactly what is so scary? Are you guys scared because John’s article is true? or scared because the statement is true or scared the word will get out on the current system?

    Here’s what scares me about our free market system of health care.
    “Two year-old Steven Olsen had one of those routine accidents that can happen to any child. He fell on a rotted tree branch while playing in the woods. A doctor had to remove a twig that went in his mouth and punctured his cheek and sinus. But a few days later, Steven grew feverish and lethargic. Twice, his parents, Kathy and Scott Olsen brought him to the urgent care doctor. Kathy told the medical staff, “Something is very wrong with Steven.” But twice the urgent care staff told her not to worry. By then, Steven was rubbing his forehead, barely awake. On the third visit, Steven was finally admitted to the HMO-approved hospital, where Mrs. Olsen asked the medical staff, “Please do a CT scan.”

    A few years ago, under traditional, fee-for-service medicine, Steven would have gotten that scan. But Steven got his health care under the family’s “managed care” HMO plan, as do 90% of those Californians fortunate enough to have insurance. The doctors and hospitals which contract with the HMOs know that every penny they spend on patients like Steven comes out of their own pockets, subtracted from the monthly per-patient fee paid them by the tightfisted HMOs.

    So Steven’s doctors told his parents a scan was unnecessary, ignoring his mother’s concerns, and saving all of $800 the test would have cost. Three days later, the boy fell into a coma. The cause was a brain abscess. Expert physicians testified that had Steven received the scan when requested, he would be perfectly healthy today. The abscess could have been easily detected by a scan and then successfully treated.1”.

    BTW Rhinehold are you saying the VA is not subject to any rules or regulations and the only oversight is by our elected representatives, speaking of scare tatics. Are you also saying these are the only 2 choices available to us as a country? Now that is scary. Im just glad I know better than that.


    Posted by: j2t2 at January 7, 2008 10:18 PM
    Comment #242515

    Rhinehold-
    Aren’t there some things people should be scared of? The Right Wing today seems to have a habit of trying to dull people to anything and everything that could inspire them to resort to government intercession. For all their success in scaring people about big government during the last decade, it seems like fear is more and more the appropriate response. People do have reason for their anxiety.

    Posted by: Stephen Daugherty at January 7, 2008 11:31 PM
    Comment #242529

    Rhinehold, a recent study by Healthgrades found that an average of 195,000 hospital deaths in each of the years 2000, 2001 and 2002 in the U.S. were due to potentially preventable medical errors, otherwise called malpractice in the legal system.

    Seems pretty clear to me that since these errors are preventable, there is some motive causing the hospital staff to kill patients through negligence, and for the life of me, I can’t think of a single greater cause than trying to process as many patients as possible as quickly as possible in order to maximize the profit per hour for all associated with the hospital or invested in it.

    Its not an over the top comment that profit kills. It is evidenced in the research. Though I would like to see a comparative study between non-profit hospitals in the U.S. and for profits. That would be a potentially informative bit of research.

    Posted by: David R. Remer at January 8, 2008 3:32 AM
    Comment #242539

    j2t2,

    Sad story but hardly an indictment against free market philosophies since that is precisely NOT what we have now. Your example displays this, when the customers (parents) asked for a CT scan, the company (hospital) would have done it. It was the introduction of a 3rd party into the process that should not be there IMO that causes the issues.

    We have an abortion of a medical system right now, as I have always said. I want to make the system between the patient and the doctor only, using proven free-market philosphies. Others want to use proven (to not work) socialist philosophies. Still others want to use unproven statist philosphies, etc.

    That the majority of people want the hard work taken away from them enough to give up their own liberty is an indictment on them, not the people proposing the solutions…

    Posted by: Rhinehold at January 8, 2008 9:05 AM
    Comment #242541

    Rhinehold:

    Others want to use proven (to not work) socialist philosophies.

    Proven not to work?
    What is your measurement for success?
    Canada has a socialized medicine system. Their life expectancy is higher than the US and has a very low infant mortality rate.

    Posted by: john trevisani at January 8, 2008 9:38 AM
    Comment #242543

    Rhinehold I see we have agreement on the uselessness of insurance companies in this situation. If everybody made enough money in this country to have a substantial HSA then perhaps we could agree on 2 things. Unfortunately that is not the case for many people so until that time that free market approach wont be any better than the free market system we have now.
    The liberty to die early and in the street for lack of proper medical care doesnt seem to me to be on my list of liberties so I dont feel the threat of “loss of liberty” on this issue. In fact smokescreen comes to mind.

    Posted by: j2t2 at January 8, 2008 9:40 AM
    Comment #242546

    J2 and John
    Do you think our lifestyle plays any part in our shorter “life expectancy?”
    Maybe people would need less healthcare services if they saved their money for healthcare, instead of spending it on big macs?
    Maybe We the People should do our part if we believe healthcare is too expensive?
    Maybe, govt is the answer to all problems, is nothing but an excuse for those too lazy to do it themselves?

    Posted by: kctim at January 8, 2008 10:16 AM
    Comment #242548

    John-

    Canada’s system is socialized insurance; service providers are primarily on a “fee for service” basis. About 70% of health services are delivered by the private sector. That does nothing to address yours or David’s fear of death by profits.

    And I don’t think France’s system can be replicated here (or anywhere else for that matter), although it would be neat to see all of the non salaried people signing up and paying for CMU insurance as required by law. We can’t make them buy auto insurance here as it is.

    My biggest complaint about health care is that a guy that I don’t even know (my company’s HR) gets to decide which health care plan is best for my family. I’d like to make that choice. If government were involved I’d have the same complaint.

    So again what is it that you want? A complete takeover of the private health providers (unlike France and Canada)? Single payer and the elimination of private insurance (and their employees)? Or just socialism because you are in awe of our altruistic, efficient and “fair” federal government?


    Posted by: George in SC at January 8, 2008 11:08 AM
    Comment #242555

    kctim,

    Canada has a socialized medicine system. Their life expectancy is higher than the US and has a very low infant mortality rate.

    Do you think our lifestyle plays any part in our shorter “life expectancy?”

    Do you think babies “lifestyle” plays any part in their higher mortality rate!?

    Posted by: Philippe Houdoin at January 8, 2008 11:41 AM
    Comment #242557

    kctim,

    Maybe people would need less healthcare services if they saved their money for healthcare, instead of spending it on big macs?

    Au contraire!
    People should spend (and eat) more big macs!
    Beside exploding McDo benefits, tt reduce drastically healthcare cost. Deadly heart attacks and strokes are very effective way to reduce healthcare costs, as any way to reduce population as early as possible.

    Stop healing elders will to.
    Free euthanasia for everyone will to.

    What cost the most to healthcare system isn’t the elders and their long, coslty and hopeless deceases!? And you want more people to live longer knowing this!?!

    Nonsense.

    Maybe We the People should do our part if we believe healthcare is too expensive?

    To state it’s too *expensive*, one should first secure its *efficiency*, its *yield* can not be better.

    And when compared to many others countries systems, the US healthcare system does NOT have a good one. It cost MORE, but produce LESS output.

    We can debate the reasons of such a low efficiency, but to state as factual it’s too “expensive” is quite a shortcut…

    George in SC,

    I don’t think France’s system can be replicated here (or anywhere else for that matter)

    May I ask you why?
    What happened to the can-do Americans!?

    Posted by: Philippe Houdoin at January 8, 2008 12:00 PM
    Comment #242558

    PH
    You don’t have an immediate heart attack and die from eating junk food. It is proceeded by any number of illnesses which require healthcare that would otherwise be needed.

    Our country is different than other countries, so comparing them to each other is pointless unless one is willing to toss away the ideas this country was founded on and become a different country. I am not willing to do that.

    “We can debate the reasons of such a low efficiency, but to state as factual it’s too “expensive” is quite a shortcut…”

    YOu lost me on this one my friend. I said IF people believe healthcare is too expensive, then they should live a healthier life and save for illness. I didn’t claim it was efficient or expensive or anything else.

    Posted by: kctim at January 8, 2008 12:19 PM
    Comment #242559

    John,

    Rhinehold:
    Others want to use proven (to not work) socialist philosophies.

    Proven not to work?

    No, Rhinehold is right: France system for instance is proven not to work since 1945.

    ;-)

    PS: today, 75% of France healthcare system cost deficit are due to longtime deceases costs. It’s directly connected to our demography. Considering current french fertility rate, this trend should reverse earlier than feared at first, around 2020. Even babyboomers will die eventually. Using their demographic burden today as a rationale to destroy a system which works quite efficiency otherwise is pure ideology. A dishonest one.

    Posted by: Philippe Houdoin at January 8, 2008 12:21 PM
    Comment #242561

    kctim,

    You don’t have an immediate heart attack and die from eating junk food.

    That because you don’t eat enough of it yet.
    ;-)

    Our country is different than other countries, so comparing them to each other is pointless unless one is willing to toss away the ideas this country was founded on and become a different country. I am not willing to do that.

    Hum? Since when observing difference(s) transform things!? Except for Quantic Theory, it doesn’t that much. Plus ANY country is different than others countries. And? Comparing involves different objects, otherwise it’s pointless. What’s interesting (or should) is seeing differences, precisely.
    You don’t want to do such comparison, okay, but your rationale to not doing it - fear to become a different country - seems irrational.

    I didn’t claim it was efficient or expensive or anything else.

    Sorry if I didn’t make me clear enough.
    My point is healthcare is always expensive. It’s not free as in beer, and probably will never be.

    What should matter more is its efficiency.
    Spending on health without any result is pure waste. Spending nothing on health will produce the same, but far more cheap. The question is less how much we spent on health but more how *well* we do it.

    In private sector lingua, that’s called ROI.

    Posted by: Philippe Houdoin at January 8, 2008 12:51 PM
    Comment #242564

    True Philippe, spending without results is wasteful, but what contributes to those negative results is very important.
    Americans could spend less on health IF they led healthy lives.
    Americans could spend less on health IF they didn’t abuse it.
    Americans could spend less on health IF they didn’t rely on others to pay for it.

    For us, how “well” we do it, isn’t about govt taking our money and doing it for us, it is about us accepting the responsibility and doing it for ourselves.

    I am still studying this “medFICO” thing, but if a giving a number will help trim costs, I’m open to listening.

    Posted by: kctim at January 8, 2008 1:18 PM
    Comment #242565

    kctim,”Maybe people would need less healthcare services if they saved their money for healthcare, instead of spending it on big macs?”
    Of course but there are lots of people who dont eat big macs on any regular basis and still cannot save for well a house, car, retirement, education, oh yeah and healthcare. But screw those just starting out eh kc we got ours afterall. At least we have the liberty to die in the streets or be forever in debt (providing our medFICO scores are good enough)should a medical emergency arise or we find ourselves in an accident.
    I do pretty good for myself and I still find it hard to save much in this day and age and I dont lead a very fancy lifestyle.

    Posted by: j2t2 at January 8, 2008 1:25 PM
    Comment #242567

    Bon soir Philippe-

    I do not want to misrepresent your health care system or your society;

    But it would take a Lois XVI moment to change the U.S. enough that it could adopt concepts like the Code du Travail and collective agreements/contracts for all salarie like in France.

    Just curious, how much does CMU cost a person making, say 20k euro/year?


    Georges

    Posted by: George in SC at January 8, 2008 2:07 PM
    Comment #242569

    Yes J2, the absolute extreme is the only possible end if we honor each others beliefs and let them live their own lives, isn’t it.
    And yes, we should just ignore those who waste and abuse so that we do not miss those who are struggling.
    And yes, everybody “starting out” deserves to have AC, a newer car, a DVD player, TV, PC, internet don’t they. Shoot, I’m surprised I made it all those years without that stuff.
    And yes, it is not right for me to tell you that you cannot help others in MY way, but it is right to force me to help others in YOUR way.

    Its funny how you guys think EVERYTHING not in line with your personal agenda is the end of the world.

    Posted by: kctim at January 8, 2008 2:35 PM
    Comment #242571

    Kctim, George, et al:
    Take a look at the table here: http://en.wikipedia.org/wiki/Health_care_in_Canada#Canadian_health_care_in_comparison


    The socialist version seems to be working a little better than putting corporations in charge of your health care.

    Posted by: john trevisani at January 8, 2008 2:44 PM
    Comment #242572

    John-

    From the same page:

    The Canadian system is for the most part publicly funded, yet most of the services are provided by private enterprises. Most doctors do not receive an annual salary, but receive a fee per visit or service.[1] According to Dr. Albert Schumacher, former president of the Canadian Medical Association, an estimated 75 percent of Canadian health care services are delivered privately, but funded publicly.

    “Frontline practitioners whether they’re GPs or specialists by and large are not salaried. They’re small hardware stores. Same thing with labs and radiology clinics …The situation we are seeing now are more services around not being funded publicly but people having to pay for them, or their insurance companies. We have sort of a passive privatization.”[1]


    Again, how does this system address your concern of for-profit hospitals killing non-payers? I’m not sure what you want here…

    Posted by: George in SC at January 8, 2008 2:51 PM
    Comment #242573

    George,
    The wiki has plenty of info. For example, directly above the your first paragraph is:
    About 30% of Canadians’ health care is paid for through the private sector.
    Meaning that 70% are covered by the government plan. And of the 30% they are covered for services not covered in the government plan. And the 30% of people using the private insurance services, it’s paid for by employers.

    Is the Canadian plan generating profit for the pharma companies, HMOs, etc…?

    Posted by: john trevisani at January 8, 2008 3:10 PM
    Comment #242574

    Interesting table there John.
    Tell me, how do socialists like being able to sit down, study the information and then make a choice as to what is the best option for their own personal life? Must be a heavy burden to be able to freely choose option 1 or option 1.

    Comparing those with that right, to those without that right, is ridiculous.
    And giving up that right is even more ridiculous.

    Posted by: kctim at January 8, 2008 3:38 PM
    Comment #242575

    kctim:
    The table illustrates the measurable differences between health care systems. Canada, France, etc.. happen to have a socialized systems. The US has a free market system. In the table are measurable elements relating to a health care system. How much it cost, how many people die, etc… That’s what the table states.

    What you seem to be referring to is equal to monitoring the lifestyle choices of people. You seem to be saying that a particular lifestyle is the desired lifestyle and that everyone should live in a certain manner. Are you advocating a totalitarian rule?

    Posted by: john trevisani at January 8, 2008 4:06 PM
    Comment #242579

    I know what the table is saying John, but it is comparing two different types of govt with each other and if one wishes to remain the US, it means nothing.

    “You seem to be saying that a particular lifestyle is the desired lifestyle and that everyone should live in a certain manner”

    You are kidding, right?
    I am not the one saying you must contribute to and use a govt program instead of being able to choose for yourself.
    I am not the one saying you must believe as I do and that you must care as I do.
    The freedom to think, believe and live your life as you see fit, is not totalitarian rule, is it?
    Seems to me that govt forcing people to live in a certain manner so that others may have “free” healthcare, is closer to totalitarian rule than what I believe in.

    Posted by: kctim at January 8, 2008 4:42 PM
    Comment #242581

    kctim:

    Americans could spend less on health IF they led healthy lives.
    Americans could spend less on health IF they didn’t abuse it.

    Sure sounds like you’re saying people should lead healthy (or whatever you determine to be healthy) lifestyle. And once everyone leads a lifestyle to your liking, then they wouldn’t use healthcare as much.

    Posted by: john trevisani at January 8, 2008 4:57 PM
    Comment #242585

    No John, I personally don’t care how somebody lives their own life. IF they really are concerned with the price of healthcare, then it would be in their interest to stay healthy, would it not?
    If I care about getting acne, do I keep drinking tons of soda? Nope. Doesn’t mean I want to force others to stop though, does it.

    You’re fishing John. Assuming I am saying the same thing as you but in a different way, and that is not the case. Not even remotely.

    Posted by: kctim at January 8, 2008 5:21 PM
    Comment #242590

    “France is tops, and the United States dead last, in providing timely and effective healthcare to its citizens, according to a survey Tuesday of preventable deaths in 19 industrialized countries.”

    “Had the United States performed as well as any of the top three industrialized countries, there would have been 101,000 fewer deaths per year, the researchers said.”

    http://tinyurl.com/29txj8

    Ah yes, we are the worlds only superpower :^(

    Posted by: KansasDem at January 8, 2008 6:35 PM
    Comment #242592

    I think I see a reason for your mistakes, John… You say:

    The table illustrates the measurable differences between health care systems. Canada, France, etc.. happen to have a socialized systems. The US has a free market system. In the table are measurable elements relating to a health care system. How much it cost, how many people die, etc… That’s what the table states.

    Canada and France, etc.. to not have socialized medicine. The United States does not have a free market system. To use these terms as you do makes it hard to have a decent debate with you because you misuse them too much.

    Remember, Canada recently had to allow for private healthcare, France and England already have them… In all of these cases, the richer get better service.

    The problem in the US is not the free market system since there hasn’t been one in use in the healthcare industry for decades. Instead we have monopolistic forces and 3rd party decision makers, much as we would have if government is introduced, that almost guarantees that we will not be paying the most efficient amount for healthcare services.

    And when a state like Mass. is not forcing (IMO unconstitutionally) everyone to purchase health insurance, further moving people away from the free markets, it will only get worse. :/

    Posted by: Rhinehold at January 8, 2008 6:46 PM
    Comment #242593
    No, Rhinehold is right: France system for instance is proven not to work since 1945.

    Erm, France’s system is socialist now? I have been told repeatedly by people, like you, that it is not… Oh well.

    Posted by: Rhinehold at January 8, 2008 6:49 PM
    Comment #242597
    Rhinehold I see we have agreement on the uselessness of insurance companies in this situation.

    Which is why so many Democrats are all for mandating everyone purchase this insurance. Never understimate a Democrat to drive a bad idea until it goes over the cliff…

    If everybody made enough money in this country to have a substantial HSA then perhaps we could agree on 2 things.

    Wouldn’t it make more sense then, instead of throwing the idea out with the bathwater, that we agree to fund the HSAs for anyone who has a poverty level income? The same effect would have occured AND we would be able to keep our choice and liberty intact as well AND put the actual purchaser back in control of what gets paid for services so that the market forces will bring the costs down to even better levels than any other system.

    And, the fun part, if they do choose to live healthy lifestyles they could continue to build and earn interest on those funds, rolling them over, and perhaps build some wealth or the very least prepare for possible unforseen medical issues in the future. Self resepect and self esteem go up, they have an incentive for being healthy (which they do not have now NOR would they have in any of the programs offered up by our CARING Democratic hopefuls)

    Or does that just not fit in with your true goals?

    Unfortunately that is not the case for many people so until that time that free market approach wont be any better than the free market system we have now.

    For probably the third time in just this thread, we do *NOT* have a free market healthcare system. I suspect you know that but simply don’t care…

    The liberty to die early and in the street for lack of proper medical care doesnt seem to me to be on my list of liberties so I dont feel the threat of “loss of liberty” on this issue. In fact smokescreen comes to mind.

    Well, 3 things in response to this *****-filled sophmoric rhetoric…

    1) You would have to know what the term liberty means, your comments suggest you don’t. A look at dictionary.com:

    1. freedom from arbitrary or despotic government or control.
    2. freedom from external or foreign rule; independence.
    3. freedom from control, interference, obligation, restriction, hampering conditions, etc.; power or right of doing, thinking, speaking, etc., according to choice.

    2) The idea of the United States was that everyone enjoyed their liberties, not that you were free to give up other’s because you don’t want yours. Protection of the minorities, etc.

    Why are you upset with Bush’s Patriot Laws then, after all, those who support them don’t see what the big deal is and say ‘you have the liberty to be killed by a terrorist’, etc. I doubt you’ll see the irony though…

    It is thinking like yours that allowed segregation and Jim Crow laws…

    3) The only smokescreen is your inability to carry on an intelligent conversation about this subject because you refuse to accept that someone else might disagree with you with valid concerns. I’ve listed previously many valid liberty concerns, including right to freely associate, freedom of choice, privacy concerns, private property rights, etc, but since you refuse to read anything but what you yourself write, it seems futile to even continue debating the topic with you.

    Posted by: Rhinehold at January 8, 2008 7:07 PM
    Comment #242613

    Rhinehold “Wouldn’t it make more sense then, instead of throwing the idea out with the bathwater, that we agree to fund the HSAs for anyone who has a poverty level income? The same effect would have occured AND we would be able to keep our choice and liberty intact as well AND put the actual purchaser back in control of what gets paid for services so that the market forces will bring the costs down to even better levels than any other system.”

    It might make sense Rhinehold, why dont you elaborate on this plan to supplement HSAs? How does the monopoly currently in place go away by this method? If you think that market forces are suddendly going to come into play and people will be able to choose then please elaborate. I just dont see it.

    “And, the fun part, if they do choose to live healthy lifestyles they could continue to build and earn interest on those funds, rolling them over, and perhaps build some wealth or the very least prepare for possible unforseen medical issues in the future. Self resepect and self esteem go up, they have an incentive for being healthy (which they do not have now NOR would they have in any of the programs offered up by our CARING Democratic hopefuls)”

    Or does that just not fit in with your true goals?

    Rhinehold Im not against people living healthy lifestyles in fact I encourage it. I believe living a healthy lifestyle is its own reward. Incentives may work to some degree with certain people but even presidents dont always eat their broccoli. And if you have ever tried to talk a smoker into quitting when they werent ready then you know how effective incentives arent. Now how about those that wreck their bicycle when they are 20 and cannnot function in society due to injuries. How do HSAs help in those type of cases?
    Rhinehold my true goal in this particular thread is for this Country to have a health care system that works for all people in our society not just the few. I can seperate my political ideologies from the issue because I really dont have an ax to grind.


    “For probably the third time in just this thread, we do *NOT* have a free market healthcare system. I suspect you know that but simply don’t care…”

    Wrong Rhinehold I do care. What we have is what passes for free market healthcare today. We have corporations ruining the health care system for the gain of the few. You can call it what you want but more important how do HSAs address this issue. Certaingly not by “put the actual purchaser back in control of what gets paid for services so that the market forces will bring the costs down to even better levels than any other system.” as you suggest. Why because even today the insurance companies do this and the doctors are forced to respond by cutting services, IMHO.

    “Well, 3 things in response to this *****-filled sophmoric rhetoric…”
    suffice it to say that I disagree with your liberty speel and insults but lets save that for another thread as its off the subject a bit for this one.

    Rhinehold “but since you refuse to read anything but what you yourself write, it seems futile to even continue debating the topic with you.” Hey man I actually read your stuff and honestly I learn alot, I also disagree with some of it, but it does help me to understand your position and mine as well. So keep trying.


    Posted by: j2t2 at January 9, 2008 12:51 AM
    Comment #242624

    Rhinehold,

    Canada and France, etc.. to not have socialized medicine.

    Socialized funded Healthcare system doesn’t means every health providers are to be socialized too.

    In France, we have a socialized funded two-parties healthcare system, where both public *and* private providers cooperate under the regulation of a social body (not the governement itself).
    Every adult workers, non-workers and retirees are contributing a fee relative to their income.

    Funding is socialized, services are not.

    You keep confusing socialized funding with a full socialized medicine, where all is public.

    No, Rhinehold is right: France system for instance is proven not to work since 1945.

    Erm, France’s system is socialist now? I have been told repeatedly by people, like you, that it is not… Oh well.

    And now you’re confusing socialized healthcare system with socialist system! Whoa.
    Since 1945, France policymakers were more often conservators than socialists. And it was De Gaulle government, not known for being one bit of a socialist - sorry, who created this healthcare system.

    As I said above, our system is socialized funded. Doesn’t make it socialist (eh?) or our medicine socialized either.

    Oh well. At least you’re not trying to claim it’s proven to “not work” since so long, that’s a given…

    Posted by: Philippe Houdoin at January 9, 2008 5:36 AM
    Comment #242625

    kctim,

    I am not the one saying you must contribute to and use a govt program instead of being able to choose for yourself.

    “And” ?
    Nobody ever say one *must use* it. Which will be very hard to enforce, although.

    The issue is (and always was) about enforcing contribution on everyone, on only some, only few or none and on which income source.
    Like so often these days, the issue is about contributing or not some of your income back to the country which allow (education, infrastructure, security, health) you to earn more.
    Aka are people enough self-sustainable capable on everything or not, so they don’t have to contribute anything to their society or not.

    That supposed the concept of Society in this era of individualism have still its place.
    Maybe not.

    Posted by: Philippe Houdoin at January 9, 2008 6:29 AM
    Comment #242626

    George in SC,

    But it would take a Lois XVI moment to change the U.S. enough that it could adopt concepts like the Code du Travail and collective agreements/contracts for all salarie like in France.

    It doesn’t for France either.
    Our current healthcare system was designed right after WW2. France was neither the first neither the only country to have one similar, and AFAIK not so much had to cut off their leader head in order to install it.
    Many have still a King or a Queen, even.

    ;-)

    Just curious, how much does CMU cost a person making, say 20k euro/year?

    Hard to tell, as CMU, the universal component to our healthcare system, is only 7-8 years old. AFAIK, it cost around 6 billions in 2006, to compare with the total healthcare cost this same year: 140 billions.

    As France spent less on his healthcare system than US while socialized funds pay for 75% of its cost, I guess adding universal coverage cost only a marginal amount while providing around 1 to 3 millions (5% of population) of french healthcare who used to have none.

    Posted by: Philippe Houdoin at January 9, 2008 7:27 AM
    Comment #242627
    Our current healthcare system was designed right after WW2.

    But, wasn’t universal until around 2000.

    Posted by: Rhinehold at January 9, 2008 7:45 AM
    Comment #242632
    Our current healthcare system was designed right after WW2.

    But, wasn’t universal until around 2000.

    And? Going universal in 2000 didn’t need to cut off our leader head or whatever societal revolution either.

    I guess I miss your point here. AFAIK, US healthcare system is not universal too, so what?

    Posted by: Philippe Houdoin at January 9, 2008 10:25 AM
    Comment #242643
    It might make sense Rhinehold, why dont you elaborate on this plan to supplement HSAs? How does the monopoly currently in place go away by this method? If you think that market forces are suddendly going to come into play and people will be able to choose then please elaborate. I just dont see it.

    The current HSAs allow for people to put tax free money into ‘401k’ type of plan that rolls over each year and earn interest. Instead of pooling money from everyone and then redistributing it, why not accept that most people can get by putting into their own, at their descresion, and take much less in tax money from the working class to help fund those that can’t afford to put funds into their own plans. The funds can then pay for normal medical coverage outright and the premiums for catastrophic healthcare which is not very much at all.

    Once this occurs, we can tell the likes of Aetna, WPS, Blue Cross Blue Shield and all other HMOs to go screw themselves and when we go to the doctor we actually pay for the services ourselves. We actually look at the bill and see what he is charging instead of just paying a small copay. Do you know how much your doctor charges for an office visit? I’ve looked, it’s beyond stupid.

    THEN, if we don’t like how we are treated by our doctors, we find one that doesn’t charge as much for an office visit (or more, depending upon what we are willing to pay and why, utilizing choice) and bring market forces to bear in the system. The healthcare system right now is buffered from any and all market forces at the present, they just have to negotiate with the insurance companies on how much they can get from you since you can’t/won’t go anywhere else. You will no longer be tied to the insurance company that your company offers for you, in fact they would not have to offer insurance at all, increasing how much they can pay you directly which can go into your HSA… Nifty huh?

    Rhinehold Im not against people living healthy lifestyles in fact I encourage it.

    I am too, which is why I support putting the choices into the hands of the people, not the government or corporations. This will incent them to live healthier lifestyles because they don’t want to pay for that lung transplant or quadruple bypass. We can use the government to provide oversight and ensure that no one is attempting to defaud anyone, which is what they are best at. Oversight of themselves is what they are worst at…

    I believe living a healthy lifestyle is its own reward.

    Yes, for many people it is. For some it is not. How many people smoke today, even start smoking, knowing what we know about it’s long term effects?

    Incentives may work to some degree with certain people but even presidents dont always eat their broccoli.

    Yup, but those that it does work on, which is the majority IMO, because how much you have at the end of the month in your bank account is proven to be, by far, the best motivator of all.

    And if you have ever tried to talk a smoker into quitting when they werent ready then you know how effective incentives arent.

    Taxing cigarettes excessively brings down smoking rates, we know. While technically not an incentive but a ‘decentive’, we do know that it can work when planned out right.

    Now how about those that wreck their bicycle when they are 20 and cannnot function in society due to injuries. How do HSAs help in those type of cases?

    They help pay for the premiums for catastrophic healthcare, the insurances companies that will be involved in that will still make a profit, but it will not be nearly as nefarious as it is now with them making all of the decisions on what you can and can’t do. It’s a different industry altogether that operates strictly on a pay me now to avoid paying later/gambling that it won’t happen to you mentality. They do not have the power to tell your doctor that ‘they won’t pay for procedure a, b or c’ when you and your doctor have agreed that those are your best options.

    Rhinehold my true goal in this particular thread is for this Country to have a health care system that works for all people in our society not just the few. I can seperate my political ideologies from the issue because I really dont have an ax to grind.

    Good, because nothing that the Democrats (or Republicans from what I’ve heard) will work for all people. They will provide mediocre coverage for all people, the rich will still go outside of the system to get better coverage, just like in Canada, England and France, and we will continue to encourage unhealthy living, denial of services based off of politics as well as finances, and eventually, in a few decades, have to make the decision to abandon the system or continue to bankrupt the country to continue paying for it as we do now with SS/Welfare and Imperalism around the world…

    What we have is what passes for free market healthcare today. We have corporations ruining the health care system for the gain of the few. You can call it what you want but more important how do HSAs address this issue.

    It is not a free market, by definition. A free market means that an individual (the customer) bargains a price with the provider of services/product (the doctor/hospital) for a price that is low enough that the individual agrees to it and high enough that the doctor agrees to it. The individual will not pay more than he feels it is worth and the doctor will not accept less than he feels that it is worth.

    Unfortunately, we now place two other entities into this equation when we deal with healthcare. The government and the insurance companies. Between them they control all aspects of setting prices, between requiring high malpractice insurance fees and paperwork that takes nearly 30% of each dollor in medical care spent to denying procedures that are necessary and worked out between the doctor and patient because they have a monopoly on the transaction. Removing both of these entities with the HSAs will allow the price to be determined by the market value of the transaction, not the arbitrary inflated cost that monopolistic forces introduce into the system…

    Certaingly not by “put the actual purchaser back in control of what gets paid for services so that the market forces will bring the costs down to even better levels than any other system.” as you suggest. Why because even today the insurance companies do this and the doctors are forced to respond by cutting services, IMHO.

    The insurance company is not the purchaser. They do not negotiate a price with the doctor that the client is willing to pay, they negotiate one that THEY are willing to pay. This results in services being cut, because the client has no where else to go. And the prices that the doctors requires for their fees now is inflated by the same process, knowing that they are free to raise their rates in the monopolistic system as well as pay for unnecessary paperwork and malpractice insurance brought on by governmental influence into the system as well.

    In fact, I have seen people who do have enough money decide that they won’t use insurance at the doctor and just pay cash. Their bill usually gets cut by 2/3 because the Doctor knows that they don’t have to go through the billing process with the insurance companies. They have to inflate those prices to pay for the services that they provide and the insurance companies don’t pay for, yet they are still on the hook to take on because of the way our system works.

    My best suggest, if you want to know the why doctors charge so much, is to find out how much your doctor charges the insurance company for an office visit and schedule some time with your family doctor and ask him why it is so much? Have him break it down for you. It’s an interesting discussion indeed…

    Posted by: Rhinehold at January 9, 2008 12:44 PM
    Comment #242645
    Socialized funded Healthcare system doesn’t means every health providers are to be socialized too.

    No, that pretty much does mean that. You are trying to twist the meanings of the words, possibly not familiar with the nuances of them, but some government funding of healthcare is not ‘socialized healthcare’. Heck, in the US we have some government funding of healthcare as well, but I don’t think anyone would call it a socialized system.

    In France, we have a socialized funded two-parties healthcare system, where both public *and* private providers cooperate under the regulation of a social body (not the governement itself).

    Yup, I’m familiar with the system. Were it not going bankrupt I would choose it most definately over England and Canada’s system. I wouldn’t choose it over a true free-market system with a governmental safetynet though…

    Every adult workers, non-workers and retirees are contributing a fee relative to their income.

    Funding is socialized, services are not.

    You keep confusing socialized funding with a full socialized medicine, where all is public.

    No, I’m pretty clear on all of that. You are the one that took my statement that said ‘socialized systems’ and applied it to France. I certainly didn’t mean for it to be, or I would have said ‘like France’.

    And now you’re confusing socialized healthcare system with socialist system! Whoa.

    Nope, that would be you projecting again.

    Since 1945, France policymakers were more often conservators than socialists. And it was De Gaulle government, not known for being one bit of a socialist - sorry, who created this healthcare system.

    I understand that. Which is why I never claimed, once, that France had a socialist healthcare system or even a socialized one… Again, that was you.

    As I said above, our system is socialized funded. Doesn’t make it socialist (eh?) or our medicine socialized either.

    Oh well. At least you’re not trying to claim it’s proven to “not work” since so long, that’s a given…

    Publicly funded is the term I think you are wanting to use… It is not ‘socialized funded’ but it is publicly funded. There is a huge difference there…

    And again, I never said that the France system was a socialist system, the kind of system that won’t work. France’s system works (for now) for France.

    Of course, France likes to play with the term ‘liberty’. Things are different in the US. OR they were… perhaps it is me who has too much faith in my fellow citizens…

    Posted by: Rhinehold at January 9, 2008 12:53 PM
    Comment #242647
    And? Going universal in 2000 didn’t need to cut off our leader head or whatever societal revolution either.

    Nope, but it did require small steps to get there, not an overnight overhaul of the system. For the US to be where France is now, society wise, would require a lot more smaller changes (ones that are in place in the Democratic Party leadership) before we can fully abandon our notion of liberty as presented to us by B. Franklin, T. Jefferson, J. Adams and G. Washington.

    The Dems are trying to get us there, it just takes time if you don’t want to have an armed revolt.

    I guess I miss your point here. AFAIK, US healthcare system is not universal too, so what?

    I was just pointing it out. Your country itself had to get there slowly, it did not embrace the ‘universal healthcare as a right’ progressive perversion of what rights are until just recently, certainly not in 1945…

    Posted by: Rhinehold at January 9, 2008 12:58 PM
    Comment #242658

    Rhinehold,

    You are trying to twist the meanings of the words, possibly not familiar with the nuances of them

    I wont deny that, as it’s clearly the case.

    What I found confusing is the term socialized system is both used for state healthcare system (like the soviet one for instance) and the more flexible multi-tiers systems existing in many nations today.

    Yup, I’m familiar with the system. Were it not going bankrupt I would choose it most definately over England and Canada’s system.

    As I’ve several time said, it’s going bankrupt because the right wing in power since a decade in France *steal* from its budget (when it had a positive net, but also now!) and don’t pass back all what is collected to fund it.

    They wants it to bankrupt, fast if possible, for ideological motives.

    I wouldn’t choose it over a true free-market system with a governmental safetynet though…

    Where such beast could be observed these days?

    Publicly funded is the term I think you are wanting to use… It is not ‘socialized funded’ but it is publicly funded. There is a huge difference there…

    Okay, I fail to grasp it then. Thanks for pointing it, I’ll check the difference.

    Your country itself had to get there slowly, it did not embrace the ‘universal healthcare as a right’ progressive perversion of what rights are until just recently, certainly not in 1945…

    It did. Since 1945.
    But, before the CMU law, people had to prove they were contributing to healthcare system to benefit it, which restrains (we even can say refrain, I guess) many people to access it in time, when they needs it.

    The CMU reverse the proof burden, considering that healthcare system should now prove people can’t benefit from it, as far less people don’t than people do.

    The fact this law was named CMU doesn’t means the universal concept was not there long before, but just that it was badly allowed.

    Posted by: Philippe Houdoin at January 9, 2008 1:55 PM
    Comment #242711

    Rhinehold:
    What is your opinion on medFICO?

    Posted by: john trevisani at January 10, 2008 8:06 AM
    Comment #242719

    I think it’s a joke, but there is at least an attempt to find a way to identify those who choose to live unhealthy lifestyles and charge them more for healthcare.

    I would prefer the removal of the blocks between patient and doctor that are in place now, then medFICO would never have been thought of, and I don’t want it to be implemented, but as long as we continue to flail about in this area we are going to see ‘solutions’ like this come about.

    Posted by: Rhinehold at January 10, 2008 10:48 AM
    Comment #243468

    I like the medfico score. Quality health care is a luxury and needs to be treated as such. I think the medfico score is a great way for health care providers to determine if a patient is worth treating or not. It is a great tool in risk management and the sooner it is implemented, the better off everyone will be.

    Posted by: Jim at January 21, 2008 7:36 PM
    Comment #244815

    Under the Fair Credit Reporting Act (FCRA), medFICO will make Healthcare Analytics a “consumer reporting agency” (CRA) and make any doctor or hospital [that reports to this new CRA] a “furnisher of data.”

    As newcomers to the credit industry, I suspect they aren’t going to realize right away that they now have to comply with the FCRA. If that happens, I expect a long line at Federal District courthouses.

    Some who are knowledgeable about credit could end up profiting from medFICO failings.

    I don’t expect Congress to do anything so the courts and consumer lawyers will likely be the consumer’s only allies.

    Posted by: Noah_Bodie at February 7, 2008 4:05 PM
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