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Yesterday I got a call from a friend who retired as a corporate tax lawyer for a highly regarded law firm.  He said, "Al, I was watching television and what did I see, exactly what you wrote me about a few days ago was being reported as a new discovery"

It's being called a loophole, first described as such by the AP story that gets picked up everywhere, and then repeated as such in every report that I could find by googling.  Except it's not and never was a loophole at all, but something more revealing of the essential quality of this health care reform effort.

This was my email to B. sent last Tuesday:

On Health Care Reform....your old specialty

One of the hot button emotional justifications for this bill is that people with insurance will not have them cut off for when they need it the most.  Rescission are excessive, yet they can be controlled by state laws that put the burden of proving fraud on the insurer.  The current proposals does not federalize this, merely states that cancellation can only be for fraud.

Actually that's the case now.  And various state Departments of Insurance, those that have not been the victim of "regulatory capture" do defend those clients abused by this practice.

The following is why I'm contacting you.  From the Senate bill:

‘‘(a) IN GENERAL.—A group health plan and a health
insurance issuer offering group or individual health
insurance coverage may not establish—
‘‘(1) lifetime limits on the dollar value of bene7
fits for any participant or beneficiary; or

‘‘(2) unreasonable annual limits (within the
meaning of section 223 of the Internal Revenue
Code of 1986) on the dollar value of benefits for any
participant or beneficiary.

If someone has a catastrophic illness or accident, what would be a "reasonable" annual limit.  If it didn't cover all treatment, it's not reasonable to the patient.

I tried to research the specific code that they referenced with no luck.  How about some help by finding out how this IRS code defines reasonable limits on annual insurance that the bill makes reference to.  

Al

The "loophole" is not exactly hidden, being right toward the front, page 16 of the bill available here.  The clause was an embarrassment, a contraindication of the principles laid down by President Obama for minimal requirements for this legislation, but a loophole is something different from Websters": an ambiguity or omission in the text through which the intent of a statute, contract, or obligation may be evaded"

What is also disturbing is how CNN described this as something that would be fixed, like a typo, ignoring the fact that if the individual insured is not going to pay, then the public in the form of taxes or increased premiums will pay.  And the commentator also described that "loophole" as saying that the definition of reasonable limits would be left to federal regulators.

No program actually described the other defect of this clause, that it made reference to a specific IRS section, 223 of 1986, that my friend could find no reference that remotely related to defining limits on annual health insurance payments.

The limit on annual insurance payment has been in this bill for the three weeks that it has been published, on the web, examined by the staffs of congress members, evaluated by thousands of paid journalists, and millions of amateurs, like myself.  Yet, this was not noticed.

While this was clear for anyone to see, there are hundreds of clauses, all referencing other sections of existing federal and state law. Those are actually complex, and real loopholes are to be expected as they will be designed into the bill by those who will benefit from the real law, as opposed to the rhetoric meant for the uninformed.

Harpers Magazine wrote, and I expanded on, how this bill is the essence of a perverse well documented phenomenon, regulatory capture, where in the guise of government controlling a corporate sector, the reverse happens, and the government and the sector becoming allies against the people.

I'm convinced we are seeing this occur right before our eyes  

-------Addendum ----------

I do read the actual bill, at least some of it.  I also read the reports by the Chief Actuary of the Medicare division of HHS on the house bill.  But, in spite of my reaching his secretary at 8 last night, she could not put the current report on the effects of the Medicare buy-in on their web site.

This leaves us the dark, since it is not available anywhere on the Wide World Web; so must take second hand reports, that as in this "loophole" are often less than accurate.

While I have posted many diaries here, and on my personal web site, Health Care Beyond Partisanship, all opposed to this legislation, I try to read material that supports it.  This articlein the Current New Yorker is worth reading, but not convincing to me for reasons to be found in this essay.

For more detailed essays, including a comparison of the CBO and the CMS Actuary's office biases, give my personal site linked above a try

Originally posted to ARODB on Sat Dec 12, 2009 at 10:35 AM PST.

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Comment Preferences

    •  Actually (0+ / 0-)

      This is not a loophole, and it is not necessarily unfavorable.  The reference to Code Section 223 is to the section  that allows high deductible health plans.  Annual limits, and what constitutes an unreasonable annual limit, are discussed in IRS Notice 2004-50.

      "Well, I'm sure I'd feel much worse if I weren't under such heavy sedation..."--David St. Hubbins

      by Old Left Good Left on Sat Dec 12, 2009 at 01:24:04 PM PST

      [ Parent ]

      •  If the insurance is through job, all bets are off (1+ / 0-)
        Recommended by:
        arodb

        anyway.  ERISA section 514 lets insurance companies off the hook for any consequences of omission of benefits. HCR goes even further to make sure insurance companies cannot be held liable for negligence.

        See Richard Johnston's diaries on the subject.

        Torture: An act... specifically intended to inflict severe physical or mental pain or suffering upon another person within his custody or physical control.

        by MsGrin on Sat Dec 12, 2009 at 08:22:20 PM PST

        [ Parent ]

  •  die quickly (3+ / 0-)
    Recommended by:
    DWG, puffmeister, MsGrin

    its the fair thing to do if you get sick.
    /snark

  •  Forgot to hit post on my first comment... (6+ / 0-)

    So this is it.

    I do read the bill, some of it.  I also read the reports by the Chief Actuary of the Medicare division of HHS.  But, in spite of my reaching his secretary at 8 last night, the current report on the effects of the buy-in are not on their web site, or anywhere else.

    So we are in the dark and must take second hand reports, that as in this issue are often less than accurate.

    For more detailed essays, give my personal site a shot:
    Health Care Beyond Partisanship

  •  Aaarrgghhm had no idea. Illuminating if (1+ / 0-)
    Recommended by:
    Zotz

    disturbing...

    ps the IRS tax code does have something known as the 7 percent floor - below which the IRS says one is on one's own, and above which certain costs are tax deductible [if memory serves].

    I am wondering if there may be a relationship here between that portion of the tax code and the language in this Bill. That may simply be the place where a certain important term - such as "reasonable" is defined.

    Since the Congressional Research Service [hardworking lawyers in windowless room paid very very little] is in charge of these provisions, there msy be a connection that is reasonable after all - even if the allowance of 'caps' is inherently unfair.

    Perhaps your friend  can parse this out as a definition of "reasonable annual limits"

    without reference to health care

    We will restore science to its rightful place....We will harness the sun and the winds and the soil .... All this we can do. And all this we will do.

    by puffmeister on Sat Dec 12, 2009 at 10:48:42 AM PST

    •  It shouldn't take a lawyer to... (8+ / 0-)

      engage in this degree of research to determine a provision that will affect almost every person in the United States on a life and death level.

      If there is a definition in the code referred to, even if ambiguous, this law could have made it clear, or at least provided the subsection.

      The first reaction by Democratic leaders is that the writers were not responsible for the "loophole" meant as merely a typo.  Then they ignored the misreporting--that the limit amount will be up to a federal regulator, and now they say they will "fix" it.

      If they botched something this easy, what about the other clauses that are claimed to be doing something that they may not be doing at all.

      This is a sample of regulatory capture for all to see.

      •  I actually downloaded (1+ / 0-)
        Recommended by:
        arodb

        part of the IRS code including that Section 223 and didn't see anything that seemed relevant.

        It did remind me why I didn't go to law school.

        The referencing of other sections of the law makes modern law very difficult to simply read and understand.

        Particular sections become the intellectual and financial fiefdoms of people who can devote enough time to them.

    •  congress passes the laws, not your imaginary (1+ / 0-)
      Recommended by:
      puffmeister

      [hardworking lawyers in windowless room paid very very little]

      True, US tax attorneys at Treasury, not CRS, who do work on things like the Regs don't get paid too much but they are frequently there to work on the Masters at Georgetown while working there. I declined to take an offered job there but I really wish I had.

      We are in a time where it is risky NOT to change. Barack Obama 7-30-08

      by samddobermann on Sun Dec 13, 2009 at 03:56:21 AM PST

      [ Parent ]

      •  they are indeed the unsung heroes of (0+ / 0-)

        congressional legislation; their lawyers provided all the important supporting language for the electric vehicle tax break legislation that was my heart's passion, while working on enviro issues as a one-year congr fellow for my boss [a NJ House Member] back in the 107th.

        Needless to say with the Repubs in control, the bill he eventually dropped into the hopper did not go far...

        [I know what you mean about the pull - I too considered an application there, as I longed to go back to DC, but decided to stay up north w the hubby; the commute was just too hard, and the Republ control just too depressing]

        We will restore science to its rightful place....We will harness the sun and the winds and the soil .... All this we can do. And all this we will do.

        by puffmeister on Sun Dec 13, 2009 at 10:53:55 AM PST

        [ Parent ]

  •  Why don't they consider (3+ / 0-)
    Recommended by:
    neroden, arodb, nextstep

    creation of a government program for people who have used over a certain amount of their insurance benefits in a year? The company pays the first $X after which the government picks up that tab. This would ensure that everyone gets the care that they need while providing increased predictability to the insurance companies.  

    •  That had been available... (1+ / 0-)
      Recommended by:
      neroden

      it was "major medical" that only went into effect when the limits were reached.  Most people with some assets used to get it.

      Those with fewer assets would fall into Medicaid if their resources were depleted.  

      Obama is attempting to ensure that sickness will not bankrupt anyone.  To do this the Government, or the Taxpayers, or the mandated other users, must bear the cost of those with catastrophic illness.

      The "loophole" was an acknowledgment that it is expensive.

    •  Wasn't that basically Kerry's plan when he (2+ / 0-)
      Recommended by:
      akeitz, neroden

      ran in 2004?

    •  I'm pretty sure that the change (2+ / 0-)
      Recommended by:
      neroden, kurt

      was due to self-insured companies either wanting an upper limit or having the federal government pick up the tab over a certain dollar figure.

      Since the federal government didn't want to budget and pay for the likely cost explosion, a senator (probably Reid) decided vague caps might be better for the federal government financially.

      Also, having an unlimited exposure might make it illegal for insurers with essentially finite reserves to sell policies in some states, causing all commercially insured people in those states to become uninsured.

    •  Another possibility (0+ / 0-)

      is when people reach a policy limit, to collect back by law all amounts above say CPI-adjusted old Medicaid levels payment levels and use the money to pay for more care at CPI-adjusted old Medicaid levels.

      That would encourage providers to manage expensive cases better and would prevent patients from suddenly loosing out on care.

      When this recaptured money runs out, then the best-paid providers would have to continue to provide care and drug makers the needed drugs.

    •  A lot of problems (0+ / 0-)

      could be solved if insurers bought drugs by subscriber base age.

      Buying drugs on an all the patient needs basis would eliminate the need to try to micromanage prescribing and do a lot to minimize the policy limit problem.

      Alternately, I think if more than $20,000 has been spent on a drug for patient, then maybe the drug should be supplied by the drug maker for say $7.25/day.

      The drug maker at $20,000 for the patient has already made a "killing" and drug pricing shouldn't cause a killing.

      •  Perhaps someone with more (0+ / 0-)

        knowledge on this could correct me, but I suspect that a larger portion of drug costs represents R&D than in the past? Given this, it costs the drug company relatively little to have more people taking the drug. Switching more patients to a generic drug doesn't really save any or much money on a system wide scale, it still costs the same amount to develop the new drug regardless of whether a thousand or a million people take it.

        It would be kind of like microsoft over pricing its best operating system so that a substantial number of people are forced to use an older version.

        I think we would be much better off if we had a system that focused on maximizing the number of users (of course I mean patients that actually need and benefit from the drug) rather than profits. Perhaps a larger portion of R&D costs should be paid by the government directly so the cost of a new drug can be closer to its actual production cost.

        •  I have proposed a number of times (1+ / 0-)
          Recommended by:
          scotths

          the the US government (and the EU) buy out drug patents.

          The protease inhibitors generally have just a few years left on their patents.

          The patents for the immune drugs inhibitors used for things like RA last another decade until about 2019.

          The blood cell booster, long-term contraception, clot buster, and migraine drug patents are running out soon.

          The expensive drugs are the major cause of the preexisting condition problem.

        •  It has become very difficult (0+ / 0-)

          to find blockbusters since more and more drugs are becoming generic.

          What is happening is that low-incidence ailments never of much interest before are being researched and new products made because it is easier. These products are often sold for tremendous prices.

          Insurers don't want people with rare ailments paying $5,000/year in premiums who might need drugs sold for $100,000/year.

      •  Insurers negotiate drug prices big time (0+ / 0-)

        John Aravosis over at AmericaBlog did a series of posts about a year ago describing his experience when BC/BS cut off his asthma drugs in June because he had reached his limit. He's a lawyer and his investigation is detailed, but the upshot is:
        through discovery he found BC/BS has a deal with Walgreen and Merck that results in BC/BS paying about $2.00 per dosimeter (that's how Advair is packaged). However, they were "billing" his insurance account $375 for that dosimeter. Consequently, his $2000 drug ceiling was reached in 6 months, although BC/BS had only paid out $12 for his drugs.  

        Those who are too smart to engage in politics are punished by being governed by those who are dumber. ---Plato

        by carolita on Sat Dec 12, 2009 at 04:12:54 PM PST

        [ Parent ]

  •  This is a serious concern, but... (4+ / 0-)
    Recommended by:
    samddobermann, neroden, kurt, arodb

    I think that private insurance companies need to guard against two competing risks:

    1.  We need to make sure we don't cut insured people off from needed coverage, or make people go bankrupt because they can't afford it.
    1.  We need to make sure that the high-priced treatment of a few leads to dramatically increased costs for the many.

    There are some solutions to this:

    1.  Reinsurance for catastrophic coverage, provided to insurance companies through a gov't funded pool.
    1.  Rockefeller's amendment to make sure 90% of premiums go to delivery of services, not overhead and/or profits.
    1.  Ending the anti-trust loophole.  

    "It is a serious thing to live in a society of possible gods and goddesses." - CS Lewis, Weight of Glory

    by Benintn on Sat Dec 12, 2009 at 11:12:54 AM PST

    •  Epistimological problem.... (4+ / 0-)

      You describe two items, first to continue, second to curtail

        1.   We need to make sure we don't cut insured people off from needed coverage, or make people go bankrupt because they can't afford it.

        2.  We need to make sure that the high-priced treatment of a few leads to dramatically increased costs for the many.

      Problem is one persons high priced treatment, heart replacement, life time dialysis, are all very expensive, and will lead to higher costs that must be paid for by some method.

      Individual, or voluntary group (private insurers) or government, currently financed by devaluing the dollar which has a diffuse but serious cost to most people.

      No easy answers to any of this, and my greatest reason for rejecting this bill, based on logic and emotion, is the Presidents presenting this as "without the cost of real painful change."

      It's simply not possible.  

      •  One of the things that must be considered is (2+ / 0-)
        Recommended by:
        Fabian, arodb

        having a body outside the insurance industry determine what treatments are the standard of care.  While we do not want caps, we do want to control costs in a humane and reasonable way.  People in the throes of a medical crisis are not the best judges, nor are for profit insurance companies and in many cases neither are doctors trying to protect themselves from malpractice.  We have quite a conundrum in this country....based on how our medical system operates, everywhere we look we have serious conflicts that interfere will getting to better medical outcomes without bankrupting either the individual or the system.

        "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

        by lakehillsliberal on Sat Dec 12, 2009 at 11:40:11 AM PST

        [ Parent ]

        •  Malpractice is a dirty word... (1+ / 0-)
          Recommended by:
          lakehillsliberal

          among democrats, and this is a fatal flaw in this bill.  Malpractice methods are the antithesis of the theory of this bill, that risk-reward optimization shall provide effeciencies to expand care.

          Yet malpractice is quite the opposite.  It is outcome, even if reasonable based on best practice that can end a docs career.  The existing malpractice, the the current law only slightly touches, militates against this law and betrays it not as being in the interest of all Americans, but designed by those who control a given party in power.

          It's rather tragic.  

          •  We have conflicts everywhere we look. I believe (2+ / 0-)
            Recommended by:
            Fabian, arodb

            one of the things that reduces the need for malpractice is having a clearly developed standard of care recognized by all parties and set by a disinterested body.  If there is a problem then it can be adjudicated by referencing these standards and comparing them to what was delivered.  Bad doctors hid in the current system and that is what all doctors are paying for, I would think they as a group would be outraged and fight to change that but I guess they would rather carp about malpractice insurance.  

            "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

            by lakehillsliberal on Sat Dec 12, 2009 at 12:17:15 PM PST

            [ Parent ]

            •  Medical science advances (1+ / 0-)
              Recommended by:
              arodb

              rapidly.

              Bacteria change rapidly. An antibiotic that worked well in August 2008 may not be working well now in dozens of hospitals out of 5,000 in the US.

              Does the patient get the new $250 antibiotic or older $4 antibiotic?

              Do only people from Britain or Greece get the $250 antibiotic?

              What if the patient says he was in London last week and used the Underground?

              What if Dr. Best gives the $250 antibiotic to all his rich patients?

              Also, if such a system was developed medicine would be transformed into a computer-based system.

              There was an argument quite a while back where a person said he didn't need math in his job anymore.

              Many doctors won't share knowledge if clerks and computers would replace them.

              •  We are not talking about computers but most (1+ / 0-)
                Recommended by:
                arodb

                European countries have standards of care. Insurance companies today have things they will cover and things they won't...I really don't want an insurance company making the decision but on the other hand if we have determined that we cannot live without for profit insurance(which a good portion of the population has) then we need to have a reasonable control on costs and not create a system that just opens the spigots on treatments.  Standard of care would be ongoing and include new research incorporated but only once it has been proven.  If a patient wants untested medicine we have clinical trials for that.  I think the system we have now is more dangerous and more hap hazard than having what I suggest.  A standard of care would account based on available research that a certain portion of the population does not respond to generics and would give the doctor the freedom to use the brands once he had tried the alternative and the patient could expect his insurance company to pay for it.

                Even is we had single payer...we would have to do this.  Single payer is not the same thing as any treatment anytime at any cost.  A system like that is not sustainable.

                "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

                by lakehillsliberal on Sat Dec 12, 2009 at 01:15:49 PM PST

                [ Parent ]

                •  There are such things as guidelines (1+ / 0-)
                  Recommended by:
                  arodb

                  Even insurance companies use them.

                  But if you see premiums going up by 10% a year, it isn't because the nurses are getting 10% annual raises, it is mainly because care provision is changing.

                •  There is a great deal of variation in care (1+ / 0-)
                  Recommended by:
                  arodb

                  Care in the ER costs more because ER doctors practice medicine much more defensively than many other doctors.

                  If you get an anti-depressant from a GP his standards may vary from a psychiatrist.

                  Care in Britain can vary depending on where you live. It's called the "postcode lottery" by the Brits.

                •  "A standard of care would (1+ / 0-)
                  Recommended by:
                  arodb

                  ....give the doctor the freedom."

                  Ummm!

                •  You don't MEAN standard of care; that usually (1+ / 0-)
                  Recommended by:
                  arodb

                  means a minimum level below which doctors (etc) should not fall.

                  I think you are call for Evidence based care; a term which refers to the latest we know about what works best and what doesn't.

                  It would include guidelines as to whom it would apply. For example kids with ALL, acute lymphoblastic anemia AND a certain allele (form of a gene) should get it; those with a slightly different configuration should get it in a low dose with careful monitoring and those with yet another configuration should not get it at all and instead of wasting time they should go directly to other treatments.

                  That is an example where we have identified a gene which regulates the use of the drug.

                  In other cases there may not be such a clear cut line. For some conditions we only learn by trial and error with each person which drug fits best. This right now is the situation with Depression. However, we know that there is some genetic component so it is a good practice to ask about family history and if another relative has had good results with a particular medication, start with that. Someday we will learn about the genetic configurations which determine response to the various drugs.

                  Use of the correct terminology helps. By using the wrong term - especially if you communicate with a legislator, you are giving your approval to the minimum standard of care, below which could be malpractice.

                  We are in a time where it is risky NOT to change. Barack Obama 7-30-08

                  by samddobermann on Sat Dec 12, 2009 at 03:14:59 PM PST

                  [ Parent ]

                  •  Thank you for the correction. However we get (1+ / 0-)
                    Recommended by:
                    arodb

                    there...I would prefer an independent group of scientists and doctors developing reasonable guidelines(both practice and costs) and not the insurance companies would be my personal preference.

                    "When fascism comes to America, it'll be wrapped in a flag and carrying a cross." Sinclair Lewis

                    by lakehillsliberal on Sat Dec 12, 2009 at 05:26:26 PM PST

                    [ Parent ]

              •  This is nonsense, with regard to antibiotics and (0+ / 0-)

                what standards of care are. Also your idea that if a lot of stuff were on a computer doctors would have so little to do that they would quit.

                We are in a time where it is risky NOT to change. Barack Obama 7-30-08

                by samddobermann on Sat Dec 12, 2009 at 01:33:22 PM PST

                [ Parent ]

          •  Malpractice (3+ / 0-)
            Recommended by:
            samddobermann, Fabian, arodb

                Doctors careers are not ended by single malpractice cases, or two or three or five malpractice cases where the doctor was negligent. Even alcoholic and drug addicted doctors are suspended temporarily based on a number of cases.  Medicare fraud is another way a physician typically loses his license.  It is medical profession and insurance company propaganda that doctors lose their licenses based on a few negligence cases.  Boards of Professional Responsibility punish doctors for poor practices as frequently as police departments punish police officers for beating up citizens. Check your state's Medical Board of Professional Responsibility.  In every state practicing according to best practices or even acceptable practices is a complete defense to a malpractice claim.
                 Name one doctor whose career was ended by one malpractice case, or two or three or five malpractice cases where the doctor wasn't a drug addict, peddling drugs, or committing fraud.  Enough with the urban legends.  

            •  There are some things (1+ / 0-)
              Recommended by:
              arodb

              that don't "end" careers but....
              [smirk]

              Supermarket giant Meijer Inc. will pay $3 million to settle claims over having employed four pharmacists who were barred from federal health programs, officials said.

              The pharmacists worked at Meijer stores in Michigan and Ohio from 1997 to 2006. They had been barred from Medicare, Medicaid or the U.S. military's TRICARE program.

              Grand Rapids, Mich.-based Meijer brought the issue to the government's attention, the U.S. Attorney's Office for the Western District of Michigan said.

              LINK

              Government money should always have strings attached.

              Show me the POLICY!

              by Fabian on Sat Dec 12, 2009 at 01:36:19 PM PST

              [ Parent ]

              •  They were probably barred for fraud, not (2+ / 0-)
                Recommended by:
                Fabian, arodb

                malpractice. The government agencies that you mention all try to go after fraud like billing for prescriptions that don't exist and weren't really filled.

                There are few crooked pharmacists but those few should be run out. Not only are they defrauding the taxpayers, they are likely to cut other corners or will in the future.

                We are in a time where it is risky NOT to change. Barack Obama 7-30-08

                by samddobermann on Sat Dec 12, 2009 at 03:20:18 PM PST

                [ Parent ]

                •  Either/or is fine with me! (0+ / 0-)

                  Fraud is less personal than medical malpractice, but just as destructive.  In a world of finite resources, money taken from the system to line pockets is money not available to provide care.

                  Show me the POLICY!

                  by Fabian on Sun Dec 13, 2009 at 02:48:40 AM PST

                  [ Parent ]

            •  A doctor that has lost a few (1+ / 0-)
              Recommended by:
              arodb

              expensive malpractice cases probably can't get the malpractice cover that state law requires him to have in order to practice.

          •  arodb, you really misunderstand the malpractice (1+ / 0-)
            Recommended by:
            arodb

            situation. I'll try to get back to you later today or tomorrow on your site.

            Maybe we can work up something that will be a good diary for here.

            We are in a time where it is risky NOT to change. Barack Obama 7-30-08

            by samddobermann on Sat Dec 12, 2009 at 01:30:57 PM PST

            [ Parent ]

  •  This is some Medicaid case law (1+ / 0-)
    Recommended by:
    neroden

    that may be of interest to some people, mainly lawyers:

    http://www.nls.org/...

  •  Without price controls (3+ / 0-)
    Recommended by:
    kurt, lakehillsliberal, arodb

    there has to be annual limits.

    Drug companies discover new drugs often.

    No law in the United States prevents a drug company from pricing a drug at $300,000/dose or even $3 million/dose.

    A truly expensive case might be a burn patient who needs a few organ transplants too. This might cost about $1 million total.

    Remember, a hospital bill isn't a cost statement, it is a revenue optimization tool.

    A simple annual limit is a crude instrument. One doesn't want drug companies to move toward $1 million/year/patient pricing.

    •  You make sense... (0+ / 0-)

      but the democratic leadership doesn't operate at this level.  They say they are going to correct the "loophole"

    •  There are few severe burn patients in a year. (0+ / 0-)

      The really expensive cases, which are much more common, are the infants that are born extremely prematurely and never were saved before the last 20 years or so. There is even a term for them, million dollar babies. Except some cost as much as 2 million dollars. With the high rate of prematurity in the US, that is a big cost.

      The rate of prematurity can be reduced from its current high rate in the US by the best practices if set up in hospital systems and doctors were educated.

      The rate of premature births and their attendant expense went way down at InterMountain Health care when they examined the records and figured out what medicare was influencing and what worked best. By aggressively disseminating the information to their entire staff, but not mandating it, the drove the prematurity rate way down. It resulted in a tremendous saving of money, but more importantly healthier babies and families!

      InterMountain has done the same for other diseases.

      This type of medical practice is what this reform bill is trying to put into motion. But to do so we have to restructure the payment system. Intermoutain actually looses payment while the are saving the system money and increasing survival.

      We are in a time where it is risky NOT to change. Barack Obama 7-30-08

      by samddobermann on Sun Dec 13, 2009 at 03:49:41 AM PST

      [ Parent ]

  •  Every day there is another reason ... (3+ / 0-)
    Recommended by:
    samddobermann, carolita, arodb

    ...to follow the approach of "start over." That, of course, will not happen. If it did, it would probably screw the Democrats' chances in November worse than they already are likely to be. Since I know that getting affordable, universal health coverage is beyond the reach of the current political system, some days I wish Canada would invade, or at least annex, us.

    Don't tell me what you believe. Tell me what you do and I will tell you what you believe.

    by Meteor Blades on Sat Dec 12, 2009 at 12:35:23 PM PST

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