doublegunshop.com - home Forums From Justice Roberts....

Are you sure your lawn guy is a good example. I believe it shows that you sit back with comfortable means and refuse to acknowledge what joe average has to contend with.

The reason for taking on a partner over an employee is to have someone with 'skin in the game' or an incentive to create billable services. Your reason for having a partner is to make a nonproducer entitled to the others production. Wouldn't most legal partnership agreements limit the liability, or is your legal perspective one of a taker not creator.

Your lawn business may survive forever on paper, but are you going to be satisfied with their service if no one stopped by for the last six months. With your new revelation of medicare taxes and scheduled increases, does that make it easier for a start up company to do business. Remember this wink and a nod didn't even get to the taxes or penalties that'll fall under obamacare.

Gnomon, we have single payer in Canada. It is a disaster. Single payer (government only) means inefficient, bureaucratic bloat. No getting around it.

Yes, I know, it doesn't HAVE to be that way. But human nature being what it is, government being what it is and bureaucracies being what they are, costs will spiral out of control so fast your head will spin.

Why is it a disaster?

What percentage of revenue goes toward medicine and what per percent goes to overhead?

I do not know about your country and will not comment upon it, but here in the USA Medicare and Social Security are well-run, low-overhead agencies that undercut private suppliers. Since I don't know the Canadian situation I don't think it appropriate to comment upon your government.

However "inefficient" you may think your program is, you guys are getting a far better medical outcome per buck than we are.

I disagree. Aside from that, there are no private suppliers for Social Security, unless you are referring to defined benefit pension plans. Many, if not most, DB pension plans are currently severely underfunded.

Regarding private suppliers for MediCare, there are plenty of health insurance companies in this country that could be said to be alternatives to MediCare. If MediCare is undercutting those companies, how is it that virtually every big health insurer offers a Medicare risk contract that beneficiaries can select as an alternative to government Medicare? These companies offer these "senior plans" because the plans are profitable for them and because subscribers like them. No undercutting here, either.

Actually, they are probably not getting better medical outcomes per buck of medical expenditure. It may look that way because of differences in the way the medical expenses are counted, and because the U.S. legal system forces huge incremental costs onto our system that are not actual medical expenditures. Some of my best friends (and my son) are lawyers, but I still think tort reform is part of the solution to the health care conundrum in the U.S.

Can you explain these risk contracts? Are you referring to Medicare Advantage Plans? If so, they are subsidized by the govt. at an avg. cost 14% greater than traditional medicare.

I realize you'll tend to selective pot stir, but could you elaborate on your comments. Is it simply a matter of repetition to convince yourself of validity. Are you just smarter than regular folks. Do these topics come up over cocktails and lunch at the upscale country clubs.

Since you don't know and you volunteer that it's inappropriate to comment, how might you conclude about medical outcome. Do you subscribe to the end justifies any means. I can appreciate that you draw your own conclusions, but do you prefer if folks ignore questions about your support comments.

Yes to Advantage plans. The insurers, providers, or integrated health networks agree to take over total responsibility for care for their subscribers. The feds like this because it relieves Medicare of the risk associated with these beneficiaries (hence the reference to "risk contracts," as they are known in the trade). The feds are happy to subsidize the Advantage plans because then they no longer have to deal with the beneficiaries and their ills. If the Advantage plans could not run their plans at a profit, they would not offer the plans. I mentioned these plans to refute Gnomon's suggestion that MediCare is somehow undercutting the private plans. In fact, MediCare is aiding and abetting the private plans.

I also mentioned governmental waste. An example of this in the MediCare context would be the PACE programs (Program of All-inclusive Care for the Elderly). PACE programs are notoriously lucrative cash cows for the providers, because the providers are paid per member per day. In 2007, the national average provider payment was $3000 per member per month (PMPM), with a high of $4300 in NYC and a low of $1700 in Miami, with PACE programs operating in about 28 states. Five years later, allowing for the rapid, compound inflation in health care costs, the national average is probably approaching $5000 PMPM. In the Los Angeles market area in 2008, the payment for a full-time PACE participant was about $4700. Full-time means the participant is in the PACE center five days per week, but not all are. Reimbursement in L.A. was a bit over $200 PMPDay, as I recall. Why does this matter in this discussion? Because nationally, about 40% of PACE funding was coming from MediCare and MedicAid, all administered by the Centers for MediCare Services (CMS), using your tax money. In CA, MedicAid is called MediCal and is administered a bit differently than the federal programs. In CA, there is no requirement for PACE participants at Federally Qualified Health Centers (FQHCs) to pay any premiums, MediCare or otherwise, because the MediCal guidelines set a sliding fee scale based upon ability to pay. The fee scale slides all the way to zero for a lot of the local participants. That means that 100% of the cost of PACE is paid with our tax dollars, and the FQHC PACE operators even get a higher payment rate than do for-profit operators. PACE programs are a wonderful idea and provide a range of necessary services, but waste and abuse are rampant, increasing the overall cost of health care in this country.

What it boils down to is this--->How many dollars does it cost the federal government to spend one dollar?

Without looking it up, I seem to remember that the administrative costs of SS are about 3%. No private insurance company can match that - it is indeed a well-run entity. Whether or not SS should be doing all it's doing is another issue, but it is efficient.

There's a hell of a lot of money in SS which is why the industry wants to privatize it. That would be a real scam. Millions of tiny retirement accounts, expensive to manage, getting fleeced by Wall St.

Replacement wrote (in part) " I mentioned these plans to refute Gnomon's suggestion that MediCare is somehow undercutting the private plans. In fact, MediCare is aiding and abetting the private plans."

I had thought that the Advantage Medicare plans were given to the private providers to manage because of intense lobbying by the industry. The Advantage plans are much more expensive, administratively, thann Medicare. A larger percentage of Medicare dollars goes to health care if paid directly by Medicare than if paid via the private contractors.

The same thing with student loans - there is no reason why banks should administer student loans and take a fee if the gov't can do it for less. Obama cut the banks out of the chain and now the money that goes into student loans has a lower administrative cost.