Quote stecoop01:When you have a leaky pipe, you don't increase the water pressure!

I've been reading about the comparison of medical cost payment systems: the current 'Fee for Service' payment system and the newest concept called 'Bundled' payment system. Medicare has been grossly abused by both patients and those in the medical care system. It currently uses Fee for Service where they itemize every single thing from the cost of Q-tips to major operations which also can be broken down to itemized charges which ends up as a very large bill in the end.

The newer (but not always or necessarily better concept, the Bundled system, ostensibly charges fees on the basis of a history of overall 'normally expected' fees encompassing everything that it took to make you well again. I really don't understand how they will not itemize in order to come up with a cost. Unless it is like an all you can eat buffet...the owners know how much a typical human is likely to engorge him/herself and charge accordingly rather than charge for every bite. I really don't understand it all just yet.

On the one hand it sounds like it might put some reigns on a runaway and corrupt system. The Rand think-tank seems to like it...which alone may be an indicator that you'd better read the fine print. But there are lots of caveats.

I understand that the Obama administration has favored the Bundled system and that some of that has been included in Obamacare. And that may or may not be good.

One thing that is good about Obamacare is that the insurance companies can't turn you down for pre-existing conditions. But, that is not to say that you won't be paying a lot more, because of your pre-existing condition, in increased premiums. I have not seen anything in Obamacare that says that insurance companies cannot increase their rates because of a pre-existing condition. They can still discriminate using increased premiums..that we have to pay!

Insurance companies would almost always insure anyone for any ridiculous and risky thing providing the insured paid enough money for the coverage. Most people would just not pay the exorbitant premiums out of choice but now that our government is acting as a collection enforcer bully boy that will break legs if your don't pay the protection money we have no choice but to pay up...or pay the fine (the symbolic breaking legs part).

There is a rather lengthy study of 'Bundling' with all kinds of charts and graphs that is interesting...at least the Executive Summary in the beginning is more understandable to those averse to charts and graphs.

But a quicker understanding might be better seen on the Wikipedia description. Especially, look at the
Advantages and the Disadvantages sections. It seems to me that corruption will take place no matter what kind of system they come up with. Whether they nickel and dime you to death on tiny things or whether they obscure it all in one package sum. Just another gimmick! As long as they don't take away my Medicare, I don't really care how they work the books. But, the quality of care we get under Medicare may depend on how they 'rig the system'.

Medicare Payment Bundling: Insights from Claims Data and Policy Implications
Analyses of Episode-based Payment

www.aha.org/content/12/ahaaamcbundlingreport.pdf

http://en.wikipedia.org/wiki/Bundled_payment

Insurance is gambling. The insurance company bets that they will make money on you and you are betting that you will prevent your losses (money or health, etc). The insurance company, like any casino, is rigged to win. Some healthy people may feel they have led a very healthy life, eating all the right foods, exercising, or whatever. Some of those people may feel that they want to gamble that they will save a bundle of money by not throwing it all on the insurance company roulette table. Do they not have the right to gamble as much as the insurance company does? What the government is doing is forcing everyone to throw their money down on the insurance company roulette tables...forcing them to gamble. Once they throw their money down...they won't get it back...it's gone...the only way you will win (if you want to call it winning) is to get sick...you may lose some of the money you didn't gamble in the first place by having to pay out of your own pocket directly to the medical establishment...but at least you are not making some insurance casino CEO wealthy.

Thom, it's nice to quote the President with “we can't cut our way to prosperity.” But it's empty, meaningless rhetoric.

The bottom line on sequestration is, HE SIGNED THE BILL. He made it law in 2011. Even if he were any kind of negotiator (he's not - he's never been up to the job, IMHO), he signed a dumb bill because he thought it was politically expedient to do so.

We have Bernie Sanders, we have Elizabeth Warren - and that's about it. Harry Reid's a bad joke. Those of us who have to live with the consequences of what these rich people foist on us have virtually no say, certainly no clout, in Washington.

Barack Obama enthused millions of people - then disgusted us with politics. It's not that he's done no good at all - the ACA is a solid baby step forward on a huge issue. But Guantanamo is still open, our drones still kill children, the Patriot Act is intact, whistleblowers are jailed, and banksters get off scott-free. We're still in Afghanizstan, we're still the biggest bully on the block, our infratructure is decaying, we've fallen behind the world in transportation and energy - and there are no jobs. We're all working multiple part-time jobs with no benefits in Obama's America. We will not remember him fondly.

So, he's right about not cutting our way to prosperity - but that's exactly what he signed on to do. No credibility, no hope for the country.

I agree - ALICEINWONDERLAND - with who you hold accountable for aggressivily thwarting efforts to apply alternative energy and clean fuel opptions, but again when it come to "Electric" cars even those in engineering and technology say it isn't a clean alternative, for many reasons; one being disposal of battery cells - simmilar issue to cell phones when they are worn out. But more so is the amount of "power" it would take to draw efficient energy on a day to day bases. It would be like our population doubled and turned on all the lights.

But rather than continue going back and forth...Lets agree that we both understand that there are other clean and efficient alternatives for powering our vehicles, homes, and offices; Solar energy, Wind energy, Wave energy, and Biodiesels derived from hemp, sugarcane, algea, etc. (Not corn or wheat).
And yes we - you, me, and ever tax paying s.o.b. voter must get the message out to enact and fully fund a new Energy Policy that moves us away from oil dependency.
Our children will see the positive effects but it will be our Childrens children who will fully bennefit...That's if we start now.

MMmmNACHOS says "Alternative fuels - such as hemp - are the real starting points towards cleaner fuels." No argument there! Hemp is the answer to many of our problems. Too bad the oligarchs are so determined to suppress it.

As for those electric scooters... I see that as a classic example of arrested development in the context of engineering & technology. The oligarchs are hell-bent on keeping us hooked on their nasty oil, so other technologies that could provide a viable alternative are never fully developed, if at all. But given the choice, I'd pick hemp over anything else. - Alice I.W.

Another Soldier, Another Sucker.
War begot War begot War begot...Would you agree with this KEN WARE???

You Ken are certainly well versed in the game (strategy) but in the end war will be the demise of everyone. War has already killed hundreds of millions just in our life time...Not just soldiers, but innocent people, whoes lives are underminded as "collateral damage", and then further insultes us through ill generalizations, such as "the ends justify the means". BULLSHIT!

Howard Zinn (a WWII Bombadire Pilot, American History Teacher, and Author) hit the nail on the head when he wrote in his book "Passionate Declorations; essays on war and justice" about how war does not create or protect freedom; it actual raises contempt and fuels the seeds of future wars. He went on to say how stopping Hitler was the right thing to do but questions the "excessive" bombing raids of the U.S. Raids that bombed entire towns and villages where thousands of innocent people lived. And in his book "The Bomb" he talks about and questions the dropping of the second Atom Bomb. In fact both bombs were excessively unnecessary...Instantly killing over one million innocent people. In the days that followed the death toll would near two million people. And the years to follow would equate to even more.
The sad truth is...Japan was ready to surrendor, but the U.S. being the meathead bullys had to prove a point...Which then launched us into an Prick Waving Contest...I mean "arms race". Now here we are 100 wars later and still no peace, just more dead bodies and debt.

When will greedy war-like mongers stop cheating peaceful people out of life.
LIFE IS NOT CHEAP...STOP WARRING!

Electricity for automobiles - ALICEINWONDERLAND - is not a sound starting point if you are looking for cleaner. Yes the car itself won't be burning fossil fuel but again the idea is just trading tit for tat. I will say that these electric scooters - I own three - are a great mode of transportation for going short distances (less than 10 miles). We use ours to go to the beach, run to the corner store, I even have a small trunk on mine to hold a small bag of groceries...And of course the bag is a reusable one. ;)
Alternative fuels - such as hemp - are the real starting points towards cleaner fuels. Not only does hemp burn clean but it process clean and there is minimal to no waste. Further more hemp crops can be turned 3x's more than corn or wheat and they do not depleat the soil of nutrients.

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DAnneMarc - The Pentagon and the White House have recognized a real threat to our way of life and that threat is China. They are presently shifting resources to the China Sea, Korea, Japan and Australia. The threat that the Cold War posed has faded into history, but it has been replaced by another Communist threat, China. We like to see China as a trading partner who provides cheap goods (at the cost to the American Worker) and buys our Treasury Notes. They realize that their economy and financial stability is dependent on our buying their goods, thus this has made them a Super Power economically and as a military power. But do not be deceived by their facade, they are still a nation that has plans of domination of their region. We have signed treaties with all the above named nations and we are obligated to respond militarily if they should infringe on the sovereignty of our allies. A non-nuclear confrontation with China is still a scenario that Washington and the Pentagon have prepared war plans for, in the event it is necessary to defend those we have signed military treaties with us and would defend them if needed. China and Japan have come close to a confrontation over the Islands the Japanese and Chinese both claim as their own. The only reason I bring this up is I believe we can cut some of our military expenses, but we need to be ready for war if we are called on to do so. One thing history has taught us, is no matter how unthinkable war might be, we can never rely on the opposing force to think in a like manner, therefore we must be ready to defend ourselves and our allies in every conceivable scenario of war. We thought it would be insane for Germany and the Nazi's to attack all of Europe one piece at a time, but they did it. We thought the Japanese would never attack us, but they attacked us and we were not ready. Let’s just hope for peace and hold out a hand of friendship, while always holding a hammer of war in the other, in order to protect and defend our way of life. No matter how bad we perceive Washington to be, the rule of another nation would be much worse. I have seen War and it is ugly and should be avoided if at all possible. But to be unprepared for War would be even worse. Therefore I believe we can cut our military spending to a reasonable cost, but we should never cripple our ability to defend ourselves and our allies in all theaters of the World. The time has long passed where we can see our physical boundaries as the only place we have to defend from an enemy that sees no boundaries, like China and North Korea. I am not making them the Boogey Man that we have to fear to keep our military strong, we need a strong military so no other country perceives us as a weakened country and might make the mistake of pushing us or our allies to the brink of having to fight a non-nuclear or conventional war against them. Leaders in the past have made such a mistake and it led to two World Wars and hundreds of millions of lives were lost, not to mention the undeclared wars we have fought in. We too have made the mistake of thinking our military strength would prevail and we wasted many lives on both sides. Hopefully we have learned our lesson concerning war, but we can never allow another country to think they could defeat us or our ability and willingness to wage war if needed. Also, I think it is time Europe started spending more of their resources to protect Europe and we spent much less. We have already closed 2/3 of the bases that were operational during the Cold War, and we should also expect countries like Japan and South Korea to finance more of the military costs we are paying for at the present time. We can agree to disagree.

Smoke and Mirrors: Obama DOE Fracked Gas Export Study Contractor's Tobacco Industry Roots

http://www.desmogblog.com/2013/01/24/doe-lng-export-study-contractor-tob...

DeAnneMarc - How do you like the idea of our children speaking Chinese as a first language in 25 years? There are legitimate enemies out there that you seem to overlook by suggesting we close all our bases around the World. We need to re-evaluate our military not destroy it. We need to invest more in our internet technology capabilities in the military and as a nation and reduce the spending on hardware. With the exception of ending the war on Hard Drugs, I believe you are voicing what most Americans have been calling for. Even Obama could not get a single payer health care program through and he had the Senate and the House for the first two years in office or he did not want to. With the cuts to Medicare, many doctors in California have had second thoughts about accepting new patients, especially those in medical fields that are specialists. I have friends and relatives that use Medicare and have had conversations with their doctors that are Specialists in specific fields and the feedback they get is not looking good for older Americans that are retired and require the services of these doctors such as Orthopedists. Urologists and the alike that treat ailments that affect older (and young) people as our population of retired baby boomers grows year by year. So be careful what you wish for, the Affordable Healthcare Act is also having problems and issues since Obama was not able to correct the "Bugs" in his bill that he said he would correct in his second term. And since the Republicans own the House those corrections never took place. Here in California (and I know you are also are a Californian) the Insurance Companies have been able to raise the premiums on many policies by as much as 20%, because of loop holes that were not corrected by the Obama Administration and the Dem.'s in Washington. But, I do agree we need a good National Health Care Act that is not flawed like the one Obama pushed through by a squeak. We all have a wish list to fix the woes of our country and her citizens...Have a good evening and a great day tomorrow.