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Judge allows health-care initiative to proceed

Original post made on Aug 4, 2018

A measure that would cap how much local health care providers can charge their patients for medical services is set to appear on Palo Alto's ballot in November after a Santa Clara Superior Court judge ruled on Aug. 1 to reject the hospitals' legal challenge.

Read the full story here Web Link posted Friday, August 3, 2018, 5:26 PM

Comments (65)

12 people like this
Posted by Gloria Pyszka
a resident of Another Palo Alto neighborhood
on Aug 4, 2018 at 1:56 pm

The Hospital /SEIU ballot measure is going to cause reprcussions far beyond PA and Stanford/PAMF etc. . I have a hard time with the ballot approach b/c the common reaction ( voting) will be, "You should see my PAMF/Hospital statement. Boy, it's about time, something was done." Well, what? I had the "pleasure" of using Stanford's ER and as a an admitted patient 3x in 2017 (very bad year beginning with an MVC). I have the complete itemized billingstatement and reimbursements from Stanford, Medicare as well as my supp. Lucky me, I didn't pay a penny. Were there too many pennies charged by Stanford in the first place? I don't know. But what I can tell you is that Medicare pays a very small fraction of the billed amount. And, the supp pays even a smaller fraction of Medicare's fraction. The whole charge/billing structure is a can of worms across the nation, but I'm not sure at all that th ballot is the way to address it. This time I'm signng my own name instead of my rotating nom de guerres. Why? Because I have had the experience upon which to make a few remarks based upon first-hand experience. Even now, I don't know what the actual numbers as a patient that are "reasonable" for any given service. I hope that eventually an intelligent analysis will be offered by a body that can accurately do the analysis. I know that we Palo Altans are an opinionated bunch, sometimes fast on the draw, with numbers to back the accusations. But, be careful before your point fingers. And no, I don't work for Stanford. I'm just a LOL Palo Altan.


14 people like this
Posted by Esther Granderson
a resident of Old Palo Alto
on Aug 4, 2018 at 2:14 pm

Bring back Marcus Welby, MD. He never seemed to have a problem with these kinds of issues and his young associate (James Brolin) was always able to cover for him in a most professional & caring manner. Of course, that was TV-land.

Despite countless advances in medical technology, the experience of going to a doctor has really gone downhill.

Whatever happened to the trusted general practitioner? Nowadays every doctor is a specialist who refers you to another specialist and the pills they prescribe often border on the reckless and irresponsible.

Big pharma and the billable hours format are the real crooks behind all of this.
It's all about money now.


19 people like this
Posted by Bill Ross
a resident of College Terrace
on Aug 4, 2018 at 4:47 pm

A general rule for initiative measures is that you can only file an initiative for powers that the local government has. Here, neither the City Charter nor applicable sections of the Government Code provide that a charter city like Palo Alto has the power to pass on medical fees and charges. At the City Council hearing on the matter one Councilmember asked if the City's costs would be covered if the matter was litigated and was assured that they would be. So who is covering the City's costs? More importantly why doesn't the City immediately appeal (take a writ) this ruling? This is a dispute between PAMF, Stanford Hospital and the SEIU that should be resolved either by a labor mediator rather than something on the Ballot--which Palo Alto taxpayers will have to pay for. The Health Care providers and the Unions should pay to resolve this matter--not the voters and taxpayers of Palo Alto. The vote is meaningless--it would require the City of Palo Alto to review the cost of medical services--something that it does not have the legal power to do?!!


6 people like this
Posted by Online Name
a resident of Embarcadero Oaks/Leland
on Aug 4, 2018 at 5:06 pm

Online Name is a registered user.

Bill, just curious how patient pricing is a labor matter rather than a consumer protection issue? Some of the pricing and is absolutely outrageous as is using physician assistants to perform the work of doctors. I'll spare you the details but I was amazed at the cost of one test and then even more shocked when I got the PA's card and learned she wasn't a physician.

Obviously Palo Alto lacks the expertise to police health care and the costs could be staggering.


7 people like this
Posted by Gloria Pyszka
a resident of Another Palo Alto neighborhood
on Aug 4, 2018 at 5:48 pm

I'll add that Stanford's charges for MRI's and CT Scans are ungodly high, at least in my book. And, charges for everything, vary natonwide between health providers. The Bay area is one of the highest. Check out the Medicare sites on their national rankings;. Although not a rating of fees for services, it does place Stanford and UCSF as high in overall quality. For whatever that means. Personally, one of my ER visits was for an AMI (acute mycardial infarction - heart attack, plain and simple. I ended up an emergency with 5 stents (for this LOL that's a lot). I gave my doctor, who practices both at Stanford and at PAMF, a bottle of champagne (good stuff too. ) I figured that it was the least I could do b/c he saved me from "open heart". That's where hospitals like Stanford come in handy b/c the doctors do LOTS of procedures/surgeries. "Practice makes perfect." Most of the time.
Oh, the PAMF Urgent care doctor was incredible; he did the tests, made the decisons, and got me over to Stanford in record time. Now, that's worth something in my book.


1 person likes this
Posted by R. Davis
a resident of Crescent Park
on Aug 4, 2018 at 6:04 pm

QUOTE:...the experience of going to a doctor has really gone downhill.

And let's not even get started on the ER experience.

QUOTE: Whatever happened to the trusted general practitioner?

It's called Intenal Medicine now...even the GPs got 'specialized'.



8 people like this
Posted by Annette
a resident of College Terrace
on Aug 4, 2018 at 7:11 pm

Sounds like the City is involved whether it should be or not and that residents will be impacted financially whether that's fair or not. I have long thought the world of medical insurance and coverage and plans to be convoluted and possibly even deliberately that way.

Suggestion: have a few Town Halls on this so that voters can cast an informed vote. Let both sides present their strongest argument as to why this initiative should pass or fail. And record at least one, just as the CC meetings are recorded, so that voters who cannot attend one of the Town Halls can view the proceedings at home and draw their own conclusions.

I am more likely to vote against an initiative that I do not fully understand rather than risk inadvertently supporting something that is not what it purports to be on the surface. This is one issue that demands thorough explanation.


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Posted by resident
a resident of Adobe-Meadow
on Aug 4, 2018 at 9:53 pm

I do know that PAMF negotiates with specific insurance companies - if you go into their finance office there is a listing available. If you are signed up with some insurance company that they have not negotiated a contract with you could be in trouble. I have some choices within my company's collection of services so have to make sure it all works. Also for drugs it has to be listed in the insurance companies formulary to get the cheaper rate. I just had that experience and it is costly in any event.


7 people like this
Posted by Do the Right Thing
a resident of Another Palo Alto neighborhood
on Aug 5, 2018 at 6:33 am

Under “Powers” our city charter up front states:

“The city of Palo Alto, by and through its council and other officials, shall have and may exercise all powers necessary and appropriate to a municipal corporation and the general welfare of its inhabitants which are not prohibited by the Constitution of the State of California or by this charter, and which it would be competent for this charter to set forth specifically, and the specification herein of any particular powers shall not be held to be exclusive of, or any limitation upon, the general grant of powers heretofore or hereafter granted to municipal corporations by the Constitution or general laws.”

I know that it must be very difficult for these councilmembers to imagine that their job is anything except fielding overdevelopment activities, but “general welfare” of its inhabitants is actually their job and can include such things as SAFETY (remember that? So hard, I know) and public health.

“Pierce wasn't persuaded by the argument and noted that the laws cited by Stanford pertain to regulation of health care service plans, while the initiative concerns itself with the costs charged by providers.”
Brilliant judge! Providers and service plans have long made it impossible for policyholders to even be privy to those cost schedules, much less have any recourse in relationship to them, which have such an impact on people’s lives. There are even studies showing that difficult medical billing problems after care can negatively affect health outcomes.

The welfare of residents - and of cities in regards to healthcare costs of employees - is definitely the city’s concern. I think it’s really sad and disappointing to see Stanford try to use federal preemption arguments, which were really developed as a way for insurers to avoid any responsibility to millions of medicare patients and federal employees under state insurance laws, and to strip them of any power to use the courts to protect themselves and as a check and balance on bad faith behavior.

The state recently made a rule that Californians canot use patient copay discount programs, and I am still subject to those rules despite having a federal plan. Federal preemption in relationship to insurance contracts has nothing to do with regulation of local costs. The judge was right, there was no basis for federal preemption in relationship to costs charged/billing, and cities have a strong vested interest in abusive and excessive billing. I can’t understand why Stanford, a non-profit institution supposedly focused on health, would do this. Surely all those smart minds can figure out how to provide good care while paying attention to not shaking down their patients.

For the love of money is the root of all evil, so says the Good Book...


9 people like this
Posted by Me 2
a resident of Old Palo Alto
on Aug 5, 2018 at 10:31 am

SEIU = a pox on the public.

"I know that it must be very difficult for these councilmembers to imagine that their job is anything except fielding overdevelopment activities, but “general welfare” of its inhabitants is actually their job and can include such things as SAFETY (remember that? So hard, I know) and public health."

Uh, it's not the council that has to worry about it on a day-to-day basis. It's about creating a whole new department within the city that needs to be paid by taxpayers. And I'm sure the SEIU has plans to unionize that department to make sure they get their claws into our pocketbooks.

This is Trump-style populism gone amok. SEIU and Trump are two sides of the same coin.


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Posted by other health care providers
a resident of Community Center
on Aug 5, 2018 at 11:41 am

Does "other health care providers" include private therapists, who almost universally refuse to accept insurance?


4 people like this
Posted by the home of repeal and replace
a resident of St. Claire Gardens
on Aug 5, 2018 at 11:49 am

All this whining! We don't have problems with health care any more, ever since Repeal and Replace.

I'm actually tired of all this winning, all these great new laws and congressional wins.

“I am going to take care of everybody … Everybody’s going to be taken care of much better than they’re taken care of now.”


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Posted by Rev. Beecham
a resident of Barron Park
on Aug 5, 2018 at 12:49 pm

[Post removed.]


16 people like this
Posted by Online Name
a resident of Embarcadero Oaks/Leland
on Aug 5, 2018 at 1:15 pm

Online Name is a registered user.

@Rev., another way to reduce the cost of health insurance would be to eliminate payments to religious hospitals like Dignity providing "Catholic health care" where they sacrifice the mothers for the fetus.

I watched a friend die a long slow death at Dignity where they treated her 'morality" instead of her disease, in her case live and kidney failure due to drinking.

The "abomination" was her family's "acceptance" of their repeated prescribing medicines contraindicated for patients with liver and kidney problems when the deaths of other family members from similar alcohol-related illness should have given them a clue.


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Posted by Rev. Beecham
a resident of Barron Park
on Aug 5, 2018 at 1:30 pm

@Online Name

I concur with your opinion. Blind faith is often a precursor to bad tidings.

Then again, it the mother's responsibility to care for her unborn child by abstaining from alcohol and drugs as it is detrimental to the healthy development of a fetus.

One's sense of morality should come from within. While it is an unfortunate tragedy that your friend died in childbirth, perhaps she should have addressed her drinking issue prior to getting pregnant & during her pregnancy.

Responsibility also comes from within & your friend was being reckless & irresponsible.

BTW, I am not Catholic.


4 people like this
Posted by Online Name
a resident of Embarcadero Oaks/Leland
on Aug 5, 2018 at 1:58 pm

Online Name is a registered user.

"While it is an unfortunate tragedy that your friend died in childbirth, perhaps she should have addressed her drinking issue prior to getting pregnant & during her pregnancy."

Rev. Beecham, my friend did NOT die in childbirth. She wasn't pregnant and had never been pregnant.

She like other family members suffered and died from alcohol-related complications. Dignity ignored her family history and downgraded her eligibility for a liver transplant for "moral" reasons.


4 people like this
Posted by Rev. Beecham
a resident of Barron Park
on Aug 5, 2018 at 2:10 pm

>>>She like other family members suffered and died from alcohol-related complications. Dignity ignored her family history and downgraded her eligibility for a liver transplant for "moral" reasons.

Apologies for misreading your initial post.

That was 'morally' reprehensible for Dignity to pass judgement like that.

Like the separation of 'church & state', there should also be a separation of 'religeous dogma & the practice of medicine'.

I would consider changing faiths or doctors.


8 people like this
Posted by Caleb
a resident of Nixon School
on Aug 5, 2018 at 3:06 pm

Get the government OUT OF MY RELIGION!

There is no way that the government should use our taxpayer dollars to try and (first) gain favor inside my church, and (then) start influencing my church, to the point of eventually dictating rules. Or worse, at some point favoring another church over mine.

[Portion removed.]




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Posted by Rev. Beecham
a resident of Barron Park
on Aug 5, 2018 at 3:21 pm

[Post removed.]


Like this comment
Posted by Crimson Tide
a resident of another community
on Aug 5, 2018 at 3:37 pm

[Post removed.]








4 people like this
Posted by Caleb
a resident of Nixon School
on Aug 5, 2018 at 4:26 pm

[Post removed due to deletion of referenced comment.]


4 people like this
Posted by R. Davis
a resident of Crescent Park
on Aug 5, 2018 at 5:41 pm

[Post removed due to deletion of referenced comment.]


16 people like this
Posted by Surprised by perceptions
a resident of Duveneck/St. Francis
on Aug 6, 2018 at 12:01 pm

As a physician, I am really surprised by a lot of the replies to this post. I'm not upset, but I realize that even in this very educated community, most lay people don't understand how complicated health care is. To debunk some of the misinformation posted above:

- the City of Palo Alto government is NOT in the healthcare business. It is going to become a very expensive, and irresponsible, proposal to have them allocate costs of individual aspects of healthcare. (How much should it cost to amputate 1 toe? How about if 2 toes on the same foot need amputation vs. the big toe on one foot vs. the little toe on the other? Same reimbursement? 50%?)

-The SEIU vs. Stanford issue is really a power play by SEIU. What SEIU wants - and Stanford won't give - is to allow more of their employees to become SEIU union employees. When Stanford said "no," SEIU started a smear campaign that culminated with the ballot measure.

-All who are concerned here should research the term "pharmacy benefit manager" if they wish to see where the real expenses lie.

-Physicians make up 8% of healthcare costs. Currently, local hospitals are having a hard time recruiting generalists because they simply can't make a living. $80-120K is not abnormal for a full time generalist. For institutions who wish to recruit the "best and brightest," that's simply becoming more difficult.

-While the desire to vote for the low-hanging fruit of "cheaper healthcare in Palo Alto" looks tempting, consider that cheaper costs may lead to A) waiting longer to see a physician; B) being sent to an NP who has 10-15% the training of an MD (and is not always supervised onsite as CA law does not require onsite supervision...just some kind of "supervision;") C) Even less time spent with your doctor/NP/therapist D) less access to innovative tests.

-"The experience of going to the Doctor has really gone downhill." Agree. And the experience of BEING a doctor has too. The confluence of those two factors has put American medicine on a crash course.

-For those so inclined and able, concierge medicine [with some local practices charging $20K/patient/year] may improve your "downhill" experience. But assigning the City Council to lower costs will not....



4 people like this
Posted by Not as surprised
a resident of Gunn High School
on Aug 6, 2018 at 12:53 pm

I agree with every word, Surprised.

But some local hospitals charge gratuitous and outrageous fees to recoup other losses.

Some of these other losses are essentially required by law. Others are management choices, or other management activity or lack of activity (such as under paying physicians or optimizing profit over patients).

When a patient needs a hospital, there is no time to check for these landmine charges.

So they should be influenced by law.


4 people like this
Posted by concerned
a resident of Barron Park
on Aug 6, 2018 at 12:57 pm

How could the Palo Alto council even pretend that it is interested in health when they gleefully voted Verizon's plans for 5 G and numerous cell towers. These will make us all sick.

One of the reasons hospitals charge so much is that they have to cover the cost of the uninsured.


9 people like this
Posted by Caleb
a resident of Nixon School
on Aug 6, 2018 at 1:24 pm

"Physicians make up 8% of healthcare costs."

Do you have links to the *actual study* that cites this number? (not the "re-links" that spew forth with that number without substantiation, like the medscape page or the jackson press release without annotation.)

What do you think of this JAMA study addressing the monopolies in Medicine?
Web Link

Your statement against organized workers, as a person claiming to be a physician, is not surprising. Do you see any value for healthcare workers having strong representation?


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Posted by Surprised by perceptions
a resident of Duveneck/St. Francis
on Aug 6, 2018 at 1:45 pm

@not as surprised. Good points. So many points could be made as things are so complicated.....which is another reason why local government is ill-equipped to tackle this.


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Posted by Surprised by perceptions
a resident of Duveneck/St. Francis
on Aug 6, 2018 at 1:50 pm

@Caleb-
Here you go on salary date quoted:

Web Link

Further clarification of the breakdown and rationale:
Web Link


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Posted by surprised by perceptions
a resident of Duveneck/St. Francis
on Aug 6, 2018 at 1:56 pm

@Caleb, to further respond to your points:

1) You posted an EDITORIAL from JAMA. I could critique it, but it's a critique itself. Best to review data.

2) I made no statement against organized workers. I simply stated the history between Stanford and SEIU that led to the ballot measure. Unionization of physicians would help our profession actually as it would provide leverage against unreasonable administrative demands and better protect the physician/patient relationship. One example of what has happened when a physician tackled her employer without the benefit of union representation is playing out right now in Palo Alto. Web Link


4 people like this
Posted by Typical Expense
a resident of Charleston Meadows
on Aug 6, 2018 at 2:04 pm

Went to the ER. Thought I might need some stitches for a cut on my pinky.

After triage, I waited 3 hours to be seen (by a nurse).

Received a tetanus shot, some Neosporin to cover the wound and a band-aid.

Cost: $934.00




3 people like this
Posted by Caleb
a resident of Nixon School
on Aug 6, 2018 at 2:11 pm

That was the press release I referred to already (... or the jackson press release without annotation)

You did not answer the question directly - so shall we assume your support for doctors unions would also extend to the all levels of healthcare workers having representation?

Correct, the JAMA link is an editorial, with facts. So I'll amend the question you ducked: What do you think of this JAMA piece addressing the monopolies and in Medicine?


6 people like this
Posted by Get Real
a resident of Stanford
on Aug 6, 2018 at 3:29 pm

"Bring back Marcus Welby, MD. He never seemed to have a problem with these kinds of issues...Of course, that was TV-land."

"Big pharma and the billable hours format are the real crooks behind all of this. It's all about money now."

No kidding. At Palo Alto Medical Foundation, physicians are evaluated by high much revenue they generate. The less less time they spend with with patients = more appointment billings.

MDs are getting to be just like lawyers.


5 people like this
Posted by surprised by perceptions
a resident of Duveneck/St. Francis
on Aug 6, 2018 at 4:11 pm

@Caleb,

1) The Jackson Press report references the Centers for Medicare and Medicaid Services (CMS) data on health care spending and physician compensation. CMS collects this data from insurers, 3rd party vendors, and other sources. There is no "randomized study" involving a control arm (or rats) that produces this data. If you are truly interested, I encourage you to look at their website. Their data is the data that the US government uses in making policy decisions, etc.

2) Regarding unions, I cannot speak for other professions. For physicians, unionization could help with accreditation, legal matters regarding patient litigation, credentialing & privileges, limiting administrative burden (ie limiting the number of patients that administration wants physicians to see each hour) and salary negotiation. Food service workers, environmental workers (many of whom are SEIU members) do not face these issues at work, but again, their own professions face their own employment obstacles that I am not privvy to.

3) Regarding the editorial that you sent, there's a lot of information in there, and it's stuff most healthcare professionals are aware of, but are paralyzed by. Defensive medicine is not discussed at length, whereby over-ordering of [expensive] tests is common to fend off medical litigation or the medical board. Other countries do not deal with this burden as heavily. Also, as mentioned, medical school debt is not subsidized here as in other countries. Hospital CEOs do not make $5million in many other countries, big Pharma is not in bed with the government, and PBMs are not such a large source of waste....


2 people like this
Posted by Surprised by perceptions
a resident of Duveneck/St. Francis
on Aug 6, 2018 at 4:16 pm

@getreal - so I guess you're not aware that one of the tenets of medical billing depends on time spent with the patient. For coding - more face to face time = higher billing code. Billing could also be done by complexity. Complex patients with problems generate higher billing codes because there's more decision making and more time required. So stuffing more patients into an hour doesn't produce more minutes in the hour. It just means less time with each patient and lower billing codes.


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Posted by Jim
a resident of Menlo Park
on Aug 6, 2018 at 4:27 pm

> the measure would ban local health care providers from charging more than 15 percent of what it costs them to provide care.

I think this should say "15 percent over".


11 people like this
Posted by I’m with surprised
a resident of Crescent Park
on Aug 7, 2018 at 1:00 am

@surprised by perceptions. Please stay engaged in this issue and please keep posting good sources. Please even draft an argument against the initiative. Why isn’t the initiative to cap insurance profits? I’ve always supported unions - lots of family members in them. But not in CA. This is over the top. By trying to simplify an incredibly complex pricing/negotiation system into a simple 15% “cap” the Union has only demonstrated that they don’t understand anything about how those charges are generated. I’m annoyed this Union is wasting public funding and time on their fight with Stanford. It costs the City a lot to put an initiative on the ballot. I’d rather see that $200k+ go to school lunches, homeless shelters and programs, food banks, VA services, assistant for the elderly, library funds, school funds, habitat restoration, water conservation - you get the idea. Keep personal personnel fights out of our ballot box. SEIU has some themselves a real disservice this time. For the first time in my life I think I’m voting against the union. May my long deceased grandfather understand and forgive me.


2 people like this
Posted by Annette
a resident of College Terrace
on Aug 7, 2018 at 11:27 am

Annette is a registered user.

@surprised by perceptions - I agree with the poster who asked that you stay engaged and continue to post helpful sources. Please do.


4 people like this
Posted by Why?
a resident of Midtown
on Aug 7, 2018 at 8:23 pm

So how much of this reaction to this measure is simply knee jerk because its sponsored by a Union?

The reality is that the hospitals in question are consistently among the most expensive in the region. This is for routine care and basic stuff like MRI's and the like.

If you pull their IRS 990's for a hospital system they are doing quite well. From 2011 to 2016 Packard Childrens Hospital had a net profit AFTER expenses of about 730 million. Don't take my word for it. Web Link

This is above and beyond the usual shell game of unnecessary building, more VP's than you can shake a stick at, Executive compensation of a NON profit making almost 1.5 million a year for the CEO and the like. (all of this is detailed in the 990's)

The measure has its merits. and the profit curve of the facility seems to point to unnecessarily high charges for basic care and services of a hospital that is supposed to serve the community


2 people like this
Posted by Me 2
a resident of Old Palo Alto
on Aug 8, 2018 at 3:30 pm

"So how much of this reaction to this measure is simply knee jerk because its sponsored by a Union?"

One particular union. The SEIU is bad news.

"The reality is that the hospitals in question are consistently among the most expensive in the region. This is for routine care and basic stuff like MRI's and the like. "

I'm the last person to defend Stanford and the consolidation of healthcare in the Bay Area that they're driving, but what's your point?

If you don't like Stanford hospital, there are others in the region to go to. And, by the way, prices are always negotiated with insurance carriers. That's the real price. Your out of pocket costs are really driven by the plan you have, which includes your co-pay and deductible and so forth. And there's always a cash price that you can ask for.

What's missing from all these pricing "disclosures" for ER visits, MRIs, etc. is whether the cost was just on an invoice to paid by insurance, what was the out of pocket costs and so forth.

The last thing I (or anybody who's a resident of Palo Alto) want is to have the city balloon out it's already bloated infrastructure to pay for a new agency to regulate based on a poorly worded proposition (yeah, I know, it's redundant) that is driven not by public benefit, but a dispute between a private entity and a union.

The motives are disgusting, but par for the course for a bloodsucking union like the SEIU.


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Posted by The Big Rip-Off
a resident of Stanford
on Aug 8, 2018 at 3:59 pm

My great-grandfather was a country doctor in rural Kansas. He never got wealthy but was a devoted MD to all of his patients.

He was often paid with chickens, eggs and various quilt works. His billing book was always filled with IOUs yet he never resorted to a collection agency or refused to treatment to anyone.

Doctors today are different. Most get into the field & 'specialize' so they can rake in the big bucks. Add payola from pharmaceutical companies & they've got it made.


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Posted by Bunyip
a resident of Adobe-Meadow
on Aug 8, 2018 at 10:14 pm

Irony is that this will affect business and the SEIU workers will be the first to be laid off.

Go unions!!


2 people like this
Posted by Anon
a resident of Another Palo Alto neighborhood
on Aug 9, 2018 at 7:12 am

Above postings contain references pointing to 8-10% of total expenditures going to physician income. Anyone have a reference that shows how the total healthcare spending pie gets sliced? In particular, I would like to know how much actually gets spent by the insurance companies companies themselves "inside"-- that is, money that never makes it to doctors, nurses, aides, clinics, hospitals, or, drug companies.

This particular initiative is rather odd, but, I also think that *all* hospitals and clinics receiving public and/or insurance money should have to disclose how much of the money they get is actually spent on the cost of providing care.



10 people like this
Posted by Caleb
a resident of Nixon School
on Aug 9, 2018 at 10:01 am

"I would like to know how much actually gets spent by the insurance companies companies themselves "inside"-- that is, money that never makes it to doctors, nurses, aides, clinics, hospitals, or, drug companies."


We have three healthcare delivery systems in America:

1. Socialized Medicine: ie.. the VA. Lowest overhead - next to nothing, as the costs of the doctors and buildings do not have anything added on by insurance companies for profit, administration, exec bonuses, etc..

2. Single Payer: Medicare, etc.. has a 1.2% overhead

3. For profit insurance companies: I've heard numbers as low as 12% to as high as 30%. It costs a lot of money to fill buildings with workers whose job it is is to deny claims, etc.. Plus profit. Plus exorbitant salaries, stock and bonuses for executives.

Plus those buildings have to have gold-plated faucets in the C Suites. Someone is paying for all that.

Example: John Martin, Gilead Sciences (yes, pharmaceutical,) made $863 million in the ACA era (aprox 5 years?)

My guess is he had gold-plated faucets in his Gulfstream G650ER.

Insurance companies: 2010-2015, the "CEOs of 70 of the largest U.S. healthcare companies cumulatively have earned $9.8 billion"

Averages over $20 million a year. Plus the gold faucet costs.

How much healthcare could we provide with 10 billion over 6 years? Instead, we got... what? More Gulfstreams?


(Don't worry about them, though: they also all just got HUGE tax cuts, because they *really* needed them.)


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Posted by Commies!!!!
a resident of Downtown North
on Aug 9, 2018 at 12:30 pm

I'm waiting for the guy who screams that we don't have socialized medicine in the good ol' you ess of vay

Good post, Caleb


2 people like this
Posted by Puh-tey Poot Putin
a resident of Midtown
on Aug 9, 2018 at 12:59 pm

Socialized Medicine!!!!!!

O. M. Gosh!!


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Posted by Me 2
a resident of Old Palo Alto
on Aug 9, 2018 at 3:32 pm

"How much healthcare could we provide with 10 billion over 6 years? Instead, we got... what? More Gulfstreams?"

How good will our healthcare be if it were operated like SF MUNI? Or California High Speed Rail?

Okay, those are an extreme examples of governmental incompetence. But let's say we use the VA model. Gotta love how good the service is:

Communication lapses led to 16 patient deaths at Memphis VA hospital, OIG says Web Link

Nearly 100 patients died waiting for care from Los Angeles VA
Web Link

307,000 veterans may have died awaiting Veterans Affairs health care, report says
Web Link

Yes, it's all unicorn and roses at the VA.


8 people like this
Posted by Caleb
a resident of Nixon School
on Aug 9, 2018 at 4:44 pm

@me2: "Yes, it's all unicorn and roses at the VA"

Ask 100 vets if they want to:

a) use private for-profit insurance companies
b) be in MediCare
c) stay in (and obviously improve) the VA

Google the poll results.

Single Payer would be existing healthcare systems (Medicare for all.)

Are you arguing for For-Profit insurance companies to get in between you and your doctor?

For 30% off the top?

What *are* you arguing for? I've read your posts, and I can't figure out what you are looking for?


1 person likes this
Posted by Me 2
a resident of Old Palo Alto
on Aug 9, 2018 at 5:31 pm

"Ask 100 vets if they want to:

...

Google the poll results."

Of course VA. "Free to them" is free. But free doesn't necessarily mean good either. McDonalds is cheaper than Baume, but you can't argue that McD's is necessarily better, although I do like the fries.

"Single Payer would be existing healthcare systems (Medicare for all.)... Are you arguing for For-Profit insurance companies to get in between you and your doctor?"

Not making any arguments, but knowing as much as I do about government-run insurance like Medicare and Medi-Cal, I know that cost control is more important than care. Much more. Price controls have lots of unintended consequences that we experienced under Nixon.

"What *are* you arguing for? I've read your posts, and I can't figure out what you are looking for?"

I'm not arguing for anything. I poke holes in arguments from dogmatic points of view. It's a lot of fun, especially when you poke the residentialists.


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Posted by Syl
a resident of Old Palo Alto
on Aug 9, 2018 at 8:50 pm

[Post removed.]


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Posted by Me 2
a resident of Old Palo Alto
on Aug 9, 2018 at 9:18 pm

[Post removed.]


2 people like this
Posted by Caleb
a resident of Nixon School
on Aug 10, 2018 at 10:01 am

"I poke holes in arguments" "I'm not arguing for anything."

Well, that's easy, isn't it? Certainly, your admitting you have no answers or substantial thoughts means one don't need to waste further time reading your posts. One can invest time in substantive posts, from critical thinkers, rather than a post that grouses about everything yet offers nothing.

Thank you.


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Posted by Me 2
a resident of Old Palo Alto
on Aug 10, 2018 at 11:48 am

"Well, that's easy, isn't it? "

No it isn't. I would be the first to admit that there are no easy answers to our healthcare situation. All ideas have major flaws. To advocate for one solution without understand the downsides is actually much easier than recognizing the complexities. That's what I mean by poking holes in arguments from dogmatic points of view.

Single payer helps with the cost issue at the detriment to services levels. Our state/local/federal governments have a track record of mismanagement, corruption *and* subject to political whims. Imagine a federal single payer solution that doesn't include abortions because some Christian fundamentalist Democratic majority in Congress and the Presidency (yes, it's not a political party thing - there are conservative Democrats as there are liberal Republicans regardless of what MSNBC and Fox would want you to believe) doesn't believe in it?

Those are among the complexities of single payer. To not acknowledge those issues is policy whitewashing and that is really what will get us in trouble.


2 people like this
Posted by Caleb
a resident of Nixon School
on Aug 10, 2018 at 12:14 pm

[Portion removed.]

“Complaining about a problem without posing a solution is called (google it).”

― Theodore Roosevelt

Perhaps the better choice would be Francis Jeffrey: "The tendency to whining and complaining may be taken as the surest sign symptom of..."

(look up the rest of it...)

This initiative is a proposed solution. Like all solutions, there are usually trade-offs and decisions to be made. One can study and decide, or one can follow the route admirably described by Francis Jeffrey.

ie.. the easy, least taxing, way.


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Posted by Me 2
a resident of Old Palo Alto
on Aug 10, 2018 at 12:48 pm

[Portion removed.] If you're unwilling to discuss the tradeoffs, no one can make an informed decision on what the path forward should be.

[Portion removed.]


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Posted by Me 2
a resident of Old Palo Alto
on Aug 10, 2018 at 1:15 pm

Here's a quote for you Caleb,

"Progress is impossible without change, and those who cannot change their minds cannot change anything."

- George Benard Shaw


2 people like this
Posted by Caleb
a resident of Nixon School
on Aug 10, 2018 at 1:40 pm

Your strawmen are looking rather feeble in the slightest breeze.

"If you're unwilling to discuss the tradeoffs"

Please - continue: what do you propose? No proposal? What do you favor?

After all, with all your self-described "dogmatic points of view" you've been completely unable to have a position or thoughts on moving forward? That sounds like you are saying you are UNABLE to have a point of view, despite having so many "dogmatic points of view".

Ahhh, I apologize, I was slow to pick up on this: you have too many "dogmatic points of view" to have a point of view.

I have great respect for those (right, left or center) who have spent time understanding an issue, make suggestions, and honestly discuss with an eye towards continued improvement. I'm not sure I have conversed with one with so many points of view to not have a point of view.

Quite unique.

Have a good day.


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Posted by Me 2
a resident of Old Palo Alto
on Aug 10, 2018 at 1:49 pm

"I have great respect for those (right, left or center) who have spent time understanding an issue, "

I probably have more hands on experience with insurance and billing than most people who just read a lot of things on the internet who become "experts."

I hate insurance companies. They suck.

And believe it or not, Medi-Cal is *WORSE* than insurance companies.

So Caleb, what are your sources of knowledge?


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Posted by Caleb
a resident of Nixon School
on Aug 10, 2018 at 2:10 pm

"So Caleb, what are your sources of knowledge?"

My sources are NOT anonymous internet posters who make sweeping, useless statements that cannot be independently verified. For example:

"And believe it or not, Medi-Cal is *WORSE* than insurance companies."

One could google your "fact" but, c'mon... Besides: smell test - how many Medicare eligible citizens forego Medicare for private, for-profit insurance companies? How many Americans support ending Medicare and throwing themselves to the wolves of private, for-profit insurance companies?

*

By the way: the root of your "dogmatic points of view" is DOGMA. You may be better served by claiming your view is PRAGmatic.

dog·mat·ic
inclined to lay down principles as incontrovertibly true.

synonyms: opinionated, peremptory, assertive, insistent, emphatic, adamant, doctrinaire, authoritarian, imperious, dictatorial, uncompromising, unyielding, inflexible, rigid


prag·mat·ic
dealing with things sensibly and realistically in a way that is based on practical rather than theoretical considerations.

*


So start posting under another name, and claim your view is pragmatic, not dogmatic. Non-critical readers may actually believe you for a bit. Although with statements like the above "Medi-Cal is *WORSE*..." well, the dogma shines through anyway.

Just saying...



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Posted by Me 2
a resident of Old Palo Alto
on Aug 10, 2018 at 7:11 pm

Your dedication to single payer is almost religious, with the fervor so great. No discussion allowed.

It's blasphemy!

Caleb - single name does not make you known. You're just as anonymous as me. If that's your real name....


8 people like this
Posted by Caleb
a resident of Nixon School
on Aug 11, 2018 at 8:39 am

"Your dedication to single payer is almost religious, "

That's hilarious - your dogma is showing... how dogmatic!

I've made two comments about Single Payer; one in reference to the three systems in these country (Medicare overhead at a skimpy 1.2% vs for-profit insurance) and a comment that referenced your statement of (dogma) against Single Payer.

re: anonymity - my statement was only to not blindly accept an anonymous poster's blanket over-simplifications as " sources of knowledge".

Not only to you adhere blindly to your self described Dogma, your Dogma blinds you to basic reading comprehension.

Alas, you have yet to be FOR anything, only against everything in healthcare. Your "No discussion allowed" statement is absurd - YOU have yet to discuss any solution!

Some credit to you: at least you do not try the trite "across state lines" and "tort reform" babble.



dog·mat·ic
inclined to lay down principles as incontrovertibly true.
synonyms: opinionated, adamant, doctrinaire, authoritarian, imperious, dictatorial, uncompromising, unyielding, inflexible


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Posted by Me 2
a resident of Old Palo Alto
on Aug 11, 2018 at 9:07 am

It's clear with you avoiding answering my questions that you only have desk-jockey knowledge of healthcare. Pretty obvious when you can't engage on substantial discussion and just parrot talking points.


4 people like this
Posted by Caleb
a resident of Nixon School
on Aug 11, 2018 at 10:23 am

"It's clear with you avoiding answering my questions that you only have desk-jockey knowledge of healthcare. Pretty obvious when you can't engage on substantial discussion and just parrot talking points."

OMG - you win!!! I'm sooooo busted! I'm an anonymous online poster who claimed: "I probably have more hands on experience with insurance and billing than most people who just read a lot of things on the internet..."

Oh, wait, that's YOU. btw: what talking points did I use?

But for grins, let's say you are some sort of anonymous EXPERT (ha) and I know nothing... why haven't you told us what you are FOR?

All your Dogma allows is complaining. You've been asked time after time what you prefer, and you fail every time. You dissemble. You lie. You use strawmen. Blanket claims. Over-generalizations. On and on.

Yet you have nothing.

I have yet to see a series of document-able facts and a solution.

Zip. Nada. Nothing.



I repeat: "Your 'No discussion allowed' statement is absurd - YOU have yet to discuss any solution!"



dog·mat·ic
synonyms: opinionated, adamant, doctrinaire, authoritarian, imperious, dictatorial, uncompromising, unyielding, inflexible


2 people like this
Posted by Dave Ross
a resident of Portola Valley
on Aug 12, 2018 at 10:03 am

I get my healthcare at PAMF, and have been a patient at Stanford Hospital. So even though I don't live in PA any more, I'm following this discussion with some interest.

Many commenters have used the SEIU initiative as a launch pad for their frustration with the whole health care system. Nothing wrong with that, discussion is good. I'm especially interested in the idea of regulating a business' charges.

Living, or even hanging out in Palo Alto has gotten so expensive it's clear we need more of this. Has anyone had their house remodeled lately? How about: the fees Palo Alto attorneys charge their clients, the price of baby sitters and the real killer - restaurant charges. I don't eat in downtown any more because the cost of a meal has gotten so high (I do sometimes eat at the Panda Express on ECR near California Ave - very reasonable). Why not regulate them all?

This whole new area of governance may be exactly what Palo Alto needs. But watch out - City Hall is already bursting at the seams. The number of people needed to regulate these businesses is going to be immense, so that means more (expensive) construction or trying to outbid Palantir for office space. And of course, all of those regulators will need places to live, to park, to eat, and will need baby sitters and attorneys from time to time. It seems like less winning to me, when I try to think it all the way through.


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Posted by Me 2
a resident of Old Palo Alto
on Aug 12, 2018 at 10:46 am

" I'm especially interested in the idea of regulating a business' charges. "

What's flawed about the proposition is that it supposedly caps pricing at 15% above costs. That's what makes this such a poorly worded proposition. It conveniently does not cap the *costs*, so the SEIU is free to keep negotiating higher pay for nurses. Prices will continue to climb as the nursing shortage continues.

Of course the SEIU wasn't going to cut itself off at the knees by really addressing our skyrocketing healthcare costs. It's free to suck in a higher percentage of patients' pocketbooks while pretending to do something about it.

If you really want to impact pricing, then you should be capping pricing regardless of costs, putting a ceiling on salaries in the process. However, putting an arbitrary price ceiling usually results in a reduction in supply. There are tons of examples not just in the United States, but around the world where price ceilings fail. Venezuela is the existing example.

Fundamentally the problem is that demand signals are separated from supply response. For people with insurance, healthcare is low cost, leading to higher demand. Meanwhile insurance buffers those signals, and their response is to deny deny deny to cap their costs. That in turn causes providers to increase prices to make up for the losses from denied claims.

And on it goes.


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Posted by Dawg
a resident of Adobe-Meadow
on Aug 12, 2018 at 7:56 pm

Hah, yeah, a complete lack of preferred solutions. But great at picking everything apart.

Dawgomatic.


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