1950 hospital maternity bill

[Scott Shepherd]

Ken, I agree. I also know that money is like water and electricity. It takes the path of least resistance. If you decide it's a great idea to take more money from the rich in the USA, once you sign it into law, I don't believe for one minute everyone that's rich will sit around and say "Aren't I great, I'm helping save someone else". My educated guess is they will be googling "Cheapest place in the world for taxes" and then the next search will be "Property in cheapest tax rate in the world". The money will leave the USA for good, taking all our "Sugar Daddy's" from us, leaving less Sugar Daddy's to pay the bills. If it's less of them, and more of us, their share will go up again. It will either cause them to go broke or to leave as well. Eventually, the burden will come back upon us, as individuals and we'll have to pay more.

People with money won't sit and let it get taken from them without their permission. I know if I were rich, I certainly wouldn't.

[Jason Roehl]

But, Ken, that's how the free market works. Maybe Scott's employer doesn't give him the difference. It only takes one other employer to dangle that offer, though... Employees are not forbidden from voting with their feet.

One thing I almost NEVER hear mentioned is that if everyone in this country has health care coverage, it's no longer insurance. Insurance, by definition, leaves out the highest-cost/highest-risk segment of the population, or escalates their costs dramatically to be in line with their probable use of their policy.

Glenn mentioned that we spend something like $6700 per capita on health care in this country. If I had to pay that for my household of 5, I'd be ticked. For one, that would be a major portion of my income, and two, I don't use anywhere near that amount of health care services each year (so far). Not even close. Last year, I spent about $300 on a dentist (stupid wisdom tooth), and that was it. This year, nothing so far. I don't run to the doc for every little sniffle--I have to have something pretty wrong with me before I go--and I try to stay fit and eat healthy.

[Scott Shepherd]

Wow, the post office does a good job? You mean the post office that's going broke?

Military is efficient? You mean the military that just spent billions of dollars bringing the F-22 out, only to have the Pentagon say it's outdated and they don't need it now? BILLIONS of dollars. Remember when we used to talk Millions? Now it's BILLIONS on one project?

You mean the stealth ship that got scrubbed after BILLIONS invested? That Military is efficient? It's not the men and women of the military that are inefficient, it's the system.

DMV? State, local, it's all the same. Their hand in my pocket and giving me poor service.

IRS is efficient? Another WOW! Have you seen the tax code? Have you called the IRS for help? I have. I've been told "I don't know" by their people because it was too complex for them to have an answer for me.

Wow, if you think those operations are efficient, I'd strongly suggest you read up on Dr. Deming's work. It's a great read and he was one of the smartest people this country ever saw. And he wasn't a politician! He was a manufacturing guy.

[Scott Shepherd]

Just for those interested, I think reading this could shed some light into other things. I think if you apply this to our current situation, you'll see we're taking the wrong approaches on many levels. Everywhere these techniques have been applied, they have worked amazing results. It really is an amazing thing to witness and be part of, and it really does work.

This is from wikipedia, but it's all accurate information, directly from his publications :

Deming philosophy synopsis

The philosophy of W. Edwards Deming has been summarized as follows:
"Dr. W. Edwards Deming taught that by adopting appropriate principles of management, organizations can increase quality and simultaneously reduce costs (by reducing waste, rework, staff attrition and litigation while increasing customer loyalty). The key is to practice continual improvement and think of manufacturing as a system, not as bits and pieces."[20] In the 1970s, Dr. Deming's philosophy was summarized by some of his Japanese proponents with the following 'a'-versus-'b' comparison:
(a) When people and organizations focus primarily on quality, defined by the following ratio, quality tends to increase and costs fall over time. (b) However, when people and organizations focus primarily on costs, costs tend to rise and quality declines over time.
[edit] The Deming System of Profound Knowledge

"The prevailing style of management must undergo transformation. A system cannot understand itself. The transformation requires a view from outside. The aim of this chapter is to provide an outside view—a lens—that I call a system of profound knowledge. It provides a map of theory by which to understand the organizations that we work in.
"The first step is transformation of the individual. This transformation is discontinuous. It comes from understanding of the system of profound knowledge. The individual, transformed, will perceive new meaning to his life, to events, to numbers, to interactions between people.
"Once the individual understands the system of profound knowledge, he will apply its principles in every kind of relationship with other people. He will have a basis for judgment of his own decisions and for transformation of the organizations that he belongs to. The individual, once transformed, will:

• Set an example;
• Be a good listener, but will not compromise;
• Continually teach other people; and
• Help people to pull away from their current practices and beliefs and move into the new philosophy without a feeling of guilt about the past."

Deming advocated that all managers need to have what he called a System of Profound Knowledge, consisting of four parts:

1. Appreciation of a system: understanding the overall processes involving suppliers, producers, and customers (or recipients) of goods and services (explained below);
2. Knowledge of variation: the range and causes of variation in quality, and use of statistical sampling in measurements;
3. Theory of knowledge: the concepts explaining knowledge and the limits of what can be known (see also: epistemology);
4. Knowledge of psychology: concepts of human nature.

Deming explained, "One need not be eminent in any part nor in all four parts in order to understand it and to apply it. The 14 points for management in industry, education, and government follow naturally as application of this outside knowledge, for transformation from the present style of Western management to one of optimization."
"The various segments of the system of profound knowledge proposed here cannot be separated. They interact with each other. Thus, knowledge of psychology is incomplete without knowledge of variation.
"A manager of people needs to understand that all people are different. This is not ranking people. He needs to understand that the performance of anyone is governed largely by the system that he works in, the responsibility of management. A psychologist that possesses even a crude understanding of variation as will be learned in the experiment with the Red Beads (Ch. 7) could no longer participate in refinement of a plan for ranking people."[21]
The Appreciation of a system involves understanding how interactions (i.e. feedback) between the elements of a system can result in internal restrictions that force the system to behave as a single organism that automatically seeks a steady state. It is this steady state that determines the output of the system rather than the individual elements. Thus it is the structure of the organization rather than the employees, alone, which holds the key to improving the quality of output.
The Knowledge of variation involves understanding that everything measured consists of both "normal" variation due to the flexibility of the system and of "special causes" that create defects. Quality involves recognizing the difference in order to eliminate "special causes" while controlling normal variation. Deming taught that making changes in response to "normal" variation would only make the system perform worse. Understanding variation includes the mathematical certainty that variation will normally occur within six standard deviations of the mean.
The System of Profound Knowledge is the basis for application of Deming's famous 14 Points for Management, described below.

[edit] Dr. W. Edward Deming's 14 points

Deming offered fourteen key principles for management for transforming business effectiveness. The points were first presented in his book Out of the Crisis. (p. 23-24)[22]

1. Create constancy of purpose toward improvement of product and service, with the aim to become competitive and stay in business, and to provide jobs.
2. Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
3. Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the product in the first place.
4. End the practice of awarding business on the basis of price tag. Instead, minimize total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust.
5. Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
6. Institute training on the job.
7. Institute leadership (see Point 12 and Ch. 8 of "Out of the Crisis"). The aim of supervision should be to help people and machines and gadgets to do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers.
8. Drive out fear, so that everyone may work effectively for the company. (See Ch. 3 of "Out of the Crisis")
9. Break down barriers between departments. People in research, design, sales, and production must work as a team, to foresee problems of production and in use that may be encountered with the product or service.
10. Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
11. a. Eliminate work standards (quotas) on the factory floor. Substitute leadership.
    b. Eliminate management by objective. Eliminate management by numbers, numerical goals. Substitute leadership.
12. a. Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
    b. Remove barriers that rob people in management and in engineering of their right to pride of workmanship. This means, inter alia," abolishment of the annual or merit rating and of management by objective (See Ch. 3 of "Out of the Crisis").
13. Institute a vigorous program of education and self-improvement.
14. Put everybody in the company to work to accomplish the transformation. The transformation is everybody's job.

"Massive training is required to instill the courage to break with tradition. Every activity and every job is a part of the process." [23]

[edit] Seven Deadly Diseases

The "Seven Deadly Diseases" include

1. Lack of constancy of purpose
2. Emphasis on short-term profits
3. Evaluation by performance, merit rating, or annual review of performance
4. Mobility of management
5. Running a company on visible figures alone
6. Excessive medical costs
7. Excessive costs of warranty, fueled by lawyers who work for contingency fees

"A Lesser Category of Obstacles" includes

1. Neglecting long-range planning
2. Relying on technology to solve problems
3. Seeking examples to follow rather than developing solutions
4. Excuses, such as "Our problems are different"

Deming's advocacy of the Plan-Do-Check-Act cycle, his 14 Points, and Seven Deadly Diseases have had tremendous influence outside of manufacturing and have been applied in other arenas, such as in the relatively new field of sales process engineering.

[Ken Fitzgerald]

Ah ideology!

Perfect in theory.....has absolutley nothing to do with practical application....

[Scott Shepherd]

Ah ideology!

Perfect in theory.....has absolutley nothing to do with practical application....

Ken, Deming was one of the most successful people in the history of manufacturing. His principles are responsible for Toyota and Honda in the 50's, 60's and 70's when they were producing amazing quality. The Toyota Production System (Possibly the most successful system in manufacturing in the world) is based on Deming's work. The USA wouldn't listen to him, the Japanese thought he was brilliant. They invited him to Japan, he taught and spoke and changed their entire economy and world.

Deming was one of the most brilliant people manufacturing ever saw. His ideas, principles, and work speak for themselves. There's no where it's been applied that it didn't create astounding results. Having worked in places that followed Deming's principles, I can tell you that it's something very special and amazing. The problem is getting senior management to get their head out their behind and get with the program.

If you don't know anything about Deming, take the time to study him. His principles have been applied to failing school systems, and those schools turned into very successful school systems. Everywhere it's been applied, it's changed the places and industries for the positive.

I think that's a long way from "theory". He had about 70 years in manufacturing and changing processes in all sorts of operations. He lived more "practical application" than you or I ever will. His systems work. Can you say that about our current system? I can't.

[Ken Fitzgerald]

Scott,

His theory as you presented it here might work well with the Japanese society. Their society has a totally different attitude than the US society.

I agree in principle with a lot of what you presented here. The trouble arises when you suggest that someone in business administration give up control by tearing down walls between departments......quit worrying about short term profits...... Long range planning? What is that? Let's just worry about this months numbers.....and of course we have to have the "flavor of the month number" to worry about. The list of things he suggests that current American business administrators would fight is endless....

There is a difference between administering a business plan and managing people and circumstances. There are far too many administrators and damn few managers.


As it would take courage on the part of our govenment leaders to pass a well researched, planned, and financially viable health care system...it would take the same kind of courage to make changes as you suggest in businesses. I'm getting old and am quite skeptical. Neither is going to happen in my lifetime. Instead, business leaders will keep playing climb the ladder...change ladders .....reach for higher pay.....don't be on the same rung when the short term decisions fail and you could be held accountable.... and the politicians will hurriedly pass something that will be an abomination but they'll find a way to weasel out of being held responsible for the outcome or at least a way to look the public in the eye and say "It wasn't me.....yes I voted for it.....but I didn't mean to".


...Yup old and skeptical. that's me.

[Eric Larsen]

My mother-in-law's bill for my sister-in-law's birth.

This the TOTAL bill from the hospital. (She never throws anything away)

.

My mother still has my 1968 bill. I was born on a Navy base and the total cost was $8. It would have been $2 less if I didn't have that Y-chromosome.

[Jeff Wright]

If corporate America isn't going to pay for it, who is? Hint- you and me.

If you think it'll reduce employee benefit costs, you should read what's being proposed. Mandatory pay into the system. Last time I checked, the government hasn't run a single program that did what it was supposed to for the amount it was sold to the public.

I really don't want anything run by the people that run the IRS or Department of Motor Vehicles. Does anyone actually believe these morons we send to Washington are capable of putting together a plan that works on anything? If so, you have more faith in them than I do.

What they should be doing is studying the life's work of Dr. Deming and understanding how to apply his processes to the health care system. They tried it in education with outstanding results (of course we don't use it because that would make sense).

The solution to everything isn't handing over power and money. We've been dumping money into education by the truck fulls since I was a kid. Every election year, all you hear is "we need more money for education". Does anyone actually believe our kids are smarter today? I have a relative that just graduated high school. I mention someone being Cambodian. They said "Is that real, or did you just make that up?".

Money's nothing the problem, it's the method. Fix the method and all else will resolve itself.

Scott, it's nice to find another fan of Deming and his 11 Points to Process/Quality Improvement. I still believe today's current Quality Improvement Processes are warmed-over Deming foundational ideas (Six Sigma, etc.). The man was still teaching five-day per-week classes the day he died at age 100.

[Greg Peterson]

The AMA is throwing their support behind H.R. 3200. They like it.

Now lets see what the senate crafts, and then lets see what happens after that.

[Mitchell Andrus]

My mother still has my 1968 bill. I was born on a Navy base and the total cost was $8. It would have been $2 less if I didn't have that Y-chromosome.

I don't want to know what the $2.00 was for.
.

[Mike Henderson]

I'm a little late to the discussion but the problem I find in today's health insurance system is that it prices people out of the system.

Example: You work many years and always have health insurance, paid either by you or your employer. While you're employed, you have some health issue - the worse for insurance is some cancer, even if the cancer is something easily treated, like skin cancer. Then you lose your job and run out your COBRA and have to apply for an individual policy.

I can just about guarantee you that no company will accept you, at any price. And if by some miracle you were able to find a policy, the price would be so high you probably couldn't afford it.

So my proposal is that as long as you maintain health insurance, you would be guaranteed to be issued a policy at a single rate. That is everyone of a certain age pays the same amount, no matter what your health history. But that's only if you maintained your health insurance continuously from the time you started working (maybe 20-22 years of age). If you don't require continuous coverage, people will select against the system by only buying coverage when they get sick.

Second, there must be an incentive against utilization. That is, it must cost something to use medical care. It can be adjusted for family means (income) but everyone must pay something. If you don't do that, people will not think before using health care. For very serious illnesses, the amount the family pays would be limited. You don't want to destroy a family, you want to get the "average" family to think before consuming health care.

I'm neutral about having a government plan. Medicare works well (except there's no incentive against utilization) and it's a 100% government plan.

Mike

[Eric Larsen]

I'm neutral about having a government plan. Medicare works well (except there's no incentive against utilization) and it's a 100% government plan.

I've experienced emergency care in Europe (1980s). What would have cost thousands here was free there. (They literally laughed at me when I whipped out my credit card to pay the bill.)

Without getting too political, I think we should all enjoy the same health care as our senators.

[Ken Fitzgerald]

I've experienced emergency care in Europe (1980s). What would have cost thousands here was free there. (They literally laughed at me when I whipped out my credit card to pay the bill.)

Without getting too political, I think we should all enjoy the same health care as our senators.

That will never happen!

[Eric Larsen]

That will never happen!

"Some men see things as they are and say why - I dream things that never were and say why not." -- George Bernard Shaw


Frankly, we deserve it. We've been protecting the free world for generations. Why should we not have the same level of health care that Canada, Norway or Germany enjoys?