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Posted by Katarain (Member # 6659) on :
 
I'm actually going to start this with the case against Universal Health Care. I am very much FOR universal health care, but I am not good at debating or articulating the reasons why. I'm not good at interpreting statistics if I tried to research this myself from the bare bones facts.

So, I come to you (pro-universal health care folks) for help in countering a facebook conversation I have had with my best friend's husband. This whole healthcare debate is particularly frustrating, because of all of my family and friends, I can only think of 2 who actually agree with me. It's lonely!

This started with my link to this: http://www.progressivefox.com/?p=721

Background, my best friend, let's call her Jane, recently had a liver transplant, after a lifetime of bad health. She is doing great now.

Here are his arguments. They seem compelling.

quote:
The problems listed in this are very real, but the purposed healthcare bill will only make it MUCH worse. Here is why. HR3200 is the on bill in the house and the only one available for review. Google or Bing it. According to it, you will be able to keep your insurance as long as you keep your job or the insurance does not change in any way. Otherwise you will be forced to be on a government approved plan. Good so far right??

1. Ok, the government can tell you which procedures, medications doctors and hospitals are on the approved list. If yours isn't too bad, you can't sue them as you can an HMO.
2. Tenncare was the posterchild of the Clinton healthcare plan which was going to prove to everyone how great it was. Well Jane was on it when we first Married and it came close to killing her. The only approved specialist were over 100 miles away and they were the worst of the worst. The medication she needed was not on the approved list. out of room, but this is BAD

quote:
Oh yes one more thing. We need a solution for pre-existing, but forcing the companies to take them will only make them go bankrupt immediately. Those who have severe illness will always cost the insurance company MUCH more than they will ever make from them.. The only way that the insurance company will be able to afford to cover them is a. raise rates for everyone (thus the million dollar surcharge mentioned in this article) or b. raise rates for those who are high risk, but this is unaffordable and eliminates any benefit of having insurance in the first place.

What Obama's "plan" aka hr3200 will do is put insurance companies out of business and force everyone on a single payer socialised system..

I propose that the government pay insurance companies to take high risk customers. They will audit the company and pay the extra cost for those with high risk. This is not perfect, but MUCH better than anything being considered now...

I replied with my frustrations over people not getting the healthcare that they need under the current system, and asked what he thought about everyone paying the same amount to spread out the costs. He replied:

quote:
COST: Katarain, in 2007 it cost $7,421.00 per man, woman and child in the USA. So if the insurance company made NO money and has NO overhead it would cost $1855.25 per month for you to insure your family of three.. If we shared cost to everyone.. Does that sound Fair? Can you afford it?
Source: http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358

quote:
THE POOR: There is already a federal government medical insurance program for the poor. It is called Medicare and is sucks. It is full of read tape and eligibility requirements.. Welcome to a government ran healthcare system. I and most against socialised medicine are not saying "get a job or die", we simply know the truth, and the truth is that many people will die from poor care, and no-one will get good care if the USA goes to a socialised system. We ARE NOT saying that the current system is great, only that this current proposal is a death sentence for many..
quote:
REGULATION: In the story that you link to, the problems are all related to cost savings measures of the insurance company. This will only get worse with a socialised system. The cost numbers I give above assume that ALL families work and pay premiums. The truth is that many are retired or too poor to pay premiums, so the rest of us will have to make up the difference, so rather than paying 1855.25 a month you may pay more like $3000.00 a month or more, which could approach 100% of your income. So that leaves one solution, and that is to cut cost. Well how will the government cut cost? We can only assume that it will be like other socialised systems and insurance companies, which will be "managed care". "Managed Care means that they will tell you what care you can get and who can give it and where you can go to get it... Unlike an insurance company, your family can't sue the government when you die from their "care"...
I then said something about the idea that costs will go down if everyone has preventative care available to them, and doctors and hospitals won't have to inflate costs to cover what is unpaid by the uninsured. Then the conversation died.

This is probably too long, but even if you don't reply to this specifically, please share your thoughts about the healthcare debate. I would imagine there is already a thread about that here, but I didn't see it on the front page--unless someone started it with a bad title.
 
Posted by AvidReader (Member # 6007) on :
 
quote:
I then said something about the idea that costs will go down if everyone has preventative care available to them, and doctors and hospitals won't have to inflate costs to cover what is unpaid by the uninsured.
I remember a thread we had about that at one point. The big pilot program somewhere up north helped a bunch of people but didn't actually save the government any money. Can't find it now, but maybe someone who understands our search button remembers it. (I never find the threads I want with the search button.)

This is where I think Eugene Robinson had it right the other day. We should be having two health care debates. One should be what we should be doing to help people that aren't currently covered for the things they need. The second should be how to pay for it. Saying we want to help millions of people and that we want to bring down costs implies a lower quality of care for everyone. Any other scenario requires an explanation that we just aren't getting.

I think what I as a conservative would like to see is a discussion where we all address our unrealistic expectations. Like Obama laughing at the idea of telling people when to die because there don't exist enough bureaucrats to do it. Or the idea that the richest, most powerful nation on the earth can cure cancer for everyone that gets it. One side has some legitimate hopes, one has some legitimate fears, but both sides seem to be getting rather carried away with them, in my opinion.
 
Posted by Samprimary (Member # 8561) on :
 
Conveniently, I have a half a decade's worth of ranting about health care that I can just cherrypick and use to obliterate the comical notion that UHC is worse than what we got.

Read as much of it as you can stand or skip to the next post, whatever. Just know that the people who still buy into the Sarah Palin-esque model of UHC ("they're going to euthanize us!" etc) are being inexcusably retarded by this point. They are displaying epic levels of cognitive dissonance that keeps them voting against their own interests and the interests of the country.

· The leading cause of personal bankruptcy in the United States is unpaid medical bills; the United States has more lost productivity and a lower average working age range than any of the other 'modernized' high-income nations such as the G8.

· Half of the uninsured people in America owe money to hospitals and a third are being pursued by collection agencies.

· Children without health insurance are less likely to receive medical attention considered reasonable and appropriate for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X-rays or consultations.

· The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance. Part of this is correlative to the higher risks and lifestyles of poorer demographics and part of this is certifiably due to the consequence of moral hazard models in leaving chronic and/or life threatening conditions untreated.

· Americans spend $5,267 per capita on health care every year, almost two and half times the industrialized world’s median of $2,193; the extra spending comes to hundreds of billions of dollars a year. The extra spending does not provide us with anything approaching the effectiveness of non-actuarial models.

· We have fewer doctors per capita than most Western countries.

· We go to the doctor less than people in other Western countries.

· We get admitted to the hospital less frequently than people in other Western countries.

· We are less satisfied with our health care than our counterparts in other countries.

· American life expectancy is lower than the Western average.

· Childhood-immunization rates in the United States are lower than average.

· Infant-mortality rates are in the nineteenth percentile of industrialized nations, which means that we have higher infant mortality rates than some developing countries.

· Doctors here perform more high-end medical procedures, such as coronary angioplasties, than in other countries, but most of the wealthier Western countries have more CT scanners than the United States does, and Switzerland, Japan, Austria, and Finland all have more MRI machines per capita.

· The United States spends more than a thousand dollars per capita per year—or close to four hundred billion dollars—on health-care-related paperwork and administration. In contrast, a country like Canada spends only about three hundred dollars per capita.

· And, of course, every other country in the industrialized world insures all its citizens; despite those extra hundreds of billions of dollars we spend each year, we leave forty-five million people without any insurance.

quote:
Health insurance here has always been private and selective, and every attempt to expand benefits has resulted in a paralyzing political battle over who would be added to insurance rolls and who ought to pay for those additions.

Policy is driven by more than politics, however. It is equally driven by ideas, and in the past few decades a particular idea has taken hold among prominent American economists which has also been a powerful impediment to the expansion of health insurance. The idea is known as “moral hazard.” Health economists in other Western nations do not share this obsession. Nor do most Americans. But moral hazard has profoundly shaped the way think tanks formulate policy and the way experts argue and the way health insurers structure their plans and the way legislation and regulations have been written. The health-care mess isn’t merely the unintentional result of political dysfunction, in other words. It is also the deliberate consequence of the way in which American policymakers have come to think about insurance.

“Moral hazard” is the term economists use to describe the fact that insurance can change the behavior of the person being insured. If your office gives you and your co-workers all the free Pepsi you want—if your employer, in effect, offers universal Pepsi insurance—you’ll drink more Pepsi than you would have otherwise. If you have a no-deductible fire-insurance policy, you may be a little less diligent in clearing the brush away from your house. The savings-and-loan crisis of the nineteen-eighties was created, in large part, by the fact that the federal government insured savings deposits of up to a hundred thousand dollars, and so the newly deregulated S. & L.s made far riskier investments than they would have otherwise. Insurance can have the paradoxical effect of producing risky and wasteful behavior. Economists spend a great deal of time thinking about such moral hazard for good reason. Insurance is an attempt to make human life safer and more secure. But, if those efforts can backfire and produce riskier behavior, providing insurance becomes a much more complicated and problematic endeavor.

In 1968, the economist Mark Pauly argued that moral hazard played an enormous role in medicine, and, as John Nyman writes in his book “The Theory of the Demand for Health Insurance,” Pauly’s paper has become the “single most influential article in the health economics literature.” Nyman, an economist at the University of Minnesota, says that the fear of moral hazard lies behind the thicket of co-payments and deductibles and utilization reviews which characterizes the American health-insurance system. Fear of moral hazard, Nyman writes, also explains “the general lack of enthusiasm by U.S. health economists for the expansion of health insurance coverage (for example, national health insurance or expanded Medicare benefits) in the U.S.”

What Nyman is saying is that when your insurance company requires that you make a twenty-dollar co-payment for a visit to the doctor, or when your plan includes an annual five-hundred-dollar or thousand-dollar deductible, it’s not simply an attempt to get you to pick up a larger share of your health costs. It is an attempt to make your use of the health-care system more efficient. Making you responsible for a share of the costs, the argument runs, will reduce moral hazard: you’ll no longer grab one of those free Pepsis when you aren’t really thirsty. That’s also why Nyman says that the notion of moral hazard is behind the “lack of enthusiasm” for expansion of health insurance. If you think of insurance as producing wasteful consumption of medical services, then the fact that there are forty-five million Americans without health insurance is no longer an immediate cause for alarm. After all, it’s not as if the uninsured never go to the doctor. They spend, on average, $934 a year on medical care. A moral-hazard theorist would say that they go to the doctor when they really have to. Those of us with private insurance, by contrast, consume $2,347 worth of health care a year. If a lot of that extra $1,413 is waste, then maybe the uninsured person is the truly efficient consumer of health care.

The moral-hazard argument makes sense, however, only if we consume health care in the same way that we consume other consumer goods, and to economists like Nyman this assumption is plainly absurd. We go to the doctor grudgingly, only because we’re sick. “Moral hazard is overblown,” the Princeton economist Uwe Reinhardt says. “You always hear that the demand for health care is unlimited. This is just not true. People who are very well insured, who are very rich, do you see them check into the hospital because it’s free? Do people really like to go to the doctor? Do they check into the hospital instead of playing golf?”

For that matter, when you have to pay for your own health care, does your consumption really become more efficient? In the late nineteen-seventies, the rand Corporation did an extensive study on the question, randomly assigning families to health plans with co-payment levels at zero per cent, twenty-five per cent, fifty per cent, or ninety-five per cent, up to six thousand dollars. As you might expect, the more that people were asked to chip in for their health care the less care they used. The problem was that they cut back equally on both frivolous care and useful care. Poor people in the high-deductible group with hypertension, for instance, didn’t do nearly as good a job of controlling their blood pressure as those in other groups, resulting in a ten-per-cent increase in the likelihood of death. As a recent Commonwealth Fund study concluded, cost sharing is “a blunt instrument.” Of course it is: how should the average consumer be expected to know beforehand what care is frivolous and what care is useful? I just went to the dermatologist to get moles checked for skin cancer. If I had had to pay a hundred per cent, or even fifty per cent, of the cost of the visit, I might not have gone. Would that have been a wise decision? I have no idea. But if one of those moles really is cancerous, that simple, inexpensive visit could save the health-care system tens of thousands of dollars (not to mention saving me a great deal of heartbreak). The focus on moral hazard suggests that the changes we make in our behavior when we have insurance are nearly always wasteful. Yet, when it comes to health care, many of the things we do only because we have insurance—like getting our moles checked, or getting our teeth cleaned regularly, or getting a mammogram or engaging in other routine preventive care—are anything but wasteful and inefficient. In fact, they are behaviors that could end up saving the health-care system a good deal of money.

Sered and Fernandopulle tell the story of Steve, a factory worker from northern Idaho, with a “grotesque looking left hand—what looks like a bone sticks out the side.” When he was younger, he broke his hand. “The doctor wanted to operate on it,” he recalls. “And because I didn’t have insurance, well, I was like ‘I ain’t gonna have it operated on.’ The doctor said, ‘Well, I can wrap it for you with an Ace bandage.’ I said, ‘Ahh, let’s do that, then.’ ” Steve uses less health care than he would if he had insurance, but that’s not because he has defeated the scourge of moral hazard. It’s because instead of getting a broken bone fixed he put a bandage on it.

http://www.pnhp.org/news/2005/august/m_gladwell_on_the_m.php

quote:
Starr Sered and Fernandopulle interviewed a wide range of uninsured Americans with many levels of education, including graduate degrees. Many were employed at the time of their interviews and some had the opportunity to purchase insurance, but for amounts that would significantly reduce their take-home pay, making it unaffordable. Others could not work because of untreated or under-treated health care issues. Still others had been laid off after plant closings, but their chances of securing employment again if the economy improves are slim due to health conditions that have been exacerbated with lack of care. They also demonstrate that adhering to the work ethic guarantees neither health insurance nor steady work and income.

The final chapter of the book outlines suggestions that have been made for universal health coverage in America, but there is no easy solution. The authors argue that the current system for the poor is not economically sound. Without access to preventative care, problems worsen until there is no choice except to visit the emergency room or receive other exorbitantly priced treatment, which may be paid for by Medicaid or may never be paid. They contend that any feasible solution must sever the link between paid employment and insurance and must provide a minimal level of health care for all Americans, much as we provide a minimal level of education via the public schools. They argue that not only is this a humane way to treat citizens, but it is much more cost-effective than the current system.

http://www.thefreelibrary.com/Susan+Starr+Sered+and+Rushika+Fernandopulle,+Uninsured+in+America:...-a0151099654

quote:
One of the state's largest health insurers set goals and paid bonuses based in part on how many individual policyholders were dropped and how much money was saved.

Woodland Hills-based Health Net Inc. avoided paying $35.5 million in medical expenses by rescinding about 1,600 policies between 2000 and 2006. During that period, it paid its senior analyst in charge of cancellations more than $20,000 in bonuses based in part on her meeting or exceeding annual targets for revoking policies, documents disclosed Thursday showed.

The revelation that the health plan had cancellation goals and bonuses comes amid a storm of controversy over the industry-wide but long-hidden practice of rescinding coverage after expensive medical treatments have been authorized.

http://www.latimes.com/business/la-fi-insure9nov09,0,3065397,full.story?coll=la-home-center

quote:
In a number of respects, this disparity between health insurance and health care comes from the fact that everyone gets sick, will age, and die. At some point in their life, every insured person will cost an insurance company money. Insurance companies can’t make much profit on human health care, unless they exclude or limit people from coverage and benefits. Otherwise, premiums aren’t profit centers, they are just pre-payments for health care we know we’ll need in the future.

To increase profits, insurance policies with benefit limits are commonplace, and no benefits are paid if those limits are exceeded, regardless of needs. You get a debilitating illness, such as cancer, and you receive a maximum payment from the insurance company that is a fraction of the total medical costs. It's as if you were a car and had reached your Blue Book value; you're declared totaled. From there, you pay the full cost of continued treatment, which can be hundreds of thousands of dollars. For people with health insurance, this is one of the main causes of bankruptcy: people have to use up their savings and sell their homes in order to pay uncovered medical costs.

http://www.rockridgeinstitute.org/health/logic_of_the_health_care_debate.pdf

quote:
An estimated 2 million babies die within their first 24 hours each year worldwide and the United States has the second worst newborn mortality rate in the developed world, according to a new report.

American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway, Save the Children researchers found.

Only Latvia, with six deaths per 1,000 live births, has a higher death rate for newborns than the United States, which is tied near the bottom of industrialized nations with Hungary, Malta, Poland and Slovakia with five deaths per 1,000 births.

"The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn rate is higher than any of those countries," said the annual State of the World's Mothers report.

http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html

quote:
On Feb. 3, Joyce Elkins filled a prescription for a two-week supply of nitrogen mustard, a decades-old cancer drug used to treat a rare form of lymphoma. The cost was $77.50.

On Feb. 17, Ms. Elkins, a 64-year-old retiree who lives in Georgetown, Tex., returned to her pharmacy for a refill. This time, following a huge increase in the wholesale price of the drug, the cost was $548.01. ...

The increase has stunned doctors, who say it starkly illustrates two trends in the pharmaceutical industry: the soaring price of cancer medicines and the tendency for those prices to have little relation to the cost of developing or making the drugs.

Genentech, for example, has indicated it will effectively double the price of its colon cancer drug Avastin, to about $100,000, when Avastin's use is expanded to breast and lung cancer patients. As with Avastin, nothing about nitrogen mustard is changing but the price.

quote:
people who analyze drug pricing say they see the Mustargen situation as emblematic of an industry trend of basing drug prices on something other than the underlying costs. After years of defending high prices as necessary to cover the cost of research or production, industry executives increasingly point to the intrinsic value of their medicines as justification for prices.

Last year, in his book "A Call to Action," Henry A. McKinnell, the chairman of Pfizer, the world's largest drug company, wrote that drug prices were not driven by research spending or production costs.

"A number of factors go into the mix" of pricing, he wrote. "Those factors consider cost of business, competition, patent status, anticipated volume, and, most important, our estimation of the income generated by sales of the product."

In some drug categories, such as cholesterol-lowering treatments, many drugs compete, keeping prices relatively low. But when a medicine does not have a good substitute, its maker can charge almost any price. In 2003, Abbott Laboratories raised the price of Norvir, an AIDS drug introduced in 1996, from $54 to $265 a month. AIDS groups protested, but Abbott refused to rescind the increase.

And once a company sets a price, government agencies, private insurers and patients have little choice but to pay it. The Food & Drug Administration does not regulate prices, and Medicare is banned from considering price in deciding whether to cover treatments.

nyt

quote:
Two years ago, Tracy Pierce's life changed dramatically when he was diagnosed with kidney cancer.
"I have no treatment. Three months has gone by and I haven't had any treatment," Tracy Pierce told KMBC's Jim Flink in May 2005.
When Flink talked to Tracy Pierce, his cancer was attacking his body. Despite being fully insured, every treatment his doctors sought for him was denied by his insurance provider. First-Health Coventry deemed the treatments were either not a medical necessity or experimental.
"I don't know what else to do but just wait," Tracy Pierce said last May.
As he waited, his doctors appealed again and again, including a 27-page appeal spelling out that Tracy Pierce would die without care. Coventry dismissed each request.

http://news.yahoo.com/s/kmbc/3257367

quote:
Tirhas Habtegiris was an East African immigrant and only 27 when she died Monday afternoon.

She'd been on a respirator at Baylor Regional Medical Center at Plano for 25 days.

"They handed me this letter on December 1st. and they said, we're going to give you 10 days so on the 11th day, we're going to pull it out," said her brother Daniel Salvi.

Salvi was stunned to get this hand-delivered notice invoking a complicated and rarely used Texas law where a doctor is "not obligated to continue" medical treatment "medically inappropriate" when care is not beneficial.

Even though her body was being ravaged by cancer, this family says Tirhas still responded and was conscious. She was waiting one person.

"She wanted to get her mom over here or to get to her mom so she could die in her mom's arms," says her cousin Meri Tesfay.

http://www.wfaa.com/sharedcontent/dws/wfaa/latestnews/stories/wfaa051214_lj_african.bb0e76d.html

quote:
In the Treatment of Diabetes, Success Often Does Not Pay

With much optimism, Beth Israel Medical Center in Manhattan opened its new diabetes center in March 1999. Miss America, Nicole Johnson Baker, herself a diabetic, showed up for promotional pictures, wearing her insulin pump.

In one photo, she posed with a man dressed as a giant foot - a comical if dark reminder of the roughly 2,000 largely avoidable diabetes-related amputations in New York City each year. Doctors, alarmed by the cost and rapid growth of the disease, were getting serious.

At four hospitals across the city, they set up centers that featured a new model of treatment. They would be boot camps for diabetics, who struggle daily to reduce the sugar levels in their blood. The centers would teach them to check those levels, count calories and exercise with discipline, while undergoing prolonged monitoring by teams of specialists.

But seven years later, even as the number of New Yorkers with Type 2 diabetes has nearly doubled, three of the four centers, including Beth Israel's, have closed.

They did not shut down because they had failed their patients. They closed because they had failed to make money. They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.

Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.

Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications.

Not surprising, as the epidemic of Type 2 diabetes has grown, more than 100 dialysis centers have opened in the city.

"It's almost as though the system encourages people to get sick and then people get paid to treat them," said Dr. Matthew E. Fink, a former president of Beth Israel.

nyt

quote:
Patients in the United States reported higher rates of medical errors and more disorganized doctor visits and out-of-pocket costs than people in Canada, Britain and three other developed countries, according to a survey released on Thursday.

Thirty-four percent of U.S. patients received wrong medication, improper treatment or incorrect or delayed test results during the last two years, the Commonwealth Fund found.

Thirty percent of Canadian patients reported similar medical errors, followed by 27 percent of those in Australia, 25 percent in New Zealand, 23 percent in Germany and 22 percent in Britain, the health care foundation said.

"Driven up by relatively high medication and lab or test errors, at 34 percent, the spread between the United States and the countries with the lowest error rates was wide," Cathy Schoen, senior vice president of Commonwealth Fund

http://news.yahoo.com/s/nm/20051103/hl_nm/errors_dc

Now, keep all these in mind when deciding which solution for health care is the most 'appropriate.'

These all act as a brushing on the surface of the issue, demonstrating what passes as acceptable under our current 'system.' It doesn't even go into what I would call real depth; it's just that the evidence against a private system is so profound that I can fill your screen with words that just hint at the various arguments you can make in favor of adopting the successful system used by all other modern nations. These stories, and the umpteen billion others like them, are the start since they analyze the means by which a for-profit system manages profit at the increasing cost of measurable health benefit.

I shall also repost my three part Some Things You Really Didn't Want To Understand About Our Health Care System, circa 2005

quote:
PART THE FIRST: CHEAP RHINOPLASTY IS THE RESULT OF A COLLAPSING MEDICAL SYSTEM

The most important doctor in society, the most important doctor you will ever have, is the family doctor. The GP who knows your weight, your blood pressure, complains when you smoke, all of that. As has been noted, they make a decent salary but nothing special. They're in line with what European doctors make.

Until you factor in malpractice insurance, which has been increasing its rates about 20% a year for the past decade or more, while doctor salaries have not kept in line. On account of this, the take-home pay of these doctors most critically associated with health and well-being is going down. (http://www.gnyha.org/3283/File.aspx).

A perfect example of how disastrous this trend is is to look at New York City hospitals' malpractice insurance, which has gone up 147% in five years, to the point where they are shutting down obstetrics divisions.

The end result of all this is that doctors are being chased into lucrative sub-fields in order to maintain their lifestyle. They have bills to pay, but under our current system, doctors are not paid to make people well, they are paid to perform procedures. Even worse, they are only really paid for the procedures they didn't have to perform on people who cannot pay. Many doctors, to maximize their income, are learning to perform the most expensive procedures possible, and they are competing to get into fields where they don't have to do work that they won't get paid for.

If they paid doctors to make people well, you'd have a lot more GP's, who are the ones on the front lines actually doing this. Instead, the 'winners' in the current system are carving out transplant hearts and vacuuming out fat and stapling stomachs and crowding quickly into any and all available fields where you don't have to do shit for anyone who can't pay, and thus, are not forced to accept the poor people of society as a financial liability. Since medical professionals are all crowding these optional procedure fields as fast as possible, prices for these services are going down. It's not a demonstration of how uninfluenced competition is working to our benefit in some fields as much as it it is another hilarious symptom of a malfunctioning medical system.

Cosmetic surgeons and the like are the 'winners' of our current system. They do completely optional and expensive procedures, only for people who pay out of pocket, they are not forced to work through thieving bureaucratic intermediaries, they are not forced by financially 'unfortunate' policies to care for those who cannot pay, and despite being under the catchall term of a medical profession, they're a little different -- they are actually all but irrelevant to our general health. They cater only to those who have the excess wealth to spend on optional procedures.

The end result is that the government has already been forced to bribe doctors with taxpayer money to remain as essentially skeleton crews in necessary medical fields which HAVE to be staffed (city hospitals, etc) but nearly NO competent doctor would stay in business in if they were forced to rely upon the profit model. Just about every single top doc in places like North Dakota or Arkansas is essentially bribed by the government with huge amounts of supplemental income to not leave. It's another example of how we're trying inefficiently to sneak in socialized solutions to float the broken moral hazard model and still somehow pretend, for the benefit of some schmucks, that it's seaworthy of its own accord.

PART THE SECOND: HELLO MEDICARE PLEASE KEEP MY ILLUSIONS, PRETENSES, AND PARENTS ALIVE

There's also another issue and it becomes evident when you ask seniors what form of healthcare they want. The big old socialized medical care program called Medicare, known alternately as being 'the most popular program in America' and 'the politically untouchable juggernaut.' Socialism, right here in the heart of the dear old U.S. because private medical care wouldn't touch the issue of care for the elderly.

Why? The elderly have the same sort of issue which leaves orphan diseasers to sit in a corner and die. There is no way to make taking care of old people profitable. Good thing that private insurers get to bypass the issue of maintenance of the elderly.

Thanks, Medicare, for being the big bad socialized medical program that makes 'private' health coverage remotely feasible!

PART THE THIRD: KILL GRANDMA

A free market health care system can work but only if nothing forces our hospitals and care networks to do anything for those who cannot pay upfront. In a free market system, you either pay or you don't. If you can't pay, you don't get the service. In the case of medical care, if you don't pay, you die. It's tough, but it's the only way the system can work. Right now, medical providers HAVE to treat people regardless of their ability to pay, in life-threatening situations. This ****s the entire system right up. Because uninsured people don't get stuff looked at when it's minor (because they can't afford to pay), they let things get worse, go to the ER, where they either die or live, and in any event run up huge bills. If the hospital can't get that person to pay, they have to make up for the shortfall elsewhere, or go out of business. So everyone else pays higher rates for things. Which FORCES a kind of socialism on the system anyway.

In order to be a good capitalist, you have to kill grandma. If you cannot pay during a life-threatening ordeal, you have to die. If you don't practice this then all you get is incredibly ------ socialism where everyone ends up absorbing all the costs for the old and the poor anyway even though we're not giving them effective care, just 'necessary' care. Kill grandma. Kill grandma kill grandma and squint real hard and pretend that the mere existence of paltry private charity that will save some people absolves you of any guilt for supporting a system that will leave scores more out on the streets in front of hospitals to die. The problem here is that people's will to actually follow through with their "free market will save the Universe" rhetoric is not strong when faced with an uninsured sick person. Especially an uninsured sick OLD person (who tend to vote in large numbers, and whose population is always increasing) So we start building slipshod systems like Medicare and Medicaid. Kill grandma, otherwise you're a ------ capitalist. You're welcome to say that the free market is the solution to our current woes but you can't pretend that it comes without some extraordinarily worrying sacrifices. If you don't have the balls to kill grandma, then you're going to have to swallow your pride and your 'the free market will save the world' bull and stick up for a socialist model.


 
Posted by Christine (Member # 8594) on :
 
quote:

1. Ok, the government can tell you which procedures, medications doctors and hospitals are on the approved list. If yours isn't too bad, you can't sue them as you can an HMO.
2. Tenncare was the posterchild of the Clinton healthcare plan which was going to prove to everyone how great it was. Well Jane was on it when we first Married and it came close to killing her. The only approved specialist were over 100 miles away and they were the worst of the worst. The medication she needed was not on the approved list. out of room, but this is BAD

Right now, the insurance companies are telling you which doctors you can see and what procedures you can have and as far as I can tell, the ability to sue them is not helping matters. I'm not sure about Tenncare, but it's not universal health insurance. Neither, for that matter, is the current Obama plan. I might argue against it only in that it doesn't go far enough and that these halfway measures never seem to work out right.

quote:

What Obama's "plan" aka hr3200 will do is put insurance companies out of business and force everyone on a single payer socialised system..

As far as I can tell, nobody has actually read the details of the bill and cannot possibly know this. This argument fails to convince me that the poster knows what he's talking about largely because it is throwing around Republican buzz words designed to scare people - ie socialized (which he didn't even spell right). The credibility factor here is 0. Obama insists his health care plan won't put anyone out of businesses. Republicans insist that it will. Who doy ou believe? They're all a bunch of lying politicians, so you believe the words that scare you the most.

quote:
COST: Katarain, in 2007 it cost $7,421.00 per man, woman and child in the USA. So if the insurance company made NO money and has NO overhead it would cost $1855.25 per month for you to insure your family of three.. If we shared cost to everyone.. Does that sound Fair? Can you afford it?
Source: http://www.kaiseredu.org/topics_im.asp?imID=1&parentID=61&id=358

That sounds about like what we're paying, yes, between the employer, our premium, and our outrageous deductible.

quote:
THE POOR: There is already a federal government medical insurance program for the poor. It is called Medicare and is sucks. It is full of read tape and eligibility requirements.. Welcome to a government ran healthcare system. I and most against socialised medicine are not saying "get a job or die", we simply know the truth, and the truth is that many people will die from poor care, and no-one will get good care if the USA goes to a socialised system. We ARE NOT saying that the current system is great, only that this current proposal is a death sentence for many..
No, it's not. It's called Medicaid. If you can't get your fact straight, it's best to look them up because missteps like this really hurt credibility. Medicare is a program for the elderly and disabled and actually works pretty well. Medicaid is for the poor and may have issues, but my sister in law on Medicaid delivered her baby for free. My last baby, WITH insurance, cost me about two grand.

I'm out of time right now...I'll say more later. [Smile]
 
Posted by TomDavidson (Member # 124) on :
 
quote:

As far as I can tell, nobody has actually read the details of the bill and cannot possibly know this.

Heck, the bill isn't that long. It's over a thousand pages, yes, but that's in very large type with big margins. (Seriously.) I've read the vast majority of it, and it's not even my job to do so. I'm pretty confident that a fair number of people have read the whole thing by now.
 
Posted by manji (Member # 11600) on :
 
quote:
Originally posted by Christine:
This argument fails to convince me that the poster knows what he's talking about largely because it is throwing around Republican buzz words designed to scare people - ie socialized (which he didn't even spell right). The credibility factor here is 0.

Maybe the guy's British. He's fairly consistent in his spelling of the word.
 
Posted by dabbler (Member # 6443) on :
 
My understanding is that the reason insurance companies don't pay for preventative measures like dieticians or the diabetes bootcamp is because they expect you to have a different insurance later in life benefitting another company. Why bother spending the extra cash if statistically it won't be profitable for yourself?
 
Posted by Christine (Member # 8594) on :
 
quote:
Originally posted by TomDavidson:
quote:

As far as I can tell, nobody has actually read the details of the bill and cannot possibly know this.

Heck, the bill isn't that long. It's over a thousand pages, yes, but that's in very large type with big margins. (Seriously.) I've read the vast majority of it, and it's not even my job to do so. I'm pretty confident that a fair number of people have read the whole thing by now.
LOL, well, maybe some people have, but I keep seeing interviews with congressmen who haven't so it gives me little hope. I haven't read it, but like with you, it's not my job.

So, having actually read it, what do you think?
 
Posted by Darth_Mauve (Member # 4709) on :
 
One advantage that Insurance Companies have over Govt health plan, that I haven't seen discussed, is investment income.

One of the largest revenue sources of the big insurance companies was the investment of your payments. They take the $1000 you pay, buy stock, and pay your medical bills out of some of the dividends.

Remember those lessons, how investing a couple hundred dollars a month when you are 22 will leave you a multi-millionaire by the time you retire? Well the insurance companies do the same thing, on a bigger and more researched way. That is something the Govt. Insurance Option won't be able to do, so it will be less competitive to the other insurance companies.
 
Posted by Farmgirl (Member # 5567) on :
 
I'm not against health care coverage for all -- I'm just not sure this is the best way to go about it.

I still think there has to be a better way (less government involvement) to improve on our current system, make it more competitive, etc. Kind of like car insurance in that it might be mandated, but companies have to compete against each other to give the best offer & rates.

Of course, to do that, there would also have to be some tort reform (to control costs) and also some way of stopping the more unethical doctors who order many procedures/tests that are not needed just because a patient is well-insured and all the procedures are covered/paid. (Most doctors are NOT like this, I know -- but I have personally witnessed a couple of cases in friends that really sent out red flags to me, and there have been articles about it).

But I really hate to see the government this deeply involved in my health care. HIPPA is thrown out the window.
 
Posted by Paul Goldner (Member # 1910) on :
 
"there would also have to be some tort reform (to control costs)"

http://www.factcheck.org/article133.html
 
Posted by TomDavidson (Member # 124) on :
 
For what it's worth, I'm confident that a single-payer system would produce tort reform within a couple years. Sadly, that's not what we're looking at. [Frown]
 
Posted by Christine (Member # 8594) on :
 
That's kind of the impression I got.
 
Posted by The Pixiest (Member # 1863) on :
 
quote:
Originally posted by TomDavidson:
For what it's worth, I'm confident that a single-payer system would produce tort reform within a couple years. Sadly, that's not what we're looking at. [Frown]

Not while Lawyers make the Laws.
 
Posted by Paul Goldner (Member # 1910) on :
 
Considering that tort reform won't make health care cheaper, why should we want it?
 
Posted by Darth_Mauve (Member # 4709) on :
 
Good try Pixiest, but the facts show that Tort Reform is just a way of distracting peoples attention from true Healthcare Reform. People simply hate lawyers more than insurance companies, so whenever people try to fix the insurance system, the insurance companies point their fingers at the lawyers.

Tort reform passed in Missouri a few years ago.

It happened after a large drop in the market (before this recession).

The insurance companies make a lot of their money by investing your premiums until they are needed to pay for your healthcare. However when the market fell, those profits disappeared. As a result the insurance companies needed to increase fees to make up for those lost profits. The doctors complained. The insurance companies explained that it wasn't the fault of their bungled investment strategy, but it was those pesky lawyers suing for pain and suffering.

The doctors complained and threatened to leave the state.

The state responded with torte reform, limiting the amount of compensation that I could get if a doctor or hospital leaves me in pain for life.

The mal-practice rates, however, did not go down.
 
Posted by Farmgirl (Member # 5567) on :
 
quote:
Originally posted by Darth_Mauve:

The state responded with torte reform, limiting the amount of compensation that I could get if a doctor or hospital leaves me in pain for life.

The mal-practice rates, however, did not go down.

Dan, then that's just wrong! (of the insurance companies). The whole purpose of tort reform should be to drop malpractice premium rates for doctors, so they can treat patients for less.
 
Posted by twinky (Member # 693) on :
 
quote:
Originally posted by Farmgirl:
I still think there has to be a better way (less government involvement) to improve on our current system, make it more competitive, etc. Kind of like car insurance in that it might be mandated, but companies have to compete against each other to give the best offer & rates.

There are a lot more people who still need to live when they don't have health insurance than there are people who still need to drive when they don't have car insurance. That is, the cost of the uninsured always exists; the problem with profit-driven health insurance is that it incentivizes dropping expensive subscribers when those are precisely the people who most need coverage.
 
Posted by kmbboots (Member # 8576) on :
 
Of course it is wrong. For us and for doctors. It was great, though, for the insurance companies.

Why do you think that insurance companies would lower their rates if they didn't have to?
 
Posted by SenojRetep (Member # 8614) on :
 
quote:
Originally posted by Farmgirl:
quote:
Originally posted by Darth_Mauve:

The state responded with torte reform, limiting the amount of compensation that I could get if a doctor or hospital leaves me in pain for life.

The mal-practice rates, however, did not go down.

Dan, then that's just wrong! (of the insurance companies). The whole purpose of tort reform should be to drop malpractice premium rates for doctors, so they can treat patients for less.
The rates didn't go down, but they also didn't rise as quickly as the national average, which is the more salient point. I'm having trouble finding good sourced data, but this brief outlines the 2002 increase in malpractice insurance rates in each of the 26 states that have caps on awards. The average rate increase in 2002 across the US was 25%. In Missouri, the increase was only 13%. Of all the states with caps only six (of 26, or about 1/5) exceeded the mean national rate increase.

Nothing conclusive, because the statistics are so sparse, but the indication is that tort reform in those 26 states had significant downward pressure on malpractice premiums.
 
Posted by SenojRetep (Member # 8614) on :
 
Here's an academic study that tracks defensive medical costs (i.e. unnecessary tests) in the face of various forms of tort control. The result: for the specific case they studied (skull fracture) tort reform decreased the total cost of medical treatment somewhere between 10-50%, depending on the type of tort law in place. That's a savings of (on the high end) about $12,000 per patient.

Settlement caps are not, according to the study, very effective at mitigating costs. This is reflected in some of the other data I've found on decreasing malpractice premiums. The reason malpractice costs are increasing so dramatically doesn't seem to be due to abnormally large settlements. Rather, it seems to be due to an increased likelihood of litigation (lots more little lawsuits). The study linked above points out that the most effective examples of tort reform consist of a mandatory arbitration before the case goes to court, which fits with the model that what's really driving malpractice rates (and defensive medicine) is the increase in the number of lawsuits, not the occasional large payouts.
 
Posted by kmbboots (Member # 8576) on :
 
I have long thought that for lawsuits that while actual damages awarded should go to the plaintiff but that punitive damages awarded should not.

It might cut down on general litigiousness if it weren't such a lottery.
 
Posted by fugu13 (Member # 2859) on :
 
kmbboots: sounds good to me, provided that the court has the option of awarding some reasonable percentage (ten or twenty, maybe) of and above the actual damages to the plaintiff (as part of the punitive damages).
 
Posted by Blayne Bradley (Member # 8565) on :
 
Oh man this thread has alot of stuff to read :-/ *better print it out*
 
Posted by Tstorm (Member # 1871) on :
 
About a month ago, I talked with someone at the college about the tort reform in Missouri. He was far more knowledgeable about the details, and he was quite convinced that it was a huge mistake. The insurance companies gained from it, and the people who might have legitimate tort claims in the future have been seriously harmed by it. That was the down-low from him, anyway.

Although the doctors may or may not admit it, there is evidence that a small percentage of doctors are responsible for most of the claims. I read a well-researched article on that subject, several years ago. Now, I wish I'd kept my research on that handy...I don't suppose anyone else knows about the veracity of this?
 
Posted by AvidReader (Member # 6007) on :
 
Great post, Samp. I'm not in the "what we have now is better" camp, but I think there are different problems and pitfalls we need to think about if we move away from it. Knowing what we don't like isn't enough for me.

I did want to comment on this:

quote:
The leading cause of personal bankruptcy in the United States is unpaid medical bills; the United States has more lost productivity and a lower average working age range than any of the other 'modernized' high-income nations such as the G8.
I know this is going to sound crazy at first blush, but I don't know that that's as terrible a thing as we make it out to be. No, bankruptcy isn't great. But if the options are buy health care you can't afford, declare bankruptcy, and fight against a terrible disease or get minimal coverage paid for by insurance and maybe it's enough, well, I think I'd rather take the credit hit for seven years.

I've known people who declared bankruptcy. For one woman, it was a chance to start over and make better decisions with her credit. For another, it ws the sad after-effects of an ugly divorce. She rented a place on the water for several years, and when the time was up her mom co-signed a loan on a lovely corner lot suburban home. No one I've know has ever been permentantly harmed by bankruptcy, so if there's some huge impediment it causes that I'm not aware of, please let me know. From my perspective, it seems to be more an inconvenience than something we should be afraid to choose over cancer treatments.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by AvidReader:
I know this is going to sound crazy at first blush, but I don't know that that's as terrible a thing as we make it out to be. No, bankruptcy isn't great. But if the options are buy health care you can't afford, declare bankruptcy, and fight against a terrible disease or get minimal coverage paid for by insurance and maybe it's enough, well, I think I'd rather take the credit hit for seven years.

That is an insanely inefficient way of getting anything done. The idea that the system actually works because people's financial futures are ruined (and you're not mentioning the effects of that on personal lives, children, education, financial support of parents, work, ie productivity, and the financial system in general), while it doesn't sound crazy to point out, is indeed thoroughly nuts to actually promote as positive. Though such a scenario can and does happen, the fact is that many people don't even have the means or the credit to financially ruin themselves in pursuit of treatment in the first place kind of goes to show that pointing out one cludgy and downright nauseating option doesn't justify the status quo. That and intentionally planning to default on massive debts before incurring them, even in the pursuit of medical treatment, is fraud.

I mean, really, this idea is wrong on so many levels that I begin to feel mean for wanting to list them all. I'll just add that nothing then protects the debtor from further exposure to medical risk following a bankruptcy, and nothing guarantees that a person can float their debts through a long illness, nor should we as a society be looking at massive personal debt (this is distinct and non-compatible as a concept with public debt), which is also highly toxic debt, as a positive thing.

In short, as an argument against reform, such a caveat about our current system reads like a dinner menu on the titanic. Perhaps a few people will indeed be served before the ship sinks. But they're all going down, and there aren't enough life boats for everybody.


quote:
No one I've know has ever been permentantly harmed by bankruptcy, so if there's some huge impediment it causes that I'm not aware of, please let me know.
Well, those people spent money that wasn't theirs, and then were excused from paying it back. The people that lent it to them got screwed, and it was all perfectly legal. I haven't met many people who have ever been bankrupt, and I have no statistics on it to use here, but I'm certainly not going to make the assumption that it's a panacea for middle class financial strife. It's also a huge net negative for the banking system.

Bankruptcy protection is a humane and right headed practice that is meant to keep people from total personal ruin, which in the old days would have made them slaves to their debts, along with their families. It is still not a good thing, nor something to aspire to or think of as a fall back strategy.

[ August 13, 2009, 08:47 AM: Message edited by: Orincoro ]
 
Posted by Samprimary (Member # 8561) on :
 
quote:
No, bankruptcy isn't great. But if the options are buy health care you can't afford, declare bankruptcy, and fight against a terrible disease or get minimal coverage paid for by insurance and maybe it's enough, well, I think I'd rather take the credit hit for seven years.
1. also don't you dare get sick in those next seven years!

2. the credit failure passes the cost on to .. guess who! the people who didn't get sick and have to go bankrupt!
 
Posted by SenojRetep (Member # 8614) on :
 
President Obama's pitch in Portsmouth, NH included the following two statements, which I find mind-bogglingly dissonent
quote:
Medicare and Medicaid are on an unsustainable path. Medicare is slated to go into the red in about eight to 10 years. I don't know if people are aware of that.
quote:
I do think it's important for particularly seniors who currently receive Medicare to understand that if we're able to get something right like Medicare, then there should be a little more confidence that maybe the government can have a role—not the dominant role, but a role—in making sure the people are treated fairly when it comes to insurance.
The Republicans have a similar dissonance problem, when they argue that *gasp* UHC will be paid for with Medicare cuts (think rationing, death panels, etc.) while arguing that socialized medicine is fundamentally bad.

Personally I look at the mess Washington made implementing Medicare and Medicaid and Social Security (all noble aspirations but lousy implementations), and combine that with the incredible fractiousness and corporate influence that has invaded national politics since those programs were passed, and I can't imagine any federal bill implementing a form of UHC that I'd want to live under. The details of the bills emerging from the House and Senate reinforce that belief for me; I think they're all significantly flawed, and would lead to an unsustainable growth in entitlement that would make our Medicare problem (which is HUGE) look like a molehill.

The current system isn't sustainable, but that doesn't mean that the proposed solutions will be any better. I think they'll be worse, and I think it's largely because of a culture in Washington that values handouts (to constituents, to industries, to campaign financers) above fulfilling responsibilities.
 
Posted by The Pixiest (Member # 1863) on :
 
And how long before UHC becomes unsustainable just like medicare and medicaid?

If rationing is inevitable, and it sure seems like it is, shouldn't the people who are able to buy their insurance be the ones to benefit from their money?

Yes, it's awful to die untreated because you can't afford it... but imagine how awful it will be to die under treated when you COULD have paid for treatment, but under UHC it went to someone else.

How fair is that?
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by The Pixiest:
And how long before UHC becomes unsustainable just like medicare and medicaid?

If rationing is inevitable, and it sure seems like it is, shouldn't the people who are able to buy their insurance be the ones to benefit from their money?

Yes, it's awful to die untreated because you can't afford it... but imagine how awful it will be to die under treated when you COULD have paid for treatment, but under UHC it went to someone else.

How fair is that?

You keep arguing against this as if it is an inevitability. Even in nations with UHC, where people don't routinely die waiting for treatment by the way (as the currently do here), you can *still* pay for treatment as well.

I don't know exactly how to argue against this notion, because you're projecting all the worst possible outcomes imaginable coming out of UHC, and then comparing them with the best possible outcomes of private coverage. Then you're acting as if when and if these problems do crop up in the future, they will never be dealt with or ironed out at all, and we'll just all be screwed forever. Ironically it's that attitude that leaves a lot of us royally screwed *right now*. It's like the Bush admin's stupid deflection of arguments in favor of stem cell research, saying that it was still "years away" from producing any results, therefore it need not be supported, when what they really wanted to do was placate the religious right, without actually getting involved in a legislative battle.

Maybe UHC has a long road ahead before we ever come close to getting it right. Let's take that road, with all due caution, but also with boldness, and with some hope of success, and faith in ourselves to succeed when it counts the most. Why are the people who are so massively enthralled with American exceptionalism so pessimistic about our actual abilities to do anything as a nation? It makes you wonder why a conservative like Limbaugh (as an extreme example) would have faith in our nation's ability to basically start another entire nation over again, or even two at the same time, but have absolutely zero confidence in our ability to run our own medical system. Is that not bizarre to anyone else?

You're also claiming as inevitable, a couple of things that have been expressly denied as plans for UHC. You will still be able to pay for coverage, and in fact the effect of UHC is meant to reduce that expense. The fact remains that a lot of people currently die for no reason under our system, the way it is right now. We have an obligation, from where I sit, to try and correct that. Argue till you're blue in the face about how this isn't going to *actually* work, but why do you insist on characterizing it as a plan meant to fail? Really, it's off-putting in the extreme, and it's what makes your argument look nutty and reactionary.
 
Posted by MrSquicky (Member # 1802) on :
 
quote:
Originally posted by The Pixiest:
And how long before UHC becomes unsustainable just like medicare and medicaid?

If rationing is inevitable, and it sure seems like it is, shouldn't the people who are able to buy their insurance be the ones to benefit from their money?

Yes, it's awful to die untreated because you can't afford it... but imagine how awful it will be to die under treated when you COULD have paid for treatment, but under UHC it went to someone else.

How fair is that?

I've got wonder about the sense of scale here. Even if this nightmare scenario were at all likely to come true, we're not talking one to one. Maybe it's more like a thousand to one or ten thousand to one.

So, yeah, either ten thousand people die because they can't afford care or one person dies though they could afford it because of rationing...oh, and the cost of medical care is significantly decreased and people as a whole are healthier.

Even in this negative hypothetical, I'm gonna go with the ten thousand people getting care at the expense of the one.
 
Posted by The Pixiest (Member # 1863) on :
 
Orincoro: You keep acting like UHC is free. This will be a huge tax burden on us all. People who COULD afford insurance will not be able to afford it once the taxes kick in. Companies will find it's cheaper to use the government health care so they'll stop providing private health care.

Those of us who plan ahead, work hard, save hard, and take care of ourselves should not be called upon to sacrifice ourselves for those who don't. And that's exactly what UHC is. Rewarding the grasshoppers, not the ants.

You can call me as many names as you like.
 
Posted by The Pixiest (Member # 1863) on :
 
quote:

So, yeah, either ten thousand people die because they can't afford care or one person dies though they could afford it because of rationing...oh, and the cost of medical care is significantly decreased and people as a whole are healthier.

This is nothing but unfounded assumption. The government never does things better or cheaper. When they get bloated, they don't cut the fat, they raise taxes. It is absolutely INSANE to think that the government can handle this more efficiently than the private sector.

I also don't want the government meddling in my private life to make me "healthier." People with *agendas* get into politics. What becomes policy will NOT be what makes us healthy, but what pleases the special interest groups. Just like the food pyramid.


I don't want the government to know every medical problem I've ever had, either.

And rationing doesn't just affect who dies, it's also about quality of life. Maybe not having your medications doesn't kill you but your migraines come back? Or you return to being morbidly obese? Or your sciatica comes back? I don't think this is a one in ten thousand scenario. I think it's one, depending on the depth of the rationing, that we could all face.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by The Pixiest:
Orincoro: You keep acting like UHC is free.

I was raised to believe that the value of a thing is not directly proportional to its cost. I was also raised to know the difference between spending money and wasting money. And finally, I was raised with the oft repeated expression from my father: "you can always stay home, but if you go out, you pay for it." Meaning, to him, that his money was meant to be spent, and shouldn't be counted too dearly against the benefits of living well.

quote:
Originally posted by The Pixiest:

You can call me as many names as you like.

Then I suppose we might as well add "social Darwinist" to your list of accolades. I didn't know you could be so selfish, or more exactly, I didn't know you were so self interested. It makes me wonder why you expect any sympathy as a member of an oppressed minority yourself. By dint of my position in life, if not for my own personal accomplishments, I can both afford health care and am not a member of any American minority. Maybe all that was gotten to cheaply for me to truly value it enough to deny it to other people in service of my own interests.
 
Posted by The Pixiest (Member # 1863) on :
 
Who's more selfish? the person who works for a living or the person who expects to live off the person who works for a living?

When I was foster parenting, there was a disagreement between me and the birth mother. I was buying generic formula from Wal*Mart for half the price of the name brand stuff. The birthmother (who knew what the babies were getting fed because I sent a can of it along to her visitations in rehab) complained that her kids should be getting the name brand stuff at twice the price. I'm not sure how much info I should give on the birthmother, but let's just say she'd never worked and had lived off the state her entire life.

Of course, the social workers were on her side and ordered me to get on WIC which would supply me the name brand. I said I'd rather spend my own money on generic instead of waste it. The social worker blurted out "But it's GOVERNMENT money!"

Now tell me who's selfish?
 
Posted by Orincoro (Member # 8854) on :
 
That isn't selfishness, it's waste. I'm not in favor of waste, and you know that. You can give me a thousand anecdotes about wastefulness and stupidity and greed, or I can supply them myself, but I will not be cowed by them.
 
Posted by FlyingCow (Member # 2150) on :
 
quote:
It is absolutely INSANE to think that the government can handle this more efficiently than the private sector.
This assumes an interest in the private sector to view health care from a position of wanting to increase efficiency of service rather than simply wanting to increase profits.

I think we currently have the latter, and there's no incentive for private companies to move from the latter to the former.
 
Posted by The Pixiest (Member # 1863) on :
 
Competition pushes them to increase efficiency of service.

If they can provide more for less they will get the customers. That's a basic rule of capitalism.

I WOULD like to see the law tweaked to make sure they don't take your money in health and drop you or jack up your rates in time of sickness. That's fraud.

But we don't need UHC for that.
 
Posted by TomDavidson (Member # 124) on :
 
quote:
Competition pushes them to increase efficiency of service.

If they can provide more for less they will get the customers. That's a basic rule of capitalism.

Correction: it's a basic premise of capitalism. It's clearly not a rule.
 
Posted by MattP (Member # 10495) on :
 
quote:
Those of us who plan ahead, work hard, save hard, and take care of ourselves should not be called upon to sacrifice ourselves for those who don't.
This is just a reformulation of "if you're poor, you're lazy" and that's bull. I know many people who are relatively poor who work long hours at difficult jobs and yet still can't afford much medical care or insurance. My brother-in-law went through law school battling Crohns Disease and took his finals in the hospital following surgery that required him to crap into a bag through a hole in his stomach for the next couple years. That experience left him tens of thousands of dollars in debt.

Even if you *have* insurance, a medical crisis can quickly wipe you out. My father in law just passed away from complications related to diabetes. He had insurance through his employer but he still had about $100,000 in outstanding medical bills when he died.

I've been responsible too, putting money into my 401K steadily for several years, avoiding excessive debt, and getting a job with amazing medical insurance, but I'm still scared to death about what could happen if I acquired a serious illness. Jobs are tenuous these days and if the timing of a layoff is poor and/or it's difficult to find another job quickly I could be bankrupted regardless of how well I'd planned.

I'm perfectly willing to give up a bit of what I've got to both improve the situation for lose less fortunate than me and to ensure that regardless of what happens I'll have some ensurance that medical care will be available for me should I or my family need it regardless of my fortunes in having an employer that offers an adequate plan. And yes, I know it sticks in your Libertarian craw, but I'm willing to force you to do the same.

[ August 13, 2009, 12:22 PM: Message edited by: MattP ]
 
Posted by Mucus (Member # 9735) on :
 
quote:
Originally posted by FlyingCow:
quote:
It is absolutely INSANE to think that the government can handle this more efficiently than the private sector.
This assumes an interest in the private sector to view health care from a position of wanting to increase efficiency of service rather than simply wanting to increase profits.
Not to mention, it also assumes that an absolutely frightening percentage of the developed world outside America is insane.

quote:
Originally posted by Orincoro:
... Why are the people who are so massively enthralled with American exceptionalism so pessimistic about our actual abilities to do anything as a nation? It makes you wonder why a conservative like Limbaugh (as an extreme example) would have faith in our nation's ability to basically start another entire nation over again, or even two at the same time, but have absolutely zero confidence in our ability to run our own medical system. Is that not bizarre to anyone else?

Only if you assume that these people believe that American exceptionalism means that they believe that America is exceptionally good. If you think of it from the perspective that they just believe that America is exceptionally bad, then it starts to make much more sense [Wink]

(for example, it explains that exceptional problem with government efficiency above)
 
Posted by FlyingCow (Member # 2150) on :
 
quote:
If they can provide more for less they will get the customers. That's a basic rule of capitalism.
If they can make better profits by covering fewer people, they will do so. That's a basic rule of capitalism, too.

quote:
I WOULD like to see the law tweaked to make sure they don't take your money in health and drop you or jack up your rates in time of sickness. That's fraud.
From their eyes, it isn't. When you got your insurance, you were healthy and cost little. When you got sick, you cost a lot more. In their eyes, you should be paying a greater amount because you are using a greater amount of money.

From their perspective, it's simple economics. Netflix charges more for people who want more movies at one time, Cable companies charge more for people who want more channels, and health care insurers charge more for people who want more services.

Their goal is profit. If you cost more, they will want to charge you more. If you're going to cost them $1 million over 50 years, they'll want you to pay them at least $1670 per month. If you were to pay them less than that, they lose money.

And why would they be in business to lose money?
 
Posted by The Pixiest (Member # 1863) on :
 
Cow: Yes, they should be charging more while you're young and healthy to cover what you will cost when you're old and sick. I'm fine with rates creeping (that's creeping, not soaring) up as you age... people usually earn more money as they get older too... I'm also fine with charging more (or denying service) for people who wait till they're old or sick to seek insurance.

That was your question, right?

(btw, not everyone costs a million dollars. If they did, insurance, private OR government, would be untenable.)
 
Posted by rivka (Member # 4859) on :
 
One thing that I keep meaning to point out is the cost of medical care to the uninsured v. the insured, because of the way insurance companies negotiate with those who work with them. Insurance write-offs are frequently 50-90% of the bill -- and yet the uninsured have to pay the ENTIRE amount.

And people think the bill will make things worse? No. It's not close enough to single-payer, but at least it's moving in the right direction.
 
Posted by The Pixiest (Member # 1863) on :
 
OR hospitals and doctors could just bill the insurance company the whole amount and pass it on to the insured if the insurance company refuses to pay (thus making a very unhappy customer.)

This practice of letting the insurance company pay less than individuals is crazy too.
 
Posted by rivka (Member # 4859) on :
 
quote:
Originally posted by The Pixiest:
OR hospitals and doctors could just bill the insurance company the whole amount and pass it on to the insured if the insurance company refuses to pay (thus making a very unhappy customer.)

That's actually usually forbidden by the contract between the insurance company and the doctor/hospital/etc.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by The Pixiest:
I'm also fine with charging more (or denying service) for people who wait till they're old or sick to seek insurance.

Well, I come from the belief that medical care should be a right, in practice the same as the right to fire and police protection, and protection under the law, all of which the state provides through taxation. That you will surely never agree with.

quote:
(btw, not everyone costs a million dollars. If they did, insurance, private OR government, would be untenable.)
I think we're seeing that an insurance industry is untenable in the sense that it cannot achieve a reasonable mission of providing health care where it is most needed, including preventative care as well as other types of care. Sometimes you need the government to do things because it makes no sense for private businesses to do them, and in fact private businesses' motivations make their handling of the system unresponsive to real needs, rather than bottom lines. I think we have such a case here.
 
Posted by The Pixiest (Member # 1863) on :
 
Orincoro: Then there's no sense in us debating. You'll take UHC no matter how bad it is.

Rivka: Maybe that's why my doc doesn't take insurance. I have to bill the insurance company separately. (and why I'd never go with an HMO) But she's really good and I dread her upcoming retirement.
 
Posted by FlyingCow (Member # 2150) on :
 
quote:
Cow: Yes, they should be charging more while you're young and healthy to cover what you will cost when you're old and sick. I'm fine with rates creeping (that's creeping, not soaring) up as you age... people usually earn more money as they get older too... I'm also fine with charging more (or denying service) for people who wait till they're old or sick to seek insurance.

That was your question, right?

Not really. Health care "creeping" up is not viable for an individual insurance plan. It either goes up in equal measure to the expected need of the individual, or the increased cost of the individual has to spread out through increases in premiums to a larger (healthy) group.

So, for instance:

John is a healthy individual who costs an insurance company $3,000 per year, or $250 per month. The insurance company charges John $300 per month for coverage, ensuring a $50 profit.

John goes to the doctor one day to find out he has hypertension. Because of this, it will cost more than the average healthy person to cover his medical expenses. Let's say for sake of argument, this works out to $6,000 per year. The insurance company would need to now charge him $550 per month to maintain their same profit margin.

A year later, John is diagnosed with leukemia. It is estimated that his health care will cost, in total, about $1,000,000 dollars over the next 50 years. To maintain the same profit margin, the insurance company would now need to charge just over $1,700 per month.

The problem is that John is an individual, and he has an individual relationship with the insurance company.

If John got his insurance through a small company (say, 200 people), the cost of his insurance would be paid by his company... and likely passed on in equal measure to all 200 employees. So, his hypertension would increase his premium only 1/200th of the amount it would if he were an individual. Instead of $3000 more per year for an individual, it would work out to $15 dollars more per year for each individual.

The leukemia would work out to about $100 more per year per individual.

Of course, the company is put in the middle. They can either a) take the hit themselves and not pass it to the employees, b) ask the employees to pay more each month for health insurance, c) some hybrid of a and b, or d) drop their group medical plan.

Of course, they could also find some reason to sever John's position, in which case they could avoid paying the premiums entirely in 18 months when his Cobra coverage lapses.

What you call "creeping" rates only works when the costs of the individual are defrayed over a large group. Rather than charging all their healthy customers more, the insurance companies are charging their unhealthy (read: costly) customers more. This has the result of keeping premiums low for the healthy customers (maintaining customer base and profit) and charging the costly customers for their costly service (either maintaining profit, or eliminating cost when coverage is dropped).

It's very capitalistic. As profits go, so does the insurance company's behavior.

Of course, those who need their insurance coverage the most are the ones who are hurt the most. Those that don't need it beyond routine medical care don't have to worry... until their situation changes.

So, the healthy people in this country with employer-provided insurance are sitting pretty... until they lose either their health or their job, at which point they will realize the unfortunate realities of the way the system is set up.

Edit: spelling

[ August 13, 2009, 01:51 PM: Message edited by: FlyingCow ]
 
Posted by The Pixiest (Member # 1863) on :
 
No, the point of insurance is to spread risk. When they take on John as a customer while he's healthy, they charge him based on the odds of him getting sick.

It's a bet. They look at the books and see, spread over a large enough population, what they need to charge to make a profit. People who stay healthy till they suddenly drop dead from a heart attack = winning bet. People who die slowly from cancer/AIDS/Alzheimer's = Losing bet.

But like Vegas, they play the odds and make a profit.

To jack up the rates once someone becomes sick is like not paying on the bet.
 
Posted by Badenov (Member # 12075) on :
 
One of the things I've noticed about proponents of UHC is that they seem to be willing to accept any solution as long as it, in theory, provides medical care to everyone. And that's great. I'm for that. Here's the question that they are ignoring. Is the American Government *capable* of effectively and efficiently managing a healthcare system that provides care for everyone *and* drops healthcare costs? I have seen no evidence that suggests it is capable of doing this. I have only seen evidence that efficiency will drop and costs will, as a result, increase.

As an employee of a government contractor, I have to work very closely with the government. My paycheck is paid by the US government as directly as it can be without me being and actual government employee. I have spent the last 3 months waiting for the government to make decisions on my next work assignment. During that time I have had absolutely no work to do. So the government has paid the company I work for a considerable amount (I imagine it's close to 30000, though I am not certain. I receive roughly half of that).

In my dealings with government employees, I see evidence of constant in-fighting on the minutia of bureaucratic process. I have yet to find two government employees that agree on how the documentation for the work that we are contracted for is to be written. Because of that, all documentation is rejected the first time because it doesn't meet one person's unpublished criteria. Once it's rejected, it has to be rewritten to comply, and is sometimes handed to a different person who might reject it because their criteria is different from the other person's. Everything about how the government works is inefficient and requires far more people than it should. I have no doubt that the government *could* function on less than half the money it receives. Unfortunately, it's more than willing to spend every cent it's able to get and more.
 
Posted by Christine (Member # 8594) on :
 
Badenov: My husband works for an insurance company. If you want to trade horror stories about inefficiencies, we could, but let's just put it this way: The corporate world isn't any better at this than the government. It may seem like they should be due to profit motive but unfortunately, laziness takes over and they'd rather just jack up the rates rather than take simple steps to run their operation more smoothly.

I don't know that health care costs will go down with a UHC plan, but I doubt seriously that they would go up.
 
Posted by FlyingCow (Member # 2150) on :
 
quote:
It's a bet. They look at the books and see, spread over a large enough population, what they need to charge to make a profit. People who stay healthy till they suddenly drop dead from a heart attack = winning bet. People who die slowly from cancer/AIDS/Alzheimer's = Losing bet.
Ah, I see the misunderstanding.

They don't do this.

If they did this, the coverage for healthy individuals would be far more expensive, because they'd be spreading the risk over everyone. But they don't... they want to keep the healthy people insured, and want to avoid insuring people that will cost them money.

Why would they want to insure unhealthy people? It doesn't make any business sense. The ideal customer is someone who stays healthy, gets one checkup per year, has no prescription medications, a perfect family history, maintains a healthy diet/exercise regimen, etc.... that person is pure profit. They want to insure a lot of those people.

The sick people who cost thousands and thousands of dollars per year... they are not profitable. They want to avoid those people.

In fact, they can even go out of their way to overcharge and "purge" businesses that employ these people.

Now, I don't know if a government option is the answer, or if UHC is the answer, or what. I know the current system is badly broken and needs to be fixed.

I suppose some way of forcibly regulating prices and increases, preventing insurance companies from "pricing out" sick patients, and raising the rates for everyone to account for the increased cost might have some impact.

But that level of government regulation would be akin to a government take-over of the private insurance industry anyway, so I don't know how much more palatable it would be than a government option.
 
Posted by kmbboots (Member # 8576) on :
 
quote:
Originally posted by The Pixiest:
And how long before UHC becomes unsustainable just like medicare and medicaid?

If rationing is inevitable, and it sure seems like it is, shouldn't the people who are able to buy their insurance be the ones to benefit from their money?

Yes, it's awful to die untreated because you can't afford it... but imagine how awful it will be to die under treated when you COULD have paid for treatment, but under UHC it went to someone else.

How fair is that?

Pix, not so long ago I would have agreed with you. The unfairness of such a thing would have made me livid. The I came to realize that "fair" is overrated. Life itself is not fair. It is not fair that I was born to parents who did a good job raising me and that some are born to parents who don't or can't - any more than it is fair that some people will never have to work for a living and that some people will never be able to. It isn't fair that cancer strikes some people and not others. Nor is it fair that some people can eat anything and not gain an ounce and that some have nothing to eat. Or that I can sing but not do calculus. You get the idea.

It isn't fair that some people get billions of dollars in exchange for "managing" a company into bankruptcy while others work their whole life at low wage jobs to have it all wiped out because of illness.

None of it is fair. It's a lottery. We aren't going to be able to make it fair. The best we can do, I believe, is to make it the kind of world we would want it to be if we had no idea who we were going to be.
 
Posted by Darth_Mauve (Member # 4709) on :
 
At first I was going to say that if Insurance Companies are going to work, and you don't trust the government to work, who do we trust?

Then the third idea did strike me...let the market truly take over.

The problem is that companies buy the vast majority of insurance that we use. As such there is no ultimate consumer that the insurance company must please.

The doctors and providers are the ones that deal with the patients.

The complainers are the patients, rarely the people in human resources at the company that buys the insurance.

Right now a $10 toy given away to the purchasing/human resource people, and a lot of sincere looking people, is all it needs to counterbalance the grief that an employee gives them when the insurance company turns down a $20,000 medical bill.

So lets make it simple. As of 6/1/2010 it will be illegal for any company, corporation, or employer to offer medical insurance to their employees.

The employees, millions of them across the country, will become the clients of the insurance companies. The insurance companies will have to find ways to sell their products to the people that they will then service.

Retail solution to a wholesale problem.
 
Posted by The Pixiest (Member # 1863) on :
 
Mauve: that's the way it should be anyway.

Then we could choose our insurance based on what we want rather than absurd package deals.

For instance, I'd take catastrophic care with a large deductible that never pays for any sort of "alternative medicine."

I can buy my regular medication. I can pay for my doctor visits. It's Cancer or Alzheimer's I'm worried about. Not broken bones and colds.

And I'm for damn sure not going to use Homeopathic, or eastern or herbal medicines to try to fix what ales me and it annoys me I'm helping pay for those who do.
 
Posted by The Pixiest (Member # 1863) on :
 
Cow: I know they're doing that. And it's fraud. and it should be fixed. But we don't need UHC to fix it.

Boots: We can't make it fair but we should strive to make it fair. While giving voluntarily of one's own wealth to help another might be good, stealing from someone to help another is neither fair nor good.
 
Posted by kmbboots (Member # 8576) on :
 
But, Pix, that our "own wealth" is ours has, for the most part, very little to do with "fair".
 
Posted by The Pixiest (Member # 1863) on :
 
boots, dear, we work for it, we save it, we don't frivolously blow it, we don't spend it on meth, alcohol or other drugs, we don't commit crimes and go to prison, we plan for the future, we skip fun things that are too expensive...

Our wealth is ours because we're responsible. To take it away for those who do not do all those things is downright evil. Further it rewards laziness, drug use, crime and frivolous wastes of money. Simply because there's no reason to work hard and be frugal.
 
Posted by TomDavidson (Member # 124) on :
 
quote:
Our wealth is ours because we're responsible.
And yet many people are wealthy who are not so responsible, and many people are responsible who are not wealthy. I don't think you're going to be able to prove a strong correlation there.
 
Posted by Katarain (Member # 6659) on :
 
I have heard that argument before, to put it crudely, that the lazy good-for-nothings don't deserve health care because they haven't earned it. They should get a job and pay for it themselves. My problem with that argument is it does not cover every reason why someone might not be able to pay for health care.

Let's say that the concept is a legitimate one, that lazy good-for-nothings don't deserve health care. I'm willing to let them benefit from the system so that the rest of the people who can't afford it but do deserve it can have it.

(But then, I don't think anyone should have to pass any sort of test to prove worthiness for health care--monetarily or otherwise.)
 
Posted by The Pixiest (Member # 1863) on :
 
Tom: True, there are those who did not work for their wealth or scammed for their wealth. Those type of people make headlines but they're not really the norm.

And there are those who came to responsibility late in life. Didn't pay attention in school or didn't realize that you have to major in something that makes money... they ended up poor.

And there are those with the pseudo-wealth of credit cards. They aren't wealthy no matter what kind of car they drive. They're in debt.

But the hard working middle class and upper classes who are there because they scrimped and saved and worked for it should not be looted to pay for those unwilling to do the work.
 
Posted by kmbboots (Member # 8576) on :
 
Ah, Pix, have you never known poor people who do the best they can?

Sure, all those things you mention play a part in wealth, but such a small part compared to sheer dumb luck and opportunity.

An example, my brother-in-law and sister have done everything right. Worked hard, saved, bought a modest home in poor condition and basically rebuilt it. After 20plus years of being a stellar employee, he has lost his job because - through no fault of his - the company has downsized and kept the cheaper employees. My sister, despite her lupus, works three jobs. My BIL does handyman work for neighbors.

Of course, they have lost their insurance. My sister can't get her medications any more. My brilliant straight-A student niece has had to drop out of college. They are teetering on the edge of losing their home.

No meth, crime or frivolity involved.

Now the grandson of the guy who started the company that downsized my BIL, despite having never worked for the company - or anyone(and being plenty frivolous) - is set for life.

And that is a fairly mild example of what is going on all over.

It isn't fair that vets who come home so broken that they can't work or people with genetic mental illness end up living on the subway. How is it their fault?

We, in this country, tend to think of wealth as an indicator of virtue. It really isn't.
 
Posted by The Pixiest (Member # 1863) on :
 
I've been laid off twice myself... I've even had my meager savings wiped out by sickness (I didn't default on what I owed either, I put it on my credit cards and suffered.) I've been so poor I fretted so much about the price of a big mac I couldn't enjoy it.

And when I got out of school, we were in the middle of a recession and I couldn't find a job for 10 months. When I did, it paid less than I was making while working through school.

I can't address the case of your BIL. I don't know what other circumstances exist there and I can't speculate without being potentially insulting. (and you're the last person here I'd want to insult.)

As for veterans, we owe them our thanks, our support and free medical care for life. They put their lives on the line for us.

btw, people who don't deserve/understand their wealth tend to blow it. For example, lottery winners tend to go through their winnings and end up back at work in something like 5 years. (I know.. citation needed and I don't have one.) Unless that gentleman's grandson has an accountant with the power to reign in his spending, don't be surprised if "set for life" ends with him living in a ditch.
 
Posted by Mucus (Member # 9735) on :
 
Or to put it in more statistical terms, the US isn't actually all that socially mobile. Your parents have a very heavy influence on your earning potential.

For example:
quote:
The truth is that the US sits with the UK at the bottom of the international league table of social mobility.

Family background has as strong an influence on socio-economic opportunity in the classless United States as it does in the supposedly hidebound class-ridden UK.

http://news.bbc.co.uk/2/hi/americas/8162616.stm

With the more concrete results here:
quote:
Countries differ in the extent
to which family economic
status is related to labour
market success of
children in adulthood
More than 40% of a father’s
earnings advantage is
passed on to sons in
France, the US, Italy and
UK, less than 20% in
Canada, Finland, Norway
and Denmark

http://www.irpp.org/events/archive/20081128/corak.pdf
 
Posted by kmbboots (Member # 8576) on :
 
I'm not insulted (not would I be, I would just answer your questions).

And I don't think that you are "bad" for thinking that way. As I said, I used to as well. It just isn't the sort of thing that you get till you get it.

I just know that it is a "there but for the grace of God (or fate or whatever) kind of world.
 
Posted by FlyingCow (Member # 2150) on :
 
quote:
Cow: I know they're doing that. And it's fraud. and it should be fixed. But we don't need UHC to fix it.
Well, first off, the current bill on the table is not the same as Universal Health Care. It is creating a parallel government-run option alongside existing insurance companies - much like the tax-subsidized US postal service exists in a world with FedEx and UPS.

BUT, more to your point, I think, is that you feel the government shouldn't be in the health care business. That's fair.

Though I think the regulatory changes that would be needed to "fix" the current system and wrangle the existing insurance companies would be such top-down pressure that it would be as though the government was in charge of all the insurance companies.

You would need to force the insurance companies to do things like taking customers they don't want to insure, raising costs on healthy customers evenly, forcing a tiered payment structure among all companies to enforce fairness, etc.

I don't know if all of those things are even constitutional.
 
Posted by scifibum (Member # 7625) on :
 
quote:
The best we can do, I believe, is to make it the kind of world we would want it to be if we had no idea who we were going to be.
I just want to remark that this is a beautifully expressed idea.
 
Posted by kmbboots (Member # 8576) on :
 
Thanks. I can't take credit for it. I wish I could remember where I first heard it (and where it was much better expressed).
 
Posted by Blayne Bradley (Member # 8565) on :
 
The Canadian Government Provincial and Federal does a fairly good job at it.

Lots of people should see Sicko, it exaggerates the awesomeness of Canadian UHC a bit (hard to do as afterall we are awesome) but I find it its his best movie and makes up for him being something of an ass in Farenheit.

But the point is that American HC is terrible terrible evil that focuses on profit not on care and that while in the US UHC won't probably be as good as Canadian or European HC its better then whats there now.

Businesses abuse the people, lets trust bust them.
 
Posted by Vadon (Member # 4561) on :
 
quote:
Originally posted by kmbboots:
Thanks. I can't take credit for it. I wish I could remember where I first heard it (and where it was much better expressed).

Pretty sure you're thinking of John Rawls. [Smile]
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by The Pixiest:
Orincoro: Then there's no sense in us debating. You'll take UHC no matter how bad it is.

"I'll give you the final word... ... you're an idiot"
 
Posted by kmbboots (Member # 8576) on :
 
quote:
Originally posted by Vadon:
quote:
Originally posted by kmbboots:
Thanks. I can't take credit for it. I wish I could remember where I first heard it (and where it was much better expressed).

Pretty sure you're thinking of John Rawls. [Smile]
That isn't where I heard it, but yes, it certainly fits.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by The Pixiest:

But the hard working middle class and upper classes who are there because they scrimped and saved and worked for it should not be looted to pay for those unwilling to do the work.

(Edit: I'll amend the personal attack)

To put it mildly, that disgusts me. That's a hatefully arrogant thing to say. I really hadn't seen any indication of this kind of petty selfishness and misanthropy from you before this issue came up. Now it's written all over everything you write.
 
Posted by kmbboots (Member # 8576) on :
 
Orinoco, that was wrong, hurtful, unnecessary and not useful.
 
Posted by Orincoro (Member # 8854) on :
 
Probably you're right.
 
Posted by Blayne Bradley (Member # 8565) on :
 
quote:
Originally posted by Orincoro:
quote:
Originally posted by The Pixiest:

But the hard working middle class and upper classes who are there because they scrimped and saved and worked for it should not be looted to pay for those unwilling to do the work.

To put it mildly, you disgust me. When and how did you become such a hatefully arrogant person? Because I really hadn't seen any indication of this kind of petty selfishness and misanthropy from you before this issue came up. Now it's written all over everything you say.
I think it would be more useful to the debate to point out WHY Ayn Rand is NOT to be taken seriously and focus on the discussion as to why it is ethical for those with more to care for the those with less. Could be wrong but I think Utilitarianism I think may provide some of the better thoughtout arguments.
 
Posted by ClaudiaTherese (Member # 923) on :
 
quote:
Originally posted by kmbboots:
Thanks. I can't take credit for it. I wish I could remember where I first heard it (and where it was much better expressed).

[Smile] A favorite of mine, too. [Even if we know it's not J Rawls!]:

quote:
As a thought experiment, the original position is a hypothetical designed to accurately reflect what principles of justice would be manifest in a society premised on free and fair cooperation between citizens, including respect for liberty, and an interest in reciprocity.

In the state of nature, it might be argued that certain persons (the strong and talented) would be able to coerce others (the weak and disabled) by virtue of the fact that the stronger and more talented would fare better in the state of nature. This coercion is sometimes thought to invalidate any contractual arrangement occurring in the state of nature. In the original position, however, representatives of citizens are placed behind a "veil of ignorance", depriving the representatives of information about the individuating characteristics of the citizens they represent. Thus, the representative parties would be unaware of the talents and abilities, ethnicity and gender, religion or belief system of the citizens they represent. As a result, they lack the information with which to threaten their fellows and thus invalidate the social contract they are attempting to agree to.




[ August 13, 2009, 07:01 PM: Message edited by: ClaudiaTherese ]
 
Posted by katharina (Member # 827) on :
 
It may not be in the bill, but the President himself has raised the possibility of a panel deciding what will and won't be given.

quote:
Folks who really want to stick it to Obama and sow hysteria about "death panels" will extract this from Obama's same fateful interview with David Leonhardt of the Times (my emphasis):

THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?

I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

DAVID LEONHARDT: So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.


So Obama "suspects" that the legislative process will produce some sort of independent group that can give non-determinative "guidance" on end-of-life care for the chronically ill, with an eye towards saving money. Just don't call them death panels!

http://justoneminute.typepad.com/main/2009/08/there-he-goes-again.html/
 
Posted by Orincoro (Member # 8854) on :
 
quote:
It’s not determinative
And there you have it. An independent group set up find ways of saving money. Brilliant. It's 1984! It's 1984! There are independent groups! It's not determinative! A single line in an interview that is not concerning actual litigation is more telling than everything discussed within that litigation or by the countless legislators and officials who mght preside over that system, NOT TO MENTION THE VOTERS! FUR RLZZ> OH NOOZZZ WE HAZ TEH DEPTH PANULLZZZZ!!!

(edit: I'm Srsly)
 
Posted by ClaudiaTherese (Member # 923) on :
 
Oops, just saw Rawls was already suggested and declined.

Was on a dying computer and missed it -- ah well. Still, good to jog my memory. I like Rawls.
 
Posted by scifibum (Member # 7625) on :
 
do you mean "legislation" there where you wrote "litigation", Orincoro?

I think Obama was only stating the obvious: when you have a limited pool of resources, something/somebody will have to decide where to allocate them. So what? Would it be better if he publicly fantasized that everyone will get the equivalent of millions of dollars worth of care for as long as they care to continue receiving it?
 
Posted by Vadon (Member # 4561) on :
 
quote:
Originally posted by ClaudiaTherese:
Oops, just saw Rawls was already suggested and declined.

Was on a dying computer and missed it -- ah well. Still, good to jog my memory. I like Rawls.

I like him too. [Wink]

The only time I've heard him referenced in a nonacademic medium was the West Wing when Will Bailey was trying to justify the tax increase on the wealthy to his interns. Perhaps that's where you've heard it?
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by scifibum:
do you mean "legislation" there where you wrote "litigation", Orincoro?

I think Obama was only stating the obvious: when you have a limited pool of resources, something/somebody will have to decide where to allocate them. So what? Would it be better if he publicly fantasized that everyone will get the equivalent of millions of dollars worth of care for as long as they care to continue receiving it?

Should we also fool ourselves into believing that the equivalent doesn't *already exist* in the private sector?
 
Posted by kmbboots (Member # 8576) on :
 
Could have been. Could have been on a T-shirt. It likely was Rawls or Rawls-derived. I just didn't know it was Rawls.
 
Posted by katharina (Member # 827) on :
 
I didn't expect you to acknowledge the plausibility of it, Orincoro. Goodness knows people will lie to themselves to an amazing degree in order to keep thinking well of themselves.
 
Posted by fugu13 (Member # 2859) on :
 
The President raised the possibility of a panel deciding what will and won't be given when he specifically said such a panel wouldn't decide what will and won't be given?

quote:
And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance.

 
Posted by Blayne Bradley (Member # 8565) on :
 
quote:
Originally posted by Orincoro:
quote:
It’s not determinative
And there you have it. An independent group set up find ways of saving money. Brilliant. It's 1984! It's 1984! There are independent groups! It's not determinative! A single line in an interview that is not concerning actual litigation is more telling than everything discussed within that litigation or by the countless legislators and officials who mght preside over that system, NOT TO MENTION THE VOTERS! FUR RLZZ> OH NOOZZZ WE HAZ TEH DEPTH PANULLZZZZ!!!

(edit: I'm Srsly)

you spend too much time on Encyclopedia Dramatica.
 
Posted by AvidReader (Member # 6007) on :
 
quote:
Originally posted by FlyingCow:
Well, first off, the current bill on the table is not the same as Universal Health Care. It is creating a parallel government-run option alongside existing insurance companies - much like the tax-subsidized US postal service exists in a world with FedEx and UPS.

Is now a good time to point out that the post office is millions in debt? </tongue in cheek> I'm only nervous about the government option in conjunction with the universal insurance requirement. Telling people they have to buy insurance when you know the only plan they can afford is yours is conflict of interest. I much prefer the non-profit idea I'd heard floated around. But I work for a credit union, so I'm biased towards the non-profit approach.

quote:
Though I think the regulatory changes that would be needed to "fix" the current system and wrangle the existing insurance companies would be such top-down pressure that it would be as though the government was in charge of all the insurance companies.
I suppose that depends on what it would take the insurance companies and doctors to renegotiate. If they won't do it without government pressure, than I suppose the market has left us no choice and it's corporate Darwinism at work. But maybe they just need a few incentives. Maybe groups that negotiate better prices for doctors that coordinate care and promote wellness could get a spiffy tax break or grant dollars. I guess I'm not convinced we need the stick yet when a carrot might suffice - and doesn't seem to have been tried.

quote:
You would need to force the insurance companies to do things like taking customers they don't want to insure, raising costs on healthy customers evenly, forcing a tiered payment structure among all companies to enforce fairness, etc.
Right now, the insurance companies seem willing to agree to take pre-existing conditions if everyone has to buy insurance. While many boards and CEOs are probably happy to fiddle while Rome burns, I do think enough want to save the industry and ensure future profits to make some changes. What we could really use is a way of telling one group from the other and encouraging HR departments everywhere to only use the latter. Enough money changing hands might be all it takes to ensure the system we want to see.

quote:
I don't know if all of those things are even constitutional.
Well, that's a different problem. I'm not sure how we'd know until we tried it. I suppose it'd be FDR all over again. Keep putting something out there until something sticks.
 
Posted by Darth_Mauve (Member # 4709) on :
 
Kath, that quote from the President is suggesting an independent group of ethicists, scientists, and doctors to help determine where we should and should not draw the lines on coverage. It won't say, "You can't have that procedure" only "we can't pay for it." Other options from donations to private pay would be available. The panel are to recommend, with no enforcement listed.

Do you see why claiming that is a "Death Panel that would kill my Down Syndrome Baby" is a lie?

Do you see that such panels exist now, but without the ethicist, the public oversight, or the independent doctors--but with the accountants and bean counters who are determining profits.
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by katharina:
I didn't expect you to acknowledge the plausibility of it, Orincoro. Goodness knows people will lie to themselves to an amazing degree in order to keep thinking well of themselves.

I didn't expect you to have any real sense of proportion. And you don't!
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Originally posted by The Pixiest:
The government never does things better or cheaper.

This is completely untrue and is the second startlingly untrue statement which you have based your opposition to UHC upon.

Your conclusions are broken because they follow from very bad premises such as that one,

quote:
the government is a monopoly with no incentive to reduce waste.
that one,

quote:
It is absolutely INSANE to think that the government can handle this more efficiently than the private sector.
that one (especially considering that this apparently 'insane' notion is actually strongly evidenced by every single other high-income nation on earth and that a case directly rebutting your statement is presented in this very thread), etc
 
Posted by DarkKnight (Member # 7536) on :
 
I read this on AARP's website and it is pretty interesting to me.
AARP
quote:
HOW IT'S PAID FOR: Revenue-raisers include: $544 billion from a new income tax surcharge on single people making $280,000 a year and households making $350,000 and above; $37 billion in other tax adjustments. About $500 billion in cuts to Medicare and Medicaid. About $200 billion from penalties paid by individuals and employers who don't obtain coverage.
Those numbers seem very optimistic to me. The $200 billion from penalties is a little frightening as well.
quote:
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through tax penalty with hardship waivers. The penalty is 2.5 percent of income.

So if you fail to have health insurance for a day you are penalized for it? Now I see how they can raise $200 billion in tax penalties.
From HR2300:
quote:
SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.

`(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of--

`(1) the taxpayer's modified adjusted gross income for the taxable year, over

`(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.

This is from the AARP website:
quote:
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payroll under $250,000 annually are exempt.
I find this to be a little misleading. If I reading the bill correctly, Employers, on a sliding scale up from $250,000, MUST pay 8%. If you choose not to have health insurance from your employer (ie. covered by spouse's insurance) then your company, depending on payroll, must pay an average payroll amount of 8% to the Health Insurance Exchange Trust Fund. So even though you are covered by health insurance you are still going to lose a percentage of your salary to pay for health care. The exact percentage could be higher than 8% unless your employers spreads the tax across all employees.
quote:
SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COVERAGE.

(a) In General- A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution--

(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and

(2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.


 
Posted by Christine (Member # 8594) on :
 
quote:
Originally posted by The Pixiest:
boots, dear, we work for it, we save it, we don't frivolously blow it, we don't spend it on meth, alcohol or other drugs, we don't commit crimes and go to prison, we plan for the future, we skip fun things that are too expensive...

Our wealth is ours because we're responsible. To take it away for those who do not do all those things is downright evil. Further it rewards laziness, drug use, crime and frivolous wastes of money. Simply because there's no reason to work hard and be frugal.

This is the heart of the libertarian philosophy -- that those who have many have (generally) earned it and those who haven't have (generally) done something wrong. It's the part that sounds nice on paper. Unfortunately, in real life I have seen no such clear breakdown of who has wealth and who doesn't based on level of responsibility. Even though we theoretically live in a society with "equal opportunity" the vast majority of us end up in approximately the same social class as our parents. We have approximately the same opportunities they did. Knowing the right person still is a better way to get a job than actually being competent. Plenty of people who have middle class jobs are useless and weigh their company down and plenty of them don't get fired because they go out to lunch with the boss and know how to brown nose. My father has a government job and calls it "welfare for the middle class" because of all the people who do nothing and yet earn a paycheck.

I had more thoughts but I gotta go...
 
Posted by Jenny Gardener (Member # 903) on :
 
Part of the challenge is that it actually IS more profitable for society to help people be well, but most folks (including those In Charge) want immediate results. There's a cultural challenge. In order for long-term prosperity, people in the short term have to see how their small actions contribute to the whole picture. For instance, people are discovering that small actions like reusing bags at the grocery store and turning off the lights can help everyone be better off in the long run. But it is a little late, considering the Big Picture, to stop or reverse climate change. We're in the midst of it, and the best we can hope for is mitigation. I think the same thing is happening with health care. Our population is huge, and resources are limited. Regardless of wealth distribution, some people are GOING TO DIE from not being able to access the care they need when they need it. The difficult decisions must be made. The question is, who will be put in the position to make those decisions? Government, medical professionals, insurance company executives, families, or individuals? Personally, I think that each individual capable of making a decision should have as much control over his or her health decisions as possible.
 
Posted by Blayne Bradley (Member # 8565) on :
 
Hahahahahahhahaha! Glenn Beck is funny! Hes saying your about to lose the best healthcare system in the world YET 16 months ago he was talking about how terrible the US system is.

hahahaha!
 
Posted by kmbboots (Member # 8576) on :
 
Blayne, you might want to time your posts or phrase them in such a way that it isn't quite as obvious that you are getting all your news from Jon Stewart. [Wink]
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by Christine:
Even though we theoretically live in a society with "equal opportunity" the vast majority of us end up in approximately the same social class as our parents. We have approximately the same opportunities they did. Knowing the right person still is a better way to get a job than actually being competent.

As a total aside, I find it interesting to be the product of one parent who lived in low class poverty, and another parent who grew up in what 1950's California would have termed upper middle class surroundings. I suppose if you do the math, I should statistically be driven towards the middle, and what's even more interesting is that my parents encourage all of their children in their higher education pursuits, *none* of which was in what could be called a money making field of study.

That said, I'm slightly ashamed to admit that I could probably get myself on the staff of a couple of different US Senators and Representatives through family connections. I probably would have had to pursue a different course in college, but it would have been doable. I won't, for a lot of reasons, but I could were I inclined to. I think Pix or Kat would have a hard time disagreeing with the idea that I probably wouldn't be the best person for that job, and yet I know I could get it.

In regards to what you've said Christine, I entirely agree. The theory is nice sounding, but is completely blown away in practice. It's also far too anarchistic and barbarian for my personal sensibilities. It's really never outside the realm of possibility for anyone to lose everything they have, no matter how careful and diligent and honest and hard working they've been. You could be framed for a murder tomorrow, or struck with an incredibly expensive disease, and be completely devastated by it, financially and emotionally. Would that be your fault? Would you be to blame for the murder and the disease because you didn't live in such a way that such a thing would never happen to you in any circumstances? Or are you willing to roll the dice in life just for the chance of getting ahead partly on luck, and then slamming the door on those who never got the least bit lucky?

Pix, you've suffered from depression right? Somebody helped you to get over that, didn't they? In your head, did that person do so in order solely to profit from your successful treatment? Had you been stuck in the hands of an incompetent person, or a person who had betrayed your trust, would you have been at fault for that, in the condition you were in? At what point did your personal responsibility for the turnout end? Or has no one ever helped you, not really, in anything in your life?
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by kmbboots:
Blayne, you might want to time your posts or phrase them in such a way that it isn't quite as obvious that you are getting all your news from Jon Stewart. [Wink]

The guy has started naming threads after TV Tropes topics, so I think we're not seeing any attempt at subtlety here.

Which is fine with me- Blayne's gotten funnier since he started reading a little more widely.
 
Posted by Blayne Bradley (Member # 8565) on :
 
quote:
Originally posted by Orincoro:
quote:
Originally posted by kmbboots:
Blayne, you might want to time your posts or phrase them in such a way that it isn't quite as obvious that you are getting all your news from Jon Stewart. [Wink]

The guy has started naming threads after TV Tropes topics, so I think we're not seeing any attempt at subtlety here.

Which is fine with me- Blayne's gotten funnier since he started reading a little more widely.

Examples out of curiosity?
 
Posted by kmbboots (Member # 8576) on :
 
I'm just teasing you, Blayne. I watch Jon Stewart, too.
 
Posted by Blayne Bradley (Member # 8565) on :
 
I know, but I'm curious which posts were funnier then usual so i can determine if they were intentionally funny or unintentionally funny [Smile]
 
Posted by Orincoro (Member # 8854) on :
 
I don't know really, you're just not trying to be funny in the way that wasn't funny before, and thus are naturally funny rather than simply having no one get it. That and you're reading TV Tropes, which is a bottomless bag of funny, so you're just absorbing the mojo.
 
Posted by SenojRetep (Member # 8614) on :
 
So, between Sibelius' CBS interview (where she suggested the public option wasn't essential), Obama's statement in Colorado that it was "just a sliver" of necessary reform, and Sen. Conrad's statement that he wouldn't vote for any bill containing a public option, it seems the public option is dying in the dog days of August (Howard Dean notwithstanding). The Baucus-Conrad co-op compromise seems to be gaining momentum as the most likely structural mechanism for implementing reform.

Now if we could just couple that with Sen. Wyden's Healthy Americans Act, Peter Orzag's IMAC panel, and some rational tort reform to contain defensive medicine costs and I think we'd have a bill that would 1) maintain significant individual autonomy over care 2) provide universal health insurance and 3) decrease the overall amount spent on healthcare in the US.

<edit>I thought the IMAC panel would review the Medicare prescription drug costs; turns out I was wrong. The CBO found the IMAC panel wouldn't significantly impact health costs. What really is needed is for Obama to fulfill his campaign promise to setup a review of drug costs under medicare. Unfortunately, he evidently promised a lobbyist that he wouldn't (in exchange for industry support of the current reform plans). What we need is IMAC, but with a review not only of procedures and fraud cases, but also of the Medicare drug plan. While IMAC as currently stood up would only save $2 billion over the next decade (according to the CBO analysis), the drug review could save as much as 100 times that much (according to candidate Obama's estimate, based on an Institute for America's Future study).</edit>

<edit2>And I should have included electronic medical records (preferably that could travel with the individual on a smart card) as part of the "good idea" plan above. I believe there were some funds within the ARRA to do that, and maybe that was sufficient; but if not, it should be more fully funded.</edit2>

[ August 17, 2009, 11:40 AM: Message edited by: SenojRetep ]
 
Posted by Katarain (Member # 6659) on :
 
I think this sounds interesting:
quote:
So Conrad has come up with an alternative: public cooperatives. These non-profit groups, run similarly to rural electric co-ops would be given several billion dollars of government money to get started and would -- in theory -- compete with insurance companies to offer better and cheaper medical coverage.
From http://abcnews.go.com/Politics/HealthCare/Story?id=8341010&page=1

As long as everyone gets covered at affordable rates, I'll be happy.

(And that means I would also be in favor of government subsidies for people who still can't afford whatever options are out there.)
 
Posted by Blayne Bradley (Member # 8565) on :
 
Ultimately reasons n+x to not live in the united states unless your making 6 figure.
 
Posted by SenojRetep (Member # 8614) on :
 
quote:
Originally posted by Katarain:
(And that means I would also be in favor of government subsidies for people who still can't afford whatever options are out there.)

Such subsidies (up to 400% of poverty level) are a part of Sen. Wyden's plan. He essentially funds them by repealing the employer tax <edit>deduction</edit>. Repealing the tax <edit>deduction</edit> is anathema to unions which is why his plan has caught a lot of flak from the Democratic establishment.

Here is Jacob Weisberg in Slate on why Wyden's plan is preferable to any of the bills currently under consideration. Here is a link to the plan itself.

[ August 17, 2009, 01:49 PM: Message edited by: SenojRetep ]
 
Posted by SenojRetep (Member # 8614) on :
 
Here's an interesting New Yorker article (linked to in the Slate article from the last post) by a cancer surgeon on the pragmatics of health-care reform. The central premise is that any transformation of the health care system needs to be based around small increments from the current state. Any broad-based change (like a shift to single-payer overnight) is likely to disrupt the system and incur significant transaction costs (like, for instance, lives lost due to paperwork requirements). He points out that of the several nations with UHC, none of them do it exactly the same, and all of them built their particular form of coverage on whatever underlying health care structure already existed.

The author cites Massachusetts' program as one that achieves quality care, on an arc toward universality, while not significantly disrupting the system. He does ding the MA solution, though, for not appropriately reining in costs, and for failing to anticipate the growth in demand for subsidies as people lost their jobs in the recent downturn.
 
Posted by Darth_Mauve (Member # 4709) on :
 
One note I have heard often recently, though I don't know its validity (Senators were shouting it.) The majority of Health Care Bankruptcies in the US are from people who have health insurance.

Between large co-pays (20% of $1,000,000 is still a lot of money.), Deductibles, and hidden costs--even with insurance in this system, a major illness strips you of everything.
 
Posted by AvidReader (Member # 6007) on :
 
quote:
Originally posted by SenojRetep:
Here's an interesting New Yorker article (linked to in the Slate article from the last post) by a cancer surgeon on the pragmatics of health-care reform. The central premise is that any transformation of the health care system needs to be based around small increments from the current state.

What a great article, Senoj. I loved the history of how other countries came to have their systems. I think he's right. I don't think any of those systems would work best for us since we're not in the same situation as any of those countries were.

If the non-profit insurance groups get founded, I wonder if they could carry good insurance plans for just a few months at a better price than Cobra. That might take some of the pressure off people who change jobs, especially if the pre-existing conditions exclusions are outlawed. I agree with the Slate article that employer based coverage leaves something to be desired, but that might be a small fix to keep it relevant.
 
Posted by Samprimary (Member # 8561) on :
 
Harpers: See, Obama has to be bolder and go with more sweeping changes or he will be like Hoover.

New Yorker: Ha ha, yeah right.
 
Posted by Parkour (Member # 12078) on :
 
!alert!

major issue incoming!

The G.O.P. has realized they can no longer filibuster and they are as we speak moving the goalposts.

quote:
Sen. Mike Enzi (R., Wyo.) said the Democrats would be making a mistake by forging ahead on their own. "We need to get a bill that 75 or 80 senators can support," he said. "If the Democrats choose to shut out Republicans and moderate Democrats, their plan will fail because the American people will have no confidence in it."
http://online.wsj.com/article/SB125072573848144647.html
quote:
Well, we're talking about one sixth of the American economy. This is a pretty important thing. And I always look at bipartisan bills as somewhere between 75 and 80 votes, both Democrats and Republicans. And one reason why I decided to leave the group of seven is because -- well, there were a number of reasons. Number one, I don't think they've given Senator -- the Democrats have given Senator Baucus very good flexibility to really be able to put something together. Eighty of the top Democrats in the House are insisting upon a government option or a government plan. I can't be for that, and I don't think -- I don't know of any Republican who is really for that.
http://www.foxnews.com/story/0,2933,540941,00.html
quote:
As the senior Republican on the Finance Committee, Grassley has the potential to attract GOP votes by giving his blessing to a bill, and congressional Democrats and the White House consider him the key to winning bipartisan support for President Obama's top domestic priority. In recent days, however, some Democrats have accused Grassley of trying to undermine the reform effort, for example by refusing to debunk rumors that the Democratic health bills would create "death panels" empowered to decide whether the infirm live or die.

On Wednesday, he denied those claims and fired back at Obama, saying the president should publicly state his willingness to sign a bill without a controversial government-run insurance plan. Such a statement, he said, is "pretty important . . . if you're really interested in a bipartisan bill."

"It's not about getting a lot of Republicans. It's about getting a lot of Democrats and Republicans," Grassley said. "We ought to be focusing on getting 80 votes."

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/19/AR2009081904125.html


whaaaaaaat?

I was not expecting unfilibusterability for this reform bill currently? What's going on? The news has been all about the townhalls and the invective, so color me confused as to why it's translated into a worse situation for the GOP.

Is this temporary, or is this bill going to go down painlessly on a party line vote?
 
Posted by Vadon (Member # 4561) on :
 
*My Liberal/Democratic bias does slip in a bit.*

I think the major change was the 'leaked' story of the Democratic leadership and the white-house planning to split the bill into two votes and use reconciliation. http://online.wsj.com/article/SB125072573848144647.html

The Republicans have seen this and are now crying for bipartisanship, but as Nate Silver pointed out at 538 today, they have no real interest in bipartisanship with their complete rejection of the co-op proposal as an alternative to the public option. They didn't even give the impression of wanting to compromise. I think that the Democrats are finally wising up and realizing that the Republicans aren't interested in being constructive with health care reform. They just let the misinformation go floating around without unequivocal rejection. By letting lies go uncontested, the democrats and Obama have been losing points in favorability, so why should they stop a good thing for them politically? They're being obstructionists, so the democrats are saying, in slightly more diplomatic terms, "We tried to be nice, but screw you."

Nate Silver thinks this is a bluff, and I think it could very well be. Either way, it is somewhat changing the tides for the moment.
 
Posted by Parkour (Member # 12078) on :
 
quote:
Originally posted by Vadon:
The Republicans have seen this and are now crying for bipartisanship, but as Nate Silver pointed out at 538 today, they have no real interest in bipartisanship with their complete rejection of the co-op proposal as an alternative to the public option. They didn't even give the impression of wanting to compromise.

They did give the impression of wanting to compromise. It was just false. This is because they have no strategic option besides stonewalling any health care reform. If health care reform works, they lose.
 
Posted by DarkKnight (Member # 7536) on :
 
I don't get why being opposed to the current bills means you are against healthcare reform? To make a blanket statement against Democrats like the ones being made against Republicans...this means Democrats are in favor of imposing a tax penalty of 2.5% of your yearly income for being without health insurance for a single day. Is that really what you want? Change jobs and most likely have to pay a whopping penalty because you went without health insurance for a day?
How about this scenario...a married couple both work, both companies provide health insurance but the plan for the wife is much better than the plan offered by the husband's company. The husband declines the health care from his company (he is covered by his wife's) and is given $1000 (This is true where I work although YMMV.) Under Obama's plan the husband's company would have to pay 8% of the average pay in his company to the government even though the husband has health insurance. Not 8% of the husband's pay, but 8% of the average pay....
Is this really what you want?
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by DarkKnight:
Is that really what you want? Change jobs and most likely have to pay a whopping penalty because you went without health insurance for a day?

Why are you so confident that this exact language will be preserved in the final bill, or that should it happen this way, there will not be legislation undertaken to amend such an unfair policy? I mean, I'm against this particular picayune, but it's not a deal breaker for me at all. I believe if this were the only sticking point, congress would be able to smooth it out fairly easily.

See, it's not that I think being against this bill means you are against any reform, but the people against this bill are sure *acting* as if they are against *any* type of reform. What you're pointing out is important, but in what way is this one point a deal breaker, or something you think couldn't or wouldn't be resolved? Do you believe legislation can actually be passed on anything without us having to go back in time and fix things like this so that they work better? Do you think all legislation, no matter how important, should be held up until there is no objection to any fine point? Honest question: how do you think this is a different case from the myriad legislation congress deals with every session?
 
Posted by DarkKnight (Member # 7536) on :
 
quote:
Why are you so confident that this exact language will be preserved in the final bill, or that should it happen this way, there will not be legislation undertaken to amend such an unfair policy? I mean, I'm against this particular picayune, but it's not a deal breaker for me at all. I believe if this were the only sticking point, congress would be able to smooth it out fairly easily.
Except that they are not and they plan on $200 BILLION coming from tax penalties against individuals and employers...so how do you remove that and not come up $200 billion short?
quote:
What you're pointing out is important, but in what way is this one point a deal breaker, or something you think couldn't or wouldn't be resolved?
It is a deal breaker to me because I am sure the are other small sentences in the bill that are just like that one.
quote:
Do you believe legislation can actually be passed on anything without us having to go back in time and fix things like this so that they work better?
Irrelevant point. The issue is not whether this particular bill just needs to be tweaked slightly or not. The issue is that they are trying to tackle a gigantic complex issue in one massive plan which is bound to fail because of unintended consequences.
Instead let's do it many smaller steps instead of one big overall sweeping massive reform.
Focus on getting people without health insurance coverage first. Start with the people who are eligible for Medicaid but don't have it and get them enrolled. A possible way to do that would be to start at where people without health insurance go to get health care. If you can't pay, you get treated first, and then you are referred to a caseworker who can see if you are one of the millions who are eligible for Medicaid or other government assistance. In the end, the provider can get paid if the individual is supposed to be covered.
In another bill, we can work with health insurance companies to provide a low cost catastrophic care plan to young people who are healthy and people who make enough money to have health insurance but choose not to have it.
Work on getting electronic records passed as well.
These are just smaller first steps which would be much easier to get passed.
quote:
Do you think all legislation, no matter how important, should be held up until there is no objection to any fine point?
This is the same question you asked before.
quote:
Honest question: how do you think this is a different case from the myriad legislation congress deals with every session?
Honest answer: The Cash for Clunkers program should have been a simple easily run program yet is far behind in payments and is managed terribly. The government couldn't deal with a small, popular, billion dollar program yet they are going to perform well with a gigantic trillion dollar plus program?
Start small. Keep going forward but allow the changes you made to take place before you keep throwing changes at a massive system.
Sure it will take time but it has a much better chance of being done right
 
Posted by Samprimary (Member # 8561) on :
 
quote:
Sen. Mike Enzi (R., Wyo.) said the Democrats would be making a mistake by forging ahead on their own. "We need to get a bill that 75 or 80 senators can support," he said. "If the Democrats choose to shut out Republicans and moderate Democrats, their plan will fail because the American people will have no confidence in it."
"A supermajority is not enough! Your legislation doesn't truly have the public's support unless a superdupermajority voted for it!"
 
Posted by Noemon (Member # 1115) on :
 
:: laugh ::
 
Posted by ClaudiaTherese (Member # 923) on :
 
This thread needs more ellipses. Without sufficient ellipses, one would have to spell out exactly what one means.

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

^----[extra: share the wealth!]
 
Posted by Orincoro (Member # 8854) on :
 
quote:
Originally posted by DarkKnight:

Start small. Keep going forward but allow the changes you made to take place before you keep throwing changes at a massive system.
Sure it will take time but it has a much better chance of being done right

You are perfectly aware of the political ramifications of either slowing or hurrying the process. In an ideal situation, yes, the administration could afford to enact reform on a longer time scale. However, I'm not entirely sure that would ever work. The pace of reform has raised the collective blood pressure in Washington, but it's also made public and in the open a lot of the handwaving done about reform by conservatives. Given a longer time frame, I would expect conservatives to simply have more time to stonewall and win smaller victories against reform, whereas doing this all at once, in the broad daylight with all eyes focused on the prize, certainly catches public attention and shows people that there is a debate going on, and encourages them to join it. Do you think we'd be discussing this with any vigor if it were yet another of dozens of bills passed slowly over years, for which either party had plenty of time to invent rationales for failure or handwaving dismissals of success?

As Tom said a ways back, we've been waiting 30 years for reform, and in the meantime thousands of people die every year, needlessly, at the hands of a morally corrupt insurance system. I don't want this process to be done when I'm 50, and I think if we try to do it that way, it will never happen.
 
Posted by Samprimary (Member # 8561) on :
 
There will also necessarily be jumps in reform which cannot be small, such as the inevitable leap towards universal coverage. And I will reiterate that universal coverage will happen; it's only a matter of time.

This is a perfect example of a scenario in which it is worse, policywise, to 'slowly' expand coverage, like if we were to progressively lower the age of medicare enrollment and progressively expand the extent of medicaid coverage. It would expand costs associated with increased coverage but the system would still leave a bulk of our working populace uncovered, so that nothing is being done about their health which centrally allows us to gain access to the overall improvements in quality of life, economic benefits, and reduction in cost that uhc systems provide.

These 'small changes' would be tantamount to looking again at a structure with a weak foundation and attempting to solve that problem by asking "so how many floors should we add to it?"

You don't do this. You go for the big change. You demolish the structure and build the new kind that works so well that every other block in the city has it.

This isn't to say that "many smaller steps instead of one big overall sweeping massive reform" doesn't have its place. I, myself, certainly wished the G.O.P. had chanced upon the idea that this logic should also apply when it comes to their own plans as well, such as the Patriot Act.
 
Posted by Darth_Mauve (Member # 4709) on :
 
DK, thanks.

For pages and in threads the Pro-Obama care people have asked for rational debate, not name calling, screaming, or panic.

You offered it, and it seems that some folks try push you off with--"That doesn't matter" or "Its politics"

You have a good point. There will be a fine system for being un-insured. You go without insurance, you pay a fine.

The bill does not make clear if there will be a grace period to allow you to shop and get the insurance that best suits you, or if you will have to grab the closest thing to avoid a big fine.

However, your $20,000,000 in fines and payments is not going to come from charging $20 to millions of people per day they are not insured. It will come from corporations and small businesses that would rather pay the government than go to the efforts of supplying their employees with insurance.

I would argue more, but my son is begging for attention, by sitting on the computer.
 
Posted by Samprimary (Member # 8561) on :
 
http://www.huffingtonpost.com/2009/08/21/death-panel-myth-creator_n_265547.html
 
Posted by Samprimary (Member # 8561) on :
 
Another surprise for me: the latest turnover to the pro-reform side is ...

http://www.alternet.org/media/141986/lou_dobbs_tours_single-payer_systems_abroad_and_realizes%2C_holy_crap_they%27re_good/


lou dobbs?
 


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