I think this was brought up in the "I apologize for voting for Barack Obama" thread but the title kind of set a tone that didn't make me inclined to follow the subsequent conversation very closely and besides, the thread threw a wide net. I just want to talk about one thing:
Should health insurance be mandatory?
Some of the discussions on this site have me softened to the idea of a single-payer system. Well, that and the fact that two years ago my husband took a job in which we were given a "choice" between crappy insurance and crappier insurance. I'm afraid that I no longer see private insurance as a system in which individuals are given any kind of choice -- employers, maybe, but not individuals.
So when I made my decision to vote for Barack Obama, his new ideas on health insurance didn't bother me all that much. I knew he didn't want a single payer but I figured he knew that the country wasn't ready for that yet. Too many outspoken conservatives have us scared that Canadians are dying left and right of routine medical conditions.
Here's the thing: It seems to me that in this case, the compromise solution may be worse than either extreme. An individual mandate that we all carry insurance? Oh, I believe there will be waivers and discounts for hardship cases...I don't know if those waivers and discounts will be enough and perhaps nobody does yet since there are several bills running around at the moment and it is therefore impossible to debate the fine points. So let's just hit the highlights:
Is this middle-ground approach a good idea? How will it help and how will it hurt?
Posted by Tresopax (Member # 1063) on :
quote:Should health insurance be mandatory?
Yes, because society ends up providing a sort of "moral health insurance" anyway - if a man is dying in the street, we are morally obligated to help him. And often at the point where society is morally forced to intervene, health conditions have worsened to the point where there are only a few options and all of them are very costly. We should expect responsible citizens to take measures to avoid forcing society to incur that cost, and that means we should expect them to have their own insurance plan that will prevent their health conditions from getting to the point where they are a huge cost on society.
But that, of course, means we'd have to make such a plan available to them in a financially reasonable way.
Posted by TomDavidson (Member # 124) on :
A middle-ground approach is a bad idea. If we're going to do it right, single-payer is the way to go.
Posted by malanthrop (Member # 11992) on :
The pretense is socialized medicine but there is little difference between this government and the last. They are controlled by big business and lobbyists. There is no better business position to have than the government mandating your product. Since auto insurance is legally required, why not health insurance? Drug companies may not be able to charge as much per pill but since everyone has "free" healthcare they'll follow the WalMart route and make up for it in bulk. Although the government may limit the cost for the procedures,tests and pills, since the govt is paying, they will order every test, procedure and pill to recoup profit. There will be shortages and lines with many in line who don't need it. Medicare and Medicate are full of fraud. I live in Florida where the elderly, worrying about their mortality, visit the doctors on a weekly basis just to get checked out and visit with the doctor they consider a friend - all at tax payers expense. Before they leave for the day, the doc schedules another appointment where they'll sit and talk about how they feel the same as last month or week. Right now I have great insurance with a small copay. The copay is just large enough to keep me out of the doctors office for the sniffles but small enough to be quite acceptable if I were truly ill. Free health care will be overused. People are naturally capitalistic and will take full advantage of any possibility for profit. Profit in the form of "free" care or profit on the part of the provider. I'm a govt contractor and spent many years in the military. Believe me, when the government is paying the bill, it is taken full advantage of.
[ July 22, 2009, 09:14 AM: Message edited by: malanthrop ]
Posted by Scott R (Member # 567) on :
I'm not convinced by stories of gloom and doom any more than I am by rainbows and kittens, malanthrop.
Posted by Jamio (Member # 12053) on :
I believe a middle ground solution is a bad idea. I am a conservative, but I would much prefer a European-style health care system, even if that means European-style taxes, than a hacked-together compromise where nobody gets what they want.
Posted by malanthrop (Member # 11992) on :
All insurance is single payer. I pay $150 per month for auto insurance but have never filed a claim. My payments are shared with other drivers who may have filed a claim. If I had free government provided comprehensive auto insurance, I would've filed many claims by now. I've been rear ended in my truck more than once and had other peoples car doors slam into mine in parking lots. These incidents did little structural damage to my vehicle so the cost of the deductible and potential increase in premiums dissuaded me from taking advantage of the coverage. If everyone in the situation called the insurance company, premiums would be much-much higher. If we had a nationalized government provided comprehensive auto policy, I would've had many, many new paint jobs by now.
Posted by Mucus (Member # 9735) on :
How accurate is the mandatory auto insurance analogy to what is currently being proposed? (not familiar with the current US proposal)
Posted by AchillesHeel (Member # 11736) on :
I dont like the idea of "mandatory" free, and govt. designed health care is much more acceptable. But the system now only helps the rich, and the people with no shame who put thier hand out to the feds for anything they can. A hard working person who takes care of themselves, is much more likely to develop and suffer from preventable conditions than someone who is second generation wealth or welfare.
Personally I dont understand why so much attention is being given to the idea of health care reform, and yet our veterans still suffer in those mausoleum's called hospitals. If a vet is told that they need to stay overnight or for any length of time its usually a death sentence, and many go without the healthcare that they earned due to the generally kavorkian pessimism of the doctors and staff. I say fix thier healthcare before ours.
Posted by Christine (Member # 8594) on :
There are several current US proposals, which is making the discussion difficult.
But I don't think the analogy between auto and health insurance works. Quite frankly, a few hypochondriacs aren't going to scare me off of getting everyone checked out on a regular basis. Regular well visits can prevent more costly procedures in the future. And as far as needing a new paint job -- I'm not sure what the health equivalent of that is but let's say I take a bad spill and need a few stitches. Sure, my father-in-law stitched up his kids himself because he didn't have health insurance and they all lived but, well, please give me a doctor! You never know what kind of badness or infections will spring from amateur work.
People with good private insurance take advantage as well, which is factored into your rates. That's why health insurance companies have gone to plans like the one I "chose" in which my yearly per person deductible is $2,600 and after that they only pay 85%. My other "choice" was a $4,000 per person deductible. In my case, I haven't gone to the doctor any less because I never went frivolously. It just costs more.
quote:Originally posted by malanthrop: They are controlled by big business and lobbyists. There is no better business position to have than the government mandating your product.
This part, I'm afraid, I may have to agree with. Sometimes the government seems to exist to serve big business.
Posted by rivka (Member # 4859) on :
quote:Originally posted by TomDavidson: A middle-ground approach is a bad idea. If we're going to do it right, single-payer is the way to go.
I agree.
Posted by MattP (Member # 10495) on :
This is the problem with a system that has two major powers with opposing views and the perception or political necessity that the correct solution must always be the some sort of compromise.
It's like one of us wants to walk to the store and the other wants to drive so we "compromise" by pushing the car.
Posted by Sterling (Member # 8096) on :
I'm kind of taking a "wait and see" approach to this and hoping that wiser heads will prevail. I think mandatory insurance could be a good idea, but only if it comes with some strong guidelines for care to reduce waste and curb the current practice of defensive medicine (among other things).
Posted by malanthrop (Member # 11992) on :
Single payer is the best way to spread costs. Just as with retirement, saving a little every month leads to a nice nest egg later in life, paying a normalized health care premium throughout one's life recoups the bulk of health care costs while elderly. On one hand I agree that there are problems, although I do not really like legal mandates. If health care were legally mandated throughout one's adult life, the later costs would be distributed. Essentially the relatively low premium you paid while young and healthy would pay for the huge expense later in life. As they admit, 80% of the health care costs for an individual throughout their life is spent in the last year of life. I hate to admit this, but the best answer I see is legally mandated health care through private industry. (like auto insurance)
It is much more preferable to require it by law than to let the law tax and control it. Take a look at social security payments. These are taxes to support one later in life, but the return on investment is pathetic and cannot be transferred to one's family/dependents. If the individual chose to invest and or save the same amount as their social security payment, they would be far better off in retirement than the pittance the government gives. It would be better if the govt legally required you to save 6.5% of your income.
We've gotten away from individual responsibility. I would eagerly accept a choice to be mandated to either save an equivalent Social Security tax or submit to the social security tax. The government return on investment is always less than the free market.
As a Libertarian, I hate to admit this...but I believe the best answer is to legally require private sector health care from the age of adulthood and outlawing the prior conditions standard. Just as one can buy a set rate life insurance policy early in life, the older you wait the more expensive it is. This is a free market product where the consumer is guaranteed to die and collect the pay out but the company knows it will make money over the long term. Selling health insurance to a sick or elderly person makes absolutely no sense.
Mandating coverage with equal premiums regardless of age or condition, to private insurance companies might be the way to go. The government will always cost more. Perhaps the first step toward universal should be a universal requirement to buy free market health care....like auto policies.
[ July 22, 2009, 11:21 AM: Message edited by: malanthrop ]
Posted by aspectre (Member # 2222) on :
I've always thought it strange that women get lower auto premiums than men due to statistics and this is not considered discriminatory. Under this same statistical concept in insurance, shouldn't blacks pay higher health care premiums due to increased statistical health problems and collect social security payments at a younger age? If I were the NAACP I would demand social security payments given at a younger age for African Americans. Why should a man pay his entire life when statistically he has little chance of collecting?
Posted by Lyrhawn (Member # 7039) on :
quote:From malanthrop: I hate to admit this, but the best answer I see is legally mandated health care through private industry.
I'm curious. Where in your scenario do I, the young person, get the money to spend while I'm young and healthy to pay for when I'm old and riddled with disease? The problem with that equation, of course, is that I don't have excess funds at the moment. That's why young people are the largest demographic of uninsured people: A combination of no money, and either a trust or a prayer of faith in our young invulnerability. Mandating coverage isn't going to make that magically happen. If we don't have the money, we don't have the money.
quote:from malanthrop: Mandating coverage with equal premiums regardless of age or condition, to private insurance companies might be the way to go. The government will always cost more.
The irony there is that the argument most bandied about by conservatives against single payer is that the government, with all its resources, would drive private insurance companies out of business. And then on the other hand they argue that government is inherently wasteful. Someone from the Right needs to explain to me how the system will be both more wasteful and more efficient than private industry, as that appears to nail down the definition of mutual exclusion as well as anything I've ever seen.
quote:from malanthrop: All insurance is single payer. I pay $150 per month for auto insurance but have never filed a claim. My payments are shared with other drivers who may have filed a claim. If I had free government provided comprehensive auto insurance, I would've filed many claims by now. I've been rear ended in my truck more than once and had other peoples car doors slam into mine in parking lots. These incidents did little structural damage to my vehicle so the cost of the deductible and potential increase in premiums dissuaded me from taking advantage of the coverage. If everyone in the situation called the insurance company, premiums would be much-much higher. If we had a nationalized government provided comprehensive auto policy, I would've had many, many new paint jobs by now.
Near as I can tell, this is exactly where the auto insurance analogy sort of falls down, or at least, gets muddled. You've completely disregarded the role of the PCP. They're there to keep the knucklehead stuff out of the hospitals so there aren't dramatic wait lines for every cough, sniffle and headache riddled patient demanding an MRI. Just because you want an MRI doesn't mean you get one, regardless of the system, in much the same way that you don't get vicodin just because you want it. Your primary care physician is there to be a gatekeeper, in a sorely under appreciated role, I might add, in order to make sure the system works. Sadly, we don't have enough of them, and they spend far too much time dealing with insurance company red tape to actually get a great deal of medicine accomplished. I suppose for the purposes of this analogy, the PCP is the claims adjuster, and they don't just sit around, ideally, rubber stamping every medical decision a patient makes. If patients made ALL their own medical decisions, we wouldn't even need doctors, we'd just need WebMD and a sign up sheet for the x-ray room.
quote:from malanthrop: The government will always cost more.
Yeah, I get the argument in principle, but private industry has to do a lot of things in healthcare that government wouldn't. Government doesn't need to turn a profit, and they don't need to spend vast sums of money on advertising, at least, not after the initial funds are provided to educate the public. They have the ability to provide services at cost.
You can make a lot of arguments about how hard it might be to get a knee replacement surgery, but the bottom line is that European style government health care provides more, better care, for less money per capita. No one is arguing that, like France or England, the government be the employer of all the doctors and hospitals in the country, so regardless this will never be European style health care, regardless of the fear mongering, but it could end up being something of a hybrid.
Posted by Christine (Member # 8594) on :
quote:Originally posted by malanthrop: [QBaThe government will always cost more. Perhaps the first step toward universal should be a universal requirement to buy free market health care....like auto policies. [/QB]
My husband works for a health insurance company. Not only has this company offered us the worst insurance we've ever had, but they are also the most inefficient, muddle-headed, bureaucratic nightmare that he's ever worked for. As a small example, last night my husband had to deploy a new software application. Sounds simple enough, but while he was working at 10:00 at night, he had 5 people on the phone with him including a vice president. Yeah, that's a great use of resources. And that's just the tip of the iceberg.
I've also heard horror stories of government inefficiency from my father, who works for the DOD, but I have seen no evidence that private business is more efficient than government. Bureaucracies, private or public, are inefficient.
But private business has to turn a profit on top of that inefficiency.
What private industry does that the government cannot is provide competition, but I'm not sure how well that concept applies in the case of health care. Individuals do not get to choose between competing plans, only their employers do. Often, individuals have no choice at all. And if the government MANDATES health insurance and then keeps it private, I can't help but think that this will increase costs now that the insurance companies have a captive audience.
But I'm open for disagreement.
Posted by aspectre (Member # 2222) on :
The SocialSecurity system was designed under the assumption that most people would statisticly have little chance of collecting. Assuming no improvements in geriatric healthcare during the 21stCentury, ~8% of all BabyBoomers are expected to live long enough to collect over 35years worth of SocialSecurity pension payments. More realisticly, I'd be amazed if some of the Boomers don't make it into the 22ndCentury (over 70years of pension benefits). Why should anyone who is capable of working (or possesses wealth that generates income equivalent to more than 2000hours of minimum wage per year) receive retirement benefits from the taxpayer?
Posted by malanthrop (Member # 11992) on :
As you said, the young and healthy neither afford or need it. It's self negating. The statistics of the small percentage of people who don't have it include those who don't need it and illegal aliens. Neither of which I am too concerned about. I do worry about people with preexisting conditions. I believe we should have a government program to cover everyone provided you: A-prove need and B-prove citizenship. Problem is the government is a scam. Social Security is the best example....I just moved my 59 year old neighbor with 6 herniated disks. He was covered medically by the government but the 18 month process from appeal to reapeal for social security (36 months) resulted in him losing his house. Guess what, the government now owns his house and are suggesting renting forclosures to prior owners. Let me get this correct....he's completely dissabled but the govt process to collect social security disability is so slow he loses his house to the government. Sounds like a great scam to me. All his lawyers insist he is definitely disabled and will get the SS money with back pay but the govt via Fannie and Freddie now own his home and are considering renting it to him.... This is what is wrong with government control.
My other neighbor just got his SS disability rejection letter (standard procedure to be rejected at least once} He was an industrial painter for 35 years and hasn't worked in a year and a half. He passed out on the job. You see, his civilian and union doctor have declared him unfit to work and fully disabled. As a union member he is not allowed on the job site, but the union will not give him his disability pension until the govt declares him disabled as well. Problem is, the SS administration doctors looked at his file and said he can work. Wonder why the union and government are so tight....they sure cover each other's backs. One doesn't have to give him his pension for another six years so long as the other says he isn't disabled. Although one considers him disabled and wont let him back on the job. Good deal....Card Check anyone?
Posted by ClaudiaTherese (Member # 923) on :
quote:Originally posted by AchillesHeel: Personally I dont understand why so much attention is being given to the idea of health care reform, and yet our veterans still suffer in those mausoleum's called hospitals. If a vet is told that they need to stay overnight or for any length of time its usually a death sentence, and many go without the healthcare that they earned due to the generally kavorkian pessimism of the doctors and staff. I say fix thier healthcare before ours.
*mildly
The VA system has what is probably the most extensive and efficient quality improvement system in US healthcare. Outcomes measures studies and updated protocols are in constant use.
This is in response to relatively poor conditions in the mid-70s. That situation has changed, however.
And so someone with an acute heart attack gets as good as (or better [depending on which study]) care when seen at the typical VA hospital, as compared to the average Medicare patient seen at a non-VA site. That is to say, even though the VA patients tend to be sicker and have more complex medical histories, their mortality rate from an acute MI is equivalent to or better than that of non-VA patients.
Would that more of our parents and grandparents with heart attacks could be seen at VAs.
quote:Yet, despite these admirable accomplishments, the perception persists that the care offered through the VHA is of poor quality. In this issue of the [New England Journal of Medicine], Petersen and her colleagues report on an investigation undertaken with the explicit hypothesis that patients 65 years old or older who were treated for myocardial infarction in the VA system would receive care of poorer quality than patients treated through the Medicare program and that, accordingly, the VA's patients would have worse outcomes.11 The investigators found that patients who were admitted to VA medical centers had a greater burden of chronic illness and sustained more severe infarctions, yet they had similar mortality at 30 days and 1 year. As the authors themselves point out, comparisons between different systems of care are prone to bias, especially if one system is more likely to treat patients who are more severely ill. In fact, nearly 70 percent of veterans who use the VA are admitted to non-VA hospitals under the Medicare program rather than VHA medical centers when they have an acute myocardial infarction.12 In this instance, however, the patients admitted to VHA facilities have more coexisting conditions.11,12 To the extent possible, the authors addressed this problem by adjusting for most of the important variables known to influence survival after acute myocardial infarction and still observed no differences in survival rates — a fact that supports the validity of their findings.
I'm just one story, but my experiences with Taiwan's single payer system are devoid of complaint. I had a fairly serious problem, I had no difficulty getting the tests I needed done, and my treatment options made available.
However, politicians need to raise payroll taxes to fund it, and they are too afraid to for fear of losing votes. It's a serious problem.
Posted by The Pixiest (Member # 1863) on :
Lyr: the government is a monopoly with no incentive to reduce waste. When they run out of money, they just charge us more for their services by raising taxes. It's nigh impossible to fire a government employee. I don't understand how you can think the government is not wasteful?
That's not to say businesses don't get wasteful. But when businesses get bloated, then hit hard times, they fail (unless the government bails them out. Which is yet another argument against corporate welfare.)
The government never goes out of business. It just gets older.. bigger... and more bloated. Bad programs rarely get repealed, they just get more money thrown at them.
The same thing will happen with health care.
Christine: The government exists to buy votes with tax payer money. They need large contributions to buy the advertising to tell the voters what they'll get if they vote for the "right" people, so they hit up big business. Then that business needs a payback so you get things like Sudafed being banned, and bail outs. This is nothing new. Ask Preston Tucker.
Edit: Oh, I forgot to say, I think the compromise is worse than either extreme too. I think socialized health care is one of the worst ideas in politics today, but the idea that we can compromise and make everything ok is just downright nutty. Having the government in a market is like trying to compete against microsoft. You're going to lose. And in the meantime you're adding complexity and confusion.
Posted by aspectre (Member # 2222) on :
Your point? Insurance companies constitute an effective monopoly with HUGE incentives to generate waste.
Posted by The Pixiest (Member # 1863) on :
aspectre: the fact you had to pluralize "company" shows that they are not a monopoly.
You could argue they're a trust, but we have laws for that.
Posted by malanthrop (Member # 11992) on :
The VA is good for veterans. You want an example of truly socialized medicine, look to active duty hospitals. I was active duty for 12 years, during this time my family received excellent care. They were free to seek care on the outside. I as an active duty service member had one choice,...base hospital. Only when getting my VA physical for separation was it pointed out I had bone spurs in my wrists and ankles that had been documented but not told to me. You see, I could still do my 50 push ups and pass the physical so no matter how much I complained about the pain, they would neither tell me the findings or treat them. I had complained about heart burn for five years and the military refused to run tests unless I quit smoking. The VA found I had H-pilori in my stomache, a bacteria and the #1 cause of ulcers. One week of antibiotics cured years of pain. I cracked a molar right down the middle and through the root. My family had excellent care through United Concordia, I on the other hand had one choice,...base dentist. They declared it not an emergency. Greatest pain I've ever suffered in my life. Two weeks to get an appointment. The people ahead of me were soldiers who needed checkups prior to going to the desert. When I was 28 years old I had chronic bronchitis and sore throats. The military doctors after a year of complaints decided they should remove my tonsils. Extremely painful to have your throat carturized at that age. The military gave me liquid children's tylenol for the pain. Fortunately my mother in law could write scripts and gave me something for the suffering she saw....the military and my single provider refused. I've experienced govt health care, it sucks. Everyone who retires or separates around me "discovers" serious injuries the "free" govt system missed or kept to themselves.
Posted by TomDavidson (Member # 124) on :
quote:I've experienced govt health care, it sucks.
Why do you think that military health care can be considered representative of government health care?
Posted by malanthrop (Member # 11992) on :
quote:Originally posted by TomDavidson:
quote:I've experienced govt health care, it sucks.
Why do you think that military health care can be considered representative of government health care?
Military health care is very much like government health care...lack of choice. While military dependents under TriCare are free to go anywhere, the active duty member can only be seen at one location, the base hospital. Government healthcare will be setup the same way. You see the doctor in your neighborhood or region, that's it. No second opinions. Hope the doctor in your area isn't too busy for you to get good care.
Posted by Lyrhawn (Member # 7039) on :
Where are you getting that from?
Posted by TomDavidson (Member # 124) on :
quote:Government healthcare will be setup the same way.
What makes you so sure? None of the proposals I've seen work this way.
Posted by Mucus (Member # 9735) on :
quote:Originally posted by Lyrhawn: Where are you getting that from?
I'm pretty sure its an American meme (for lack of a better word). For example :
quote:During seminars in which doctoral students in health services administration had to research various countries’ health care systems and describe them to their peers, the authors noted that the American students all raised an issue in which the foreigners present showed no interest-whether or not patients had free choice of physician. Often the comment was, “I was unable to find out whether there is free choice of physician.” Evidently their source authors had not considered this a significant issue either. This particular preoccupation among the students echoed one of the first questions Americans in general ask about the NHS. One of the “myths” about the NHS is that Americans have a free choice of physician (and this is positively valued) whereas in the NHS one must accept the physician assigned.
Tom and Mal: I don't think anyone has a clue what's in the 1000+ page bill including the people voting on it. Obama doesn't know, he said so yesterday.
Posted by malanthrop (Member # 11992) on :
quote:Originally posted by The Pixiest: Tom and Mal: I don't think anyone has a clue what's in the 1000+ page bill including the people voting on it. Obama doesn't know, he said so yesterday.
I agree completely. I nor none of the people voting on it could've read the 1000 pages yet. Some pages are out there...no new private sector policies after enactment, automatic medicaid enrollroment for illegal alien children, abortion coverage, etc. Regardless of which side the aisle you are on with any particular issue, they want to vote it in as soon as possible. Obama doesn't know what's in the bill but he wants it passed now. It has to be passed this month even if it doesn't go into effect until 2012. It is purely politics. Nobody knows what is in the bill. Even the people voting for it haven't read it all. This scares me the most. They let the lobbyists, special intersts and aids write it for them. They don't care what it means because all it means to them is a slogan for reelection, "we passed healthcare reform". "Reform" like "change" can mean anything, but those words sound good to the voters.
Posted by DarkKnight (Member # 7536) on :
quote: The plans contain four proposals that will substantially weaken the ability of the market, already limited by burdensome regulation, to restrain medical spending.
First, they will impose rich, standard packages of benefits, with low deductibles, for all Americans. Those policies, typically containing everything from in-vitro fertilization to mental health benefits, are usually far more expensive than anything most people would pay for with their own money.
Second, the plans would impose on a federal level the doctrine of community rating, in which all customers have to be offered the same rates, regardless of their health risks. Community rating forces young people to pay far more than their actual cost, a main reason for today's 46 million uninsured, while it subsidizes older patients.
Third, Obama would ban consumers from buying private insurance across state lines, perpetuating the price differences in today's fragmented market, instead of allowing all Americans to shop anywhere for the best deals.
Fourth, both plans propose what's known as a "public option," or a Medicare-style plan that would compete with the private offerings. The previous three proposals would make the private plans extremely expensive. With the same subsidies, the Medicare-style plan could put them out of business.
Posted by Christine (Member # 8594) on :
quote:Originally posted by The Pixiest: aspectre: the fact you had to pluralize "company" shows that they are not a monopoly.
You could argue they're a trust, but we have laws for that.
Ah, and now you get into my biggest problem with the marriage of capitalism and government. You see, we may have LAWS that are designed to help increase competitiveness and break up monopolies/trusts, but these laws are only useful if ENFORCED.
I'm with you on one thing -- I want bloated businesses to fall on their asses and fail. I am fed up with corporate welfare and do not believe that there is any such thing as a company that is too big to fail. It is competition and ingenuity that makes capitalism works and this works best on small scales. When you have giants looming over you, it is nearly impossible to even get into a business.
What's worse is that the government passes laws all the time designed to prop up their buddies and smack down new upstarts. The success story of Southwest Airlines is pretty amazing, when you read about how all the big airlines lobbied congress to get laws passed to prevent Southwest from flying anywhere. Specifically targeted laws designed to put down a competitor?!?
I'm not sure why health care has gone the way that it has. I do know that big businesses work hard to make sure that you NEED insurance because you can't afford even the smallest treatment otherwise. It costs more to go to the doctor if you are uninsured. That is to say, the insurance company will pay less than you would have. Hospitals and insurance companies come up with these complicated pricing scams...the hospital initially charges the insurance company what they would charge you because the government says dual pricing is illegal. But then the insurance company sends the bill back and says we'll pay x and the hospital takes it.
Oh, and hospitals like to charge insurance companies for different procedures than they actually did to get more money. There's a local insurance company that I used to use that was absolutely terrific but lots of hospitals and doctors are starting to refuse to take that insurance because they call them on their lies when they pretend you got an expensive procedure when really it was a cheap one.
If I had a point, I lost it somewhere... Posted by TomDavidson (Member # 124) on :
quote:First, they will impose rich, standard packages of benefits, with low deductibles, for all Americans. Those policies, typically containing everything from in-vitro fertilization to mental health benefits, are usually far more expensive than anything most people would pay for with their own money.
When they say "typically containing," does that mean they will contain these services? Just as an example: I have a pretty rich package of standard benefits from my insurer, but it doesn't include in-vitro fertilization, gastric bypass, elective dental work, etc. I don't see why they're assuming these plans will.
Posted by The Pixiest (Member # 1863) on :
Christine: The only way to get government out of bed with business is to reduce the power of government. So long as there are politicians, they will be for sale. And Business has the most to gain and the most to spend in buying them.
If the government has less power over our lives... If the government lives by the constitution, business will have little or no reason to buy favors because there will be no favors to be had.
Posted by malanthrop (Member # 11992) on :
I'll give you another example of government backed insurance. Florida has a "universal" homeowners insurance policy called Citizens. This is by far the most expensive homeowners insurance policy in the state and it it a state run policy. It's for the "poor" people who can't get insurance elswhere. In reality it covers beach front mansion home owners who no sane insurance company would cover. At the same time (although I don't want my rates to go up) the state passes laws limiting the rates private companies can charge. So, for the "protection of the people" the FL legislature will not allow State Farm to raise my rate from $1000 per year to $1200 per year. St Farm decides to cancel all FL home owners policies and the homeowner end's up paying $1800 per year to the government via Citizens. See how it works.....The legislature protects the people from predatory capitalist insurance companies, drive them out, the state policy costs even more. Brilliant form of taxation.
Posted by DarkKnight (Member # 7536) on :
quote: When they say "typically containing," does that mean they will contain these services?
If they based it off of the Massachussetts plan it will. this is part of an editorial by Romney.
quote: The Massachusetts plan costs the state more than expected, largely because the legislature has been unwilling to further reduce state payments to hospitals for free care. The costs should be brought in line by eliminating these payments, by requiring sustainable copremiums and by removing coverage mandates (for example, every policy is now required to include unlimited in vitro fertilization procedures).
Posted by Orincoro (Member # 8854) on :
quote:Originally posted by rivka:
quote:Originally posted by TomDavidson: A middle-ground approach is a bad idea. If we're going to do it right, single-payer is the way to go.
I agree.
Thirded.
Posted by Orincoro (Member # 8854) on :
quote:Originally posted by TomDavidson:
quote:I've experienced govt health care, it sucks.
Why do you think that military health care can be considered representative of government health care?
Also apros pos, why does he think that a collection of personal complaints, from the mouth of an avowed denier, should be taken at face value? This is why anecdotal evidence is not useful in arguing against a major program- one that doesn't even yet exist. Use your experience, and do better- what could be more intuitive? I mean, mal comes from the military, an organization wholeheartedly committed to the idea that they are capable of learning from their mistakes and doing better the next time- even in the face of those mistakes being repeated.
Posted by Darth_Mauve (Member # 4709) on :
quote: The statistics of the small percentage of people who don't have it include those who don't need it and illegal aliens. Neither of which I am too concerned about.
Where did you get these statistics?
They sound almost racist with the "blame it on the immigrant" sentiment not found in the argument yet.
I know that I've spent years without insurance because I was between jobs, or the jobs I worked for didn't offer it.
During that time I put off medical visits, dental visits, even medication because I couldn't afford it.
And I am not an illegal alien. Did I need it? Probably could have used it for preventive care, and the worry about it every time I felt ill didn't help.
The statistics I've seen show millions uninsured.
Yes, they are young, and hoping to be healthy.
This is seen as a bad thing, since the idea is that the young will end up paying for the old and the healthy will pay for the sick.
Guess what.
That is how insurance works. That is how the insurance at your job works. That is how the insurance you can get elsewhere works. The healthy folks at IBM pay into the insurance so that the sick folk get their hospital bills covered. The young folks at Microsoft pay their insurance so that the retirees or those close to it get their health care covered.
This is how it works now with one difference. Now, the insurance companies make a profit off of the young and the healthy.
Posted by Orincoro (Member # 8854) on :
That, and they have a vested interest as for profit entities to spend the smallest amount possible on care, and the largest amount possible on overhead- thus private insurance boasts a 30% overhead, while nationalized health care systems carry overhead of 1-2%, ideally.
What I want to know is if we pay US congresspeople 150K a year, and the heads of a multitude of other services like the postal service, the military, the state department, the FBI, the CIA and countless others a similar rate, why do we simultaneously buy into the idea that private insurers must, in order to attract talented people and thus stay competitive in their markets, pay their executives millions of dollars? I mean, I'm not against there existing such a business, but the argument that this particular type of business is going to be better at handling health care money overall doesn't hold much water. Health care is not like the car industry, it's not like the entertainment industry, or any other business of consumables, and it shouldn't be treated that way- why do we treat health care as a product? Why do we model our use of health care money in this way? Because you can refuse to buy a CD if it costs 30 dollars (remember when they cost 30 dollars?), and you don't get hurt- but when you refuse insurance to yourself because you can't afford it, you hurt yourself, your family, and incidentally you hurt every other recipient of that coverage as well. When a bookstore or a clothing store has an excess of products and no buyers- they drop the price, sell out and making something new. When insurance companies have an excess of claims and not enough people paying in- what can they do?
Posted by Christine (Member # 8594) on :
quote:Originally posted by Darth_Mauve:
quote: The statistics of the small percentage of people who don't have it include those who don't need it and illegal aliens. Neither of which I am too concerned about.
Where did you get these statistics?
I missed this earlier. Wow, is this a weird thing to say. I know a lot of people who have no health insurance. I have been without insurance myself once, for a period of 8 months when I was between jobs. None of the people I know have chosen to be uninsured because they were young and healthy. They have all had no choice because their jobs did not offer it. Very few were even unemployed for long periods of time...mostly they just had crap jobs. One person I know REALLY could have used it when his appendix burst. Even when feeling excruciating stomach pains he delayed going to the hospital because he had no health insurance. He spent hours in surgery and nearly died and at the end he had $100,000 in medical bills to repay on minimum wage.
Posted by Samprimary (Member # 8561) on :
quote:Originally posted by The Pixiest: Lyr: the government is a monopoly with no incentive to reduce waste.
If this is your premise by which the rest of your objection rests upon, it's startlingly wrong.
Posted by andi330 (Member # 8572) on :
I've just turned 30, and I've never been a day without health insurance. However, there was a one year period when I was paying for it myself, and it was pretty expensive. I was waiting tables, and didn't make enough hours for health care (joy). I have several pre-existing conditions including Asthma and GERD, both of which require regular medication (expensive) and I knew that I couldn't afford to not have insurance, because then I'd have that fun waiting period when I finally got insured again.
Thing is, even though I paid quite a bit every month for my insurance through Blue Cross, my monthly premium was so high that I couldn't afford my regular well patient visits. My GERD meds ran out and I couldn't afford the copay for the doctor visit for a prescription, nor could I afford the $100 deductible for the medication (it was an annual deductible, but I couldn't pay it even once). I got pneumonia. Yep, even though I was paying for health insurance so that I could have well patient visits to take care of my conditions, I couldn't afford the copays, so I got sick anyway.
I might as well have saved myself the $150 (it may have been more than that) a month for all the good my insurance helped my poor broke waitress self at the time. There has to be some way to make insurance affordable to the working poor.
Posted by DarkKnight (Member # 7536) on :
quote: They have all had no choice because their jobs did not offer it.
They do have a choice to get health insurance on their own, and they chose not to.
quote: One person I know REALLY could have used it when his appendix burst. Even when feeling excruciating stomach pains he delayed going to the hospital because he had no health insurance. He spent hours in surgery and nearly died and at the end he had $100,000 in medical bills to repay on minimum wage.
That person could have gotten catastrophic care health insurance for around $76 a month or less (I used myself for the quote). With a high deductible the person might have to pay back $5000 but wouldn't be owing $100,000.
Posted by imogen (Member # 5485) on :
I didn't know what "single payer healthcare" was either, so I followed Scott's link and also got educated. Thanks Scott!
Apparently that's what we have here (Australia).
For comparison: our tax rates are higher than the US, I think (start off at about 15%, go up to 45% for the highest bracket - here ) We also have a flat goods & services tax at 10%. There are no sales taxes, and no state taxes.
Medicare covers every citizen. This means that all public hospital care is free. You can also get bulkbilled (free) doctor care, but it often means longer waiting periods at the GP, and often less detailed care. If you don't go to a bulkbilling clinic, visits cost about $60AUD, but medicare covers about $40 of that.
We also have private health insurance. It costs about $1000/year, and it means we don't have to pay the medicare levy (another tax - but low income earners don't have to pay it), and that we can get private rooms/other benefits. In the 5 years I've had private heath insurance for hospitals, I've never used it.
In that time, I gave birth to my son. We went through a public midwife program at the public hospital. This included midwife care throughout the pregnancy, house visits during labour, one on one care once I was admitted to hospital (with the same midwife we had been seeing all through pregnancy), and as it turned out, an epidural, emergency theatre forceps delivery and a day and night after care, with a private family room in the post delivery ward. We could have stayed longer if we wanted, but we wanted to go home. All free, all covered by medicare.
For the entirety of my pregnancy, the only thing I payed for was part payment for my ultrasounds - I payed about $60 per scan.
Posted by DarkKnight (Member # 7536) on :
quote: OBAMA: "We already have rough agreement" on some aspects of what a health care overhaul should involve, and one is: "It will keep government out of health care decisions, giving you the option to keep your insurance if you're happy with it."
THE FACTS: In House legislation, a commission appointed by the government would determine what is and isn't covered by insurance plans offered in a new purchasing pool, including a plan sponsored by the government. The bill also holds out the possibility that, over time, those standards could be imposed on all private insurance plans, not just the ones in the pool.
Indeed, Obama went on to lay out other principles of reform that plainly show the government making key decisions in health care. He said insurance companies would be barred from dropping coverage when someone gets too sick, limits would be set on out-of-pocket expenses, and preventive care such as checkups and mammograms would be covered.
It's true that people would not be forced to give up a private plan and go with a public one. The question is whether all of those private plans would still be in place if the government entered the marketplace in a bigger way.
He addressed some of the nuances under questioning. "Can I guarantee that there are going to be no changes in the health care delivery system?" he said. "No. The whole point of this is to try to encourage changes that work for the American people and make them healthier."
He acknowledged then that the "government already is making some of these decisions."
Posted by Christine (Member # 8594) on :
So if I hate my current insurance and want the government insurance, do *I* get a choice to buy government insurance or is it my employer who gets that choice?
Posted by Lyrhawn (Member # 7039) on :
DK -
I think when he says "health care decisions" in your initial quote, what he means is, they won't force you onto the government plan, they'll allow you to choose whichever plan you think is best for you. Hence the comma, and the statement that follows where he mentions you having the option to keep your insurance.
He says absolutely nothing about not trying to pass new legislation that will reform obvious flaws in the system.
quote:It's true that people would not be forced to give up a private plan and go with a public one. The question is whether all of those private plans would still be in place if the government entered the marketplace in a bigger way.
When reworded, that comes out as "Yes, the quote that we just pretended isn't true IS actually true, but we'd like to make a totally different point that doesn't really involve the quote at all, but talks about health care reform in general."
They wouldn't call it health care reform if it wasn't reforming something. If private insurance can't compete with government insurance, then what's all this crowing about the inefficiencies of government? The whole point is to reduce cost and improve care. Private industry has shown that they are unable to do this under the current system. Time for something else.
Posted by Blayne Bradley (Member # 8565) on :
Oh how I love being Canadian with our free care and healthier citizenry with life expectancies that go past 100 years even with our poor.
Posted by Mucus (Member # 9735) on :
Ummmm, no.
Posted by DarkKnight (Member # 7536) on :
quote: I think when he says "health care decisions" in your initial quote, what he means is, they won't force you onto the government plan, they'll allow you to choose whichever plan you think is best for you. Hence the comma, and the statement that follows where he mentions you having the option to keep your insurance.
I think what he means is
quote: In House legislation, a commission appointed by the government would determine what is and isn't covered by insurance plans offered in a new purchasing pool, including a plan sponsored by the government. The bill also holds out the possibility that, over time, those standards could be imposed on all private insurance plans, not just the ones in the pool.
Indeed, Obama went on to lay out other principles of reform that plainly show the government making key decisions in health care. He said insurance companies would be barred from dropping coverage when someone gets too sick, limits would be set on out-of-pocket expenses, and preventive care such as checkups and mammograms would be covered.
quote: They wouldn't call it health care reform if it wasn't reforming something. If private insurance can't compete with government insurance, then what's all this crowing about the inefficiencies of government? The whole point is to reduce cost and improve care. Private industry has shown that they are unable to do this under the current system. Time for something else.
Private companies can only spend the money brought into their plans. That is their only source of income. Obama can pull money from the general fund, or raise taxes on the rich, tax health care benefits on everyone, (EDIT removed the line Rabbit pointed out below) How do you compete with someone who has virtually unlimited revenue streams? You can't. Health insurance companies have to make a profit, or at the very minimum be revenue neutral, they spend what they take in. Obama has no such restriction.
[ July 24, 2009, 07:19 AM: Message edited by: DarkKnight ]
Posted by The Rabbit (Member # 671) on :
quote:Simply print more money to cover any shortfalls, just like we do with Social Security
You do realize that 1. Social Security has always been in the black, in fact the general fund has been borrowing from the SS fund for decades and 2. the idea that the government can just print money to cover its debts is a myth.
[ July 24, 2009, 07:27 AM: Message edited by: The Rabbit ]
Posted by DarkKnight (Member # 7536) on :
quote: You do realize that 1. Social Security has always been in the black, in fact the general funding has been borrowing from the SS fund for decades and 2. the idea that the government can just print money to its debts is a myth.
I went and removed that part...but the point still remains that the government does not have to be revenue neutral in this. In fact, using your example, they could pull money from SS fund to pay for health insurance so the overall point still remains
Posted by fugu13 (Member # 2859) on :
quote:2. the idea that the government can just print money to its debts is a myth.
No, it really isn't. I mean, hardly anyone does it in the literal sense (though some do, see Zimbabwe), and doing it to a large degree leads to utter disaster (Zimbabwe's another great example), but lots of countries try it to some degree -- usually with long-term negative effects, though some argue that the short term effects can be worth it.
For instance, take a look at the balance sheet of the federal reserve. It holds substantial amounts of assets (the amount has shot up, and it acquired those assets by offering money that didn't previously exist. This is "printing money" in order to combat what would have been debits from the government -- bank failures, for instance). You can see some of that on the total borrowings balance sheet, which has shot up several orders of magnitude over previous levels, though it is slowly declining now.
The reason we're still seeing deflation, instead of the inflation one might think from that vast increase in the money supply, is that banks are sitting on money. That reduces the multiplier, so any additive effect is overwhelmed by the multiplicative effect's decrease. If the multiplicative effect increases before the fed can back out of its positions . . . well, things could get interesting.
[ July 24, 2009, 08:02 AM: Message edited by: fugu13 ]
Posted by Mucus (Member # 9735) on :
The Rabbit: You may also have seen this referred to as "quantitative easing" which has been popping into the news for roughly half a year now
quote:Quantitative easing, commonly called "printing money," essentially supplies more funds to the banking system than are needed to maintain the Fed's interest rate target. Prior to mid-September, the Fed had been neutralizing the impact of its new lending facilities on the target rate by selling some of its Treasury bills, which drains away the excess funds.
quote:Private companies can only spend the money brought into their plans. That is their only source of income. Obama can pull money from the general fund, or raise taxes on the rich, tax health care benefits on everyone, (EDIT removed the line Rabbit pointed out below) How do you compete with someone who has virtually unlimited revenue streams? You can't. Health insurance companies have to make a profit, or at the very minimum be revenue neutral, they spend what they take in. Obama has no such restriction.
Sure he does.
First off, private insurance makes billions and billions of dollars in profit every year. The idea that government would cost more and sell at a loss is somewhat kooky to me, given the immense profits of the industry. They make money by denying care. Sort of defeats the purpose of wellness doesn't it? Private companies have stockholders, and the government has taxpayers. There's still someone to answer to. If costs were to spiral out of control, do you really think it would take that long for someone to gut the system to bring down costs? Republicans will be waiting in the wings for the next half century to do just that. And that's actually fine with me. It'll keep the system on its toes.
The unlimited revenue stream is pointless. If private industry is cheaper, people will use private insurance. If the government option is cheaper, people will use the government option. How are unlimited funds going to make one cheaper than the other? The problem is, I think the argument you're making is that private insurance MUST deny care to people, for to approve all claims and make people as healthy as can be would bankrupt them. Near as I can tell, that's admitting a fundamental flaw in the current system.
This isn't about basic economic theory, it's about getting us a healthy nation at a price that won't break the bank. The status quo doesn't work. Maybe a public option won't either, but something's gotta give, and just trusting the market to sort it all out hasn't worked, and shows no sign of working. What would you suggest?
Posted by King of Men (Member # 6684) on :
Governments can default on their debts a bit more easily than private citizens, because forcing them to pay may easily be more costly than just writing off the money. This is of course especially true of the US, which presumably can at least maintain its national territory against any possible combination of irate creditors, up to and including every other nation in the world, combined. (The economic effects are something else again, to be sure.) Usually, though, state bankruptcy is a bit of a disaster, so it's hidden with clever devices like inflation. It would be interesting to know how much of Britain's war debts from the Napoleonic and Great wars were really paid back, and at what rate of real interest.
Posted by AvidReader (Member # 6007) on :
quote: They said any legislation that emerges from the talks is expected to provide for a non-profit cooperative to sell insurance in competition with private industry, rather than giving the federal government a role in the marketplace.
Medicare patients getting denied service was the part that had me really nervous about the plan. Making patients pay for coverage that won't be accepted by doctors is a really bad plan. But making people buy coverage is a good path to abuse, too. This seems like a nice compromise.
With any luck, it'll cost less than heavily regulating the industry like they do with car and home insurance. I mean, Florida's having trouble keeping home insurers. I'd hate to think what health insurance would look like with the state meddling.
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