quote:Originally posted by fugu13: This means people have to switch jobs if they want to switch health care, and many people have health care plans that do not effectively meet their needs.
Maybe this is the bit I don't get. What does any insurance do other than establish a cheap copay for the doctor, lower the cost of your perscriptions, and cover hospital stays? I don't think I've used enough health care or seen enough insurance plans to get why there would be a difference.
As for Dark Knight's suggestion that I'd actually get the money instead, I'm ambivilant. Sure, it's nice to get more money, but if my employer gets a better deal because they're insuring 100+ at a time, I may not get enough to make up the difference in what I get now.
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quote:Originally posted by AvidReader: I don't think I've used enough health care or seen enough insurance plans to get why there would be a difference.
Suppose you or a member of your family suffered from a malady that was expressly not covered by your insurance, or your insurer refused to pay for procedures you or your doctor felt were important, but you could not afford yourself. It could be something as simple as feeling that you need coverage for psychiatry, but not having it covered.
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quote:Originally posted by Orincoro: Suppose you or a member of your family suffered from a malady that was expressly not covered by your insurance, or your insurer refused to pay for procedures you or your doctor felt were important, but you could not afford yourself. It could be something as simple as feeling that you need coverage for psychiatry, but not having it covered.
I thought they all did that?
Let's face it, if insurers were interested in offering what the patient wanted, they'd offer supplemental packages. I've got accidental death and dismemberment, long term disability, and turned down the optional cancer insurance. If they're not offering it now as an extra, I'm not sure I trust them to come out with better packages because you're buying your own.
And while I trust my employer to pass along at least most of what they pay for my insurance, I wouldn't have trusted my last one. I'm willing to bet if you do away with the employer subsidy, most Americans will never see a penny of it.
It goes back to the greedy CEO/indifferent board problem we've been ignoring for the past couple decades. If we deal with that, maybe we can trust business as a whole to do right by their employees. At the tail end of a recession is not when I'd put my faith in employee bargaining power.
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I don't disagree, just trying to point out why a system that offers vastly unequal standards of coverage would be inherently problematic. The solution in the states to this problem has been to ignore it. Not a great plan, but it's an American tradition. As Churchill said: "You can always count on Americans to do the right thing - after they've tried everything else."
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But coverage will always be unequal. Even if we went single payer, there isn't enough money to give every American access to the best treatments. I have no idea what criteria the government would use to decide who gets all their treatments and who just gets some. The one advantage to the current system is we all know better jobs mean better benefits. We can plan around that.
Of course it's not fair. But no system we can devise will ever be fair. People with more money get better stuff because they can always afford to go around the rules if they have to. No plan can change that fact until we find a way to do away with finite resources.
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AR: a few things. First, if two employers stop offering health insurance, and one rolls the (many thousands of dollars) they were paying for health insurance into wage compensation and the other doesn't, do you think the second one won't suffer significant disadvantages? It isn't like they aren't choosing to pay the health insurance premiums in the first place. If you feel they're so greedy as to not offer in pay what they're paying in health insurance, how on earth do you explain that they're offering health insurance?
The idea that people in bad jobs should be subject to bad health care is abominable. It is not something that can be "planned around". Moving to a system where prices are equalized across large, overlapping groups, people can choose which available health insurance to buy without being cornered into purchasing just one option by price insurance, health insurance companies can offer varied products (such as how they cover prescription medication, hospice care, supplemental programs like smoking cessation, et cetera) that drive competition, and those who cannot afford health insurance due to their income are given assistance would do much to rectify the sorry state of healthcare we have now. Keeping things tied to employers is unlikely to make any significant dent in the current health system, because health insurance providers will continue to have near-monopoly service provision ability, and perverse incentives to please companies instead of provide good health care coverage (since quitting a job is very costly for an employee -- everything up to that limit is profit that can be captured by the company).
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There are a lot of differences between health insurances.
- Copay to see PCP - Copay to see Specialist - Copay to see out of network provider - Requirement or no requirement to see in-network - Copay for emergency room visit - Deductible for hospital stay - Copay for prescriptions - How hard it is to be prescribed certain meds under your insurance (pre-authorization requirements) - Whether Mental Health is treated under a Parity agreement (in which mental illness is reimbused like all other medical illnesses)... this will be federally mandated but I don't think it's taken effect yet. - How well therapy vs med management for Mental Health is covered (copay, number of visits, deductible) - How insurance treats hospitalizations (how quickly do they stop paying, or how cutthroat are they) - Do they cover things like nutrition consult, benefits for gym membership, things like that
That's all I could think of from the top of my head.
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A big difference I have noted is which doctors you can see. Right now, I am having fun picking out a dentist with my new insurance plan. Right now, I am switching doctors because my health care plan changed.
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quote:Originally posted by fugu13: AR: a few things. First, if two employers stop offering health insurance, and one rolls the (many thousands of dollars) they were paying for health insurance into wage compensation and the other doesn't, do you think the second one won't suffer significant disadvantages?
If people are already having a hard time finding work and no word has come on when we can expect to see new jobs created, no. Not really.
quote: If you feel they're so greedy as to not offer in pay what they're paying in health insurance, how on earth do you explain that they're offering health insurance?
I think not offering it at all under the current system would be hard for most big companies. I think many people who want to work for a large company are interested in the stability, so health insurance is a big draw. I also think the minute a handful manage to do away with it without the employees all leaving for other jobs, the rest will follow suit.
Honestly, if the single payer crowd gives it another decade or two, the idea of employer provided coverage may be downright passe.
quote: The idea that people in bad jobs should be subject to bad health care is abominable.
Well, what it should be and what's possible are two different things here, in my opinion. Again, when we fight for finite resources, the people with more resources people want will always win. Even if your employeer isn't part of things, how much money you make - and can afford to spend - will still determine how good your coverage will be.
The exception would be the single payer system, and again, I have no idea how they would divide things. Do we continue to give better care to rich people since they pay more taxes? Do we give it to the young since they have the most earning potential left? Do people with dependants get first priority? Any way we slice it, it's still unfair to someone. Money seems as good as any standard to set at random.
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Yes, money is a fairly reasonable standard, once we're above basic care. Tying health insurance to place of employment actively defeats that, making it so health care is determined less by money and more by a person's chosen/available career paths. The system I've proposed would make money a far more potent force in helping people receive health care. The system you're supporting allows insurance companies to capture more of a person's income without giving them proportionally more care, since there's such a barrier to switching to insurance that would fit their needs better.
quote:If people are already having a hard time finding work and no word has come on when we can expect to see new jobs created, no. Not really.
The proposed plans in Congress wouldn't go into full effect for years. We aren't creating a health care plan for the next year or two, we're creating a health care plan for generations.
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quote:Originally posted by fugu13: The system I've proposed...
Fugu-
Did you ever look at Wyden's plan? If not, you should. It is nearly point for point what you've proposed here.
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I've looked it over some. Many of the parts of it make sense. I don't see any reason to institute an employer tax to subsidize health care; that should be dealt with using the current tax system (changing rates as needed), not by adding new taxes.
If I'm reading it right, the minimum level of care for a plan might even be too high, but better to err on that side.
I'm not sure that requiring insurance companies to enroll everyone makes sense. My rough approach is to have the government divide the population into very broad, overlapping groups using simple demographic data. Any insurer who insures more than N people in a group (N would need to be tuned, of course) must be available to everyone in that group. This would result in many large insurance companies required to cover anyone, a few medium insurance companies that aren't yet required to cover anyone, but are required to cover large parts of the population, and a lot of small insurance companies offering specialized things that can pick and choose. I suspect it is in those companies that a lot of innovation would happen, eventually reaching the big companies.
It would also prevent a company trying out a new system from suddenly having to cover a huge number of people overnight.
I would also prefer it if the questions of physician compensation were left more to the market. Government involvement in physician compensation has had pretty severe negative effects in several other countries.
But yes, overall, from overview information, I like the plan.
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quote:Originally posted by fugu13: I'm not sure that requiring insurance companies to enroll everyone makes sense. My rough approach is to have the government divide the population into very broad, overlapping groups using simple demographic data. Any insurer who insures more than N people in a group (N would need to be tuned, of course) must be available to everyone in that group. This would result in many large insurance companies required to cover anyone, a few medium insurance companies that aren't yet required to cover anyone, but are required to cover large parts of the population, and a lot of small insurance companies offering specialized things that can pick and choose. I suspect it is in those companies that a lot of innovation would happen, eventually reaching the big companies.
Yeah, when you mentioned that earlier I thought "that's a better idea."
I wonder if the principle would be too difficult to sell in legislation, though. "Cover everyone; no exceptions" is cognitively much simpler. There's complexity not only in tuning "N" but also choosing the right "groups," since demographics can be sliced and diced in so many ways.
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quote:Originally posted by AvidReader: Honestly, if the single payer crowd gives it another decade or two, the idea of employer provided coverage may be downright passe.
That's my theory, anyway.
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Yahoo's got an article up on a new healthcare compromise. I hadn't seen this one before, but I admit I've just been skimming the plans. I think my favorite part is this:
quote: Insurers would be required to release their administrative costs included in premiums and profits. That provision is designed to help customers determine whether they are getting a fair deal at a good price.
This I love. It provides really important information to consumers without getting terribly intrusive into the business. It's like when my charity I donate to sends me the anual pie chart of where the money goes.
Honestly, that's what I'd love to see most of all. If the insurance companies really think their prices are fair, why not break down their costs for us? And if they don't want us to know where the money's going, it probably is time to get a non-profit doing the same job.
I really hope something along those lines ends up in the final bill.
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I don't understand why the press keeps saying time is running out for healthcare reform. So if we don't pass something this instant we have lost our last, best hope? If nothing passes, it can't be brought up again?
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DK, right now we have it on the top of our todo list, with a congress and a president both interested in making a big change.
But if it gets defeated, and the Dems lose ground in the Senate after the next election, there won't be the same drive to get it done.
And those suffering under the system as is, will continue to suffer. (I don't mean just the uninsured, but he small businesses that have to turn over more and more of their profits to keep their employees insured, the doctors who fight as hard as the patients to get paid and coverage, etc.)
It will have gone down twice in 20 years to viscous defeat.
It won't be resurrected again until some major disaster leaves people dead due to bad health care.
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quote:Originally posted by TomDavidson: I love the idea of "viscous defeat." It's actually a fortuitous typo.
In 9 AD (2000 years ago) in a battle the lasted from Sept. 9 through Sept. 11, the Roman General Varus and three Roman legions were defeated by Germanic tribes lead by Hermann (also known as Arminius). Archeological evidence recently discovered near Osnabruck Germany, suggests that the Germanic tribes maneuvered the Roman legions into a swamp where they were forced by the mud and quick sand to break ranks. I think "viscous defeat" describes it very well. (and its timely to boot).
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