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Author Topic: Universal Health Insurance is Coming to the US
Lavalamp
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Apparently, the "talk" in Washington is that we're going to have this...and soon. Big business is pushing for it, conservatives are pushing for it, liberals are pushing for it. Insurance companies and hospitals are pushing for it. The plan I'm hearing about outlines as follows:

1) Mandatory minimum coverage for every US Citizen
2) Individuals pay for their own coverage
3) Treat the entire population as one huge insurance pool
4) Subsidize minimum coverage for the poor, at least partially through a 4% tax on employers
5) Individuals and employers can opt for increased coverage through supplemental providers

The big question appears to be how to pay for it, and even there a consensus seems to be developing that says we definitely do not want to do this through any sort of borrowing. In other words, we pay for it now with current dollars instead of mortgaging the future.


Now...here's what I don't get. A few years ago on a talk show I heard an insurance executive explain how such a plan "could never work." That it would be more expensive than if people were just insured through their employers -- he basically denied that a giant pool like the entire population of the US would have access to better rates than smaller pools through employers would. I didn't understand it then, and apparently this thinking isn't general among the folks floating trial balloons now.


So...anyway, what do you all think of this? I see major benefits in improved healthcare for many, and reduced costs for hospitals (that currently have to "eat" the cost of caring for uninsured folks who come in through the Emergency Department. I think it solves a particularly nagging problem related to children growing up in poverty in the US. And I think it provides a benefit to employers, especially small companies that never get good rates and seeming have to renegotiate their coverage every year, seeing double digit inflation and essentially having to decide whether or not to keep that benefit for employees.

I'm particularly interested in how Libertarians and fiscal conservatives are going to react to this proposal. Supposedly the political insiders are saying that this is going to happen, no doubt.

Sorry, no link, I've condensed from days of radio reports.

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Tante Shvester
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May it be so, and speedily.
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lem
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I thought we already had universal health insurance with Medicare and Medicaid.
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Will B
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Well, you may be right, Lavalamp, but things gleaned from media are often just the bias, rather than the facts. I'm sure that someone is talking about this idea, but that it *will* happen and that everyone supports it will need some confirmation.

Libertarians will hate the idea, of course, of putting government in charge of yet another private decision, and won't like the fines or jail time that go with dissent. Conservatives won't like that either, nor the new tax and the new entitlement program. I suspect once we start getting prosecuted for not buying the right type of insurance, we won't either.

Anything's possible, but this would be a big jump, and a lot of people will notice that micromanaging the purchasing decisions of the middle class can't help the poor pay their bills. If we *did* want to make other people help the poor with their medical bills, we'd have some sort of government program to do that. Come to think of it...

[ February 11, 2007, 12:23 PM: Message edited by: Will B ]

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The Pixiest
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I think the lovely insurance I have through my employer will be reduced to whatever the gov't says is the minimum.

I think this will hurt research by harming the profit motive.

I think we will end up paying more and getting less.

I think we will end up with longer lines at the emergency room because every little thing is covered.

This is the worst idea for individuals since Withholding.

On the other hand, it'll buy a TON of votes.

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andi330
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First of all, to lem, Medicare and Medicaid are only for specific segments of the population. Medicare is available only to older people, or to people who are disabled, not the population as a whole. Likewise Medicaide is only available to people who are poor, and I mean really poor. For example, as a single woman, I would have to earn less than $9800/year in order to qualify for Medicaid. During the year when I earned about $15,000 for the year, I had to pay for insurance out of pocket, and a Blue Cross HIPAA policy (I have pre-existing conditions) was costing me about $120/month. I could manage to pay the insurance, so that if I had a car wreck or something I wouldn't be paying out of pocket for the cost of the Emergency room but I couldn't afford the co-pay for regular visits to the doctor or my medication and ended up with pneumonia as a result.

On to The Pixiest, I don't agree with a couple of your statements. My understanding of the way Universal Healthcare would work means that while everyone has that option, it's not a requirement. Private companies would still exist, and you would have the option to take something else, this just guarantees that a BIG segment of the population, which is currently uninsured, finally has some option on healthcare and that employers would at least have to give their employees the option of the Universal Healthcare benefit.

I adamently disagree that Emergency Rooms will become even more overcrowded, this should actually lessen the wait. One of the primary reasons for overcrowded Emergency rooms today is that people with no health insurance go to Emergency rooms for things which aren't emergencies. The reason this happens is that emergency rooms are required by law to treat anyone regardless of insurance coverage status. So people go to the Emergency Room for things that they should be going to a GP for because they can't go to a GP, becuase they can't afford to pay the full bill out of pocket.

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Lavalamp
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<edit: I was writing this as andi posted. She covered much of what I say here...better!>

WillB and Pixiest. I notice that both of you are objecting to things that are explicitly NOT in this plan. I'm wondering if that's deliberate -- like you just believe it'll be so screwed up that the worst will happen -- or if you're just attacking the idea of it all rather than the (admittedly not completely specified) proposal that is supposedly under consideration.

Supposedly, conservatives DO agree that something is needed and they are happy that it will not be put entirely on the backs of employers (4% of employee gross is more than some employers pay now, but a lot less than others pay for employee healthcare). I'm just repeating what was said in the radio program, though, I don't know which conservatives are liking it, and whether or not they could be viewed as just pandering for votes.

One of the specific reasons that supporters have given for this proposal is that it would NOT cover everything and that Emergency Departments of hospitals would see some relief because at least some stuff that is covered would be handled in doctors' offices rather than waiting until it became an emergency situation.

Hospitals with EDs face a huge crisis now because they are the primary source of medical care for a lot of uninsured/underinsured people. The number of people using the ED as a birthing center, for example, has been growing steadily and points not only to further unrecompensed costs for those facilities, but a major healthcare problem as well.

It's pretty well known in the health care field that EDs are a big expense.


Re: Medicare/medicaid -- check the eligibility requirements. While there ARE a lot of people on those assistance types of coverage, there are a huge number of people who do not qualify. Recent trends in legislation have been aimed at shrinking the rolls. What that translates to is a lot of people on the margins slipping from "insured" to "uninsured" with very little safety net.


Economically, fiscal conservatives might find something to be happy about with universal coverage. The cost to the country for caring for the uninsured is growing (see above re: medicare for one reason why). If we found a way to pool the coverage and buy it cheaply enough, we will not only have a net savings by shifting some of the costs away from expensive EDs to cheaper treatment outlets, we'll also save money because of a general improvement in health.

There's a financial "downside" of course in that some of these sick folks get well enough to reproduce and have more children who may end up on public assistance. It sounds brutal to think of it in these terms, but if we're going to pay for this, we need to think of more than just current citizens.

Another question is what to do about illegal aliens. It may also be cheaper to insure them (and require them to be insured) than it would be treat them in EDs. And it'd be healthier. Of course, since we'd end up assisting some that we don't deport, we have the additional burden of deciding where to draw that line. However at present it appears we're only talking about covering US citizens.

As I understand it, the Insurance companies are heavily involved in coming up with this proposal. It appears that they would all insure the minimal coverage at the pooled rate and, as I understand it, they'll all be doing business so you could choose whichever one you want. That's a substantial improvement over the coverage most people have today -- dictated by their company and negotiated without much say, limited severely by the companies' willingness to take on small higher-risk pools, etc.

I can see how this would "win votes" but I don't actually see it as a bad thing designed merely to win votes. I think it'll win votes because most people in this country recognize that their insurance is too expensive, getting worse coverage per dollar invested as the years go by, and that they are lucky to have even that. I think most voters recognize that the cost of medical services has increased in part because so much of the burden IS placed on providers to cover the costs when the person is uninsured and can't pay. If people had access to affordable health insurance (this proposal actually does say MANDATORY), the bills most of pay should decrease.

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Will B
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What was it that I objected to, that wasn't in the plan?
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Lavalamp
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prosecutions for not buying the right type of insurance...

jail time for dissent...

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Will B
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You said "mandatory minimum coverage." If there is no prosecution of those who violate the minimum, what's "mandatory" about it?

I said jail time OR fines, because these are the penalties our legal system applies in prosecutions. Has some other type of penalty been proposed instead for those who don't comply? You didn't mention any alternatives.

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ClaudiaTherese
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We cover about 25-30% of the population via Medicare, Medicaid, VA system, Public Health Districts, WIC, etc. We pay more for this per citizen (per every citizen, mind you, not just the ones covered) than other countries pay per citizen to cover everyone.

I fail to see the evidence to support the claim that this should cost more. Inefficiency has been costing us much much much more than anyone else's efficiency for some time now.

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aspectre
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Businesses which provide health insurance for their employees back the plan because their insurance premiums already partially* covers emergency room visits by the uninsured. So those businesses which cover their own employees will have a decreased portion of their premiums being used to provide health insurance for the businesses which don't cover their own employees.
ie Ethical businessmen won't have to pay out so much money to support the rats'patooties competing against them.

WorldTradeOrganization regulations do not allow the discounting of perks (eg health insurance) off the sales price of exports.
WTO regulations do not force businesses based in countries which provide national health insurance to add the value of that free healthcare onto the sales price of their exports.
Putting ethical US businesses at a disadvantage in the competition with British/French/Dutch/German/etc businesses.

* The remaining part being covered the extra premium paid for Medicare, by extra tax paid to cover Medicaid, by individuals who have automobile/medical/liability/disaster insurance, and by those who pay for their own medical expenses.

[ February 11, 2007, 02:31 PM: Message edited by: aspectre ]

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Will B
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It doesn't seem clear that tripling or quadrupling the size of an inefficient program will necessarily make it more efficient.
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aspectre
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Medicare is considerably more efficient than private insurance companies in terms of the percentage spent on actual medical care as opposed to paperwork and other administrative expenses. The VeteransAdministration is even more efficient than Medicare.
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Boon
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Let's talk specifics about those of us on middle ground.

My husband works, and makes decent money. Not a lot, but enough for us to live on with careful budgeting. We fall sort of in the middle, with regards to medical coverage. Our children qualify for medicaid, but we do not. (We went ahead and put them on it just for emergency coverage, but we pay for regular doctor visits out of pocket.) Honestly, we qualify for food stamps, too, though we don't take them. (The kids would also qualify for free lunches and breakfasts at school if we weren't homeschoolers.)

Our budget does not allow us to purchase health insurance through his work, even though he works for one of the biggest health systems in the state. It would cost us over $500/month for family coverage. That's as much as our house payment, homeowner's insurance, and car insurance combined.

We do set aside a small amount every month into our emergency fund, and we pay for our own health care and perscriptions out of pocket (about $50 a month, not including our savings).

How exactly would "mandatory" coverage work for people like us, who don't have the extra money to pay for it?

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Lyrhawn
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I support universal healthcare.

The billions of dollars wasted every year treating the uninsured, and treating people whose problems got out of control due to a lack of preventative care, and wasted through paper shuffling must end.

This is going to be painful up front I think, but in the long run we're talking billions, maybe trillions of dollars in eventual savings. We're going to switch to paperless recordkeeping, so digital files can be transferred at the drop of a hat across the medical care network, saving lives, reducing accidents, cutting down on lawsuits, and reducing the cost of administrative work. We're going to focus on preventative healthcare, an ounce of prevention really is worth a pound of cure, and we're going to prove it. Getting everyone insured, and getting everyone on the road to healthy will save billions more than just treating them when they become too sick to manage by themselves.

We need to put a lot of thought into how we want to build such a system, and how we are going to pay for it, and I think there WILL be a major up front cost for it, and it'll be painful for a few years, but we're going to be very happy with it in the long run. If we can pay a half trillion dollars for the war in Iraq, we can pay a much smaller fee to fix the health of our own citizens. We've got to do this, and we've got to get it right.

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ClaudiaTherese
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quote:
Originally posted by Will B:
It doesn't seem clear that tripling or quadrupling the size of an inefficient program will necessarily make it more efficient.

One could try redoing based on principles which are more efficient. It doesn't seem that novel an idea to me.
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Will B
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If we're going to do that, we could do it *without* tripling or quadrupling its size, and save even more money!

Lavalamp, I'll take your word for it that Medicaid is insufficient at present. So let's say we want to fix it. Why not fix it? Why instead start a new program to regulate what middle-class people do with *their* health insurance? You might as well try to fix problems with WIC by starting up a new program for childless rich men.

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aspectre
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The US could also train as many physicians, nurses, technicians, etc as it needs
instead of allowing medical/etc schools to create an artificial shortage of labor to inflate wages of medical personnel
so that the top-ranks / top-earners can afford to bribe legislators into allowing them to run medical/etc schools
in such a manner that an insufficient number of physician/etc candidates are accepted for training.

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Christine
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Universal Health Care scares me to death. I have seen no evidence that the federal government can run much of anything better than private companies and every example of universal health care I have seen has lowered the standard of health care for everyone. If something serious goes wrong and you are in Canada, you want to come to the U.S. Many of them do, if they have the money. (And sometimes if they don't.)

I was not under the impression that Medicare is well run. Administrative costs aside, I was under the impression that they did not negotiate with hospitals for lower costs. Insurance companies do more than pay your bill. If you've ever been uninsured (as I have) you learn a few hard truths. When you walk into a hospital with no insurance they charge you more than they charge the insurance companies!! I don't mean a little bit, either. I'm talking orders of magnitude in some cases. You usually don't see it, it's usually masked, but I once forgot my insurance card when I went to the hospital and had to send in my insurance info later. They sent me the initial bill, though --- $10,000! When I got the statement from the insurance company, it was $1,800. That's not the worst I've heard of, either.

I don't know what the answer is with uninsured people and health care in this country. It's not that I don't sympathize. I have been uninsured (granted, briefly) and I know many uninsured people. My brother in law (uninsured) had his appendix rupture and almost died. He was in the hospital for two weeks and when all was said and done, the hospital slapped him with a $100,000 bill! Now, he makes $10,000 a year, so I don't know what they expect from him. (I believe the current plan is to send them $100 a month for the rest of his life.) I would bet good money that if he had been insured, the insurance company wouldn't have paid nearly that much. Maybe a good start, then, would be to charge regular people like my brother in law the same amount that they really charge the insurance companies.

The trouble with insurance in this country is that no one wants to talk about real problems. Instead, all I see is seemingly sympathetic politicians vying for reelection, spouting nonsense that maybe seems good on the surface. "Come on, country, we can give health insurance to all Americans." Well, there's no such thing as a free lunch, and sometimes lunch isn't worth the cost. (Take the lunch I had yesterday -- worst cheeseburger I've had since McDonadl's and they charged me $10 for it.)

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aspectre
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The middle class would be better off being covered by Medicare than by private insurers.
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jlt
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How do Canada and the UK do it?
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ElJay
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Will B, you keep talking about taking away health care choice from middle-class people. I'm upper-middle class, by virtue of a good job and no dependents, and I don't have any choice in my health care. My company picks an insurance company, negotiates rates, and tells me how much it will cost to be covered. Sometimes they change providers, and some people need to find new doctors, because the old ones aren't covered anymore. Every year the cost goes up, and the company decided how much of the increase they will cover and how much will be passed on to us. I have weekly allergy shots, and with the last change they went from being fully covered to requiring a co-pay.

I'm not complaining. . . I have good coverage, and the cost to me is reasonable and worth it. But I certainly don't have choice, except for to choose to be insured under my company's plan or uninsured. I fail to see how that would be different with government mandated health care.

You can argue the quality of care would be worse, but comparing the US to countries with socialized systems I think we'll see it doesn't have to be. But I don't see how you can argue it takes away choice, for the vast majority of Americans who get their insurance through their jobs.

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ClaudiaTherese
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quote:
Originally posted by Will B:
If we're going to do that, we could do it *without* tripling or quadrupling its size, and save even more money!

Not with decent outcomes. Ours are piss-poor for the system in general, at least in comparison.
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ClaudiaTherese
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quote:
Originally posted by Christine:
Universal Health Care scares me to death. I have seen no evidence that the federal government can run much of anything better than private companies and every example of universal health care I have seen has lowered the standard of health care for everyone.

That's an odd claim. Why, then, do other countries (such as Canada and New Zealand) have better morbidity and mortality rates?
quote:
If something serious goes wrong and you are in Canada, you want to come to the U.S. Many of them do, if they have the money. (And sometimes if they don't.)

If something goes seriously wrong and it needs to be dealt with quickly, then it is done quickly in Canada. If something goes wrong and can wait to be dealt with, it often must wait.

So sure, if you want bunion surgery done quickly, you might want to go to the States. But that isn't true across the board.

(Witness the morbidity and mortality outcomes for major diseases referenced above.)
quote:
Administrative costs aside, I was under the impression that they did not negotiate with hospitals for lower costs.

That is incorrect.
quote:
"Come on, country, we can give health insurance to all Americans." Well, there's no such thing as a free lunch, and sometimes lunch isn't worth the cost. (Take the lunch I had yesterday -- worst cheeseburger I've had since McDonadl's and they charged me $10 for it.)

As jlt asks, how do you think Canada and the UK do it? They spend less per capita to cover all of their people than we spend per capita to cover 25-30%, and they have better overall outcomes. How do you make sense of this by your lights?
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Dagonee
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How do UK/Canada outcomes compare to outcomes for insured people here?
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ClaudiaTherese
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Depends on how you qualify "insured." Are you wanting to compared to people who have at least partial insurance at some time over a one year period, or something more comprehensive? That is, how much coverage counts, and for how long must it be?

----------------

Edited to add other links that may be of interest to the thread:

Recent cuts to Medicare and Medicaid funding
WHO research tools (including WHOSIS)
The Commonwealth Fund -- on International Health Policy***


***e.g,
quote:
In the article, "On the Front Lines of Care: Primary Care Doctors' Office Systems, Experiences, and Views in Seven Countries" (Health Affairs Web Exclusive, Nov. 2, 2006), the authors report on survey results that reveal striking differences in primary care practice internationally—differences that highlight the importance of having national policies in place to support primary care. According to the survey, U.S. physicians are among the least likely to have extensive clinical information systems or quality-based payment incentives, the least likely to provide access to after-hours care, and the most likely to report that their patients often have difficulty paying for care.[emphasis added]


[ February 11, 2007, 06:31 PM: Message edited by: ClaudiaTherese ]

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Occasional
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Yea, I would like some actual figures on that as well. All I see at the moment is rhetoric - on both sides.

By the way, we tried to pass Universal Healthcare once before. Hillary Clinton was the point guard. All three houses were Democrat. It got nowhere fast. What is so different now that this would actually pass this time around?

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ClaudiaTherese
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quote:
Originally posted by Occasional:
Yea, I would like some actual figures on that as well.

On what, exactly? For quantification, you have to be specific.
quote:
All I see at the moment is rhetoric - on both sides.
*smile

I'm pulling together sites with figures in an edit above.

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Lavalamp
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My understanding of the current proposal (which may change -- both the proposal and my understanding of it), is that:

- private insurers offer the insurance. It's not government offering the insurance, it's Blue Cross, PacHealth, HMOs, PPOs, all the same stuff we have now.
- people always have some way of opting out if they can afford to do so (see self-insured motorists laws) -- almost nobody does this because the costs and plans are better inside the system than outside.
- the savings come from private insurers giving EVERYONE their best rates, not hitting small companies and their workers with high rates because they are in a smaller, higher risk group.

Basically, the reason health insurance is so costly in this country is because the risk is spread over small units of coverage. Large employers get huge dividends and can always outcompete. Also, laws are fragmentary so that state to state things are radically different. Even though there are standards for billing forms (set basically by Medicare's example), every other aspect of the system is duplicated 50+ times with varying degrees of success.


Special to Boon: I really don't know what the answer to your question is, but the show said that people who can't afford it will be given subsidies to get the basic coverage. I'm hoping that there's a sliding scale for such coverage so that people can get partial assistance as well, when they need it. But I haven't heard a proposal specifically about that.

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Lavalamp
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Will B: According to what I heard, every person who is currently insured through a company should be able to get the basic portion of their coverage from the same provider for less money. Or, you don't like your current provider, you'll have the option of picking a different one. I suppose there will be a small percentage of people so outraged by the government's having cooked up this scheme that they'll rebel and refuse to go with a licensed insurance carrier. I don't know that this will lead to incarceration or a fine. What was mandatory is that the pool of insurable people included EVERYONE in the country -- that's the unique aspect of this proposal, frankly. They still have to sell their products to all those consumers out there, but the prices are set not one dinky company at a time, but for the entire country, once.


I know someone who is in an informal insurance pool of the faithful. Everyone agrees to send money to whoever gets sick or needs treatment. Last I checked, most states are requiring those firms to incorporate and meet state insurance laws. I suppose if you were planning to set up something along the lines of a non-regulated insurance company, you might have problems. But I don't believe that the FBI is going to come track people down who choose not to sign on with a particular insurance company.

As long as the opt-outs are a relatively small percentage of the population, it won't make a statistical blip on the actuarial tables that are used to set the rates. The companies might use such opt-outs as a way to argue for a (slight) rate increase, but I can't imagine that a good statistician at DHHS couldn't beat them into submission -- let alone an act of Congress.

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Christine
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Lavalamp (and otherss): I think the point I was trying to make (albeit hidden in a bunch of other stuff) is that it seems to me that there are options to fix the problems in our current health care system without resorting to mandatory universal coverage, which tends to limit patients ability to see a doctor. (At least, this is hat people in the UK and Canada have told me....in the UK they see something called a health visitor...a nurse with an extra year training.)

This year, our health care premium went up $50 a month. This is not unusual. It goes up faster than the cost of inflation and I can't imagine what will happen if it continues down this path. Clearly, for both the insured and uninsured, there are problems, but I question that universal health care is the answer.

We are so often given only two choices in this country...in this case stay the same or universal health care. I'm tired of only having two choices. Why don't we have a real conversation about the problem and brainstorm solutions? We might surprise ourselves and find something else.

quote:
That's an odd claim. Why, then, do other countries (such as Canada and New Zealand) have better morbidity and mortality rates?
If I had to guess, I would have to say cultural differences can account for a lot of this. It's hard to say, though, because I don't know exactly what you are referencing here. There are three kinds of lies...you know the rest...if there is truth in statistics it is in the details that are almost always left unsaid.
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fugu13
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I'm worried about the pool of insurable including everyone in the country. While I'm all for approaches that result in everyone in the country having plans available to them, requiring total population coverage availability for every plan seems a recipe for massive cost barriers to entry into the insurance market and difficulties in tailoring coverage to be more suitable for sub-populations.

edit: And no, insurance companies won't give everyone their best rates, they'll offer everyone rates that allow them to make money given the demand for health care. At least initially those will be higher than their best rates right now. Of course, very few people are directly paying insurance companies' best rates right now, because there's an incentive for employers to subsidize (and siloize) health insurance.

While I support making pools large enough to prevent significant adverse affects, some variation among pools will greatly help with efficient allocation of health care (and coincidentally provide incentive for people to do things that put them in healthier pools, likely improving health in the nation indirectly). For instance, have pools for each state, for age brackets, for large cities, for entire categories of employment (overtime eligible can be a pool; so can not overtime eligible, and maybe people with a commute over a certain distance).

[ February 11, 2007, 07:07 PM: Message edited by: fugu13 ]

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twinky
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quote:
Originally posted by Dagonee:
How do UK/Canada outcomes compare to outcomes for insured people here?

Unfortunately my original reference has vanished from the Web -- that, or my Google-fu is weak -- but I read about a fairly detailed study comparing health outcomes in the U.S. and the U.K. that controlled for everything I could think of that would be reasonable to control for.

FWIW, the result was that outcomes in the U.K. were better accross the board. I was surprised -- I would have thought that the wealthiest Americans would have access to better care, but that expectation wasn't borne out. The study was linked on Ars Technica, but the post containing the link has fallen off the bottom of their science journal archives. I've actually posted the Ars link here a couple of times before, back when the post was still there.

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ClaudiaTherese
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quote:
Originally posted by Christine:
It's hard to say, though, because I don't know exactly what you are referencing here. There are three kinds of lies...you know the rest...if there is truth in statistics it is in the details that are almost always left unsaid.

I reference WHO data. It's true that statistics can be misrepresented -- data never speaks for itself, of course. However, I'd hazard that you can't even begin a substantive discussion without knowing the standard data that is out there.

Regarding price-fixing by Medicare: Statement of the American College of Physicians - American Society of Internal Medicine to the Senate Appropriations Committee, Subcommitte on Labor, Health, and Human Services, and Education: For the Record of the Hearing on Medicare Reimbursement for Physicians and Hospitals (January 30, 2003)

-----

quote:
Originally posted by Christine:
[QB]...without resorting to mandatory universal coverage, which tends to limit patients ability to see a doctor. (At least, this is hat people in the UK and Canada have told me....in the UK they see something called a health visitor...a nurse with an extra year training.)

Individual anecdotes aside, the comparison population surveys have shown US citizens are not as happy with their own system as other countries' citizens (Finland, Denmark, Canada, UK, Australia, New Zealand, et al) are with their own systems.

Additionally, US patients are more likely to be victims of medical error, either through wrong dosing or laboratory error.

[ February 11, 2007, 07:20 PM: Message edited by: ClaudiaTherese ]

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twinky
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CT, you rock. [Smile]
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ElJay
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quote:
Originally posted by Occasional:
By the way, we tried to pass Universal Healthcare once before. Hillary Clinton was the point guard. All three houses were Democrat. It got nowhere fast. What is so different now that this would actually pass this time around?

I read an interesting article about that recently, actually, I'll try to find it. The up-shot was that she pissed off a lot of the Democrats in congress who had been working on universal health care for a long time, and they refused to support her plan. So in that case, it was more a political infighting issue than something wrong with the plan.
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ClaudiaTherese
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twinky, I wonder if the article you remember is either

1) "U.S. Health Care Spending In An International Context," Reinhardt et al. Health Affairs.2004; 23: 10-25

or 2) "The United Kingdom and United States Health Care Systems: a Comparison," Home Health Care Management Practice. 2004; 16: 109-116

---

(Hey, thanks! [Smile] )

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twinky
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I think it was more recent than that. I read about it last year, and it seemed to be a recent study. I could be wrong, though.
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ClaudiaTherese
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I haven't kept up on the literature in the last year, but I will go check PubMed. I'd like to read it.
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Bella Bee
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I think free national healthcare is wonderful. It's not any where near perfect, of course.

This is the NHS website. It's obviously wildly positive, but it explains the history and set-up of the service.

Yes, we have crazy waiting times for certain treatments. There’s a bit of drug rationing which goes on - if you want certain drugs which have been deemed by the government regulating body to be unnecessary, you‘ve got to pay for them. And a lot of the time, employers still get BUPA or other insurance for their employees - if you can get your employees treated faster, you get them back to work faster and you don't have to pay for unproductive sick leave and temp cover. And there's never enough money to do everything that needs doing, or people, or equipment. But I still have yet to meet anyone in this country who would do away with the NHS altogether. They just want to improve what we already have.

I can go to my GP for anything, without thinking about how much it will cost. If I need a prescription, under my current circumstances, I pay £6, which is about $12.

I'm probably getting quite serious dental surgery soon on the NHS. It's going to take a few weeks until I have a consultation and a few months before I get the surgery, but it's not an emergency, so I don't care (it'd be different if it was cancer, but there you go - nothing's perfect - at least you‘d get treated).
But the fact is, I'm a currently (unofficially - I'm not on the dole) unemployed, recent graduate, with no savings. If I needed insurance, I'd have to ask my parents to pay for it, which would be unfair at this point, after they've supported me through school, or do without it and just pray I didn't get sick. As it is, this won't cost me a penny.

And when, hopefully in the next few months, I get a job, I'll be happy to pay my taxes to make sure other people get the same privilege when they need it. It's good to know, whatever your circumstances, and whatever happens, you've got that healthcare safety net.

To be honest, it bothers me that many people in the US seem to think that it's fine to let other people go hang as long as they personally are okay. It’s a kind of ’pull the ladder up Jack, I’m alright’ mentality. I'm not saying it would be any different in this country, if someone wanted to set up national healthcare today. There would be total outrage, I’m sure - especially from conservatives. The NHS was set up after the war, when everyone was envisioning a brighter future, and there was not the same kind of fear of a nanny-state that you get nowadays. I completely understand that a lot of people don't see why other people should benefit from their hard earned money.

The USA is a great country, and I don't see the harm in dreaming big - in believing that some things are too important to ignore. Yes, maybe some people who would benefit from universal healthcare would be lazy slackers, spongers, losers. Who cares. It's still better than letting them die unnecessarily.
To me, it's just the right thing to do.

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ClaudiaTherese
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quote:
Originally posted by Bella Bee:
I'm not saying it would be any different in this country, if someone wanted to set up national healthcare today. There would be total outrage, I’m sure - especially from conservatives. The NHS was set up after the war, when everyone was envisioning a brighter future, and there was not the same kind of fear of a nanny-state that you get nowadays.

*nods

It was a divisive issue at the time of Canada's birth throes of universal healthcare coverage in Saskatchewan. Physicians went on strike, and replacement physicians had to be flown in from outside the province. However, both provincial and national surveys of Canadian physicians place them firmly in the "pro" category as a group now.

Of note, the US almost had universal coverage back in the 1920s, at least for children, but there was a deeply funded push by the American Medical Association to defeat the Sheppard-Towner Act in 1922. The American Academy of Pediatrics was formed when a group of pediatricians separated from the AMA in in specific reaction to this.

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Samprimary
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quote:
Universal Health Care scares me to death. I have seen no evidence that the federal government can run much of anything better than private companies
In the case of this particular idea, there's a phenomenal pool of evidence to show that public healthcare is assuredly superior to our private model. You just have to look at every comparably high-income nation in the world. They treat the populace better, they cover everyone, and they do it for cheaper.
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Samprimary
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quote:
By the way, we tried to pass Universal Healthcare once before. Hillary Clinton was the point guard. All three houses were Democrat. It got nowhere fast. What is so different now that this would actually pass this time around?
The private model is getting ready to train-wreck, works terribly, and is becoming grotesquely unraveled in rural medical networks. There's a large segment of the population which used to be virulently opposed to a social model, but have since changed their ideological tune after having been faced with inarguable evidence, anecdotal and otherwise, of the system falling apart and being an embarrasment.

When a system becomes inarguably inoperable, it cracks even the most stolid ideological blocks. In the case of healthcare, we stuck with the private model until it was not sufficiently deniable that the present system is not acceptable. In a way, we passed the threshold of dissonance.

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Christine
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quote:
Originally posted by Samprimary:
quote:
Universal Health Care scares me to death. I have seen no evidence that the federal government can run much of anything better than private companies
In the case of this particular idea, there's a phenomenal pool of evidence to show that public healthcare is assuredly superior to our private model. You just have to look at every comparably high-income nation in the world. They treat the populace better, they cover everyone, and they do it for cheaper.
Really? Where is your evidence for this? I am from Missouri (really) -- Show me!! I am open minded and willing to look at new ideas. But I have never seen any evidence to suggest that this is the case. I know for a fact that Canada taxes its population at up to 50% (depending upon the province). This doesn't seem cheaper to me.
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twinky
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quote:
Originally posted by Christine:
I know for a fact that Canada taxes its population at up to 50% (depending upon the province).

It's up to 47%, actually, and then only if you earn more than CDN$118,000 annually and live in Newfoundland or Labrador. (Canada Revenue Agency.)

quote:
Originally posted by Christine:
Where is your evidence for this?

All of the charts in this post are distilled from OECD data on health spending and various other health-related statistics. The entire spreadsheet (1.4 MB Excel file) is linked on that page, and that's only a subset of the available data (the "frequently requested" health care data). I've further taken a subset of that in the interests of making this post sometime before 2008.

First, spending. The first three columns are total health care spending as a percentage of GDP in 1970, 1990, and 2004. While I've ommitted some countries that are in the full list, if you check the OECD's data you'll see that the U.S. is indeed the highest spender in both categories, by quite a bit -- that is, I haven't doctored the data to make my point.

The second set of three columns is US dollar health care spending per capita. As above, while I've ommitted some countries, the U.S. is the largest spender.

code:
		1970	1990	2004		1970	1990	2004

Austria 5.2 7 9.6 193 1328 3124
Canada 7 9 9.9 299 1737 3165
Finland 5.6 7.8 7.5 191 1419 2235
France 5.3 8.4 10.5 205 1532 3159
Germany 6.2 8.5 10.6 269 1738 3043
Greece 6.1 7.4 10 159 844 2162
Iceland 4.7 7.9 10.2 163 1593 3331
Ireland 5.1 6.1 7.1 117 794 2596
Luxembourg 3.1 5.4 8 163 1533 5089
New Zealand 5.1 6.9 8.4 211 995 2083
Norway 4.4 7.7 9.7 141 1393 3966
Portugal 2.6 6.2 10.1 51 674 1824
Spain 3.5 6.5 8.1 95 873 2094
Sweden 6.8 8.3 9.1 312 1589 2825
Switzerland 5.5 8.3 11.6 351 2029 4077
United Kingdom 4.5 6 8.1 163 987 2508
United States 7 11.9 15.3 352 2752 6102

One caveat: some of the %GDP figures are estimates, though the one for the U.S. is not.

Onward! Infant mortality isn't an unreasonable metric for taking a rough guess at quality of care. This chart shows deaths per 1,000 live births:

code:
		1970	1990	2003

Australia 17.9 8.2 4.8
Austria 25.9 7.8 4.5
Belgium 21.1 6.5 4.3
Canada 18.8 6.8 5.3
Czech Republic 20.2 10.8 3.9
Denmark 14.2 7.5 4.4
Finland 13.2 5.6 3.1
France 18.2 7.3 4.0
Germany 22.5 7.0 4.2
Greece 29.6 9.7 4.0
Hungary 35.9 14.8 7.3
Iceland 13.3 5.8 2.4
Ireland 19.5 8.2 5.1
Italy 29.0 8.2 4.2
Japan 13.1 4.6 3.0
Korea 45.0
Luxembourg 25.0 7.3 4.9
Mexico 79.4 36.2 20.5
Netherlands 12.7 7.1 4.8
New Zealand 16.7 8.4
Norway 12.7 6.9 3.4
Poland 36.7 19.3 7.0
Portugal 55.5 11.0 4.1
Slovak Republic 25.7 12.0 7.9
Spain 28.1 7.6 3.6
Sweden 11.0 6.0 3.1
Switzerland 15.1 6.8 4.3
Turkey 145.0 55.4 28.7
United Kingdom 18.5 7.9 5.3
United States 20.0 9.2 6.9

The U.S., though it spends more on health care both per capita and as a percentage of GDP, has a higher infant mortality rate than any other industrialized nation.

That's a start. There's tons of data out there comparing public health care delivery to private -- all you have to do is look.

[Edited to remove a redundant sentence and bold the descriptions of each chart, and add the measurement criterion for infant mortality.]

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Will B
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"What was mandatory was that the pool of insurable people included everyone in the country": if that's all we're talking about, I withdraw any objection.

Someone else:
quote:
I'm not complaining. . . I have good coverage, and the cost to me is reasonable and worth it. But I certainly don't have choice, except for to choose to be insured under my company's plan or uninsured. I fail to see how that would be different with government mandated health care.
That's a pretty big choice. I opted out of my employer's health insurance, and went for a private plan. This is already legal. (I saved money, too.)

There are also people who are self-employed, who should not be required by law to buy insurance they don't think they need.

--

Really, if you're going to argue for universally required health insurance, I think your argument will work better if you don't cite UK, Canada, etc., for two reasons.

One is that their excellent systems make people wait years and years for surgery. They're pretty good at emergency care, but if you can wait, you waaaaaaaaaaaaaaaaaiiiiiiiiiiiiiiiiiiiiiiiit. (Whereas in the USA, we're also pretty good at emergency care -- and it may not be denied -- but if you can wait, you *might* have to wait till you can pay for it.)

The other reason is that they don't have a plan like the one that's being proposed. They don't have universal mandated health insurance; they have socialized medicine. Very different beasts.

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Lyrhawn
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Why do people have to wait?
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ElJay
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You want to post some back-up on waiting "years and years" for surgery?
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ClaudiaTherese
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quote:
Originally posted by Will B:
Really, if you're going to argue for universally required health insurance, I think your argument will work better if you don't cite UK, Canada, etc., for two reasons.
...
They don't have universal mandated health insurance; they have socialized medicine. Very different beasts.

What? In what way is Canada "socialized medicine" as opposed to "universal mandated health insurance?"

You have that backwards. Canada is universal health insurance provided provincially. This is distinct from the system in the UK. In Canada, the physicians are in private practice, although they are paid through public sources.

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