REAL WORLD EVENT DISCUSSIONS

My Totally Awesome Healthcare Reform Plan

POSTED BY: SERGEANTX
UPDATED: Tuesday, August 11, 2009 13:06
SHORT URL:
VIEWED: 8301
PAGE 1 of 2

Thursday, August 6, 2009 12:48 PM

SERGEANTX


OK, normally I'm all about keeping the government out of economic problems. The thing is, when they've had such a hand in creating the problem, and when it's as intractable as the health care conundrum, I'll make an exception.

So, here it is: We set up a program that sends every person in the US (up to a certain income level, but a fairly high one, 80k per individual let's say) a check for a percentage of their health insurance deductible. The percentage is graduated, the poor get 100% funding, all the way up to upper middle class who'd get 5% or something. For that year they can spend this money only on health care expenses that apply to the deductible. At the end of the year, if they haven't used all of the money, the remainder is their's to keep.

Then we sit back and wait while health care prices come tumbling down. In the meantime, we beef up the safety net to cover the hardcore cases, people who can't get insurance at all, and can't afford to pay out of pocket, etc. Once prices have reached something close to a sane level, we start reducing the amount of the deductible covered by the government and lower the income rates that would qualify.

SergeantX

"It's a cold and it's a broken hallelujah"

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 1:03 PM

BYTEMITE


This is probably a good idea to cut costs, loosen the grip of the insurance companies (goddamn scam that they are) and allow us to get more money to help the people who really can't pay, and who otherwise would drive up prices for everyone else.

The only thing I really see missing is the elderly and children. How would they fit into this program?

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 3:00 PM

SERGEANTX


Quote:

Originally posted by Bytemite:
The only thing I really see missing is the elderly and children. How would they fit into this program?



Well, that's what I was referring to with the "beef up the safety net" bit of hand waving. I'd start with expanding Medicare and the like.

SergeantX

"It's a cold and it's a broken hallelujah"

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 3:16 PM

SIGNYM

I believe in solving problems, not sharing them.


Quote:

We set up a program that sends every person in the US (up to a certain income level, but a fairly high one, 80k per individual let's say) a check for a percentage of their health insurance deductible. The percentage is graduated, the poor get 100% funding, all the way up to upper middle class who'd get 5% or something. For that year they can spend this money only on health care expenses that apply to the deductible. At the end of the year, if they haven't used all of the money, the remainder is their's to keep.
How is this supposed to work? I know you have the idea that if people had to watch their pennies to get health care, market forces would take over and the problem would be solved. But if you can't get insurance in the first place, you have no deductible. If you can't get insurance from a commercial plan, you're covered by Medicare anyway and you don't need the $$$. And the only thing it would promote is insurance with low DEDUCTIBLES, not necessarily low premiums.

I personally like the idea of single payer. But if I can't get that, then I REALLY want to see a public option. Because if government is such a bumbling entity, then the insurance compnaies have nothing to fear. But if not, then the insurances are going to have to run for their money! And if the goverment is the preferable option, then it deserves to win the market.

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 3:35 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


I don't really see where or how this would cause the costs of health care to come tumbling down. As it stands, I have to allocate my pennies to go to my health care. How would my continuing to do so drop the price of my insurance or my deductible? And if the government is giving me money towards my deductible, then how does that make me likely to be tighter with that money? Does the fact that I get to keep it at the end of the year if I don't waste it on useless things like doctor's visits, checkups, and the like mean that I'm more likely to avoid the doctor and save that money? If so, I can tell you that doesn't really work very well. As it stands, I have to put aside money for my deductible; having that money put aside in my savings account doesn't make me go to the doctor or keep me from going. When I need the doctor, I need the freaking doctor, no matter what the cost. Sorry, but you can't just ward off infection by saying, "I can't afford to be sick right now." Illness does not equal laziness, as much as some people would like you to believe that.

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 3:38 PM

ANTHONYT

Freedom is Important because People are Important


Hello,

The public 'option' is only truly an option if you can opt out of it.

I suspect that people who wish to keep private health insurance will essentially be paying for health insurance twice: Once via taxes, and then again with what's left after taxes.

That is not, to my mind, a very good option.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 3:44 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by AnthonyT:
Hello,

The public 'option' is only truly an option if you can opt out of it.

I suspect that people who wish to keep private health insurance will essentially be paying for health insurance twice: Once via taxes, and then again with what's left after taxes.

That is not, to my mind, a very good option.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner



Tell me, am I not paying for health care twice already, and in essence getting nothing for my money?

I'm paying for your healthcare if you work for the federal, state, or local government, and I don't seem to be able to "opt out" of paying for it, even though I get *NOTHING* for that money.

And I'm paying for your healthcare if you're in the military, and I have no choice to "opt out" of that, either. Again, I get *NOTHING* out of my country's military escapades overseas except for higher taxes to pay for the longterm healthcare of the victims of my government's fucked-up policies.

Hey, they want health care and coverage, let 'em buy it on the open market like they want the rest of us to do!

Can someone please show me where the "opt out" option is in this single-payer "public option" system?

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 3:56 PM

ANTHONYT

Freedom is Important because People are Important


Hello,

Well, we actually do get something for that money, Kwicko. We get the public services provided by the public employees. Those employees are attracted to their position by a combination of pay and benefits.

Now, you and I can probably agree wholeheartedly that there are many public servants (and perhaps entire government agencies) that we would be happy to live without.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 4:03 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by AnthonyT:
Hello,

Well, we actually do get something for that money, Kwicko. We get the public services provided by the public employees. Those employees are attracted to their position by a combination of pay and benefits.

Now, you and I can probably agree wholeheartedly that there are many public servants (and perhaps entire government agencies) that we would be happy to live without.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner



Well, you actually do get something from MY labors, too, Anthony. You get me being part of the "consumer nation", paying taxes and keeping the businesses and government afloat.

I still say that if we as a nation don't want "socialized medicine", then we absolutely need to do away with MediCare, MedicAid, VA benefits, and any and all coverage of government employees. If any of these people want health care coverage, they need to go out and buy it on the open market like the rest of us are forced to do - WITHOUT benefit of taxpayer subsidies paying for it. If it's good enough for us, it's good enough for them.

And hey, maybe all that "competition" for their health care dollars will bring the prices down, eh? Isn't that kinda what Sarge wants? Market forces, and all that?

Edited to add: Also, Anthony, saying that they took those positions for a combination of the pay and the benefits isn't really a valid answer, is it? I mean, can't I make the same claim of the auto workers who have recently lost not only the retirement that they were supposedly guaranteed when they put in their 20, 30, or 40 years or more at the factory, but also lost their health care that was also promised them?

So just because we as a nation SAID we were going to give these people these benefits, doesn't mean in any way that we're actually OBLIGATED to give them these benefits, does it? I mean, isn't that the "new reality" that we've been told to expect by Wall Street? Sorry, but I won't lose any more sleep at night over some poor Iraq-war IED victim losing his benefits than you would feel over a factory worker nearing retirement losing his benefits when GM decided to declare bankruptcy. Hey, that kid signed up, after all; it's not like he was drafted, right? He knew the risks going in, or he damned well should have!

Mike


NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 4:31 PM

SERGEANTX


I apparently failed in describing the plan.

Quote:

Originally posted by SignyM:
How is this supposed to work? I know you have the idea that if people had to watch their pennies to get health care, market forces would take over and the problem would be solved. But if you can't get insurance in the first place, you have no deductible.



I mentioned taking care of the people who can't insurance by expanding Medicare.

Quote:

And the only thing it would promote is insurance with low DEDUCTIBLES, not necessarily low premiums.


No, it would promote exactly the opposite, which is the main point of the plan.

The single most pervasive problem in health care right now is runaway inflation. The normal market incentives are completely broken because we're abusing insurance.

Insurance is supposed to be for unexpected calamities that you couldn't hope to pay for from savings. But for decades the insurance industry has encouraged us to use insurance to finance day-to-day health care expenses. This is where the incentives get screwed. An insured patient has virtually no incentive to curtail health care expenses. As long as they have coverage, they might as well shoot for the moon.

This is obviously dysfunctional and couldn't NOT produce price inflation. But the insurance industry was able to manage it for several decades because they were running things more or less like a ponzi scheme. As long as they could expand their customer base, they could afford the higher prices without raising premiums that much. I'd wager they even looked at price inflation as good for their bottom line because it pushed more and more people into the insurance game, to the point we're at now where people see health insurance as the only way to afford health care.

But think about how screwed up that is. It's like using a credit card to buy groceries and pay the bills because you can't afford them with the money you make. At some point you have to face reality and take a hard look at your budget.

Anyway, like any ponzi scheme, once the expanding customer base dries up, you're screwed. We're in the final stages of that now. Without an expanding base, they're forced to raise premiums and cut back on benefits. (That's why they're so eager for the "individual mandate", but even that will just give them a "fix" for a few more years.)

HMOs were supposed to solve this problem, and they actually worked for a while. But generations of customers weened on the idea that the "doctor/patient" relationship was sacred, balked at the idea of "bureaucrats" setting limits on their treatments and implementing cost saving measures. Consumer pressure, along with extensive lobbying by the AMA, goaded congress into regulating away the HMOs ability to cut costs, which meant we were back in the same boat.

So the insurance companies (the only people in the equation with any incentive to cut costs) are stuck "negotiating" with doctors for lower prices and setting tighter limits on what they'll cover. But these sorts of things are extremely unpopular and also push up against regulatory constraints.

Which brings us to my glorious plan. The point is to get the market weened off using insurance to pay for regular health care expenses. With the government covering the deductible, customer have little reason to go for low deductible plans (with their heavy-duty premiums), quite the opposite in fact. They'll be looking for catastrophic plans with very high deductibles (and very low premiums). And, since they're looking at the very real possibility of keeping the money covering their deductible, if they can avoid using all of it, this will effectively simulate paying "out of pocket". They'll have very real incentive to negotiate for lower prices and look for bargains.

Once this takes hold, we'll have a growing portion of the health care market that suddenly cares a lot more about what they're spending. And I don't mean that they'll "care" because Obama says it's good for the nation. I mean that they'll "care" because it hits them in the pocketbook. When they are the direct beneficiaries of savings, and the ones to feel the loss of excessive spending, the dynamic will start to change. They'll actually ask a doctor what their office visits cost. They'll ask about cheaper options when such a thing is viable. They'll get a second opinion, not because Aunt Sally says it's a "good idea", but because they think the treatment recommended by Dr. A sounds too damned expensive. When customers start really pushing for cheaper sources of health care (which they haven't been doing for decades), I'm betting that within five years we'll not only see health care inflation halted, prices will begin to drop well below current levels.




SergeantX

"It's a cold and it's a broken hallelujah"

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 4:48 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Thanks for the response, Sarge. It's certainly something to think about. I'm glad you clarified it a bit, and there might be some merit in what you're proposing. Definitely something to mull over.

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 4:51 PM

ANTHONYT

Freedom is Important because People are Important


Hello,

Health benefits are something that any employer may choose to offer in order to create an incentive for people to apply for a position. If the government is going to be an employer (and it is) then it should have the right to offer health benefits to its employees for positions where such an incentive is useful to secure qualified applicants.

I can think of few people who would volunteer for the armed services if they were not made some assurances as to health care, for instance.

I enjoy having 911 service and police protection and fire fighting services. I enjoy having public roads that are relatively safe and well-lit. There are many other public services I enjoy, and I am happy to pay taxes so that these services can be maintained. Providing health care is an important part to making sure that these services are properly staffed. (Though, you should disabase yourself of the notion that all health care derived from public employment is some miraculous inexpensive bounty. My health coverage in public service was very much like my health coverage from private employment- the job only paid for part of it.)

I don't know what job you have Kwicko, but I expect that if your employer deems it important to fill the position, then they offer health coverage. In this case, it is still the choice of the employer to offer it or not.

Public health care will necessarily force me to pay for insurance not only for people whose services I may not care to subsidize, but also for myself and others who may not wish to partake of the service.

The end result may be that I can no longer afford my private health plan in addition to the taxes which pay for the public 'option.' Even if I can afford it, my pocket is still being picked in a way not amenable to me.

It seems that a very slight majority may soon be putting a weight on the minority that they may prefer not to bear.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 5:15 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

I enjoy having 911 service and police protection and fire fighting services. I enjoy having public roads that are relatively safe and well-lit. There are many other public services I enjoy, and I am happy to pay taxes so that these services can be maintained.


Sounds like you're a socialist! ;)

Quote:

Providing health care is an important part to making sure that these services are properly staffed.


How ever do they manage to do it in countries with national health care, then? I mean, if it's such an important incentive and all. Are you saying that if we had a universal healthcare plan, no one would join the police force anymore? Seems a bit farfetched to me...

Quote:

Though, you should disabase yourself of the notion that all health care derived from public employment is some miraculous inexpensive bounty. My health coverage in public service was very much like my health coverage from private employment- the job only paid for part of it.


And at the federal level, it's more than 75% of it.

Quote:

Public health care will necessarily force me to pay for insurance not only for people whose services I may not care to subsidize, but also for myself and others who may not wish to partake of the service.


And that's the rub - You're fine with picking MY pocket to pay for the benefits for those who invaded a nation and fought in a war I was bitterly opposed to. You have no problem whatsoever denying me the right to "opt out" of paying for their murderous behavior. I'm forced, with threats of prison and theft of my money, to pay for insurance for people whose services I don't want to subsidize and find morally objectionable.

The difference being, if my job offers health insurance, they don't pick YOUR pocket to pay for it. You can't make that claim about government employees or the military, can you?

Quote:

The end result may be that I can no longer afford my private health plan in addition to the taxes which pay for the public 'option.' Even if I can afford it, my pocket is still being picked in a way not amenable to me.


Again, please explain to me how this ISN'T happening right now. *I* am paying for my own health care. In addition to that, *I* am paying for the health care of some young psycho-in-training who joined the army in the hopes of getting to blow someone up - and that is not amenable to me! Given a choice, I'd much rather have that extra pick-pocketed money go to someone like a UAW worker - you know, someone who actually BUILDS THINGS for a living, someone who contributes to this country, instead of someone who destroys things and kills people for fun and profit, and lives like a leech that feeds on fear and hatred.

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Thursday, August 6, 2009 7:56 PM

FREMDFIRMA



Yowza, that sounds a little hostile even for you, Mikey, in fact, you're starting to sound like...
Me.

Bit scary, that.

-F

NOTIFY: N   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 1:45 AM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Thanks, Frem!

Although, truth be told, I'm doing it intentionally as an illustration of the all-or-nothing attitude that seems to be so prevalent in the discussion these days. The vast majority of those who are currently decrying "socialized" healthcare would be up in arms at the mere mention of some of the things I'm proposing. I'm asking them to put up or shut up. If they don't want socialized medicine, then let's by all means do away with it completely. If they're so against "socialism" in all its forms, let's do away with it completely; let's have done with armies, police, fire departments, public roads and schools, and the like.

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 3:43 AM

ANTHONYT

Freedom is Important because People are Important


Hello,

I'm afraid I'm not a 'kill em all and let God sort 'em out' kind of guy, which is the embodiment of an all or nothing philosophy.

There are obviously many public employees I'd prefer not to subsidize. Even amongst what I consider to be 'essential services' there are people who disgust me.

But while there are individual (or even groups of) policemen and military employees who behave in ways I detest, I still recognize that I'd rather have these services than not have them.

However, my experience of a toothache does not inspire me to drill holes in all my teeth. Just because I pay for some people against my will does not therefore imply that I wish to pay for all people against my will. It may be just a matter of scale, but so is the difference between a paper-cut and a decapitation.

As to the dilemma of 'would someone join the police or military if everyone had health care' I'd say the answer is probably yes. However, I do not think as many people would do so if no health care was offered. Especially if no health care was offered for those jobs, but was offered for other jobs. There are people who choose a job based on the quality of benefits, or avoid jobs because of the lack thereof.

Now, if you want to sell me on a tax form that allows me to specify which government departments get my money, and what percentage thereof, I'd be all for it. Then when they collect their taxes, they can budget for the upcoming year based on what they actually collected the previous year. This sort of thing would make me really happy.

Such a form would allow you to minimize your expenditure on functions you don't agree with.

--Anthony







"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 6:33 AM

DREAMTROVE


employers don't offer health insurance, it's never happened to me, but then again, why would they? It already costs a ridiculous amount, due to our regulator and tax structure, to hire an American, who is no more qualified than his overseas counterpart.

Besides, it's not the responsibility of the employer. It's the responsibility of the industry to provide affordable products and services in order to get customers. The problem is that there is too much govt. interference protecting the cabal that overcharges, so that it isn't a free market, and there is an industry of price fixing.

Free the market, completely, and then provide a per-need assistance program for which the poor can apply. People need surgery for injuries, or cancer, but no one needs their stomach stapled shut to keep them from eating. This nonsense is created by a pay everything plan.

If the govt. has to pay for this nonsense, then taxes go up, if an employer has to pay for it, then they hire fewer employees.

<-- something no one seems to get: A company's productivity, and hence profits, are determined by the number of employees they have. Every company would prefer to have more employees. It's what they usually do with excess money. They can't do this when they have to spend the money on stuff that no one needs, like interest on the debt for some parasite in washington dc's wars. Whether a corporation is paying corporate income tax or deducting personal income tax from your paycheck, they're paying the tax, and the tax receipts are now all going to pay for interest from debts from various wars made by an entity which is technically not part of the united states, which is our govt.

As a footnote: Does it ever both anyone that the flag, pretty as it is, that americans die to defend is that of the british east india trading company?

Oh, and because the south park aesthetics are really bugging me, Mike, have a gift.













Or a variation on the classic





Mike that was...




Edit:

Alternatively, the deadliest thing to come out of Japan:









Or, of course





Just some thoughts.

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 6:47 AM

ANTHONYT

Freedom is Important because People are Important


"As a footnote: Does it ever both anyone that the flag, pretty as it is, that americans die to defend is that of the british east india trading company?"

Hello,

It is not. The stripes are nearly identical, though. But then, many of the world's flags have striking similarities.

Many of our national pride songs were borrowed from British sources, so I'm not surprised to see that our stripes bear a striking resemblance to a British corporate imperial flag. Our founding fathers were British, and often businessmen.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 6:49 AM

SIGNYM

I believe in solving problems, not sharing them.


SARGE

Quote:

I apparently failed in describing the plan.... The single most pervasive problem in health care right now is runaway inflation. The normal market incentives are completely broken because we're abusing insurance.

Maybe. But I'll get to that later.
Quote:

Insurance is supposed to be for unexpected calamities that you couldn't hope to pay for from savings. But for decades the insurance industry has encouraged us to use insurance to finance day-to-day health care expenses. This is where the incentives get screwed. An insured patient has virtually no incentive to curtail health care expenses. As long as they have coverage, they might as well shoot for the moon.
Yes, this is true. But the same might be said for care providers- doctors, radiologists, anesthesiologists, testing laboratories etc. The more procedures, the more reimbursement. This happens all across the spectrum of care, from day-to-day care to catastrophic coverage to end-stage treatment/ hospice.

However, day-to-day health care is NOT what's driving costs. In fact, day-to-day health care (in theory, anyway) is what KEEPS people healthy. There are bigger drivers in healthcare costs besides stuffy noses:

End-of-life treatment. The last six months is typically the most expensive.

Chronic illnesses of the medically uninsured treated in the ER. I read a study which showed that five patients accounted for 80% of ER costs in one hospital in a year. (I'll try to find the study because I'm ballparking the figures) These people had diabetes, mental illness, emphysema/ asthma which would reach critical levels. These people would be better off, and cost less, if treated regularly in a clinic setting.

Uncoordinated care. Mayo Clinic spends half of what other university-research hospitals spend by forming TEAMS which handle all aspects of a patient's care, not just shuffling a patient from one specialist to another.

Insurance "administrative" costs and profits, pharma profits etc.
Quote:

This is obviously dysfunctional and couldn't NOT produce price inflation.
Again, yes, but... Other nations use single payer: publicly-funded, privately-provided. The SAME DRIVER (more treatment= more reimbursement) is in place in their systems too. Nonetheless, their health care is approximately ONE HALF the cost of ours, per person. So is the "misuse" of insurance REALLY the problem? Is the "broken" market system really the issue? Or is there some other factor which creates such cost pressures?
Quote:

But the insurance industry was able to manage it for several decades because they were running things more or less like a ponzi scheme. As long as they could expand their customer base, they could afford the higher prices without raising premiums that much. I'd wager they even looked at price inflation as good for their bottom line because it pushed more and more people into the insurance game, to the point we're at now where people see health insurance as the only way to afford health care.
But they HAVE been raising premiums! Premiums have been going up at roughly double the inflation rate for the past two decades.
Quote:

But think about how screwed up that is. It's like using a credit card to buy groceries and pay the bills because you can't afford them with the money you make. At some point you have to face reality and take a hard look at your budget.
Indeed. But that means that we have to look at CORPORATE budgets too. Where are we (collectively) spending unnecessarily? And personally, the insurance companies do not provide a "value-added" service as far as I can tell.
Quote:

Anyway, like any ponzi scheme, once the expanding customer base dries up, you're screwed. We're in the final stages of that now. Without an expanding base, they're forced to raise premiums and cut back on benefits. (That's why they're so eager for the "individual mandate", but even that will just give them a "fix" for a few more years.)
If we're forced into the maw of the current private health insurances... well, screw that.
Quote:

HMOs were supposed to solve this problem, and they actually worked for a while.
Not really. I used to belong to Kaiser Permanente. But (in addition to screwing up my daughter's delivery and cuasing a brain-bleed and permanent disability) they mis-dx hubby's prostate cancer for BPH/infection, gave him antibiotics and ibuprofen and told him to go home. This went on for five years! They never tested for cancer. In the past three years ALONE, among the roughly 50 people I work with regularly, one person's spinal tumor was mis-dx for three years as "arthritis" (they never took an MRI), another's herniated disks were mis-dx for five years as "fibromyalgia" (no MRI), another person's pituitary tumor was mis-dx for two years as "depression" (no appropriate testing or MRI). In that so-called non-profit system, the doctors at each facility get a fixed amount per patient (called "capitation") but then get to split the leftover money at the end of the year as a "bonus". The system is geared to NOT provide treatment. If you come in with the same problem fifty times in a row, (sore neck) they'll give you the same non/ cheap treatment fifty times in a row, without ever bothering to FIND AND FIX THE PROBLEM.
Quote:

But generations of customers weened on the idea that the "doctor/patient" relationship was sacred, balked at the idea of "bureaucrats" setting limits on their treatments
WITH GOOD REASON!
Quote:

and implementing cost saving measures. Consumer pressure, along with extensive lobbying by the AMA, goaded congress into regulating away the HMOs ability to cut costs, which meant we were back in the same boat.
Which regulations?
Quote:

So the insurance companies (the only people in the equation with any incentive to cut costs) are stuck "negotiating" with doctors for lower prices and setting tighter limits on what they'll cover. But these sorts of things are extremely unpopular and also push up against regulatory constraints. Which brings us to my glorious plan. The point is to get the market weened off using insurance to pay for regular health care expenses.
A very cost-INeffective approach. Regular treatment for chronic conditions like diabetes and COPD, and routine screening for common cancers saves money in the end.
Quote:

With the government covering the deductible, customer have little reason to go for low deductible plans (with their heavy-duty premiums), quite the opposite in fact. They'll be looking for catastrophic plans with very high deductibles (and very low premiums). And, since they're looking at the very real possibility of keeping the money covering their deductible, if they can avoid using all of it, this will effectively simulate paying "out of pocket". They'll have very real incentive to negotiate for lower prices and look for bargains.
This assumes that "people" are in a position to shop around. If you're covered by your workplace, you get what they negotiate.
Quote:

Once this takes hold, we'll have a growing portion of the health care market that suddenly cares a lot more about what they're spending. And I don't mean that they'll "care" because Obama says it's good for the nation. I mean that they'll "care" because it hits them in the pocketbook. When they are the direct beneficiaries of savings, and the ones to feel the loss of excessive spending, the dynamic will start to change. They'll actually ask a doctor what their office visits cost. They'll ask about cheaper options when such a thing is viable. They'll get a second opinion, not because Aunt Sally says it's a "good idea", but because they think the treatment recommended by Dr. A sounds too damned expensive. When customers start really pushing for cheaper sources of health care (which they haven't been doing for decades), I'm betting that within five years we'll not only see health care inflation halted, prices will begin to drop well below current levels.
Possibly true. But I went from a cheap insurance plan to a more expensive one because the cheap quality of care was... literally- life-threatening.


NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 7:30 AM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Thanks, DT - all of those are great, and some of them may indeed turn up as an avatar. For now, though, I'm enjoying being the angriest man on the internet. It just feels... RIGHT.







Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 8:19 AM

RUE

I have a vote and I'm not afraid to use it!


"Every company would prefer to have more employees."

Uhhm - no. Every company would prefer to have FEWER employees doing the same amount of work as a larger number of employees (higher productivity). That means they spend less for what they sell, and have a higher profit.

***************************************************************

Silence is consent.

NOTIFY: N   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 8:53 AM

SERGEANTX


Quote:

Originally posted by SignyM:
.. the same might be said for care providers- doctors, radiologists, anesthesiologists, testing laboratories etc. The more procedures, the more reimbursement. This happens all across the spectrum of care, from day-to-day care to catastrophic coverage to end-stage treatment/ hospice.



That seemed too obvious too mention. That's why it's so critical that the consumer cares about prices. If they don't, all the people you mention will just keep raising them until someone does. I'm really not sure how you can reasonably deny that dynamic.


Quote:

However, day-to-day health care is NOT what's driving costs. In fact, day-to-day health care (in theory, anyway) is what KEEPS people healthy. There are bigger drivers in healthcare costs besides stuffy noses:

End-of-life treatment. The last six months is typically the most expensive.

Chronic illnesses of the medically uninsured treated in the ER. I read a study which showed that five patients accounted for 80% of ER costs in one hospital in a year. (I'll try to find the study because I'm ballparking the figures) These people had diabetes, mental illness, emphysema/ asthma which would reach critical levels. These people would be better off, and cost less, if treated regularly in a clinic setting.

Uncoordinated care. Mayo Clinic spends half of what other university-research hospitals spend by forming TEAMS which handle all aspects of a patient's care, not just shuffling a patient from one specialist to another.

Insurance "administrative" costs and profits, pharma profits etc.



I'm talking about price inflation. You're talking about overall health care spending. They're different animals. The overall spending is still affected by the factors I'm targeting - because higher prices will make things cost more - but the total amount spent doesn't necessarily affect inflation.


Quote:

Again, yes, but... Other nations use single payer. The SAME DRIVER (more treatment= more reimbursement) is in place in their systems too. Nonetheless, their health care is approximately ONE HALF the cost of ours, per person.


Look a little closer at the stats. These other nations don't spend as much on health care as we do for a variety of reasons, but they're still facing the same problem with inflation. Still, you're right that single payer can control inflation better than the mess we have now. But they'd be doing basically the kinds of things the HMOs were trying and that people freaked out about. The buzzword for that is "rationing", and mostly it's a repub scare tactic, but the point is, you'd have the state making the decisions to save money rather than the patient.

Quote:

Quote:

But the insurance industry was able to manage it for several decades because they were running things more or less like a ponzi scheme. As long as they could expand their customer base, they could afford the higher prices without raising premiums that much. I'd wager they even looked at price inflation as good for their bottom line because it pushed more and more people into the insurance game, to the point we're at now where people see health insurance as the only way to afford health care.


But they HAVE been raising premiums! Premiums have been going up at roughly double the inflation rate for the past two decades.



Perhaps I should have included a timeline. The time period I was referring to were the four to six decades preceding the last two.

Quote:


Quote:

HMOs were supposed to solve this problem, and they actually worked for a while.


Not really. I used to belong to Kaiser Permanente. But ...



Hey, I said they worked to slow health care inflation. I didn't say I liked them. I was in one too and it sucked. As should be obvious by now, I'm not a favor of top down approaches to deciding where health care spending should be cut. I think things work much better when patients make these calls. But they'll never choose to save money if they have no incentive to do so.

My point wasn't that HMOs were a good way to go. I was just pointing out that the insurance industry eventually reached a point where they had to do something about the inflation. But at that point, it was really too late.


SergeantX

"It's a cold and it's a broken hallelujah"

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 9:24 AM

RUE

I have a vote and I'm not afraid to use it!


"But they'd be doing basically the kinds of things the HMOs were trying and that people freaked out about."

Not necessarilly. For one thing insurance companies and insurance-run HMOs still have the practice of recission: dropping patients off of coverage when they really need it on any flimsy pretext. (Anything for a profit, eh ?)

Government will have no such capability.

Futher, government will be picking up the tab for disability and chronic illness. It behooves them to treat people early and get them as well as possible as quickly as possible, an incentive private medical systems don't have.

***************************************************************

Silence is consent.

NOTIFY: N   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 9:45 AM

ANTHONYT

Freedom is Important because People are Important


"Futher, government will be picking up the tab for disability and chronic illness. It behooves them to treat people early and get them as well as possible as quickly as possible, an incentive private medical systems don't have."

Hello,

The idea of government picking up a tab creates a friendly impression in my mind that the government will somehow be paying for all of this from an imaginary pocketbook, and that because the contents of this imaginary pocketbook are limited, they will seek to spur greater efficiency and wholesomeness of treatment throughout the process. After all, in the long run, it's cheaper to treat someone competently once than to treat them incompetently multiple times.

But in the reality, I suspect the government will not have any such thing as a limited pocketbook. I suspect they will acquire as much money as they need (from us) by using the threat of inadequate health care as a penalty for not endorsing additional funding. Because they can either tax us, or print as much money as they need (another form of tax), they will not actually have any incentive to behave efficiently and well.

The usual question posed by advocates at this point is usually, "Well, is private health care any better?"

And this sounds to me a lot like, "You've been enjoying shitty product A, so try shitty product B, now with more odor!"

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 9:46 AM

UNABASHEDVIXEN


Signym said:

Quote:

Again, yes, but... Other nations use single payer: publicly-funded, privately-provided. The SAME DRIVER (more treatment= more reimbursement) is in place in their systems too. Nonetheless, their health care is approximately ONE HALF the cost of ours, per person. So is the "misuse" of insurance REALLY the problem? Is the "broken" market system really the issue? Or is there some other factor which creates such cost pressures?


As someone who lives in a country with a single-payer, publicly-funded, privately-provided health care system (Canada) I feel compelled to weigh in. I have to tell you, we're watching you all up here and scratching our heads. It's hard to believe there is such hand-wringing over your nation's healthcare system. Canada has universal health care - everyone has "insurance" as it were, regardless of who they are, and everyone accesses the same system. We get world-class care, despite what you may have been told. And we spend about 7-8% of our GNP on healthcare (the numbers fluctuate, but it's below 10%). The US spends about the same (the last figure I heard was 8%) and has 65 million people without health insurance of any kind. I just don't get it.

"Socialized medicine" is a term only used in the US. It's not a term that is used to describe what we have, except by the US. We call our system universal healthcare, ie everyone is eligible (with some exceptions - you have to be a landed immigrant or citizen, and depending on which province you live in there can be a residency requirement).

There have been a lot of scare tactics used by the Republicans, saying that a system similar to Canada's would cause all sorts of decline in care, that the government would decide who gets treated and how. That's all BS. I'll use my own case as an example. I am 30. Shortly after my 20th birthday I was diagnosed with clinical depression, generalized anxiety disorder, and panic disorder. Over the last ten years I've lived in three different cities in two provinces (BC and Ontario). I've been a student, unemployed, underemployed, and now, thankfully, am gainfully employed. I never had to worry about not having access to medical care. I was able to see doctors, counselors, attend group therapies, etc. (all providers of my choice). I can't be without medical care - I am monitored pretty closely. Currently, I have a fantastic team at a clinic I found. I see a physician, a clinical social worker, and a psychiatrist. I also have access to a nurtitionist, a pharmacist, and registered nurses for things like flu shots (flu shots are free on Ontario, but not in all provinces). In short, I get the best care I can imagine, and I never worry that if I change jobs I will lose my health insurance, or that it will matter that I have a pre-existing condition.

SergeantX wrote:
Quote:

The buzzword for that is "rationing", and mostly it's a repub scare tactic, but the point is, you'd have the state making the decisions to save money rather than the patient.


Um, no.

It's true that some things (like IVF) aren't funded, but the government doesn't decide anything on a patient-by-patient basis, and there's very little in terms of treatment(I actually can't think of anything) that you could get under the US system that isn't available under ours, except for things like elective or cosmetic surgery - actually, we can get elective surgery, but the waits can be quite long.

Does the government decide what procedures are covered? Yes and no. The government funds medicare, at the federal and provincial levels. Medicare is overseen by the provincial governments, but is mostly delivered by local health authorities, who decide about standard care for any given disease, injury, etc. There tends to be uniformity across the board, but with some small regional differences (like the flu shot). There is no bureaucrat anywhere looking at my records and adding up how much I cost the healthcare system (I know it's a lot!). No one decides what treatment I get except me and my doctor. Doctors are definitely aware of the cost of healthcare (as I'm sure they are under HMOs, etc), but they don't let it dictate treatment. I've had all sorts of blood tests, x-rays, etc etc, just to rule things out. We're all owners of the system, so, speaking for myself, I am aware that everytime I access the system it costs us all. I don't use it capriciously. But I also don't hesitate to get the care I need. Most folks I know feel the same.

Is our system perfect? By no means. There can be long waits, especially for certain services, and in rural areas. We have a shortage of doctors, nurses and other health care professionals (though that's more to do with lack of training than lack of funding). Sometimes we have to travel to another city for treatment (again, especially if we live in rural areas). I think our mental health system has a long way to go. Our system is heavily strained by our elderly population. We've got work to do to be sure. But our hospitals are as nice as yours and they're open to everyone. There are at least 6 hospitals where I live (Ottawa) and I can go to whichever I choose, should I need to. If you ask us, the vast majority of Canadians (around 85%) wouldn't trade our system, and for every horror story you've heard from here, we've heard 10 from the US.

Point of interest: our healthcare system is commonly attributed to the work of a man named Tommy Douglas (though there were many involved). In a semi-recent (about 5 years ago I think) poll of Canadians, we picked him, from long list that was eventually narrowed to 10, as the greatest Canadian who ever lived. That's how we feel about our system.

I'm pretty well-versed in our system's mechanics (I worked for the NDP [yes, I am a Social Democrat - which is different from a Socialist] Health Critic for a time) so I'd be happy to give a Canadian perspective if anyone has specific questions. We're watching your debate very closely up here (we get bored for political news in the summer, as our politicians are all on the barbeque circuit).

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 10:04 AM

SIGNYM

I believe in solving problems, not sharing them.


Oh, thank god for a real Candian to speak up! I have two good Canadian friends (Mississauga. Fred (not his real name) developed non-Hodgkins lymphoma when he was 45. As soon as he was dx (which was about two days after he coughed up blood) he went in for open-chest surgery to debulk the tumor, then chemo, then he had bone marrow taken out and cleaned up, his own bone marrow was killed with high doses of radiation, and he had an autologous bone marrow transplant. It was a long, grueling procedure which required a couple of months in the hospital, one of those months was in reverse isolation. Fifteen years later he is alive and productive.

And what did it cost him and his wife?

NOTHING.


When people ask me (with a sneer in their voice) if I want the Canadian healthcare system here, my answer is a loud and unequivocal YES!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 10:15 AM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:


But in the reality, I suspect the government will not have any such thing as a limited pocketbook. I suspect they will acquire as much money as they need (from us) by using the threat of inadequate health care as a penalty for not endorsing additional funding. Because they can either tax us, or print as much money as they need (another form of tax), they will not actually have any incentive to behave efficiently and well.



Which is EXACTLY what the military currently does to us. "Pay up, or you won't be safe! Pay up, or the terrorists win! Pay up, or we'll let you die!" Then they either crank up the taxes to pay for their latest little war, or they simply go and print or borrow more money to pay for it.

So it seems as if the big problem many have is not the borrowing or taxing - it's what we use the money for. Use it to kill people with different cultures from us, and that's a "good" use of the money; use it to try to take care of Americans here at home, and it's "evil" because that's "socialism".

Funny thing is, it seems like the average Iraqi insurgent now has better universal healthcare than I do, because we're providing it for them. How fucked up is that?

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 10:27 AM

SERGEANTX


Quote:

Originally posted by UnabashedVixen:
There have been a lot of scare tactics used by the Republicans, saying that a system similar to Canada's would cause all sorts of decline in care, that the government would decide who gets treated and how. That's all BS.



I tend to agree. I wrote this up as a thought experiment as much as anything. I do think something like my proposal could work. But it's just not politically viable. Despite the goofballs raising hell at the town hall meetings, there's really not that much support for dealing with health care as a free market commodity.

And of course the biggest reason a plan like mine would never fly is because it promotes a major change to the insurance industry's business model. They'd fight against it tooth and nail and they have more than enough influence in congress to have their way. Not to mention, our congress isn't in the habit of creating legislation that gives more decision-making power to consumers, especially when they can retain such power for themselves.

Quote:

Quote:

The buzzword for that is "rationing", and mostly it's a repub scare tactic, but the point is, you'd have the state making the decisions to save money rather than the patient.


Um, no.



I'm not sure what you're saying no to. I'm not saying they'd make calls on a patient-by-patient basis (though I'd honestly be a little more comfortable with that approach). No, they'd control spending through policy decisions that set blanket conditions and qualifications on who was eligible for what treatments and under what circumstances. Please correct me if that's not the case, but I'm pretty sure that's how it works in general. Or does everyone just get whatever they want?

Quote:

Is our system perfect? By no means. .. [but] the vast majority of Canadians (around 85%) wouldn't trade our system, and for every horror story you've heard from here, we've heard 10 from the US.


That sounds about right, and if we're going to give up on the free market in health care, the Canadian system seems pretty good me. Especially compared with the giant turd our reps are currently squeezing through congress. But here's what I don't get? Why do you all take it so personally that people in the US might not want to go your way? I can understand the desire to correct obvious misstatements, but, you know, different strokes for different folks, right?


Quote:

We're watching your debate very closely up here (we get bored for political news in the summer, as our politicians are all on the barbeque circuit).


Heh.. ok. Maybe that explains it then.

Here's a question for you:

I read an article on the French health care system a while back, and it made similar statements about percentage GDP and the like, but said that, "like everyone else, the French have a growing problem dealing with runaway health care inflation". Were they right about that? The everyone else part? Has Canada managed to put the lid on price inflation? I've heard it hasn't, but you likely know more.

(btw, Welcome to the board. We don't get much new blood these days )

SergeantX

"It's a cold and it's a broken hallelujah"

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 10:39 AM

ANTHONYT

Freedom is Important because People are Important


Hello Mike,

I know you enjoy posing hypothetical A-B scenarios to make your points, but they aren't necessarily applicable to my feelings on the issue.

If I had my druthers, we wouldn't be occupying half the world with troops (and I'm not just talking about Afghanistan and Iraq.) We'd have a military about half its current size, and we'd still be safe just so long as no country initiated an arms race. I have a very big problem with our borrowing and taxing and careless money printing. Just because government misspends my money in area A does not mean I want them to also misspend it in area B. You'll also note that I never referred to socialism as 'evil.' I have only ever maintained that it is inefficient. And in fact, I believe that the more government takes control of a process, the less efficient it seems to become.

So the hypothetical scenario of 'Why are you willing to kill people with tax dollars and not save people with tax dollars' doesn't really apply to me. I prefer not to kill people with tax dollars, either. But as you so well illustrated, the government has turned the military into a big sucking hole. This does not inspire me with confidence as to their ability to administer an efficient health care system. It's not 'Either A or B.' You're arguing that I should embrace A AND B. Well hell, why would I double down on nonsense?

Of additional concern is that I can not seem to find any reliable information about how this thing is supposed to work. All I know is that Senator A is screaming that it will kill my grandmother and that Senator B is screaming that I could die without it. Chances are that even after it passes, it'll be years before all the merits and flaws of the system are even realized. So I'm being asked to trust the money-sucking mismanagement people with another money-sucking program without even any clear idea about what the bloody program will specifically entail.

The Canadian fellow above made me feel hopeful, but Mike, nothing you've said has inspired me with confidence.

Not to mention the fact that if there is an efficient Canadian health care system, you can be sure that we will NOT be adopting it. We'll brew something homegrown and ungainly.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 10:54 AM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by AnthonyT:

You'll also note that I never referred to socialism as 'evil.' I have only ever maintained that it is inefficient. And in fact, I believe that the more government takes control of a process, the less efficient it seems to become.



It seems to me that there are several "socialized" healthcare systems already in place - some of them even in place here in the U.S. - that put the lie to the "inefficiency" claim. Signym and Rue have repeatedly posted up lists of countries that spend far less per capita on their healthcare systems, get better outcomes, and live longer, healthier lives while spending less to do so. Medicare, Medicaid, and the VA have also been help up as examples of how government healthcare can be done right.

Quote:


The Canadian fellow above made me feel hopeful, but Mike, nothing you've said has inspired me with confidence.



Well, then, feel free to listen to that "fellow" (but for the record, I think a "vixen" is usually a female). Whatever it takes to convince you that universal healthcare isn't the bid bad bogeyman that the insurance companies and their "grassroots" lobbying efforts would have you believe it is.

Hell, I don't care if you don't listen to me. I'd worry if you did. If anyone ever started listening to me, the righties would no doubt dub me "the messiah" or "the one" or "the anointed" or "the chosen".

Quote:


Not to mention the fact that if there is an efficient Canadian health care system, you can be sure that we will NOT be adopting it. We'll brew something homegrown and ungainly.



Sadly, that may be true. Americans have an unfailing ability to look around the world, find what works, and then do the complete opposite in their never-ending quest to "improve" it.

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 11:04 AM

ANTHONYT

Freedom is Important because People are Important



Hello,

My sincerest apologies to fellowizing a female. :-(

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 11:50 AM

UNABASHEDVIXEN


No worries at all Anthony :) I'll take it in the spirit it was intended.

SergeantX said:

Quote:

I'm not sure what you're saying no to. I'm not saying they'd make calls on a patient-by-patient basis (though I'd honestly be a little more comfortable with that approach). No, they'd control spending through policy decisions that set blanket conditions and qualifications on who was eligible for what treatments and under what circumstances. Please correct me if that's not the case, but I'm pretty sure that's how it works in general. Or does everyone just get whatever they want?


Well, basically it works like this: the regional health authorities, in concert with the provincial governments, decide what treatments will be covered and how. But they do it on a medical basis. Like, what is the standard treatment for this condition? It's not about who's eligible - everyone that has the condition/disease etc is eligible for whatever treatment they need. So decisions aren't made based on your circumstances, previous health conditions, etc. Doctors of course make decisions on what treatment is best based on lifestyle factors, age, etc. But what I'm trying to say is that you will never hear a doctor or other healthcare professional say "you need this, but it's too expensive" or "you're too old/fat/unhealthy and not worth the investment." People don't get everything they want, but we do get everything we need. I don't know how to explain it better than that. It's just there's this pervasive idea, it seems, that under universal health care some soulless entity is deciding your fate. It's just not the case.

For example, you know some of my medical history. In addition to that, I have a problem in my stomach called hyperacidity - basically my tummy makes too much acid and it makes me sick. So my doctor prescribed a medication and referred me to a specialist - in this case a GI doctor who is going to put a camera down there and see what's going on. My doctor thinks that stress is causing my problem, but she wants to make sure I'm not growing an ulcer - as I'm 30, that would be pretty uncool. This treatment was decided on with my doctor and me talking about the options. I will then talk to the specialist (I had to wait about 6 weeks to get in) about further options he or she can suggest once they've seen my insides. The standard of care here is no different that it would be in the US - I think it's probably better in some cases, based on what I've heard about HMOs etc. I've done research on my particular condition, and there is nothing else much to be done, besides what my doctor has recommended.

I'm sorry if I seem to take it personally. It's just hard because the attacks on "socialized medicine" seem directed at us more than, say, Europe, and it's so frustrating to have people define a system they've never used. I just want you to know what it's really like to live with universal health care. For more on this, check this Facebook group out:

http://www.facebook.com/inbox/readmessage.php?t=1075788905103&f=1&e=0#
/group.php?gid=121164321440


In terms of escalating costs, yes, it's a factor. I confess I'm not sure about the inflation issue, but our difficulties with rising health care costs are mostly about an aging population. Boomers are getting older and they're a huge cohort, so there's a lot of worry about how we'll handle that many elderly people at once.

I recognize that there is a huge difference between the US and Canada re: market forces and private/government control. In Canada, doctors make good money in most cases, but it's not a job you go into if you want to make it rich. And we do lose docs to the US because the Canadian system can be restrictive and doctors get frustrated. Like I said, it's not a perfect system. And it may be that the US would do better with something more like a European system (the UK comes to mind). I just think you have to recognize that in certain circumstances, the private sector isn't the best bet. Frankly it sickens me that companies make huge profits off sick people. Health care for profit is just so craven. And to me (and most Canadians) health care is a right, not a privilege. The ironic thing is that folks who can afford to pay for medical care are less likely to need it - being poor makes you sick.

I'm happy to be the token Canadian on this thread :) And thanks for the welcome. I'm trying to be less of a lurker and get more engaged with my fellow Browncoats.

People before profits

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 1:29 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

Originally posted by AnthonyT:

Hello,

My sincerest apologies to fellowizing a female. :-(

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner




Hey, if she's here as a Browncoat, she's already one of the guys, so to speak.

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 1:32 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


Quote:

It's just there's this pervasive idea, it seems, that under universal health care some soulless entity is deciding your fate. It's just not the case.


And in truth, that IS the case when it comes to for-profit insurance-industry-run health care!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 1:57 PM

NCBROWNCOAT


I rarely come to the RW boards but here I am. I just had to weigh in on this debate with my idea.

Have a "national basic health insurance plan" that all inaurance companies have to offer to all, no exclusions for pre-existing illnesses etc. and let them compete on the basis of price.

Just like auto insurance, it would be cheaper to have an higher personal deductible (or co pays) but you would have to prove that you could pay it.

It has to be divorced completely from your work place (my pet health care peeve) and you would buy it like you do auto or homeowners insurance but you would get a predetermined tax deduction.

The same basic health care would be offered to Medicare and Medicade receipients (supplements would be available for Medicare patients like there is today).

This insurance would also be available not only from insurance companies but coops and multi state groups etc thus providing competition to traditional health insurers.

For those not enrolled in the "national basic plan", Medicare or Medicade, enrollment in catastrophic insurance (with a very high deductible) is mandatory with health savings accounts available (like those available today).

I came to this combination of public and private insurance after wangling with the militiary's Tricare (the military's family insurance plan) and private insurance over care for my daughter who has a chronic mental problem (Aspargar's Syndrome-high functioning autism) and my own recent experience with wonderful care for possible cancer under private insurance.

I have to say that the thing that spotted my possible cancer were regular yearly exams. As soon as something suspicious was spotted I was scheduled for a second look in a few days.

When that was inconclusive, I was scheduled for a biopsy within a week. Fortunately, I found out it was benign within two day after the biopsy but I'll be followed closely for the rest of my life.

But now it's a black mark against me if I ever try to get insurance on my own away from an employer. And my daughter may never be able to get private insurance under our current system

That's why I like this combo plan.

Ok, now hack away at it! I can take anything now after what I've been through in the past month.


http://fireflyfaninnc.livejournal.com/








NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 2:06 PM

SIGNYM

I believe in solving problems, not sharing them.


Quote:

But now it's a black mark against me if I ever try to get insurance on my own away from an employer. And my daughter may never be able to get private insurance under our current system
I have a duaghter with similar issues. Same problem with insurance. I HAVE to apply for SSI for her because she needs the INSURANCE. If I were assured that "no-exclusion" insurance would be available, I'd drop the SSI in a heartbeat.

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 2:59 PM

KWICKO

"We'll know our disinformation program is complete when everything the American public believes is false." -- William Casey, Reagan's presidential campaign manager & CIA Director (from first staff meeting in 1981)


NCBC, you SHOULD post here more often.


I'd love to hack away and rip your plan to shreds, but on first blush it doesn't look like a bad idea at all. Kinda what many of us have been calling for for years now - a "safety net" kind of program that covers EVERYBODY, and "option up" programs that you can buy into if you want more, up to and including so-called "Cadillac programs".

It doesn't cut anybody off at the top - it simply extends some level of healthcare downward to the bottom. You don't HAVE TO carry anything more, but you are free to upgrade as much as you want, if you can pay for it. And if you have a "pre-existing condition", you're still going to get some level of coverage, rather than the current practice, which tends to involve rescission (dumping you from your current coverage for no valid reason), and then leaves you out in the cold with what is - NOW THAT YOU'VE BEEN DUMPED BY YOUR PREVIOUS CARRIER - a "pre-existing condition".

Mike

Sweeping generalizations are always wrong!

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 3:29 PM

NCBROWNCOAT


Quote:

Originally posted by SignyM:
Quote:

But now it's a black mark against me if I ever try to get insurance on my own away from an employer. And my daughter may never be able to get private insurance under our current system
I have a duaghter with similar issues. Same problem with insurance. I HAVE to apply for SSI for her because she needs the INSURANCE. If I were assured that "no-exclusion" insurance would be available, I'd drop the SSI in a heartbeat.



That's what I'm afraid of for my daughter once she ages out of my family plan (that consists of me and my daughter but we pay the same rates as a family of different sizes from 2-infinity, so I'm subsidizing those employees with larger families).

She's 20 now and the insurance carrier recently extended "student" coverage to age 25. I don't know what I'm going to do when that happens as her current (and excellent)team of counselors and psychiatrists doesn't take Medicade or any other type of "government" insurance.

Also as part of my plan it would encourage medical students to become primary physicians like internal medicine, pediatricians etc with large breaks on med school tuition. And malpractice reform also.

I'd also encourage people to use "physician extenders" like Nurse Practioners and Physician Assistants for basic care. Most practices in my area include one or more in their practice for "grunt" medical work like routine physicals, routine checkups, minor illnesses and prescribing routine meds.

My basic health care provider is an excellent FNP. She was the one that wouldn't let me out of the office at my annual physical without making me sit me down with the scheduling clerk for my routine annual mammogram at the local radiology practice. If I didn't obey her she had 1 family physician and 2 board certified gynecologists to sic on me if I didn't do it LOL.

She's also the one that personally called me early on the morning that she got the results to tell me that the biopsy was negative.

Also, when I broke an arm about 7 years ago, it was the Orthopedic Physician Assistant that saw me in the ER. After looking at the X-rays and talking with the Ortho doc by phone she set my arm so that I could go home that evening with possible surgery the next day after an office consult. The next day the Ortho doc decided that I didn't need surgery because the PA had set the bone so well. They both monitored my arm and I avoided surgery all together. I did have 6 physicial therapy treatments after the cast was removed but in all it cost much less than the potential surgery.

An Ortho PA also did all the preliminary work ups in the hospital on my Mom when she fell and broke her hip two years ago.





http://fireflyfaninnc.livejournal.com/








NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 3:44 PM

RUE

I have a vote and I'm not afraid to use it!


What I'm seeing here is a debate between people who have adequate health insurance or are young and healty --- and people who have run headfirst into the brickwall of our privately run medical 'care'.

I would hope that the comfy people expand their thinking a little to take into account those who are pressed by necessity.

***************************************************************

Silence is consent.

NOTIFY: N   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 4:14 PM

SERGEANTX


Quote:

Originally posted by rue:
I would hope that the comfy people expand their thinking a little to take into account those who are pressed by necessity.



I'm not saying I've had it worse, or even as bad, as others here. I've probably been pretty lucky, all in all. But I'm far from comfy. I have no savings, no retirement and I've been only partially employed now for six months. I have five figures worth of medical debt from when I was raising my sons. (the irony there is that most of it was accrued when I was insured, due to the insurance cos. fucked up shell games). Personally, I'd likely benefit a great deal from full-blown socialized medicine.

It seems the common assumption of liberals that people who object to their plans are stingy and/or privileged people with narrow self-interested concerns. I've most often found that to be untrue. People like that exist, of course, but in my experience, they're that not interested in arguing politics on matters of principle. I'd wager that most conservatives here, even people like Auraptor, aren't the kind of people you seem to imagine. They just have different values, and different assumptions about how things work than you do.

SergeantX

"It's a cold and it's a broken hallelujah"

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 4:15 PM

NCBROWNCOAT


Quote:

Originally posted by Kwicko:
NCBC, you SHOULD post here more often.



You guys should know that I'm a very rare animal (at least according to both political parties).

I'm fiscally conservative, socially just left of center (I was born in 1960 so officially I was brought up thinking about a person's character and not skin color or sexual orientation-what any one does in PRIVATE is their concern as long as it is between mutually consenting ADULTS), disgusted with BOTH political parties enough to officially be registered Unaffiliated (what NC calls us indys-note the little i) And I vote both sides of the ticket. Last year Republican for President and Senator. Democratic for my local Congressional Representative.

But then again, I may just be the majority.

http://fireflyfaninnc.livejournal.com/








NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Friday, August 7, 2009 4:19 PM

ANTHONYT

Freedom is Important because People are Important


Hello Rue,

As someone with a dead thyroid, no native testosterone production, and hypertension- someone who gets health care from CIGNA through my employer, one would imagine that while young, I am not healthy. One might further imagine that since I have a 20 dollar copay per office visit, and since I must visit the office every month in order to monitor my conditions, a public health care option is theoretically likely to benefit me. After all, I'm currently paying about a thousand dollars per year for some very basic health coverage, and that figure is only accurate if I never actually get sick or visit the doctor.

My wife, with a host of her own medical problems, has the identical plan. And she pays nearly identical amounts for it.

So, we ought to stand to save a lot of money if universal health care gets implemented. Not only that, but initial service levels are unlikely to decline. After all, it's CIGNA. They aren't exactly beacons of customer service or healthfulness. They are more like a minimum guarantee.

However, this seems to me both a short term view and a selfish view.

1) While my situation may improve immediately, I am not entirely sure that the initial improvements will not be squandered over time, and even reversed.

2) I do not think it is my right, as a less-affluent person, to go around robbing more affluent people to pay for my medical conditions. I do not feel this way now that I am in the lower-middle class, and I did not feel this way when I was in the lower-lower class. I do not think it is my right to demand to be taken care of by others just because it benefits me to make such a demand.

Charity at gunpoint isn't charity at all. It's bloody robbery. Even as a child, I was able to grasp the concept that while Robin Hood was fun to watch on television and in movies, robbing the rich was still a crime, no matter how 'comfy' they were.

So, to reiterate-

Will I benefit from universal health care? Almost certainly, at least in the beginning.
Will I cost the system more than I put in? Almost certainly, at least in the beginning.
Will I be picking the pockets of my neighbors to sustain myself? Almost certainly, for the rest of my life.

But I'm still not sanguine about doing so. The whole concept rubs me the wrong way. And not because I'm young and healthy and 'comfy' either. I'm two paychecks away from insolvency, like most people.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Saturday, August 8, 2009 6:08 AM

SERGEANTX


Quote:

Originally posted by ncbrowncoat:
I rarely come to the RW boards but here I am. I just had to weigh in on this debate with my idea....



Whoa, hold on there....

This topic is dedicated to honoring and lavishing praise on MY Totally Awesome Health Care Reform Plan. You go get your own damn thread!!!

Ok... I'm kidding. I guess I can share.

Your plan looks pretty reasonable. I definitely like the idea of decoupling health insurance from employment. Your's has the added feature of politically viability - ie the vested interests of health care might allow it to happen - which mine clearly does not.

I can't get behind mandated insurance of any form, but since congress seems hell bent on cramming that down our throats, we should at least be allowed to go with a low-cost, catastrophic policy like you mentioned.

The only major thing lacking would be some serious mechanism to combat health care inflation, which was the primary focus of my musings.

SergeantX

"It's a cold and it's a broken hallelujah"

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Saturday, August 8, 2009 12:46 PM

PIZMOBEACH

... fully loaded, safety off...


Quote:

Originally posted by SergeantX:

I can't get behind mandated insurance of any form, but since congress seems hell bent on cramming that down our throats, we should at least be allowed to go with a low-cost, catastrophic policy like you mentioned.



S-X - I believe you may be misreading Congress just a tad (or I could be), in that "mandated" means more like: if there is a public option and you don't opt out of it for something pricier, you need to at least ENROLL, not that congress will be knocking on your door with their hands out.

I think it’s a HUGE mistake to keep ANY financial incentives in this new form of health care, for either side. It is one of the major reasons why what we have is effed up. Seriously, don’t we all realize that money incentives always trump good intentions? Do we have to keep learning that?

A. Insurance company's negotiate and haggle with Dr.s for each service provided to maximize their profits above what you and I pay for the same coverage. There's a stupid amount of time spent between provider and insurer arguing over whether that splint was necessary, that x-ray was necessary. It is anathema to HEALTH CARE. It’s there because of money and profit concerns. Goodbye profit concerns, hello enlightenment.

B. Flip side, patient says: “I got a pain in my what’s-it, but I'm sure as hell not going to go to the Dr. just yet - it will cost me MONEY, and I'd rather keep it for xyz. If it gets real bad I'll just go over to the ER (eff the cost, it's America!).” And we pay for ER costs or other costs by missing out on early diagnosis.

And no deductibles, no caveats, no preconditions, no “if you don’t smoke and eat kale” rebates. Just, if you need care you get care, and then go back to your life.

Great News! When the sample group is 300,000,000+, the numbers make us virtually all the same, those huge numbers can even-out the most extreme cases with those that use the system very little. For every one of you who have what you think is an extreme health situation there are (tens of) thousands with the opposite situation, and that balances every thing out. When the sample group is this large it is beyond personal - AnthonyT, it’s noble to be concerned about how you may impact the system in a negative way, but statistically, in terms of how you might influence things, you are inconsequential - statistically thousands of times over - sorry! :)

It really is like Vegas - in that statistically the house always wins. NO MATTER WHAT. Doesn't matter about your hot streak. Personally, you may win occasionally and even win big, but the casino doesn’t care *personally,* there are so many players coming through the doors (and losing) that statistically they will always come out ahead. The more you play the more you play into the odds - same with health care. The bigger the pool the more the extreme cases are reduced to an average. My current insurer does not differentiate between myself and a smoker because they say, the pool is so big. That’s only one insurer - no doubt that a national insurer will enjoy even better odds.


Scifi movie music + Firefly dialogue clips, 24 hours a day - http://www.scifiradio.com Now available on your iPhone


NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Saturday, August 8, 2009 2:25 PM

RUE

I have a vote and I'm not afraid to use it!


AnthonyT

The difference between you and about 40% of USers at some point during any year is that YOU HAVE HEALTH INSURANCE.

Think of you and your wife with your collection of health conditions AND NO HEALTH INSURANCE. How long would you last, financially ? How long would you last, medically ?

That is what our lovely for-profit private system had created. Is that what you wish to see continue ?

I can't help but think that when you hear something about public health care you reflexively think Cuba. Perhaps you should visit Canada and get to know some Canadians\ Canadiens to get a better perspective. Eh ?


***************************************************************

Silence is consent.

NOTIFY: N   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Sunday, August 9, 2009 5:45 AM

SIGNYM

I believe in solving problems, not sharing them.


Anthony-
Quote:

I do not think it is my right, as a less-affluent person, to go around robbing more affluent people to pay for my medical conditions. I do not feel this way now that I am in the lower-middle class, and I did not feel this way when I was in the lower-lower class. I do not think it is my right to demand to be taken care of by others just because it benefits me to make such a demand.
I think you got it bass-akwards, Tony. If Somali pirates were holding a ship full of medical supplies destined for our shores, you'd go take it back, wouldn't you?

The poor aren't robbing the rich folks. It's the other way around.

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Sunday, August 9, 2009 7:18 AM

ANTHONYT

Freedom is Important because People are Important


Hello,

Signy, you are lost in the morass between metaphor and reality.

Show me how the rich are, in reality, robbing the poor. And not metaphorically.

--Anthony



"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Sunday, August 9, 2009 7:26 AM

SIGNYM

I believe in solving problems, not sharing them.


Profit.
Usurious interest rates.
Copyrights and patents.

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Sunday, August 9, 2009 7:33 AM

ANTHONYT

Freedom is Important because People are Important


Hello,

Profit isn't robbery, Signy. Thank God.

I sell my product for profit 5 days a week.

My product is my ability to do a type of work, my profit is my paycheck. (Though one may wish to deduct expenses like medical, food, and lodging which are required to maintain my product.)

Are you suggesting that when I profit from my labor, I am robbing someone?

--Anthony




"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

Sunday, August 9, 2009 7:35 AM

ANTHONYT

Freedom is Important because People are Important


Hello,

I see you added interest rates and Copyrights and Patents.

Interest Rates are mutually agreed upon terms for borrowing money. If only one party agrees to the deal, nothing happens. So, no robbery.

Copyrights and Patents are valuable to me. I hope that someday I will write something worthy of sale, and that no one will copy that something and sell it as their own, depriving me of income.

If I was an inventor, I'd feel the same way about patents.

--Anthony

"Liberty must not be purchased at the cost of Humanity." --Captain Robert Henner

NOTIFY: Y   |  REPLY  |  REPLY WITH QUOTE  |  TOP  |  HOME  

YOUR OPTIONS

NEW POSTS TODAY

USERPOST DATE

OTHER TOPICS

DISCUSSIONS
Elections; 2024
Fri, March 29, 2024 06:56 - 2076 posts
Russia Invades Ukraine. Again
Fri, March 29, 2024 06:20 - 6156 posts
Russia says 60 dead, 145 injured in concert hall raid; Islamic State group claims responsibility
Fri, March 29, 2024 06:18 - 57 posts
In the garden, and RAIN!!! (2)
Fri, March 29, 2024 02:54 - 3414 posts
BUILD BACK BETTER!
Fri, March 29, 2024 02:49 - 11 posts
Long List of Celebrities that are Still Here
Fri, March 29, 2024 00:00 - 1 posts
China
Thu, March 28, 2024 22:10 - 447 posts
Biden
Thu, March 28, 2024 22:03 - 853 posts
Well... He was no longer useful to the DNC or the Ukraine Money Laundering Scheme... So justice was served
Thu, March 28, 2024 12:44 - 1 posts
Salon: NBC's Ronna blunder: A failed attempt to appeal to MAGA voters — except they hate her too
Thu, March 28, 2024 07:04 - 1 posts
Russian losses in Ukraine
Wed, March 27, 2024 23:21 - 987 posts
human actions, global climate change, global human solutions
Wed, March 27, 2024 15:03 - 824 posts

FFF.NET SOCIAL