The U.S. Health Care Debate

[ICantSpellDawg]

Am I missing the other thread on this? Where is it?

Anyway, healthcare is a big and intimidating question in the U.S. Many on the left would like to see a single payer plan, many from the center left would like a hybrid system that will eventually turn into a single payer plan (maybe with private suplementals)

The right is confused, and rightfully so. We are tasked with coming up with a plan that is new and will be hard to sell. What is very important is that we first find out what the main prolems are:

A. Exponentially rising cost.
This is the most important aspect of the discussion. Cost of premium is a real concern for most Americans, but that is due to the cost of care in the first place. One reason that cost is so radically out of control is a lack of transparency. co-payments, while used as a tool to give the insured an incentive have become relatively meaningless in relation to cost. As an example; I could visit doctor A and pay $20 or I could visit doctor B and pay $20. Actual cost to the insurer would msot liekly be very different - both doctors may have the same level of proficiency, but one costs much more than the other. As it stands today, there is no real way of knowing as the insured and no real reason to care in the short term. In the long term, this ignorance of cost leads directly to higher premiums. A way needs to be developed to adequately give an incentive to the insured to go with the value and what works - but they need to be ably to quantify it and feel the benefit and consequence of wasteful medical spending.

Another problem with rising costs is that, contrary to assumption, insurance companies prefer higher medical costs. the higher the cost, the higher the premium and the larger the percentage of your income they can expect, giving rise to company growth and investment. Even if they are payign more, thsi is offset by the amount that they will charge in the long run. I'd rather make 8% of 100 than 12% of 10.


I've got quite a bit more I wrote a whole list I-VII at home, but I'm at work now, so I'll try to post more her when I get home. I focus on insured pools, adverse selection, current working plans etc.

[ICantSpellDawg]

Anyway, I watched a bit of the Obama show last night and was not impressed. He really isn't that great at explaining detailed plans. Most of it seemed to be "why not?"

[Lemur]

Was his telethon last night? Missed it. Does anybody know if an actual proposal has been put forward?

[Husar]

We have a commission here that tests medications for their effectiveness, weighs that up against the price etc. and then decides which the ensurance companies have to pay for, if a new medication has essentially the same effect as an old one wrapped into a new package with a higher price tag, then they will decide the insurance companies only have to pay for the old one etc.
Of course this system is criticized as well but it might help keeping the premiums down, here you usually get the impression that insurances would rather not pay at all anyway.

[Lemur]

I'm just guessing from your response, but you haven't had much contact with Health Insurance companies, have you, Gelatinous Cube? 'Cause you're glossing over a whole lot if you have.

[rory_20_uk]

Mmm.. healthcare debate. I've always sympathized more with Democrats than Republicans on most issues, but the whole universal healthcare thing...

I believe tax breaks or some other form of subsidizing cheap Health Insurance is the way to go. The Canadian or British model is not. Doctors go to school for 12 years to do the very difficult and specialized job that they do. They deserve the pay--on top of that, the pay is necessary to keep incentive for people to keep wanting to be doctors. Health Insurance is the easy out. You pay less to go to the doctor, the doctor still gets his giant paycheck.

In the UK doctors take 6 years to qualify. Where do your lot waste the other 6 years?
The pay incentive is there to help in part cover the vast bills that doctors have after over a decade in training; the pay is also more than in most european countries. These are not struggling to get doctors.
If the UK / Canadian way isn't to your liking - and it ain't perfect - then look at Switzerland: Americans pay 17% GDP, Swiss yet 12% their outcomes are better than America's.

[KukriKhan]

I'm just guessing from your response, but you haven't had much contact with Health Insurance companies, have you, Gelatinous Cube? 'Cause you're glossing over a whole lot if you have.

Well, he's a young man in an organization that provides the largest socialized medical care in the world. So, the whole thing is likely kinda theoretical for him.

In the end, this issue is not even about health care at all, right? Rather, the issue is "insurance".

[Philippus Flavius Homovallumus]

I'm a firm believer that Medical Care is one of the "big three" along with Law Enforcement, and Fire & Rescue. It should be free at the point of use. That could either mean that A: it comes direct from your taxes, or B: everybody pays for state health insurrance that does not go up if you use it and is affordably low to begin with.

After all, you wouldn't expect to have to pay the fireman to put our house out or save your child, you shouldn't have to pay a state Doctor for his services, either.

[rory_20_uk]

I'm a firm believer that Medical Care is one of the "big three" along with Law Enforcement, and Fire & Rescue. It should be free at the point of use. That could either mean that A: it comes direct from your taxes, or B: everybody pays for state health insurrance that does not go up if you use it and is affordably low to begin with.

After all, you wouldn't expect to have to pay the fireman to put our house out or save your child, you shouldn't have to pay a state Doctor for his services, either.

If you're storing petrol in open containers and go around the house smoking I do think you should pay for cleaning up the resulting explosion.

Similarly with healthcare. There are some risks we can't alter in our lives for certain diseases be it gender, ethnicity or other underlying genetic problem, but the vast majority we can, be it the drunk morons that come in on Friday night to the 45 year old drinker / smoker / no exercise / high fat diet for the last 30 years who'se finally had his overdue heart attack.

There are several ways of doing this. A tax on alcohol / tobacco that is ring-fenced for the healthcare, these people should pay more insurance - in the same way that if I drive a Ford Fiesta I'll pay significantly less insurance than if I choose to drive a Nissan GTR - and / or a charge for attending A&E. £5 or £10 still means about a 90% subsidy by the state assuming no treatment is required, but at least this discourages the true timewasters. If you've had an MI then £10 for over £1,000 treatment is still the bargain of the century.

[LittleGrizzly]

There are several ways of doing this.

I don't completely disagree with your first suggestion, I don't think we should charge at the medical end of the scale but when they actually buy the product. So alcohol and cigerettes for example should have tax on them at the point of purchase. I don't think alcohol does but considering ive heard figures of around 75% of the price of a pack of cigerettes is tax i think cigerettes more than make up for thier bruden on the health service (the fact that that money doesn't go to the health service is the goverments fault) Alcohol in comparison seems quite cheap, junk food also, is dirt cheap for the harm it causes long term.

[Evil_Maniac From Mars]

I'm a firm believer that Medical Care is one of the "big three" along with Law Enforcement, and Fire & Rescue. It should be free at the point of use. That could either mean that A: it comes direct from your taxes, or B: everybody pays for state health insurrance that does not go up if you use it and is affordably low to begin with.

After all, you wouldn't expect to have to pay the fireman to put our house out or save your child, you shouldn't have to pay a state Doctor for his services, either.

You may not have to pay the fireman to put out the fire in your house, but you or your insurance company will have to pay for the damages to the house.

[Crazed Rabbit]

Safeway, the US company, has had success in keeping insurance payments for their employees steady - as in not increasing while the rest of the nation does. They've done that by providing incentives, ie lower insurance prices, for healthier employees. The result is healthier employees and non-increasing costs. But they are still limited in the size of incentives they can provide to healthy employees.

In Texas they had success in putting a lid on malpractice payoffs.

Of course, Obama wants to go with neither of these two proven methods.

We should allow insurance companies/employers to charge unhealthy employees the full amount more that it costs to insure them (ie charge a smoker $1400 more per year instead of being limited to charging only $300 more per year compared to a non-smoker [approximated costs, of course]), and pass a federal law putting a lid on malpractice payoffs.

CR

[Seamus Fermanagh]

...I'm in the Military, and currently dealing with a very serious injury to my foot--the treatments and surgeries for which are entirely free to me.....

You paid your taxes, just as did the rest of us, and that's what paid for your "free" healthcare. The contract is simple: you agree to risk getting your *** shot off to protect mine and my neighbor's, and we agree to pay for your healthcare. No gripes here about that.

But NOTHING IS EVER FREE. TANSTAAFL is a universal norm.

[KukriKhan]

Even though I'm a smoker, I agree with this.

I'm on-board too. I'm convinced that my vices (cigarettes, beer) will probably statistically not only shorten my life, but also make end-of-life measures more expensive. I'll pay for that, for the privilege of indulging my bad habits.

But again, we're not talking about health care here, we're talking about insurance, and betting with or against "the odds", and putting down the appropriate ante into the insurance "pot".

-edit-
I have a (:crosses fingers:) stellar driving record: no accidents or citations in 44 years and 2.5 million miles driven. Yet I know that I will pay more to GEICO to insure a fire engine red convertible Corvette, than I will for a beige tudor ford escort. The Corvette will cost more to replace, and it's a both citation- and accident-magnet.

[Proletariat]

I'm on-board too. I'm convinced that my vices (cigarettes, beer) will probably statistically not only shorten my life, but also make end-of-life measures more expensive. I'll pay for that, for the privilege of indulging my bad habits.

They don't, tho. The 'smokers should pay' garbage is just a guilt trip. If you get lung cancer and die of it, you'll spend 6 months in a hospital dieing on pain meds around age 70. If you live to 98 with full blown Alzheimer's you'll need round the clock care, often costing as much as 7-8k a month until you finally pass. Plus, you paid more into the healthcare kitty with all your sin tax contributions from buying your cigarettes (I know you get your's from the Ukraine, but you get the idea).

Whether it's more expensive or not, it shouldn't matter. Should homosexual men pay more for insurance since their lifestyle puts them at higher risk for disease? Should blacks pay more for their higher incident rates for heart conditions? How about the obese? You eat more than two cheeseburgers a week and you better pay, fatty. What about scuba divers and their burden on emergency care?



Make it honestly universal or don't bother at all, sez I.

[Beskar]

I like how Gelantinous Cube pretty much has the free universal healthcare option because he is in the army, but is against it. In America, isn't it 60% cannot afford Health Insurance? I remember seeing Americans get chemo-treatment then stay in tents outside the hospital as they couldn't afford to have a bed on the inside due to the costs.

Basic and Essential Healthcare should be free as a human right. However, if you want cosmetics or anything like that, you pay for it. (outside grievous injury and other things)

[Crazed Rabbit]

They don't, tho. The 'smokers should pay' garbage is just a guilt trip. If you get lung cancer and die of it, you'll spend 6 months in a hospital dieing on pain meds around age 70. If you live to 98 with full blown Alzheimer's you'll need round the clock care, often costing as much as 7-8k a month until you finally pass. Plus, you paid more into the healthcare kitty with all your sin tax contributions from buying your cigarettes (I know you get your's from the Ukraine, but you get the idea).

Whether it's more expensive or not, it shouldn't matter. Should homosexual men pay more for insurance since their lifestyle puts them at higher risk for disease? Should blacks pay more for their higher incident rates for heart conditions? How about the obese? You eat more than two cheeseburgers a week and you better pay, fatty. What about scuba divers and their burden on emergency care?



Make it honestly universal or don't bother at all, sez I.

The opinion essay about the Safeway insurance said that it cost the company $1400 more per year to insure a smoker. I can't speak for whatever method they used to come up with that number. They also did do health check-ups on employees, so obese people did pay more.

In America, isn't it 60% cannot afford Health Insurance?

No. Much, much less.

I like how Gelantinous Cube pretty much has the free universal healthcare option because he is in the army

No, he doesn't. He earned that healthcare and it was not free.

Basic and Essential Healthcare should be free as a human right.

Why should it be a right for a sick person to take money from others to get care for themselves?

CR

[LittleGrizzly]

Why should it be a right for a sick person to take money from others to get care for themselves?

Because whereas some animals leave thier sick to look after themselves we like to think we are above that.

[Louis VI the Fat]

It remains one of the world's great mysteries - how come Americans pay fifty to 100 percent more for healthcare than the rest of the developed world, but have results that are not, shall we say, stellar.
And healtcare and rising costs aren't very rosy in Europe, Canada and Japan to begin with.


To throw in a thought - would you pay 10% of your annual income, for your entire life, to add eightteen months to your life spend in ill health at the age of 81? Cause basically, that is what we are doing.


Prole - I take it you naughty girl still haven't given up smoking?

Neither have I. One day, one day...

[KukriKhan]

It remains one of the world's great mysteries - how come Americans pay fifty to 100 percent more for healthcare than the rest of the developed world, but have results that are not, shall we say, stellar.
And healtcare and rising costs aren't very rosy in Europe, Canada and Japan to begin with.


To throw in a thought - would you pay 10% of your annual income, for your entire life, to add eightteen months to your life spend in ill health at the age of 81? Cause basically, that is what we are doing.


Prole - I take it you naughty girl still haven't given up smoking?

Neither have I. One day, one day...

Not me, man. I don't demand much of myself, but I do insist on honesty when I'm talking to myself. And the truth is: I will continue with the smokes until it hurts too much. So far, it doesn't. I offer supportive words of admiration to anyone who quits smoking, but I know, deep down inside, that I never will. Except when I also quit breathing, of course.

(I know you get your's from the Ukraine, but you get the idea).

Heh. You should see the huge black-bordered warning they put on their packs. I assume it says something like: "This chit gon' kill you, Comrade."

So yeah, I'll pay for the privilege of being left to my own neferious devices.

[Lemur]

Uhm, unless you have a terrible doctor, the results are hardly less than stellar.

I think Louis is referring to common indexes of a nation's health; infant mortality, life expectancy, etc. On most measures we don't do well. Last I heard we were 36th in results and number on with a bullet in costs. I'll let a more statistically-inclined Orgah hunt down the numbers. Like Barbie says, "Math is hard."

Universal healthcare can't work for America, but examples of nearly universally affordable health insurance have occured in the past, and can occur again.

I don't understand why universal or "single-payer" healthcare simply can't work in the U.S.A. I'm not saying it's the best solution, or arguing that we should adopt it, but to flatly state that it cannot work here is interesting, and requires elaboration on your part. Every other major industrialized nation has some sort of universal healthcare. Japan, Germany, Taiwan, France, Sweden, Finland, France, South Korea, Australia, Britain, Netherlands ... the list goes on. And let's not forget the Canucks.

If just about every first-world nation can make it work, why is it flatly impossible here? I'd like to hear your reasoning.

[Crazed Rabbit]

Well, for one, a public plan would likely be able to drive drug costs down, as other nations have. But the US currently pays for most of drug R&D through higher drug prices in our country. So if the public plan was successful at lowering drug costs, we'd destroy a lot of the R&D budgets for drug companies. The other nations that have public entities negotiating low drug prices get away with it because us Americans are currently picking up the tab.

I'd love for someway to force all those free-loaders to pay higher prices, so we in the US could pay lower prices.

As for not working; even the recent democratic plan would leave some 30 millions or so uninsured. Over half of the amount of people who are not insured right now.

CR

[Alexander the Pretty Good]

America has decided two things. One, that we don't want capitalism any more. Two, that we have infinite money.

Lets live it up. Bring it on. Free healthcare and insurance and prescriptions for everyone.

[Beskar]

If I remember right, Canada has the best healthcare in the world and I think Cuba is second. (This is on average per citizen)

Anyway, America can remove money from its over inflated defence budget to fund it easy. It's sad you rather pay more money in killing people than saving lives.

[Evil_Maniac From Mars]

If I remember right, Canada has the best healthcare in the world

and I think Cuba is second.

[Alexander the Pretty Good]

If I remember right, Canada has the best healthcare in the world and I think Cuba is second. (This is on average per citizen)

Anyway, America can remove money from its over inflated defence budget to fund it easy. It's sad you rather pay more money in killing people than saving lives.

If I'm reading the budget summary right we spent about $600B on the DoD and about $1T on Social Security + Medicare + Medicaid in 2008. I'm far from sure that I read it right, but we're already paying more in welfare programs than in killing people. Course, I'd like to drastically cut the killing people part, but when you have infinite money, who freakin' cares...

[Crazed Rabbit]

If I remember right, Canada has the best healthcare in the world and I think Cuba is second. (This is on average per citizen)

Really? In Canada, people die on waiting lists. Some pay thousands of their own money so they can travel to the US and buy treatment because they don't want to wait for years.

Cuba - maybe you should consider the possibility that such claims are propaganda.

CR

[Banquo's Ghost]

Well, for one, a public plan would likely be able to drive drug costs down, as other nations have. But the US currently pays for most of drug R&D through higher drug prices in our country. So if the public plan was successful at lowering drug costs, we'd destroy a lot of the R&D budgets for drug companies. The other nations that have public entities negotiating low drug prices get away with it because us Americans are currently picking up the tab.

I'd love for someway to force all those free-loaders to pay higher prices, so we in the US could pay lower prices.

I thought you were a free market sort of fellow? Maybe a different system would force drug companies to reduce their current extortionate prices? For example, the British system of NICE (a quango that assesses treatments for the NHS on grounds of cost-benefit) has often rejected a drug for use in the health service because its cost per quality life year is too high - and amazingly - assuming their subsequent "moral" crusade in the papers fails - the drug company concerned often drops its price or comes to a deal.

I think there is great scope for reducing drug costs and therefore medical costs across the globe. Not least because nations fund vast universities which could be doing a great deal of public research for the benefit of many.

I am intrigued to understand more about the US system because of Lemur's thread in The Other Place. As far as I know, our resident prosimian is a intelligent middle class professional. A couple of weeks ago, he tried amateur surgery during which his fingers came off worst. Despite the severe risk of tetanus, infection etc, he could not face the potential cost of having a quick check up and asked for advice on this forum. IIRC, he cited the fact that to claim on his insurance would cost him a great deal of time and hassle, if it was paid at all. Moreover, he noted that it was not possible to change the insurance company to a more supportive one.

The issue about people being uninsured under the system is certainly one concern. But if people who are insured feel so constrained by its workings that they won't even get a simple check up, there is a whole other problem.

Is it actually true that it is difficult/impossible to change one's insurer? How then does the market drive efficiency through choice? Is it true that check-ups like the example above are fraught with concerns and possible costs so that preventative examinations are foregone - thus increasing the likelihood of major (and far more costly to the system) interventions later? Is it true that Lemur is too manly and therefore disdained the ministrations of kindliness when lesser mortals would have fled to the doctor weeping like little girls?

I would be interested in the answers to the above to inform my understanding of the debate.

[Philippus Flavius Homovallumus]

I'm inclined to agree. Monday I have to call my GP to tell him one of my friends has Swine 'flu. I will likely get swabbed and then have anti-virals. It's not going to cost, and because I don't work I don't pay National Insurrance right now.

[rory_20_uk]

They don't, tho. The 'smokers should pay' garbage is just a guilt trip. If you get lung cancer and die of it, you'll spend 6 months in a hospital dieing on pain meds around age 70. If you live to 98 with full blown Alzheimer's you'll need round the clock care, often costing as much as 7-8k a month until you finally pass. Plus, you paid more into the healthcare kitty with all your sin tax contributions from buying your cigarettes (I know you get your's from the Ukraine, but you get the idea).

Whether it's more expensive or not, it shouldn't matter. Should homosexual men pay more for insurance since their lifestyle puts them at higher risk for disease? Should blacks pay more for their higher incident rates for heart conditions? How about the obese? You eat more than two cheeseburgers a week and you better pay, fatty. What about scuba divers and their burden on emergency care?



Make it honestly universal or don't bother at all, sez I.

Smokers don't just kill themselves. They also help kill others. In this way they are worse than Heroin users who generally just kill themselves.

Blacks aren't renowned for heart disease. That is persons from the Indian subcontinent. This is an unalterable genetic factor.
Obesity is a choice, as is scuba diving. These should pay more.

Well, for one, a public plan would likely be able to drive drug costs down, as other nations have. But the US currently pays for most of drug R&D through higher drug prices in our country. So if the public plan was successful at lowering drug costs, we'd destroy a lot of the R&D budgets for drug companies. The other nations that have public entities negotiating low drug prices get away with it because us Americans are currently picking up the tab.

I'd love for someway to force all those free-loaders to pay higher prices, so we in the US could pay lower prices.
CR

Generic drugs are cheap, and slightly worse. The cycle is that healthcare costs a load. When you get ill, since it's cost a fortune you want the best, not the most cost efficient. One drug is 5% better and twice the cost? Great - bring it on. Treatment was massively expensive, and so is insurance.

Lots of R&D is done in Europe, but all with the eye to the American market.