The U.S. Health Care Debate

Um, Grizz.. who wants Costa Rica? :inquisitive:

Quote:

---

Originally Posted by LittleGrizzly

Yes, it is, and if it isn't immediately, it will be.

Costa Rica seem to have done okay for themselves, and without the expense of an armed forces...

---

Only because everyone knows we, the US, won't let them be invaded.

Quote:

---

Yes, it is. If the military is the only state organization that receive free healthcare, I don't see how you could claim otherwise.

I don't care what's your job, where you'd been fighting and what not. You signed up, for I guess a few reasons. You're doing your job, which involve getting shot at. That's dangerous and brave, but that's what you signed up for.
Having a military is not essential for a nation, it's essential for the US, because of their honestly war-focused foreign policy and their role as a superpower. That doesn't change the fact that a soldier shouldn't have more rights than the average citizen.

---

Preposterous. He is not receiving health care. Nor did he agree to be in the military for free. The military agreed to compensate him for his service - with both a salary and complete health insurance.

CR

Only because everyone knows we, the US, won't let them be invaded.

During the cold war... its a possibility. Since the collapse of the soviet union theres has been no need for that American threat either.. the sanctions they would get from alot of countrys around the world would make invading Costa Rica not worthwile...

The only country (s) where any sanctions wouldn't make a difference as they are already there would not be able to launch an invasion of Costa Rica anyway, besides North Korea has more pressing concerns... any other country would be so battered by sanctions that even if everyone agreed not to take military action against thier invaders the invasion would be extremely counter productive...

Um, Grizz.. who wants Costa Rica?

The same people who want a cold damp rock just off mainland europe (uk) the evil boogey men who will came and get us if we don't have a military...

Quote:

---

Originally Posted by LittleGrizzly

Im not saying never have a military, But tell me what threat should they be worried about requiring the build up of thier military now?

---

Not the most stable of regions, is it?

Quote:

---

If the situation changes in 50 years time sure. As things stand they have saved themsleves 50 years of unnessecary expense, and i see them saving themselves another 50 years of unnesecary expense... all to the benefit of Costa Ricans and the dismay of wargamers and military enthusiasts!

---

It costs a lot to progressively wreck, underfund, or even destroy a military over the course of fifty years and then suddenly be forced to build it back up, as Canada is figuring out right now. When Trudeau and his ilk shattered the military, many people either ignored it or had a similar attitude that you have (oh, we don't really need it now, but if we do in the future...), and now and in the near future they will have to pay the price.

So who pays? It's kind of like my earlier post on the health systems around here. ~;)

:focus: :whip:

~:smoking:

Quote:

---

Originally Posted by rory_20_uk

Whilst I agree with this, sadly there's a massive amount of grey between these two cases. Even with these two there's some variance. And it is the case that State would be free?

For example, although most women have boob jobs to, uh, uplift their self image, there are some who have very unequal breasts and this causes significant psycological distress. Then there's post cancer / trauma or even infection.

And if someone is having recurring flare ups of gall stones, it would over time be cheaper to whip it out once and have a 3 day inpatient stay than have attacks every few months requiring far more state resources.

~:smoking:

---

Essentially if it is elective and not health related (health including psychological as mentioned) then it should be paid by the individual. I would include gall stones within the non-elective state funded side of the equation. If a patient wants there own Dr or single room then that is a user pays (private health) add on.

Bankruptcy, social Darwinism, and the War on the American Middle Class:

Quote:

---

NIGHTMARES OF AMERICAN MEDICAL#CARE

As someone who has lived roughly half my life in the United States and half in Canada, and as an economist by profession, I think I can provide a vivid sketch of American healthcare.

There actually is no system.
There is private health insurance for most middle-class people, and the tradition, not a requirement, is that this is paid by your employer as an employee benefit.
Since there are about 1,500 insurance companies looking for this business, the nature and quality of the policies vary immensely.

For a privileged cut of the population – those working for the government and large corporations and legislators – the benefits are very good, and they get excellent medical care.

As you may imagine, the quality and quantity of the benefits goes down as you move down the prestige scale. For a more typical office worker, there will usually be many limits on the policy. Examples: an annual $1500 deductible; a 15-20% deductible for each procedure; and, in some cases, coverage that is as low as 60% of costs.

This is why health care is the single largest cause of personal bankruptcy in the U.S. Inflation in fees and costs by the health-providing industry means that a single-day as an outpatient with some relatively minor procedure – has a full cost on the order of $7,000 when all the bills are in.

Spoiler Alert, click show to read: 

I say ‘when all the bills are in’ because the patient for weeks after the procedure will receive bills: from each doctor, from the anesthetist, from the hospital, from laboratories, from the ambulance company, etc. There will be items on your bill, on a long computer list, like $150 for the use of a scissors or $10 for some aspirins in a cup.

Under some insurance policies, you pay and are later reimbursed. This can still cause a cash crunch where the bills are high. Under other policies, the bill you receive will be for the residual after separate billing to your insurance.
In any case, if you do not pay the balance fairly promptly, your file will be turned over to a collection agency who will then hound you daily for the money.
There are invariably disagreements with the insurance company over specifics. You usually have an 800-number where you will often wait a long time to talk to call center about the issue. Because of the complexity of the terms of a given policy, you will have to be well-informed even to discuss your point.
On some policies, even pretty decent ones, you are required to call an 800-number before going to the emergency room to get the insurance companies permission for what you are doing. Otherwise, you will pay the emergency-room bill yourself.

But even for pretty good insurances, typically policies have lifetime limits on benefits. If you are struck with something really seriously expensive, you will reach the end of your benefits.
Note the fact that very good to excellent coverage for upper-middle class and government people effectively silences those who would be active in changing the system.

This is a key reason why the healthcare chaos never becomes a burning political issue. It also provides a lever to be used if someone, as the Clintons did, wants to reform things. Upper middle-class people were directly appealed to, being told in a barrage of ads that the excellent level of their care would be reduced, a very effective ploy.

For many of the privately insured however, benefits range from mediocre to terrible. America has more than forty million with no benefits, but a statistic never given, and more important, is the huge number of under-insured.
Note that you can approach some companies to buy your own insurance if your employer provides none. Because you are not part of pool in these circumstances, your fees will be very high. The benefits are also likely to be poor to mediocre.

The industrial sector of the U.S. has badly declined for decades, and with its decline the opportunity for decent, employer-paid insurance for most working people. The growth sector of the economy is services, and these places typically offer poor or no insurance. Of course, many of these are the infamous McJobs.
People in non-union factory or middling office jobs or much of the service industry get benefits so limited that a serious event can throw them into bankruptcy. This is how the policies, where they are available, are priced low enough for such employers to afford.

There are many other disturbing elements in this national healthcare chaos.
For example, your private health records are in the hands of private insurance companies, and this is marketing information in which they trade for profit.
It is possible for your private health-care information to disqualify you from employment somewhere else.
People with better policies hang desperately on to their jobs for fear of losing coverage in middle-age, just when you most need it.
Morality enters American health care, as some private companies will not cover procedures such as abortion.

You may have a policy with which you are quite satisfied, but for some reason, usually cost-cutting, your employer may change insurers suddenly. You will be faced with a whole new set of qualifiers, requirements, 800-numbers, deductibles, and limits. And this can happen a number of times in your career, and it is very unsettling.

Companies deeply concerned about costs will gradually work their way down from excellent policies to mediocre ones. You must adjust accordingly.
There are hundreds off details not possible to cover outside of a major essay. As an example, not many years ago, if you lost your job, you, in most cases, immediately lost your insurance. Too bad if you or your child had chronic needs. Now, there is a time-limited bridging mechanism – for which you must apply, fill out forms, and pay – that allows you to be insured until you secure your new job with new insurance.

The chaos includes often-impoverished county hospital emergency wards for the really poor. These will still try getting some degree of payment out of you according to your means. In general, the care in such places is poor. There is the Veterans’ Administration system for qualified ex-soldiers. There is Medicare for retired Americans, a system whose benefits are completely inadequate to modern needs. If you retire without a supplemental insurance – either paid by your past employer in a good job or by yourself in other cases – you may face serious problems.

There is the Medicaid system for poor Americans. It is an extremely complex system, and the extent and nature of benefits vary considerably from state to state. If you move from one state to another you can lose coverage for the services you were using before. Again, depending on the state, you may be required to make co-payments for services. You really do have to be needy to qualify for benefits, and your means are examined in detail. For some Medicaid services, officials are entitled to recover expenses from a beneficiary’s estate.
Private hospitals in the U.S. – generally the best but not always – are in various jurisdictions required to take a certain quota of non-insured patients. This quota is never generous. The cost of this effectively gets dumped onto the insured, increasing the cost of insurance.

This also leads to some bizarre results. Suppose you are an uninsured person picked up on the street by an ambulance after an accident. The ambulance will be calling ahead to the nearest hospital to see whether they can take another uninsured. If the answer is no, another hospital is called. This continues until there is a taker, however, by that time, you may expire in the ambulance, a not uncommon event.
Imagine the horrors as an uninsured person, whether a citizen or a visitor from abroad, of getting mugged in the United States? First, there is the horror of the mugging or rape or assault, and then the horrors of dealing with the Medical Kremlin.

This brief review gives you a realistic sketch of healthcare in America. If you are young and healthy, you need not be overly concerned. Of course, it is precisely the pool of young and healthy people that insurers love, because their employers pay but the employees don’t use many benefits. That is why institutions like the high-tech industry or huge multi-national corporations have such good policies. They get used comparatively little.

Note the fact that very good to excellent coverage for upper-middle class and government people effectively silences those who would be active in changing the system.

This is a key reason why the healthcare chaos never becomes a burning political issue. It also provides a lever to be used if someone, as the Clintons did, wants to reform things. Upper middle-class people were directly appealed to, being told in a barrage of ads that the excellent level of their care would be reduced, a very effective ploy.


The entire ‘system’ segments the population into many different pools, from low risk with excellent benefits to high risk with terrible benefits. It truly is medical Social Darwinism, organized by lawyers and financiers.

---

link

Do you dislike socialised healthcare? Do you insist on individual freedom? Then don't take your cue from socialist countries like Canada and the UK. There are other options:

Quote:

---

An understanding of how France came to its healthcare system would be instructive in any renewed debate in the United States.

That's because the French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine."

---

link

Hm, great article. If this thing is inevitable for America, than I hope we go with the French style, if anything at all.

Quote:

---

Originally Posted by Louis VI the Fat

Do you dislike socialised healthcare? Do you insist on individual freedom? Then don't take your cue from socialist countries like Canada and the UK. There are other options:link

---

While it gets into very sparse detail, the article makes the system sound promising - especially after they find a way to cut it off from payroll taxes.

Quote:

---

Originally Posted by TuffStuffMcGruff

While it gets into very sparse detail, the article makes the system sound promising

---

The nice people over at the embassy translate lots of stuff for curious Americans.

http://ambafrance-us.org/IMG/pdf_Uni...ustainable.pdf

Not all is rosy, of course. As the questions about sustainability above and the more brief and factual article below show.

Quote:

---

France is often seen by liberals as the ideal system. It has universal health care, with few waiting lists. France has the highest level of satisfaction with their health care among all European countries. How can this be? What is their secret?

France provides a basic, universal health insurances through large occupation-based funds. The General National Health Inusrance Scheme covers 83% of French workers, while other occupational specific (e.g.: for agricultural workers, for the self employed, for miners, etc.) cover the remainder. About 99% of individuals are covered by this universal health insurance system.
However, France utilizes more market-based ideas than most people realized. Copayment rates for most services are 10%-40%. About 92% of French residents have complementary private health insurance.

In essence, the French system avoids widespread rationing because, unlike true single-payer systems, it employs market forces. Even the OECD says that the “proportion of the population with private health insurance” and the degree of cost sharing are key determinants of how severe waiting lists will be.
Insured. About 99% of French residents are covered by the national health insurance scheme.
Cost. France is the third most expensive health care system (~11% of GDP).

---

http://healthcare-economist.com/2008...-world-france/

The thing about waiting lists is that they need to build more hospitals to meet the demand and also that fact everybody can get healthcare treatment, opposed to people simply not getting any treatment as they can't afford it.

Quote:

---

Originally Posted by Louis VI the Fat

Not all is rosy, of course. As the questions about sustainability above and the more brief and factual article below show.

---

The French system is very expensive and probably unaffordable in the long term. Besides, drug prescription and use in France are insanely (and irresponsibly) high. On the plus side, the availability and 'bedside manner' of French doctors are exemplary and chronic diseases like for instance diabetes are fully covered under the system.

Like I said before, health is a common good just like public order or fire prevention. It only works well if it works for everybody. And the key to a good system is socialised funding, not socialised medicine (or state medicine).

We spend a trillion dollars on various programs and have nothing to really show for it. Quite frankly that's retarded.

What we're doing is not working and anyone who can't see that is either and idoit or an imbecile.

How we fix the problem is a whole nother problem entirely but I think we can start with some common sense solutions.

I agree with Adrian; for everyone or no one. One of our problems is all our bloated programs which hamstring everyone and only cater to a few people who fit a mold that is probably outdated.
-

Let's not forget the bureaucratic overhead incurred by all of these organizations trying to shift the costs off onto each other. Can't find the linkie, but I clearly recall reading that something between 7%–10% of all healthcare costs are created by this shuffle.

I know this: Costs are rising geometrically, and neither the nurses, doctors or patients are seeing that money. Too many parasites.

Quote:

---

Originally Posted by Adrian II

The French system is very expensive and probably unaffordable in the long term. Besides, drug prescription and use in France are insanely (and irresponsibly) high. On the plus side, the availability and 'bedside manner' of French doctors are exemplary and chronic diseases like for instance diabetes are fully covered under the system.

Like I said before, health is a common good just like public order or fire prevention. It only works well if it works for everybody. And the key to a good system is socialised funding, not socialised medicine (or state medicine).

---

I agree to some extent. The Common good is best served by individual responsibility and consumer choice. Find a way to make that happen and we may find more common ground.

Quote:

---

Originally Posted by TuffStuffMcGruff

The Common good is best served by individual responsibility and consumer choice.

---

With all due respect, this thread has advanced beyond slogans. We are talking about the pros and cons of certain systems such as the French one. There is a wealth of English language information about it. So why don't you read up on it and join us?

The AMA reverses its position. Again.

The new president of the American Medical Association, which represents the interests of the nation’s doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.

Dr. J. James Rohack told CNN that the AMA supports an “American model” that includes both “a private system and a public system, working together.”

In May, the AMA told a Senate committee it did not support a government-sponsored public health insurance option.

Quote:

---

Originally Posted by Lemur

The AMA reverses its position. Again.

The new president of the American Medical Association, which represents the interests of the nation’s doctors, said Wednesday the group is open to a government-funded health insurance option for people without coverage.

Dr. J. James Rohack told CNN that the AMA supports an “American model” that includes both “a private system and a public system, working together.”

In May, the AMA told a Senate committee it did not support a government-sponsored public health insurance option.

---

I wonder what sort of blackmail that involved?

I've been hearing about this local situation on talk radio for several days now from the health care debate side as well as the "everybody needs a passport, enhanced driver ID" border control side. It's finally been reported in the local paper so I could provide a link.
Thank goodness the Border Patrol does have flexibility in enforcement for these type of emergencies, and hopefully this particular case has a happy ending.

Ontario is Canada's most populous province, and I find it troubling that this type of situation arises as frequently as it does. It receives more press now than in the past because of the need for passports, passport cards or enhanced driver ID's, where in the past all one had to do is verbally declare their residence and move on.

Whatever the outcome of the drive to change the US healthcare system I hope we don't end up with too many situations like this on our side of the border.

Quote:

---

Originally Posted by Hosakawa Tito

Whatever the outcome of the drive to change the US healthcare system I hope we don't end up with too many situations like this on our side of the border.

---

I dont buy your talk radio stuff. Every time I speak to American friends lately, I thank heaven that we don't have your health care system over here. The mere thought that I might develop a cancer or a heart condition and my entire family would go broke because, hey, the insurance company just retracted some clause or cut my entitlement on some technicality... I'd rather die without treatment than see my family go bankrupt and end up in the gutter. The New York Times had some harrowing stories yesterday, and there must be many millions, judging by the figures. A friend of mine in New York just lost his job and insurance, then lost his leg in an accident. Since he had a small melanoma that was removed twenty years ago, no US insurance company will admit him for a decent premium.

What does your talk radio say about people like him?

EDIT

Another beauty here: six out of ten Americans skip or delay health care for financial reasons.

Apreil 2009 - The April Kaiser Health Tracking Poll finds that six in ten Americans continues to say that they or a member of their household have delayed or skipped health care in the past year. A solid majority of the public believes health care reform is more important than ever because of current economic problems.

The country’s overall economic problems have not dampened their interest in pursuing health care reform: a solid majority of the public (59%) believes health care reform is more important than ever compared with the thirty-seven percent who say we can’t afford health reform because of economic problems.

The most common actions taken due to costs were substituting home remedies or over-the-counter drugs for doctors visits (42%) and skipping dental care or check ups (36%). Additionally, three in ten (29%) did not fill a prescription for medicine and two in ten (18%) cut pills in half or skipped doses.

And what do you think will happen in the majority of these cases? The health issues will pop up in worse form and require much more expensive treatment. Way to go, guys.

I wonder how many people in the US are calculating right now: shall I get that essential treatment this year and sell my home to pay for it, or shall I die and let my family inherit the home?

Wal-Mart comes down in favor of the Obama plan, whatever it turns out to be. Interesting.

Quote:

---

Originally Posted by Lemur

Wal-Mart comes down in favor of the Obama plan, whatever it turns out to be. Interesting.

---

Sounds like they're betting on it not happening and trying to ride a good PR wave in the mean time....

Quote:

---

"We are entering a critical time where those of us who will be asked to pay for health care reform will have to make a choice on whether to support this legislation. The choice will require employers to consider the trade off of a coverage mandate and higher taxes for the promise of a reduction in health care cost increases. We also believe that a mandate must be accompanied by provisions that will reduce health costs and dramatically improve the value we get for our health care dollar.

"And the promise of savings in the bill must be more than just words. The bill should contain 'trigger' provisions that guarantee that promised savings take place both for the federal government and for employers who provide insurance. Walmart believes that if we support a mandate and are being asked to pay higher taxes, we should be assured in return, that savings will be real."

---

Quote:

---

Originally Posted by Lemur

Wal-Mart comes down in favor of the Obama plan, whatever it turns out to be. Interesting.

---

What a fabulous way to get rid of all your small-store competitors with the extra government costs and regulations.

CR

Quote:

---

Originally Posted by Crazed Rabbit

What a fabulous way to get rid of all your small-store competitors with the extra government costs and regulations.

CR

---

"But the mandate doesn't require small businesses to provide health insurance"

The article even states this. Talk about a knee jerk response...

~:smoking:

Quote:

---

Originally Posted by Xiahou

Sounds like they're betting on it not happening and trying to ride a good PR wave in the mean time....

---

No, they hope it will cause the other retailers to go broke, since they already offer more insurance than most retail companies and for all intents halfway there when it comes to the Obama plan and all the others will have to play catch-up. It's the Wal-Mart way.

Quote:

---

Originally Posted by Beskar

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

---

It use to be in the 70's and 80's (good old days: no waiting time & all drugs are covered) but in the last 2 decades it came crashing down because of all of the abuse the system had taken. Irresponsible change by the governments (like the flawed Private&Public partnership) and ... how to say this without sounding too xenophobic : lots of peoples came to Canada, get welfare while they stayed then get threaded for free then move away to a sunnier country or stay and 'enjoy' a life on welfare (the money is waisted on them because they don't pay taxes). There is also lack of doctors: get free education then leave the country and make big buck and enjoy easier work down south. Sometime i think we should do like the military: we pay your education but you have to give X years of service to the community in return (of course peoples who pay for their education are free to go where-ever they wish).

Quote:

---

Originally Posted by Melvish

Irresponsible change by the governments (like the flawed Private&Public partnership)

---

:inquisitive: If I recall correctly, Alberta, which uses a partnership similar to this, is one of the better provinces in Canada for healthcare.

Quote:

---

Originally Posted by Evil_Maniac From Mars

:inquisitive: If I recall correctly, Alberta, which uses a partnership similar to this, is one of the better provinces in Canada for healthcare.

---

Yes they fixed the biggest flaws by using strong regulations.
One of the flaw i was making allusion is like : private clinics giving higher priority for botox injection than cancer screening test because the former net bigger profit.

The biggest problem we face now is that a vast proportion of doctor leave Canada, so the waiting time are very long and finding a family doctor is near impossible.

585 doctors departed in one year

Quote:

---

Originally Posted by Melvish

Yes they fixed the biggest flaws by using strong regulations.
One of the flaw i was making allusion is like : private clinics giving higher priority for botox injection than cancer screening test because the former net bigger profit.

The biggest problem we face now is that a vast proportion of doctor leave Canada, so the waiting time are very long and finding a family doctor is near impossible.

---

Gee, almost sounds like a failure of the system.:inquisitive:

Quote:

---

"But the mandate doesn't require small businesses to provide health insurance"

The article even states this. Talk about a knee jerk response...

---

Well, not now. And just how small is small? 10 employees, 50, 100?

Any way, it's going to hurt their smaller competitors. Like regional chains that liberals in the US are always whining are getting driven out of business by Walmart. And then said idiots demand a slew of more regulations that will hamper the smaller stores more than Walmart.

CR

I think that we can all agree that healthcare in the US is broken and needs to be reformed. Very few people don't believe that there is a major problem with our system. As I don't see health-care as a God provided right, but rather a recent man-made privelage, I expect that there would be problems with a modern system that would cover 300 million people without stealing from the wealthy to pay for people who don't care enough to provide for themselves or their families.

We all agree, but where some of us are open to keeping the problems going - but stealing a rich man's wallet to pay for the system, others recognize that the underlying problems need to be resolved before "who is paying" will matter in the long term.

We don't know what we are paying for. Simply using someone elses money to pay for it as a solution is just adding to the the inequity and long term unsustainability of the system. Lets resolve the issues that can be resolved in short order. Once this happens, we can leave it up to the States like we leave auto and home insurance etc; some have State backed options, others don't.

We are starting to rely on hairbrained, massive, unread, partisan, treatises as legislation. Peoples hired hands don't even read the bills anymore. We are spending more money on things that we understand less in the hopes of solving problems.

In the UK, some people are suggesting a fee for visiting the doctor:

Quote:

---

The Social Market Foundation said the only way for the NHS to cope was to raise taxes to put more money into the system, limit demand or work more effectively.

The NHS is already looking to make savings and the think-tank said there was little appetite for tax rises.

Instead, they said charging for GPs would be a good way to reduce demand.

Report author David Furness said: "It would get people thinking twice about whether the visit was essential.

"If we don't introduce rationing like this, there will be rationing by stealth through waiting lists, crumbling hospitals and poor quality services."

---

CR

The truth, which I've never seen any politician admit, is that rationing of some sort is not only inevitable, it's already in place. Everywhere. The only question is how do you implement it.

Quote:

---

Originally Posted by Lemur

The truth, which I've never seen any politician admit, is that rationing of some sort is not only inevitable, it's already in place. Everywhere. The only question is how do you implement it.

---

If I can buy as much of something as I can afford, it's not rationing... or am I missing your meaning?

Edit:
Unsurprisingly, the current Democrat proposal is basically a turd.

Quote:

---

Though President Obama and Democratic leaders have repeatedly pledged to alter the soaring trajectory -- or cost curve -- of federal health spending, the proposals so far would not meet that goal, Elmendorf said, noting, "The curve is being raised." His remarks suggested that rather than averting a looming fiscal crisis, the measures could make the nation's bleak budget outlook even worse.

---

That completely undercuts the administration's argument for hurriedly ramming this bill through Congress. According to the CBO, the cost of doing nothing would indeed be cheaper than rushing through the current proposals- not the other way around, as has been suggested.

If we're going to do this, can we at least take some time and try to put a little thought into it? How many times are artificial deadlines and threats of impending doom going to be used to rush bills through Congress (often before they can even be read)?

Quote:

---

Originally Posted by Xiahou

If I can buy as much of something as I can afford, it's not rationing... or am I missing your meaning?

---

Unless you are independently wealthy and wish to blow your fortune on medical treatment, your healthcare choices are rationed by your insurance company.

Quote:

---

Originally Posted by Xiahou

According to the CBO, the cost of doing nothing would indeed be cheaper than rushing through the current proposals- not the other way around, as has been suggested.

If we're going to do this, can we at least take some time and try to put a little thought into it?

---

Sounds good to me. Where are the experts, the visionaries, the eggheads who can really examine this problem? Shouldn't there be blue-ribbon commissions or something, or are we already past that? Rushed, sloppy reform sounds worse than no reform at all.

As broken and untenable as I think our current system is, I despair of the congresscritters improving on it.

[QUOTE=Lemur;2292688]Unless you are independently wealthy and wish to blow your fortune on medical treatment, your healthcare choices are rationed by your insurance company.


Sounds good to me. Where are the experts, the visionaries, the eggheads who can really examine this problem? Shouldn't there be blue-ribbon commissions or something, or are we already past that? Rushed, sloppy reform sounds worse than no reform at all.

As broken and untenable as I think our current system is, I despair of the congresscritters improving on it.[/QUOTE]

The best way to achieve that is to demand the congresscitters to be in it. same with their pension plan & cola's.

Quote:

---

Originally Posted by Lemur

Unless you are independently wealthy and wish to blow your fortune on medical treatment, your healthcare choices are rationed by your insurance company.


Sounds good to me. Where are the experts, the visionaries, the eggheads who can really examine this problem? Shouldn't there be blue-ribbon commissions or something, or are we already past that? Rushed, sloppy reform sounds worse than no reform at all.

As broken and untenable as I think our current system is, I despair of the congresscritters improving on it.

---

I've never had my treatment "rationed". I spend around $800 a month (Plan, Meds, co-pays, etc) and get whatever I need. I get numerous procedures every year. Empire blue Cross has been pretty good. I'm worried because I can't pay more than $800 per month and the rate of increase is faster than I am earning by a mile.

Health Care is broken partially because of adverse selection in the private system, partially because there is a veil over the prices that have an indirect but eventual impact on premium.

The system is broken because the care is becoming too expensive for anyone to afford. There is no magic bullet to solve this. Make a government plan and you've gotten rid of adverse selection, but they have no intention of increasing transparency, which will just mean that in a few years we have an even more broken government plan.

A coherent political analysis from Klein:

There are problems with the Democrats' approach to health care. It places too much of a burden on employers. The House bill is quite deficient when it comes to changing the incentives for doctors and hospitals (which is the only real hope for controlling costs). But the Republicans have absolutely no credibility on this issue. Indeed, they have spent 30 years allowing the current system to deteriorate or actively making it worse (caving to Pharma on the Medicare drug plan, for example).

This is the moment for the Democrats to demonstrate that they can lead and legislate. If they can't bring this off, they will--rightly--be back in electoral trouble before long.

So. Just watched POTUS's Kabuki press conference, where he said that Doc's over-prescribe drugs and treatment based on compensation schedules, and that Big Pharma overcharges by 50%, based on their recent cave-in to reduce drug costs. Oh, and suggested that a blue-ribbon panel of unelected, administration-appointed medical experts outta decide what treatment should be provided to what patient, and that he, being POTUS, would not reduce his personal medical plan to a level commensurate with that of an "average" American. And that the reason for the big hurry is that if you don't set deadlines "in this town (DC)", things never get done.

Since the bills are still being crafted in congressional commitees and aren't even on the floor for vote (and therefore details are still speculative and negotiable) I can only regard this media event as not directed at me at all, but rather to the congresscritters.

Q: Do we (citizens and taxpayers) pay for this network coverage? I watched it on C-Span, which I pay for on my cableTV bill.

Maybe a day will come when a POTUS will have a press conference where mid-question by Helen, POTUS will say "And by the way, have you made a will yet? Go to LegalDocuments.com for a cheap, state-recognized document. Meanwhile, Helen, as to Iran....".

Q: Did POTUS O sell health care reform to the citizens?

My dad heard about one provision where, after age 65 and every five years thereafter, you'd have to meet some government appointee and get counseling or something on your health. Needless to say, he is not pleased with that kind of crap.

Quote:

---

Oh, and suggested that a blue-ribbon panel of unelected, administration-appointed medical experts outta decide what treatment should be provided to what patient

---

More stupid government enforced decisions, here we come!

One problem is states deciding what has to be included in health insurance plans, taking choices away from the consumer, and forbidding (IIRC) people to buy health insurance from companies in other states. And rules limiting how much more companies can charge unhealthy lifestyle people. Because giving people choices about what they want to buy and letting there be incentives to be healthy is much too rational for the dems!
:wall:
CR

Quote:

---

Originally Posted by KukriKhan

So. Just watched POTUS's Kabuki press conference, where he said that Doc's over-prescribe drugs and treatment based on compensation schedules, and that Big Pharma overcharges by 50%, based on their recent cave-in to reduce drug costs. Oh, and suggested that a blue-ribbon panel of unelected, administration-appointed medical experts outta decide what treatment should be provided to what patient, and that he, being POTUS, would not reduce his personal medical plan to a level commensurate with that of an "average" American. And that the reason for the big hurry is that if you don't set deadlines "in this town (DC)", things never get done.

Since the bills are still being crafted in congressional commitees and aren't even on the floor for vote (and therefore details are still speculative and negotiable) I can only regard this media event as not directed at me at all, but rather to the congresscritters.

Q: Do we (citizens and taxpayers) pay for this network coverage? I watched it on C-Span, which I pay for on my cableTV bill.

Maybe a day will come when a POTUS will have a press conference where mid-question by Helen, POTUS will say "And by the way, have you made a will yet? Go to LegalDocuments.com for a cheap, state-recognized document. Meanwhile, Helen, as to Iran....".

Q: Did POTUS O sell health care reform to the citizens?

---

I didn't listen to the speech, but from what I've heard from news commentators who critiqued it afterwards....no details just rhetoric & politician-ese. Some of the alleged details that have been talked about sound quite disturbing, and if true, means either POTUS O hasn't read the thing or he's not being honest. Like:

People with private plan coverage get to keep it. "Alleged detail" - If the terms of the private plan are changed then you are required to drop it and must be enrolled in the public option, thereby eventually squeezing out private plans.

End of life medical decisions....dodgy evasive answers that say a whole lot of nothing. "Alleged detail" - Your 80 year old grandmother's need for surgery *let's say a knee-joint replacement* will be determined by bureaucrats who will decide if she's worthy of the cost.

Tort reform....not a peep. Doctors pay huge premiums to protect themselves against lawsuits. They also prescribe many expensive diagnostic tests & procedures whose sole purpose is to CYA to avoid culpability in unforeseen medical malpractice suits.

Medicare & medicaid. The guvment hasn't fixed these programs to make them financially viable into the future, but we need to rush this new legislation through with little to no time to actually read and comprehend what it entails. Why?

My biggest pet peeve - Our legislators private health coverage will not be affected by any of this health reform. Like their 100% pensions & yearly cost of living increases that are vested after one measly term in office, they are safely insulated from any effects of the health plan legislation they determine is best for the rest of us. You want them to get this right and fix health care then they have to be in it.

Obama is empty. Its pointless to listen to him, unless you want to understand an issue less.

Last night was more of the same. "Our plan will save money - Republicans are politicians who would rather attack me than save you money. This isn't about me. Saving money is good because it saves you money"

His described rationale is a nightmare.

I thought this was a fun analysis of Obama's healthcare talk. I snickered a couple times.... :beam:

Obama: Things Stink

Spoiler Alert, click show to read: 

—Barack Obama has seen the present, and it doesn’t work.

In the present, we all go broke. In the present, our health care “premiums and out-of-pocket costs will continue to skyrocket.”

In the present, “if we don’t act, 14,000 Americans will continue to lose their health insurance every single day. These are the consequences of inaction. These are the stakes of the debate that we’re having right now.”

So said Obama Wednesday night in a news conference. And make no mistake, the present stinks because the past stank.

In the past, an (unidentified) Republican administration left Obama and the nation with a “$1.3 trillion annual deficit” as kind of an inheritance tax. And now Obama must deal with it.

How will he do this while at the same time providing 97 to 98 percent of the American people with state-of-the-art, affordable health care that they can never lose even if they lose their jobs or get sick?

He will do this by eliminating waste, fraud and abuse in the health care system. He will do this by making health care more efficient.

That’s the future. The future is really going to be sweet. And we’re not even going to have to wait that long for it.

“We will pass reform that lowers cost, promotes choice and provides coverage that every American can count on,” Obama said. “And we will do it this year.”

Obama understands that upon hearing this, some of you may grow “anxious” or “skeptical” or “cynical.” He even understands that you might feel “queasy.”

Fight those feelings. And fight the impression that every president promises to eliminate waste, fraud and abuse and yet those things remain with us.

President Obama promises something else: He will soak the rich. Getting rid of waste, fraud and abuse will pay for only two-thirds of his health care plan. The remaining third will be paid for by limiting “the itemized deductions for the wealthiest Americans.”

What about the S-word? What about “sacrifice” for the rest of us? Happily, the future contains no such need.

Jake Tapper of ABC News specifically asked Obama about sacrifice and whether ordinary Americans will have to “give up some things” in order to enjoy the enormous benefits Obama is promising.

“They will have to give up paying for things that don’t make them healthier,” Obama said. “If there is a blue pill and a red pill and the blue pill is half the price and works just as well right now, why not pay half-price?”

Why not indeed? And so all we have to do is find a whole lot of blue pills.

But don’t worry, we will. And they won’t cost much. “We inherited an enormous deficit,” Obama said. But “health care reform will not add to the deficit; it is designed to lower it.”

And as it is designed, so it shall be. Because that is the way of Washington, isn’t it?

I admit that the promise of enormous benefits at little or no cost — the deficit will actually shrink! — makes me a little “anxious,” “skeptical,” “cynical” and “queasy.” Perhaps it makes you feel the same way.

But what choice do we have? The past is a mess. The present stinks. And the future?

Well, if there is one political promise you can believe, it is this one: Our future is ahead of us.

Feel better?

Quote:

---

Originally Posted by Xiahou's article

providing 97 to 98 percent of the American people with state-of-the-art, affordable health care that they can never lose even if they lose their jobs or get sick?

---

How did America get to a state where it is considered hilarious satire to suggest health care for...the sick?

I think Obama is on the right track. The man has three great qualities: he has a 'can do' mentalitity, he has a knack for finding the right advisors to surround himself with, and he is a natural born salesman who can pitch his policies. Obama might just succeed in giving back the American middle class such 'outlandish' amenities as access to health care for the actual sick.

I think Obama knows where the problem's at. A liberal use of the rod for those with their snout in the through sounds like just the ticket. Every international comparison shows Americans pay much more for much less actual healthcare. It is time to give the money back to the American people.

The rich, for their part, will have to get used to the fact that if a person falls ill at the age of twenty five, it is not his family's income and inherited fortune that decides whether he'll be a productive citizen or be doomed to poverty. That America can be the land of opportunity again. Instead of the country with the lowest social mobility in the entire developed world. I support anything that returns America to its middle class. Obama's effort to overhaul health care seems a good start.

I find it interesting, Louis, that you selected a 25 year old man, for your narrative. Much of your vaunted universal health care system includes rationing, and employs metrics which heavily favor the young, not necessarily the deserving or those able to pay for their own treatment, no?

Great article by Peggy Noonan, as always.

Spoiler Alert, click show to read: 

Common Sense May Sink ObamaCare

It turns out the president misjudged the nation’s mood.

• By PEGGY NOONAN

This is big, what’s happening. President Obama appears to have misstepped on a major initiative and defining issue. He has misjudged the nation’s mood, which itself is news: He rose from nothing to everything with the help of his fine-tuned antennae. Resistance to the Democratic health-care plans is in the air, showing up more now on YouTube than in the polls, but it will be in the polls soon enough. The president, in short, may be facing a real loss. This will be interesting in a number of ways and for a number of reasons, among them that we’ve never seen him publicly defeated before, because he hasn’t been. So we may be entering new territory, with new struggles shaped by new dynamics.

His news conference the other night was bad. He was filibustery and spinny and gave long and largely unfollowable answers that seemed aimed at limiting the number of questions asked and running out the clock. You don’t do that when you’re fully confident. Far more seriously, he didn’t seem to be telling the truth. We need to create a new national health-care program in order to cut down on government spending? Who would believe that? Would anybody?

The common wisdom the past week has been that whatever challenges health care faces, the president will at least get something because he has a Democratic House and Senate and they’re not going to let their guy die. He’ll get this or that, maybe not a new nationalized system but some things, and he’ll be able to declare some degree of victory.

And this makes sense. But after the news conference, I found myself wondering if he’d get anything.

I think the plan is being slowed and may well be stopped not by ideology, or even by philosophy in a strict sense, but by simple American common sense. I suspect voters, the past few weeks, have been giving themselves an internal Q-and-A that goes something like this:

Will whatever health care bill is produced by Congress increase the deficit? “Of course.” Will it mean tax increases? “Of course.” Will it mean new fees of fines? “Probably.” Can I afford it right now? “No, I’m already getting clobbered.” Will it make the marketplace freer and better? “Probably not.” Is our health care system in crisis? “Yeah, it has been for years.” Is it the most pressing crisis right now? “No, the economy is.” Will a health-care bill improve the economy? “I doubt it.”

The White House misread the national mood. The problem isn’t that they didn’t “bend the curve,” or didn’t sell it right. The problem is that the national mood has changed since the president was elected. Back then the mood was “change is for the good.” But that altered as the full implications of the financial crash seeped in. The crash gave everyone a diminished sense of their own margin for error. It gave them a diminished sense of their country’s margin for error. Americans are not in a chance-taking mood. They’re not in a spending mood, not after the unprecedented spending of the past year, from the end of the Bush era through the first six months of Obama. Here the Congressional Budget Office report that a health care bill would not save money but would instead cost more than a trillion dollars in the next decade was decisive. People say bureaucrats never do anything. The bureaucrats of CBO might have killed health care.

The final bill, with all its complexities, will probably be huge, a thousand pages or so. Americans don’t fear the devil’s in the details, they fear hell is. Do they want the same people running health care who gave us the Department of Motor Vehicles, the post office and the invasion of Iraq?

Let me throw forward three other things that I suspect lessen , or will lessen, support for full health-care reform, two of them not quantifiable.

The first has to do with the doctors throughout the country who give patients a break, who quietly underbill someone they know is in trouble, or don’t charge for their services. Also the emergency rooms that provide excellent service for the uninsured in medical crisis. People don’t talk about this much because they’re afraid if they do they’ll lose it, that some government genius will come along and make it illegal for a doctor not to charge or a hospital to fudge around, with mercy, in its billing. People are afraid of losing the parts of the system that sometimes work—the unquantifiable parts, the human parts.

Second, and this is big, some of the bills being worked on in Congress will allow for or mandate taxpayer funding of abortion. Speaking only and narrowly in political terms, this is so ignorant as to be astounding. A good portion of the support for national health care comes from a sort of European Christian Democrat spirit of community, of “We are all in this together.” This spirit potentially unites Democrats, leftists, some Republicans and GOP populists, the politically unaffiliated and those of whatever view with low incomes. But putting abortion in the mix takes the Christian out of Christian Democrat. It breaks and jangles the coalition, telling those who believe abortion is evil that they not only have to accept its legality but now have to pay for it in a brand new plan, for which they’ll be more highly taxed. This is taking a knife to your own supporters.

The third point is largely unspoken but I suspect gives some people real pause. We are living in a time in which educated people who are at the top of American life feel they have the right to make very public criticisms of . . . let’s call it the private, pleasurable but health-related choices of others. They shame smokers and the overweight. Drinking will be next. Mr. Obama’s own choice for surgeon general has come under criticism as too heavy.

Only a generation ago such criticisms would have been considered rude and unacceptable. But they are part of the ugly, chafing price of having the government in something: Suddenly it can make big and very personal demands on you. Those who live in a way that isn’t sufficiently healthy “cost us money” and “drive up premiums.” Mr. Obama himself said something like it in his press conference, when he spoke of a person who might not buy health insurance. If he gets hit by a bus, “the rest of us have to pay for it.”

Under a national health-care plan we might be hearing that a lot. You don’t exercise, you smoke, you drink, you eat too much, and “the rest of us have to pay for it.”

It is a new opportunity for new class professionals (an old phrase that should make a comeback) to shame others, which appears to be one of their hobbies. (It may even be one of their addictions. Let’s stage an intervention.) Every time I hear Kathleen Sebelius talk about “transitioning” from “treating disease” to “preventing disease,” I start thinking of how they’ll use this as an excuse to judge, shame and intrude.

So this might be an unarticulated public fear: When everyone pays for the same health-care system, the overseers will feel more and more a right to tell you how to live, which simple joys are allowed and which are not.

Americans in the most personal, daily ways feel they are less free than they used to be. And they are right, they are less free.

Who wants more of that?

Does anyone know where I can find a copy of the health care bill? I saw a list of "O NOZE, LOOK WHAT TEH EVIL DEMS PUT IN HERE!!!", and I wanted to see how much of it was true. Specifically, it said that page 241 contains a part that mandates all doctors be paid the same, regardless of specialty. I really hope that is not the case, as there are much better ways of dealing with the shortage of primary care physicians.

Also, has there been any talk at all about how to solve the issue of supply? Any succesfull reform of insurance and medical costs will inevitably increase demand for the health care system. In order for reform to work, many more doctors, nurses, and technologists must be trained. Unfortunately, the next couple of years are going to be awfull no matter what because it will take several years for future nurses to earn their degrees and 8 years before the current crop of high school graduates can graduate from Med school.

Quote:

---

Originally Posted by woad&fangs

Does anyone know where I can find a copy of the health care bill? I saw a list of "O NOZE, LOOK WHAT TEH EVIL DEMS PUT IN HERE!!!", and I wanted to see how much of it was true.

---

Last I heard, there was one bill in the House and two in the Senate, each on 1,000+ pages long. I doubt there's a human being on Earth who knows exactly what's in each one, especially given that they're being debated and amended right now.

Quote:

---

Originally Posted by Lemur

Last I heard, there was one bill in the House and two in the Senate, each on 1,000+ pages long. I doubt there's a human being on Earth who knows exactly what's in each one, especially given that they're being debated and amended right now.

---

Which is why for the sake of common sense it shouldn't be rushed through. To me, it speaks ill of a desire for real leadership on Obama's part if he wants it rammed through.

CR

There's a difference between "ramming" something through and trying to maintain momentum against powerful status quo forces that are playing for a humiliation which will rob the president of the influence necessary to change things.

This seems to be the ultimate Achilles heel of the greatest democracy - along with the bizarre ability to add pork amendments - the legislature seems utterly incapable of constructive debate to find solutions. It seems to me any bill that breaks the barricades will be a victory (especially if it challenges the insurance industry to innovate) and in normal democracies, that would be the start of further amendments to make the thing ever better. FUD is no substitute for governance.

It just appals me that anyone can think Third World healthcare of this magnitude is worth defending.

I will never forget the astonishment I felt on reading Lemur's post some while back. An intelligent professional avoiding being checked for tetanus and infection because he was wary of the possible bill. Insanity for any country, let alone the leading economy. Adrian, as ever, is dead right.

Well put Banquo, I was thinking something simular, but couldn't formulate it as eloquent. :bow:

I'll just add, if this reform fail, when will someone attemt on it again? I'll suspect that Obama will have to deal with bedget sanitation the next few years and the next election will probably be about the debt. That's about 5-6 years, but probably earliest two elections from now, so 2016. And as two presidents have failed, unless the system is on the brink of collapse, that president won't touch it either. So about 2020 at earliest?

Quote:

---

Originally Posted by Banquo's link

all so they can satisfy their Wall Street investors.

---

Happens again and again that "customers" get dumped or tricked or whatever just to please the shareholders. :thumbsdown:

Quote:

---

Originally Posted by Banquo's Ghost

There's a difference between "ramming" something through and trying to maintain momentum against powerful status quo forces that are playing for a humiliation which will rob the president of the influence necessary to change things.

This seems to be the ultimate Achilles heel of the greatest democracy - along with the bizarre ability to add pork amendments - the legislature seems utterly incapable of constructive debate to find solutions. It seems to me any bill that breaks the barricades will be a victory (especially if it challenges the insurance industry to innovate) and in normal democracies, that would be the start of further amendments to make the thing ever better. FUD is no substitute for governance.

It just appals me that anyone can think Third World healthcare of this magnitude is worth defending.

I will never forget the astonishment I felt on reading Lemur's post some while back. An intelligent professional avoiding being checked for tetanus and infection because he was wary of the possible bill. Insanity for any country, let alone the leading economy. Adrian, as ever, is dead right.

---

We need a blood enemy. Rome Fell when there was no blood enemy. Lashing and drinking the blood of our large competitors keeps us alive.

I can't wait for China to get big enough for us to slaughter. Bet your biscuits that our parties will agree way more then.

Hell, I'd settle for Ruskies or even Europeans.

Quote:

---

Originally Posted by Husar

Happens again and again that "customers" get dumped or tricked or whatever just to please the shareholders. :thumbsdown:

---

Like many market failures, this market appears to disenfranchise the customer. As I understand things, one is largely at the mercy of one's employer - and whatever choice they have made.

Now, if individual customers could choose widely between insurance companies independently of employment, and anti-monopoly laws ensured there was a competitive market free of collusion, we might see some innovation and accountability. I understand that in theory one can choose, but that it is prohibitively expensive so de facto, such cover has become a perk of employment.

Corporations will always tend towards monopoly, removing customer choice and use political power to deflect change.

And then one factors in the very high cost of modern healthcare, so the majority of people require a subsidy to access it. This may be from employers "bulk buying" and building some of that cost into remuneration packages, or a direct government subsidy from taxation. The former leads to the inequality of a dysfunctional market - the latter argues for health being a public service entirely.

Quote:

---

Originally Posted by Banquo's Ghost

Like many market failures, this market appears to disenfranchise the customer. As I understand things, one is largely at the mercy of one's employer - and whatever choice they have made.

Now, if individual customers could choose widely between insurance companies independently of employment, and anti-monopoly laws ensured there was a competitive market free of collusion, we might see some innovation and accountability. I understand that in theory one can choose, but that it is prohibitively expensive so de facto, such cover has become a perk of employment.

Corporations will always tend towards monopoly, removing customer choice and use political power to deflect change.

And then one factors in the very high cost of modern healthcare, so the majority of people require a subsidy to access it. This may be from employers "bulk buying" and building some of that cost into remuneration packages, or a direct government subsidy from taxation. The former leads to the inequality of a dysfunctional market - the latter argues for health being a public service entirely.

---

One problem is that health care through employment encourages that only those well enough to work have easier access to health care. If you seperate it from that qualifier (which you should for moral reasons) the prices should be expected to go up because of increased adverse selection.

The system here is obviously broken, but somehow still functioning. We should take the time to bring everyone to the table on this and hack out a solution that adequately make everyone unhappy but extends health care to the large majority.

Allow people to understand cost and contain costs on their own; current deductible and co-pay systems don't work. Maybe a very low percentage system, not to deter care, but rather to impact who the consumer uses based on value for the dollar - it needs to be enough to get people looking for more basic care that actually works.

Encourage Insurance companies not to seek higher costs for built premiums and then obscure our view of what will impact our prices in the future. This will be harder to do.

The Democratic idea of a Salary based system could work. Obviosly salaries don't have to be the same, but based on some sort of accredidation. Salaries will dissuade "tack-on sales" tactics that Doctors are known for and encourage an understandable pricing system based on previous averages and cost of materials, not just throwing a dart at the wheel of fortune.

Some ideas, but I think that most are on board for this.

What I am not on board for is paying more so that poor gamblers and alchoholics can keep spending their money on booze and drugs while me, my parents and people who actually drive the economy are taxed to death for it.

Their kids are one thing, but scumbags who have no interest in their own health can die in the street if they can't find a charity willing to work for free, as far as i'm concerned. Here lies the snag in current negotiations.

From CNN Money, five items of grand stupidity and lies from Obama in the health care bill:

Spoiler Alert, click show to read: 

5 freedoms you'd lose in health care reform
If you read the fine print in the Congressional plans, you'll find that a lot of cherished aspects of the current system would disappear.
...
1. Freedom to choose what's in your plan

The bills in both houses require that Americans purchase insurance through "qualified" plans offered by health-care "exchanges" that would be set up in each state. The rub is that the plans can't really compete based on what they offer. The reason: The federal government will impose a minimum list of benefits that each plan is required to offer.
0:00 /2:07Health reform and you

Today, many states require these "standard benefits packages" -- and they're a major cause for the rise in health-care costs. Every group, from chiropractors to alcohol-abuse counselors, do lobbying to get included. Connecticut, for example, requires reimbursement for hair transplants, hearing aids, and in vitro fertilization.
...
2. Freedom to be rewarded for healthy living, or pay your real costs

As with the previous example, the Obama plan enshrines into federal law one of the worst features of state legislation: community rating. Eleven states, ranging from New York to Oregon, have some form of community rating. In its purest form, community rating requires that all patients pay the same rates for their level of coverage regardless of their age or medical condition.

Americans with pre-existing conditions need subsidies under any plan, but community rating is a dubious way to bring fairness to health care. The reason is twofold: First, it forces young people, who typically have lower incomes than older workers, to pay far more than their actual cost, and gives older workers, who can afford to pay more, a big discount. The state laws gouging the young are a major reason so many of them have joined the ranks of uninsured.
...
Second, the bills would ban insurers from charging differing premiums based on the health of their customers. Again, that's understandable for folks with diabetes or cancer. But the bills would bar rewarding people who pursue a healthy lifestyle of exercise or a cholesterol-conscious diet. That's hardly a formula for lower costs. It's as if car insurers had to charge the same rates to safe drivers as to chronic speeders with a history of accidents.
3. Freedom to choose high-deductible coverage

The bills threaten to eliminate the one part of the market truly driven by consumers spending their own money. That's what makes a market, and health care needs more of it, not less.

Hundreds of companies now offer Health Savings Accounts to about 5 million employees. Those workers deposit tax-free money in the accounts and get a matching contribution from their employer. They can use the funds to buy a high-deductible plan -- say for major medical costs over $12,000. Preventive care is reimbursed, but patients pay all other routine doctor visits and tests with their own money from the HSA account. As a result, HSA users are far more cost-conscious than customers who are reimbursed for the majority of their care.

The bills seriously endanger the trend toward consumer-driven care in general. By requiring minimum packages, they would prevent patients from choosing stripped-down plans that cover only major medical expenses. "The government could set extremely low deductibles that would eliminate HSAs," says John Goodman of the National Center for Policy Analysis, a free-market research group. "And they could do it after the bills are passed."

4. Freedom to keep your existing plan

This is the freedom that the President keeps emphasizing. Yet the bills appear to say otherwise. It's worth diving into the weeds -- the territory where most pundits and politicians don't seem to have ventured.
...
So for Americans in large corporations, "keeping your own plan" has a strict deadline. In five years, like it or not, you'll get dumped into the exchange. As we'll see, it could happen a lot earlier.
...
The employees who got their coverage before the law goes into effect can keep their plans, but once again, there's a catch. If the plan changes in any way -- by altering co-pays, deductibles, or even switching coverage for this or that drug -- the employee must drop out and shop through the exchange. Since these plans generally change their policies every year, it's likely that millions of employees will lose their plans in 12 months.

5. Freedom to choose your doctors

The Senate bill requires that Americans buying through the exchanges -- and as we've seen, that will soon be most Americans -- must get their care through something called "medical home." Medical home is similar to an HMO. You're assigned a primary care doctor, and the doctor controls your access to specialists. The primary care physicians will decide which services, like MRIs and other diagnostic scans, are best for you, and will decide when you really need to see a cardiologists or orthopedists.
...
The danger is that doctors will be financially rewarded for denying care, as were HMO physicians more than a decade ago. It was consumer outrage over despotic gatekeepers that made the HMOs so unpopular, and killed what was billed as the solution to America's health-care cost explosion.

The bills do not specifically rule out fee-for-service plans as options to be offered through the exchanges. But remember, those plans -- if they exist -- would be barred from charging sick or elderly patients more than young and healthy ones. So patients would be inclined to game the system, staying in the HMO while they're healthy and switching to fee-for-service when they become seriously ill. "That would kill fee-for-service in a hurry," says Goodman.

In reality, the flexible, employer-based plans that now dominate the landscape, and that Americans so cherish, could disappear far faster than the 5 year "grace period" that's barely being discussed.

Well this would certainly screw the country over.

CR

A little more info on our current system of rationing:

The legal basis for rescission is that when you sign an insurance application, you are warranting that the information on the application is true; if it turns out not to be true, the insurer can get out of your insurance contract. It’s particularly nasty in practice because the insurer does not immediately investigate your application to determine if it is accurate before selling you the policy (that would be impractically expensive); instead, the insurer waits – years, in many cases – until you actually need expensive health care, and then does the investigation, which at that point is worth it because of the payments the insurer could potentially avoid. Also, you can lose your coverage for innocent mistakes, which are easy to make since the application form asks you if you have ever seen a doctor for any one of a long list of medical conditions that you are certain not to recognize or understand. (In a Congressional hearing, the CEO of a health insurer admitted that he did not know what several of the conditions listed on his company’s application were.)

Quote:

---

Originally Posted by Lemur

A little more info on our current system of rationing:

The legal basis for rescission is that when you sign an insurance application, you are warranting that the information on the application is true; if it turns out not to be true, the insurer can get out of your insurance contract. It’s particularly nasty in practice because the insurer does not immediately investigate your application to determine if it is accurate before selling you the policy (that would be impractically expensive); instead, the insurer waits – years, in many cases – until you actually need expensive health care, and then does the investigation, which at that point is worth it because of the payments the insurer could potentially avoid. Also, you can lose your coverage for innocent mistakes, which are easy to make since the application form asks you if you have ever seen a doctor for any one of a long list of medical conditions that you are certain not to recognize or understand. (In a Congressional hearing, the CEO of a health insurer admitted that he did not know what several of the conditions listed on his company’s application were.)

---

Your link takes me to a radio station page about fine print: which is sort of relevant, but none of the stories mentioned are health care.

I would be interested in the original for your quote. :bow:

Quote:

---

Originally Posted by Banquo's Ghost

I understand that in theory one can choose, but that it is prohibitively expensive so de facto, such cover has become a perk of employment.

---

Hence our current confusion. Two hundred years ago, only rich folks were treated by Doc's. One hundred years ago, local (neighborhood or small town) Gen Practioners did the job - often as a town employee. Sixty years ago, the auto companies spear-headed the drive to keep their sizeable workforce stable by keeping them healthier, so purchased bulk group insurance as a job perquisite (and at first, doctors and nurses on the job site), as you've said. Other industrial companies followed suit. HMO's got invented in the 1970's, merging doctors, hospitals and insurance together into an uneasy alliance, to serve industry.

Medical treatment and its guarantor, insurance, is such a widespread perk that it's no longer seen as a perk, but a right. Add the governmental programs Medicare and Medicaid (for the old and indigent) and you have a persuasive argument that de facto, tho' almost by accident, since most people are covered by some kind of insurance, we think all people should be.

In short: what was once a privilege, then a product, then a perk, has become a right. Just like police, fire, water, sewer, roads, libraries and electricity (and down the line: TV, radio, telephone & internet).

We're, as I understand the state of discussion in the US currently, haggling over the money part: who pays, who gets paid, how much, and how often. That there is some entitlement to medical treatment doesn't get discussed much. It's already an assumption on all sides.

Quote:

---

Originally Posted by Banquo's Ghost

I would be interested in the original for your quote. :bow:

---

Gah! Evil NPR moves teh linkies. Here's the original referencing article.

The This American Life crew [...] has a segment in this weekend’s episode on rescission of health insurance policies — insurers’ established practice of looking for ways to invalidate policies once it turns out that the insured actually needs significant medical care. (The segment is around the 30-minute mark; audio should be available on that page sometime on Monday.) The story describes a couple of particularly egregious cases, such as a woman who was denied breast cancer surgery because she had been treated for acne in the past, and a person whose policy was rescinded because his insurance agent had incorrectly entered his weight on the application form.

If I remember correctly, HillaryCare failed because the administration came up with the plan and foisted it on Congress, which balked when their paymasters squealed.

ObamaCare is different, Congress is creating the plan. Which means the lobbyists are in full force, hands extended, trying to get a piece of the pie. This is why ObamaCare should fail, at this point it has nothing to do with getting the best care for the people, just the best deal for the industry. If Obama actually believes that the finished product will reduce the overall medical expenditures of government programs and improve care of patients, he's more naive than I thought.

Quote:

---

Originally Posted by Lemur

Gah! Evil NPR moves teh linkies. Here's the original referencing article.

---

We should simply make a law only allowing rescission in the first month or two after being granted insurance.

CR

Thanks, Lemur. Fascinating. :bow:

Quote:

---

Originally Posted by Crazed Rabbit

We should simply make a law only allowing rescission in the first month or two after being granted insurance.

---

That was my first thought but then wouldn't the insurance companies just front load the costs and healthcare get even more expensive?

Quote:

---

Originally Posted by Banquo's Ghost

That was my first thought but then wouldn't the insurance companies just front load the costs and healthcare get even more expensive?

---

Front load how?

Want an example of how screwed up our system is? I am currently unemployed. I shopped around and found insurance that provided better coverage than what I had under my employer and cost less than what my share of the monthly premium (which was about 1/3 of what the total monthly charge was) for my employee sponsored insurance was. Rather than providing economies of scale, as you suggested, employer coverage quite often costs more because healthy individuals have to pay more to even out the premiums of high health risk employees.

What's even better is that were I still employed and if I wanted to refuse my employer's coverage and purchase this private plan, I would be prohibited from doing so. I would be free to refuse my employer's coverage, but just being eligible for it would make me ineligible for purchasing an individual plan. :dizzy2:

Sadly, ObamaCare, from what I've seen, does nothing to address any of this insanity. The simplest thing we could do to reform our dysfunctional healthcare would be to separate medical insurance from employers. :yes:

Quote:

---

Originally Posted by KukriKhan

Hence our current confusion. Two hundred years ago, only rich folks were treated by Doc's. One hundred years ago, local (neighborhood or small town) Gen Practioners did the job - often as a town employee. Sixty years ago, the auto companies spear-headed the drive to keep their sizeable workforce stable by keeping them healthier, so purchased bulk group insurance as a job perquisite (and at first, doctors and nurses on the job site), as you've said. Other industrial companies followed suit. HMO's got invented in the 1970's, merging doctors, hospitals and insurance together into an uneasy alliance, to serve industry.

---

Don't forget about how employee medical benefits were popularized as a way around FDR's wage controls since they weren't treated as income....

Quote:

---

Originally Posted by Xiahou

Front load how?

---

I would assume that premium costs would go up high enough to cover the profits now made by recission.

Quote:

---

Originally Posted by Xiahou

Want an example of how screwed up our system is? I am currently unemployed. I shopped around and found insurance that provided better coverage than what I had under my employer and cost less than what my share of the monthly premium (which was about 1/3 of what the total monthly charge was) for my employee sponsored insurance was. Rather than providing economies of scale, as you suggested, employer coverage quite often costs more because healthy individuals have to pay more to even out the premiums of high health risk employees.

What's even better is that were I still employed and if I wanted to refuse my employer's coverage and purchase this private plan, I would be prohibited from doing so. I would be free to refuse my employer's coverage, but just being eligible for it would make me ineligible for purchasing an individual plan. :dizzy2:

Sadly, ObamaCare, from what I've seen, does nothing to address any of this insanity. The simplest thing we could do to reform our dysfunctional healthcare would be to separate medical insurance from employers. :yes:

Don't forget about how employee medical benefits were popularized as a way around FDR's wage controls since they weren't treated as income....

---

That's an example of why I am concerned about the model. One might be able to judge if private insurance funded healthcare worked if there was a decently free market - the insurance companies would be competing to lower prices and increase cover security. However, they would also cherry pick the very best risks - and so even more citizens would be left without cover.

Quote:

---

Originally Posted by Banquo's Ghost

That's an example of why I am concerned about the model. One might be able to judge if private insurance funded healthcare worked if there was a decently free market - the insurance companies would be competing to lower prices and increase cover security. However, they would also cherry pick the very best risks - and so even more citizens would be left without cover.

---

Or those people who smoked and didn't exercise would simply have to pay more, as with automobile insurance, where people who crash and get speeding tickets pay more.

Quote:

---

I would assume that premium costs would go up high enough to cover the profits now made by recission.

---

Are they making a significant amount of revenue from that? I'm just guessing, but I don't think they'd be a large rise in premiums.

CR

Well, if you want to see what it looks like when the government imposes insurance mandates and does nothing to control costs, just look at MA. Ir don't work. Or hell, look at Medicare Part D.

Talk about starting a bombshell, eh? I figure since Congress has adjourned for the summer, we can take a look back at what they've done concerning Healthcare. To my knowledge, the current legislation has passed through the House committee concerning it, but lying in wait until Congress re-convenes.

I'm not going to pretend that I know much about Healthcare reform, because I don't. I especially don't know or understand anything that's happening concerning the current bill (which is causing some frustration amongst voters) and I figure I'm more lost than most because I haven't had to worry about health insurance. So I figure I'll get some education.

SO, what I want to get from y'all is

1. What exactly is the current Congress Healthcare Bill doing for Americans? What are the parts of the Bill?

2. I know Switzerland has a pretty sweet system, what makes that system "sweet"? Conversely, what makes the American system "bad" or "broken"?

Here is a link to a page that has a good number of articles looking at healthcare in different ways. Of course they've got an agenda, but that is mainly "see how bright we are! Hire us to sort it out" so in the way you're looking at it they're pretty neutral.

~:smoking:

I have merged this new thread with the existing one.

:bow:

Thank you BQ

The status quo rocks!

Our six-month-old daughter cost over $22,000.

You’d think, with a number like that, we must have used fertility treatments—but she was conceived naturally. You’d think we went through an adoption agency—but she is a biological child. So surely, we were uninsured.

Nope. Birthing our daughter was so expensive precisely because we were insured, on the individual market. Our insurer, CareFirst BlueCross BlueShield, sold us exactly the type of flawed policy—riddled with holes and exceptions—that the health care reform bills in Congress should try to do away with. The “maternity” coverage we purchased didn’t cover my labor, delivery, or hospital stay. It was a sham. And so we spent the first months of her life getting the kind of hospital bills and increasingly aggressive calls from hospital administrators that I once believed were only possible without insurance.

The Healthy Americans Act

A reform proposal that could cover everyone, help fix Medicaid, and according to the OMB, would be budget neutral the first year and would actually start saving money thereafter. I'm not intimately with this proposal, but it has support from both parties and wouldn't throw us trillions of dollars further into debt. But, we're not discussing any alternatives....

The status quo is far from perfect, but sometimes no reform is better than bad reform- and that seems to be what our current choice is. :sweatdrop:

Quote:

---

Originally Posted by Xiahou

The Healthy Americans Act

A reform proposal that could cover everyone, help fix Medicaid, and according to the OMB, would be budget neutral the first year and would actually start saving money thereafter. I'm not intimately with this proposal, but it has support from both parties and wouldn't throw us trillions of dollars further into debt. But, we're not discussing any alternatives....

The status quo is far from perfect, but sometimes no reform is better than bad reform- and that seems to be what our current choice is. :sweatdrop:

---

Your link is broken, Xiahou.

fixed....

stupid netbook.... grumble...

Quote:

---

Originally Posted by Banquo's Ghost

IThat's an example of why I am concerned about the model. One might be able to judge if private insurance funded healthcare worked if there was a decently free market - the insurance companies would be competing to lower prices and increase cover security. However, they would also cherry pick the very best risks - and so even more citizens would be left without cover.

---

Insurance uses sub-standard ratings to insure higher risk applicants and/or exclusions of certain specific risk factors in an otherwise complete coverage package. I suspect that you wouldn't see a very great increase in the number of uninsureds, though the premium cost would be allocated quite differently.

Quote:

---

Originally Posted by Xiahou

The Healthy Americans Act

A reform proposal that could cover everyone, help fix Medicaid, and according to the OMB, would be budget neutral the first year and would actually start saving money thereafter. I'm not intimately with this proposal, but it has support from both parties and wouldn't throw us trillions of dollars further into debt. But, we're not discussing any alternatives....

The status quo is far from perfect, but sometimes no reform is better than bad reform- and that seems to be what our current choice is. :sweatdrop:

---

I'm looking at on the senator's website, and I'm surprised your in support of it. Link.

Quote:

---

Under the Healthy Americans Act, insurance companies will have to enroll every individual who signs up and insurers will be prohibited from raising prices or denying coverage if individuals are sick or are at risk of becoming sick. Previous and existing health problems, occupation, genetic information, gender and age could no longer be used to determine eligibility or the price paid for insurance. Insurance companies will be forced to compete to keep their subscribers healthy.

---

So insurance companies will be mandated to accept anyone who wants to sign up? :inquisitive:

Quote:

---

Individuals will choose from a variety of private plans offered in their state, including any employer-based option that may be available to them. Sign-up will be as simple as checking a box on a tax form. Consumers will get help and advice on choosing the best coverage for them from state-based Health Help Agencies (HHAs) and Human Resource departments.

---

So we're still prohibited from looking for plans out of the state, and we get advice from the gov't on what plan is best....

Quote:

---

All employers, along with individuals and the government, will share the responsibility of financing health care. Employers who provide employee health benefits would be required to convert their workers' health care premiums into higher wages for two years after the bill is enacted. Employees, in turn, would be required to purchase private health coverage with their higher wages. To ensure that health care coverage is affordable, the plan would fully subsidize the premiums for those who live below the poverty line. Those people earning between 100 percent and 400 percent of the federal poverty line ($10,400 annually per person) would also receive subsidies on a sliding scale to help pay their premiums. The bill also creates a generous standard deduction to help Americans pay for health coverage regardless of whether they get coverage on their own or through their employers.

---

More mandates. So not only are insurance companies forbidden from denying anyone who asks, but workers are forced to get insurance. And, of course, businesses are required to jack pay up to workers to compensate for the workers being required to pay for insurance. This basically forces every company to provide "health insurance pay" since if workers are all required to pay for health insurance, they're going to only seek jobs where employers have the ability to offer health pay. So basically, either moderate/low income workers are punished, or small businesses.

Quote:

---

The Healthy Americans Act gives every American control over their health care choices and their budgets, with a transition to the new system that will be seamless for many people. Premiums will be paid from a deduction on their paychecks just like many other deductions currently withheld. The only change many people will notice is that they can see how much their health care costs them. And any costs incurred for health care will be balanced out by the raise they get from their employer to pay for it.

---

No, it doesn't give us control because it forces people to buy insurance and won't even open up state lines to offer more choices. And the method of paying premiums amounts to nothing more than another tax, which is either paid by the business or the person.

Quote:

---

Employers who don't currently offer health benefits would have to make phased-in "Employer Shared Responsibility Payments," which would be used to provide financial assistance to individuals and families of modest income.

---

Isn't this something very similar to what obama was proposing?





Now, don't get me wrong, I like that it apparently cuts out costs(somehow, I'm not quite understanding the explanation of how that is), but I'm failing to see why you're in support of it given all this other junk.

edit: to be fair, it does seem more coherent and sensible than some of the alternatives being floated.

There aren't enough specifics to judge whether this is a good idea or not.

Quote:

---

Individuals will choose from a variety of private plans offered in their state, including any employer-based option that may be available to them. Sign-up will be as simple as checking a box on a tax form. Consumers will get help and advice on choosing the best coverage for them from state-based Health Help Agencies (HHAs) and Human Resource departments.

---

So there will still be wide disparity on what one pays for coverage dependent on where one lives. Where's the "cost control" in that?

Quote:

---

Under the Healthy Americans Act, insurance companies will have to enroll every individual who signs up and insurers will be prohibited from raising prices or denying coverage if individuals are sick or are at risk of becoming sick. Previous and existing health problems, occupation, genetic information, gender and age could no longer be used to determine eligibility or the price paid for insurance. Insurance companies will be forced to compete to keep their subscribers healthy.

---

One of the problems with the current system is that doctors are paid for treatments to patients, but not outcomes *quality/effectiveness of care*. However, where in this new proposal is patient responsibility?
If you become ill because you don't follow prescribed treatments *diet, weight reduction, stop smoking, medications, etc...* should you be covered?

No mention of tort reform...that's a crock.

I want to know, in detail, what treatments/medications for illnesses are not covered or are there no limits?
Will there be out of pocket copayments for medications & procedures?

Can you seek treatment outside your prescribed coverage and pay all costs out of pocket?

Why is there a seperate system for our Legislators or are they covered by this too?

Quote:

---

Originally Posted by Shinseikhaan

I'm looking at on the senator's website, and I'm surprised your in support of it. Link.

---

I'm not really sure where you read that I supported it. :inquisitive:
However, a cursory glance seems to suggest that it accomplishes many of the same goals of current proposals without trillions in new debt. That alone makes it better than what's being bandied about now. I'm not yet convinced that it's better than the status quo, but we should jettison the current proposals and use something like this as a jumping off point.

Protesters are, in fact, fascists

While the possibility of astro-turfing is no doubt there, I think the way that some representatives (i.e. those I dislike) are imploding as they lash out. It seems more like a paranoid attempt to explain away unfavorable protesters to a healthcare bill that no one really understands, which leads into my next point.

If the Democrats were more intelligent in the "carrying-through" of the healthcare bill, it would be a paper that says This is what the Healthcare Bill will do for you than simply say "Trust us guys, this is in your best interests". I don't really know what is in the bill, and I'm not planning on surfing the web to find an 18-page report on the first paragraph of the bill, let alone a summary of what the bill will do, what it will cover, etc. etc. I will say that the Republican "let's just hate on it because it's a Democrat bill" is a little childish, but I do wish they'd figure out a nice bill to counter the Democrats one.