The U.S. Health Care Debate

[Xiahou]

Or if you have my insurance, they bill $800, then the insurer decides what they think the operation ought to cost in their private fantasyland, pays that (or doesn't), and then you get stuck with the remainder. Worst of both worlds.

It could vary from state to state, but I only know of one way that could happen. If your plan is part of a network and you went outside the network to get your treatment.

My insurance would have pre-negotiated rates with all providers in their network. Therefore, when I saw a doctor, they would get reimbursed the preset amount by my insurance company. Now, if I went to a provider outside the network they could charge whatever they wanted, but my insurance would still only pay what their network rate is. It's a way of keeping premiums down.

I actually had the pleasure of telling an office's billing dept to go to hell when they tried to bill me for the difference between the network rate and what they would've liked to charge me. When I called their office, they tried to tell me that I was responsible for the difference. I told them they were in my network and were not allowed to charge me more- he persisted. I then asked for the guys name and contact information, called my insurance company and told them they were trying to bill me beyond the network coverage. Once I explained everything, they said they'd call him and take care of it. I never heard from them again- it was a pretty satisfying experience.

[Tribesman]

...why does the Soviet Union win if this principle is extended to all age groups?

You should understand that by now.

It is simple to understand

The whole reason is because its the democrats not the republicans

[Seamus Fermanagh]

You should understand that by now.

It is simple to understand

The whole reason is because its the democrats not the republicans

Well, there a some who do view things through exactly that lens, along with others from the other party who have the mirror position. I envy them their clarity, in a way. I've never been able to look at politics and truly think "My guy is perfect your gal is a twit" since I hit double digits in age.

Current US healthcare consumes more than 16% of the GDP. While it can be argued that the therapeutic treatments available are the best, or among the best, on the planet, it is also readily apparent that we've got the worst hybridized system in the world to pay for it.


I oppose a national health system (or the "public option" which will beget it) because I:

1. Don't want government managing health care as I think it's extraneous to the purpose of government in general and of our federal government in particular,

2. Don't want the federal government involved because the federal government is bloated and overly involved in the lives of all Americans and should be pared back, not enhanced,

3. Don't want the federal government involved because of their miserable track record in terms of efficiency, and

4. Believe that ANY such effort by the federal government exceeds their constitutional mandate and therefore believe they have no standing to make such laws (of course, I'm one of the 12 remaining people who also thinks the 10th ammendment is still part of the Constitution, so what do I know).


I believe we would be better served by a system of private insurance and fee-for-services, regulated by the government ONLY to the extent necessary to prevent fraud. Under such a system, not all will receive medical care (some by choice, others by circumstance).

Life cannot be "legislated" into fairness. Attempting to do so is well-intentioned utopianism.

[jabarto]

1. Don't want government managing health care as I think it's extraneous to the purpose of government in general and of our federal government in particular

See my response to bullet point #4 of this post.

3. Don't want the federal government involved because of their miserable track record in terms of efficiency, and

People trot this line out all the time. But really, how many things has the government messed up with? Last I checked, the Interstate Highway System and USPS were resounding successes. And it's worth mentioning that we already have nationalized medicine for our government, military personnel AND their families, and the elderly. It's pretty obvious that the government can handle UHC.

4. Believe that ANY such effort by the federal government exceeds their constitutional mandate and therefore believe they have no standing to make such laws (of course, I'm one of the 12 remaining people who also thinks the 10th ammendment is still part of the Constitution, so what do I know).

Doesn't the constitution explicitly state that the government is responsible for the welfare of its citizens?

I believe we would be better served by a system of private insurance and fee-for-services, regulated by the government ONLY to the extent necessary to prevent fraud.

Why would you want ANY private insurance? Do you really want the industry to be (mostly) regulated by the people who will profit from it? Besides which, the insurance companies have proven themselves unable to render the services for which they're being paid, over and over and over again. They're worthless and should have been out on their asses years ago.

Under such a system, not all will receive medical care (some by choice, others by circumstance).

And that's why such a system would merely be a band-aid over a gushing artery.

Life cannot be "legislated" into fairness. Attempting to do so is well-intentioned utopianism.

I know a little group of people called "every industrialized nation on the planet except for this one" who would like a word with you.

[drone]

Doesn't the constitution explicitly state that the government is responsible for the welfare of its citizens?

Do you realize how dangerous this connection would be? It's bad enough with the abuse of the interstate commerce clause. Making this a precedent would nanny-state us to death.

Now that I think of it, does that statement occur outside of the preamble? The preamble itself does not give the government any powers, it just puts the rest of the Constitution into context for judges.

Edit-> Seamus, will you marry me?

[Louis VI the Fat]

I know a little group of people called "every industrialized nation on the planet except for this one" who would like a word with you.

Nononon!!

We are quite happy the way it is. Big Pharma consists of many European corporations. They are perfectly happy to have the US as a playground. They love the American allergy to protecting the interests of civilians against corporations.

The US federal government is a perfect tool for our interests. The average US citizen is a perfect tool too. Erm..I mean, a perfect tool in the global struggle against healthcare communism!



Many European companies are a member of the largest and wealthiest lobby group in Washington, that of Big Pharma. See link below.
Please don't kill European profits by insisting Washington protects the rights of American citizens over our rights to suck you dry? Please?
http://www.statemaster.com/encyclope...ers-of-America

(Note that the PhRMA is a lobby group representing the pharmaceutical industry in, not of, the US )

[ICantSpellDawg]

Since we already provide food stamps to some, why don't we just buy everybody food?

[Tribesman]

Since we already provide food stamps to some, why don't we just buy everybody food?

You already do.

[Seamus Fermanagh]

People trot this line out all the time. But really, how many things has the government messed up with? Last I checked, the Interstate Highway System and USPS were resounding successes. And it's worth mentioning that we already have nationalized medicine for our government, military personnel AND their families, and the elderly. It's pretty obvious that the government can handle UHC.

Tricare works well, though it does help to minimize costs when well over half of your client base is under the age of 40 and a large minority of the recipients are required to pass physical fitness tests periodically or risk losing their jobs.

Medicare has a raft of problems and is NOT noted for its efficiency. It is noted for encouraging a number of the better physicians to forgoe working with medicare patients at all. Even adjusted for inflation, Medicare is so grossly over the costs predicted for the program at its outset as to be laughable.

My fear is not that the government can't handle UHC, but that it will do so according to its own glorious standards.

Doesn't the constitution explicitly state that the government is responsible for the welfare of its citizens?

No, the preamble to the Constitution states that WE THE PEOPLE are establishing this Constitution to "provide" for the common defense and "insure" domestic tranquility, but only to "promote" the general welfare. Government was meant to encourage that welfare, and to establish conditions that would allow everyone the chance to better themselves. It was never meant to underwrite the whole thing. Our founders would likely to have deemed such a notion preposterous.

Why would you want ANY private insurance? Do you really want the industry to be (mostly) regulated by the people who will profit from it? Besides which, the insurance companies have proven themselves unable to render the services for which they're being paid, over and over and over again. They're worthless and should have been out on their asses years ago.

I think you'd be surprised at the quality of coverage provided if the health insurers were allowed to craft their own policies and provide the insurance needed by the individual themselves. Instead, there are more mandates and "must includes" than you can comfortably list. All such must be paid for and it is impossible in many places for insurance companies to establish substandard ratings and underwrite risk fairly.

I do thank you for your clear expression of a sentiment that I believe DOES underly a segment of the support for UHC in the United States -- a loathing for corporate capitalism. Whether intended or not (and mostly I think it is) the 'public option' will eat private insurance alive. It is impossible to out-compete an entity that can lose money endlessly without ending up bankrupt.

I know a little group of people called "every industrialized nation on the planet except for this one" who would like a word with you.

A foolish opinion, held by thousands, is still foolish.

Still, since many of them can vote, we will very likely see UHC in my lifetime and I will have to learn to cope with life in a Socialist Democracy. Franklin's quip about liberty and safety falls on deaf ears.

I breathe, therefore you are required to feed me, clothe me, entertain me, and keep me healthy to the maximum extent possible. My existence trumps all! Is that not what government is for?

[Lemur]

Still, since many of them can vote, we will very likely see UHC in my lifetime and I will have to learn to cope with life in a Socialist Democracy. Franklin's quip about liberty and safety falls on deaf ears.

I breathe, therefore you are required to feed me, clothe me, entertain me, and keep me healthy to the maximum extent possible. My existence trumps all! Is that not what government is for?

By this logic, should we have publicly funded fire departments? Police departments? Roads? Libraries?

Some things are already judged to be better handled by the government than a business. Do any, some, or all of them make us a "Socialist Democracy"? Is healthcare a special, different thing from any other service? If so, how?

Is every other industrialized nation a "Socialist Democracy"? Does this apply to South Korea, Taiwan, Japan, Australia? If not, why not? If so, why?

Are you suggesting that every other industrialized nation in the world is socialist in some fundamental way that we are not?

[jabarto]

Tricare works well, though it does help to minimize costs when well over half of your client base is under the age of 40 and a large minority of the recipients are required to pass physical fitness tests periodically or risk losing their jobs.

Medicare has a raft of problems and is NOT noted for its efficiency. It is noted for encouraging a number of the better physicians to forgoe working with medicare patients at all. Even adjusted for inflation, Medicare is so grossly over the costs predicted for the program at its outset as to be laughable.

My fear is not that the government can't handle UHC, but that it will do so according to its own glorious standards.

this morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly regulated by the US department of energy.
I then took a shower in the clean water provided by the municipal water utility.
After that, I turned on the TV to one of the FCC regulated channels to see what the national weather service of the national oceanographic and atmospheric administration determined the weather was going to be like using satellites designed, built, and launched by the national aeronautics and space administration. I watched this while eating my breakfast of US department of agriculture inspected food and taking the drugs which have been determined as safe by the food and drug administration.

At the appropriate time as regulated by the US congress and kept accurate by the national institute of standards and technology and the US naval observatory, I get into my national highway traffic safety administration approved automobile and set out to work on the roads build by the local, state, and federal departments of transportation, possibly stopping to purchase additional fuel of a quality level determined by the environmental protection agency, using legal tender issed by the federal reserve bank. On the way out the door I deposit any mail I have to be sent out via the US postal service and drop the kids off at the public school.

After spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the department of labor and the occupational safety and health administration, enjoying another two meals which again do not kill me because of the USDA, I drive my NHTSA car back home on the DOT roads, to ny house which has not burned down in my absence because of the state and local building codes and fire marshal's inspection, and which has not been plundered of all it's valuables thanks to the local police department.

I then log on to the internet which was developed by the defense advanced research projects administration and post on freerepublic.com and fox news forums about how SOCIALISM in medicine is BAD because the government can't do anything right

Okay so you're probably not a freeper but you get my point.

No, the preamble to the Constitution states that WE THE PEOPLE are establishing this Constitution to "provide" for the common defense and "insure" domestic tranquility, but only to "promote" the general welfare. Government was meant to encourage that welfare, and to establish conditions that would allow everyone the chance to better themselves. It was never meant to underwrite the whole thing. Our founders would likely to have deemed such a notion preposterous.

Perhaps. I don't know.

I think you'd be surprised at the quality of coverage provided if the health insurers were allowed to craft their own policies and provide the insurance needed by the individual themselves. Instead, there are more mandates and "must includes" than you can comfortably list. All such must be paid for and it is impossible in many places for insurance companies to establish substandard ratings and underwrite risk fairly.

I do thank you for your clear expression of a sentiment that I believe DOES underly a segment of the support for UHC in the United States -- a loathing for corporate capitalism. Whether intended or not (and mostly I think it is) the 'public option' will eat private insurance alive. It is impossible to out-compete an entity that can lose money endlessly without ending up bankrupt.

Now wait a second. You just said that the government would do a poor job of running a UHC system. Why, if that's the case, would the insurance companies go under? If the government doesn't manage healthcare well, no one will drop their private coverage.

Oh, and I don't think most people want to eliminate the private option. The politicians sure don't.

A foolish opinion, held by thousands, is still foolish.

Still, since many of them can vote, we will very likely see UHC in my lifetime and I will have to learn to cope with life in a Socialist Democracy.

It's only been a generation since McCarthyism and Reagan's subsequent efforts to plunder this country ended. I would be very surprised if UHC happened in my lifetime (and I'm probably younger than you).

Then again, I do think UHC is an inevitability. There wil come a point when the populace has been screwed over badly enough for long enough that something will have to change.

Franklin's quip about liberty and safety falls on deaf ears.

What liberty is being given up in the name of security here?

I breathe, therefore you are required to feed me, clothe me, entertain me, and keep me healthy to the maximum extent possible. My existence trumps all! Is that not what government is for?

Hmmmmm yes why would the government want a happy, healthy workforce? I wonder...

[Tribesman]

Our founders would likely to have deemed such a notion preposterous.

Like they would have deemed bacteria, modern medicine, powered flight, nuclear energy and motorcars as proposterous notions , while finding the notion of slavery normal.

[Seamus Fermanagh]

Now wait a second. You just said that the government would do a poor job of running a UHC system. Why, if that's the case, would the insurance companies go under? If the government doesn't manage healthcare well, no one will drop their private coverage.

Oh, and I don't think most people want to eliminate the private option. The politicians sure don't.

It doesn't matter how poorly they do. They can't go bankrupt if they screw up. If an insurance company makes bad judgement in assigning risk, it loses money. It then has to raise rates to compensate. Raising rates makes it less attractive to potential customers. A "public option" would never need to raise rates no matter how much money it lost as the taxpayers would be forced to absorb the cost -- or do you see Congress voting to direct in increase in co-pays etc. after promising their constituents "free" healthcare? Moreover, as currently written, there is a lot of economic incentive for small businesses to STOP providing any healthcare benefit, thus dumping those workers into the "public option" by default. Admittedly, in the case of this last point, no "final language" bill has been promulgated.

[Papewaio]

A foolish opinion, held by thousands, is still foolish.

Still, since many of them can vote, we will very likely see UHC in my lifetime and I will have to learn to cope with life in a Socialist Democracy. Franklin's quip about liberty and safety falls on deaf ears.

I breathe, therefore you are required to feed me, clothe me, entertain me, and keep me healthy to the maximum extent possible. My existence trumps all! Is that not what government is for?

US of A is the superpower whose citizens enjoy the most personal freedoms. However that does not make the US of A automatically have the citizens with the most personal freedoms in the world. Beating Russia and China in personal freedoms does not put one at the top of the list.

I'm pretty sure there are countries that have UHC + Free Market Economy + Socialistic Democracy that have more personal freedoms for their citizens.

=][=

I see a balance of power. The more free market the economy the more socialist the government needs to be (there are other ways to get to the same end point). Essentially the more powerful the horsepower on the car, the better the suspension need to be to smooth out the trip.

Health Body = Healthy Mind. So to remain competitive on the world stage having a well educated and fit population would seem a smart option to follow. One only has to see the costs of a steadily aging population to understand that lack of working fitness is a major economic drain.

[Evil_Maniac From Mars]

I'm pretty sure there are countries that have UHC + Free Market Economy + Socialistic Democracy that have more personal freedoms for their citizens.

I can't name a single European country with those and more personal freedoms, and I think that is what you're getting at.

[Lemur]

It could vary from state to state, but I only know of one way that could happen. If your plan is part of a network and you went outside the network to get your treatment.

You're assuming I'm on an HMO, which I am not; it's a PPO, and they change what is in and out of network on an arbitrary and daily basis.

Also, you clearly don't understand how they figure the deductible. I don't hit my limit until I have spent X dollars, but they figure X by what they think procedures ought to cost, not by what they actually do. So you could very easily need to be $10,000 out of pocket before you hit their $2,000 deductible limit. It's a total scam.

Life cannot be "legislated" into fairness. Attempting to do so is well-intentioned utopianism.

Given how many real-world examples there are of national health systems that work adequately, I don't think you need to be a starry-eyed idealist to say that those systems deserve serious consideration. Empiricism, to my way of thinking, is the opposite of utopianism.

[Xiahou]

You're assuming I'm on an HMO, which I am not; it's a PPO, and they change what is in and out of network on an arbitrary and daily basis.

No, I've never been in an HMO and I didn't assume you were either. The situation you described sounds exactly like what could happen if you got a procedure outside of your provider network. Generally speaking, out of network HMO care is just flat out denied coverage. All non-emergency care must go through the HMO. When you're talking in-network and out of network coverage, you're talking about PPOs.

Also, you clearly don't understand how they figure the deductible. I don't hit my limit until I have spent X dollars, but they figure X by what they think procedures ought to cost, not by what they actually do. So you could very easily need to be $10,000 out of pocket before you hit their $2,000 deductible limit. It's a total scam.

Nope, I understand deductibles, but I think you're talking about the out of pocket maximum. Again, being in network or out of network makes all the difference. My max out of pocket for a family was $2500 in network and it jumped to $10,000 for out of network service. When you're part of a PPO type plan, it's just a bad, bad idea to go to a provider who isn't part of the network. Whenever I was thinking of moving, I would get on my insurers website and make sure there was an in-network hospital nearby (there always was). To be put in the position of going to a non-network hospital for treatment could end up costing thousands of dollars.

I'm not saying it's perfect, but I don't think it's accurate to say that they screwed you over with some sort of bait and switch. I'm sure had you called and told them that you were having procedure A done out of network, they would've told you how much they'd reimburse for it. Out of network coverage is always expensive, and in my opinion, best avoided.

For anyone interested, here's a description of HMOs, PPOs, and POSs. I've had experience with the last two, but never an HMO.

[Lemur]

A "hospital" that was in newtwork? ORLY? Are you quite sure?

A girl I used to work with did just as you described, made sure the clinic where she was getting the procedure was in-network. Turns out the radiologist was not. So the surgeon was fine, the nurses were fine, the pharmacy was fine, but the radiologist was not. And she got stuck with a really nice bill. Last I talked to her, she was still paying it off.

Normal people can't compete with that kind of bureaucratic opacity. Most of us have jobs and lives. The status quo is untenable.

[Xiahou]

A "hospital" that was in newtwork? ORLY? Are you quite sure?

A girl I used to work with did just as you described, made sure the clinic where she was getting the procedure was in-network. Turns out the radiologist was not. So the surgeon was fine, the nurses were fine, the pharmacy was fine, but the radiologist was not. And she got stuck with a really nice bill. Last I talked to her, she was still paying it off.

Normal people can't compete with that kind of bureaucratic opacity. Most of us have jobs and lives. The status quo is untenable.

Yeah, a hospital. Which isn't a clinic. In a clinic, individual doctor's can and often are treated as separate practices. You need to make sure the specialist that you're there to see is in network.

The flip side of that is if the provider is in-network, but the clinic itself is not. If the provider orders up tests and you get them performed at the clinic, which is out-of-network, you can quickly find yourself in billing hell. That's a definite sore spot for PPOs. Luckily, most of us will never encounter that- the examples I've seen of it involved people with rare diseases or conditions who need care at very specialized facilities. Unfortunately, people in those situations are going to have a difficult, expensive future ahead of them no matter what insurance they have.....

The question is, should the entire system be changed to accommodate these cases? If the government forces insurers to allow people specialized care at any facility of their choosing, what will happen to everyone else's costs? It's not hard to find stories of maltreatment for chronic disease sufferers in countries with government-run healthcare, so I don't think it's a panacea either.

From my perspective, I kind of like the way HMOs look. My wife and I are both fairly young and healthy so we don't need specialized care and an HMO would offer comparatively low premiums and offer near total coverage for any common medical services we'd be likely to have. Plus, pretty much all non-emergency care has to be referred thru your primary physician and pre-approved, taking the guess work out of what's going to be covered where. Unfortunately, there just aren't any available to me due to the tangle of rules and regulations that cover the insurance industry.

If the government must meddle in health coverage, I think the most helpful things it could do is separate medical coverage from employment, improve transparency, and break down barriers to insurance competition. Of course [I]something/I] is going to have to be done about medicare/medicaid too. Those are the 500lb gorillas that everyone is afraid to look at- Im afraid no one is going to have the courage to fix those until it's too late.