From the New York Times: http://www.nytimes.com/2008/04/29/health/policy/29kaiser.html

According to a new study commissioned by the Kaiser Foundation, for every one percent increase in the unemployment rate we can expect 1.1 million people to lose their health insurance (60% of these will be children).

At the same time, a one percent increase in unemployment cuts state revenues by 3-4 percent, so states' requirements to balance their budgets will require that programs for the uninsured (Medicaid, SCHIP), which are already being cut, be cut further.

In a separate poll, also conducted by the Kaiser Foundation, 28% of Americans said they had a serious problem paying for health care, 42% reported that they or a family member had skipped some sort of medical treatment because of cost and 24% said they had declined a recommended test or treatment because of cost.

It will be interesting to see whether this ends up having much effect on the election. Remember that back when they actually talked about issues, Hillary and Barack had an honest difference as to whether the government ought to require that everyone have health insurance (Hillary) or whether poor people ought to be given the "option" of remaining uninsured (Barack):"Sen. Clinton's idea is that we should force everyone to buy insurance," Obama said in a statement released to CNN on Sunday. http://www.cnn.com/2007/POLITICS/11/26/clinton.obama.health/index.html

...or whether poor people ought to be given the "option" of remaining uninsured (Barack)


Yes, mandates or no mandate (for adults without kids). Remember Obama does require people with children to buy insurance. And Obama points out that mandates must have sanctions to enforce them, so if someone does not get insurance, Clinton would punish them. Otherwise the mandate is not really a mandate.

And I don't think your "poor" reference is as accurate as it might be. It is not just the poor that get to opt out. Also, Obama's plan does have subsidies for the poor via medicaid and SCHIP, and further subsidies for those that have too much to qualify for those programs:

Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.

http://www.barackobama.com/issues/healthcare/

Personally I think both programs are improvements over the current situation, but don't come close to what should be done. Mandates are the better policy, but will be a lot harder to get past a senate fillibuster and enacted into law.

The problem is that health care in this country is for profit once that is taken out of the equation the price may come down.
National Health care works in many of the industialized nations of the west(most of europe) and yes there are some problems. But our current system has many many more.

I agree that mandating health care may be somewhat difficult...

But, like auto insurance, perhaps companies could be seen as the enforcers? Many companies ask you if you have auto insurance when you apply for work, the same can be done for health insurance. Not so much a penalty, but a social pressure ensuring compliance. Especially since it would be in the company's best interest to hire insured employees as they are directly affected by said employees health.

Since the poor will likely be covered by a medicaid type fix, this should resolve the mandate accountability issue.

See, was that all that difficult?

Yes, mandates or no mandate (for adults without kids). Remember Obama does require people with children to buy insurance. And Obama points out that mandates must have sanctions to enforce them, so if someone does not get insurance, Clinton would punish them. Otherwise the mandate is not really a mandate.

And I don't think your "poor" reference is as accurate as it might be. It is not just the poor that get to opt out. Also, Obama's plan does have subsidies for the poor via medicaid and SCHIP, and further subsidies for those that have too much to qualify for those programs:

Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.

http://www.barackobama.com/issues/healthcare/

Personally I think both programs are improvements over the current situation, but don't come close to what should be done. Mandates are the better policy, but will be a lot harder to get past a senate fillibuster and enacted into law.

You are right to call me out for my oversimplification. My biggest problem with the opting out provision is that it threatens to destroy the insurance market through adverse selection. Also, if you allow someone to opt out and simultaneously offer guaranteed coverage for prior conditions, you introduce a serious moral hazard.

The only way insurance can work is to require that everyone be covered. If you don't you always end up in a death-spiral of increasing premiums driving healthy people to opt out, which drives premiums even higher, and so forth, or else insurance companies canceling policies on the sick in order to control costs. Neither of these is desirable and that's at the heart of my criticism of Obama.

But Obama did specifically focus on the poor with his "opt out" comments in the piece I quoted, in which he accused Clinton of requiring poor people to buy insurance that would be beyond their means.

My preference is for a straight socialized single-payer system to provide basic care with the option to buy private insurance to supplement it. This approach seems to work best (look, for instance, at France (http://www.businessweek.com/magazine/content/07_28/b4042070.htm)). The problems with Canada's system stem in large part from its prohibition of supplementary private insurance, not from the baseline of socialized insurance. But that's not going to happen here and I think there are enough differences between the Clinton and Obama plans to make Clintons clearly superior (http://www.nytimes.com/2008/02/04/opinion/04krugman.html?_r=1&oref=slogin).

Here is a good, clear discussion (http://www.nytimes.com/2008/01/02/business/02leonhardt.html) of the differences between the two Democrats' policies and the philosophical underpinnings of their differences. Curiously enough, I am much more compelled with Obama's reasoning (focusing policies on what we know about real people's psychology of risk and time preference instead of assuming idealized rational economic actors) but still prefer Clinton's mandates because for all his criticism of them, Obama doesn't offer a better alternative.

My preference is for a straight socialized single-payer system to provide basic care with the option to buy private insurance to supplement it. This approach seems to work best (look, for instance, at France (http://www.businessweek.com/magazine/content/07_28/b4042070.htm)).

We are in agreement on this.

I ain't weighing in here, except to say this is one of the smartest posts I've ever read on this forum. Well done.

You are right to call me out for my oversimplification. My biggest problem with the opting out provision is that it threatens to destroy the insurance market through adverse selection. Also, if you allow someone to opt out and simultaneously offer guaranteed coverage for prior conditions, you introduce a serious moral hazard.

The only way insurance can work is to require that everyone be covered. If you don't you always end up in a death-spiral of increasing premiums driving healthy people to opt out, which drives premiums even higher, and so forth, or else insurance companies canceling policies on the sick in order to control costs. Neither of these is desirable and that's at the heart of my criticism of Obama.

But Obama did specifically focus on the poor with his "opt out" comments in the piece I quoted, in which he accused Clinton of requiring poor people to buy insurance that would be beyond their means.

My preference is for a straight socialized single-payer system to provide basic care with the option to buy private insurance to supplement it. This approach seems to work best (look, for instance, at France (http://www.businessweek.com/magazine/content/07_28/b4042070.htm)). The problems with Canada's system stem in large part from its prohibition of supplementary private insurance, not from the baseline of socialized insurance. But that's not going to happen here and I think there are enough differences between the Clinton and Obama plans to make Clintons clearly superior (http://www.nytimes.com/2008/02/04/opinion/04krugman.html?_r=1&oref=slogin).

Here is a good, clear discussion (http://www.nytimes.com/2008/01/02/business/02leonhardt.html) of the differences between the two Democrats' policies and the philosophical underpinnings of their differences. Curiously enough, I am much more compelled with Obama's reasoning (focusing policies on what we know about real people's psychology of risk and time preference instead of assuming idealized rational economic actors) but still prefer Clinton's mandates because for all his criticism of them, Obama doesn't offer a better alternative.

Obama's 'opt out' option is a health care bubble that has gotten us to where we are today.
(Hey, I didn't even have to mention race and Obama in the same sentence. Go figure... Somehow that race card he's playing doesn't have to be played everywhere...)

This is why I like Hillary's health care better. Not to mention, that Taiwan analyzed the global health care systems and selected one that resembles Hillary's. That tells me a lot!

The best thing to do for health care system is to get the insurance companies out of it.

This is something I've had in mind for a week or two. Employment issues aside, here is a situation that has hit my family, and I'm sure will hit others soon.

My mother is 58. She was laid off in the last recession (about 4-5 years ago.) While she's competent and capable, she's a computer person, and there are more than enough of those to go around.

She's also been diagnosed with a polycystic disorder that has resulted in part of one kidney being removed, and there are cysts in her liver.

I'm sure that there are, or have been, a lot of baby boomers like her getting laid off, for simple mathematical reasons. Their coverage is more expensive, especially or those who have been diagnosed with any problems... and by this point in their lives, it's likely that they have. It's cheaper to hire someone who's younger, and has less experience, and also, who's cheaper to insure.

So mom's really kinda stuck. She's self-employed, as a result of being unemployed, and she's having a hard time making ends meet. Insurance for her is much higher due to her age and her medical history. And because we live in Massachusetts, it means that any potential employer would have to provide coverage, and for someone her age, it'll cost more. So she's less employable than ever, and getting less so as time goes on, and thus less likely to be able to afford health insurance.

As I said, I live in Massachusetts, and we're all told we have to have insurance, it's the law now. But for her, and with her history, it's really, really expensive. I don't expect a straight answer from her on the topic, but my educated guess is that she simply doesn't have it, can't afford it. The consequences up here are that the uninsured lose their tax exemptions. I think, for her, that this is still probably cheaper than ponying up the dough for insurance... but since she's self-employed, and seems regularly short on cash, I don't know what her taxes look like, either. So the penalties are there... but in this case, it really seems like adding insult to injury.

Now, it's not all gloom and doom for every resident... there is a state-sponsored plan for the poor (defined as those who make less than twice the poverty line, I think) but the fact remains that it means people who can't afford will have to admit that they can't afford... and that's a hard thing to stare in the face, and I think that the older folks who have been busting their ass for decades have a harder time handling that than some of us younger ones do. We still have time to make up for that for ourselves.

I think the insurance guys have to be taken out of the loop. I don't see any way to get decent health care for a reasonable cost if the insurance company is responsible for paying dividends to their shareholders. My dumb-assed understanding of insurance is that it's a numbers game, and that over time, it's expected that you'll pay enough to cover what you'll eventually need. But now that so much of the population is hitting retirement age, and given that medicare and medicaid are worse off than social security, the insurance companies are going to be forced into some really screwy tactics if they're going to remain profitable and still cover the old folks. And the only tactic I can see that will work is for them to start heavily overcharging the rest of us to stay afloat.

There's the possibility that the insurance could be subsidized by government to avoid having to raise prices, but there's a hard line to draw. One of the local insurance providers (Tufts) took a hit almost immediately when the law went into effect. Tufts is one of the providers of choice, and people know that. Tufts got swamped. So providing insurance for everyone really is more expensive. It takes a lot more in terms of human resources to handle such a massive load of paperwork. And that means more salaries. So who's to say that insurance is costing more because of the real world cost of running the offices, or because they're gouging everyone else to cover their losses on the old folks.

So, those who are insured are having to pay more, and that's a fact of life. Policy rates have gone up. And insurance companies can safely raise rates, anyway, because they know that people need to be insured now. So it hits the people who can afford... even though it's harder to afford these days.

But for folks like my mother... and I have to imagine that after 2 recessions, there are a lot more older folks who are out of work, and still getting older... it still doesn't really help. We're facing a lot of upcoming crises. The baby boomers are still retiring, and that's going to take its toll on social security, medicare, medicaid, and on insurance policies as well, since I doubt that the providers have really been squirreling away every dollar. Even if we mandate insurance for everyone, that means we're all going to have to cover the policy writers' costs for covering the swelling numbers of elderly. It's a clever way of dumping some of the cost on to the general populace... and we'd have to fund it one way or the other, but I think I'd rather pay the high taxes, and have some sort of universal health care system in place. The government is responsible to the taxpayers. The insurance companies aren't.

Uber, thanks for sharing. With major complex problems such as health care, I look at it this way, we have to start somewhere. It works in other countries, it can work here. We just have to be willing. I think Hillary's plan is the best. Taiwan had recently analyzed global health care systems including our current one, and they selected a system similar to Hillary's. To me, that speaks volumes.

Good luck with your mom.

I think Hillary's plan is the best. I agree that Hillary's plan is the best of what's on offer, but uber-stupid writes:
I don't see any way to get decent health care for a reasonable cost if the insurance company is responsible for paying dividends to their shareholders.
and Hillary, Obama, and McCain all want to keep sending all your health care dollars through private insurance companies, who will deduct a significant fraction for profit and overhead, leaving less to pay the doctor.

...and Hillary, Obama, and McCain all want to keep sending all your health care dollars through private insurance companies, who will deduct a significant fraction for profit and overhead, leaving less to pay the doctor.


....and there inlies the problem.


Other than the argument that it's not the government's role to provide healthcare to the People, an argument that's a load of horseshit when you consider everything else we expect of the government, I have not heard a single compelling, fact based case against a single-payer system that covers basic care that can be supplemented by private insurance. Not one.

There's a lot of anecdotal BS and hyperbole out there but nothing based in reality.

....and there inlies the problem.


Other than the argument that it's not the government's role to provide healthcare to the People, an argument that's a load of horseshit when you consider everything else we expect of the government, I have not heard a single compelling, fact based case against a single-payer system that covers basic care that can be supplemented by private insurance. Not one.

There's a lot of anecdotal BS and hyperbole out there but nothing based in reality.


very complex, and while a single payor system makes some sense, it can also create a TON of problems.

First, no one should expect mortality and morbidity statistics to change, or disease outcomes to change simply based on changing the payor system. There are far too many cultural variables at play here.

Two, We already have a single payor government run healthcare in two forms. One, is the VA, which is hopelessly bogged down in the chronic disease of the goverment itself. Beauracracy (?sp). Anecdotally, I posted some time ago about my B-I-L who has been diagnosed with lung cancer (OVER two months ago), he is doctoring through the VA and guess, what........HE STILL HASN'T EVEN STARTED ANY TREATMENT YET........Scandalous, and unacceptable.

The other form is Medicare, which pays a ridiculous pittance that does not even begin to cover most treatments tests, etc. Many, MANY institutions no longer accept medicare assignment. We do NOT. We will send medicare a bill, and take whatever they pay, HOWEVER, the patient will STILL BE RESPONSIBLE for whatever medicare does not pay, which is sometimes substantial.

When I was in the military, if you wanted to order a CT or MRI, you had to fill out FORM after FORM, and jump through all kinds of hoops to justify the test......meanwhile the patient sits suffering quietly.

IMHO, the government is fairly incapable of pretty much doing anything competently and efficiently, and the sheer levels of idiocracy present within much of the federal dumberment leaves me with absolutely no confidence that they can run a system as complex as healthcare.

OTOH, 50 million uninsured is not acceptable either.....I don't know what the answer is. But my faith rests not in the government. Perhaps, a government funded private insurance plan that is COMPLETELY RUN BY A PRIVATE INSURER, and merely funded by the government. But this is a serious issue, and far more complex and nuanced than has simply been presented here.

First, no one should expect mortality and morbidity statistics to change, or disease outcomes to change simply based on changing the payor system. There are far too many cultural variables at play here.

Yes, why would anyone think that more women getting prenatal care, and kids getting care growing up, would mean they would be any healthier or less likely to die. That is just silly. And while a few kids might not die from a toothache*, I am sure that would not change the statistics since clearly more people would die from.... other stuff.

* http://www.washingtonpost.com/wp-dyn/content/article/2007/03/02/AR2007030200827.html


Two, We already have a single payor government run healthcare in two forms. One, is the VA, which is hopelessly bogged down in the chronic disease of the goverment itself. Beauracracy (?sp). Anecdotally, I posted some time ago about my B-I-L who has been diagnosed with lung cancer (OVER two months ago), he is doctoring through the VA and guess, what........HE STILL HASN'T EVEN STARTED ANY TREATMENT YET........Scandalous, and unacceptable.

Yes, because as we know, no one covered by private insurance has ever had treatment delayed by bureaucracy, or had treatment denied, or been dropped from coverage once they started to draw on their insurance and not just pay into it. *

* http://abcnews.go.com/WN/story?id=3846673

There are plenty of successful healthcare systems in place in other countries. Why can't the US government do some research and figure this crap out. It's probably really simple.

There are plenty of successful healthcare systems in place in other countries. Why can't the US government do some research and figure this crap out. It's probably really simple.


The politicians and the voters are the ones who need to do the research and voters need to support the politicians/candidates with the best plans with their votes.

That was good.

I would like to see the health care system become unattached to employment. I think it was a huge mistake to link the two when originally done. There are multiple reasons for this, but it has created some very large problems.

I am coming around to the idea of basic care / single payer system and private supplemental insurance. There are problems with it, but I would think they can be worked out.

As to behavioral economics as described in the NY Times piece, I'm in the Obama camp. People do not act rationally, and there are mountains of evidence to show this. I am most familiar with behavioral finance and how people make investment decisions based on emotion rather than data, but I am convinced that they (we) don't act in their (our) best interests.

One last item - HRCs use of targeted tax incentives compounds the problem of the complexity of the tax system, while also laying the groundwork to paying favors for special interest groups. I think that is the exact opposite of what should be done. A simpler code with fewer favors to targeted groups.

I am coming around to the idea of basic care / single payer system and private supplemental insurance. There are problems with it, but I would think they can be worked out.

As to behavioral economics as described in the NY Times piece, I'm in the Obama camp.



Ok, who are you, and how did you steal moneyman's password? Because that is some pretty undiluted liberalism you just wrote.

Ok, who are you, and how did you steal moneyman's password? Because that is some pretty undiluted liberalism you just wrote.

Its just being open minded. Truth is, I have been influenced by some of those posting here. You, OES, Fredke, TMB, et al. Amazing what a guy can learn from people who know more than he does and are willing to share their knowledge.

I think the employer involvment has to continue or wages have to increase by enough to offset the loss of employer contribution. The problem I see with the dual system is that it cherry picks the younger and healthier portions of the population and leaves older and chronically ill to pay the high premiums for the suplemental insurance. no different than allowing insurance companies to cherry pick. I'm for a single provider all the way with government, employer and personal contributions according to income. Socialize it or privatize it but a mix is going to leave out the middle while taking care of both ends.

I think the employer involvment has to continue or wages have to increase by enough to offset the loss of employer contribution. The problem I see with the dual system is that it cherry picks the younger and healthier portions of the population and leaves older and chronically ill to pay the high premiums for the suplemental insurance. no different than allowing insurance companies to cherry pick. I'm for a single provider all the way with government, employer and personal contributions according to income. Socialize it or privatize it but a mix is going to leave out the middle while taking care of both ends.

Problem with the employer involvement - Not everyone works for someone. I'm self-employed, can't join a big insurance pool, and a cancer survivor. I've said this here before, and I'm pretty much screwed as to choices. When my current insurance company raises its premiums, which generally happens twice a year, all I can do is say "Thank you sir, may I have another."

My cancer treatments were relatively cheap: Under $50k for the works. I'll easily spend that in premiums over the next 5 years. In addition, to keep the costs reasonable, I have a $10k deductible. I have been paying premiums into this plan for about 12 years. When I needed to collect, the insurance company wrote the checks, then raised my premiums. To this point, they have certainly made a smart investment by insuring me. They have collected far more in premiums than they have paid out.

In the event that the docs inadvertently left a few cancer cells floating around in my body, that's where I can really put it to the insurance company, though. I'll need a combination of chemo, hormone therapy and radiation, maybe some hospital stays, and who knows, possibly hospice services as well. I can't wait till those sonsa*****es have to write those checks.

Bitter? Me? Never. Sometimes the reality of the situation just sucks. I have to live with the fact that there's about a 50/50 chance that grim scenario I painted comes to fruition. In addition, there's a 100% chance that the insurance company will raise my premiums again and again and again.

That's why I think the employer involvement system doesn't work. But that's just me.

Same thing happens for small businesses. One employee gets cancer and that company's group policy rates go through the roof. There's a good article here (http://www.nytimes.com/2008/03/27/business/smallbusiness/27sbiz.html)in the NY Times on insurance problems for the self employed and small business owners.

There are some really sharp minds at work in this thread. It is good for Americans to be engaged in a conversation about their healthcare, rather than who won American Idol last night, or whenever that thing ends :rolleyes: .

The combination socialized healthcare and optional privatized insurance seems to be a great meeting in the middle. But I still have a nagging question in my mind: Doesn't it seem that the idea of keeping people well and living longer even if they cannot pay appear to be contradictory to a capitalistic society where everything comes down to money in versus money out? What we are talking about is a product/service that is truly life and death in its necessity (unlike oil..), but the price of this product/service continues to escalate at faster and faster levels (like oil).

Truly, we cannot make the determination in our lives as to whether we can use less healthcare or find an alternative to healthcare. When you have a medical need, you have it, and you can't take the bus or bike to work.

I see issues with employer involvement, too, though.

I think for big companies who are sitting on a lot of capital, but who are miraculously not handing out huge bonuses, it might work, because they can afford to pay. But for so many smaller companies (A small business is defined as a company with 500 or fewer employees) it really hurts. Me? I'm in the process of starting up a small business, designing and building custom furniture. I'm an open minded, free thinking, pretty liberal guy. But that doesn't put more money in the bank to help fund this kind of thing.

Wages should go up, but I think that's a whole other issue. Wages are a fixed dollar amount, and as we've all seen lately, the dollar is anything but a fixed value amount. The price of everything is going up. I think at this point I'd rather be paid in items of fixed practical worth like gasoline and bread, so that I know that I'll be getting the things I need. 10 bucks isn't ten bucks anymore if it's not able to buy what it used to. Keeping up with inflation doesn't help if inflation can't keep up with the actual cost of living.

Back to insurance... I've been in the Army, I'm familiar with paperwork... but I'm also familiar with the basic understanding that when the paperwork was wrapped up, something usually happened. But even then, I think civilian medicine would be handled a lot differently, since the VA hospital system is notoriously over-wrought. When there's a fire, or a 911 call, the paperwork happens later. If the 911 operator directed the caller to a website to fill out the requisite forms, it would be ugly. The evening news would have footage that very night of crows picking out the operator's insides.

When there are civilian voters who are able to decide if they're happy with the way things are being run, things can change. Soldiers can't vote. It's one of the perks. And for all of our complaints, the fact is that there are government agencies who have demonstrated an ability to run efficiently and cut the fat from their operation.

I'll admit that I think that the system has to break before it can be fixed, and it will only be fixed in increments. If the government announced tomorrow that there would be a heavy additional income tax to cover health care, the country would collectively sh!t itself. If we're stuck dealing with health insurance providers, I think it would provide incentive for us to make sure that there were regulatory laws governing their behavior. If we need to be insured, they have to provide the insurance, and they have to provide the coverage (...or they DIE!) It's a cooperative system. And eventually I think the strategy is that the populace would grow collectively fed up enough with privatized health care to demand a government run system.

We do need to be able to gauge what it would be like, for hospitals, for insurance companies, for administrators... if everyone were insured. We need to be have a way to say "OK, everyone's there, this is what it's costing us," before we can see what needs fixing. I'm hoping that the Massachusetts experiment is one of the stepping stones that gets us there. But the fact is, it's a pretty big endeavour. I think that once the taxpayers all have to have insurance, they'll collectively be able to shout down things like:

-higher medication prices.
-tort law favoring lawyers instead of doctors. I doctors could actually be tried by other doctors... you know, an actual jury of their PEERS, that the cost of insuring against malpractice would drop a lot.
-high profits for the insurance companies. If we have to be insured, the government is the only tool we have to be able to regulate what we're paying.

I do still lament the situation my mom is stuck in. It does suck. But I think that the point is long past where we really needed to do SOMETHING. I think I like Obama's ideas better, and if it actually is the case that he's in favor of simpler policies that are actually easier to comprehend, then I'll fall on his side in this thing. But one way or another... enough is enough. It's not going to be pretty, no matter how we swing it. And for all our lamentations about Military spending, and the actions of the Fed, I don't think that special interests' interests are going to be neglected any time soon, until we're able to collectively line them up against the wall.

But we also have the benefit of retiring baby boomers. They're the ones who are going to suffer if this doesn't work itself out. And everyone knows that old people have nothing better to do than sit around and vote. I'd love to see the mass of them rise up and say "Hey, you see this world and economy that we built? Well, we hate it! So there! nyahhhhhhh."

Boy did I wake up on the weird side of the bed this morning... I'm going to go get more coffee.

I agree that Hillary's plan is the best of what's on offer, but uber-stupid writes:
I don't see any way to get decent health care for a reasonable cost if the insurance company is responsible for paying dividends to their shareholders.
and Hillary, Obama, and McCain all want to keep sending all your health care dollars through private insurance companies, who will deduct a significant fraction for profit and overhead, leaving less to pay the doctor.

Yup, the whole issue of a for profit health care system is a major problem. From the pharmaceutical cos, to the insurance cos, to the doctors and lawyers...etc. The difficulty is selecting which segment to target without destroying the entire system. I believe Hillary's plan creates a foundation for modifying the system, and provides for a way forward, while at the same time covering everyone.

Obama's plan includes the irresponsible aspect of "opting out" which has in part created/contributed to the very health care bubble we have today. If you opt out, then you put the system at risk cause you cannot predict when/how you get sick. So, when you do get sick, our society inevitably bears the cost.

Some things like health care, and education, should be exempt from our capitalist "for profit" society.

Yes, why would anyone think that more women getting prenatal care, and kids getting care growing up, would mean they would be any healthier or less likely to die. That is just silly. And while a few kids might not die from a toothache*, I am sure that would not change the statistics since clearly more people would die from.... other stuff.

* http://www.washingtonpost.com/wp-dyn/content/article/2007/03/02/AR2007030200827.html




Yes, because as we know, no one covered by private insurance has ever had treatment delayed by bureaucracy, or had treatment denied, or been dropped from coverage once they started to draw on their insurance and not just pay into it. *

* http://abcnews.go.com/WN/story?id=3846673


In the case of dental care, yes, but that's not exactly the same as health insurance. Many dentists I know, now refuse ANY insurance and will only accept cash payment. It would be YOUR responsibilty to submit the bill to insurance to recover whatever you could. According to the ones that I know, there are MANY dentists going to this format now. I won't argue the poor access to dental care if you are poor, but as far as health care, I've seen FAR, FAR too many people who HAVE insurance or even medicaid, and do not ever go to their physicians for primary care, or preventative medicine. Far too many. One of my favorite questions, and I am usually kind of, well let's be kind, and say blunt about this, is I ask any patient with symptoms lasting longer than 48 hours......"Have you talked with your regular doctor about this?" WELL, over 90% say no....then I ask them rather directly....."Why not?" Usually get the response that they haven't had time to call, or didn't want to bother them. My favorite response is "No, I don't even know who it is"...to which I will reply, "Oh, so you don't have one then?", and I get the "NO, I have one, I've just never seen them."....MEANWHILE, the chart shows multiple visits to the ED over the preceding years.

Sorry, but I have little faith in people, and NO faith in the government.

As to your second statement...yes, our health care system is failing, and needs help. I believe I stated that above. I'm just not sure what the correct remedy may be. I stated above, that something HAS to be done, that much is certain. But we have to make sure that the remedy is not worse than the disease.

I'm a bit confused with these anecdotes. You work at the ER right, so you will almost by definition get the worst cases of people not given a sh!t until they are truly in trouble. (sure there are accidents that have to go to the ER but that is not the discussion here, right).
How can that sample in any way be used to probe the population as a whole? You will hardly ever see the people that went to the doctor when they had some discomfort in the nads and got an early diagnosis.


In the case of dental care, yes, but that's not exactly the same as health insurance. Many dentists I know, now refuse ANY insurance and will only accept cash payment. It would be YOUR responsibilty to submit the bill to insurance to recover whatever you could. According to the ones that I know, there are MANY dentists going to this format now. I won't argue the poor access to dental care if you are poor, but as far as health care, I've seen FAR, FAR too many people who HAVE insurance or even medicaid, and do not ever go to their physicians for primary care, or preventative medicine. Far too many. One of my favorite questions, and I am usually kind of, well let's be kind, and say blunt about this, is I ask any patient with symptoms lasting longer than 48 hours......"Have you talked with your regular doctor about this?" WELL, over 90% say no....then I ask them rather directly....."Why not?" Usually get the response that they haven't had time to call, or didn't want to bother them. My favorite response is "No, I don't even know who it is"...to which I will reply, "Oh, so you don't have one then?", and I get the "NO, I have one, I've just never seen them."....MEANWHILE, the chart shows multiple visits to the ED over the preceding years.

Sorry, but I have little faith in people, and NO faith in the government.

As to your second statement...yes, our health care system is failing, and needs help. I believe I stated that above. I'm just not sure what the correct remedy may be. I stated above, that something HAS to be done, that much is certain. But we have to make sure that the remedy is not worse than the disease.

Problem with the employer involvement - Not everyone works for someone. I'm self-employed, can't join a big insurance pool, and a cancer survivor.

One policy solution to this is to allow people who are self employed (you, farmers, etc) and businesses below a certain size to purchase insurance from the same pool as state employees. There are some advantage to such a plan. + I know our governor proposed such an idea at one time, but I don't think it went anywhere. I do think it a good idea as a stopgap measure, and one to help people like you.

Note, this is different from state insurance pools, like the one your state has: http://www.healthinsurance.org/risk_pools/ Those are small separate pools for those who can't get insurance. It would be far better to allow anyone to join the state employee pool, rather than create a different high risk pool.

I did want to pass along that link, you might find it useful at some point.

One of the big issues in emploer involvement is a transitionary (potentially) issue. Like it or not, a very high percentage of health care dollars are being born by business now. I've been involved in decisions around employer provided plans for 30 years & while the employee portion has increased both in dollars and as a % of the policy cost over that time, the employer portion is still way over 50% of the costs in most companies. So whatever happens, whatever plan is adopted, if we go to a single payor plan, these dollars have to be captured somehow.....or all you are doing is giving businesses a big benefit at either the expense of the individual or the government (& hence the individual).

As to somone's comment about the inefficiency of government run programs, I would point to the Social Security administration as one that is run pretty damn efficiently. Check out the administration costs as a % of total outlays....and I don't hear many complaints about people not getting their checks. I think it's possible to run the program efficiently....it's just going to take some hard decisions....as I've posted on numerous occasions.

Len

Ok, there exists decades of statistics that say exactly what percentage of the population gets this or that illness, life expenctancy, desease, ceasarian sections, lung cancer etc. These numbers exist. Therefore it is possible to calculate the cost of healthcare for the entire USofA. It is also theoretically possible to design an efficient way of managing and executing a healthcare system for the country.

The insurance companies know these statistics very well. Their amibition is to only insure the healthy and not the people who are prone to sickness. That's just smart business. If they are stuck with high risk people, they jack the rates up without mercy. If someone gets sick within a group of low risk people, it's a great excuse to raise rates for the group even though statisticly it doesn't make sense.

Having many insurance companies in not as efficient as having one insurance company (the government). Everyone is insured. The statistics are known and the costs are predictable.

I'm a bit confused with these anecdotes. You work at the ER right, so you will almost by definition get the worst cases of people not given a sh!t until they are truly in trouble. (sure there are accidents that have to go to the ER but that is not the discussion here, right).
How can that sample in any way be used to probe the population as a whole? You will hardly ever see the people that went to the doctor when they had some discomfort in the nads and got an early diagnosis.


True enough, and I am seeing a specific subset of the population as a WHOLE.

HOWEVER, most recent ED studies have discovered an unnerving trend, that is, that more and more people, both insured and uninsured are beginning to view and utilize the ED as a convenient care model. ED visits are up nationally exponentially, and this is putting a real crunch on the system. In many big city ER's, wait times can reach 12-15 hours, and people are often examined in the waiting room or in a hallway. Recent data suggests that this trend will continue to worsen, and may increase M&M due to overcrowded ED's.

One policy solution to this is to allow people who are self employed (you, farmers, etc) and businesses below a certain size to purchase insurance from the same pool as state employees. There are some advantage to such a plan. + I know our governor proposed such an idea at one time, but I don't think it went anywhere. I do think it a good idea as a stopgap measure, and one to help people like you.

Note, this is different from state insurance pools, like the one your state has: http://www.healthinsurance.org/risk_pools/ Those are small separate pools for those who can't get insurance. It would be far better to allow anyone to join the state employee pool, rather than create a different high risk pool.

I did want to pass along that link, you might find it useful at some point.

When you add an influx of high risk to a limited insurance pool, you change the dynamics and those in that pool have to collectively pay the difference. Far better for a federal program like medicaid to spread the cost out among the whole population rather than over burden an existing pool. If we're gonna go for it, lets go for it. O-bama, O-bama, O- bama. :)

If we're gonna go for it, lets go for it.


I agree. I'd also suggest taking what we have in SSI to cover the difference between what we pay and what employers pay. SSI is not enough to live on. Take away the costs of healthcare for retirees and I'd be willing to bet that it's a wash or it's a win for the vast majority of retirees with no perceived increase for the rest of us.

When you add an influx of high risk to a limited insurance pool, you change the dynamics and those in that pool have to collectively pay the difference. Far better for a federal program like medicaid to spread the cost out among the whole population rather than over burden an existing pool.

The idea to add people to the state pool is a stopgap measure. It is to make things better, but I have said before that state level programs are problematic for many reasons.

I have also said before my 3 word slogan/plan is "Medicare for everyone!" Works better as a slogan than a policy, but as a policy it would work better than what we have now. Medicare, the thing the old folk get, not that nasty medicaid, which is clearly bad, being for poor people and all.

The idea to add people to the state pool is a stopgap measure. It is to make things better, but I have said before that state level programs are problematic for many reasons.

I have also said before my 3 word slogan/plan is "Medicare for everyone!" Works better as a slogan than a policy, but as a policy it would work better than what we have now. Medicare, the thing the old folk get, not that nasty medicaid, which is clearly bad, being for poor people and all.


Good, then people will STILL have to pay for a portion of their bills.....because if they simply expanded medicare without drastically increasing the reimbursement, providers will continue to bill patients for the remainder of the amount due. Poor people will STILL get bills that they cannot afford. :thumbsup:

The idea to add people to the state pool is a stopgap measure. It is to make things better, but I have said before that state level programs are problematic for many reasons.

I have also said before my 3 word slogan/plan is "Medicare for everyone!" Works better as a slogan than a policy, but as a policy it would work better than what we have now. Medicare, the thing the old folk get, not that nasty medicaid, which is clearly bad, being for poor people and all.

Shouldn't be two programs, just the one that serves everyone. If we have govt/private health plans, the govt plan should be competitive. Otherwise you have two tiered quality of care. Medicare requires a supplemental policy for old folks or care is cost prohibitive. Lets go Uncle Sam Cross cradle to grave.

if they simply expanded medicare without drastically increasing the reimbursement, providers will continue to bill patients for the remainder of the amount due.What's this "continue?" Right now, I thought it was illegal to bill Medicare patients for more than the gov't will reimburse.

But you're absolutely right on the principle. There is no excuse whatsoever for medicare's stinginess about reimbursments.

As part of cost management, it might be necessary to adjust medical professionals' expectations of income to something closer to European numbers (high five figures, not mid six figures), but since physician reimbursment is only around 20% of medical costs and since most physicians lose money for each medicare patient they see, it would still be necessary to raise reimbursments to something above the break-even level.

Shouldn't be two programs, just the one that serves everyone. If we have govt/private health plans, the govt plan should be competitive. Otherwise you have two tiered quality of care. Medicare requires a supplemental policy for old folks or care is cost prohibitive. Lets go Uncle Sam Cross cradle to grave.We can't afford to give solid-gold treatment to everyone. We just can't. But it would not work well (think Canada) to make it illegal for wealthy people to purchase supplemental health care.

So the only workable system I can see is a manadatory universal baseline insurance that covers a lot of basic care, but not everything---might want to limit organ transplants and joint replacements for octagenarians in favor of more extensive care for children. Then those who have the money and want to spend it can buy additional coverage on the private markets to pay for things beyond what the government program covers.

It would be two tier, of course, but what would be different from today is that the bottom tier would have a decent level of basic coverage for major illnesses and injuries.

What's this "continue?" Right now, I thought it was illegal to bill Medicare patients for more than the gov't will reimburse.

But you're absolutely right on the principle. There is no excuse whatsoever for medicare's stinginess about reimbursments.

As part of cost management, it might be necessary to adjust medical professionals' expectations of income to something closer to European numbers (high five figures, not mid six figures), but since physician reimbursment is only around 20% of medical costs and since most physicians lose money for each medicare patient they see, it would still be necessary to raise reimbursments to something above the break-even level.


not illegal, not if you refuse medicare assignment, which many of us do now.

As far as reducing salaries, that won't fly, physician salaries have already been dropping for the past ten years almost, and many will likely leave medicine. Many more would not pursue it as a career if salaries dropped precipitously, and we are already staring at a shortage of providers. I know if my salary dropped much at all, I would leave medicine. I could stand a mild drop or reduction, but if it dropped a bunch, I would leave and go pursue something else. I think many physicians feel the same.

Then I'm still voting for McCain.

Then I'm still voting for McCain.


Yep, and let's say that you do make health insurance a governmental thing. Does that mean that providers will be government employees? If you make most physicians and surgeons salaried employees with no hope of increasing income by seeing an increase in patients. Do you have any idea how slow the whole system will become. Many physicians will adopt a "Who cares?" attitude and will only see so many patients a day. Surgeons will only operate on so many patients per day, making sure to be done by 2-3pm. The entire system will become backlogged and overflowing. Most providers will adopt a government employee attitude, and I don't think that that is necessarily a good thing.:thumbsup:

Yep, and let's say that you do make health insurance a governmental thing. Does that mean that providers will be government employees? If you make most physicians and surgeons salaried employees with no hope of increasing income by seeing an increase in patients. Do you have any idea how slow the whole system will become. Many physicians will adopt a "Who cares?" attitude and will only see so many patients a day. Surgeons will only operate on so many patients per day, making sure to be done by 2-3pm. The entire system will become backlogged and overflowing. Most providers will adopt a government employee attitude, and I don't think that that is necessarily a good thing.:thumbsup:
Dogs and cats, living together in harmony!

Yep, and let's say that you do make health insurance a governmental thing. Does that mean that providers will be government employees? If you make most physicians and surgeons salaried employees with no hope of increasing income by seeing an increase in patients. Do you have any idea how slow the whole system will become. Many physicians will adopt a "Who cares?" attitude and will only see so many patients a day. Surgeons will only operate on so many patients per day, making sure to be done by 2-3pm. The entire system will become backlogged and overflowing. Most providers will adopt a government employee attitude, and I don't think that that is necessarily a good thing.:thumbsup:
most of the physicians I work with are out of the OR by 3pm anyway!!!
how 'bout piered level salary increases like every other federal employee? most Fed workers I know aren't hurting for cash and they don't have the pay grades that dr.'s would require (GS-15+)
http://www.fedjobs.com/pay/pay.html

remove their requirement for privatized malpractice insurance (federally backed malpractice rules) and reimburse school tuition payments (or highly subsidize them like they do now for rural practicing physicians) and dr.'s don't need to make more than 200K...come on. do you really need the Porsche and second home? NO.
remove the costs that drive up physician salaries and they will decrease...
anything more is pure greed. by your logic, physicians are treating more and more patients just to make more and more $$.....
starting to sound like that Henry Potter med student that comes on here...

most of the physicians I work with are out of the OR by 3pm anyway!!!
how 'bout piered level salary increases like every other federal employee? most Fed workers I know aren't hurting for cash and they don't have the pay grades that dr.'s would require (GS-15+)
http://www.fedjobs.com/pay/pay.html

remove their requirement for privatized malpractice insurance (federally backed malpractice rules) and reimburse school tuition payments (or highly subsidize them like they do now for rural practicing physicians) and dr.'s don't need to make more than 200K...come on. do you really need the Porsche and second home? NO.
remove the costs that drive up physician salaries and they will decrease...
anything more is pure greed. by your logic, physicians are treating more and more patients just to make more and more $$.....
starting to sound like that Henry Potter med student that comes on here...


Physicians do WANT to make money, wtf? do you think they are motivated purely by altruistic notions. That is rather naive. You will see more of the best and brightest going into business and other fields that can guarantee a good income. In fact, that is already starting to happen. I was talking an hour ago with a friend in surgery and he said basically that he would definitely leave medicine if his salary dropped at all. He basically said the same thing, "I went to school for most of my life, got treated like cr*p as a resident, and then they're gonna make me take a pay cut, F that"

Physicians do WANT to make money, wtf? do you think they are motivated purely by altruistic notions. That is rather naive. You will see more of the best and brightest going into business and other fields that can guarantee a good income. In fact, that is already starting to happen. I was talking an hour ago with a friend in surgery and he said basically that he would definitely leave medicine if his salary dropped at all. He basically said the same thing, "I went to school for most of my life, got treated like cr*p as a resident, and then they're gonna make me take a pay cut, F that"
that oath don't mean much anymore, huh?
I don' t think they're solely driven by altruism whatsoever...but I see a few of the folks I work with interested more in research and teaching than in $$$...they're mostly older, established physicians...not the young, greedy ones (the "most of my life" comment speaks volumes)..

your retort did nothing to counter my assertions that being a federal employee isn't all bread and water like you made it sound..