Health Care Reform

[bubba]

How do you force people who could pay for insurance but haven't to purchase a policy? Do you arrest them if they choose not to purchase? Do you withhold care? Unless service is completely free, people who won't buy insurance now won't buy it after the government takes over unless some serious penalty is involved. If you are one who believes that your budget won't handle a premium payment now, why would you believe that your budget would be able to handle a premium payment after the government gets involved?

 

[Gone4Good]

How do you force people who could pay for insurance but haven't to purchase a policy?

This is one of the many avenues by which every attempt to construct a "market based" health care solution eventually leads back to a "single payer" system.

 

[samclem]

How do you force people who could pay for insurance but haven't to purchase a policy? Do you arrest them if they choose not to purchase?

Maybe it would be the same as taxes. Somehow people find a way to pay them, even people who "don't have any money" after paying the cable bill and the three car payments.

Maybe payment of mandatory private health care premiums would be verified when taxes are filed--provide the insurer's name and the policy number for al persons filing the return and claimed as a dependent on it. Even people without income file returns (to get the EITC and other payments). And, yes, if the government passed a law saying health insurance is mandatory, then I suppose there would be fines for those who don't comply. Just like there are fines/jail time for those who don't pay their taxes. it's not much of a stretch--people who don't have insurance and get a serious illness wind up taking from others--through public assistance, or costs borne by hospitals and other providers that get passed on to the insured population. Is it theft? I guess not, but it taking from others against their will (the "taking" done by government or in compliance with government laws). So, if the government tells everyone that insurance is mandatory, then there would be consequences for those who choose not to buy it. There would be vouchers for the poor, so poverty would not be an excuse. And poor people who won't take the simple step of getting their kids enrolled for free health care (available today) and seeing that they get checkups and other medical attention should be receiving some additional "attention" from authorities.

Hey, I'm not crazy about this government intrusion into health care either. But, the truth is that we, as a society, have decided that we will not allow people to make the choice or suffer from the circumstances that lead them to not have health care insurance. With that as a given, I'd prefer that we put in place a system that retains the factors of competition and free enterprise as much as possible. A government single payer doesn't retain these benefits.

 

[Texas Proud]

As reported in the NYT, the assumption is $1 trillion over 10 years . . .



http://www.nytimes.com/2009/06/14/us/politics/14address.html?hp

So even using the $1.5T number, over 10 years, for 46MM people, comes out to about $3,200 per person per year.

I thought the plan was to 'fix' the system, not just insure the uninsured...


And that is my point... there is no 'fix' in the plan... I would still be paying out a huge amount for my insurance.... I would still be 'stuck' with the insurance company I have as my small company has only one plan... and we are so small our rates are high...


I was copying some of my wife's bills to submit for reimbursement.... and one of the problems is that the 'billed amount' is so high that if you did not have insurance you would go broke... the hospital bill was $10,791... but we got a provider discount of $8,763... so our costs was $2,028... Now, if I did not have insurance... I would have been expected to pay the full $10,791... when someone comes up with a plan to fix the health care provider side of the problem then maybe I am on board.... all that I see is the argument of who will be paying for the services....

 

[jambo101]

As a Canadian we've had the Government run health care system for 40+ years, todays average cost out of your taxes is about $50 a week,It may not be a perfect system but its worked well for me and my family over the years,one big upside is if you lose your job or cant work you are still covered, and you will never get a doctor,clinic or hospital saying refused medical coverage due to pre existing conditions.
http://www.pnhp.org/news/2007/july/canadian_and_us_he.php

 

[lets-retire]

Exactly. Your DW and my friend has same the problem. Pre-existing conditions. Not covered. What more is there to stay. If you are healthy or have money, our system works great.

No, I didn't conveniently forget to include specifics. I thought I already done this. I had regular employment. The lack of coverage was not for anything experimental. As a matter of fact, the doctor was surprised they wouldn't cover it.

But it is rather interesting that you make this entire debate about my little situation. It sounds like you aren't familiar regarding how common this problem is.

The bottomline is that we are being told scary stories about how bad it will be when the government takes over with rationing etc. We already have rationing.

Take care.

My point is you seem to only tell the bad about this system we have. I've had rather extensive experience with private health care in the last few years at several hospitals in several states and with three different insurers and have not had the issues you seem to be having. I've also made it very clear on other threads, perhaps before you joined, that my hopes of ER have essentially be quelled due to the DW's medical issues, but that is the price of living in a society that gives me the freedom to do as I choose and become as successful as I wish. If the safety net is too strong then it also works to limit ones potential.

I have also been subjected to government run health care, and can say hands down, the private side is much better. The philosophy of the government health care in the US I've seen has been, "If it isn't going to kill the person treat the symptoms until no more improvement can be reached, then stop." I've seen people tear mucsles and receive simple PT for it when a surgical cure was easily performed and would have had long lasting benefits. Instead the government gave PT because it was cheap and got the people back to "health" quickly, nevermind the person goes down every year or so with a reinjury to the same area. I also have that lingering issue with a muscle tear I had. I have had some of my government issued injuries cured, after reinjuring the same part and seeing a private doctor. The tear I just deal with it and press on.

I'm sorry you haven't been abe to obtain good care. Apparently you have many more stories to tell about your own health care, that you haven't shared. One or two bad experiences should color you vision as badly as it has. I, unfortunately, am on first name basis with numerous doctors at various hospitals and have no serious complaints, except for the billing agencies used (they are idiots).

 

[lets-retire]

As reported in the NYT, the assumption is $1 trillion over 10 years . . .



http://www.nytimes.com/2009/06/14/us/politics/14address.html?hp

So even using the $1.5T number, over 10 years, for 46MM people, comes out to about $3,200 per person per year.

Your figures are correct, however, I am dubious of many of the monetary estimates for new government programs. The administration is saying most of the money will come from savings in other areas. I agree that are some inefficiencies, however not in the amounts required. Assuming the numbers are correct most of the money is going to come from savings in Medicare. That program is already seriously underfunded, but somehow they are going to lower costs enough to adequately fund the program and generate enough savings to pay for more. I don't see that happening, especially with more and more doctors retiring while the demands for their services are going up. Not only is there an increase in demand there is a decrease in supply. That is the perfect storm of rapid inflation.

 

[walkinwood]

Text of the president's speech to the AMA today

and video of the speech last week in Greenbay, WI.

He refers to data from this article in the New Yorker in both speeches. I highly recommend reading the article.

I am absolutely for having a public option, for results-based compensation, and for mandatory health insurance. I don't think a single-payer system is politically feasible in our country.

I took a look at Massacheusett's insurance exchange site. According to Mitt Romney (and, I'm no fan), individual healthcare premiums fell 50% after the mandatory healthcare insurance went into place. If you dig through the documents on the site, there is some good information, but I couldn't find any confirmation of Romney's statement. In any case, rates in NJ are 40% higher with much larger co-pays and deductables.

 

[huusom]

I am absolutely for having a public option, for results-based compensation, and for mandatory health insurance. I don't think a single-payer system is politically feasible in our country.

Walkinwood:

I'm 100% with you on this. We need a public option for healthcare ins. The insurance companies are fighting with everything they got to stop it from becoming a reality. [moderator edit - politics]

There is no competitions and choice with the current system because the health care premium is going up so much more than wages and inflation. If there is true competion then we would not have to come to this.

 

[Notmuchlonger]

I think its absurd to refuse people on preexisting conditions. I'm glad its being looked at.

 

[ziggy29]

I think its absurd to refuse people on preexisting conditions. I'm glad its being looked at.

Me too, but in reality refusing preexisting conditions makes total sense as long as insurance is optional. A model where insurance is optional AND where there can be no refusal or risk-based pricing for pre-existing conditions is one that's 100% unsustainable due to adverse selection -- people would only buy insurance when they are sick or injured, and cancel it as soon as they got better.

So any elimination of bias against pre-existing conditions must -- MUST -- be coupled with an absolute mandate for all to be covered, and with harsh penalties for noncompliance (harsh enough that buying insurance is cheaper).

 

[walkinwood]

Me too, but in reality refusing preexisting conditions makes total sense as long as insurance is optional. A model where insurance is optional AND where there can be no refusal or risk-based pricing for pre-existing conditions is one that's 100% unsustainable due to adverse selection -- people would only buy insurance when they are sick or injured, and cancel it as soon as they got better.

So any elimination of bias against pre-existing conditions must -- MUST -- be coupled with an absolute mandate for all to be covered, and with harsh penalties for noncompliance (harsh enough that buying insurance is cheaper).

I fully agree. I'm living the "unsustainable model" right now. I live in NJ & purchase my own health insurance policy. NJ is a "community rating" state, so personal insurance plans cannot bias against pre-existing conditions, age or sex. However, since it is not mandatory, people do not enroll until they absolutely need to. When I last took a look, less than 100,000 people had individual insurance in the state. As a result, premiums are high!

 

[walkinwood]

Walkinwood:

I'm 100% with you on this. We need a public option for healthcare ins. The insurance companies are fighting with everything they got to stop it from becoming a reality. The republican politicians are once again out of touch with what average americans have to put up with.

There is no competitions and choice with the current system because the health care premium is going up so much more than wages and inflation. If there is true competion then we would not have to come to this.

Have you written/called your congressman and senators? It is easy to do.

Member Web Site Listing (by State) - United States House of Representatives, 111th Congress, 1st Session
U.S. Senate: Senators Home

I haven't found a way to send a message to all three in a single form, so cut & paste.

 

[samclem]

When I last took a look, less than 100,000 people had individual insurance in the state. As a result, premiums are high!

Yes, if we are going to eliminate underwriting for pre-existing conditions, then insurance will have to be mandatory to be affordable. Still, in your situation in NJ, eliminating incentives for employer-provided insurance (e.g. by eliminating the tax deduction insurers receive for these premiums, and by taxing as employee income the value of any employer-provided insurance) would help. Even if insurance weren't mandatory, you can bet that more than 100K NJ residents would be buying their own individual policies if their employers weren't covering them. It would be a start.

 

[Gone4Good]

I thought the plan was to 'fix' the system, not just insure the uninsured...

Well, I guess it depends on what you think "fixing the system" means. Plenty of people think the large, and growing, population of uninsured is a problem in need of fixing. Others think you can't get control of costs until everybody is insured (see some of the comments above about 'adverse selection'), so universal coverage is a step in that direction.

Beyond that, we haven't exactly seen the details of whatever plan survives the sausage making process. It does seem, however, that ambitions are getting watered down enough so that whatever comes out the other end will fall far short of what is required to "fix the system" by any objective definition.

 

[Gone4Good]

He refers to data from this article in the New Yorker in both speeches. I highly recommend reading the article.

In 2006, Medicare spent fifteen thousand dollars per enrollee in McAllen, Texas, almost twice the national average. The county's income per capita is twelve thousand dollars.

Holy cow!

 

[M Paquette]

How do you force people who could pay for insurance but haven't to purchase a policy? Do you arrest them if they choose not to purchase? Do you withhold care?

Even better, what sort of Kafkaesque actions do we impose on people who can pay for insurance, who want to pay for insurance, and who are denied insurance?

Perhaps we could bring them before the Magistrate until the insurance companies decide they are acceptable, or they die.

 

[bubba]

Even better, what sort of Kafkaesque actions do we impose on people who can pay for insurance, who want to pay for insurance, and who are denied insurance?

Perhaps we could bring them before the Magistrate until the insurance companies decide they are acceptable, or they die.

Frankly, I'm not sure there's a good answer to my question or yours.

 

[lets-retire]

As reported in the NYT, the assumption is $1 trillion over 10 years . . .



http://www.nytimes.com/2009/06/14/us/politics/14address.html?hp

So even using the $1.5T number, over 10 years, for 46MM people, comes out to about $3,200 per person per year.

Now the estimate by the CBO is 3 trillion dollars. That is twice what the original estimate is. So for the 46 million people the cost goes up to $6400, assuming no cost overruns (which is highly unlikely in my estimation). There doesn't seem to be much savings in the program. If they are only able to reduce to cost of medical coverage by a couple thousand dollars, is it worth it? I would want to see much greater savings per person before they completely overhaul a system that still works for most people.

 

[Martha]

Now the estimate by the CBO is 3 trillion dollars. That is twice what the original estimate is. So for the 46 million people the cost goes up to $6400, assuming no cost overruns (which is highly unlikely in my estimation). There doesn't seem to be much savings in the program. If they are only able to reduce to cost of medical coverage by a couple thousand dollars, is it worth it? I would want to see much greater savings per person before they completely overhaul a system that still works for most people.

They are not considering the savings by promoting best practices. And we know that it saves quite a bit when comparing different clinics and hospitals in the US.

 

[Martha]

How do you force people who could pay for insurance but haven't to purchase a policy? Do you arrest them if they choose not to purchase? Do you withhold care? Unless service is completely free, people who won't buy insurance now won't buy it after the government takes over unless some serious penalty is involved. If you are one who believes that your budget won't handle a premium payment now, why would you believe that your budget would be able to handle a premium payment after the government gets involved?

This is why I favored Wyden's plan of two or three years ago. It did keep insurance companies but premiums were collected through the income tax system.

 

[lets-retire]

You are correct, but that is because it is not included in the bill. If it takes legislation to get the medical industry to change i highly doubt they will do anything not required of them.