Health Care Reform

[Rich_by_the_Bay]

This recent article is very thoughtful. With each new policy statement, there seems to be merging of priorities between the strong "national health care" advocates and the "private care at all cost" advocates.

Maybe we're all getting a bit more realistic?

 

[FinallyRetired]

Rich, I think this is the most important recommendation, and the one that, if adopted, would bring the most immediate relief. I would also most likely result in higher premiums for the average individual already insured, but would alleviate the immediate problem while working towards a more optimal solution:

7. Create state or regional insurance exchanges to pool risk, so that Americans without access to employer-based or other group insurance could obtain a standard benefits package through these exchanges. Employers should also be allowed to participate in these exchanges for their employees' coverage.

 

[ziggy29]

Could be. I think the ideologues are realizing that they aren't going to get the "ideal" system for their beliefs, and yet just about everyone, regardless of ideology, thinks the current system is broken with respect to cost and insurability of some individuals.

 

[MichaelB]

When big business acknowledged the need to change the way health care is funded, real reform became a realistic objective.

The recommendations Rich linked make sense. They set aside the political issue of providing coverage for everyone, which threatens to sidetrack other meaningful and necessary changes, and focus on aspects that seem to be shared by a larger political constituency.

 

[armor99]

I would love to see heathcare get de-coupled from your employer altogether. I think that would actually allieviate a lot of inherent problems. If you choose your health care insurance like your car insurance, then there would be more competition in the health care market. More competition ususally means better prices, and better service. A company can only afford to have a few different medical coverage options. Maybe those options are not right for you. With personal coverage... you might get to pick from a whole host of plans, options, deductibles, etc. I know for a fact my car insurance coverage had MANY more options than my health coverage does.

I think all of us that currently have insurance, have gone throught the endless finger pointing between doctors and insurance companies as to what they will pay for or not. But what really is our current recourse if we are un-satisfied with our service provider? As long as your company uses ABC medical company... you are stuck with them. As a result ABC medical company is not very motivated to do a better job for you.

But if you suddenly said... "I am unhappy with my service, I will give my business to XYZ medical company instead" well... you can see how that would get someones attention. And if many people did that... a LOT of attention....

 

[walkinwood]

I would love to see heathcare get de-coupled from your employer altogether.

I fully agree with that! Healthcare insurance is not a core-competency of businesses

Here is another link to policies being considered for healthcare reform.
Two Health Care Must-Reads - The Atlantic Politics Channel

 

[heardoc]

I see that tort reform is not on the table. I don't see many significant changes without it.

 

[ziggy29]

I see that tort reform is not on the table. I don't see many significant changes without it.

It may not be on the table yet because the majority party's leadership isn't a big fan of it. But at some point, to pass a law to get to the president they need to get 60 senators on board, and they will have to throw some bones to the opposition and the moderate wing of their own party in order to get there. Who knows what those bones will be, but this is one possibility.

 

[huusom]

I would love to see heathcare get de-coupled from your employer altogether. ....

Amen, I see no reason for employer based health insurance. It's a fact of life that people changes job. We need to be able to keep the same health insurance regardless of who we work for. I have the same car insurance for the last 25 years but I'll change in a heart beat if I don't like the company service/price any more.

 

[Trek]

As a compromise you could leave the system more or less like it is, but make the insurance companies accept everyone, kill the underwriting and cap premiums or base monthly premiums on the individuals total income (Germans do it that way).

Wouldn't something along those lines be acceptable to the majority? The companies are still private, everyone still has to pay for their insurance yet everyone is covered since you can't be denied coverage.

Maybe the insurance companies lose some profit with premium caps or whatever, but they can make that up by bringing in millions of new customers that could not qualify or afford health insurance previously.

 

[ziggy29]

As a compromise you could leave the system more or less like it is, but make the insurance companies accept everyone, kill the underwriting and cap premiums or base monthly premiums on the individuals total income (Germans do it that way).

If insurers have to accept everyone without underwriting, there MUST be a universal coverage mandate or else adverse selection will be a big problem.

The Massachusetts model was supposed to bring a universal mandate, but the problem is that the penalties for noncompliance have not been severe enough to get sufficient compliance from the younger and healthier.

 

[Trek]

If insurers have to accept everyone without underwriting, there MUST be a universal coverage mandate or else adverse selection will be a big problem.

Since most people are already insured, are you saying that adding more of the 47 million uninsured would add a huge cost burden? Is that group statistically unhealthy and hence uninsured or are many just unable to afford even basic insurance because they are poor?

But while not directly tying insurance to employment, under a mandatory mandate it could be made that all employees must enroll in a health insurance program and the self-employed must provide their insurance data when filing quarterly earning for example. That would get most the young and healthy right there.

 

[ziggy29]

Since most people are already insured, are you saying that adding more of the 47 million uninsured would add a huge cost burden? Is that group statistically unhealthy and hence uninsured or are many just unable to afford even basic insurance because they are poor?

What I am saying is that if we set up an insurance system where everyone was accepted and everyone would pay the same price (i.e. no underwriting), those who were younger and healthier (who would see their rates go way up) would often refuse to play if allowed to do so.

And if we decoupled health insurance from employment (which I do favor), individuals would have to buy their own policies. Most young and healthy people are covered under employer group plans almost by default, but many of them would probably choose not to purchase their own, especially if they have to pay ~2-3x the current going rate for someone young and healthy in order to subsidize the higher risks.

As for the mandate, as I said, Massachusetts already has it. They just need to step up enforcement and make penalties for non-compliance much stiffer than they have been in the past.

 

[Trek]

Right, well definitely you need a system that ensures everyone is signed up and doles out stiff penalties if otherwise.

To bring out the German system again health insurance is mandatory, but not tied directly to employment. However, when you are hired for a job, you must enroll in an insurance program which you pay for, not the company. If people get caught (most likely the self-employed), there are stiff penalties and fines, including jail at the extreme.

 

[rescueme]

Amen, I see no reason for employer based health insurance.

I'm retired, pre-Medicare, and have pre-existing conditions which currently under private medical insurance I could not afford.

If I didn't have my "employer based health insurance" (which also covers my DW) I would certainly have major problems.

 

[ziggy29]

I'm retired, pre-Medicare, and have pre-existing conditions which currently under private medical insurance I could not afford.

If I didn't have my "employer based health insurance" (which also covers my DW) I would certainly have major problems.

I don't think the objection to tying employment with health insurance is that it's a "group" plan that enables even the mostly uninsurable to be covered. Lack of consumer choice, lack of ability to decide how much coverage you'll pay for and lack of portability are the main things. Oh, and the inequities of tax treatment between employer-provided coverage and individually purchased plans.

 

[Bimmerbill]

Heck, as a relatively young working stiff I am worried about increases in premiums. There will be a point where I'll have to weigh continuing working with going on the dole.

I already have a bad taste in my mouth after seeing coverage some "poor" folks get for their autistic sons. In home care provider, easter seals programs, etc. I'm too rich to qualify for that and would have to pay out of pocket for DDs support/treatment.

As I shoulder more and more of the tax burden (a la middle class) I find myself getting cranky. Maybe I'm just jealous.

Not that I'm saying universal care is a bad thing. I just think I'll be the ox tied to the yoke.

 

[Zoocat]

This essay by Charles Hugh Smith on his blog "Of Two Minds" presents a very intelligent and interesting analysis of the idea of "socialized" health care as opposed to "social welfare" healthcare and why the Obama solution may be the answer.
charles hugh smith-Weblog and Essays

 

[Stevewc]

I just noticed this write up.
Maybe some of you will find it informative or at the least a peep into what is being considered.
Steve

http://swampland.blogs.time.com/2009/05/21/baucus-predicts-gop-votes-for-health-care-reform/

 

[samclem]

Is a "pranayam" like a sweet potato? And, is this paranayam yoga the kind with the fruit at the bottom, or is it all mixed in? I like to mix it myself, it is good exercise. Do you do any exercise--like calisthenics?

 

[Texas Proud]

This thread has not popped up lately... so I read a few of the posts back a way...

Tell me this.... if, as a country, we are paying to much for healthcare (as the politicians continue to point out all the time)... then how is a government system that will cost the taxpayers trillions of dollars over the next few decades supposed to 'fix' things?

Where are the savings going to come from? And if we have those savings, then why is it so much more expensive?

BTW, one of the ways that at least one other country spends less in medical costs is they don't pay the doctors much. When I was in the UK, one of the guy's wife was a doctor... I said something about her making more than him... he said she made about half of what he made... and he was not highly paid...

 

[samclem]

This thread has not popped up lately... so I read a few of the posts back a way...

Tell me this.... if, as a country, we are paying to much for healthcare (as the politicians continue to point out all the time)... then how is a government system that will cost the taxpayers trillions of dollars over the next few decades supposed to 'fix' things?

Where are the savings going to come from? And if we have those savings, then why is it so much more expensive?

I think the reasoning is that we spend a lot on healthcare but we don't get good value for our money. The care is gold-plated, there is too much high-technology, and especially the funding system (through private insurers) is "leaky" and causes a lot of trouble/costs for health care providers. If we had a single payer system then there would be rational, centralized decisions on what would be covered, and the overhead costs of providing the funding would be reduced. So, taxes would go up, but what we spend (on average) would go down. Everyone would be covered on at least the basic level.

Kinda like food, another necessity. Our food production, delivery, and funding mechanism is terribly inefficient and irrational. Nobody tells farmers what to grow, they just have to figure it out. Does that make any sense? The money we waste on food, as a nation, is INCREDIBLE-- much higher than what we spend on health care. Do you know that the raw materials for the food accounts for less than 20% of the average restaurant bill? The rest is just overhead and waste. The system is crazy. Look at the things people buy in the grocery store--wasting money on beer and soda with almost no nutritional value. And look at the size of those people--talk about the need for some rationing! In my view, this whole food funding and delivery system should be the government's first priority--it's more basic than health care, and some of the benefits will spill over. When the government takes it over, we'll get our dehydrated nutripatty every day and our liter of fiberslush. It turns out that 90% of Americans have NO food coverage, a scandal in the richest nation on earth. This modest program will significantly enhance the overall nutrition ingested by Americans. We'll save money overall, everyone gets food coverage at a basic level, and we are healthier as a people. It's hard to argue with that.

(soylent green is people)

 

[ziggy29]

Where are the savings going to come from? And if we have those savings, then why is it so much more expensive?

I see quite a few potential places to find savings, but very few (if any) that both sides of the aisle would agree on. Any such low-hanging fruit would probably already be picked where that was concerned.

Here are a few possibilities, most of which would be anathema to one side of the lawmaking aisle or the other: eliminating the overhead of private insurance and underwriting, allowing the government to negotiate drug prices, tort reform which would result in less "defensive medicine" costs, more transparency in pricing to allow an informed market-based decision in consuming health care, eliminating the link between employment and health insurance and a few other things.

Each of these has the legitimate potential of resulting in some cost savings. Some of them do have side effects, though, and most of these are "poison" for one ideology or the other.

 

[Brat]

The other "saving" from the POV of an insured patient is the amount of money I am paying for those who do not pay for the services they receive because they do not have insurance or the ability to pay for the cost of services.

 

[Rich_by_the_Bay]

Correct the Byzantine reimbursement systems, and you might eliminate the $80 tylenol tablet, which the hospital has to charge because it didn't get paid for the coronary bypass operation on that Medicaid or uninsured patient who wandered into the emergency room that week.

Or the $1000 emergency room cost for the visit for a common cold, high because among other things ERs have to maintain a high and expensive state of readiness for the "real" emergencies.

Or the futile use of ventilators, central lines, and drastic therapy for chronically demented or ill 90 year old patients in the ICU who lack a health care surrogate, or have one who can't or won't discontinue care.

Or the absurd multimillion dollar settlements for legitimate but exaggerated malpractice (if only I were worth as much...).