Health Care Reform --- Will it happen after the election?

[chinaco]

What do yo think?

It is likely that a Dem will be elected. Do you think we will have health care reform?

What should it be:

1. Universal Health Care (medicare for all). Mandatory inclusion, premiums paid via taxes.
2. Better Government Assistance and Regulation
   • Laws that make or strongly encourage insurers not exclude people and provide affordable rates? Force insurers to have one large group (same price for all).
   • Better tax laws for individuals with medical bills (100% deductible for each $ spent)
   • Laws and Regulations that encourage Insurers to create more high-deductible options.
   • Medicare and Medicaid negotiate drug prices (no brainer)
3. Medicare buy-in option with premiums based on income (means test), not health status. Of course, all the insurers would just reject unhealthy people and unload on the government... This probably would not work well.
4. If none of the above, please describe your approach.

I tend to lean toward option 2... but I am not sure that Insurers will ever cease the redlining. Plus people (insured) will want to wait until they have real health problems to buy-in (anti-selection). Let's face it, insurance is about selling off risk. It is kinda like a utility or a road. The fortunate (healthy) people pay for the unfortunate (unhealthy) people... but all are covered if tragedy strikes (and are not financially ruined).

[OAG]

Mandatory Health Care Insurance purchased by the individual or provided by the current or former employer. Too many, IMO a lot more than half of the 43 Million that do not have it, refuse to spend for it - too healthy, is the excuse (maybe a valid one).

So my vote would be #1.

Of course, even tho you maybe right about a Demo in the White House for the next 4 to 8 years, nothing happened when there was one there the last time.

[Notmuchlonger]

I have little faith our politicians will get any substantial health care reform done within the next 10 years. However if they do I would be in favor of a tax credit for purchasing your own health care. Also, do a better job of weeding out the frivolous lawsuits facing people of the medical profession.

[retire@40]

I think the only way to stop the escalating cost of health care is to put caps on end-user costs and limit liability exposure for the medical professionals.

[F-One]

Health Care Reform --- Will it happen after the election?

No - too much $$ fighting against it (insurance companies and big pharma) and contributing to the idiots politicians in our government.

The smartest system would be single payer, but any move would probably be more in line with the #2 option, although probably weakened (not as controlled) from what is listed.

Regarding comments about medical malpractice, although I have seen frivolous lawsuits (and believe some effort needs to be done in this regard - as well as frivolous lawsuits not involving medical malpractice), a much bigger emphasis needs to be placed on Doctors/nurses/hospitals regulating doctors - too many times "bad" doctors are allowed to continue practice even though they are not competent.

[poboy]

Originally Posted by F-One

No - too much $$ fighting against it (insurance companies and big pharma) and contributing to the idiots politicians in our government.

Might want to include physician opposition also.

[unclemick]

Hmmm - the number (mythical or real) I've run across(memory?) is 44 cents of every medical dollar spent in the US is currently footed by the taxpayer. Don't know if that's true.

Definitely need to run The Red Bead Experiment.

If the press of the numbers show enough businesses need to toss health coverage in the trash can alongside defined pensions to remain globally competitive then the shift to the individual/taxpayer may take place.

Hey - I wonder if Congress is bright enough to slap a tax on imports to help pay - like in the ancient days before income tax.

heh heh heh - being an ex engineer, I'm dumb enough to believe you need a central consensus based on numbers, people and $. Which means both sides of the aisle need to get their head out of you know where.

[MooreBonds]

How about the following:

The gov't takes care of hospitalization costs and in-patient operations, with a modified voucher system. You can either take the voucher for a certain operation/hospital stay to a place that only charges what the voucher is for, or you can pay additional money to stay at a hospital that provides (presumably) a slightly higher level of care for additional money or have a certain doctor perform the surgery who charges a higher fee.

The individual (and perhaps private insurers) takes care of the doctor visits, prescriptions (not related to operations/dialysis/cancer), and any elective outpatient surgery.

That way, everyone is truly protected from the catastrophic costs of cancer treatment or transplants or surgery or whatever...AND it gives the public an incentive to be smart consumers by not running to the ER for a runny nose, and to put more thought into their health care decisions.

This could create a disincentive for seeing your doctor for regular health checkups and make people wait until there's something serious (and would cost the gov't more) so why not throw in a tax deduction for a periodic physical to make sure the fiscally incompetent who piss away $ left and right but who are too cheap to spend $150 on a physical every 5 years everyone doesn't simply wait until their arm is about to fall off before going to the hospital because they don't want to pay for a doctor's visit out of their own pocket?

By the way - I know that many doctors say that they don't want to work at lower wages under a presumed national health care system, but does anyone know how much difference there would be between the gov't paying the current salaries of the health care workers vs the presumably lower salaries the gov't would pay under a national health care system?

[chinaco]

There has to be a huge amount of overhead in insurance companies and claims handling. Plus insurance companies have to make a profit.

If we ever could get to people paying for medical bills themselves... there would have to be huge savings.


It is a bit late for boomers. But if people did have medical savings accounts for general medical and everyone had catastrophic medical insurance... one would think medical costs would decrease.

[Gotadimple]

Originally Posted by unclemick

Hmmm - the number (mythical or real) I've run across(memory?)

If the press of the numbers show enough businesses need to toss health coverage in the trash can alongside defined pensions to remain globally competitive then the shift to the individual/taxpayer may take place.

Hey - I wonder if Congress is bright enough to slap a tax on imports to help pay - like in the ancient days before income tax.

heh heh heh - being an ex engineer, I'm dumb enough to believe you need a central consensus based on numbers, people and $. Which means both sides of the aisle need to get their head out of you know where.

Uncle Mick:
The shift to individuals has already begun, with many of the small businesses in the US (the largest segment of US business) either not providing health care to employees, or adding a small amount to paychecks to help individuals offset the cost of providing their own.

As for both sides of the aisle and where they place their heads. I agree.

So what will happen? Zip, zilch, nada, 0, and nothing.

--Rita

[mickeyd]

None of the above. As private citizens it is our responsibility to resolve these kind of issues without the interference of uncle Sam and his $. Or, is it our $?

[TromboneAl]

Could someone summarize the results of the Massachusetts policy? For example, how have premiums changed? Can we extrapolate to a national system?

[Insanity]

While I'm sure Congress will pass something, and while I think the legislation will be progress on the health care front, I very much doubt that it will be a solution. So hare's what I think they'll do, and then what I think needs to be done.

After months and months and months of debate, posturing, and grandstanding by both parties, Congress will come to an agreement that perpetuates the existing private companies offering health insurance system without addressing the basic failings and frailties of the existing system. It will look a lot like the current Medicare system, where taxpayers and their dependents can select from a pallet of private insurance plans offering some sort of basic insurance coverage, with additional benefits if you give them more money. Insurers will have to accept all comers into their basic plan at the basic rate, regardless of preconditions or other factors, and there will be some sort of national schedule requiring co-payments for various types of services and prescriptions.

The basic plan will primarily be paid for via a fixed flat-tax employer and employee payroll contribution, something like 15% of employer payroll and 10% of employee gross. (Congress will probably increase the minimum wage by the same 10% and change the tax tables to reduce the impact on low income households.) If they're smart about it they'll also make sure to spread the cost of the program to include all forms of taxable income: Everything from bonuses to stock options and grants should be folded in, and some uniform tax on capital gains, paid interest, dividends, and taxable retirement disbursements should be included. (But since when has Congress or any other legislative body shown themselves to be intelligent?)

Things they won't fix:
They won't create a national list of preferred, affordable medications that doctors should consider before prescribing more expensive alternatives (a'la generic Zocor instead of name-brand Lipitor) or create any system that might help contain health insurance costs.

They won't limit punitive damages in malpractice or drug lawsuits, won't require uniform billing for services, make policy coverage available for out-of-network services, regulate health care insurance executive compensation or profits, or regulate and guarantee reasonable client services, or create penalties for acts of malfeasance by the insurance companies.

[amy5708]

Originally Posted by retire@40

I think the only way to stop the escalating cost of health care is to put caps on end-user costs and limit liability exposure for the medical professionals.

Amen! A big reason health care costs are so high is because doctors are terrified they'll be sued, so they order every test in the book.

Another reason it is so high is because of the number of people who do not pay their bills. A lot of the illegals give fake names or addresses because they worry about immigration, so they get a completely free ride.

As a nurse in a hospital, I can tell you we already have socialized medicine. While some legitimately do not have access to health care, I think a lot of the hype is just hooey.

I work in Labor and Delivery, and about 80% of the moms we admit have Medicaid for them and their babies (which I help to pay). The ones that haven't been to the dr or health dept give a ton of excuses, but mainly they admit they were too lazy to get to the health department and sit for a couple of hours to do the paperwork. The health depts provide care completely free of charge.

Transportation is no excuse, because the health depts also provide transportation.

The hospital will arrange for emergency payment assistance over the phone (the hospital eats the complete cost of the bills).

It drives me nuts when someone comes in by ambulance because they state they don't have transportation, but then 5 of their friends roll in 10 minutes later. I tell them they are wasting resources meant for people who are really sick; unless the head is coming out they can wait to have thier friends bring them in. Not to mention, an "emergency" visit costs way more than a regular visit.

Sorry to rant; I love my job but I guess I'm a little jaded

[chinaco]

Originally Posted by amy5708

Amen! A big reason health care costs are so high is because doctors are terrified they'll be sued, so they order every test in the book.
....
Another reason it is so high is because of the number of people who do not pay their bills. A lot of the illegals give fake names or addresses because they worry about immigration, so they get a completely free ride.

Sorry to rant; I love my job but I guess I'm a little jaded

No apology needed... we all are ranting and for good reason.

On the ordering of too many tests. I agree that is costly and does drive up expenses. I am not sure how to solve that problem. But some of these tests probably catch disease in early stages. I kinda look at it like this, early testing can help catch things early. But of course, that is not your point... you are saying that Malpractice suits are the cause and more tests are the effect.

I have a suspicion that Malpractice is a bit of a red herring. I am not convinced that it is the primary or only reason for escalating health care costs. It is probably one factor amongst multiple other factors including escalating drug costs.

Some would say the solution is to limit the punitive damages. If awards are lowered too much... people affected [and their misery] by poor medical practices just becomes a tolerable cost of doing business. At the core are businesses/organizations that would rather not be held accountable... this is the reason for the lobbying effort. however, I agree that some sort of reform may be needed. The problem is that most are not sure how to keep medical providers on the up and up. Let's face it there are some careless healthcare providers and professionals out there. Currently this is the only mechanism holding these organizations accountable for carelessness... and sometimes honest mistakes.

It is a complicated problem for which there may not be a simple answer.

I suppose that an alternative would be to limit most suits to compensatory damage. Only award punitive damages in gross cases. And begin tracking instances of problems (create a scorecard for issues and problems) and aggressively weed out poor performers (take away their license to practice in the US).. including the business or partnership. This would drive the weak/poor performers out and improve quality.

In other words, just punish the individual severely. Make them personally accountable. But that would keep the same phenomenon going to wasted tests. I suppose there could be a average expense scorecard that holds the health care provider responsible for above average costs.

What I am getting ready to say may [or may not] be a shock to you health care professionals... however, some may be aware. I know for a fact that it happens (or was common a few years back). Part of my career has been in the health insurance industry.

Many insurance companies have a dedicated department that tracks malpractice law suites and just good old complaints. Does not matter if the plaintiff does not win. If they file... it is recorded. Any complaint is recorded. A score is compiled. If you exceed that score (i.e., are considered an above average risk), the insurance company will ban not just the person but the practice (entire partnership)... out of the network. Of course, this has the effect of driving off the health care professional that is the problem. On the other side, they track average costs. If you exceed average costs, they will penalize you. I have heard (not sure about this one) in some cases, they give the health care providers that keep costs down some form of bonus... it is not a bonus per se but a reward.

If your doctor is not in network... there could be a reason other than some negotiated contract.

[lets-retire]

I was visiting my Boomer father not too long ago and I noticed he had several bottles of pills in his bathroom (old house with two common bathrooms and no master bath). IIRC he had eight or nine bottles of drugs. The last time I visited my grandmother, who at the time was ten years older than my father currently is only having two or three bottles of pills. During the course of the visit with my father the cost of health care came up. It was also revealed most of the drugs he takes are for standard of living type issues (i.e. the meds weren't needed to live). The drugs my grandmother took were needed to keep her going. Could this also be part of the reason for the rising cost of health care? Total he was spending about $300 per month either out of pocket or from insurance for medications that were simply standard of living things. Things that several years ago were considered normal aging.

Anybody see the thread dealing with annual salaries. It looks like our doc's are paid about $3000 more per month than the next industrialized country. I'm not saying that is a bad thing, but that won't be the case with socialized health care. Do you think many doctors will want to practice medicine in the US if their wages go down dramatically. I don't think they will take a pay cut, but they won't receive pay raises for several years, all in the name of keeping costs under control.

[chinaco]

Originally Posted by lets-retire

...
Anybody see the thread dealing with annual salaries. It looks like our doc's are paid about $3000 more per month than the next industrialized country. I'm not saying that is a bad thing, but that won't be the case with socialized health care. Do you think many doctors will want to practice medicine in the US if their wages go down dramatically. I don't think they will take a pay cut, but they won't receive pay raises for several years, all in the name of keeping costs under control.

I think some may be interested in practicing medicine because it would be a calling. Others (perhaps the majority) would consider other fields. Put it like this, if one can go to school as an engineer and make more than a physician, why spend the extra time and effort.

I think part of the salary difference is due to the institution of socialized medicine in other industrialized nations. Many of those countries probably have low (or no) educational costs (paid directly by the student).

I believe what may happen in the US is outsourcing of expensive medical procedures. It would not surprise me to see some business from another country to begin pulling large floating medical ships off the coast of the US and offering lower cost services. Complete with high speed transportation to and from the dock to the ship. The same could be said for border countries such as Mexico and Canada. Not sure if Canada could implement for pay medical services on the border that are lower cost than our... but if they could, they would clean up

[ziggy29]

Originally Posted by lets-retire

Anybody see the thread dealing with annual salaries. It looks like our doc's are paid about $3000 more per month than the n