How Should Americans' Health Care be Paid For?

[kyounge1956]

As promised, here is the poll on health care. This topic has been discussed on many threads, but I'm curious about which ideas have the most support. If you like, add a comment explaining why you support the option you do.
The seventh options is my effort to summarize dgoldenz suggestion from "What are the Health Care options?"

 

[donheff]

It will be interesting to see how this one spins out. Despite all of our arguments about this I don't remember seeing any polls.

 

[Bestwifeever]

It's eventually all paid for by us, isn't it?

 

[Walt34]

I kinda like "A government plan for catastrophic illness/injury, plus optional supplemental coverage".

This retains some individual responsibility but I hate to see so many instances of people of all ages who need medical care and die or remain crippled because they simply cannot afford treatment.

Granted, though, it is an enormously complex issue.

 

[Texas Proud]

OK... since I am 'other'... I will have to explain.... this is not they system that I would embrace, but it is a compromise that try to address issues presented by so many people that want everybody covered....


I think that we can have a very basic federally funded system... a single payer system if you will... it will cover a certain list of illnesses and procedures for everybody... this list will be based on anticipated number of illnesses and a cost/benefit analysis... (this would mean that doing a heart transplant at 60 probably is not covered... and a lot of end of life procedures are not covered.... heck, maybe heart transplants are not covered at all)....


Now that we have everybody in America covered at a basic level.... there can be individually paid health insurance offered for whatever else you want covered... you can choose your deductible, if you want a Honda plan or a Cadillac plan... but, there will be regulations on these companies concerning paying for this and that.... and IF they want to offer the plan in a state, then they can not refuse anybody in that state (no cherry picking)....



Now, so someone can not decide to stay on the basic plan until they have a problem... we can have underwriting for the 'extra' plan... and a waiting period...

As an example... our company is changing dental plans.... and major surgery has a 12 month waiting period... unless you have been under a plan for the past 12 months... this to me is fair.... so add portability to the regs... (IOW, if you are on an extra plan in one state and your insurance company is not in the state you move... the insurance companies in that state can not do underwriting since you already were in a plan)....




One of the big problems.... we still need cost control... I think this plan WOULD control costs a lot better than what we have.... because the gvmt would have complete purchasing power for a lot of procedures... and the providers would adjust to the new reality...


There are a lot of other things we can do, but I am already getting long winded....

 

[chinaco]

It is difficult to put up a poll. You did a good job but the details always make the need for the "Other" category!

I would be ok with almost any of the options listed except - Status Quo

Individual Responsibility would be ok... but it would have to have some really tough rules. if insurance companies were forced to no longer red-line people and negotiating group pools were outlawed (flat price) and everyone paid the same premium... perhaps pricing based on broad age bands (e.g. 18 - 35 and 36 - 65) along with healthy living incentives... vetted and not abused (i.e., higher cost if one uses tobacco, etc). But that is it. Grouping and redlining for profit are two industry abuses. For anti-selection... if we do not make it mandatory... then one can opt out but no insurance company is obligated to insure the person for some term.. say 20 years. If the company does insure them (after the person opted) they can charge whatever premium. Add to that that no hospital has to render service ( for anything other than short-term stabilization) to anyone that cannot pay (one way or the other)...

Mandatory participation is not really needed... if opt out and means dire consequences. So, as one reaches adulthood... they opt-in or out (doesn't matter how they get it employer, private purchase, etc)... it is tracked.


But... I think the problem is so complicated, that the majority of people (and our population as a whole) would be better off with a base nationalized healthcare plan... catastrophic coverage with some level of basic care... with the ability to purchase supplemental insurance if we choose.


There is no way to please everyone with something like this.... plus most people are susceptible to being swayed by rhetoric... they are against it even though they don't really know why... other than "Rush says were communists".


I think we face some real problems in health care and that they need to be fixed. Delaying action just puts us in a worse situation.

 

[donheff]

At this point we are running 70% that want MORE government involvement than Obamacare (which relies largely on private insurance with a weak mandate). 73% if we count Tex Proud as a Gov Basic plus supplemental. So how do we as a group stack up against the underlying views of the American public?

 

[chinaco]

At this point we are running 70% that want MORE government involvement than Obamacare (which relies largely on private insurance with a weak mandate). 73% if we count Tex Proud as a Gov Basic plus supplemental. So how do we as a group stack up against the underlying views of the American public?

If you remember the use of private health exchanges was the only option that there was even a remote chance of getting a bill through congress.


Bottom line: Most in Congress do not want to address the problem.

There is a large group that hope to stall it to death. They have no intention of doing anything. The only problem some of them see is that the status quo might change.

 

[M Paquette]

I didn't see an option to "keep your government hands off my Medicare", and put all care in the hands of compassionate and understanding private businesses like the Soylent Corporation.

But that's just me...

 

[RonBoyd]

I didn't see an option to "keep your government hands off my Medicare", and put all care in the hands of compassionate and understanding private businesses like the Soylent Corporation. ...

I had that figured under "Unwritten policies" and didn't vote for it.

 

[GregLee]

Other:

The worst thing about our current system is that some people need health care but can't afford it. The straightforward way to fix this is to provide them health care by the government building clinics and hiring doctors and nurses to staff them to provide this care. Don't try to insure against illness -- treat it.

 

[dgoldenz]

Well the results of this poll sure are interesting...

 

[Silver]

I voted other.

All the listed options seem to cost-shift rather than cost-control. They present options for who pays....but no discussion related to decreasing the actual cost of health care. And I believe that BOTH issues must be addressed.

I have very strong opinions about why health care costs are so high. Sure....one of the major issues is that those of us that can pay for health care services are paying for those who cannot, so the overall charges reflect this.

But beyond that.....there is tons of waste in health care, inefficient use of expensive resources, high research costs with minimal positive impact on the greater good, and huge profits being made. There have been some attempts to standardize the provision of health care services and bring the costs down, the most recognized being the HMO's started in the 1980's, and their refusal to pay for everything that was ordered by a physician.

But overall....I believe that the costs of health care reflect the American cultural standard that we expect our lives to be extended at any cost. Our health care system reflects a lack of acceptance that many world cultures have.....which is that it is our nature to die. It is what all living things do....and although it's sad for those who grieve the loss of a loved one, death is not a bad thing. I believe to prolong life through extraordinary means is more of a cultural phenomenon than a moral one, and that we handle impending death poorly.

Trying to humanely, respectfully, and with dignity say "no" to providing someone with life-extending health care is a slippery slope. But I believe that we need to begin somewhere in order to be able to continue to provide appropriate health care services that can be fiscally managed.

 

[NW-Bound]

... the costs of health care reflect the American cultural standard that we expect our lives to be extended at any cost. Our health care system reflects a lack of acceptance that many world cultures have.....which is that it is our nature to die. It is what all living things do....and although it's sad for those who grieve the loss of a loved one, death is not a bad thing. I believe to prolong life through extraordinary means is more of a cultural phenomenon than a moral one, and that we handle impending death poorly...

+1

I cannot speak for Silver, but I myself think of cases like that described by a nurse in the following link: A Nurse’s Distress.

 

[kyounge1956]

At this point we are running 70% that want MORE government involvement than Obamacare (which relies largely on private insurance with a weak mandate). 73% if we count Tex Proud as a Gov Basic plus supplemental. So how do we as a group stack up against the underlying views of the American public?

Well the results of this poll sure are interesting...

I am totally flabbergasted that single-payer has nearly four times as many votes as the next choice. I had quite a different idea from reading the comments in the various health care related threads and absolutely no idea there was that much support for it on the forum. And to compare/contrast the views of E-R members to those of the general public, I can only suppose that E-R is way out of synch with John Q. Public. If the general public also supported a single-payer system four to one above the next most popular option, I would have expected a single-payer Health Care Act to have sailed right through Congress without a hitch.

For the sake of full disclosure, I will admit I am undecided, and haven't yet voted in my own poll. I am of a somewhat pessimistic, faultfinding disposition and can find something to dislike about each of the options, but can't seem to make up my mind which I dislike least.

 

[M Paquette]

Trying to humanely, respectfully, and with dignity say "no" to providing someone with life-extending health care is a slippery slope. But I believe that we need to begin somewhere in order to be able to continue to provide appropriate health care services that can be fiscally managed.

So you'd be in favor of some sort of committee that was empowered to deny life-extending care to individuals under some conditions. What criteria would you like to see in place to begin this process? Perhaps we can make that slope less slippery.

 

[kyounge1956]

I voted other.

All the listed options seem to cost-shift rather than cost-control. They present options for who pays....but no discussion related to decreasing the actual cost of health care. And I believe that BOTH issues must be addressed. (snip)

Cost control is a valid issue, but I don't think the most effective means of controlling costs would be the same in all of the options. The best way to control costs under the status quo might be relatively ineffectual at controlling costs under a single payer system, and vice versa. The relation between cost control and payment system is IMO something of a chicken & egg conundrum. If you look for the biggest cost savings first, they may turn out to be effective only in a system which has too little support ever to be put into effect—and if you pick a system that has the most public support you may find that it does not produce the really big savings that might have been available under some other less popular system. How to balance this out is beyond me.

I have very strong opinions about why health care costs are so high. Sure....one of the major issues is that those of us that can pay for health care services are paying for those who cannot, so the overall charges reflect this.

But beyond that.....there is tons of waste in health care, inefficient use of expensive resources, high research costs with minimal positive impact on the greater good, and huge profits being made. There have been some attempts to standardize the provision of health care services and bring the costs down, the most recognized being the HMO's started in the 1980's, and their refusal to pay for everything that was ordered by a physician.

But overall....I believe that the costs of health care reflect the American cultural standard that we expect our lives to be extended at any cost. Our health care system reflects a lack of acceptance that many world cultures have.....which is that it is our nature to die. It is what all living things do....and although it's sad for those who grieve the loss of a loved one, death is not a bad thing. I believe to prolong life through extraordinary means is more of a cultural phenomenon than a moral one, and that we handle impending death poorly.

Trying to humanely, respectfully, and with dignity say "no" to providing someone with life-extending health care is a slippery slope. But I believe that we need to begin somewhere in order to be able to continue to provide appropriate health care services that can be fiscally managed.

I don't have very strong opinions on where the biggest cost savings are available. I have extremely strong opinions, though, about denying medical care to anyone, on the basis of expense. IMO, money is less important than human life, and to say to anybody (who has not voluntarily declined treatment), "we're going to let you die because it costs too much to keep you alive" is, to put it bluntly, immoral.

 

[kyounge1956]

+1

I cannot speak for Silver, but I myself think of cases like that described by a nurse in the following link: A Nurse’s Distress.

The author, a nurse, writes:

I thought the patient should be “C.M.O.,” or “comfort measures only,” meaning we would stop doing tests on her, stop giving her antibiotics, and start giving her enough intravenous narcotics that she wouldn’t have to live in pain. The doctor heard me out and then explained that, just the week before, the patient had been mentally intact and had insisted on continuing treatment. (emphasis added)

She gets no support from me, at least not on the basis of this story. Here is a nurse who wants to determine the level of care for the sick woman based on her own opinions on the matter, and in direct contradiction to the patient's own request that treatment should continue. I don't know why this patient made the decision she did, but it's her decision to make, not the nurse's. I am surprised and disturbed by this nurse's attitude. Her point seems to be that the patient's life isn't worth living and she (the patient) ought to have had the good sense to refuse treatment and die before she got into the awful condition described in the first paragraph of the article. With such a view, I wonder why she went into oncology and not some other aspect of nursing where her work would consist largely of caring for patients who are likely to recover fully. I really do hope that when I am old and sick, the nurses caring for me are not thinking to themselves all the while "why didn't you go ahead and die before now?" and urging my relatives to discontinue treatment against my wishes.

 

[obgyn65]

I believe in universal healthcare for everyone.

 

[chinaco]

Well the results of this poll sure are interesting...

My impression is that many on this forum have health care coverage and are financially successful.

I suspect many people on this board have thought about it more than the general public.

Health care represents a financial risk to every middle class American... most just do not realize it.

Just about all Americans are 1 job loss + 1 major illness away from financial ruin... no matter how long they worked prior to the event.

However, their ignorance of the issue is not too surprising when one looks at most people's level of preparation for life events like retirement. Most are oblivious to the potential fate waiting on them. Their rosy scenario (best case) is that costs get pushed to a level that it overtakes other major cost of living like Housing.... For many it already has already overtaken the cost of housing!

As companies increasingly see the burden hit their bottom line... big increases in premium and cost will be pushed onto the employee.

 

[RonBoyd]

My impression is ...

Well put. I agree with everything you said... 100%.

 

[donheff]

I am totally flabbergasted that single-payer has nearly four times as many votes as the next choice. I had quite a different idea from reading the comments in the various health care related threads and absolutely no idea there was that much support for it on the forum. And to compare/contrast the views of E-R members to those of the general public, I can only suppose that E-R is way out of synch with John Q. Public. If the general public also supported a single-payer system four to one above the next most popular option, I would have expected a single-payer Health Care Act to have sailed right through Congress without a hitch.

I was surprised at the poll as well, primarily because of the comments during the HC debate. As to the American public, we are inconsistent. Remember the "keep your hands of my Medicare" refrain? Medicare for all with some sort of supplement (and ongoing efforts to reform the Medicare portion to control costs) might very well appeal to a large majority of Americans if it could be fairly placed before them. Unfortunately, such a proposal would get distorted and demonized with the result that many would never understand what the concept was. As for Congress, most of there actions are keyed to the next election not to the greater good or to the "opinion of the American people" they always talk about. Consider the recent don't ask, don't tell legislation. Substantial majorities of the public have supported repealing it for some time. Yet it almost didn't come to a vote in the Senate. If Harry Reid hadn't used the threat to continue the session late in the Holiday season the measure probably wouldn't have garnered the 60 votes needed to proceed to a vote. Once it was given an up or down vote it ended up with 65.

 

[ERD50]

IMO, money is less important than human life, and to say to anybody (who has not voluntarily declined treatment), "we're going to let you die because it costs too much to keep you alive" is, to put it bluntly, immoral.

Each of us do it every day.

As an example, I don't know anyone who pays to have a fully certified mechanic on their personal staff. Their car should get a full safety inspection prior to every single drive. What if your brakes failed? But it would be too expensive to do that.

You can give so many examples of this. How many CO2 and different types of smoke detectors do you have in your house, different types are better at detecting different types of smoke. Do you have a sprinkler system? On and on. We all make this decision. But, if those mechanics or other things were available 'for free', many more would insist on frequent inspections. Total expenditures would go through the roof.

And if I were in a mental state to be able to make the decision, I would absolutely decide to stop seeking medical treatment based on cost. At some point, I would not want to leave my family penniless, when the odds were against me, and I might not have much quality time left anyhow. If it's somebody else's money, sure - why not? Maybe that is what is immoral?

-ERD50

 

[Automatika]

Each of us do it every day.

As an example, I don't know anyone who pays to have a fully certified mechanic on their personal staff. Their car should get a full safety inspection prior to every single drive. What if your brakes failed? But it would be too expensive to do that.

You can give so many examples of this. How many CO2 and different types of smoke detectors do you have in your house, different types are better at detecting different types of smoke. Do you have a sprinkler system? On and on. We all make this decision. But, if those mechanics or other things were available 'for free', many more would insist on frequent inspections. Total expenditures would go through the roof.

And if I were in a mental state to be able to make the decision, I would absolutely decide to stop seeking medical treatment based on cost. At some point, I would not want to leave my family penniless, when the odds were against me, and I might not have much quality time left anyhow. If it's somebody else's money, sure - why not? Maybe that is what is immoral?

-ERD50

+1

Universal health care sounds great on paper, but I can't see how it could ever be paid for with unlimited benefits. A line has to be drawn somewhere, the real debate is where?

 

[donheff]

Each of us do it every day.

As an example, I don't know anyone who pays to have a fully certified mechanic on their personal staff. Their car should get a full safety inspection prior to every single drive. What if your brakes failed? But it would be too expensive to do that.

You can give so many examples of this. How many CO2 and different types of smoke detectors do you have in your house, different types are better at detecting different types of smoke. Do you have a sprinkler system? On and on. We all make this decision. But, if those mechanics or other things were available 'for free', many more would insist on frequent inspections. Total expenditures would go through the roof.

And if I were in a mental state to be able to make the decision, I would absolutely decide to stop seeking medical treatment based on cost. At some point, I would not want to leave my family penniless, when the odds were against me, and I might not have much quality time left anyhow. If it's somebody else's money, sure - why not? Maybe that is what is immoral?

-ERD50

+1