No health care for you! Come back one year...

[ERD50]

I gave the data point not so much as to suggest a solution but to give an idea of cost for a group that is going to be higher than average in cost. Yet spreading that cost around doesn't make insurance unaffordable in Minnesota.

OK, it is interesting that the high risk pool doesn't seem to cost all that much more to insure. By keeping costs reasonable for people, they are more likely to just get the insurance rather than try to game the system and wait until they are sick, and that lowers the total "riskiness" of that pool.

I think it all points back to the basics, we need to get everyone in a program to avoid the selection issues (on both sides), and we need to control costs, while giving people some reasonable choice and say in some matters (some of which they may need to pay for).

Am I interpreting this correctly? If the premiums are ~ 110% of "similar plans" (I assume you mean what a large employer would be charged per employee), and the premiums cover ~50% of the cost, that means the true cost is ~ 220% of "similar plans", a little more than double. Which isn't bad, esp if you just cannot get ins.

So essentially, Minnesota is "forcing" the ins cos to cast a wider net, take in more risk and spread the costs across the group (which is what ins is all about). The downside is maybe to the mega corp that negotiated a good rate, maybe because steadily employed people are healthier on average, or they have health clubs, etc... they are going to pay more.

Maybe that is what we need, but like others it is bothering me that this seems to be nothing but cost shifting, rather than tangible efforts to reduce costs. I keep hearing we have the highest costs for health care in the US and not always better outcomes, we should be able to find places to cut. What's next - when I buy a new car, there will be a 10% fee to help pay for a car for some person that just can't afford it? Hey, it's only 10%, and it will help someone.... I guess I just get tired of the "you have so we will take it" as the *first* line of response. Did they say they are going to pay for this from taxes from the top 1%? So 1% are going to pay their health care, and then pay the gap for another 99 people on top of that?

-ERD50

 

[Martha]

Your last statements are what I think is the problem... all I see is the payment side... who has to have insurance, who gets to pay more... what the plan has to have, the deductibles.... but none of that addresses the COSTS of providing healthcare... from an accounting prospective, this is the 'income' side... yes, we will get more income in the system which might mean the amount of 'income' coming from my specific plan will go down.... but I still will go to the same doctor, get the same tests, get the same results... which means the 'cost' side is the same.... I do not call this 'health care reform'.... but welfare for the poor (which seems to include a good part of the middle class)....

But maybe you do not need certain tests and certain treatments for a good outcome. There is much to be done on the good medicine side as well as the dollars and cents side. For example, I read an article that areas with high numbers of cardiac surgeons (per capita) there were far more bypasses and other cardiac procedures than areas with lower numbers of these specialists. But the outcomes were the same. Maybe a bit of rationalization when looking for work to do? Our health care sector needs to be encouraged towards best practices. Something to think about when thinking about what is the best way to compensate for care.

 

[ziggy29]

That's the key. This is welfare for primarily low income and to a limited extent middle income folks. This proposal will guarantee insurance to all at SOME price, and to the low and middle income folks at a limited price. Welfare = full price premium - limited price premium

IMO, "welfare" is a loaded term along the lines of "class warfare" and stuff like that. It evokes an emotional response rather than a more measured one. I suppose it is "welfare," but I don't know that those terms are all that helpful in respectful and open-minded public policy debate.

Like many, though, I share a concern that if the nation goes more and more to higher taxes on the affluent and more subsidies for the lower incomes, you can conceivably reduce the "incremental value" of work to the point where people decide it's not worth working longer and/or harder, and it's not worth it to try to increase earning power (and the amount one pays in taxes).

Health care is not a right, IMO, no matter what some say. Health care is, on the other hand, a basic human good that I believe a compassionate and affluent society should want to see available to all, where inability to pay or preexisting conditions are not barriers to having affordable access to preventative and pallative care. But in wanting to find ways that we can accomplish this, U.S. policymakers should try not to eliminate what's *good* about the health care system, and they should realize that you can only go down the tax-and-subsidize route so many times before the ants look over and realize they are busting their ass and have little more than the grasshopper to show for it. If such a critical mass of ants realized this and became grasshoppers, it's game over; the republic would be doomed when enough people believe earning more money is a sucker's game.

We must do better. But that's also not the same as "we have to do something," because when things seem like they can't possibly be worse, they definitely can. Change for change's sake alone is not a good idea. Many ill-advised things have occurred in history because of a desperate public's desire to "do something."

 

[Martha]

OK, it is interesting that the high risk pool doesn't seem to cost all that much more to insure. By keeping costs reasonable for people, they are more likely to just get the insurance rather than try to game the system and wait until they are sick, and that lowers the total "riskiness" of that pool.

I think it all points back to the basics, we need to get everyone in a program to avoid the selection issues (on both sides), and we need to control costs, while giving people some reasonable choice and say in some matters (some of which they may need to pay for).

Am I interpreting this correctly? If the premiums are ~ 110% of "similar plans" (I assume you mean what a large employer would be charged per employee), and the premiums cover ~50% of the cost, that means the true cost is ~ 220% of "similar plans", a little more than double. Which isn't bad, esp if you just cannot get ins.

So essentially, Minnesota is "forcing" the ins cos to cast a wider net, take in more risk and spread the costs across the group (which is what ins is all about). The downside is maybe to the mega corp that negotiated a good rate, maybe because steadily employed people are healthier on average, or they have health clubs, etc... they are going to pay more.

But not much more when you spread it out over the whole state. The issue actually isn't the risk pool or Minnesota care, which people love here in Minnesota. It is medicaid, which is for the very poor who fit into certain pigeon holes, as it is poorly funded, suffering both whims of the feds and the states.

Maybe that is what we need, but like others it is bothering me that this seems to be nothing but cost shifting, rather than tangible efforts to reduce costs. I keep hearing we have the highest costs for health care in the US and not always better outcomes, we should be able to find places to cut. What's next - when I buy a new car, there will be a 10% fee to help pay for a car for some person that just can't afford it? Hey, it's only 10%, and it will help someone.... I guess I just get tired of the "you have so we will take it" as the *first* line of response. Did they say they are going to pay for this from taxes from the top 1%? So 1% are going to pay their health care, and then pay the gap for another 99 people on top of that?

-ERD50

I talk about this every once in a while. This is where you need the experts. This is why it is important to listen to people like Rich and Meadbh when they talk about evidence based medicine. Or when they talk about checklists in hospital rooms before doing a procedure (first, wash you hands. . . ). This is where it is important to look at the differences between different clinics and hospitals and why certain ones have as good or better outcomes at a lower cost. I think that one thing we can do is try to figure out a mechanism to reward best practices.

 

[FUEGO]

IMO, "welfare" is a loaded term along the lines of "class warfare" and stuff like that. It evokes an emotional response rather than a more measured one. I suppose it is "welfare," but I don't know that those terms are all that helpful in respectful and open-minded public policy debate.

I guess it is semantics to me. I used the term "welfare" as shorthand for a wealth transfer mechanism. Or in the general meaning of the word "welfare" - ie - for others' benefit and welfare.

I was simply trying to be descriptive of what the House Democrat's bill proposes to do - mandate insurance for everyone (or pay a penalty) and then subsidize the cost of that plan for low and middle income participants through a wealth transfer mechanism. There, less emotionally charged? It is politically correct I guess. Although the House Democrat's bill was notably light on who they are hitting up to pay for this plan. Long on the pro's and short on the cons.

And move me from the ant column to the grasshopper column on this one it looks like.

 

[ziggy29]

I was simply trying to be descriptive of what the House Democrat's bill proposes to do - mandate insurance for everyone (or pay a penalty) and then subsidize the cost of that plan for low and middle income participants through a wealth transfer mechanism. There, less emotionally charged? It is politically correct I guess. Although the House Democrat's bill was notably light on who they are hitting up to pay for this plan. Long on the pro's and short on the cons.

And move me from the ant column to the grasshopper column on this one it looks like.

Heh. The thing is, when it's an incremental approach it's a frog in a pot kind of situation. Each time you add another tax and another subsidized program, you bring the ants and the grasshoppers a little bit more toward balance, and those who want it to keep going that way want small chunks to anesthetize our senses so we don't know we're being boiled alive. That can be worthwhile to a point, given that many revolutions have been fought over the have nots feeling farther and farther behind -- but if allowed to go too far, as I said, continuing to work longer and harder to maximize and increase income would increasingly become a sucker's game, and it's critical that we not let it get *that* far.

Though in the end, depending on how it's done and how it's financed, FIRE people could be among the biggest "winners" in health care reform...

 

[armor99]

Sounds like the best option would be to give the individual the choice of opting for the national plan or a private plan.

This is inherently not really fair though. The govt plan gets backing and funding from our tax dollars. Private plans do not. Therefore the national plan will always be cheaper because it is being subsidized. Eventually the imbalence of those on the subsidized plan vs the private plan will become SO great that only the VERY wealthy would ever be able to afford the private plan. This is why some people call the dual plan "stealth govt healthcare" because that is what would likely happen.

 

[ERD50]

RE: cost reductions -

I talk about this every once in a while. This is where you need the experts. This is why it is important to listen to people like Rich and Meadbh when they talk about evidence based medicine. Or when they talk about checklists in hospital rooms before doing a procedure (first, wash you hands. . . ). This is where it is important to look at the differences between different clinics and hospitals and why certain ones have as good or better outcomes at a lower cost. I think that one thing we can do is try to figure out a mechanism to reward best practices.

Agreed - if the govt wants to demonstrate to us how well they can orchestrate these efficiency improvements, here's an idea:

Implement a round of savings programs, take the savings and use it to cover more people. The reduced ER visits and preventive care benefits will result in even more savings which can be used to cover even more people, etc, etc, etc,... until everyone has been covered and we haven't spent any more of our kids/grandkids money.

What, we need to show results!!?? That'll go over big in DC

-ERD50

 

[Kabekew]

I've always paid cash for routine doctor visits so little things don't get on my "official record." My various insurance over the years have never declined me for "apparently never seeing a doctor," all they know is I've only made a couple benign prescription claims and they keep renewing me.

 

[Bestwifeever]

So far I'm encouraged. One thing I feel is key that insurance has to be mandatory, like education is, to make this work. Of course, our education is tax-based; and people who choose to go outside public education still have to pay for the general education goal. Not going into arguments about the state of education, its funding, whatever--just saying our national policy has been to provide education through high school for every kid.

It sounds like our government is working toward an insurance strategy that will also require participation and that the people who are not making enough to pay their full freight will get a break (but cannot opt out). There are a lot of economic interests to work with, but it looks to me like we are making progress. I'm truly amazed.

 

[ERD50]

What to make of this?

Is this a sign?

Clicking the link labeled:

"What's in the Health Care Reform Bill For You?"

http://energycommerce.house.gov/Press_111/20090714/hr_3200_13reasons.pdf

Brings up:

404 Not Found
The document you requested (http://energycommerce.house.gov/Press_111/20090714/hr_3200_13reasons.pdf) was not found on this server.

-ERD50

 

[Bestwifeever]

Is this a sign?

Clicking the link labeled:

"What's in the Health Care Reform Bill For You?"

http://energycommerce.house.gov/Press_111/20090714/hr_3200_13reasons.pdf

Brings up:





-ERD50

Probably a broken link. I did a simple search for "what's in the health care reform bill for you?" You can find that document here:

http://edlabor.house.gov/documents/...raftHealthCareReform-12ReformHelpFamilies.pdf

 

[ERD50]

Probably a broken link. I did a simple search for "what's in the health care reform bill for you?" You can find that document here:

http://edlabor.house.gov/documents/...raftHealthCareReform-12ReformHelpFamilies.pdf

Thanks, the other links on that page that I tried worked OK, hmmm, I thought this was the administration that was supposed to be so interweb/tube savvy

Well, there are some things in there that look like they could help. But the devil will be in the details. Maybe far too early to tell, but at least that pdf didn't seem to include any options for a high deductible policy, for those who might want to self-insure up to a point.

-ERD50

 

[Texas Proud]

But maybe you do not need certain tests and certain treatments for a good outcome. There is much to be done on the good medicine side as well as the dollars and cents side. For example, I read an article that areas with high numbers of cardiac surgeons (per capita) there were far more bypasses and other cardiac procedures than areas with lower numbers of these specialists. But the outcomes were the same. Maybe a bit of rationalization when looking for work to do? Our health care sector needs to be encouraged towards best practices. Something to think about when thinking about what is the best way to compensate for care.

I agree with your statement.... how does the proposals fix the problem?

And why can we not fix the problem you state WITHOUT insuring 47 million more people on the taxpayer's dime

 

[Texas Proud]

I saw on the news an interview with Dr. Timothy Johnson... I believe ABC


He asked the Prez about a panel of 25 people... the prez said something about them being experts and recommending procedures to follow etc... so I guess there is medical rationing buried somewhere in the bill....

(my opinion... no fact).... so it strikes me that there will be a panel that will say what we will spend money for and what we will not... just like the current insurance companies.... but this is gvmt mandate... so it is 'law'... wonder if you can pay for it yourself and get it done? IIRC, this was against the law in Hillary's plan....

 

[Texas Proud]

WOW... just read the one pager.... NOTHING in there to reduce costs...

"no more co-pays or deductibles for preventive care".... well, who is going to pay for it

"an annual cap..." again, who is going to pay for my services if I need them?

"job and life choices will no longer be based on health care coverage" how? I will still have the same plan at work... with the same insurance company.... they 'guarantee' that all the time...

 

[lets-retire]

If your high deductible plan can continue to exist in the future, the $4000 public plan may cover more stuff with less out of pocket maximums. So far they are saying there will be minimum requirements that must be met for coverage by the public plan and ultimately the employers too. No word on required coverage for completely private plans. I'm assuming the out of pocket max they are talking about will be less than $10,000.

The only minimum standard is required for a qualified health benefits plan. There is no language specifying whether the plan is employer, individual or government, only that it be a qualifying plan. If the bill is passed, the only plans available, from what I've read, will be qualifying. Policies currently in effect will still available to those who have them, but no new enrollees will be accepted if the plan doesn't meet the minimum standards. The minimum required coverage is quite extensive and pretty much covers everything. The list starts on page 27 of the bill.

The maximum out of pocket cost share is $5000 for individual and $10000 for a family, in addition to the increase in the cost of the insurance. With the restrictions on pricing, I think the "baseline" will be the highest risk people and the lower risk people will, obviously pay less than that. The least risk will be 1/2 of the highest risk. We might receive a refund every year from the insurance company, but we will still have to pay the money up front. I also haven't read anything in the bill that works on limiting the increase in doctor's bills. If the insurance companies see that they are going to have to give money back, why not pay the doctor's more money? Either way the money goes back to the consumers or the providers, not the insurance company. If someone told you you had to give up $10k and gave you two options of who to give it to (no knowledge of background and both appearing equal) would you really care who received you money?

 

[Martha]

I've always paid cash for routine doctor visits so little things don't get on my "official record." My various insurance over the years have never declined me for "apparently never seeing a doctor," all they know is I've only made a couple benign prescription claims and they keep renewing me.

There is no "official record." If you applied for a new health insurance policy you would have to disclose visits (if there was a question about doctor visits or who you see as a doctor) even if you paid with cash. Otherwise you would be lying which is arguably fraud.

 

[Martha]

Given that there are several committees working on reform, with three about to pass their own bills, I think it still is too hard to know where things are going to shake out.

Lyndon Johnson got Medicare because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost. Despite the cost, Does anyone really regret Medicare?

A political scientist I heard on the radio suggests passing a reform bill without spending too much time on the costs because if we worry about cost too much it won't get done. Then, once we have all the citizens covered there will be tremendous pressure to reduce costs. Not advocating here, just passing a position along.

 

[ziggy29]

Lyndon Johnson got Medicare because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost. Despite the cost, Does anyone really regret Medicare?

That's a tough question to answer.

Do I regret having some level of guaranteed basic health care for seniors? No.

Do I regret how Medicare has evolved, what it has done to the cost structure of health care in the U.S. and how unsustainably expensive it's getting? Yes.

In other words, I support the ends, but the means stink.

 

[ERD50]

. Despite the cost, Does anyone really regret Medicare?

That's a tough question to answer.

Do I regret having some level of guaranteed basic health care for seniors? No.

Do I regret how Medicare has evolved, what it has done to the cost structure of health care in the U.S. and how unsustainably expensive it's getting? Yes.

In other words, I support the ends, but the means stink.

Yes, it is not helpful/useful to look at some positive outcome and say that justifies the entire package. That leads to all sorts of bad decisions and I could give endless silly (and serious - ethanol) examples.

Especially, one must look at what alternatives would have done for us. It's similar to some of the energy threads we have going on. You can never justify a personal windmill because it "saves energy", because alternatively, the same investment (in energy and money) in a commercial windmill will produce far more energy. You can't look at things in a vacuum. Analyze all the options and pick the best one.

because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost.

History about to repeat itself? Heck, it's only us old pharts that remember LBJ.

-ERD50

 

[youbet]

Lyndon Johnson got Medicare because he was extraordinarily popular at the beginning of his presidency and because he lied about the cost. Despite the cost, Does anyone really regret Medicare?

I regret Johnson lied about the cost and created a funding system which was doomed to move costs from the then current beneficiaries to future beneficiaries. If he had simply bellied up to the bar and funded Medicare in real time with current taxes paying for current benefits, we'd be OK with it today.

Now, Obama seems intent on doing the same thing......... understate costs and create funding schemes that will lead to future generations paying for benefits we get today.

One day the house of cards will crumble.......

 

[ERD50]

A political scientist I heard on the radio suggests passing a reform bill without spending too much time on the costs because if we worry about cost too much it won't get done. Then, once we have all the citizens covered there will be tremendous pressure to reduce costs. Not advocating here, just passing a position along.

I understand you are not advocating, so I will question along with you.

Did this political scientist describe how well this process has worked for MediCare? I think we ought to learn from history.

I had it beat into my head and I've seen the evidence that the time spent planning a project has huge paybacks. Yes, you need to move forward and not just leave the project on the drawing board forever. But I don't think that "we will figure out how to pay for it later" is the right time to leave the drawing board.

-ERD50

 

[Martha]

I understand you are not advocating, so I will question along with you.

Did this political scientist describe how well this process has worked for MediCare? I think we ought to learn from history.

I had it beat into my head and I've seen the evidence that the time spent planning a project has huge paybacks. Yes, you need to move forward and not just leave the project on the drawing board forever. But I don't think that "we will figure out how to pay for it later" is the right time to leave the drawing board.

-ERD50

The problem is that our political system doesn't work well in solving these types of problems. We have, I believe, five committees separately working on health care reform. It is big, messy and complicated, and will get messier as the pork falls in to buy votes. The drug lobby and insurance lobby can only be overcome by people not letting up on harping on their legislators to get something done. We won't end up with a single pay even if it happened to be the best result because of lower admin costs because of rules regarding saving a dollar if you spend a dollar (because the savings are at the individual and employer side, not the government side).

I am leaning towards getting something done even with flaws because no matter what it is going to have flaws.

 

[ERD50]

I am leaning towards getting something done even with flaws because no matter what it is going to have flaws.

Flaws are unavoidable, I certainly don't expect perfection, but whatever system they propose should be demonstrably better than what we have, or they should go back to the drawing board (not do nothing).

The problem is that our political system doesn't work well in solving these types of problems.

Interesting observation. Maybe the govt should get out of the way then? One of their efforts to help, tax benefits for companies providing health care, has back fired and made people's health care dependent on staying with a single employer.

-ERD50