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

[MichaelB]

This is such a difficult issue.

We have allowed our healthcare industry to evolve without guidance or structure. The result is a system today where access is a function of employment, intermediaries act as an oligopoly, conflict of interest is rampant and the incentive structure in place is perverse. It’s a fantasy to think it can be resolved easily – just like it’s a fantasy to think that an industry covering 17% of GDP can be reworked without causing a fair bit of pain.

You gotta start somewhere. My preference would be to begin with universal access and no underwriting – put in place a structure that lets consumers shop and change. An expanded public offering, fully priced. Then I would eliminate the tax benefit for employers. Then I would expand coverage for those that can’t pay. Then reform the punitive damages and develop a national arbitration process for malpractice.

That said, I fully support the house initiative right now, because I acknowledge the realities of our political process, and they are taking on the hardest part first. In fact, I’m open to lots of alternatives and options. The one I’m not receptive to is the one that starts with “The current system works fine”...

We have already left our children a financial mess. We should not also leave them a dysfunctional health care system.

Peace.

[Martha]

Quote:

Originally Posted by MichaelB This is such a difficult issue. We have allowed our healthcare industry to evolve without guidance or structure. The result is a system today where access is a function of employment, intermediaries act as an oligopoly, conflict of interest is rampant and the incentive structure in place is perverse. It’s a fantasy to think it can be resolved easily – just like it’s a fantasy to think that an industry covering 17% of GDP can be reworked without causing a fair bit of pain.

Yes, no one wants to be the one to cause any pain, even if in the long run we will all be better off.

[ERD50]

Quote:

Originally Posted by DallasGuy It's YOUR opinion that it's a red herring...my point is about the priorities that our country has. In MY opinion is that it is important when determining whether to pay for a national health plan or not. A national health plan doesn't seem to be a high priority to YOU...I can accept that.

DallasGuy, I really want to discuss the nation's health care options, not argue with you.

But quite simply, you are wrong on both points:

Ignoratio elenchi - Wikipedia, the free encyclopedia

Quote:

Similar to ignoratio elenchi, a red herring is an argument, given in reply, that does not address the original issue. Critically, a red herring is a deliberate attempt to change the subject or divert the argument.

and read this one of many posts where I am calling for health care reform.

http://www.early-retirement.org/foru...91&postcount=7

Quote:

Broken system, but based on the way other bills I've read are structured, I really, really fear that the govt will make it worse, not better A real shame, because I actually think we are in need of some govt oversight in this area , along the lines of what samclem has defined - everyone required to have ins, the ins cos required to take all applicants, taxpayers pay for those who can't - because there really is no other way to cover everyone, and no other way for the ins cos to not pick and choose and provide reasonable cost coverage to 'existing condition' people. -ERD50

Bye-Bye now

-ERD50

[Westernskies]

Private healthcare may not be an option much longer, anyway:

It's Not An Option

By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT
Congress: It didn't take long to run into an "uh-oh" moment when reading the House's "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal. When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee. It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting the Choice to Keep Current Coverage," the "Limitation on New Enrollment" section of the bill clearly states:” Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law. So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers. From the beginning, opponents of the public option plan have warned that if the government gets into the business of offering subsidized health insurance coverage, the private insurance market will wither. Drawn by a public option that will be 30% to 40% cheaper than their current premiums because taxpayers will be funding it, employers will gladly scrap their private plans and go with Washington's coverage. The nonpartisan Lewin Group estimated in April that 120 million or more Americans could lose their group coverage at work and end up in such a program. That would leave private carriers with 50 million or fewer customers. This could cause the market to, as Lewin Vice President John Sheils put it, "fizzle out altogether.” What wasn't known until now is that the bill itself will kill the market for private individual coverage by not letting any new policies be written after the public option becomes law. The legislation is also likely to finish off health savings accounts, a goal that Democrats have had for years. They want to crush that alternative because nothing gives individuals more control over their medical care, and the government less, than HSAs. With HSAs out of the way, a key obstacle to the left's expansion of the welfare state will be removed. The public option won't be an option for many, but rather a mandate for buying government care. A free people should be outraged at this advance of soft tyranny. Washington does not have the constitutional or moral authority to outlaw private markets in which parties voluntarily participate. It shouldn't be killing business opportunities, or limiting choices, or legislating major changes in Americans' lives. It took just 16 pages of reading to find this naked attempt by the political powers to increase their reach. It's scary to think how many more breaches of liberty we'll come across in the final 1,002

[ERD50]

Quote:

Originally Posted by Martha Yes, no one wants to be the one to cause any pain, even if in the long run we will all be better off.

It is so easy to make a statement like that, when you include an assumed "better off" as part of the statement. I'm asking for a little proof (not a guarantee, but something that gives an indication of the cost/benefit).

It's not unlike some of the "greenies" who see something that claims to save energy, and tell us we would all be better off with this amazing device, when in fact it consumes more energy than it saves. But oh! it "looks" so good, it must be good! Everybody, buy one today! Save the planet!

If having the govt run stuff was so likely to improve efficiency, and spur innovation, why don't we have the govt run our grocery stores, our car companies, our electronics firms?

Imagine, instead of looking at Apple, or Sandisk, or Microsoft for an mp3 player, we could just all buy the government issue one! Have you spent 30 minutes with an iPod Touch? I am totally blown away by what that thing does, the packaging, everything - and the price. It's almost a miracle.

Can you imagine a government agency developing the iPod Touch? C'mon now.

-ERD50

[samclem]

Quote:

Originally Posted by MichaelB We have allowed our healthcare industry to evolve without guidance or structure. The result is a system today where access is a function of employment, intermediaries act as an oligopoly, conflict of interest is rampant and the incentive structure in place is perverse.

For decades the US auto industry led the world--and it did it without any (government imposed) "guidance and structure." More "guidance and structure" (CAFE, rules giving organized abor an advantage in negotiations, import quotas (explicit and back-door) ) are largely responsible for the state of the US auto industry today.

The US agriculture industry is among the most productive and efficient in the world. Amazingly, it has almost no central control. Nobody in the government tells farmers which crops to plant where and when, nobody in the government allocates fertilizer according to need, nobody in DC arranges for harvesting equipment to be on hand at each farm and for trucks to move the crops to market. Incredibly, a system based on millions of individual decisions and miraculous communication via price levels exceeds the best centrally planned systems in the world. Other governments have imposed "structure and guidance" on their agricultural system, with resulting famine.

Medical care is a commodity with some unique characteristics, but it is not entirely unique. And, the mess we have on our hands right now is largely due to Washington's "structure and guidance." Without DC's invaluable "assistance" we wouldn't have the problems we've got (though we might have a different set ). Helpful "structure and guidance" hs included poorly-constructed wage controls in WW-II that excepted fringe benefits, including medical care--which led to the idiotic employment-health care linkage we have today. Un-equitable tax treatment of employer-bought insurance vs individually-bought insurance perpetuated this foolishness. Government-mandated coverages in health insurance policies have also driven up costs and reduced freedom of choice. We've seen where "structure and guidance" leads. Maybe the solution will be found in taking less poison, not in doubling the dose and hoping for an improvement.

[ERD50]

Quote:

Originally Posted by MichaelB We have already left our children a financial mess. We should not also leave them a dysfunctional health care system.

Based on what I've seen of recent bills from Congress, I'd say they are more likely to "kill two birds with one stone" here. They will leave them a dysfunctional health care system that makes the financial mess even worse.

I wish it weren't so.

-ERD50

[DallasGuy]

Quote:

Originally Posted by ERD50 It is so easy to make a statement like that, when you include an assumed "better off" as part of the statement. I'm asking for a little proof (not a guarantee, but something that gives an indication of the cost/benefit). It's not unlike some of the "greenies" who see something that claims to save energy, and tell us we would all be better off with this amazing device, when in fact it consumes more energy than it saves. But oh! it "looks" so good, it must be good! Everybody, buy one today! Save the planet! If having the govt run stuff was so likely to improve efficiency, and spur innovation, why don't we have the govt run our grocery stores, our car companies, our electronics firms? Imagine, instead of looking at Apple, or Sandisk, or Microsoft for an mp3 player, we could just all buy the government issue one! Have you spent 30 minutes with an iPod Touch? I am totally blown away by what that thing does, the packaging, everything - and the price. It's almost a miracle. Can you imagine a government agency developing the iPod Touch? C'mon now. -ERD50

OMG, it sounds like a red herring to me! How dare you divert attention away from the real subject at hand? From now on, I'll just assume that your the real authority on everything!

Bye Bye Now!

[ERD50]

Quote:

Originally Posted by DallasGuy OMG, it sounds like a red herring to me! How dare you divert attention away from the real subject at hand? From now on, I'll just assume that your the real authority on everything! Bye Bye Now!

Hehe-heh - I'll take this one.

Nah - that was a direct comparison of govt controlling costs and innovation to private costs and innovation, not a red herring at all, a parallel.

Now, if you *really* want to drag a war into this, we can, but it will weaken your case. If we accept your premise that the money spent on the war is a waste, then the govt has even less money laying around and we need to be careful with what we have. Even more reason to approach health care reform carefully to assure that it is sustainable, or we are stealing from future generations.

-ERD50

[oliverdickens]

Am I understanding this right or missing something?

It states under the #Making health care affordable section", that the provisions stated within the bill with not start until 2013!

Four years to implement? So it would mean none of the provisions would occur until than?

If that is the case, so much for all the buzz around immediate implementation that the WH is advertizing?

Appreciate the experts on this forum interpretation.

Thanks

[growing_older]

What we have now is such a wasteful system, there seems like there ought to be plenty of room for reform that could pay for itself by squeezing the waste out. Like the rental of wheelchairs for more than their cost - I was recently diagnosed with a condition that requires a home health care machine. I can buy one online for about $500 for a super deluxe model (about $300 for a plain one) but my insurance plan will ONLY support renting for the first 10 months, then purchase. The "retail" rental through the only supplier authorized by the Dr and the insurance has a rate of $230 per month. (That is $2300 for the 10 months!!) Actually the supplier also has a $25 per month charge that I have to pay regardless of insurance on top of everything else. The supplier rep told me that actual negotiated insurance reimbursement is about $40 per month. I have a deductible to satisfy, followed by insurance pays 50% and I pay 50%. If I end up being able to use the insurance co negotiated rate, I will get the $500 machine for about $650. (Their $40 negotiated rate for 10 months, plus my $25 for the 10 months). If anything goes wrong with this or I end up being charged to "official" retail rate, I could pay up to the max of my policy out of pocket (about $2550) for the thing.

Alternatively, I could just go online and buy one for a lot less. In which case my "insurance" will pay nothing and I will still have a deductible to satisfy if I need any other healthcare this year.

HSA type plans seem much more sensible. This system is crazy.

[M Paquette]

Quote:

Originally Posted by Westernskies Private healthcare may not be an option much longer, anyway: It's Not An Option By INVESTOR'S BUSINESS DAILY | Posted Wednesday, July 15, 2009 4:20 PM PT Congress: It didn't take long to run into an "uh-oh" moment when reading the House's "health care for all Americans" bill. Right there on Page 16 is a provision making individual private medical insurance illegal. ...

Ahem. IBD may be guilty of a bit of selective reading here. Following along the current draft here, we find that page 16 is a continuation of Section 102 (a), which specifies "GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED." This section does not make individual health care coverage illegal.

I'll repeat that. Section 102 (a) does not make individual health care coverage illegal.

This section defines which health care plans are defined as 'grandfathered.' Grandfathered health care plans can qualify as acceptable health care coverage under the proposed plan without adopting the plan standards. For example, they can still have a greater than 2:1 variation in pricing across age groups, or have payment policies substantially different from a "QUALIFIED HEALTH BENEFITS PLAN."

A health benefits plan that doesn't meet the criteria for "GRANDFATHERED HEALTH INSURANCE," to be deemed acceptable for purposes of the bill, will have to meet the qualification standards in the bill.

[ERD50]

Quote:

Originally Posted by Martha Here is one of the studies showing the percentage differences in admin costs between the US (31%) and Canada (17%): NEJM -- Costs of Health Care Administration in the United States and Canada ...

The numbers in wiki get ref'd back to:

Overview National Health Expenditure Data

I guess I wouldn't be surprised at differences, the methodology might not be the same, and they might not be apples-to-apples at all.

But in a more general sense, whatever number we use, I am having trouble with the "conclusion", which seems to be (paraphrasing) - Canada has lower admin costs, Canada has single payer, so if US had single payer, the US would have lower costs.

I think that the reasons that the US has higher costs are much more complex than that. You know, what we really need is a document like the "energy conservation without the hot air".

David MacKay: Sustainable Energy - without the hot air: Industry leaders

Something that would line up all these costs and show the relative amounts and what can be clipped and what cannot. When we talk about changing one, it might just shift the cost somewhere else. We need the big picture.

-ERD50

[lets-retire]

Quote:

Originally Posted by M Paquette Ahem. IBD may be guilty of a bit of selective reading here. Following along the current draft here, we find that page 16 is a continuation of Section 102 (a), which specifies "GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED." This section does not make individual health care coverage illegal. I'll repeat that. Section 102 (a) does not make individual health care coverage illegal. This section defines which health care plans are defined as 'grandfathered.' Grandfathered health care plans can qualify as acceptable health care coverage under the proposed plan without adopting the plan standards. For example, they can still have a greater than 2:1 variation in pricing across age groups, or have payment policies substantially different from a "QUALIFIED HEALTH BENEFITS PLAN." A health benefits plan that doesn't meet the criteria for "GRANDFATHERED HEALTH INSURANCE," to be deemed acceptable for purposes of the bill, will have to meet the qualification standards in the bill.

That's how I read the section. The only thing is if the policy is grandfathered, they will not be able to enroll new people. That would lead to changing the plan features so it is compliance with the law. I don't see to many companies keeping two different versions of plans from one provider as options. I also see where there won't be any set co-pays everything will be a percentage of the cost of care. I don't like percentages, it has a tendency to increase the cost of care in my situation.

[MichaelB]

I’m not sure I understand the debate here. Is this an “alt A vs alt B” discussion or an “alt A vs not alt A” . If the latter, the benefits of “not alt A” are not clear. It’s easy to oppose when one offers no clear alternative.

In other words, the various reform efforts have now been expressed in proposed legislation. What specifically do the people opposing these efforts propose?

Regarding the role of government in overseeing the health care system, just to say “gov’t involvement is bad” is also evasive. Gov’t involvement, overseeing or direct management is sometimes ineffective and sometimes effective. Apple’s ability to make iPhones has no bearing on their ability to run our national defense (although the weapons might look different). It may or not be a red herring but it certainly is a comparison that has no meaning or application in this discussion.

My feeling is that this is a true dilemma – we can’t afford to have gov’t involved, and we can’t afford to not have gov’t involved. Certainly the evidence of business and personal enrichment at the expense of individual health care denial highlights just one of the more perverse aspects of the system we have to deal with today.

Likewise, there are social objectives that a free market cannot achieve based in individual initiative. Government enables and oversees safety, security, education and transportation infrastructure and the US is a much better country as a result of this.

[ERD50]

Quote:

Originally Posted by MichaelB I’m not sure I understand the debate here. Is this an “alt A vs alt B” discussion or an “alt A vs not alt A” .

Depends on who is posting. It does get confusing...

Quote:

If the latter, the benefits of “not alt A” are not clear. It’s easy to oppose when one offers no clear alternative. In other words, the various reform efforts have now been expressed in proposed legislation. What specifically do the people opposing these efforts propose?

samclem gave a good summary and I can't seem to find it (samclem - can you post a link to it?), there are so many health care threads, but a very short form of that is what I posted recently :

Quote:

along the lines of what samclem has defined - everyone required to have ins, the ins cos required to take all applicants, taxpayers pay for those who can't - because there really is no other way to cover everyone, and no other way for the ins cos to not pick and choose and provide reasonable cost coverage to 'existing condition' people.

IOW, give *everyone* a voucher for basic care, require best practice preventive medicine for everyone for an "ounce of prevention" to lower costs (how to enforce is a tough nut, you can't really imprison someone who does not go for a check up and you can't fine them if you are paying their way.... need some motivator though), create some standardized language for a set of plans and let people pick the plan (and upgrade if they wish and can afford it).

Oh, and STOP supporting the idea of tying health care to employment - no tax benefit for a company that provides health care, that distorts the market.


BTW, I think this same approach should be applied to education (many parallels here - we don't want to see anyone go uneducated, we all gain from an educated society, but some cannot afford to pay....). I don't think our states should be running the schools, give people a voucher and let private schools compete for their money. Poor people get the basics, others can choose to upgrade if they can pay for it.

I'd like to see those ideas bounced off a "without the hot air" format of inputs/outputs, but my gut says that is a workable, and not entirely "upsetting the applecart" plan.

I gotta run, I've been thinking about starting a separate thread on the MASS HC situation, now that the there seem to be some chickens coming to roost. I did some searching though to make sure it hasn't started already, and came up with this thread from 2006:

http://www.early-retirement.org/foru...f-20510-2.html

Interesting to glimpse into the past with some hindsight. Also interesting how little has changed in the debate, and how the same derailments come into play. IMO, "Cool Dood", who hasn't posted since early 2007 had some good insights.

-ERD50

[samclem]

Quote:

Originally Posted by ERD50 samclem gave a good summary and I can't seem to find it (samclem - can you post a link to it?)

I think there were two threads where we discussed this.

More recently "Health Care Reform" Started by Rich-in-Tampa. I chimed in at post 38, it wasn't very long:

Quote:

. . . Imagine this: - Anyone who sells health plans in a region must take all who apply (no underwriting--same price for each policy type (see below) for everyone regardless of age, sex, or medical condition) - Government mandate: Everyone must buy health insurance (therefore, no adverse selection). The poor get a voucher on a sliding scale. - A fixed number (4? 6?) of government-defined policy types with varying co-pays and features. All have basic preventative care (to reduce overall costs to the system) and an annual cap on co-pays (income based? Asset-based?). All policies have very high limits on coverage. Standardized policy types=more efficient price competition. Now, there can be free market competition between insurers within that environment. The insurance companies get a guaranteed market of 100% of the legal citizens. The taxpayers are only paying for medical care for the needy. By selecting between the 4-6 plan types, people have some say in how much insurance they buy (within limits--these limits are in place because we, as a society, now believe people should not be free to choose to go without insurance as, in the end, other taxpayers end up paying the bill. Like it or not, that's where we are). Co-pays increase customer cost-consciousness. I like this more [added: than a single-payer govt option]. I want to be able to change insurers. I want to be able to go to a different doctor. And I want the government to regulate insurers, not become one (subject to no higher independent oversight).

We had more discussions and rebuttal after that.
****************************************
Here's an earlier one: "McCain and Obama on the Issues"

I think we can and should keep in our health care system the tremendous advantages that free-market competition brings to every other aspect of our economy as we also recognize that this good/service is unique and not amenable to a pure laissez-fair answer.

[Martha]

Quote:

Originally Posted by oliverdickens Am I understanding this right or missing something? It states under the #Making health care affordable section", that the provisions stated within the bill with not start until 2013! Four years to implement? So it would mean none of the provisions would occur until than? If that is the case, so much for all the buzz around immediate implementation that the WH is advertizing? Appreciate the experts on this forum interpretation. Thanks

That is correct. One of the number of things I am not happy with.

[ERD50]

Quote:

Originally Posted by oliverdickens Am I understanding this right or missing something? It states under the #Making health care affordable section", that the provisions stated within the bill with not start until 2013! Four years to implement? ....

Quote:

Originally Posted by Martha That is correct. One of the number of things I am not happy with.

The cynic in me (well OK, I'm 99 and 44/100 % cynic ) notes that 2013 is *after* 2012. Coincidence? Or maybe a very smart person (someone smart enough to get elected President after a short term in Congress?) would notice that there seem to be some problems surfacing in MASS after just a few years of Health Care reform....

A bit more seriously (or maybe not), I would think that some of the cost savings measures at least could be phased in way before that date. Use that to lay some groundwork.

Quote:

Originally Posted by samclem I think there were two threads where we discussed this. More recently "Health Care Reform" Started by Rich-in-Tampa. I chimed in at post 38, it wasn't very long: We had more discussions and rebuttal after that. **************************************** Here's an earlier one: "McCain and Obama on the Issues"

Thanks, I guess that was the one - I seem to remember it being a bit longer and a few more bullet points, but no matter, those are the key points. Probably my faulty memory.

I would think a plan like that could be phased in also - similar to the risk pools that Martha described in Minn - just keep enlarging the pool as we go until all are covered.

-ERD50

[eridanus]

As an aside,

If you have concerns about your health and don't want the results disseminated, go to a doctor that doesn't take your health plan (some don't take ANY health plans). Pay with cash. Carefully read the privacy form you're given. If something is found, and it's expensive to test or treat it, go back to the first doctor and get insurance to cover it.

Unethical? Perhaps. But it beats being denied because a benign polyp was found.