Obamacare in the supreme ct

[modhatter]

Quote:

Originally Posted by ziggy29 I don't know anyone who is advocating a system that produces massive adverse selection as you are describing here. Yes, if done wrong -- if there is no universal mandate and there are insufficient penalties for going uninsured -- this could happen. Pretty much everyone who supports a system with no underwriting recognizes that it can not happen without a "universal mandate" -- and the penalty for noncompliance needs to be stuff, at least as expensive as a high deductible health insurance policy would cost. And as I've said before, with public subsidies (or a public option) there are ways to recoup the costs of "unhealthy lifestyle choices" at the cash register.

If we analyze the overall objective of the bill, it was to be able to offer insurance to everyone at a reasonably affordable cost, and to stop the current insurance companies abuses.

I have not seen this problem solved in any other country other than some form of universal care (whether it includes purchasing your own guaranteed policy or one supplied by the government) But I think if you read any books on the subject of health care in these other countries, they all have one common denominator. Everyone must carry a policy, irregardless or age or health. Also, none of them are run for profit. Others are government run like England HSA , similar to our Medicare (only medicare for all, not just the above 65).

And though I agree that the current bill that got passed, has not adequately addressed all the loopholes (such as low penalty fines) or competition. It is a starting point that can hopefully be refined, adjusted and changed for the better as we go forward.

Someone commented that they don't think it right that a young person of say 27 who is healthy be forced to carry an expensive policy the same as a 60 yr.old. Actually that statement as it relates to numbers is not totally correct. If it were correct however, I would still argue that the 27 yr. old will one day soon be 60 yrs. old, and will need the new 27 yr. following behind him to help off set what could be otherwise an unaffordable premium for the 60 yr. old.

Also, I wonder if anyone considered the positive effects of a more uniform employee health insurance cost for employors. We sure would have less age discrimination in the work force. When looking at hiring a 27 year old, vs a 55 year old for the same job paying the same salary, unless you come with some stunning credentials, who do you think is picked? (Especially in a bad job market like now)

As a small business owner once providing health insurance, I sure know that. The first thing the insurance companies did each year before renewal was look at the the ages of all of the employees and how many claims there were last year and if that employee or employees were still on the payroll. They set that new premium for the next year according to those factors.

So as a small business owner, if I want to be able to continue to offer my employees health insurance, or not have my policy purged, what do you suppose I do when I consider who to hire? That unfortunately is an ugly truth.

So if the current bill that requires the young and healthy to join the pool and the mandate that everyone must participate is struck down, then so goes the Pre Existing Condition part, or the Purging of Sick people and small companies.

(Actually what insurance companies do with small companies who have some chronic sick people that they want to get rid of, they raise the new rates so high each year, you are eventually forced to let your policy (or even uglier) your sick employees go. Not a very pretty picture either way.

I agree I don't think we're there yet on the cost issue because the insurance companies still have too much control, no real competition, and will always figure out a way to circumvent the problem to maintain there profits. And rightly so, as they are a For Profit Company, and have shareholders to satisfy, and promised stock options that must be made attractive to hire the best people.

But correct me if I'm wrong. Isn't the Supreme Court only allowed to decide in the legal merit of the case brought before them? And if the issue put before them is whether or not the mandate in the bill is Constitutional, the consequences of them ruling it is not - is of little concern to them (legally speaking)

It will nonetheless be very interesting hearing the arguments coming from each one of the Justices. I wonder if there will be any unexpected surprises in their rulings from either side. I am sure this board will be lit up once again.

[samclem]

Quote:

Originally Posted by modhatter So if the current bill that requires the young and healthy to join the pool and the mandate that everyone must participate is struck down, then so goes the Pre Existing Condition part, or the Purging of Sick people and small companies.

If the individual mandate were found to be unconstitutional, the insurance exchanges could still go ahead and be set up. Subsidies (i.e. forced wealth redistribution) could be set up so that no person would pay more than, say, 10% of their income for insurance (and the truly indigent would pay less than that or nothing), and the companies would have to accept every applicant and charge them the same rate. So you'd have a situation where everyone could realistically be able to afford coverage. Those who elect to make a different choice would have no government-supported coverage--not Medicaid, nothing except what they can provide for themselves, get from family or charities, etc. But, because of the premium supports, everyone would be able to afford coverage. At first many folks would skip coverage, and then the consequences of these decisions would become part of the public awareness. Wouldn't that be better than nothing? Would it be better than what we have now? Have we come so far from the idea of people ultimately being responsible for themselves that we won't permit bad decisions to have repercussions in this area as they do in every other aspect of our lives?

[dgoldenz]

Quote:

Originally Posted by modhatter If we analyze the overall objective of the bill, it was to be able to offer insurance to everyone at a reasonably affordable cost, and to stop the current insurance companies abuses. I have not seen this problem solved in any other country other than some form of universal care (whether it includes purchasing your own guaranteed policy or one supplied by the government) But I think if you read any books on the subject of health care in these other countries, they all have one common denominator. Everyone must carry a policy, irregardless or age or health. Also, none of them are run for profit. Others are government run like England HSA , similar to our Medicare (only medicare for all, not just the above 65). And though I agree that the current bill that got passed, has not adequately addressed all the loopholes (such as low penalty fines) or competition. It is a starting point that can hopefully be refined, adjusted and changed for the better as we go forward. Someone commented that they don't think it right that a young person of say 27 who is healthy be forced to carry an expensive policy the same as a 60 yr.old. Actually that statement as it relates to numbers is not totally correct. If it were correct however, I would still argue that the 27 yr. old will one day soon be 60 yrs. old, and will need the new 27 yr. following behind him to help off set what could be otherwise an unaffordable premium for the 60 yr. old. Also, I wonder if anyone considered the positive effects of a more uniform employee health insurance cost for employors. We sure would have less age discrimination in the work force. When looking at hiring a 27 year old, vs a 55 year old for the same job paying the same salary, unless you come with some stunning credentials, who do you think is picked? (Especially in a bad job market like now) As a small business owner once providing health insurance, I sure know that. The first thing the insurance companies did each year before renewal was look at the the ages of all of the employees and how many claims there were last year and if that employee or employees were still on the payroll. They set that new premium for the next year according to those factors. So as a small business owner, if I want to be able to continue to offer my employees health insurance, or not have my policy purged, what do you suppose I do when I consider who to hire? That unfortunately is an ugly truth. So if the current bill that requires the young and healthy to join the pool and the mandate that everyone must participate is struck down, then so goes the Pre Existing Condition part, or the Purging of Sick people and small companies. (Actually what insurance companies do with small companies who have some chronic sick people that they want to get rid of, they raise the new rates so high each year, you are eventually forced to let your policy (or even uglier) your sick employees go. Not a very pretty picture either way. I agree I don't think we're there yet on the cost issue because the insurance companies still have too much control, no real competition, and will always figure out a way to circumvent the problem to maintain there profits. And rightly so, as they are a For Profit Company, and have shareholders to satisfy, and promised stock options that must be made attractive to hire the best people. But correct me if I'm wrong. Isn't the Supreme Court only allowed to decide in the legal merit of the case brought before them? And if the issue put before them is whether or not the mandate in the bill is Constitutional, the consequences of them ruling it is not - is of little concern to them (legally speaking) It will nonetheless be very interesting hearing the arguments coming from each one of the Justices. I wonder if there will be any unexpected surprises in their rulings from either side. I am sure this board will be lit up once again.

Modhatter,

Thanks for the long, thought-out response, good to see. I will try to respond to each part of your post individually:

Quote:

Originally Posted by modhatter If we analyze the overall objective of the bill, it was to be able to offer insurance to everyone at a reasonably affordable cost, and to stop the current insurance companies abuses.

I think what you and other ER.org members would consider to be a "reasonably affordable cost" is very different than what the general public would consider reasonably affordable. Sell health insurance for a few weeks and you will see exactly what I mean.

Quote:

Originally Posted by modhatter And though I agree that the current bill that got passed, has not adequately addressed all the loopholes (such as low penalty fines) or competition. It is a starting point that can hopefully be refined, adjusted and changed for the better as we go forward.

As we go forward, there is no going back. Once the entitlements of health insurance subsidies are in place, it will be incredibly difficult to take them away. I truly do not think that there is any way for the bill as written to become sustainable over a long period of time. In my personal opinion, the only possible thing that PPACA can lead to when I look 20-30 years down the line is some type of single-payer system.

Quote:

Originally Posted by modhatter Someone commented that they don't think it right that a young person of say 27 who is healthy be forced to carry an expensive policy the same as a 60 yr.old. Actually that statement as it relates to numb[rs is not totally correct. If it were correct however, I would still argue that the 27 yr. old will one day soon be 60 yrs. old, and will need the new 27 yr. following behind him to help off set what could be otherwise an unaffordable premium for the 60 yr. old.

My argument was that a 27 year old is not likely to pay more for health insurance simply to subsidize a 60 year old, which is essentially what this bill requires. While the 27 year old will be 60 at some point and have to deal with these expenses then, the average income of a 60 year old person is much higher than that of a 27 year old. As I posted before, it is incredibly difficult to get someone under 30 years old to spend more than $100/month on health insurance. Trying to explain an HSA plan to someone under 30 is almost like pulling teeth.

Quote:

Originally Posted by modhatter So as a small business owner, if I want to be able to continue to offer my employees health insurance, or not have my policy purged, what do you suppose I do when I consider who to hire? That unfortunately is an ugly truth.

As a small business owner, when all policies become guaranteed-issue in 2014, you will most likely want to purge your employees from the health insurance plan and give them a defined contribution towards their health coverage instead. This eliminates a number of hassles for small employers, such as dealing with rate increases, having to review other coverage options every year, and having to explain to employees why their rates and cost-sharing are both increasing.

Quote:

Originally Posted by modhatter So if the current bill that requires the young and healthy to join the pool and the mandate that everyone must participate is struck down, then so goes the Pre Existing Condition part, or the Purging of Sick people and small companies.

Easier said than done. As stated earlier in this thread, until the marginal cost of the penalty exceeds the marginal cost of not having health insurance, many will choose to have nothing and challenge the IRS to squeeze blood from a turnip.

Quote:

Originally Posted by modhatter I agree I don't think we're there yet on the cost issue because the insurance companies still have too much control, no real competition, and will always figure out a way to circumvent the problem to maintain there profits. And rightly so, as they are a For Profit Company, and have shareholders to satisfy, and promised stock options that must be made attractive to hire the best people.

The healthcare bill will further decrease competition and leave the individual health insurance market in the hands of 3-4 large insurers. I predict that in 2014, 98% of the health insurance market will be owned by Blue Cross/Blue Shield companies, United Healthcare, Humana, and Aetna. Smaller companies cannot make a profit with an 80% loss ratio requirement. Let's revisit this post in 2014 and see if I'm right.

[dgoldenz]

Quote:

Originally Posted by samclem If the individual mandate were found to be unconstitutional, the insurance exchanges could still go ahead and be set up. Subsidies (i.e. forced wealth redistribution) could be set up so that no person would pay more than, say, 10% of their income for insurance (and the truly indigent would pay less than that or nothing), and the companies would have to accept every applicant and charge them the same rate. So you'd have a situation where everyone could realistically be able to afford coverage. Those who elect to make a different choice would have no government-supported coverage--not Medicaid, nothing except what they can provide for themselves, get from family or charities, etc. But, because of the premium supports, everyone would be able to afford coverage. At first many folks would skip coverage, and then the consequences of these decisions would become part of the public awareness. Wouldn't that be better than nothing? Would it be better than what we have now? Have we come so far from the idea of people ultimately being responsible for themselves that we won't permit bad decisions to have repercussions in this area as they do in every other aspect of our lives?

Again, I think you severely overestimate the number of people willing to pay 10% of their income for health insurance. In my experience selling hundreds of health insurance policies, the average premium tolerance is a maximum of about 5% of total income except for those in bad health whose claims will outweigh any premiums they pay anyway. The way that PPACA is set up, there is a massive marginal tax on anyone who exceeds the subsidy thresholds. Family of 4 making $92k gets a massive subsidy so their cost of insurance doesn't exceed 9.5% of insurance. Family of 4 making $1 over the maximum to qualify for subsidies gets no subsidy at all and pays 100% of their now ridiculously expensive health insurance cost. This difference can be up to $20k/year, believe it or not.

[modhatter]

Quote:

Originally Posted by samclem If the individual mandate were found to be unconstitutional, the insurance exchanges could still go ahead and be set up. Subsidies (i.e. forced wealth redistribution) could be set up so that no person would pay more than, say, 10% of their income for insurance (and the truly indigent would pay less than that or nothing), and the companies would have to accept every applicant and charge them the same rate.

Well that's why the participation in the mandate is crucial. Without it, there would be too few people to level the "cost" playing field. That is why it is considered an integral part of the whole bill. The question in my mind is: Is that of any concern to the Supreme Court in their rulings?

You and I have spared before on this subject (health care bill) so I am aware of your sentiments concerning having to pay other peoples bills. You feel everyone should earn their own way, and for the most part, I agree with you. I don't think that everyone is entitled to live in a nice house or drive a nice car, or have great clothes etc.. But where we do differ: I do feel we as a collective society should all have a right to expect at least a basic level of health care. Not necessarily the same level, but at least a marginally acceptable level for sustaining life. All other industrial countries do, and even many third world countries do. We as a county in this big world of ours are very much alone in our thinking otherwise in this matter (or at least half of our country)

And I also happen to feel that this can best be achieved by government collective sharing for the good of "the all." If you don't travel a particular highway in your state, should you not have to be taxed for it. If your house doesn't burn down, and you don't have to call the fire company, should you be reimbursed your tax money? There are some things that can only be best served by everyone putting into the pot. If you eat less, and throw out less garbage should you get a rebate? You get my drift, right?

As for Medicaid recipients. Even though they may be thankful they have it, I would guess that most would trade places with you or me in a heart beat. I think the difference here lies in our "shared list". I think health care belongs on it and you don't. I don't think the poor receiving Medicaide are always getting the same level of care that you and I do and as long as I could afford it, I would probably pay for a private policy myself. But, then again, I sure would want it if had no other options.

Actually dividing the pot up as we have proves to be not very cost effective. The government doesn't collect enough revenue to cover all the health claims that come in at this age group (Medicare -65 and over). Wouldn't it make more sense to consolidate the insurance across the board to include everyone. If you think that the government is incapable of running the show, fine. Let an outside NON PROFIT insurance company do it. (but with strict accountability)

Some countries who have a system like this allow for those who can afford more to buy supplemental insurance that will provide them with more perks (private rooms, better doctor selection, newest drugs not just generic, etc.) The mandatory basic policy premium is deducted from their pay checks weekly, or by weekly or in some cases paid for by the company, and the individual then can if they so choose, up their coverage and chose a supplemental policy of their own which they pay for themselves directly. They can choose any additional level of care that they want. (They earned it) I guess you could say it's a Medicaid for all, and if you can afford more, you get it. The basic policy doesn't allow you to go to Sloan Kettering when you get cancer, you go to your local cancer center in your area. With the supplemental (paid for by the money you have earned through your hard work), you can go to Sloan Kettering. Could you be comfortable with a system like this?

I enjoyed reading about what the Taiwanese government did (I believe it was Taiwan, if my memory serves me right) They were one of the latter nations to tackle the health care issue. They were aware of some of the bad experiences some other countries had with theirs. So they formed a committee to research I think something like 26 different countries, who have had some form of universal health care for a while.

I think it took them almost two years to complete the study, but they physically visited each country, and spoke not only with the health officials, government officials, treasury, but visited the hospitals, talked to the doctors and the staff, the patients, and every component of the industry. They made up a report of their findings from each country - listing how they ran it, what worked and what didn't, and most importantly why.

With this study in hand, they came back to their country and sat down to draw from the mistakes and accomplishments of each countries system, and put together a plan from this information gathered, to incorporate the best of what they found, and avoid the worst of what they found.

Now call me nuts, but doesn't this seem like a very logical approach for refining our own countries future health care needs and dealing with rising costs.

Just some interesting information for any of you interested.

[samclem]

Quote:

Originally Posted by modhatter That is why it [the individual mandate] is considered an integral part of the whole bill. The question in my mind is: Is that of any concern to the Supreme Court in their rulings?

I sure hope not. I'm not a lawyer, but I don't think the Supreme Court is in the business of making a law "work", they are there as the arbiter of whether legislation is consistent with the Constitution. Most laws are written with severability clauses to allow the remainder of the legislation to stand if one portion is struck down, that was deliberately not done in this case. If the individual mandate is struck down, it will be up to the Court to decide whether the rest of the legislation stands, but the intent of Congress was clear (by omission of the severability clause).

Quote:

Originally Posted by modhatter I do feel we as a collective society should all have a right to expect at least a basic level of health care.

From where does this "right" originate? It's inherently different from the rights expressed in the Constitution, as no one is forced to work for the government for free to pay for them. It might be good if we collectively paid for health care for everyone, we might agree that it would make for a better society, but I think "right" goes much too far.

[modhatter]

Quote:

Originally Posted by samclem From where does this "right" originate? It's inherently different from the rights expressed in the Constitution, as no one is forced to work for the government for free to pay for them. It might be good if we collectively paid for health care for everyone, we might agree that it would make for a better society, but I think "right" goes much too far.

You are correct SamClem. It is not a Constitutional Right. I view it more as a moral right on society as a whole. I don't need to consult my Constitution to marry who I want. It is a right that society over time has implied as my human right. Even as little as 25 years ago, the cost of carrying health care insurance for an individual or family, was not the enormous burden it is today. It was very manigable for most up until the last decade. This is a NEW early 21st Century problem that we are encountering which is getting worse every year, and we need to find solutions.

I think a compassionate society should want to find a way to provide a minimum level of health care for it's citizens.

Because our government has failed us for so many years to address this elephant in the room (not politically intended) and actively seek out some workable solutions does not bode well for our government in my mind. It is the governments role to intervene in some matters when their citizens are being hurt or abused. It is their job to govern, and protect, and institute new laws to achieve this when necessary. I think most of us feel (who were in favor of health care reform) that what did get past is better than nothing, and if it took us this long to get this past, we'll take it as a start. I think but can't say with certainty, that the public option was meant to be a stepping stone to an eventual single payer. But they could have pulled the wool over our eyes on that one two. Many say it was really never in the cards to begin with.

The one thing that I do agree with that another poster mentioned which I know is true. It is very hard to take away any subsidies once they are given. Of course the reason for that is a politicians fear of losing his or her seat if they vote in favor of taking something away. So sometimes our Democratic ways has the end result of making sure nothing gets done.

Perhaps though, if it were to prove to be a bad choice or unsustainable, we might at that point be more willing on a more united front to look at and explore some single payer options with some real serious leverage with the pharmaceutical companies as well.

[Midpack]

What a great thread!

Whether health care is a "right", moral obligation or not seems secondary at best.

We pay more than 50% more than the next highest developed country and 145% more than the average. And our costs are increasing faster than other developed countries http://upload.wikimedia.org/wikipedi..._cost_rise.svg

If we had better results to show for it, the premium might be explainable, but we don't.

• The US is 20th in life expectancy List of countries by life expectancy - Wikipedia, the free encyclopedia
• The US is 34th in infant mortality List of countries by infant mortality rate - Wikipedia, the free encyclopedia
• No other country has anything like the number of medically uninsured as the US, it's unheard of in most other countries. In the US, people who lacked health insurance last year climbed to 49.9 million, up from 49 million in 2009, 16.3% of the population.
• Our wait times are not shorter than other countries (see below - might have been true once, not any more, though people still use this argument)
• Medical bankruptcy does not exist in countries with universal health coverage like Japan, Canada, Great Britain, Taiwan, Germany, Italy, Switzerland, Sweden, Norway, Austria, Finland, and France, just to name a quick dozen. But, here in the wealthiest, most powerful country in the world, medical debt forces many people into bankruptcy. The American Journal of Medicine recently published a study showing that medical debt has contributed to over 60% of [US] bankruptcies. [In the vast majority of these cases debtors had other kinds of debt as well, such as credit cards and taxes. But they also had at least some medical debt.] Medical Bankruptcy is No Myth

In other words, there are arguably better models all around us, in practical terms we can do so much better. I wish we could share thoughts on how, but I'd be afraid of having Porky show up...

People like to point to one or two causes, there are probably many more which is part of the reason it's so difficult to address. Some of the factors (in no particular order):

• lifestyle (obesity, smoking, drugs)
• high cost and profit for intermediaries (insurance)
• excessive profit for some product and service providers
• administrative burden (millions of microplans)
• high charges for specialized services
• forced use of expensive specialized facilities for routine medical needs (emergency room)
• multiple regulations around the country
• punitive legal awards
• diagnostic overuse (expensive tests even for routine matters)
• treatment overuse (especially end of life)
• excessive unproductive labor vs technology
• excessive usage

[explanade]

Why is health care so expensive in the US? Because it's lucrative and those benefitting from the current system have worked to preserve it as much as possible.

For instance, pharmaceuticals cost way more in the US than in other countries. Big Pharma says US needs to pay higher prices to fund research that everyone benefits from -- that claim is debatable to some, as a lot of the research comes from NIH-funded work.

It's amazing there's no outrage that we're being gouged so the rest of the world could pay less. But what happened, the pharmaceutical lobbyists got to write laws, such as the prescription drug benefit, including clauses that outlaw the ability of the govt. to negotiate for lower drug prices. Plus the federal govt. actively tries to prevent Americans from importing drugs from Canada for lower prices.

What to make of these laws and actions other than they're purely for the benefit of the drug industry at the expense of the people?

Oh and citing the Constitution as not having a right to health care is an expedient way to preserve the current system. THere are a lot of things the govt. does, including many that are supported by "strict constructionists" which are not explicitly spelled out.

That 250-year old document gets trotted out when it's convenient, as if all human wisdom and foresight reached their apex in the 18th century.

[samclem]

Quote:

Originally Posted by explanade That 250-year old document gets trotted out when it's convenient, as if all human wisdom and foresight reached their apex in the 18th century.

It's true--I'm fairly fond of "that 250-year old document." It even has a built-in mechanism to allow for updating it. We all agree that the present health care "system" (ha!) is a mess, so if this is something that we're ready to cede to the government it would seem proper to amend that hoary old document to make everyone's rights and responsibilities more clear. Maybe this high and proper road will get more attention if the Supreme Court invalidates the individual mandate in the present law.

[explanade]

No amendments any time soon.

[ziggy29]

Quote:

Originally Posted by explanade It's amazing there's no outrage that we're being gouged so the rest of the world could pay less. But what happened, the pharmaceutical lobbyists got to write laws, such as the prescription drug benefit, including clauses that outlaw the ability of the govt. to negotiate for lower drug prices. Plus the federal govt. actively tries to prevent Americans from importing drugs from Canada for lower prices.

I am outraged by it. But it's not all at Big Pharma. Some of it is the price fixing of most other countries that mandate the most they will pay. I just worry that if *every* nation puts significant price caps on new medications, a significant percentage of current R&D gets scrapped.

And some of the outrage is to the legislators who prevent re-importation of medications from places whose drug safety laws are every bit as strong as those in the US, if not stronger.

Quote:

Originally Posted by explanade That 250-year old document gets trotted out when it's convenient

1761?? That was even before the Stamp Act...

[explanade]

I rounded up. I think it was 1787 and final ratification was 1789?

And it's been roughly 100 years since the last amendment?

As for R&D in pharma, it's greatly overrated. They benefit a lot from NIH-funded research and then they get to patent drugs which are slight variations of other drugs, either by the same companies or a competitor. Then they get some favorable patent terms, like keeping certain drugs off generics longer.

Plus their ad budget is larger than their R&D and they concentrate on lifestyle drugs these days. When we had vaccine scares, turned out they stopped making enough of certain vaccines because the profit margins weren't there.

Before the oil industry blew up, Pharma was ridiculously profitable, with oversized compensation for execs.

Pharma isn't the only reason for the high health care costs but it's a part of it. Then you have hospitals and other providers too.

[ziggy29]

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Originally Posted by explanade Pharma isn't the only reason for the high health care costs but it's a part of it. Then you have hospitals and other providers too.

There are plenty of reasons. The problem is that these causes are ideologically diverse, and I think too many people only argue for the subset of causes that neatly fit their ideological perspective and dismiss the other ones as insignificant -- or not factors at all since it doesn't fit their agenda. That drives me crazy and I think it's part of the reason we're collectively too ideologically stubborn and intransigent to fix this.

Quote:

Originally Posted by explanade And it's been roughly 100 years since the last amendment?

Even if you don't include the 27th Amendment (which was proposed around 1790, I think), there have been several amendments in the last 100 years -- the most recent (the 26th) in 1971.

There have been six amendments ratified since WW2.

But beyond that I would tend to agree that Washington seems to have no interest in the amendment process -- they prefer to pass Constitutionally questionable legislation and hope the Supreme Court looks the other way.

[Midpack]

Quote:

Originally Posted by ziggy29 The problem is that these causes are ideologically diverse, and I think too many people only argue for the subset of causes that neatly fit their ideological perspective and dismiss the other ones as insignificant -- or not factors at all since it doesn't fit their agenda. That drives me crazy and I think it's part of the reason we're collectively too ideologically stubborn and intransigent to fix this.

+1

Like many of the issues that have the US "stuck" at the moment...

[modhatter]

+ 1 Explanate

And Midpack, I also agree with you 100% There are numerous issues contributing to the problem.

Many countries enjoying a better standard of living than the US, higher wages etc. (where things cost a lot, like here) have been successful in developing affordable health care plans for themselves. Most of these people are very pleased with their health care in the studies conducted, and most important, they can sleep at night.

Of course all of them have abandoned the previous Health Care For Profit insurance companies. Those that still use them work on a purely administrative bases for stated service fees and still compete to a limited degree for business, with guidelines set up by the government.

In other countries they have been turned into only providers for supplemental policies for those who can afford it, wishing to purchase additional plans, but the basic coverage comes from the government.

Some, like England, have abandoned most all privately run health hospitals and organizations, though there are some privately run ones you can access if you choose to purchase a supplemental policy there as well, that gives you some additional privileges, but it is my understanding that few do so, as most are very satisfied with the HSA.

As stated, their system is the most controlled, as the government owns pretty much all the hospitals, pays their doctors not only a set salary, but a bonus plan for their successes which can increase their income substantially (more than double it in some cases) when they are successful in doing things like getting their patients to stop smoking, getting their patients cholesterol level down, getting their patients to lose weight etc, etc.. Physicians are not able to profit from expensive tests, MRI's etc. or even operations I believe. There increase in pay comes from their success rate in controlling and curing their patients and most importantly preventative medicine. They have lots of incentive to do a good job.

They (the government) progressively pursue preventative medicine by heavy marketing and easy availability to keep people healthy. All the drugs are bought by the government at greatly reduced cost, and the cost for any prescription to an individual is always $6.00

In our current Democratic system, most politicians are heavily influenced by whoever gets them (pays into their campaign) and keeps them in office or promises a good job afterwards. As well as their own party basically threatening them that if they stray from the fold and vote other than told, there will be serious consequences and they can kiss any future support goodby. This formula hardly makes for good representation for us.

It seems the only way we have ever been able to get congress to do something is just like Obama advised in his campaign when asked a question at one of his rallies. "Make Me".
I think that was very telling of the reality of politics today.

As long as the pharmaceutical companies, the AMA's , and large insurance companies are successful in convincing 1/2 the public that change to our current system is a bad thing, we will never be able to make it right. I think of Lincoln's famous statement, “A house divided against itself cannot stand.”

I also love this one too by Lincoln by the way, “These capitalists generally act harmoniously and in concert, to fleece the people”

So if we can't count on congress to make things right on their own, then it is left to us to yell loud enough and in big enough numbers to make them do it. Are we always doomed to be divided by ideological diversity?

I can't help think that on the issue of health care, we could have cross over. I know that even though I consider myself to lean mostly left, I do not agree with my representative parties in all matters.

Sometimes I see merit in a more conservative mindset of the issue. Sometimes I see solutions that can pull ideas together from both sides.

The question is: Are there enough flexible and rational people out there who can put their party aside and look at issues independently for themselves. It appears to me, you tend to think not.

I think the key here is education. Too many people don't really know all the alternatives we have available. They don't know what the rest of the world has done, and sometimes cling to the idea that American exceptional-ism trumps all, and rejects looking at things outside our borders in any global capacity. I don't know the percentages, but I do know that an uninformed decision is usually a bad decision. I WANT TO RUN FOR OFFICE. GIVE ME MY YOUTH BACK!

[explanade]

Well if you say you want free-market health care, then you are saying health care businesses have every right to maximize profits or price at what the market will bear -- though a lot of providers have non-profit status, which may confer some tax advantages.

Of course, some would say this is a dysfunctional market because there isn't transparency and consumers aren't able to shop around, either because they don't have the opportunity or they don't have the knowledge. If you need emergency surgery, you're not going to have the chance to price-compare. Plus the insurance payment scheme may have introduced price distortions into the market.

[samclem]

Quote:

Originally Posted by explanade If you need emergency surgery, you're not going to have the chance to price-compare. Plus the insurance payment scheme may have introduced price distortions into the market.

It's very useful to distinguish between two things:
1) Establishing an open (though regulated) market in health insurance
2) Establishing an open (though regulated) market in health care (procedures, medicines, etc)

Both are important, but in my opinion #1 is more important, and in some ways it can encompass #2. If people have good information on the various health insurance plans available to them (costs, customer satisfaction, wait times, any "extra" benefits above the standard package, any standardized information on outcomes for various procedures, etc) then they can make an "umbrella" choice that leaves the issue of controlling costs and assuring customer satisfaction to the insurance companies (it's all baked into the cost and quality info available to the consumer). When I buy a car, I do my research on available models, find out what they cost, see if present customers are happy and if the manufacturer has designed a good car, then I make a choice. I don't fret with trying to find the best value for every individual part and then ask Toyota to substitute a different type of engine so I can save money. It comes as a package.

Assuring that accurate information on health insurance packages (standardized information on costs, satisfaction, outcomes, etc) is available might be a valid function for the government in this whole process. They'll do a terrible job of presenting the info, but that can be done much better by private companies (compare doing your taxes using the official IRS "help" and using TurboTax.) There would be fantastic web sites/decision engines by KFF and others within a week to help folks pick the best insurance plan based on their needs, but the government probably needs to drive the collection of information from insurers/customers.

Now, there's a place for price transparency in medical care and "shopping around" as a means to help cut costs. I'd like to see the costs of various procedures because I have to make a co-pay. Insurers can make this a selling point: "all our approved providers are required to tell you in advance what their services cost--the actual cost that you'll pay and what will be paid by your insurance. You can also go to our web site and see what various procedures cost from those who are enrolled in our system". A policy like that would be more likely to get my business.

[modhatter]

Have you looked at a recent insurance prospectus lately. You'll be real hard pressed to find a lot of the detail in it. After recently experiencing this, I had to call and go up several levels to talk with someone who was willing to furnish me with "the real deal", and that sure did take a long time to get accomplished. I spent a lot of time (thank goodness I'm retired) on the phone listening to people tell me all that I need to know was stated in their brochure they had already sent me or on line at blah blah blah.com By not accepting their answers- I was subjected to being passed on to number 2 to be told the same thing, #3, and then finally #4 who fessed up to the fact, and agreed to send me the "complete" book that would answer all my questions.

Now how many of the average souls out there will question authority or perhaps for lack of a better word "less worldly" know enough to do what you and I might do. Is it ok for them to be screwed because they didn't know enough not to question what that brochure they were sent did not say?

A lot of policies written today are hardly worth the paper they are written on and some families after years of paying on it, get a big surprise when someone gets sick and needs it.

Maybe you are just referring to when the 2014 policies roll around (if they ever do)

IMHO health care should be elevated to a higher level that includes a level of protectionism for everyone (smart and not so smart) and every possible measure taken to safeguard the less sophisticated. And that all policies put on the market in the future contain a certain minimum level of protectionism that is reasonable to preserve life if you get sick (without losing your home and everything you own). From there, your on your own as to how much you want to spend.

I also hope our government will insure that all policies and prospectuses contain all the information in VERY understandable terms for everyone.

But choosing the policy, I think is the least of our problems for the future (hopefully). Like many here have posted above we have more serious problems to figure out in health care, like cost containment, how to achieve affordable availability- doctor shortages (primary care) -elimination (for real) of insurance company abuses and ultimately how to make it available for everyone rich and poor

[haha]

Quote:

Originally Posted by modhatter Have you looked at a recent insurance prospectus lately. You'll be real hard pressed to find a lot of the detail in it. After recently experiencing this, I had to call and go up several levels to talk with someone who was willing to furnish me with "the real deal", and that sure did take a long time to get accomplished. I spent a lot of time (thank goodness I'm retired) on the phone listening to people tell me all that I need to know was stated in their brochure they had already sent me or on line at blah blah blah.com By not accepting their answers- I was subjected to being passed on to number 2 to be told the same thing, #3, and then finally #4 who fessed up to the fact, and agreed to send me the "complete" book that would answer all my questions. Now how many of the average souls out there will question authority or perhaps for lack of a better word "less worldly" know enough to do what you and I might do. Is it ok for them to be screwed because they didn't know enough not to question what that brochure they were sent did not say? Actually, I think it is a mute point, as selecting the best insurance policy today, does little to really address the BIG problems at hand in that department. Smarter people will usually always make better buying decisions, and the uninformed will always make the worst. The only question I pose to you on that subject is: Is it ok to say, you deserve what you get when it comes to health care. You didn't ask enough questions or read all the small print when you signed. Sorry, your screwed. Don't you think it vitally important to protect people who generally don't make life's best decisions when it comes to an issue like health care? Shouldn't at least health care be elevated to a higher level that includes a level of protectionism for everyone (smart and no so smart)? Like many here have posted above we have more serious problems to figure out in health care, like cost containment, affordable availability, doctor shortages (primary care) insurance company abuses, how to make it available for everyone rich and poor, and as this tread first started out, the role it plays with your wages, and it's effect on business.

Good post. I recently went to a Medicare Advantage sales seminar put on by GHC here in Seattle. Judging by their questions the attendess were all well educated and curious about their opportunities. The presenter was excellent, very well organized, and I think completely out front. Yet I needed to go to 2 of these seminars to feel that I had much of a grip on the details, and I feel sure that if I joined I would be discovering things I had understood incompletely for several years at least.

A person needs time to do this kind of thing, and interest and imo the willingness to keep coming at things from different angles and watch for inconsistancies, hesitancy, body language and then ask ask ask until you get contract type disclosure.

With some things, like annuities, we can just say, no, not going to play. But health insurance, what choice do we have?

It should not be this complicated.

Ha