Socialized Medicine

Constructive ideas!

These are good ideas.

Requiring everyone to buy insurance is very important. We can't have people choose new car payments instead of health insurance and then show up in the ER expecting free care and badmouthing the system.

I think it may be a good idea to require insurance companies to sell policies to everyone who applies.

Write the policy and the coverage, set the price where you want, but then anyone can buy the policy at that price.

The government or a mandatory private pool fund will have to help underwrite the high cost patients at first.

There will need to be some tweaks for age so low paid healthy
twentysomethings are not paying as much as highly-paid, overweight, MI-having, fiftysometings but everyone has to pay - one way or the other.

There are no easy solutions.



samclem said:
Here's what I think would work to let everyone obtain care and keep things affordable. It's not what I think the country should do, but it is better than the alternative I believe we are headed for.

1) Mandatory Coverage: Everyone must buy a policy.
2) Government vouchers based on need. (Just as food stamps do for nutrition)
3) Private policies of four or five standardized types. A limited number of policy types greatly enhances price competition. Label them A-E and require that the insurers call them by that label.
4) No underwriting: If an insurer elects to sell a particular type of policy, the insurer must accept all applicants. Differences in price arr allowed based on geographic area. But--citizens can change policy types only once every 5 years (reducing the "hey-I've got a bad disease, I'm gonna go with the Cadillac policy now" syndrome)
5) All policies (of the 4 or 5 types) would cover preventative care that serves to reduce medical costs overall (Pap smears, immunizations, prenatal care, annual checkups, etc). Policies would differ by the co-pay amounts, private vs semi-private rooms, types of perscription drugs covered, degree of "doughnut-hole" that the insured would cover largely on his own, etc). All policies would feature catastrophic coverage based on the insured's household income--maybe all medical costs over 30% of income would be covered.
6) A government-run clearinghouse with with medical/consumer information. Provides info on customer satisfaction with various insurers by policy types, information on outcomes by procedures for various hospitals/centers, average out-of-pocket costs incurred by consumers in each state for each type of insurance, etc). This helps promote consumer knowledge and informed decisionmaking.
7) Individual purchase of medical care is allowed. Unlike some countries which prohibit individual purchase of medical care, it would be allowed in the US. In addition, if you want to purchase an additional medical policy to cover cosmetic surgery, experimental treatments, nursing home care, daily electroshock therapy, in-home aromatherapy, accupuncture, etc, that would be okay, too

There. The market helps provide cost controls (especially by giving consumers a stake in reducing their use of medical care and in picking insurers with the lowest costs). Provides consumers with feedback on medical care so they can make an informed choice. The "Cadillac" plans would be expensive because they cover a lot and because of adverse selection (that's the policy type the sickest people would choose), so people would be "incented" to select plans with higher co-pays, which helps drive down costs. Everyone gets the cost-effective preventative care provided in a cost-effective way, everyone is protected against catastrophic medical costs, the free market is preserved, medical costs are de-coupled from employment (which would be good for our economy as a whole), and the very poor pay nothing for their care (due to vouchers). And, if you want to take some risk by self-insuring to a larger degree, you are allowed to do it.
Click to expand...
 
robcanuck said:
In Canada, we have universal health care. We need to go to the doctor - make an appointment and go. In an emergency, we're treated in the emergency room of the hospital. Emergency surgery or treatment for life-threatening condition - immediate attention. Elective surgery -- you are prioritized and yes, there will be a wait time ( no queue jumping in Canada). I don't think the quality of health care differs significantly between our countries. I understand that per capita health care costs are much less in Canada than in the U.S. Of course, we pay more in income tax for health care. But most Canadians proudly consider our universal health care coverage as one of the most important benefits our citizenship and something we would never give up.

Rob
Click to expand...

Except all those nice Canadien folks who come to the US and pay CASH to get operated on, because they don't want to wait a couple years........;)
 
I think the doctors in this country are going to see a HUGE decrease in personal income once the health system gets nationalized. The last specialist I saw was one of the top surgeons in Egypt, and his top income year there was $40,000 a year. I am pretty sure he's making over $250K here.........
 
FinanceDude said:
I think the doctors in this country are going to see a HUGE decrease in personal income once the health system gets nationalized. The last specialist I saw was one of the top surgeons in Egypt, and his top income year there was $40,000 a year. I am pretty sure he's making over $250K here.........
Click to expand...
I don't know that the specific numbers will be what you mentioned but my prediction is that the very high reimbursement subspecialties (radiology, ophthalmology, orthopedics and a few others) will take a hit, while primary care (internal med, pediatrics, family med) will be relatively spared; the latter are already at a treacherous point.

Some will try the conceirge approach and other work-arounds. There will be some departures, fewer trainees in the $$ specialties but that will settle out over 10 years.
 
We are short of primary care providers; I think that we need to encourage people to go into primary care instead of the high dollar specialties. There is evidence that the number of specialty procedures increase as the number of specialists increase, per capita, without better outcomes.

Obama has said that his mind is open to any and all proposed solutions and he is meeting with both parties to discuss reform, now that he has a team together. We will see where it goes.
 
Rustic, of course this assumes that something needs to be done, something needs correction. If you or others don't believe that is the case then there is a good chance that you would not view this administration as having an open mind.

As far as what will be done, it will have to end up being a compromise. Personally, I favor a single payer system. I am in the minority. I will not get what I favor. But nevertheless, I hope and trust that we will have something better than what we have down, which addresses these and other issue:

--high costs including high administrative costs
--the need for evidence based care (which will help with cost)
--small employers being priced out of the insurance market
--the uninsured issue
--the adverse selection issue
--promotion of good health habits
 
Martha said:
--promotion of good health habits
Click to expand...
The devil is in the details, but this is what scares me. Of course I'm not against healthy habits but I also don't want a government that can tell me how much exercise I have to get, what I can eat and how much, whether I smoke, drink or do whatever I choose to do with my own body. If we can "encourage" healthy habits without going down the road of controlling the lifestyle of others, that would be good but I suspect we'd hear the inevitable demands that "if I'm forced to pay for (or subsidize) their health insurance, I have a right to tell them to put down that pizza and run a couple miles"...
 
That is why I said promotion, not require. For example, free nicotine substitutes. Deduction of gym memberships if you use them. Physical education in the schools. That sort of thing.
 
Martha,
The 'compromise' is what I was referring to. Three republican senators does not make a compromise. I suspect is you take a good look at the stimulus plan, you will find the pay off to the three republican senators. I saw Obama 'talk' to republican, but see no evidence he listened, and, I expect no difference for any bill that comes before congress.

The Democrats are doing what the Republicans should have done. I don't like it, but it is there party for the next two years.
 
There is an old cynical bumper-sticker joke that a conservative is a liberal who has been mugged. As an old-time insider in the health care world, I can attest to the fact that a health-care liberal is a health-care conservative who has been (seriously) sick.

I long ago dropped politics from my views on these matters. It's just too serious and universal a problem -- both financially and medically -- to continue its dysfunctional ways. I don't care whether the solution is considered liberal or conservative, we need to make it work. You have no idea...
 
Rich_in_Tampa said:
.
I long ago dropped politics from my views on these matters. It's just too serious and universal a problem -- both financially and medically -- to continue its dysfunctional ways. I don't care whether the solution is considered liberal or conservative, we need to make it work. You have no idea...
Click to expand...

Rich, can you take a look at samclem's outline posted below:

http://www.early-retirement.org/forums/showpost.php?p=789731&postcount=170

I don't see anything political in that, only solutions. They look good to me.

Originally Posted by samclem
Here's what I think would work to let everyone obtain care and keep things affordable. It's not what I think the country should do, but it is better than the alternative I believe we are headed for.

1) Mandatory Coverage: Everyone must buy a policy.

2) Government vouchers based on need. (Just as food stamps do for nutrition)

3) Private policies of four or five standardized types. A limited number of policy types greatly enhances price competition. Label them A-E and require that the insurers call them by that label.

4) No underwriting: If an insurer elects to sell a particular type of policy, the insurer must accept all applicants. Differences in price arr allowed based on geographic area. But--citizens can change policy types only once every 5 years (reducing the "hey-I've got a bad disease, I'm gonna go with the Cadillac policy now" syndrome)

5) All policies (of the 4 or 5 types) would cover preventative care that serves to reduce medical costs overall (Pap smears, immunizations, prenatal care, annual checkups, etc). Policies would differ by the co-pay amounts, private vs semi-private rooms, types of perscription drugs covered, degree of "doughnut-hole" that the insured would cover largely on his own, etc). All policies would feature catastrophic coverage based on the insured's household income--maybe all medical costs over 30% of income would be covered.

6) A government-run clearinghouse with with medical/consumer information. Provides info on customer satisfaction with various insurers by policy types, information on outcomes by procedures for various hospitals/centers, average out-of-pocket costs incurred by consumers in each state for each type of insurance, etc). This helps promote consumer knowledge and informed decisionmaking.

7) Individual purchase of medical care is allowed. Unlike some countries which prohibit individual purchase of medical care, it would be allowed in the US. In addition, if you want to purchase an additional medical policy to cover cosmetic surgery, experimental treatments, nursing home care, daily electroshock therapy, in-home aromatherapy, accupuncture, etc, that would be okay, too

There. The market helps provide cost controls (especially by giving consumers a stake in reducing their use of medical care and in picking insurers with the lowest costs). Provides consumers with feedback on medical care so they can make an informed choice. The "Cadillac" plans would be expensive because they cover a lot and because of adverse selection (that's the policy type the sickest people would choose), so people would be "incented" to select plans with higher co-pays, which helps drive down costs. Everyone gets the cost-effective preventative care provided in a cost-effective way, everyone is protected against catastrophic medical costs, the free market is preserved, medical costs are de-coupled from employment (which would be good for our economy as a whole), and the very poor pay nothing for their care (due to vouchers). And, if you want to take some risk by self-insuring to a larger degree, you are allowed to do it.
Click to expand...

The only change I might make is the "need based" vouchers. I say just give a voucher to everyone, it cuts down on administration and "loopholes" on what is defined as "need". Those that are not "needy" will be paying for it in their taxes one way or another. Simpler to just deal with it that way, IMO.

-ERD50
 
ERD50 said:
Rich, can you take a look at samclem's outline posted below:

http://www.early-retirement.org/forums/showpost.php?p=789731&postcount=170

I don't see anything political in that, only solutions. They look good to me.
Click to expand...
Take a look at Rustic23's post as an example of politics obscuring solutions (hey, we're all entitled to our view -- "just sayin'" as Janet would put it).

Samclem's thoughtful proposal contains good ideas that I support. But good ideas have been around this issue for a long time. It's the implementations that have failed, back to the Clintons and before.

Realistically my opinion is that strong leaders needs to vet this, make it happen at great political cost, keep it in place and refine it, and ultimately let Americans see that it is better than the alternatives and a reasonable part of our societal expectations. I don't think I'm naive about the difficulties it will generate, and I know what the system is like now.

The priorities I see in rough order are universal coverage, unlinking from employment, elimination of underwriting, definition of basic minimal coverage, and subsidization of the medically indigent. Part of this would include drastic reduction of the stake held by private insurers, consensus panels to define "best practice" where such consensus exists (these already exist though without universal adoption), tighter regulation of pharmaceutical companies in many realms, and bolstering of NIH and similar gov't assisted research budgets. Throw in tighter constraints on punitive awards for "good faith malpractice."

I also support enhancement of primary care and the "advanced medical home" concept.
 
Rich_in_Tampa said:
unlinking from employment
Click to expand...
This is, to me, a huge one.

There are several reasons. Many of you know through my periodic [-]bitching and moaning[/-] missives that we're trying to find a job for my wife which will have a backup set of benefits, primarily health insurance, in case I lose my job. She could probably find several jobs in town that have little to no coverage -- we know a few folks in town who run businesses and are periodically hiring even now. But right now what we feel we need is auxiliary medical coverage in case I lose mine. If we didn't link health insurance to employment, this would not be a concern.

Also, I think the link between employment and health insurance damages the entrepreneurial spirit. I suspect there are quite a few people out there with good ideas, a desire to be their own boss and who can carve out a workable business plan to start up their own business.... but they are tethered to Megacorp for the health insurance. Given that small business is the primary engine of job creation, I don't think this is a good idea.

Some may counter that a national plan that raises taxes would kill small business, and yes, it would be a counter-weight. Taxes matter. But I think a lot of suboptimal decisions are being made because of the perceived need to cling to an employer offering health insurance, and eliminating that link could greatly expand the options a lot of people feel they have.

Anyway, Rich, I'm pretty much with you in that I'm tired of seeing politics, ideology and demagoguery getting in the way too many times. Democrats shouldn't be trying to "shoot the moon" and Republicans shouldn't be throwing the "socialist" label at any attempt to gain universal coverage. The devil is in the details.
 
Last edited:
The fear that universal health care paid for by the government is not political for me. It is a fear that the country is heading in a direction that will result in an governing system more like the European countries rather than one that made American what it is.


It would seem this thread was started to be political. It's not in the Fire & Health forum.
 
Rich_in_Tampa said:
Realistically my opinion is that strong leaders needs to vet this, make it happen at great political cost, keep it in place and refine it, and ultimately let Americans see that it is better than the alternatives and a reasonable part of our societal expectations. I don't think I'm naive about the difficulties it will generate, and I know what the system is like now.

The priorities I see in rough order are universal coverage, unlinking from employment, elimination of underwriting, definition of basic minimal coverage, and subsidization of the medically indigent. Part of this would include drastic reduction of the stake held by private insurers, consensus panels to define "best practice" where such consensus exists (these already exist though without universal adoption), tighter regulation of pharmaceutical companies in many realms, and bolstering of NIH and similar gov't assisted research budgets. Throw in tighter constraints on punitive awards for "good faith malpractice."

I also support enhancement of primary care and the "advanced medical home" concept.
Click to expand...

I think we can kiss goodbye a lot of cutting edge medicine and any experimental type treatments. If someone needs a special treatment, and the govt determines it is unecessary, won't they make the doctors comply,or face fines and penalties? I guess the option is to make the patient pay the lion's share of it, so how does that help:confused:??

Canada has UHC, and it seems I hear stories about medical patients coming to the USA and paying cash for surgery because they are on a waiting list.....
 
FinanceDude said:
I think we can kiss goodbye a lot of cutting edge medicine and any experimental type treatments. If someone needs a special treatment, and the govt determines it is unecessary, won't they make the doctors comply,or face fines and penalties? I guess the option is to make the patient pay the lion's share of it, so how does that help:confused:
Click to expand...
Affordable. Universal. Top quality.

Pick any two.

If we make it affordable and universal, pricier available procedures may be unavailable and/or rationed.

If we make it affordable and top quality, it's going to be pretty hard to make it universal without all the underwriting and exclusions.

If we make it universal and top quality, the cost will go through the roof.

Basically, we have to decide where our priorities lay. Personally I prefer a "baseline" universal model which guarantees a certain minimum standard of basic care for everyone, with available "add on" premium coverage available for an extra fee. Basically, to use an automotive analogy, make a Chevy "universal" but give the option to upgrade to a Cadillac with your own money. The Cadillac upgrade could be subject to some underwriting, but not the Chevy.
 
Rich_in_Tampa said:
As an old-time insider in the health care world, I can attest to the fact that a health-care liberal is a health-care conservative who has been (seriously) sick.

.
Click to expand...

I'd rephrase that to a health-care liberal is a health-care conservative who has been (seriously) sick and didn't have a good private health care policy.

I say that because my family has had more than its share of serious health situations but fortunately we had good private coverage and had no issues financially getting the best treatments available at the time.
 
samclem said:
Here's what I think would work to let everyone obtain care and keep things affordable. It's not what I think the country should do, but it is better than the alternative I believe we are headed for.

1) Mandatory Coverage: Everyone must buy a policy.
2) Government vouchers based on need. (Just as food stamps do for nutrition)
3) Private policies of four or five standardized types. A limited number of policy types greatly enhances price competition. Label them A-E and require that the insurers call them by that label.
4) No underwriting: If an insurer elects to sell a particular type of policy, the insurer must accept all applicants. Differences in price arr allowed based on geographic area. But--citizens can change policy types only once every 5 years (reducing the "hey-I've got a bad disease, I'm gonna go with the Cadillac policy now" syndrome)
5) All policies (of the 4 or 5 types) would cover preventative care that serves to reduce medical costs overall (Pap smears, immunizations, prenatal care, annual checkups, etc). Policies would differ by the co-pay amounts, private vs semi-private rooms, types of perscription drugs covered, degree of "doughnut-hole" that the insured would cover largely on his own, etc). All policies would feature catastrophic coverage based on the insured's household income--maybe all medical costs over 30% of income would be covered.
6) A government-run clearinghouse with with medical/consumer information. Provides info on customer satisfaction with various insurers by policy types, information on outcomes by procedures for various hospitals/centers, average out-of-pocket costs incurred by consumers in each state for each type of insurance, etc). This helps promote consumer knowledge and informed decisionmaking.
7) Individual purchase of medical care is allowed. Unlike some countries which prohibit individual purchase of medical care, it would be allowed in the US. In addition, if you want to purchase an additional medical policy to cover cosmetic surgery, experimental treatments, nursing home care, daily electroshock therapy, in-home aromatherapy, accupuncture, etc, that would be okay, too

There. The market helps provide cost controls (especially by giving consumers a stake in reducing their use of medical care and in picking insurers with the lowest costs). Provides consumers with feedback on medical care so they can make an informed choice. The "Cadillac" plans would be expensive because they cover a lot and because of adverse selection (that's the policy type the sickest people would choose), so people would be "incented" to select plans with higher co-pays, which helps drive down costs. Everyone gets the cost-effective preventative care provided in a cost-effective way, everyone is protected against catastrophic medical costs, the free market is preserved, medical costs are de-coupled from employment (which would be good for our economy as a whole), and the very poor pay nothing for their care (due to vouchers). And, if you want to take some risk by self-insuring to a larger degree, you are allowed to do it.
Click to expand...

I expect that some sort of "universal, mandatory, private insurance" is the compromise that we're going to get. Insurers like the "mandatory and private" part enough to put up with the "universal access" part. Conservatives like "private", liberals like "universal", all politicians like the idea of keeping it complex. However, I think they also like the idea of "employer paid".

In your 7 points, you didn't explicitly say how this de-couples insurance from employment. Wouldn't lots of people still prefer having their employers negotiate lower group rates, then subsidize the premiums with pre-tax dollars?

I'm not sure how the A-E plans vary. If I'm paying the premium with my own money, I want an option that pays for "all services", but only after a substantial deductible. Remember that average medical costs are around $5,000 per person, so I'd expect deductibles in the multiple-thousand range.

I think "universal, private insurance" has an Achilles heal in the automatic issue area. If insurers can look at their customers, and identify a small number that are likely to have future expenses of 10x the typical expense, then the MOST profitable thing that company can do is to persuade those high-cost people to move to some other carrier. The first thing I can think of is providing really lousy service to those few people, while keeping your service levels high for the majority. But, I expect that insurers will also look for other ways to help people fint the "exit" door.
 
Having read all these posts, I was wondering if there are any Canadians out there that would be willing to jump in here and tell us their feelings on their own "uiversal health care system". I would like to hear personal experiences relative to quality of care, timeliness, cost, etc. Hopefully some people will let us know how things are north of the border. If they had a choice, would they elect that system?
 
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