Socialized Medicine

[MichaelB]

I think universal coverage is one of those levers that could really power the US for an entire generation. It would enable small business - which generates most of new jobs – to focus on business and grow, and eliminate one of the biggest cost drags for most business in the US.

This is something that could really change the competitiveness of American business.

I don’t expect reduction in total cost for health care, just redistribution. But today this burden is so concentrated on business it’s become an important drag on productivity and competitiveness.

 

[armor99]

Read the Paradox of Choice and see how debilitating so many choices and decisions can be.

Sometimes I am surprised that as many people start businesses as do. They have to know about health insurance. Have to understand tax, from sales to withholding. Have to understand employment law. Have to understand marketing. And on and on.

Choice is absolutely debilitating. Then again... so is life itself. The only way the govt would really have of "saving us all from ourselves", is by severely limiting all of our choices. I would not count that as a life worth living though. To choose is to risk. The more choices you make the less certain the outcome will be.

But this is actually my biggest fear. The govt is the champion of the "one size fits all solution". What if what is good for 90% of americans... is NOT good for me? Am I to be held captive to the "collective good"?

There is a huge push right now for stricter guidlines for the govt to impose on banks and their lending practices. Since banks do not want to be sued for any sort of "bias", they will have to come up with a set of guidlines for lending. You must have X in the bank, make a salary of Z, and credit score of over Y, etc. This in turn gets the backing and approval of the govt. In that sort of environment.... where will the next Microsoft come from? What if I actually WANT to do something riskier in my life? Is the govt to say to me, "no you cannot do that because you MIGHT fail"?

No successfull company in America got that way without taking a few risks here and there. No person has ever been able to retire early without having a higher risk portfolio at one time or another. But most of the time more risk means more reward.

If people want to live a life with as little risk as possible, that is their right... I wish them all much luck in it. But I do not want such a life for myself, and I greatly fear that as the years go by the govt will have more and more influence over my choices because of it.

 

[Martha]

I think universal coverage is one of those levers that could really power the US for an entire generation. It would enable small business - which generates most of new jobs – to focus on business and grow, and eliminate one of the biggest cost drags for most business in the US.

This is something that could really change the competitiveness of American business.

I don’t expect reduction in total cost for health care, just redistribution. But today this burden is so concentrated on business it’s become an important drag on productivity and competitiveness.

I have heard the same thing from some small and mid-sized business owners that I know. Also, there may be more full time positions available, without employers trying to avoid benefit costs by hiring a number of part time and contract employers.

As far a health care choice, I already have little. My insurance company governs my choice. I cannot buy on the market. When I go to the risk pool, their rules will govern my choices. It is even worse for my sister in California, who has an employer that bounces from one HMO to another. She has life-threatening asthma and always ends up going through a rigmarole with doctors and drugs each time the HMO changes. This winter her HMO changed in the middle of her having a gallstone problem. She lost 30 pounds from nausea and inability to eat much while she waited to be processed through a whole new system.

 

[Rich_by_the_Bay]

A tip to some who are moving from Megacorp to a small business: the routine way to do this is to resign prior to starting your new venture. However, some employers offer retiree health insurance or continuation insurance for which you pay the premiums, but at least you have access to insurance. I discovered you have to do this just right.

In my case, my employer changed from a state university to a private nonprofit, due to circumstances beyond my control. The old insurance was continuable if I retired, but not if I resigned. Because the new employer's heath insurance did NOT include retiree continuation insurance, I would have been in trouble once I FIREd.

This required that I fill out a bunch of paperwork, and that I actually take a distribution from my qualified retirement plan (I suppose to prove that I was retiring in good faith). I did so (in fact took it as a rollover to my IRA). Once I was retired I started paying the premiums. With the new employer, I declined health coverage and negotiated for them to reimburse me for my insurance premiums from the old employer.

I know it sounds complicated but bottom line if you are in this situation is to check if you can retire rather than resign if that will make your previous health insurance accessible to you.

 

[Trek]

You'd think doctors would get free lifetime medical care, like as a perk just for being a doctor.

 

[noworkethic]

I think universal coverage is one of those levers that could really power the US for an entire generation. It would enable small business - which generates most of new jobs – to focus on business and grow, and eliminate one of the biggest cost drags for most business in the US.

This is something that could really change the competitiveness of American business.

I don’t expect reduction in total cost for health care, just redistribution. But today this burden is so concentrated on business it’s become an important drag on productivity and competitiveness.

This is a point which I have never considered. At first glance it seems legitimate and important. It appears that there would be large benefits for big business also. I would very much like to hear from anyone in disagreement as to their reasons

 

[ERD50]

This is a point which I have never considered. At first glance it seems legitimate and important. It appears that there would be large benefits for big business also. I would very much like to hear from anyone in disagreement as to their reasons

I'm not in disagreement, just will point out that there is no "free lunch".

Instead of the business paying (and passing the cost onto the customer, meaning the customer pays), we will pay through our taxes.

I'm in favor of separating health insurance from employment (something the govt started BTW, through their social engineering tax codes), but I'm not sure that is going to make a huge difference when you look at the big picture. The business sheds the cost, but the consumer has less money to buy with if it goes to taxes.

If we can bring efficiencies into the system, and actually improve value, that will help.

-ERD50

 

[lets-retire]

This is a point which I have never considered. At first glance it seems legitimate and important. It appears that there would be large benefits for big business also. I would very much like to hear from anyone in disagreement as to their reasons

There are a limited number of ways for it to go. The government provides private insurance, the government acts as the insurance carrier, or the government is the medical provider. If the government provides private insurance all it is doing is adding another level of expense for health care. I do not believe this will result in the promised cost decreases. I didn't occur when the insurance companies promised to decrease costs if the state government made PL/PD required for all drivers, it won't happen if health insurance is required for all people, though it might slow the rate of increase.

If the government acts as the insurance company, it removes the profit motive and a layer of expense, but you add a huge bureaucracy that really isn't very user friendly and is very expensive. This is an opinion, but I've yet to have any dealings with the government that were easy or quick.

The third option I think would result after option one and/or two failed to provide the decreases required in the cost of health care. In my past dealings with government supplied health care it was neither fast nor quality. Granted I only received military health care from seven hospitals I can remember and treatment at two VA hospitals. None of the hospitals I received treatment at were efficient or on time. My standards for on time are very loose, meaning within 30 minutes of my appointment time. I am still dealing with the results of mistreated ailments from the military hospitals. I have had misdiagnosed/treated issues corrected when those issues resulted in further injury.

I have had extensive dealings with insurance companies and providers for my own health issues and those of my wife. The biggest problem I've had with any of it has been with the providers not filling out paperwork properly. This wouldn't be a concern if I had some rinky-dink insurance, but this is BC/BS, which happens to be a very common provider in this area. Anymore when I receive a bill that should have been covered by my insurance I ask the provider for the contract and enrollment code and who they have listed as primary on the insurance. Those have been the reasons the insurance has denied the claims, simple, very simple paperwork issues of the provider.

 

[noworkethic]

lets-retire & ERD50,

I understand that health care (with the exception of admin. expenses, ins. co. profits etc.) costs would remain approx. the same for similar service in MichaelB,s scenario. What I, amazingly, had not considered was the benefit to businesses and employees if they were not involved in the process. It is vitally important to a nation to have robust businesses and I wonder is if that factor alone is not enough to give any method of health care delivery which does not involve employers a big advantage. BTW, it is not really a personal situation w/ me as I am quite happy w/ the VA care that I receive (I understand that the Portland,OR VA hospital is unusually good.) So I really don't have a dog in the fight and I am honestly concerned about the general good.

 

[ERD50]

There are a limited number of ways for it to go. The government provides private insurance, the government acts as the insurance carrier, or the government is the medical provider.

I'm envisioning a different process. Say the govt "gave" everyone a voucher for basic health insurance each year. The individual could use that voucher with any insurance company that meets the requirements of the program. Individuals could choose to pay a higher rate out-of-pocket for various upgrades. There would be standardized language, to help people know what they are getting. Of course, we are paying for the vouchers out of our taxes, and people who don't pay taxes would be getting covered from the general fund. But this gets everyone covered (which reduces high cost ER visits and could promote preventative care).

In this way, the govt really is not very involved. They help set the minimum requirements, but since people are free to choose, competition should help drive efficiency. Which ins co will provide the best services for the money?

lets-retire & ERD50,

I understand that health care (with the exception of admin. expenses, ins. co. profits etc.) costs would remain approx. the same for similar service in MichaelB,s scenario. What I, amazingly, had not considered was the benefit to businesses and employees if they were not involved in the process.

Agreed, it would be a weight off the shoulders of business to not have to spend time on these issues. They can concentrate on their business and that should be a good thing.

-ERD50

 

[prubin]

Betsy McCaughey Bloomberg Article

I have not read every post in this thread kicked off by the Bloomberg article at
Bloomberg.com: Opinion refer=columnist_mccaughey&sid=aLzfDxfbwhzs

Keith Olberman refuted her allegations. Go to:
Keith Olbermann Traces "Anatomy Of A Smear" -- Bizarre Stimulus Attack (VIDEO)

There is anecdotal evidence to support every point of view so I won't bore you with mine.

 

[lets-retire]

I have not read every post in this thread kicked off by the Bloomberg article at
Bloomberg.com: Opinion refer=columnist_mccaughey&sid=aLzfDxfbwhzs

Keith Olberman refuted her allegations. Go to:
Keith Olbermann Traces "Anatomy Of A Smear" -- Bizarre Stimulus Attack (VIDEO)

There is anecdotal evidence to support every point of view so I won't bore you with mine.

Actually if you read my second post in this thread you will find exact quotes from the legislation. THAT is where this thread came from not media hype. I do not care what the news media or Keith Olbermann has to say about the package. They are spinning it to fit their needs. You will also read that the items I am concerned about for health care can be use of innocuous purposes, but I do not feel they will maintain their original intent and it is the ground work for the socialization of our health care.

 

[prubin]

[stuff deleted]
They are spinning it to fit their needs. You will also read that the items I am concerned about for health care can be use of innocuous purposes, but I do not feel they will maintain their original intent and it is the ground work for the socialization of our health care.

I see you spinning it "to fit" your needs. since you have been forthright in expressing your opposition to socialized medicine I will acknowledge that I favor changes to the system that might would likely result in what you refer to as the "the socialization of our health care."

 

[armor99]

I'm not in disagreement, just will point out that there is no "free lunch".

Instead of the business paying (and passing the cost onto the customer, meaning the customer pays), we will pay through our taxes.

I'm in favor of separating health insurance from employment (something the govt started BTW, through their social engineering tax codes), but I'm not sure that is going to make a huge difference when you look at the big picture. The business sheds the cost, but the consumer has less money to buy with if it goes to taxes.

If we can bring efficiencies into the system, and actually improve value, that will help.

-ERD50

Yes.... exactly.... the next time someone tells you that something is free.... just start laughing at them. Because they are either mis-informed... or trying to sell you something.

I just recently got back from a DC trip..... actually got to see the Declaration of Independanve and the Constitution. A tremendously humbling experience for me I might add. I was talking to a cab driver there about it, and he said.... "And the best part is... all of the museums here in DC are free!!!" To which I added... "Ummm.... my taxes pay for all of those places, there are not free.... we all paid for that"! To which he was completely confused and did not get my point...

 

[armor99]

You know.... the members of this forum... or at least this particular thread should perform an experiment. The next time any of us sees a doctor, ask him/her what they think about socialized medicine. Guage their reaction either positive or negative, and ask them if it comes to pass would they be likely to retire from practice, or continue on. After all, this will affect doctors directly, and I would be curious to know what the medical providers themselves feel about it. I actually did this with my own doctor recently. I believe when I asked him about it... he got this really angry look on his face and responded with ".... do not even get me started..." So I will take that as a negative reaction...

 

[lets-retire]

I see you spinning it "to fit" your needs. since you have been forthright in expressing your opposition to socialized medicine I will acknowledge that I favor changes to the system that might would likely result in what you refer to as the "the socialization of our health care."

Ok, so expressing concerns over language that is included in a law passed by our elected leaders, that clearly can be used to give the government more power is spinning? Well you're entitled to your opinion. I'm just glad I don't have to succumb to your thoughts. Look at what the law states, determine if there are any checks or balances you will find there are none so the government can grab as much power as they deem fit, whenever they deem fit. This is a very dangerous thing. The founding fathers did not want an all powerful government. They had just gotten rid of one. That is one of the reasons for the 10th amendment, to limit the power of the federal government. Even with that thought this country has steadily wandered toward socialism. Some for the good, but more often for the worse.

ERD50--I didn't think of that option. I'm not a fan of credits like that (which might be why I didn't think of it). The reason I don't like them is because the insurance companies already have the reputation of wanting only one thing and that is higher profits. If everyone is given a voucher for say $4500 for insurance and the companies live up to their reputation, then they, I believe, would feel that $4500 would be the starting point for all of their policies, because it is "free" at that point. If the government gives too little then it is not effective if they give too much then the program results in runaway inflation. Even if the amount is adjusted for the age of the individual that would serve as the starting point for pricing. Without government controlling the cost of insurance it would climb faster than it has in the past. I think I could support something like you mention, only if the local government has to approve any rate hikes, similar to utility companies, but I'd still have to mull that over.

 

[ziggy29]

I see you spinning it "to fit" your needs. since you have been forthright in expressing your opposition to socialized medicine I will acknowledge that I favor changes to the system that might would likely result in what you refer to as the "the socialization of our health care."

As far as "national health care" or "universal health care" or whatever you want to call it goes, I would reserve judgment until I saw the specifics. But I do have to say that using Keith Olbermann to defend one's position is about as meaningless as having Rush Limbaugh do it.

I'd prefer to see analyses from considerably less biased sources on either side. Not that the partisans and the ideologues don't have their good points on either side, but I'm not going to take any of it as objective analysis and I'm certainly not going to use them as the measuring stick for what is right or wrong, or what is good or bad.

I think some changes toward more universal coverage could be a good thing, but implemented wrong it could be a "cure" that's worse than the current disease.

 

[ERD50]

ERD50--I didn't think of that option. I'm not a fan of credits like that (which might be why I didn't think of it). The reason I don't like them is because the insurance companies already have the reputation of wanting only one thing and that is higher profits. If everyone is given a voucher for say $4500 for insurance and the companies live up to their reputation, then they, I believe, would feel that $4500 would be the starting point for all of their policies, because it is "free" at that point. If the government gives too little then it is not effective if they give too much then the program results in runaway inflation. Even if the amount is adjusted for the age of the individual that would serve as the starting point for pricing. Without government controlling the cost of insurance it would climb faster than it has in the past. I think I could support something like you mention, only if the local government has to approve any rate hikes, similar to utility companies, but I'd still have to mull that over.

I feel the outcome would be 180 degrees from what you describe. Maybe we need to cover this first:

"the insurance companies already have the reputation of wanting only one thing and that is higher profits."

This is not unique to insurance companies, it is the Raison d'etre for just about every business. And, in a competitive environment, the best way to maximize profits is to give your customers what they want.

Sure, the $4500 (or whatever) would be the starting point, but companies would have to try to differentiate themselves to attract business. Aren't you going to choose the company that gives you the most for your money? That is why I *like* this approach.

The last thing I would want is any sort of "utility-like" control over pricing. If it turns out that people are not getting the basic care we decide we want from free market forces, then we need to decide to raise the voucher. But we would be making that decision regardless, might just call it something else.

I say let competition work to our benefit. Don't you think the price/performance on Flash Drives (for example) has improved because the companies that make them are trying to maximize profits? This is a powerful force.

-ERD50

 

[Rich_by_the_Bay]

I say let competition work to our benefit. Don't you think the price/performance on Flash Drives (for example) has improved because the companies that make them are trying to maximize profits? This is a powerful force.

Not so sure it's that straight forward. In most of the business and consumer world, the consumer has two ultimate options: they can shop competitively at their leisure while understanding the products and options, and they can elect simply not to purchase a category of item if it lacks value for them.

In the world of health care (and a few other sectors), the consumer can and should inform him/herself but often a) ultimately must heavily rely on the advice of highly trained providers of a highly technical service and b) often does not have the luxury of declining or putting off their usage of that service. There are dangers in giving the free market too much power over access to life-sustaining, complex medical care -- I think our under-insurance problem in the USA and its unhealthy link to employment are in part results of too much pure free market influence. Total market-driven health care reimbursement will primarily benefit the insurance companies it appears.

I am a big believer in competition, supply/demand, and self-reliance but I think there are a few key areas where oversight and altruism work well in a compassionate country like ours. IMHO, federal oversight should be implemented to assure universal access to health insurance, basic quality of care (from drug approval and testing to continuing medical education, licensing, etc.), and objective research among others.

Maybe it looks different from the inside, where every day brings new stories of broken bank accounts, endless fights between patients and insurance companies at a time when your health is failing fast, and delayed plans to change jobs, retire, etc due to loss of coverage.

 

[FIRE'd@51]

The last thing I would want is any sort of "utility-like" control over pricing.

I think, to a large extent, we have that now, since the states allow the insurance companies to raise premiums based upon their experienced costs with a particular risk pool. Insurance companies continuously offer new products which compete with their existing policies. In order for a policyholder to switch to one of the new policies he/she usually needs to pass underwriting. This results in the "healthy" switching to the new cheaper policy, and the risk pool for those who can't now pass underwriting becomes a generally less-healthy and more expensive pool with premiums rising considerably faster than average. It turns out to be an "indirect" way for the insurance companies to raise rates on those less-healthy folks who have more claims. IMO, this is the biggest problem with our current health insurance system. The only way I can see to avoid this adverse selection is to mandate insurance for all and have everyone in the same risk pool. Any new product created by an insurance company should then be available without underwriting to anyone currently in the risk pool. Since everyone would be in this risk pool from birth, the only subsidy would be for the relatively small number who were born with a pre-existing condition, and I think that's fine. The total cost of insuring this pool would then be spread equally across all those in it, with no stratification due to adverse selection. All would pay the same premium (with a possible sliding scale based upon age).

 

[Rich_by_the_Bay]

I think, to a large extent, we have that now, since the states allow the insurance companies to raise premiums based upon their experienced costs with a particular risk pool. Insurance companies continuously offer new products which compete with their existing policies. In order for a policyholder to switch to one of the new policies he/she usually needs to pass underwriting. This results in the "healthy" switching to the new cheaper policy, and the risk pool for those who can't now pass underwriting becomes a generally less-healthy and more expensive pool with premiums rising considerably faster than average. It turns out to be an "indirect" way for the insurance companies to raise rates on those less-healthy folks who have more claims. IMO, this is the biggest problem with our current health insurance system. The only way I can see to avoid this adverse selection is to mandate insurance for all and have everyone in the same risk pool. Any new product created by an insurance company should then be available without underwriting to anyone currently in the risk pool. Since everyone would be in this risk pool from birth, the only subsidy would be for the relatively small number who were born with a pre-existing condition, and I think that's fine. The total cost of insuring this pool would then be spread equally across all those in it, with no stratification due to adverse selection. All would pay the same premium (with a possible sliding scale based upon age).

It is commonplace for people to be in a low risk category with insurance companies tripping all over each other to insure you, then a week later you see your doctor and find out you now have [diabetes/kidney failure/slipped disc/liver abnormality/aortic aneurysm/melanoma, etc. etc.] and are now shunned like an insurance leper for the rest of your life. Just when you really need the coverage.

At least Medicare covers everything, however inadequately.

 

[Rustic23]

Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.

Now we are about to embark on a change that will effect my health care. That worries me. While I have not facts or figures to back this up, I'll bet a significant number of the people in this country are OK with their health care. There are about 300m people in the U.S. A figure for the un-insured battered around is 40m, however, this figure would be trimmed when Medicaid is taken into consideration. At any rate, that leaves 260m with some kind of health care. I think we should be very cautious when we change the health care for 260m to accommodate the care of 40m.

Now, before the rhetoric gets out of hand, I'll concede that 260m happy customers is high, but the situation is not reversed! There are not 40M happy customers out there and 260M people fearful they will not get health care. I believe there are between 30m and 40m on medicare alone.

 

[ERD50]

I think our under-insurance problem in the USA and its unhealthy link to employment are in part results of too much pure free market influence.

As I understand it, it is just the opposite. It was govt intervention, not free markets, that led to the current "unhealthy link" between employment and insurance.

The govt gave employers a tax break for supplying insurance. This made the cost of the benefit of health insurance artificially cheaper than the cost of salary. So companies fought to out-do each other for health benefits to attract new employees, and the whole "value proposition" of health care was distorted by the tax break the govt offered. And that also made other means of getting insurance relatively more expensive for an individual. That created a spiral - people had even more desire to get their insurance through their employer. It also distanced the connection between the consumer of the service and the "payer" of the service, which inhibits free market efficiencies. That old law of Unintended Consequences at work again.

That paragraph summarizes why I am highly skeptical of govt offers to "help" any situation. But they are needed in some cases. We must choose wisely.

IMHO, federal oversight should be implemented to assure universal access to health insurance, basic quality of care (from drug approval and testing to continuing medical education, licensing, etc.), and objective research among others.

Clearly, some amount of regulation and oversight is needed. But I do think that the idea of getting vouchers so that everyone is covered, and require that an ins co cannot accept any unless they are open to all (for the basic coverage) fixes a lot of the issues facing us today.

... It turns out to be an "indirect" way for the insurance companies to raise rates on those less-healthy folks who have more claims. IMO, this is the biggest problem with our current health insurance system. The only way I can see to avoid this adverse selection is to mandate insurance for all and have everyone in the same risk pool.

That is what the voucher system would be designed to address. I could picture basic coverage, and maybe a few "upgrade" packages that would be offered w/o review for middle-to-middle/upper-class, and maybe also some "boutique" packages that could require medical tests, for those who can afford it and want it.

-ERD50

 

[ERD50]

Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.

While I might be able to say I am reasonably happy with my *current* health care alternatives, I must admit I am very afraid of what *could* happen. If my company dropped my retiree insurance, what would I do? It could be tough for some of us to get affordable coverage, depending upon pre-existing conditions.

Also, my son lost our family coverage when he graduated. He didn't have a job with coverage lined up at the time, so we had to scramble. He has coverage now, but considering that he could change jobs or get laid off, he is still in an uncomfortable position. I decided to keep the high deductible policy we got for him in effect until we have a clearer picture of his needs/risks (which may be never).


-ERD50

 

[armor99]

I read a lot about most of these arguments, both for and against. I think a lot of it, as most things do... sort themselves into two camps of thinking.

Camp #1 (and yes this is where I am)... beleives that a vast majority of people CAN in fact find ways of taking care of themselves, but there are also a lot of lazy people out there. If a lot of the social benefits provided by the govt were suddenly removed, people would not just wonder about aimlessly, but would in fact find ways of earning what they need to survive, and this includes heathcare. People in this group believe that by and large people will rise to the challenge presented to them.

Camp#2 believes that most people are incapable of caring for themselves. That if govt social programs were removed, people would litterally die on the streets. People in this camp feel it is the moral responsibility of all those who ARE capable and responsible to take care of all those who are less so. This group tends to believe that those with more "owe" what they have to those with less.