Who really robbed the middle class? Health Care

[Mulligan]

Quote:

Originally Posted by brianinsf While not 50 when I went off Cobra last month my conversion plan went from around $340 per month on Cobra to $660 per month on the high deductible plan or $875 for the same coverage. The conversion rate was still better than I could get on the open market thanks to pre-existing conditions.

I am also still under 50 and fortunately for me, I do not have a pre- existing condition. This allowed me to do the opposite. Instead of staying on a $500 a month group plan with $1000 deductible and office, script co-pay, I chose a $72 monthly $5k deductible with HSA. After being in a group plan my whole life, I didnt realize until retirement how underwriting makes insurance relatively inexpensive for clean bill of health people, and a financial nightmare for those who arent.

[modhatter]

As someone who has always been self employed and thus self insured, I can't help wonder how much the mood of the country might be different if everyone had to purchase their own health insurance. I know for those of you who receive it through your employer, you recognize it as compensation But knowing that vs having to actually pay it yourself year after year and watch the premiums jump by 10, 20 % , could you honestly say it would not effect your thinking as far as wanting a single payer plan?

I know the pat answer to that is.... Not if my pay went up by the same amount (in fact more because of taxes) But I don't know if that is an honest answer. Don't you think health insurance is taken for granted by those who have not had to purchase it for themselves for most of their life? When you started out many years ago, you were quoted a salary. The health benefits was not a serious number back then that influenced your job decision. Today yes, but back then no. So lets say everyone has to pay for their own insurance and not your employer. Don't you think that might be the reason that we are the last industrial country without some form of single payer insurance?

Here's one more to ponder. If all companies stopped offering employer based health insurance, and you became responsible for your own, which in the current market would leave you very vulnerable should you develop "a condition". Do you think this would make a difference in the way you think insurance should be administered?

[tightasadrum]

There are many great points made throughout this thread. I remember, way back in the dark ages, when I first encountered the idea of medical insurance. "why don't we just pay the doctor/hospital?" Since then it seems any hospital that encounters a patient without insurance immediately jacks up the price x5. What's that about? Oh I get it! Then when the uninsured patient can't pay the bill, the hospital gets to write it off against earnings at the hugely elevated rate.

[Huston55]

Quote:

Originally Posted by nun In the UK an independent panel assesses the efficacy of treatments. So there is rationing in the UK, but not to the extent that private health insurance rations care in the US by excluding many because of pre-existing conditions.

+1

Absolutely correct that we have health care rationing as you've described, due to pre-existing conditions, unemployment, etc. Primarily tied to the employer based, insurance company managed health insurance system described below.

Quote:

Originally Posted by TromboneAl I see no reason to couple the quality of the technology with the payment/insurance system. They are independent. Yes MRIs are expensive, but IIRC in the good old days, if you wanted to see if you were pregnant you had to kill an actual rabbit. Today you get a stick for a few bucks at Kmart. IOW I do think many would like to go back to the insurance system of the 1970s or the 1950s. The one with fewer, cheaper liability issues.

I agree. The payment/insurance system tied to employers as the primary vehicle for coverage is the problem; too many conflicts of interest and too much opportunity for manipulation.

Quote:

Originally Posted by ziggy29 I would take this in another direction besides union-bashing: Other countries have unions, but they don't have a situation where all of your health insurance is expected to come from your employer. I would submit that this unfortunate expectation that health insurance comes from employers is a bigger problem than unions here. If the U.S. didn't have this unique and dysfunctional model of tying health insurance to full-time employment, the unions wouldn't need to demand it from employers, would they? For that reason, U.S. unions are even at a competitive disadvantage to unions in other countries where the cost of employer-provided health insurance isn't a huge additional burden to the employer that grows by 10% a year or more. So the real problem here: Sever the link between health insurance and employment once and for all. This is really hurting our global competitiveness *and* the prosperity of our middle class, for union and non-union shops alike.

+1

Establish a single payer system, eliminate the middle man (insurance companies), make sure we have reasonable liability rules, and reinvest the waste we'll recapture into something more productive.

[haha]

Quote:

Originally Posted by Huston55 Establish a single payer system, eliminate the middle man (insurance companies), make sure we have reasonable liability rules, and reinvest the waste we'll recapture into something more productive.

Most countries that have universal coverage systems either are very homogeneous societies, or were very homogeneous societies when the systems were formed and voted in. Also for the large share of these European systems, well funded and well coordinated resisitance by interested parties was much less that what one finds in the US today.

Also, we Americans are not real crazy about one another overall, (except on July 4), and we don't have an all-inclusive coverage system. We'll see, but we may never get one. The tide seems to be running out with respect to large new entitlements and tax spending mandates. No matter how the oddly named Patient Protection and Affordable Care Act shakes out, it cannot work without large tax funded subsidies. Most of the people going around without insurance are not well to do people who just happen to prefer going bare. They are too poor to buy anything even remotely sound actuarially. And they are very likely going to stay too poor until some miracle comes along. So even if the mandate stands, somebody is going to have to pay the freight for many participants, and between you and me, it won't be the 1% because it can't be.

Ha

[Brat]

Health insurance as a part of an employment package started during WWI in response to wage and price controls. Wage control did not include fringe benefits so employers used health insurance as an incentive to hire. Until that time people paid for health care out of their own pocket or joined a 'mutual benefit' association which was a major medical & life insurance co-op.

Kaiser-Permanente was formed by the Kaiser Corporation because the poor Blacks that were applying at their ship yards war time industrial facilities had unmet health care needs. To assure that the care they received had a preventive focus they created their own clinics & constructed hospitals (now you know why they were headquartered in Oakland and had, originally, operations primarily in the Bay area, Portland and HI).

Blue Cross/Blue Shield used to be a non-profit formed by physicians and hospitals who wanted the public to 'join' so that they could assure that they got paid. Blue Cross/Blue Shield left that model.

[ziggy29]

Quote:

Originally Posted by modhatter Here's one more to ponder. If all companies stopped offering employer based health insurance, and you became responsible for your own, which in the current market would leave you very vulnerable should you develop "a condition". Do you think this would make a difference in the way you think insurance should be administered?

I think so. We've become used to the distorted market conditions created by the expectation that employers provide health insurance. Other countries didn't pursue that dysfunctional model and they faced the situation you described as a result -- decades ago in most cases.

We really must sever the link between health care and employment. It may be the single most important reform we can make.

[modhatter]

You may be absolutely right Ziggy. It would be good for many reasons you already mentioned including a big leg for business and fair competition, unions, as well as wake up call for US citizens. Of course, I don't expect those now enjoying their fully paid for health care plan to agree with us.

Though there are those who would vote against their own interests. I have heard it a lot concerning the tax break issue.(letting Bush's tax break expire) But of course, this is coming from the mouths of some very wealthy individuals, but I still admire their ability to look at the whole picture as opposed to only their own gain or loss.

I think health care is a more scary thing for people and the thought of not having it provided for them might be terrifying. I don't know. I can't speak from experience there. It's just a feeling I have. Maybe it's just
"I got it good", don't you dare rock my boat. To bad for the rest of you that didn't get a job with mega corp. This is mine, all mine....go away"

Now I'm just being silly.

[samclem]

Quote:

Originally Posted by ziggy29 We really must sever the link between health care and employment. It may be the single most important reform we can make.

Agreed. But all the cards seemed stacked against eliminating the link. In the 2008 Presidential campaign a candidate proposed eliminating the link and got bludgeoned very effectively. No one will be repeating that mistake again soon. Also, the issue doesn't fit neatly into either party's interest list. And, I think (at least now) that a lot of employers like things just as they are. They may whine about high health costs, but the present setup lets them attract and keep employees with an incentive that the employees cannot buy for themselves as cheaply. The whacky, inefficient delivery system puts large employers at a competitive advantage.

The new health care law will finally break the link between employers and health care. They'll drop employees and pay the cheaper fine, and pay the employees more if necessary to keep them. The employee will, if qualified by income, then turn around and get the "free" government subsidy. It will cost more than what is being done today, but at least people will be buying policies individually. When the system crashes we'll have established that precedent and we can pick up the pieces and build a rational system.

[Midpack]

Quote:

Originally Posted by samclem The new health care law will finally break the link between employers and health care. They'll drop employees and pay the cheaper fine, and pay the employees more if necessary to keep them. The employee will, if qualified by income, then turn around and get the "free" government subsidy. It will cost more than what is being done today, but at least people will be buying policies individually. When the system crashes we'll have established that precedent and we can pick up the pieces and build a rational system.

You may well be right, but I'd expect the crash to be almost immediate if costs are indeed higher as I've read. Especially sad (unnecessary?) given every other developed country has already figured out how to deliver comparable universal health care much more cost effectively than our current private system, and we could model best practices. Taiwan did so, and their admin costs are 1/3rd ours! Evidently Switzerland moved from a private system most like ours to public health care, so it can be done.

Seems clear that the majority don't really want change because corporations are providing their health care with users who have no idea (won't acknowledge) what it really costs. I know almost none of my employees had any clue even though we showed them periodically. I'm not enamoured with our current political polarization and subsequent paralysis, but I don't think the electorate wants to face facts at all.

[ziggy29]

Quote:

Originally Posted by Midpack I'm not enamoured with our current political polarization and subsequent paralysis, but I don't think the electorate wants to face facts at all.

We live in a "kick the can" society. Many people are afraid of sweeping change -- even if they believe it's needed in the long term -- and desperately seem to cling to hope that the status quo can limp along just long enough so that they are dead before it completely hits the fan.

[Midpack]

Quote:

Originally Posted by ziggy29 We live in a "kick the can" society. Many people are afraid of sweeping change -- even if they believe it's needed in the long term -- and desperately seem to cling to hope that the status quo can limp along just long enough so that they are dead before it completely hits the fan.

100% agree, how/what will change us? Hopefully short of economic or political (near) collapse..."interesting times" indeed. I will never understand why educating the mainstream doesn't help considerably, but it fails repeatedly in our culture (and some others)...

[samclem]

Quote:

Originally Posted by Midpack Evidently Switzerland moved from a private system most like ours to public health care, so it can be done.

I don't know if I'd call the Swiss system "public health care" (since the medical care isn't being provided by government employees or even by money directly from the government to medical service providers). It's a system of compulsory private coverage with significant government oversight, subsidies, limits on out-of-pocket payments, and individual involvement in paying for their care and choosing an insurer. The mandated "universal" policy has limits to the care provided, people can buy extra coverage for more expensive care if they want to. There are elements of the Swiss system I don't care for (e.g.the government regulates prices for lab fees and institutes centrally-managed fee caps that have reduced availability of some services), but I think their model has a lot to offer us.

Quote:

Originally Posted by Midpack I'm not enamoured with our current political polarization and subsequent paralysis, but I don't think the electorate wants to face facts at all.

It is going to take a crisis. Right now the people and institutions who are most influential are okay with the present "system" and things are okay (for them). When the new law dismantles that system we'll be forced to address the issue.

[Midpack]

Quote:

Originally Posted by samclem I don't know if I'd call the Swiss system "public health care" (since the medical care isn't being provided by government employees or even by money directly from the government to medical service providers). It's a system of compulsory private coverage with significant government oversight, subsidies, limits on out-of-pocket payments, and individual involvement in paying for their care and choosing an insurer. The mandated "universal" policy has limits to the care provided, people can buy extra coverage for more expensive care if they want to. There are elements of the Swiss system I don't care for (e.g.the government regulates prices for lab fees and institutes centrally-managed fee caps that have reduced availability of some services), but I think their model has a lot to offer us.

I think we have to consider accepting elements we don't care for vs paying 65% more. And that's now, before the projected 2014 changes. Switzerland has quality care, no uninsured and medical bankruptcy is unheard of. What are we getting for the premium we pay?

And that's why, to your second point, it seems so unproductive and unnecessary to adopt a more expensive system, crash and then rebuild. I don't doubt we will ('you can always count on Americans to do the right thing, after exhausting all the other options' - Churchill I believe), but this is what we've come to?

Big sigh...

[modhatter]

Midpack. You make good precise points. It is unfortunate, but it seems we are caught up in a system, both gov. and individuals, where we will not look at other avenues until "everyone is bleeding profusely". It is a shame we have to go that route. The idea of forethought seems to be a total stranger to us.

I think I know the causes and effect of our dysfunctional government, and know that without some radical procedural changes enacted there, our only strength without these changes lies with us as voters but only if we are united in cause, educated on the subject matter and rational in terms of how it's paid for.
(Phew, that sounds real attainable.)

But, I go back to my original statements. Many people are uninformed because they get all their "so called information" on TV. They are told what they should think, and how "it really is" , and they question no further.

I think those that opposed Obama's plan fell into three very different categories.

1. The totally uninformed (example a family member of mine I tried to discuss the situation with on many occasions, would fall into this group.)

2. Those who have always had good health care provided to them from their employer, and have not yet been "touched" by the travesties lurking behind the door.

3. Those that do take an interest, who actually knew what was in the bill and saw the eventual pitfalls in it's current form and would like something different.
Actually, I correct myself, #3 could apply to those in favor of health care reform as well.

The only area or issue I can see some universal
agreement about is the Wall Street (financial regulation) issue, and that is very diverse in opinions of how we handled the crises. But at least we all agree that the current system is not a good one, and needs to have some serious changes made. That's because we have all been personally touched by the issue, and in some cases devastated.

A not so funny story, but true.
As silly as it sounds, my sister and brother in law and I no longer speak. (not my choice) OVER POLITICS. Can it be true?

While the health care debate was raging, we got together one night and they said they wanted to talk Politics (Uh Oh), because they wanted to see if they could understand our (my son and I) thought process. Much to my protesting that I thought it better that we don't go there and avoid that subject, they insisted. They assured us that all would remain calm and civil and that surely we could talk and share as adults.

Fool that I was, I caved. I remember when it came to the issue of health care and I asked them a directed questions about the bill, they really didn't know anything about it. They were just against it, and all I heard were TV sound bites coming from their mouths.

After being cut off half sentence in any factual matter I tried to present, I asked her if she would just read a couple of books on the subject that I would give her, and she answered me with "I don't need to read any books to know".

I offered to read any of her right wing (for lack of better words) books in exchange, and then we could come back to the table and talk again. Needless to say, it did not end well, and here I sit over a year later, with a much loved missing sister in my life. How stupid.

My point in telling you this story is how discouraged and frustrated I feel to see a nation so divided among itself on such an important issue, and how self destructive this can be for us when some people refuse to even look at new possibilities. I don't have any procedural changes to fix that one, except eliminate all "opinion news" from the media and go back to the old way of reporting news. But alas, that would be too boring for our over stimulated cyber media minds now, and they sure would lose ratings - real fast.

I accept diversity of opinion. It the Democratic way. I just wish there was a way of making sure that these opinions were based on actual fact and knowledge and willingness to accept something new.

There will always be diversity, but perhaps a little less sometimes if we educated ourselves a little better and considered decisions we make in terms of how it relates to the whole of our society, as opposed to a select group and have some real fact backing up our decisions.

[Chuckanut]

I agree that health care should not be tied to employment. It's so iffy. You loose your job, and then have to pay full price for Cobra coverage. Does that make sense? IMHO, we need a national system, everybody is insured, and we pay it upfront with a tax specifically for that purpose. That will give each of us some idea of what medical care costs.

I can't see Obamacare being completely repealed in the USA. I know many rather conservative people who took advantage of the law to enroll their under 26 child into their plan. In several cases it allowed the young adult to get some treatment they needed. I don't think most people will want to go back to a system, where sick people OR PEOPLE WITH A PREVIOUS ILLNESS can't get insurance and treatment. That is something that can happen to almost all of us at any time, if we lose our insurance. Virtually, every other country makes it work, we can do it in the USA.

[Chuckanut]

If I am correct most felons in state and federal prisons get fully paid medical care. Correct?

[samclem]

Quote:

Originally Posted by Chuckanut If I am correct most felons in state and federal prisons get fully paid medical care. Correct?

And free meals and housing. That's what the state provides because we've taken away their freedom entirely, including their ability to provide for themselves. This exchange of freedom for a warm blanket (purchased by someone else without a choice) is, to many of us, at the root of the present debate over "government provided" health care.

Anyway, this deal (free medical care, food, a room complete with roommate) is available to anyone and is as close as your nearest 7-11. Bring a gun.

[ziggy29]

Quote:

Originally Posted by samclem Anyway, this deal (free medical care, food, a room complete with roommate) is available to anyone and is as close as your nearest 7-11. Bring a gun.

This may be true, but IMO it ought to concern anyone interested in maintaining the social order in an economic environment when more and more people are desperate because of being jobless, broke and uninsured.

[samclem]

Quote:

Originally Posted by ziggy29 This may be true, but IMO it ought to concern anyone interested in maintaining the social order in an economic environment when more and more people are desperate because of being jobless, broke and uninsured.

Yes, it bears watching, but so far property crimes don't appear to be increasing according the FBI. Despite the faltering economy and increasing unemployment, 2010 numbers were lower than 2009, which were lower than 2008. We've had over a decade of steadily decreasing property crime rates and the rates today are lower than they've been for at least 20 years. Some of this has to do with the changing age demographics (fewer young folks). FBI UCR Stats. I think people tend to overestimate the link between a worsening economy and crime.