Obama Health Insurance

[ziggy29]

So we pay it one way or the other... might as well pay it the cheapest and lowest overhead way possible - "Medicare for all" for instance.

"Medicare for all" -- at least the form encouraged by HR 676 pushed by Dennis Kucinich and others -- is a colossally regressive tax and a giveaway for upper and upper-middle class early retirees since it is almost exclusively funded by payroll taxes (like Social Security and Medicare).

If "universal health insurance" were funded primarily by payroll taxes, the massive whooooooosh you hear is the sound of 50-somethings and early 60-somethings rushing to give their notice to their employer, since they were only working for the health insurance. Plus, they wouldn't pay for it since they have no earned income to tax!

Plus a lot of doctors now won't take new Medicare patients as it is. What if everyone became a Medicare patient with Medicare's reimbursement rates?

 

[jug]

The problem is we think individually, not collectively. When young we don't need much health care and think "why should I pay for some old fart". However, as we age, we need more and more health care and assuming most of us will age to some point, we have to fund such care.

You can be healthy one moment, and things can change in a flash. Same thing with a home, you think it cannot burn down, but in a flash "sh-t happens"

Insurance however you look at it is simply funding and spreading the risk, plain and simple. So some sort of comprehensive plan must be made for our rather large risk pool and in insurance terms, the greater the pool, the more efficient the scheme will work. Perhaps this can be done on a regional mutual type of basis, but however it is done it takes the sting away from those who are hard hit.
jug

 

[barker]

If "universal health insurance" were funded primarily by payroll taxes, the massive whooooooosh you hear is the sound of 50-somethings and early 60-somethings rushing to give their notice to their employer, since they were only working for the health insurance. Plus, they wouldn't pay for it since they have no earned income to tax!

Plus a lot of doctors now won't take new Medicare patients as it is. What if everyone became a Medicare patient with Medicare's reimbursement rates?

Two thoughts on the early retiree angle. First, with unemployment expected to approach 10% (and in real numbers considerably more) those folks who could retire early would be helping the unemployed. Second, I've read that Americans in general do not save much, so the number of people ready to retire if their health insurance needs are satisfied is perhaps less than you and I would think. And I don't read anywhere that health insurance will become free, so folks have to assume the costs of health insurance and everything else too.

On the doctors not serving medicare patients, there is a lot of work to be done on that front in any case. I don't know solutions to that one - but it has to be worked on.

Agree on the insurance pool concept jug, that's the biggest problem right now - people are having to buy private insurance with individual underwriting and pre-existing health exclusions. If they could just solve this one issue, it would help early retirees tremendously.

 

[samclem]

If "universal health insurance" were funded primarily by payroll taxes, the massive whooooooosh you hear is the sound of 50-somethings and early 60-somethings rushing to give their notice to their employer, since they were only working for the health insurance. Plus, they wouldn't pay for it since they have no earned income to tax!

Plus a lot of doctors now won't take new Medicare patients as it is. What if everyone became a Medicare patient with Medicare's reimbursement rates?

I think there's an internal inconsistency between your paragraphs. People will be flocking out of their employer-sponsored plans to get into the sinking boat of Medicare--where they won't be able to find a doctor?

Now, if employers drop the coverage they provide anyway (which is entirely possible), then employees ae highly likely to retire. If companies don't want this to happen, maybe they'll sweeten the pot by offering some type of Medicare adjunct coverage.

 

[ziggy29]

Now, if employers drop the coverage they provide anyway (which is entirely possible), then employees ae highly likely to retire.

Well, that was implicit but not stated -- after all, if part of the reason to do this (in theory) would be so U.S. businesses (such as the automakers) aren't at a competitive disadvantage to foreign-based automakers because of health insurance costs, it stands to reason that most employers would feel little need to continue paying for health insurance as know it. Indeed, HR 676 would require employers to match employee payroll taxes to pay for health care, so they'd pretty much have to drop their coverage or else this increases their costs substantially, not make them more globally competitive.

Obviously, if every patient became a Medicare patient, doctors would have three choices:

(1) Accept new Medicare patients;

(2) Become a "boutique" provider for the well-heeled willing to pay their own money for doctors and procedures that Medicare won't cover;

(3) Retire or find a new line of work.

 

[OAG]

Last few posts IMO actually argue for the proverbial "status quo". Which may be what we actually can expect.

 

[ziggy29]

Last few posts IMO actually argue for the proverbial "status quo". Which may be what we actually can expect.

If nothing else, it shows what a daunting task it is to create a system where the "unintended consequences" wouldn't be worse than the status quo in the average case.

 

[samclem]

I'm not sure the options you suggest are all of those available. Other ideas/suggestions in red.

Obviously, if every patient became a Medicare patient, doctors would have three choices:

(1) Accept new Medicare patients;

(2) Become a "boutique" provider for the well-heeled willing to pay their own money for doctors and procedures that Medicare won't cover; (if this is still legal. Private payments are illegal in some countries with "free" health care)

(3) Retire or find a new line of work (fewer providers = reduced availability of care for everyone). The new doctors that replace these folks--will they be the nation's best? After all, they'll be earning significantly less than they could in other lines of work. I wonder how many people who favor more pay for teachers (to improve teacher quality) also favor reducing Medicare payments to doctors.

(4) Move to another country and continue to practice medicine.

(5) Spend less time and money on each patient. I'm sure there is a little waste to be wrung out, but it's far more likely that the already tightly-scheduled docs will be seeing 15 patients an hour in order to make a decent living. There's not much time in a schedule like that to do the smarter things, like thoroughly review the patient's medical history/records, see what meds he/she is taking, etc. This is the dumb way to save money, and it's just where we've been heading for many years.

 

[Koolau]

Maybe I missed it, but don't think I've seen a discussion of "improvements in medical treatment, technology, pharmaceuticals, etc..." as part of the problem. We can now innovate a lot faster than we can figure out how to pay for the improved medical care. Maybe that's a good thing! What better way could you spend money than to extend your life and the quality thereof?

40 years ago, blocked coronary arteries were a death sentence (with cruel and unusual punishment as part of the process!) Now, we have open heart replacement of arteries, balloon angioplasty, stents, statins, etc. etc. etc. NO ONE wants to stop this amazing progress, but at least one of the elephants in the room is that this is a huge part of the "problem" of health care costs today.

This ability to treat (or even cure) disease that was untreatable or incurable before is creating an ever increasing devide between "haves" and "have nots" when it comes to this kind of care.

In the old days, you got nitro tablets to ease the angina before you (perhaps mercifully) succumbed to the underlying heart disease. Now, if you have the money (aka insurance or a big stash or both) you can have the treatment. If not, here's some nitro pills!

Is that "right", or "fair" or "equal under the law" or...? Where (for instance) is it written that everyone has the right to any and all and the best medical care? Realistically, a law "guaranteeing" good nutrition to all would be cheaper and more effective in insuring a long or at least a healthy life than would "free" health care.

Please don't misunderstand me. I'm not suggesting any particular "stance" on this. I just don't think I've seen this important aspect of the issue discussed. IOW at some point, we could spent 100% of our GDP on health care and people would still die, so there would always be "more" we could do to extend life, reduce suffering, improve quality of life, etc. etc.

Health care issues seem so intractable that I guess I'm sort of at the "throw up your hands in despair" stage.

Again, I'm not smart enough to suggest a solution, but I don't think there are any easy, quick, effective "fixes" to this problem. Any politician who tells you s/he has "the answer" is straining credulity.

We've all suggested "fixes" and I'm not necessarily disagreeing with any of them. But for every "fix", someone else can show a direct or unintended consequence. It all comes down to "you can't get something for nothing". Push it in here and something pops out there. If it really is "20 % GDP and rising" there isn't going to be any magic bullet to change that. Only thing we can change is who pays.

Man, am I depressed!!

Any thoughts on this aspect of the issue

 

[Texarkandy]

Maybe I missed it, but don't think I've seen a discussion of "improvements in medical treatment, technology, pharmaceuticals, etc..." as part of the problem. We can now innovate a lot faster than we can figure out how to pay for the improved medical care. Maybe that's a good thing! What better way could you spend money than to extend your life and the quality thereof?

40 years ago, blocked coronary arteries were a death sentence (with cruel and unusual punishment as part of the process!) Now, we have open heart replacement of arteries, balloon angioplasty, stents, statins, etc. etc. etc. NO ONE wants to stop this amazing progress, but at least one of the elephants in the room is that this is a huge part of the "problem" of health care costs today.

This ability to treat (or even cure) disease that was untreatable or incurable before is creating an ever increasing devide between "haves" and "have nots" when it comes to this kind of care.

In the old days, you got nitro tablets to ease the angina before you (perhaps mercifully) succumbed to the underlying heart disease. Now, if you have the money (aka insurance or a big stash or both) you can have the treatment. If not, here's some nitro pills!

Is that "right", or "fair" or "equal under the law" or...? Where (for instance) is it written that everyone has the right to any and all and the best medical care? Realistically, a law "guaranteeing" good nutrition to all would be cheaper and more effective in insuring a long or at least a healthy life than would "free" health care.

Please don't misunderstand me. I'm not suggesting any particular "stance" on this. I just don't think I've seen this important aspect of the issue discussed. IOW at some point, we could spent 100% of our GDP on health care and people would still die, so there would always be "more" we could do to extend life, reduce suffering, improve quality of life, etc. etc.

Health care issues seem so intractable that I guess I'm sort of at the "throw up your hands in despair" stage.

Again, I'm not smart enough to suggest a solution, but I don't think there are any easy, quick, effective "fixes" to this problem. Any politician who tells you s/he has "the answer" is straining credulity.

We've all suggested "fixes" and I'm not necessarily disagreeing with any of them. But for every "fix", someone else can show a direct or unintended consequence. It all comes down to "you can't get something for nothing". Push it in here and something pops out there. If it really is "20 % GDP and rising" there isn't going to be any magic bullet to change that. Only thing we can change is who pays.

Man, am I depressed!!

Any thoughts on this aspect of the issue

I'm somewhat with you on this issue & I've been thinking/saying this for some time. A few extra thoughts though, if I may:

Health care costs so much because we have greater expectations of an entitlement to it and there is so much more of it available (to feel entitled to) than there used to be.

For many conditions nowadays there are myriad tests, treatments, procedures, therapies, pharmaceutical regimes, etc available to cure, contain, or alleviate the condition or prolong life that did not exist previously - and they all cost money. In the past for many conditions there was only so much they could do for certain things & beyond that you just had to live with it or die from it.

Additionally, I hear qutie a bit from docs I know about tests they run, not so much because the doc feel it's particularly indicated, but primarily because:
A. to avoid any appearance of malpractice
and/or
B. Because the patient requests/demands/expects it just because they know it's available & insurance or Medicare can be made to pay for it.

Further, I'm of a mind that perhaps things haven't changed in some ways so much as our expectations about health care have. Things weren't always so good in the "good old days" of medicine re: paying for medical treatment. In the old days you might have to sell the farm to pay for grandma's big expensive surgery or al the kids or grandkids might have to pitch some money in. Sometimes people just simply didn't have some things done because they couldn't afford it - for example, some people went around with a limp or some other handicap for the rest of their life from an accident because, frankly, they couldn't afford the surgery & therapy it might have taken to correct it - children might have grown to adulthood with only limited correction of some congenital deformity -

Nowadays, Americans have an expectation that their particular malady will be treated to the fullest extent of medical science available & that it will paid for (by somebody - insurance? Medicare?) and without completely breaking the personal family piggy bank.

I'm not saying it's good or bad that we have all this medicine & have an expectation that we should be able to get every bit of whatever's available for our particular malady - I'm just pointing out what I perceive to be the reality of it.

 

[ziggy29]

For many conditions nowadays there are myriad tests, treatments, procedures, therapies, pharmaceutical regimes, etc available to cure, contain, or alleviate the condition or prolong life that did not exist previously - and they all cost money.

Actually, there are very few new treatments that "cure" anything -- all they do is manage and treat symptoms in most cases, or prevent a chronic condition from getting worse. They don't "cure" in the sense that you often have to keep taking the treatments for life in order to manage the condition.

That's a significant chunk of costs. And if someone wanted to be cynical, they could note that there's not much money in developing "cures" for anything -- the money is in developing something that has to be taken for life. Would penicillin have even hit the market today since it actually cures many bacterial infections that used to be life-threatening? Or would today's approach be to develop medicines that merely keep the infections in check for life?

 

[barker]

Just read an interesting article in the Washington Post on this topic.

Title: We All Want Longer, Healthier Lives. But It's Going to Cost Us

Excerpt:

Over the next few months, this country will engage in the first serious national discussion on health care in 15 years. Most of the talk will be about ways to make medical insurance available to all U.S. citizens. There will be a fair amount, too, about the need to make the hodgepodge "system" of American health care safer, better and more efficient. What we're unlikely to hear, though, is something like this:
Arresting the growth of health care spending in the United States is impossible. The policies and programs we're suggesting will either accelerate the upward trend or slow it temporarily, but they won't stop it. Health care costs will go up year by year until you die, and probably until your children die, too.

 

[Independent]

I'll agree with the view that this is really tough. We all want medical care that is: immediate, state of the art, treats every malady, and free. There is nothing wrong with "wanting" this - that's human nature. The problem comes when we think this is actually possible if only the gov't had the right policy.

The U.S. already spends a much higher percent of GDP on medical care than any other rich country. Some others may have lower administrative costs, but most of the difference is probably doing fewer tests, procedures, and prescriptions (and they may pay doctors less). I don't see any benefit to the U.S. in the gov't simply trying to shift the costs around to "somebody else".

 

[samclem]

The U.S. already spends a much higher percent of GDP on medical care than any other rich country. Some others may have lower administrative costs, but most of the difference is probably doing fewer tests, procedures, and prescriptions (and they may pay doctors less).

The rest of the world also gets a "free ride" from research and development that occurs in the US. The high profit potential for successful new drug therapies, diagnostic equipment, etc is a major impetus for innovation, which trickles down, at lower cost, to other countries. We should do what we can to reign in medical costs in the US, but we should know that one result will be a reduction in the pace of innovation as we reduce the potential payoff for success in R&D. That sounds mild enough, but we're talking about treatments and possibly cures for cancers, degenerative diseases, infections, etc that affect millions in the US and around the world. We may decide, as a society, that reducing costs are worth this result, but we should be conscious of the tradeoff. Dumping more (government) money into research will not take the place of the research now done by private companies.

 

[Rustic23]

IMHO, this is really one of the toughest things the Obama administration will tackle.

Why?
Conflicting groups. Medical providers vs Insurance Providers vs Constituents vs Politicians.
Each group has conflicting expectations.

 

[ziggy29]

IMHO, this is really one of the toughest things the Obama administration will tackle.

Why?
Conflicting groups. Medical providers vs Insurance Providers vs Constituents vs Politicians.
Each group has conflicting expectations.

Agreed -- this isn't easy even in a strong economy. Now imagine it in THIS economy and imagine convincing people we can afford it.

Though in some sense, it could be easier with a terrible economy as more and more people are losing health insurance or are afraid of being laid off and losing it. In THAT sense, the iron is hot.

 

[Rustic23]

This was in the Houston paper today.

Health-care reform: Much to lose in fixing system | Viewpoints, Outlook | Chron.com - Houston Chronicle

 

[OAG]

Eliminate litigation. How you do this I do not know but if Medical Providers of all stripe were made immune to litigation the potential cost reduction would be extremely significant IM very HO.

 

[Rustic23]

I think George Will's editorial was on litigation in general in the US and what it cost us. i.e. school systems that ban running at recess. I have always wondered where they get the juries to reward the lawyers with friendly verdicts.

 

[Martha]

I think George Will's editorial was on litigation in general in the US and what it cost us. i.e. school systems that ban running at recess. I have always wondered where they get the juries to reward the lawyers with friendly verdicts.

Oddly enough, Mississippi is known for its friendly to plaintiff juries.

(Not opining on whether they are deserved.)

 

[Martha]

Eliminate litigation. How you do this I do not know but if Medical Providers of all stripe were made immune to litigation the potential cost reduction would be extremely significant IM very HO.

And make me immune too. I don't want to be responsible if I hurt someone because I am sloppy.

 

[REWahoo]

And make me immune too. I don't want to be responsible if I hurt someone because I am sloppy.

When lawyers start practicing medicine we'll all be doomed, doomed I tell you!

 

[Independent]

The rest of the world also gets a "free ride" from research and development that occurs in the US. The high profit potential for successful new drug therapies, diagnostic equipment, etc is a major impetus for innovation, which trickles down, at lower cost, to other countries. We should do what we can to reign in medical costs in the US, but we should know that one result will be a reduction in the pace of innovation as we reduce the potential payoff for success in R&D. That sounds mild enough, but we're talking about treatments and possibly cures for cancers, degenerative diseases, infections, etc that affect millions in the US and around the world. We may decide, as a society, that reducing costs are worth this result, but we should be conscious of the tradeoff. Dumping more (government) money into research will not take the place of the research now done by private companies.

I'd be satisfied if we ended the "free ride". The U.S. gov't could say that it won't pay any more for a specific drug than the average price paid by other rich countries. If this stops development, I guess I'll have to get by with no "advances" in drugs. I expect that other countries would decide they are willing to pay a little more in order to fund continuing research.

 

[Independent]

Eliminate litigation. How you do this I do not know but if Medical Providers of all stripe were made immune to litigation the potential cost reduction would be extremely significant IM very HO.

According to a study by the consulting firm Towers-Perrin, the direct cost of medical malpractice is about $30 billion. This is about 1.5% of total medical costs. Some of the $30 billion is "legitimate" in that it pays the real losses of people who were on the wrong side of doctors' errors. Some is excess claims, lawyer fees, etc. http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf

I don't know how much doctors spend on defensive medicine. It seems like it should be somewhat related to the 1.5%. Lots of states have tried to do things to cut down on malpractice lawsuits and awards. I suppose someone could try to get details on the differences in doctors' decisions on different sides of state borders, but I don't know if that has been done.

 

[OAG]

According to a study by the consulting firm Towers-Perrin, the direct cost of medical malpractice is about $30 billion. This is about 1.5% of total medical costs. Some of the $30 billion is "legitimate" in that it pays the real losses of people who were on the wrong side of doctors' errors. Some is excess claims, lawyer fees, etc. http://www.towersperrin.com/tp/getwebcachedoc?webc=USA/2008/200811/2008_tort_costs_trends.pdf

I don't know how much doctors spend on defensive medicine. It seems like it should be somewhat related to the 1.5%. Lots of states have tried to do things to cut down on malpractice lawsuits and awards. I suppose someone could try to get details on the differences in doctors' decisions on different sides of state borders, but I don't know if that has been done.

Does not seem like much, but every little bit would help. It also does not consider the money providers and practitioners spend for Malpractice Insurance (or whatever they are now calling it). Anyway, it will never happen since there is probably more profit in the insurance and attorney business than what is spent on medical care.