How would national health plan affect ER?

[Rustic23]

The link is from the Congressional Budget Office Congressional Budget Office - Home Page. It was a 2003 paper 'How Many People
Lack Health Insurance
and For How Long?May 2003
While the information is 2003 and not 2006, it does not seem to me the numbers of people without insurance for an year, which were 21-31M should have climbed to 46m in three years.

Again, mine is not so much a quibble with the numbers as what people want to do. Is the system broke? If so why. What do you want to do about it.

While requiring people to get Health insurance that don't want it, because they don't think they need it does not seem very democratic to me. I guess you could use the motorcycle helmet reasoning, 'If they do need it we will have to pay for them so lets force them to have it" Of course if this is so, then they really aren't uninsured if 'we' are going to pay for them.

By the way, doesn't the Kaiser Foundation run a large HMO in California? If so how balanced is their survey?

Now the cynic in me. Follow the MONEY! There is a reason we don't have Universal Health Care/Insurance. Politicians bleed the Insurance companies for contributions. When they stop paying they will do something.

On the other side Insurance is a business. So, would you lend your car to a known drunk? The insurance business does not want them as a customer either. Well not at the same price as the non drunk. Likewise if you have a known medical condition, they don't want to insure you. It is the same reason you want insurance. A national high risk pool like FEMA might work. However, it would only have high risk individuals so either it would require government subsidies or sky high prices.

So I guess I am back to square one. What do you think we should do? As you and I have talked before, I am not against or for Universal Health/Insurance. Just tell me:

1. What does it provide
2. What is it going to cost
3. What is the long term effect on research
4. Who is going to pay
5. What is the effect on the health care profession
6. What are the legal aspects i.e. Lawyers, Doctors, Malpractice etc.
7. If put in place what will the health care system look like 5/10/15 years from now.
8. What is the effect on quality and quantity of health care

I am sure there are more questions. Right now, health care is a political football that is being kicked around, and like the Fair TAX/Flat Tax, I doubt it is going anywhere.

 

[Shawn]

I could afford to retire now, at 48, but I'm waiting until I'm 50 to be eligible for lifetime medical/dental through my employer. If universal health coverage became available today, and it was equivalent to my expected employer-sponsored retirement coverage, then today would be my last day on the job. Why should I be a tax-paying productive member of society when the government (or someone else such as my employer) will provide something for free.

I selected my job many years ago, in part, because of the stability and retirement security that it offered. In addition, like many people here, I've saved my money throughout the years. These were conscious decisions on my part, and there is no reason that most people cannot make equivalent decisions. I made what I consider to be good choices and I don't particularly want to pay for the poor choices other people make. This is neither an argument for or against universal coverage.

 

[REWahoo]

Although I was aware that some uninsureds were that way voluntarily (worked at an employer who provided health insurance but chose not to take it), the reality of this never really hit home until I saw a bit on the ABC evening news last night. It was a short piece on the Emergency Room at Parkland Hospital in Dallas :

24 Harrowing Hours Inside the ER: An Inside Look at One of America's Busiest Trauma Centers

On some level I suppose I knew that just because someone had a job where health benefits were available, that didn't mean they were affordable. But the severity of the problem never really dawned on me until I heard the ER nurse say this:
​

One in four Texans are uninsured and of them, 80 percent have jobs. "Most of them are working people," says nurse Lisa Mack as she walks through the packed room. "It's just 'do I put food on the table for my family or do I pay for a health care plan?'"

Martha and Rich have spent a couple of years setting me up for it, and this news program caused the light bulb to go on in my head. Any Presidential candidate who advocates strongly for sensible health care reform, regardless of party affiliation, has a very good chance to get my vote.

 

[Notmuchlonger]

How would the plan on funding the plans? Raise taxes?

 

[Rustic23]

ReWahoo,
At what cost?

Medicare not SS is the government program in trouble. (I base that on hearsay not any given fact I can quote) However, if true we can't pay for the program we have.

I have seen the number that 27% of those working in Texas do not have insurance. It does not address how many of these are US Citizens. The Harris County Emergency Rooms are over run by non US citizens. Take out this portion of their clientèle and Harris County does not have a health crisis in the county hospital. That is the problem with numbers. Statistics don't lie, however people that use them may/do/will!

By the way, ABC, now how about some fair and balanced station..... like CNN.

 

[cute fuzzy bunny]

More facts in this thread:

Silly Martha...dont go trying to confuse people with the facts when their minds are already made up. Its all the fault of the illegal aliens, we'll have to double taxes, and gosh darn it, its a citizens right to not have to have health care!

But if you do want some facts...

- Illegal aliens health care costs are a smaller piece of the health care cost pie than the copier/printer paper used in hospitals. The health care costs for illegal aliens is a percentage small enough to be statistical noise against the trillions spent overall on health care. Some specific hospitals in border areas seem to have financing problems due to caring for patients that dont pay their bills. Yet if you took away those "customers", the hospitals would probably have to close down due to lack of business. And nobody is forcing them to operate the hospital under those conditions, yet they continue to stay in business.

- We spend more per capita than any country and get among the worst care. So "where does the money come from?" seems to be pretty simple. Squeeze out the insurance companies, get rid of the bureaucracy, and provide better care at a lower cost than we're all currently paying. No need for tax increases. Everyone wants to point at the tax rates in countries with socialized medicine. How about this fact: in the past 3 years the combined employer/employee costs for health care for my family has been 3x the amount we've paid in income taxes?

- I'm fine with people electing to not have health care when they can afford it, providing they dont show up at the emergency room the next time they get the flu, and they pay their doctor bills when they do go in for care. I'm not fine with people wanting their families covered but they cant afford it. This is a civilized country. We educate our children, pave our streets, jail criminals and defend our nation. How about we make sure mom doesnt have to choose between feeding the family or taking little Suzy to the doctor?

 

[Rich_by_the_Bay]

How would the plan on funding the plans? Raise taxes?

It has been estimated that about 30% of every health care dollar goes to administrative overhead. From other countries' experience and from modelling it appears that this can be decreased to about 20% or less under a system that reduces underwriting costs, staggering complex and difficult to follow policies and forms, perplexing discounting and contract vagaries, etc.

In addition, so many uninsured get their primary care from emergency rooms which, being set up for the worst, charge grossly inflated rates to give minor care. We (the insured) pay these costs now through medicaid, health insurance premiums which support reimbursements distored by cost-shifting ($70 aspirin tablet to compensate for the unreimbursed CT scan). Doctors need to do their part too, and restrain themselves from marginally helpful high tech testing which rarely changes treatment plans (not every mild knee pain or headache needs an MRI).

Out of control. Doesn't matter if your personal politics are liberal or conservative - we are in a mess and it ain't getting better.

 

[Martha]

Again, mine is not so much a quibble with the numbers as what people want to do. Is the system broke? If so why. What do you want to do about it.

Well, I think I have made clear what I want to do about it.

By the way, doesn't the Kaiser Foundation run a large HMO in California? If so how balanced is their survey?

Common and reasonable misunderstanding. No, there is absolutely no relationship between the two organizations. The Kaiser Family Foundation has an impeccable reputation.

Now the cynic in me. Follow the MONEY! There is a reason we don't have Universal Health Care/Insurance. Politicians bleed the Insurance companies for contributions. When they stop paying they will do something.

I absolutely agree. This is why I do not support Clinton.

On the other side Insurance is a business. So, would you lend your car to a known drunk? The insurance business does not want them as a customer either. Well not at the same price as the non drunk. Likewise if you have a known medical condition, they don't want to insure you. It is the same reason you want insurance. A national high risk pool like FEMA might work. However, it would only have high risk individuals so either it would require government subsidies or sky high prices.

The other option would be to bar underwriting and require everyone to get insurance, much like Senator Wyden's plan. But yes, a risk pool doesn't work without subsidies from someplace.

So I guess I am back to square one. What do you think we should do? As you and I have talked before, I am not against or for Universal Health/Insurance. Just tell me:

1. What does it provide
2. What is it going to cost
3. What is the long term effect on research
4. Who is going to pay
5. What is the effect on the health care profession
6. What are the legal aspects i.e. Lawyers, Doctors, Malpractice etc.
7. If put in place what will the health care system look like 5/10/15 years from now.
8. What is the effect on quality and quantity of health care

I am sure there are more questions. Right now, health care is a political football that is being kicked around, and like the Fair TAX/Flat Tax, I doubt it is going anywhere.

So many questions, all of which are reasonable, but can't be answered in the soundbite system of an internet message board. I will say that there are many who are looking at these issues and I have some hope that policy makers will pay attention. The paper Rich linked to is an example.

Because there are so many issues in the health care sector it makes it hard to have a global solution. So, we attack piece by piece. My piece is health coverage for the poor and for the uninsurable. Whether through a public plan or subsidized insurance. Of all the plans, I like either medicare for all (single payer but not single provider) or Wyden's plan where insurance companies stay in the mix, where everyone gets insured, the insurance companies can't underwrite but must compete on cost, and payments are collected through the income tax system. Not perfect, but a lot better.

Other people can work on the delivery end of the system, which needs a lot of work as well.

 

[Notmuchlonger]

Thanks Rich

Does anyone know if Dr's and nurses in other countries make the same wage as their United States colleagues? I wonder if they would start putting a cap on how much a nurse or Dr could make in a universal health care system. I know there is a nursing shortage. I have no idea if there is a Dr shortage in the US.

 

[DallasGuy]

How would the plan on funding the plans? Raise taxes?

How does the US fund the war in Iraq? By running huge deficits, of course. I always find it interesting that people don't want to fund universal health care but don't say anything about all of the money that the US spends all over the rest of the world...on wars and military bases and "bribes" to other countries to "do it our way". I'm guessing that health care would still be more expensive than a war in Iraq, but the idea is still the same...why not take care of the people in our own country first instead of blowing the money everywhere else but here?

 

[cute fuzzy bunny]

Hitler!

 

[W2R]

Hitler!

Hey, that didn't work the last time I used it. Nice try.

 

[cute fuzzy bunny]

ummm....

Godzilla Hitler?!?

 

[Notmuchlonger]

How does the US fund the war in Iraq? By running huge deficits, of course. I always find it interesting that people don't want to fund universal health care but don't say anything about all of the money that the US spends all over the rest of the world...on wars and military bases and "bribes" to other countries to "do it our way". I'm guessing that health care would still be more expensive than a war in Iraq, but the idea is still the same...why not take care of the people in our own country first instead of blowing the money everywhere else but here?

I just asked how it was proposed to be paid for.

 

[DallasGuy]

I just asked how it was proposed to be paid for.

And my implied answer was....stop spending our money everywhere else in the world and spend it on universal health care (or something simliar) instead.

 

[Notmuchlonger]

Ya now is a good time for a Hitlergodzilla

 

[Wags]

How does the US fund the war in Iraq? By running huge deficits, of course. I always find it interesting that people don't want to fund universal health care but don't say anything about all of the money that the US spends all over the rest of the world...on wars and military bases and "bribes" to other countries to "do it our way". I'm guessing that health care would still be more expensive than a war in Iraq, but the idea is still the same...why not take care of the people in our own country first instead of blowing the money everywhere else but here?

Careful you do not want to be called a ////.

I guess it would be by mortgaging the future of our children, our grandchildren and their grandchildren to fight the Iraq War and to pay for the brides which you alluded to. As for blowing things up hey that is called col·lat·er·al damage.

When poor people and common folk start giving large amounts of $$$$ and lining the pockets of our elected officials in the White House and in Congress (like the lobbyist and special interest groups) then maybe health care will become a priority. NO $$$$ equals no infleuence and no voice.

We've got to clear some of the room out of the prisons so we can put the bad guys in there, like the pedophiles and the politicians. Kinky Friedman

GOD BLESS

 

[Rich_by_the_Bay]

I know there is a nursing shortage. I have no idea if there is a Dr shortage in the US.

There is maldistribution (chasing the high income specialties) and possibly an early real shortage. Primary care is entering early crisis mode: boomers aging and needing more care, primary doctors retiring early , while they have the lowest income, strong responsibility and highest on-call burden.

Generally, in my opinion, a patient with undifferentiated symptoms gets best cared for by starting with primary care doctors (internal medicine, peds, etc.) because they don't feel they have to immediately do every test there is to do -- they can refer if the problem persists or is unclear. (Canada: internal medicine is not generally a primary care area, but more like hospitalists here).

There is a movement afoot to fix some of these issues (e.g. Advanced Medical Home - recognizes reimbursement for prevention, coordination of referrals, front line responsibility, counselling, family conferences, etc.).

 

[REWahoo]

ReWahoo,
At what cost?

There would definitely be a significant cost and how it would impact each of us I have no idea. But I do have one point of reference:

We were at the top of the 15% tax bracket in 2007 and we paid more for health insurance premiums ($5,000 deductible) than we did in income tax. So in my case, our income taxes could double and if we got health coverage out of the deal we wouldn't be any worse off.

YMMV.

 

[donheff]

The uninsured numbers are felt by many to be understated because they require a full year of no insurance. The sequence seems to be: have a job and be insured; get sick; become unable to work; lose insurance. Then comes the sell-off of personal savings or possessions, and finally (in some cases) personal bankruptcy.

This is what is so frustrating. The people with problems are not all (or even mostly) freeloaders who chose their bed and should now lie in it. They are our brothers and sisters, mothers and fathers. Sh** happens but you shouldn't lose everything you have due to health care bills. Other civilized countries don't allow this but we do and the reform nay sayers just blame the victims.

 

[cute fuzzy bunny]

Careful you do not want to be called a ////.

I guess it would be by mortgaging the future of our children, our grandchildren and their grandchildren to fight the Iraq War and to pay for the brides which you alluded to. As for blowing things up hey that is called col·lat·er·al damage.

When poor people and common folk start giving large amounts of $$$$ and lining the pockets of our elected officials in the White House and in Congress (like the lobbyist and special interest groups) then maybe health care will become a priority. NO $$$$ equals no infleuence and no voice.

We've got to clear some of the room out of the prisons so we can put the bad guys in there, like the pedophiles and the politicians. Kinky Friedman

GOD BLESS

My vote for the most inexplicable and disjointed post of 2008. But the year is young.

 

[armor99]

OK.... here is a small suggestion that I have. Something small.... but I think that the insurance companies could start doing this to bring down the cost of medical care. Imagine that... an actual idea to make things slightly better.
It has always amazed me that a medical insurance company will pay for triple heart bypass surgery, but they will NOT pay for a gym membership. How about the insurance companies start working out deals with gym chains to give discounts and even refunds to folks that are actively participating in going to a local gym? Let's face it, excercise done early enough, cures almost everything. They would have to work out some sort of system to verifiy who is really going etc, but I would think it should not be too hard. And there you go.... people now have an addtional incentive to go to the gym (a lower insurance rate), and the insurance company has an incentive to pay for the gym membership (a much lower chance of medical problems later). Small... simple... far from perfect.... but still a start...

 

[Martha]

Not a bad idea armor99. My BCBS plan pays for gym memberships.

I wouldn't say exercise cures almost everything. We all die anyway.

 

[Rustic23]

OK, so we get insurance to pay for gym memberships. Will everyone be required to have one? Will everyone be required to prove they use it? Will the Federal Government subsidies it?

Now lets look at what it will cost us. If I am an insurance company and I need to supply a gym membership to all my customers, I am going to go out and find out how much a gym membership cost per year, say $600, then I will add administrative cost on that say $600, and will then charge each of my customers $100 per month more for their health insurance. There is no free lunch.

REWahoo,
Just a guess, but by the time the Government bureaucracy is finished your income tax would triple, that is unless you want the fee gym membership plan.

 

[REWahoo]

REWahoo,
Just a guess, but by the time the Government bureaucracy is finished your income tax would triple, that is unless you want the fee gym membership plan.

Depends on what the women at the gym look like...