Is Univeral Health Care the answer?????

[Brat]

How is the current system working for controlling demand and how does it support public health?

There are ways to deter unnecessary use, moderate co-pays being one. Another is to adjust the reimbursement rate to line up with the effectiveness of treatments.

I agree that the poor will be higher utilizers than they have in the past, but they will be less likely to use high-cost emergency room services for primary health care. There will be shifts in utilization patterns.

 

[mykidslovedogs]

There are ways to deter unnecessary use, moderate co-pays being one. Another is to adjust the reimbursement rate to line up with the effectiveness of treatments.

You got it! That's exactly what the private system is doing right now, especially with the latest HSA and health reimbursement plan designs, and yet, people are complaining left and right about having to pay higher copays and deductibles!

 

[Rich_by_the_Bay]

Since most people can't afford private coverage now...

Oh, really?

So, if most people can't afford private coverage now, they are either paying out of pocket, going on the public dollar, or suffering from lack of care for problems the should be tending to. Hmm... sounds pretty bad.

Just to be sure I haven't lost the forest for the trees, please clarify the system you think is best.

For example, I know you have advocated that people buy a private policy when they are very young (before pregnancy age, for example; and certainly not if they already have illness or congenital conditions), forego or largely duplicating their employer-based policy even though that can be a $6-$12K benefit, and keep it for life (despite the risk of its termination over decades for any number of reasons, e.g. if they choose to leave the area where they originally bought it with some policies, etc; especially bad if they've developed illnesses in the interim.). Is that your whole vision?

So, let's hear about the system you think would be best for your fellow Americans. What is your vision? The pulpit is yours.

 

[mykidslovedogs]

OK - I shouldn't of said since most people can't afford private coverage now...
What I should've said was since many of you thinkmost people can't affod private coverage now....

Honestly, and as I have said before, I don't think the current system is perfect...I just cringe at the alternative...But since you asked what I think could work...how about this?

Gov't mandates all Americans must carry at least the most basic health insurance plan (kind of like liability car insurance). This plan design would be standardized and required that all insurance carriers must offer it in their mix of healthplans. The plan should be a high deductible (say maybe $2500 single/$5000 family deductible) HSA compatible plan. It would be the ONLY plan that insurance carriers would be required to offer on a guaranteed issue basis. The plan would have to cover preventive care (nationally recommended cancer screenings and immunizations) NOT subject to the deductible. The plan would offer a copay of around $15 or less for generic drugs, and brand prescription coverage AFTER the deductible is met and 100% coverage for all other services AFTER the deductible is met. It must cost no more than what the average working class American could afford to pay, and no less than the cost to administer the plan and pay claims. (The gov't will determine the maximum premium.) The insured would be required to use the private carrier of their choice's networks or be penalized with a higher deductible if they choose to go outside of the network. The standardized plan would be portable from state to state because it is a guaranteed issue plan.

Although it might be hard for some people to afford the deductible, at least the health care providers will still get reimbursed for balances above the deductible, so their write-offs won't be nearly as hefty, and there won't be as much of a need for health care providers to come after private insurance carriers for lost profits, like they do today when someone with a $100,000 claim or higher is uninsured. This will help bring down premiums for everyone, overall, over time.

Medicaid and Medicare remain in force as is, however, if someone over the age of 65 wants to buy the cheaper, basic plan, they would be allowed to do so, and NOT be required to go on the gov't Medicare plan if they don't want to.

Employers are prohibited from providing medical benefits, but they would be allowed to have flexible spending plans or health re-imbursement arrangements, whereby people could have tax-deductible income and/or employer contributions set aside for use to pay premiums for personal health insurance coverage or for deductible health insurance expenses, if the employer wants to offer such a benefit. Employers should not be forced, nor taxed to provide subsidies for the basic plan.

Whoever is not eligible for Medicare or Medicaid, and does not purchase this minimal level of coverage voluntarily must understand that they could be turned away for medical care with NO legal consequences to the physician for turning them away. Any physician who wants to treat the person on a pro-bono basis has the perogative to do so, provided they don't try to recapture the lost profits from the private sector.

In addition, insurance carriers will still be allowed to medically underwrite products that have more bells and whistles than the basic plan design. People who want to buy up have all the freedom in the world to do so, provided that they can medically qualify.

 

[sgeeeee]

. . .
Although it might be hard for some people to afford the deductible, at least providers will still get reimbursed for balances above the deductible . . .

Yeah. The key think in developing a universal health policy for the country is to make sure that insurance providers don't suffer.

 

[mykidslovedogs]

Yeah. The key think in developing a universal health policy for the country is to make sure that insurance providers don't suffer.

Not insurance providers...Health Care Providers. If healthcare providers were able to get reimbursed over a certain deductible, (which doesn't happen right now when they treat the uninsured), then they wouldn't have to negotiate higher rates with insurance carriers. The natural market response would be that insurance premiums would come down.

I can see that you didn't carefully read my suggestions, because the SECOND half of the equasion was that employers be allowed to offer tax deductible benefits (not health insurance) that people can use to pay the premiums and or deductible on thier basic plan design that they are mandated by the government to have.

 

[perinova]

If you exclude some unnecessary plastic surgery (ie boob jobs ), is there really a necessity to limit the use of medical care? I mean who is going to the doctor/hospital for fun?
The usual copay, as a % of the total bill, is a good deterrent to limit expenses. Add a max-out-of-pocket to protect against a very bad event.
Add a small deductible so that people pay out of pocket for the small stuff.

And we are there... Simple... Waitaminit... that is how it was prior to the HMO time. Who thought of this system where you pay pretty much nothing (flat nominal amount) for everything with no deductible? No wander why the HMO rep. refuses you all possible care you ask for.

IMHO The problem doesn't lie in cost containment.
We should
1) roll back the clock and provide everyone with (mandatory) health insurance (no HMO). Have those insurance if possible non-profit (ie mutual). Provide govt help for those who can't pay.
2) Or nationalize health insurance have it paid as % of income. ie medicare for all.

 

[mykidslovedogs]

If you exclude some unnecessary plastic surgery (ie boob jobs ), is there really a necessity to limit the use of medical care? I mean who is going to the doctor/hospital for fun?
The usual copay, as a % of the total bill, is a good deterrent to limit expenses. Add a max-out-of-pocket to protect against a very bad event.
Add a small deductible so that people pay out of pocket for the small stuff.

And we are there... Simple... Waitaminit... that is how it was prior to the HMO time. Who thought of this system where you pay pretty much nothing (flat nominal amount) for everything with no deductible? No wander why the HMO rep. refuses you all possible care you ask for.

IMHO The problem doesn't lie in cost containment.
We should
1) roll back the clock and provide everyone with (mandatory) health insurance (no HMO). Have those insurance if possible non-profit (ie mutual). Provide govt help for those who can't pay.
2) Or nationalize health insurance have it paid as % of income. ie medicare for all.

Option number one is close to perfect... (see my comments on page 7)
Option number two, IMO, will result in waiting lists.

 

[Nords]

But since you asked what I think could work...how about this?

Complex problems may have simplistic simple answers, but considering all the public dialogue and governmental incentives in a capitalistic society: if this plan was workable then wouldn't it already have been implemented?

If similar logic was applied to Wall Street then every stockbroker would be rich without ever having to collect a single commission... everyone would pick the right stocks.

 

[perinova]

Option number two, IMO, will result in waiting lists.

I don't see why. You can have a system where the "national insurance" reimburses you for bills you paid already. You set up your own apointments, compare prices ahead of time...

 

[FIRE'd@51]

MKLD,

I think your plan could work so long as the insurance companies can't offer competing basic plans which require underwriting. If they can, we would still have the adverse selection problem. Everyone, including the young and healthy, need to be in the basic plan to keep the premiums reasonable, and everyone should pay the same premium (community rated - with a possible adjustment for geographic location, but not health condition). All "bells and whistles" would have to be add ons or riders (e.g. dental, vision, but not basic major medical).

 

[mykidslovedogs]

MKLD,

I think your plan could work so long as the insurance companies can't offer competing basic plans which require underwriting. If they can, we would still have the adverse selection problem. Everyone, including the young and healthy, need to be in the basic plan to keep the premiums reasonable, and everyone should pay the same premium (community rated - with a possible adjustment for geographic location, but not health condition). All "bells and whistles" would have to be add ons or riders (e.g. dental, vision, but not basic major medical).

Agreed.

Reason something like that hasn't been implemented yet? To answer Nords...is because too many people don't like the idea of "unfairness". A system such as I proposed would still leave a difference between the haves and have nots, and there are just too many people who would vote against a tiered system. People want a plan that pays for everything without having to pay anything to obtain such services, and they don't want some people to have better coverage than other people. There is a deadlock between capitalism and socialism, and no-one wants to compromise.

 

[Brat]

Reason something like that hasn't been implemented yet? To answer Nords...is because too many people don't like the idea of "unfairness". A system such as I proposed would still leave a difference between the haves and have nots, and there are just too many people who would vote against a tiered system. People want a plan that pays for everything without having to pay anything to obtain such services. There is a deadlock between capitalism and socialism, and no-one wants to compromise.

For once I agree with you. In the search for the perfect nothing happens.

IMHO we should start with catastrophic coverage, prenatal care (post conception) and preventative care for children. After that has settled out then re-assess. To some extent the high cost for health insurance is the result of the cost shifting driven by the cost of the uninsured catastrophic care and insurer's pre-existing conditions risk analysis. With those risks out of the way the cost of health care policies may drop significantly.

 

[Freein05]

The crazy part of this whole Universal Health Care coverage and people supporting our current broken system is the US is the only industrialized country in the world without universal health care, socialized health care or a single payer system.

The US has the most costly health care system of those countries. The US is a head in infant mortality rates and behind in life expectancy. It also has over 40 million uninsured! Now go ahead and tell me about the long lines in Canada and England! Than ask a Canadian if they would like our system of health care.

Insurance companies have not been able to control costs. Part of the reason for this maybe all of those million dollar CEOs. They are for profit corporations who primary reason for being in business is to maximum share holder profits.

For those who laugh at Medicare try taking it away from seniors. You would be hung. Remember your favorite insurance company would not want them.

 

[mykidslovedogs]

The US has the most costly health care system of those countries. The US is a head in infant mortality rates and behind in life expectancy. It also has over 40 million uninsured! Now go ahead and tell me about the long lines in Canada and England! Than ask a Canadian if they would like our system of health care.

Infant mortality is a socio-economic issue, with blacks and hispanics ranking higher than other races. Which country has more blacks and hispanics than almost any other? The USA. Infant mortality rates have little if not anything to do with the health insurance system.

Life Expectancy rates in Canada were slightly higher in Canada than in America BEFORE Canada implemented socialized care. Since then, the difference in life expectancy and the USA is still about the same...again, having little or nothing to do with which kind of health insurance system we have.

Average wait time for surgery (average of all surgeries, elective or not) in Canada is 17 weeks. Some people wait up to 2 years while in excruciating pain for hip replacements.

I've talked to people who have moved to Canada and now pay more taxes there than they would have paid for their own health insurance premiums plus taxes in the USA. Many come to the USA for care, since it's right across the border, and guess what, America gets to ADD that cost of care into their total GDP/per Capita, but we don't get to count those people who come across the border as part of the population when coming up with our figures for total cost of care per capita.

Additionally, we have a higher cost of care in America than in other countries because WE CAN, and people here are willing to pay more for better services. It's easy to control the cost of care in countries such as Canada, simply by putting government limits on spending. We don't do that in America, and because we can pay more, and we choose to pay more, we simply have higher totals. If our goverment price-controlled our care, then our figures would be much more like Canada.

Similarly, if more people in Canada could afford to opt out of the public system into the private system there, then their cost of care figures per capita would be higher too.

 

[mykidslovedogs]

For once I agree with you. In the search for the perfect nothing happens.

IMHO we should start with catastrophic coverage, prenatal care (post conception) and preventative care for children. After that has settled out then re-assess. To some extent the high cost for health insurance is the result of the cost shifting driven by the cost of the uninsured catastrophic care and insurer's pre-existing conditions risk analysis. With those risks out of the way the cost of health care policies may drop significantly.

Yup.

 

[sgeeeee]

Dowling, Mike, "Mr. Dowling's Interactive Table of the Nations of the World," available from http://www.mrdowling.com/800nations.html; Internet; updated Thursday, June 29, 2006 . ©2007, Mike Dowling. All rights reserved.

http://www.mrdowling.com/800life.html

United States Life Expectancy: 77.85 years
Canada Life Expectancy: 80.22 years

United States Infant Mortality: 6.4
Canada Infant Mortality: 4.7

Note the date of last update is June 2006.

 

[mykidslovedogs]

Dowling, Mike, "Mr. Dowling's Interactive Table of the Nations of the World," available from http://www.mrdowling.com/800nations.html; Internet; updated Thursday, June 29, 2006 . ©2007, Mike Dowling. All rights reserved.

http://www.mrdowling.com/800life.html

United States Life Expectancy: 77.85 years
Canada Life Expectancy: 80.22 years

United States Infant Mortality: 6.4
Canada Infant Mortality: 4.7

Note the date of last update is June 2006.

Canada's life expectancy rates (percentage of difference) as compared to America's life expectancy rates PRIOR to Canada becoming socialized (back in the 60's) weren't much different then than they are today, so your figures don't do anything to prove that the difference has to do with socialized vs. non-socialized care.

Canada's population is primarily white. If we moved all of the blacks and hispanics from the USA to Canada, Canada's infant mortality rates would be higher. Again, your figures do nothing to prove that the difference has anything to do with socialized vs. non-socialized care.

 

[sgeeeee]

Canada's life expectancy rates (percentage of difference) as compared to America's life expectancy rates PRIOR to Canada becoming socialized (back in the 60's) weren't much different then than they are today, so your figures don't do anything to prove that the difference has to do with socialized vs. non-socialized care.
. . .

There you go again. . . Of course I never claimed that their superior longevity and infant mortality statistics were a result of socialized medicine. I simply point out that the Canadian statistics with socialized medicine are better than the US statistics.

I think most people realize that this data is important. Whenever a political discussion to discuss universal healthcare begins , you can count on someone to bring up Canada or England and claim that their care is inadequate. This is usually done with some anecdotal evidence of a person in one of those countries that got poor care. Of course it is easy enough to find anecdotal evidence of poor care in the US too, so this is not very useful. But if care were really poor in general, how would we measure it?

Very significant diferences in healthcare quality might show up in longevity or infant mortality. So we can look at Canada and ask if their care quality is so poor that it shows up in these statistics. The answer, is clearly, "No, their healthcare quality is not so poor relative to US that it shows up in these statistics." In fact, their statistics look better than ours even with a national healthcare plan.

 

[Rich_by_the_Bay]

Canada's population is primarily white. If we moved all of the blacks and hispanics from the USA to Canada, Canada's infant mortality rates would be higher.

I can't believe I just read that.

 

[mykidslovedogs]

I can't believe I just read that.

But it's true. Infant mortaliy rates have more to do with socio-economic status than they do with socialized vs. for-profit care. It's just a matter of fact, and has nothing to do with bigotry or prejudice. Blacks and hispanics simply have higher infant mortality rates than other races. - it's a matter of fact.

The fact that Canadians live longer has nothing to do with whether the care there is superior or not. It's the quality of life when you are sick, IMO, that matters most, and waiting for care while in excruciating pain is not a good solution to me.

In America, there are statistics showing that up to 50% of healthcare problems/costs can be attributed to obesity, smoking, and alcohol and drug abuse. These are social issues that have very little to do with whether the healthcare system is socialized or not. For whatever reason, people in other countries seem to live healthier lifestyles than in the USA. Could it have anything to do with moral values? (IMO, of which we have no more here in the USA?). With the family unit falling apart, and little regard for morality, people look to entertainment, work, food, drugs and alcohol to make up for the happiness that we are missing out on.

 

[cute fuzzy bunny]

It's just a matter of fact, and has nothing to do with bigotry or prejudice. Blacks and hispanics simply have higher infant mortality rates than other races. - it's a matter of fact.

I believe that this 'fact' has very little to do with the skin color of the people in question.

 

[ERD50]

So do we have any life expectancy comparisons of US, Canada and England across people of the same economic range?

The real test: Do wealthy Canadians have to pay more for an annuity?

-ERD50

 

[haha]

I can't believe I just read that.

Whoops! MKLD just fell through the outhouse seat.

Ha

 

[sgeeeee]

. . . Canada's population is primarily white. If we moved all of the blacks and hispanics from the USA to Canada, Canada's infant mortality rates would be higher. . .

Unbelievable.

I think we should just send all sick people to Canada. It would save us a lot of money and they apparently would have a better chance of getting good care.