Listened to a program today on Universal Healthcare..........

[razztazz]

(3) As a nation, we seem to look to the government for more and more solutions. I don't think this is a good trait, but it is what it is.

And there's a reason for that. Gee, I wonder why?

 

[Eagle43]

Victims. 

I see victims everywhere.  The lawyers need victims; who you gonna sue without victims.  The government needs victims;  victims vote.  We're all victims.  Them big corporations, lousy hospitals and insurance companies are screwing us bad.  Lousy doctors, people are dying in the streets.  Look outside your window; people are dying man.  Stingy pharmaceutical companies won't give us victims the pills.  We need pills.  Blasted McDonalds is selling us trash that makes us fat.  Not our fault; we're victims.  Ambulances want to charge us for a ride.  That's not fair.  Fairness.  We victims need fairness.  Walmart sells us stuff made in China that's too cheap and probably makes us ill.  Government needs to step up to the plate and make this right.  You wanna know why we need the government?  Cause we're all victims, that's why! 

Whew. Now I feel better, don't you?

 

[lets-retire]

Why not universal health care? The government normally can't wipe it's butt without messing it up. Look at all of the propgrams they run. Most government programs are extrememly ineffecient and poorly run. I've been in the government health care system and seen how bad it is. All they treat is symptoms. Can you say 800mg Motrin anyone? I had to go to the private sector to have the problems fixed. The insurance policy I recently had covered pretty much everything, except expermental proceudres. There was no percentage deductable. It was a straight fee. The total cost for the insurance was $4500 per year. This was paid for by my employer and it was a small group policy. The DW's police was much cheaper, but we had higher straight fee deductibles/co-pays on her policy and it was for large groups.

I think it boils down to what a couple other people said earlier. I have no incentive to find the cheaper doctor, I'm not paying for it. In this country the general thinking is if it is cheaper it isn't as good. Everyone wants the best doctors so it has to be expensive.

If there is no other choice then I would have to support the private insurer coverage provided by the government, not the govenment as the direct payer. I do think it is a bad idea. More entitlement programs is very bad. The main reason for the government is "establish justice, insure domestic tranquillity, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity" I see the establishment of the legal system and the military, nowhere do I see PROVIDE for the common welfare.

 

[Dawg52]

I discussed justin's idea some years ago and the people involved really couldn't give me an answer and I am not an insurance actuary, so what do I know.

Ref government as re-insurer, and using market based insurance. Wouldn't a policy from Company "A" that provides, for instance,  $30,000  dollars of insurance, with the usual $1,000, $2,000 or (select as needed)  deductibles  be pretty cheap? And wouldn't buying a catastrophic policy from Company "B" , that doesnt even kick in till you've used 30 grand worth of care be pretty cheap? It would be like having a 30,000 deductible. For the most part most people would never even touch the insurance. That's how people lower their rates now anyway. Get a bigger deductible.

So, if this can be done via regular inursance companies,  Company A and Company B, what's the problem?

Some legislation would likely be required. Guaranteed acceptance. Geographic Overlap/reciprocation. And perhaps some .. I hate to say the friggin word but, "government subsidy" for the really hard cases or to extend "lifetime caps" beyond the paltry 1 or 2 or 3 million clams you get now.  But those things are  periperal to the actual mechanism

This basically is what our company did this past year. We bought a $5,000 deductible plan from BCBS and $4,000 of gap(deductible) insurance from another company. So far no complaints. It lowered our overall premiums as well. It will be interesting to see what the renewal rates will be at the end of the year. 

 

[Rich_by_the_Bay]

Guess I have a somewhat unique perspective being on the provider side, but an unsurprising observation may be worth repeating:

People fortunate enough not to need serious health care or not to have a chronic medical condition and who are nicely employed and have a decent group policy are often quite happy with health care reimbursement and delivery. They praise an attitude of "each to his own," sense of ownership of their health, perhaps even feeling a bit invulnerable.

On the other hand (what I admittedly see disproportionately), others develop diseases from diabetes to heart disease to cancer -- sometimes during middle age. Regardless of whether they are/were CEOs, politically very conservative, and even reactionary, they usually come to despise the system. If they are very wealthy, they might come through bruised but OK if a bit frustrated. If they are financially OK but not very wealthy it often derails any plans for near-term retirement etc.

It's not just the money -- it's constraints on which doctors you can see, permission-seeking from some insurance clerk at every turn, drug substitutions, spotty coverage for chronic care, etc. Hospitals are often full or understaffed, doctors hassled, and systems broken.

So, it's like praising your auto insurance carrier when you've never had an accident -- they seem very efficient and friendly about collecting premiums. My advice is to defer judgment about the system until you've had a serious accident, not just a fender bender.

 

[Craig]

razztaxx, you're good at smart a$$ comments, but how about a real solution, buddy?

You sarcastically dismiss Texas Proud's comments above re: efficiency, but if you've ever run a business, designed a compensation plan or priced a product or service, you know that the design of a system contains incentives, implicit and explicit.  Have you ever had to think through such scenarios?

Glad to see some fair debate of this topic ... sometimes feels like democrats.org around here when the subject comes up.

Wouldn't surprise me if we do get universal government health care someday.  Educational level going down in the country, higher proportion of Americans don't understand free enterprise / market forces, more people wanting someone else to take care of them.  And, after we get it, quality will go down, the program will cost much more than advertised (gee, how did that happen?), the system will suck, and we'll be looking outside the U.S. for better health care.  At that point, folks who thought this idea (like the U.S. Postal Service) was great will then tell us the program was poorly managed, the Repubicans / Democrats screwed it up, there is bureaucratic waste, yada yada. We've seen the end of this movie.

Would be nice if we gave MSA's, etc. a chance ... they're just starting to go mainstream, and that kind of process improvement can help create a cultural change in the medical profession.

 

[Cut-Throat]

It's not just the money -- it's constraints on which doctors you can see, permission-seeking from some insurance clerk at every turn, drug substitutions, spotty coverage for chronic care, etc. Hospitals are often full or understaffed, doctors hassled, and systems broken.

There are a lot of other issues that need addressing as well. I have seen statistics that 70% of all medical care costs are administered in the last year of a patients life. In other words 'mostly unnecessary. I think we are going to have to learn how to 'throw in the towel' in life. We treat our pets better at the end of their lives.

Those opposed, often use the words, "we can't play god" - What the hell do they think a heart transplant is?

 

[Martha]

Wouldn't surprise me if we do get universal government health care someday.  Educational level going down in the country, higher proportion of Americans don't understand free enterprise / market forces, more people wanting someone else to take care of them.  And, after we get it, quality will go down, the program will cost much more than advertised (gee, how did that happen?), the system will suck, and we'll be looking outside the U.S. for better health care.  At that point, folks who thought this idea (like the U.S. Postal Service) was great will then tell us the program was poorly managed, the Repubicans / Democrats screwed it up, there is bureaucratic waste, yada yada.  We've seen the end of this movie.

Would be nice if we gave MSA's, etc. a chance ... they're just starting to go mainstream, and that kind of process improvement can help create a cultural change in the medical profession.

I understand free enterprise and market forces.  Market forces cause insurance companies to want to cover healthy people.  The people with the diabetes, cancer and heart disease don't have bargaining power.  They need government interference to get coverage.  If you look at the individual insurance market which is for the most part unregulated, you will see that there are plenty of options for young and healthy people and often no options for older sicker people.

I like MSAs.  They are a wonderful benefit for young and healthy people.  Costly for those who have to use up their deductible every year. 

We all want someone to take care of us when we are ill. 

 

[MasterBlaster]

Reading through most of the posts I get the impression that many posters believe that universal health care would be the same quality of care that we get now. Except that everyone would be covered for all of the medications and all of the procedures and nobody would have to pay too much. That is some very wishful thinking.

Be careful what you ask for. You just may end up with a system that has long waits to get care and limits just how much care you can get. And that care that you do get isn't quite as good as you had imagined. That's what universal healthcare is really all about.

Maybe that's what we as a nation really need and want. But at least lets be realistic about what universal care will really be.

 

[razztazz]

how about a real solution, buddy?

I stated at least one possible mechanism earlier. And many more over the yrs here and elsewhere. Perhaps somebody has even better ideas? Sorry, but this is just oe threat on one board. I don't intend to write a book.

You sarcastically dismiss Texas Proud's comments above re: efficiency,

Actually I thought hs flippent invocation of "Deus ex Efficiency" that didnt address the problem, was a bit sarcastic. Perhaps I was wrong

but if you've ever run a business, designed a compensation plan or priced a product or service, you know that the design of a system contains incentives, implicit and explicit. Have you ever had to think through such scenarios?

Yes. And if I hadn't would make no difference. They let me sit on a jury once without any prior criminal experience

razztaxx, you're good at smart a$$ comments

No, I'm not really. But I see many who are. Some right here

 

[Martha]

Reading through most of the posts I get the impression that many posters believe that universal health care would be the same quality of care that we get now. Except that everyone would be covered for all of the medications and all of the procedures and nobody would have to pay too much. That is some very wishful thinking.

Be careful what you ask for. You just may end up with a system that has long waits to get care and limits just how much care you can get. And that care that you do get isn't quite as good as you had imagined. That's what universal healthcare is really all about.

Maybe that's what we as a nation really need and want. But at least lets be realistic about what universal care will really be.

MasterB, I know you and I have gone around on this before, but are things so great now? Look at Rich's post:

Guess I have a somewhat unique perspective being on the provider side, but an unsurprising observation may be worth repeating:

People fortunate enough not to need serious health care or not to have a chronic medical condition and who are nicely employed and have a decent group policy are often quite happy with health care reimbursement and delivery. They praise an attitude of "each to his own," sense of ownership of their health, perhaps even feeling a bit invulnerable.

On the other hand (what I admittedly see disproportionately), others develop diseases from diabetes to heart disease to cancer -- sometimes during middle age. Regardless of whether they are/were CEOs, politically very conservative, and even reactionary, they usually come to despise the system. If they are very wealthy, they might come through bruised but OK if a bit frustrated. If they are financially OK but not very wealthy it often derails any plans for near-term retirement etc.

It's not just the money -- it's constraints on which doctors you can see, permission-seeking from some insurance clerk at every turn, drug substitutions, spotty coverage for chronic care, etc. Hospitals are often full or understaffed, doctors hassled, and systems broken.

So, it's like praising your auto insurance carrier when you've never had an accident -- they seem very efficient and friendly about collecting premiums. My advice is to defer judgment about the system until you've had a serious accident, not just a fender bender.

 

[MasterBlaster]

Martha:

I did see Rich_in_Tampas post and agree that the present system isn't so great. I just think that things could likely be even worse under a universal coverage system.

I guess I just see universal coverage as the HMO from hell.

Maybe that's the system we need but at the very least lets be honest about what we are proposing.

 

[dylar]

At the risk of injecting data into a sea of conjecture, please look at the following 2 spreadsheets from the OECD. The US spends by far the most of the developed countries and has the lowest life expectancy.

Spending

Life expectancy

Every one of the other developed countries has universal care. Every single one has better health outcomes while spending far far less.

I happen to agree that any universal care will be somewhat corrupt and less than completely efficient. But every single other developed country in the world seems to be able to make it work. I seriously doubt that the politicians in France or wherever are less corrupt than their Congressional brethren. Even with the graft and pork barrelling that must occur in those places, they still spend less and get better health outcomes.

I also struggle to understand why big (non-health care) business in the US wouldn't want to pass the cost/responsibility of keeeping its employees healthy on to the government, especially when it's demonstrably cheaper for them to do so.

 

[Nords]

At the risk of injecting data into a sea of conjecture, please look at the following 2 spreadsheets from the OECD. The US spends by far the most of the developed countries and has the lowest life expectancy.

You seem to be implying a causality rather than just a collection of facts.  Is it possible that those lower life expectancies are somehow more closely related to overweight, overwork, and cigarette smoking?

Could it be that the U.S. tackles "hopeless cases" and spends bazillions of dollars making doctors feel that they've tried everything to shield themselves from malpractice lawsuits making families feel better about doing what they think is right, whether or not there's a DNR order to merely delay the inevitable by a month or two?

I think that if any of the 180+ other countries in the world were doing it both cheaper AND better, not necessarily just one or the other, that their method would have been shamelessly copied by now.

It reminds me of a short story about a guy who couldn't afford healthcare premiums.  He finally found affordable "almost too good to be true" health insurance with a company that made him sign away just about every legal right he possessed (which itself is illegal but hey, this is a story).  The first thing the company did was tell him to quit smoking.  When they detected his cheating, they kidnapped his youngest kid and scared the heck out of everyone before returning the child unharmed.  Suddenly quitting cold turkey was a lot easier!

The following quarter, when the smoking habit had been declared kicked, they noted that his extra weight was putting him at risk.  So, they assigned him a weight-loss goal along with a diet & exercise program.

The story ended before they started working on his stress levels, but I'm sure we could all write our own endings...

 

[wabmester]

Is it possible that those lower life expectancies are somehow more closely related to overweight, overwork, and cigarette smoking?

Nooo!   You can't blame the victims.   We deserve to be fat stressed smokers.  And I want my MRI-TV! 

We already tax workers and smokers.   I think it's time for a fat tax!

 

[dylar]

I don't think that there is a correlation between spending less and better health outcomes. I think it shows that it is possible to have a universal care system and still spend less on health care than we do now.

Are overweight, stress and cigarette smoking not subjects dealt with by health care systems? I agree that we do a poor job of controlling these.

I think that if any of the 180+ other countries in the world were doing it both cheaper AND better, not necessarily just one or the other, that their method would have been shamelessly copied by now.

Uh...they all are copying each other. We are the lone developed country without universal care. Each attempt at doing the shameless copying has been beaten back by the pharmaceutical and insurance industries because they would prefer to profit from the system we have now rather than see people's health improve. There's nothing all that wrong with their positions, they are after all set up to make money. I would just prefer that we decide as a society that people's health is more important than corporate profits.

It reminds me of a short story...

I would guess that the poorer you are, the less access to health care you have, the more likely you are to smoke and be obese. I'm not sure how that argues against universal care.

 

[lets-retire]

http://early-retirement.org/forums/index.php?topic=8507.0

Here is a link to a study that shows life expectancy and the amount spent on health care. There is no corallation between the two. That leaves other life issues (smoking, stress, good genes, etc.) on the table for an explanation as to a long life.

 

[Nords]

Each attempt at doing the shameless copying has been beaten back by the pharmaceutical and insurance industries because they would prefer to profit from the system we have now rather than see people's health improve. There's nothing all that wrong with their positions, they are after all set up to make money. I would just prefer that we decide as a society that people's health is more important than corporate profits.

Ah, I see, I neglected the conspiracy aspect...

 

[dylar]

Again, I fail to see how an argument that Americans are sicker (obese, stressed, smokers) than people in other countries is an argument that supports the health care system in this country.

Ah, I see, I neglected the conspiracy aspect...

I don't think it's controversial to say that insurance and pharmaceutical companies oppose universal care. I think that their opposition to Clinton's plan back in '92 is pretty well documented. There's no tinfoil hat on my head. If you have information to the contrary, I'd love to hear it. Where do you think the additional $2500 a head we spend on health care goes?

 

[mark500]

"70% of all medical care costs are administered in the last year of a patients life."

Tell us which patients are going to die within one year and we can stop spending so much money on them.

If you want national health care, you will have to give up your right to sue.

 

[lets-retire]

Again, I fail to see how an argument that Americans are sicker (obese, stressed, smokers) than people in other countries is an argument that supports the health care system in this country.

The only thing that must be proved is that there is a better and cheaper system out there that can be successfully implemented here.  It doesn't make sense to spend billions of dollars to change the system to if it only marginally reduces costs or increases health.  The track record with the government is overspending.  So in the planing stages the program would have to show significant decreases in cost.  The only way to show these decreases is to cut service.  The argument is whether to change the system or not.  I do not have to prove that the system in place is better than anything.  You must prove the system to be implemented is better than the one we currently have. (You and I are illustrative only, not to be taken literally)  If you do not prove your system is better then we would be changing for the sake of changing, which results in wasting billions of dollars.

The link I posted clearly shows that there is no correlation between life expectancy and the amount spent on health care.  So we are left the with life choices and genes as the causes for our collectively early demise.

 

[MasterBlaster]

"70% of all medical care costs are administered in the last year of a patients life."

Therefore, I conclude, that there is an inverse relationship between health care spending and lifespan.

Spend less, live more (a healthcare novel by ESR Bob)

 

[dylar]

The only thing that must be proved is that there is a better and cheaper system out there that can be successfully implemented here.

Based on the experience of every other developed country, it is possible to have a health care system which insures everyone at roughly half the cost of our system. This can be seen from the graph you linked to.

I agree that getting the government involved will introduce inefficiencies. I tend to think that politics works the same everywhere. I doubt the legislators in Denmark or the UK or France or whereever are any less prone to porkbarrelling and graft than we are here. Yet they still are able to have a system which insures everyone at roughly half the cost of ours.

 

[lets-retire]

Yup you can get it cheaper, but you have to wait for it.  I don't want to wait for my health care.  In my case waiting is not better.

 

[Rich_by_the_Bay]

Tell us which patients are going to die within one year and we can stop spending so much money on them.

Uh.. OK.

Maybe the 78 year old man with melanoma who just has a brain metastasis removed and is on a ventilator, and who has coronary disease with one heart attack already. Too weak to start chemo which might extend his live for a few months. The hospital was full that week, with no ventilator beds. I had to transfer a young woman with a pulmonary embolism to another hospital. Very distressing and expensive for her, too.

How about the stroke patient who is 85, hemiplegic and can't talk. Saw him a few weeks ago. He was admitted to have a colonoscopy for bleeding, but developed an arrhythmia during the procedure. His blood pressure dropped and he coded. They intubated him, but after the confusion settled down it became apparent that he has had years of emphysema and could barely breathe beforehand. Now we can't get him off the ventilator.

I've got more. I don't have the answers, but I believe the facts are accurate. Every life is important, but with non-infinite resources, society has to make choices. With or without government sponsored health care.

The point is that while no one has a crystal ball, it is a fact that end-of-life care is inordinately expensive and has diminishing returns in terms of meaningful quality and length of life.

If you want national health care, you will have to give up your right to sue.

Huh? You can't sue the government?! This kind of irresponsible statement does little to strengthen otherwise sincere concerns about universal health care. I'd kick it up a notch if you intend to persuade people around here.

There are two sides, of course, but until you have experienced the chaos in the status quo, it's hard to imagine things getting worse. The nightmare has already arrived, kids.