Socialized Medicine

[FIRE'd@51]

While I might be able to say I am reasonably happy with my *current* health care alternatives, I must admit I am very afraid of what *could* happen. If my company dropped my retiree insurance, what would I do? It could be tough for some of us to get affordable coverage, depending upon pre-existing conditions.

As you should be. And it's not just limited to company retiree insurance. I had private insurance with a major company, who decided to exit the individual insurance business and canceled all its existing policies. Since I had developed some "pre-exisitng" conditions I could only get a last resort BC/BS guaranteed-issue policy, which more than doubled my premium. IMO, this is the sort of thing that shouldn't happen.

 

[ziggy29]

Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.

Me too, personally; I believe most of us who are gainfully employed (or retired) with subsidized health insurance provided for us would agree. While that is still the rather large majority of the people, the degree to which the system is broken for those who do NOT have good, heavily employer-subsidized (or government-subsidized) health insurance is becoming an increasingly intolerable situation, and one I personally hope we can find a way to address with a radical overhaul or complete socialization of the health care system. I'm not extremely optimistic that can happen, because I don't know how the greatest obstacle -- reasonably affordable coverage for all without preexisting condition exclusions -- can be overcome without a "universal mandate" for coverage.

I have good coverage now. But I'm just one chronic condition or one job loss away from having all of that come crashing down. And so are untold millions of other people, especially when finding a new job -- particularly one with decent medical benefits -- is as difficult as it is today.

 

[ziggy29]

Camp #1 (and yes this is where I am)... beleives that a vast majority of people CAN in fact find ways of taking care of themselves, but there are also a lot of lazy people out there. If a lot of the social benefits provided by the govt were suddenly removed, people would not just wonder about aimlessly, but would in fact find ways of earning what they need to survive, and this includes heathcare. People in this group believe that by and large people will rise to the challenge presented to them.

The classic balancing act of a compassionate society, I think, is trying to balance the desire to have a social safety net for those who truly can't help themselves with the desire to not see it become overused and abused by those who can. And if the only issue is temporary tough times, those who make use of the safety net need to be encouraged to bust their tail to get off of it as soon as possible.

In other words, the safety net should be a trampoline you can bounce back from -- and not like a hammock you just comfortably lay in.

 

[FIRE'd@51]

At least Medicare covers everything, however inadequately.

IMO, the Medicare model is a good one, at least parts A & B. The supplemental policies, while a big improvement over individual insurance available to those under 65, still have elements of adverse selection due to multiple risk pools. As I understand it, switching supplemental carriers often requires underwriting after the first six months of eligibility (age 65.5 for most people), but at least you have a window of guaranteed-issue opportunity at no additional premium cost when you first join.

 

[Rustic23]

Ok, how about this.

Individual/family is responsible for all medical expenses up to $5k after that a Gov policy takes over and pays the remaining expenses. You could have it reset each year or continue paying for service if it is for the same disease.

Individual either pays the first 5K or gets insurance to supplement. Insurance co must take all. The insurance co would know that in any given year they would only be responsible for 5k and set policy accordingly.

The poor are still taken care of by Medicaid, and the old by Medicare, however, even Medicare could be made to conform.

The numbers may not be right, but the idea of the Gov taking care of catastrophic expense and individuals the day to day stuff makes since to me.

 

[ERD50]

Rustic23 - the only problem I see with the $5K deductible is that it would not promote preventive maintenance. I suspect many of the poorer people would still end up in the ER after letting a problem get worse.

IIRC, WalMart instituted some donut-hole policies? They cover something like $1,000 a year, so you get your checkups and small stuff, but then you are on your own until you hit a "catastrophe" number (might have been $5K). I think that could work.


-ERD50

 

[prubin]

As far as "national health care" or "universal health care" or whatever you want to call it goes, I would reserve judgment until I saw the specifics. But I do have to say that using Keith Olbermann to defend one's position is about as meaningless as having Rush Limbaugh do it.

Did you click the link I provided? Yes Olbernam's name is in the headline of the citation, however, the article goes on to provide input from: CNN senior medical correspondent Elizabeth Cohen & James Fallows, Atlantic Monthly.

I am currently covered by Kaiser. I value the fact that Kaiser uses technology ( an electronically based record keeping system) to improve the quality of care I receive. I value the fact that every practitioner I see, at Kaiser, has immediate and accurate access to all of the care I have received. I receive, via email, summaries of doctors visits and lab results and the web based appointment scheduling system saves me and Kaiser time. Prior to being covered by Kaiser my PPO coverage was punctuated by vague assurances that my lab tests were OK, questions about medications I was taking from the practitioner who may have prescribed them, and interminable hold time while making appointments.

Closing the loop Olberman had the intellect to graduate from a 1st class university, Cornell, Limbaugh dropped out of Southeast Missouri State University.

 

[Martha]

Here is what worries me, and maybe others on the board. I am happy with my health care alternatives. I always have been.

Now we are about to embark on a change that will effect my health care. That worries me. While I have not facts or figures to back this up, I'll bet a significant number of the people in this country are OK with their health care. There are about 300m people in the U.S. A figure for the un-insured battered around is 40m, however, this figure would be trimmed when Medicaid is taken into consideration. At any rate, that leaves 260m with some kind of health care. I think we should be very cautious when we change the health care for 260m to accommodate the care of 40m.

Now, before the rhetoric gets out of hand, I'll concede that 260m happy customers is high, but the situation is not reversed! There are not 40M happy customers out there and 260M people fearful they will not get health care. I believe there are between 30m and 40m on medicare alone.

The 45 million uninsured do not include those on medicaid or other government programs.

 

[Martha]

I read a lot about most of these arguments, both for and against. I think a lot of it, as most things do... sort themselves into two camps of thinking.

Camp #1 (and yes this is where I am)... beleives that a vast majority of people CAN in fact find ways of taking care of themselves, but there are also a lot of lazy people out there. If a lot of the social benefits provided by the govt were suddenly removed, people would not just wonder about aimlessly, but would in fact find ways of earning what they need to survive, and this includes heathcare. People in this group believe that by and large people will rise to the challenge presented to them.

Camp#2 believes that most people are incapable of caring for themselves. That if govt social programs were removed, people would litterally die on the streets. People in this camp feel it is the moral responsibility of all those who ARE capable and responsible to take care of all those who are less so. This group tends to believe that those with more "owe" what they have to those with less.

I think that you are exaggerating the camps way too much.

Story time. I know a secretary that had cancer, she was in her 50s. She was eligible for SSD but there is a two year waiting period before Medicare eligibility from the date of disability. She had a house so wasn't eligible for medicaid. SSD payments were not enough for her to pay her COBRA and live on. She ended up working longer than she should and dying not that long after she left work.

I know another secretary that had an unusual illness that caused her tremendous headache pain all the time. She had to leave work. She managed to pay COBRA from short term disability payments. She went through her savings, waiting for social security disability. She was in her 20s. She died not long ago after 10 years of terrible pain, even with narcotics.

Busted. And they both had health insurance. They both were taking care of themselves and were competent people. Bad things happen to competent people too.

 

[Rustic23]

Martha,
Your examples are, IMHO, part of the problem. We all 'know someone who fill in the blanks.'

So lets say with the 46M there are another 10M stories. That is still 230M people that will undergo a change they may not want or like for the 70M. And, as we have discussed before, your 46M includes people that do not insure by choice, illegal aliens, and others.

As with the stimulus package, the only ones that are going to come out on top are the politicians. Those of us that pay the bill will pay more.

 

[Rich_by_the_Bay]

Your examples are, IMHO, part of the problem. We all 'know someone who fill in the blanks.'

Rustic, Martha's stories are anecdotal and represent something that is difficult or impossible to quantify. Absent statistics, I can verify that such stories are brought to my attention regularly. I work in a tertiary cancer referral center so probably see the worst end of the spectrum.

Hard for me to fathom how such reports are "part of the problem." My experience suggests rather that such events are the problem, at least part of it. There are just system problems that need to be fixed, like a malfunctioning system in the space shuttle or something.

Many people have no idea how little stands between them and financial disaster if they happen to get sick under the wrong circumstances. Seems to me we'll all benefit from a more reliable, durable system of payment. Republican, democratic, liberal or conservative -- could care less. Let's just get this buggy fixed: universal access for all citizens with reasonable basic coverage mandated, no cherry picking, subsidies for the legitimately poor or disabled, and fair pricing for the rest of us. That would be a good start.

 

[ziggy29]

Let's just get this buggy fixed: universal access for all citizens with reasonable basic coverage mandated, no cherry picking, subsidies for the legitimately poor or disabled, and fair pricing for the rest of us. That would be a good start.

When you say "disabled" here, I'm assuming you mean those of modest means who can't reasonably be expected to find a job capable of paying the full cost of coverage. "Disabled" isn't always poor just as "fixed income" in reference to the elderly doesn't always mean a LOW income. Someone can have a non-COLA'd pension or non-inflation adjusted annuity of $100,000 a year and be on "fixed income."

With that clarification, I pretty much agree.

 

[haha]

Rustic, Martha's stories are anecdotal and represent something that is difficult or impossible to quantify. Absent statistics, I can verify that such stories are brought to my attention regularly. I work in a tertiary cancer referral center so probably see the worst end of the spectrum.

Hard for me to fathom how such reports are "part of the problem." My experience suggests rather that such events are the problem, at least part of it. There are just system problems that need to be fixed, like a malfunctioning system in the space shuttle or something.

Many people have no idea how little stands between them and financial disaster if they happen to get sick under the wrong circumstances. Seems to me we'll all benefit from a more reliable, durable system of payment. Republican, democratic, liberal or conservative -- could care less. Let's just get this buggy fixed: universal access for all citizens with reasonable basic coverage mandated, no cherry picking, subsidies for the legitimately poor or disabled, and fair pricing for the rest of us. That would be a good start.

This has to be true. The difficulty is that those of us with decent coverage know all the possibilities for mischief once the US Congress gets down to doing their reliably dirty job, rewarding their buddies, trying to give life to their fantasies, etc.

Very rich people and people who have a personal need or family need for better coverage are the natural constituency for change, The rest of us are understandably wary.

Ha

 

[Rustic23]

Rich,
The reason I say it is part of the problem is it pulls on the heart strings but does not represent the majority of the population. It is like the stimulus bill. You would think there was not a person in the U.S. that had a job, or were not about to loose their job. Lots of people paraded before the press with their hard luck stories to convince us Congress just has to spend 800B they don't have. However, at the same time, we hear that the economy will recover weather they spend or not.

I do not question you see these cases. I do not question that medical expenses can ruin an early retirement. However, IMO, Congress could have taken the 800B they just spent and provided for all these cases forever and all the others that will pop up. I promise you a Health Care Reform bill will be just as full of PORK as the bill they just passed, and within the first 5 years the horror stories, will still be out there.

I have no faith in the Federal Government's ability to solve this problem without wrecking the health care for the rest of us. I've said it before 'Be careful what you wish for'. I also believe the Doctors may end up carrying the brunt of the cost.

 

[Rich_by_the_Bay]

The reason I say it is part of the problem is it pulls on the heart strings but does not represent the majority of the population. It is like the stimulus bill. You would think there was not a person in the U.S. that had a job, or were not about to loose their job....
I have no faith in the Federal Government's ability to solve this problem without wrecking the health care for the rest of us. I've said it before 'Be careful what you wish for'. I also believe the Doctors may end up carrying the brunt of the cost.

Yes, points taken. No doubt that the gut-wrenching stories can be misused to curry sympathy, and are sometimes inaccurate. But 40mm people underinsured and lots more on their way, while it may not be the majority of the population, is waaay too high and even the best of us can too easily enter those ranks.

BTW, some would argue that doctors already are carrying a large part of this burden in the way of uncollected bills and underpayment by MC and Medicaid. Partly true, but fortunately the incomes are already high enough that no one is feeling sorry for us , nor should they. Yet.

I share your concerns about the competency of a federal level program of any sort, but if MC is an example, mechanically, it sort of works -- the fees, rules, etc. are crazy but the checks get cut, and mistakes get detected most of the time. The competency of the private carriers is often worse -- usually regarding the part where they [-]kite[/-] cut the checks.

Complicated.

 

[ziggy29]

The reason I say it is part of the problem is it pulls on the heart strings but does not represent the majority of the population. It is like the stimulus bill. You would think there was not a person in the U.S. that had a job, or were not about to loose their job. Lots of people paraded before the press with their hard luck stories to convince us Congress just has to spend 800B they don't have. However, at the same time, we hear that the economy will recover weather they spend or not.

I certainly share your disdain for political hacks exploiting the pull-at-the-heartstrings cases where people through no fault of their own suddenly got horribly screwed by the system. I think these cases are quite rare as a percentage of the population, but they do happen and I'd like to see us be able to address those situations without watching baby go out with the bathwater. No one who works hard, prepared reasonably and had two or three bad things happen at once deserves to choose between treatment and bankruptcy. At the same time, it should take more than that to drive a complete overhaul of how health care is funded and delivered.

I do not question you see these cases. I do not question that medical expenses can ruin an early retirement. However, IMO, Congress could have taken the 800B they just spent and provided for all these cases forever and all the others that will pop up. I promise you a Health Care Reform bill will be just as full of PORK as the bill they just passed, and within the first 5 years the horror stories, will still be out there.

True to a point. I don't buy all the hype that this will save jobs and create 2-3 million jobs, but if all you do is give everyone health care, in the longer term you could see a public come to the conclusion that you don't NEED to work if Uncle Sugar is giving away health care to those of lesser means. Providing health care to all without a requirement for cost sharing or working (for those of sound mind and body) would be a recipe for disaster.

I have no faith in the Federal Government's ability to solve this problem without wrecking the health care for the rest of us. I've said it before 'Be careful what you wish for'. I also believe the Doctors may end up carrying the brunt of the cost.

That last sentence is possible, especially if the universal coverage takes the "Medicare for All" form as pushed by Dennis Kucinich in HR 676. A growing number of doctors won't even take Medicare because of the pathetic reimbursement rates, and that would ultimately mean that either (a) there will be fewer and fewer doctors willing to work with patients under HR 676 or (b) doctors will be *forced* to accept HR 676 patients, meaning they suck it up and take a big pay cut or retire.

The bottom line is that this isn't an easy nut to crack. But I don't think that's an excuse to not deal with the things that are blatantly and glaringly wrong, and start there.

 

[Rustic23]

First off, again, I do not believe the health care system is blatantly and glaringly wrong.

Second. Why stop with health care. There are blatant and glaringly wrong stories about how people get food, jobs, transportation, housing, clothing, you name it. There are people in our society that don't have what you and I have. Where does it end? What will be the next Government give away? IMO, it is not governments responsibility to provide it!

 

[Martha]

Rich,
The reason I say it is part of the problem is it pulls on the heart strings but does not represent the majority of the population. It is like the stimulus bill. You would think there was not a person in the U.S. that had a job, or were not about to loose their job. Lots of people paraded before the press with their hard luck stories to convince us Congress just has to spend 800B they don't have. However, at the same time, we hear that the economy will recover weather they spend or not.

I do not question you see these cases. I do not question that medical expenses can ruin an early retirement. However, IMO, Congress could have taken the 800B they just spent and provided for all these cases forever and all the others that will pop up. I promise you a Health Care Reform bill will be just as full of PORK as the bill they just passed, and within the first 5 years the horror stories, will still be out there.

I have no faith in the Federal Government's ability to solve this problem without wrecking the health care for the rest of us. I've said it before 'Be careful what you wish for'. I also believe the Doctors may end up carrying the brunt of the cost.

I have a lot of uninsured stories, but I told those two because both had insurance, lost it through no fault of their own, and their healthcare broke the bank.

I understand being concerned about what might be done, but we still need to do something to make things better. As it is we as a nation spend too much for what we as a nation are getting. We need to hear the stories to know the problems. It hasn't been getting better, it is getting worse, with more and more small employers dropping insurance coverage as it becomes unaffordable.

I do not buy the slippery slope argument that insuring health care for all is a step away from socialism. We provide education. We provide infrastructure. I think that providing health care separate and apart from employment will help us be more competitive. There are few countries any more that don't have a form of universal coverage.

 

[haha]

I have a lot of uninsured stories, but I told those two because both had insurance, lost it through no fault of their own, and their healthcare broke the bank.

I understand being concerned about what might be done, but we still need to do something to make things better. As it is we as a nation spend too much for what we as a nation are getting. We need to hear the stories to know the problems. It hasn't been getting better, it is getting worse, with more and more small employers dropping insurance coverage as it becomes unaffordable.

To the degree that voters will have anything to say about this issue, the stories will count far more than statistics. What sunk Hillary Care was not any studies or projections, but Harry and Louise. (And of course the usual lobbyists.)

My guess is that there will be legislation on this issue within Barack's first half term. The Republicans have been so discredited that I don't believe any anti-health care reform ad campaign could sink it, no matter how cleverly mendacious the ads might be.

Ha

 

[samclem]

I understand being concerned about what might be done, but we still need to do something to make things better.

With the first bailout ("The Emergency Economic Stabilization Act of 2008") we had to quickly "do something" so we dumped $350 billion so far (another $350 billion already in the dump trucks) and nobody knows what was accomplished or how we could even measure what was accomplished. Last week Congress voted $787 billion more, but there's not a single legislator who claims to have even read the whole thing--there's no time to even post it on the internet--it must be voted on and signed into place immediately because we must "do something." Hopefully, whatever we spend on this future re-wickering of health care will involve a more deliberate plan than we've seen to date. Maybe some debate, maybe some time for public comment--that "openness and transparency" that were supposed to be the hallmarks of change we can believe in. That has been a belly laugh. In addition to the latest outrages, it sure didn't happen the last time an administration dreamed up a healthcare revamp, and the indications to date are that the new mantra of "just do something" is intended allow opaque expediency to replace open deliberate action. I know that's not your intent, but I hope we're about done with "doing things" without a plan.

As it is we as a nation spend too much for what we as a nation are getting.

That's probably true. But, we are individuals, and we don't spend money on health care or receive our health care "as a nation." We get it as individuals. And those who have good health care (because they provided for themselves, or because they negotiated to get it as part of their employment (the dumb way Washington designed the system to work)) may be forgiven for being less than confident that this restructure won't leave them worse off. There are many equities at stake here, and the providers of health coverage will look to do all they can to reduce their expenses if given legal cover by Washington. Who, exactly, will be looking out for the interests of those who now have coverage, particularly if that coverage exceeds whatever new "good enough" standards are enacted? Trick question: When is a contract not a contract? When Uncle Sam says one side can walk away from it.

I think that providing health care separate and apart from employment will help us be more competitive.

I agree that separating health care from employment will make our industries (and our workforce) more productive.

 

[Rustic23]

I do not buy the slippery slope argument that insuring health care for all is a step away from socialism. We provide education. We provide infrastructure. I think that providing health care separate and apart from employment will help us be more competitive. There are few countries any more that don't have a form of universal coverage.

I remember when, so it can't be that long ago, that similar arguments were used to provide lunch for school kids that could not afford it. Now the majority of students in the Houston Independent School District get free or discounted lunch and breakfast.

It is a slippery slope and the fact we are even considering it means we have already traveled down that slope. You and I disagree on this issue, and that's OK. But to say it is not pushing the country further towards socialism is wrong. It is, and that is why many of us are against it.

 

[Martha]

With the first bailout ("The Emergency Economic Stabilization Act of 2008") we had to quickly "do something" so we dumped $350 billion so far (another $350 billion already in the dump trucks) and nobody knows what was accomplished or how we could even measure what was accomplished. Last week Congress voted $787 billion more, but there's not a single legislator who claims to have even read the whole thing--there's no time to even post it on the internet--it must be voted on and signed into place immediately because we must "do something." Hopefully, whatever we spend on this future re-wickering of health care will involve a more deliberate plan than we've seen to date. Maybe some debate, maybe some time for public comment--that "openness and transparency" that were supposed to be the hallmarks of change we can believe in.

Given that government has worked on this issue off and on for years, I think legislators are much better informed than they are on the economic stimulus stuff. Several proposals were worked on extensive several years ago, during the Bush administration, so there are a number of legislators who are knowledgeable. My worry isnt that something will get rammed through, but that it all will get caught up in details and the desire to please various lobbies that we have a convoluted mess. That is what in large part killed Hillary's bill. Or, that more patchwork will be done which will do little to address the cost issues, especially administration costs. As the children's book says, please all please none.

 

[Independent]

Ok, how about this.

Individual/family is responsible for all medical expenses up to $5k after that a Gov policy takes over and pays the remaining expenses. You could have it reset each year or continue paying for service if it is for the same disease.

Individual either pays the first 5K or gets insurance to supplement. Insurance co must take all. The insurance co would know that in any given year they would only be responsible for 5k and set policy accordingly.

The poor are still taken care of by Medicaid, and the old by Medicare, however, even Medicare could be made to conform.

The numbers may not be right, but the idea of the Gov taking care of catastrophic expense and individuals the day to day stuff makes since to me.

I think you are on the right track. I'll adjust the details:

1) We replace Medicare and much of Medicaid with universal catastrophic health insurance.
2) The format looks like Medicare - private hospitals/doctors paid by tax dollars.
3) Initially, a "catastrophe" is defined as spending more than 15% of your gross income on health care.
4) The plan is funded by a single, visible, flat tax on all income.
5) Once a year, the voters adjust the tax up or down, and Congress adjusts the deductible/benefits to match the tax dollars.
6) You can cover the first 15% however you want - direct pay, individual insurance, group insurance. But, no gov't subsidies.

Note that this plan covers everyone (if you have no income, then you have no deductible). But, the annual vote avoids run-away costs by keeping the price in front of all of us.

I'd like to believe that free markets can solve everything. But, there are a number of problems with that attitude and health care. One that I can't get around is that people develop conditions that dramatically impact the likely cost of future health care. I don't see a way of dealing with that without some sort of gov't mandate.

 

[samclem]

I think you are on the right track. I'll adjust the details:

1) We replace Medicare and much of Medicaid with universal catastrophic health insurance.
2) The format looks like Medicare - private hospitals/doctors paid by tax dollars.
3) Initially, a "catastrophe" is defined as spending more than 15% of your gross income on health care.
4) The plan is funded by a single, visible, flat tax on all income.
5) Once a year, the voters adjust the tax up or down, and Congress adjusts the deductible/benefits to match the tax dollars.
6) You can cover the first 15% however you want - direct pay, individual insurance, group insurance. But, no gov't subsidies.

Note that this plan covers everyone (if you have no income, then you have no deductible). But, the annual vote avoids run-away costs by keeping the price in front of all of us.

I'd like to believe that free markets can solve everything. But, there are a number of problems with that attitude and health care. One that I can't get around is that people develop conditions that dramatically impact the likely cost of future health care. I don't see a way of dealing with that without some sort of gov't mandate.

Is private care outside the system allowed? I'd want to be free to buy care, and to buy insurance that covers care that the government won't pay for. When I'm 70 and need my knees replaced, I don't want to have to settle for the govt issued "suitable substitute" roller dolly and knuckle pads.

 

[Independent]

Since I'm making the proposal, the answer is "yes". I'd like to believe that the voters who have to make a decision on taxes every year would think it's a fine idea for some people to pick up some of their own costs.

Whether or not the gov't pays for knee replacement or roller dollies will eventually depend on the trade-offs the voters are willing to make.