Americans want universal health coverage

[d]

If the US ends up with a healthcare system like England, I will **** my self

you won't have to, the system will take care of that. 

 

[Craig]

I was with the left in believing that we were better off ditching the insurance model and going for a  single payor system. 

I find this a very serious debate and not the least bit useless.

Appears there are a few coming at this from stage left ... it is a tiresome debate because of the ample evidence that government programs generally fail, especially from a service standpoint.  Employer-provided group health plans are a poor arrangement as well, ironically fostered by flawed government policy in the late 40's, when employers were limited on their private compensation policy. 

For another perspective on plans that really would work better, consider studies at http://www.cato.org/healthcare/index.html

Not clear what your real-world experience in this area has been but, reimbursement levels aside, Medicare reimburses more efficiently than many private carriers.

I'll clear it up ... I've been on the payer side for 30 years in financial management, with 20 years as a CFO.  Analyzed and managed the installation of many plans in that time, for companies up to $1.4B in size.

We've not had a truly private system in all that time ... all group health plans, insurance companies and employers are hobbled by various regulations and tax law.  Interesting that as a physician some of your first comments in response are to recap the reimbursement policies.

The challenge for most of us is quality and cost.  Again, fairly review the reports coming out of Great Britain and Canada, to name two.  I don't hear a lot of good reports on quality from those countries, or timeliness of care.

We went very wrong when employers and insurance companies became the customers for health care ... when patients are truly the customers, seeing and paying the tab, the normal market forces can begin to work. 

Frankly, there are too many participants in the current system that prefer the lucrative situation that results from insulating the system against market forces.  To the extent anyone has tried to introduce market-based reform, the left has often successfully hobbled those efforts, and made it difficult or impossible for them to bear fruit.  Health care providers (like teachers ...) are loathe to embrace a system where their efficiency and quality are rated and broadly publicized.  And now those approaching retirement are tempted to take the AARP approach of taxing everyone to cover their health care downside.

Ironically, our current group health consultant tells me that HSA's are now starting to really blossom.  Perhaps there is some hope after all.

I'm surprised that so many successful investors on this forum, taking personal responsibility for their futures, would hold the notion that government health care is a great idea.

Take care.

 

 

[Cool Dood]

Now come on, when did I say these were the facts. I have many, many examples. I will give you one. I know a person who has a house bought for $75,000, with a small down payment saved that took her years to save. She earns $20,000 a year. She has two children. Divorced. She has insurance through work. Despite the low income, she even puts a little money away in her 401k. If she lost her job because of illness, she would be SOL. But at least her employer has insurance. Many small employers are dropping insurance.

Non of my stories involve people with nice houses and nice cars that chose not to get insurance. All my stories involve people who don't make much money, but still try to save. Many have health problems so they would not be able to get affordable insurance except through work. What I am saying is that you get sick enough, you can't work. Tying health insurance to jobs is a problem.

Help out with friends and relatives? Gee, why am I still working part time? I help out all the time. I walk the walk. Do you?

Martha,

• The plural of anecdote is not data. I can also tell you sad personal stories, like about a friend who had an aneurysm and went in for surgery, but was put on the government waiting list and by the time her turn came up, her condition had worsened, the surgery required was far more risky, and she died. No story, however sad, is going to provide the answer to the difficult question of health care.
• Tying health insurance to jobs may indeed be a major problem. I was discussing the theoretical issues of health care and not the U.S. system, which I don't think I'd particularly care to defend.
• The way you describe your friends, it sounds like they couldn't afford health care and therefore, according to what I was saying, should receive it from the government -- since they weren't among those with fancy houses and all that who go without insurance. Again, I'm sure it doesn't work that way for real in the U.S., but I wouldn't want to find myself in the thankless position of defending the current U.S. health care setup.
• Yes, I do walk the walk. I'm not exactly getting rich working for a non-profit, and I volunteer and donate quite a bit.
• I went out drinking tonight, so this post is probably kind of incoherent. Also, that's why it's in bullet form -- easier to concentrate on.

 

[ladelfina]

Re: "Hillary care"

To make the plan palatable to some on the right, it mandated employer provided health insurance through regulated HMOs.

Well this made me laugh, because it's egg-ZACTly the new plan in MA which Republican governor Mitt Romney "came up with"! ...and he has an extremely pro-business background and mindset. But just put the name "Hillary" in front of anything, even anti-flag-burning, and it's instantly a non-starter.  If she's for it, they're against it.

OAP, as far as appointments are concerned, when I was paying $700+ a month to an HMO, I would usually get appointments for 4-6 weeks out. Now I can just walk down the street and drop in.

Both systems have horror stories; both systems have bureaucracy. But I'm not sure how the arrogant, punitive attitude that some posters have evidenced is going to resolve anything. Government deals with a lot of communal services that benefit everyone. Are the anti-single-payer folks also hankering for every road to be toll road? No public schooling ("I don't have kids, so why should I pay?") Police and fire assistance only if you can pay cash? ("Hey, I'M careful.. MY house isn't gonna burn down. Why should I pay for firefighters that are gonna save someone ELSE's house?"). Give me a break!

As Rich pointed out, there is a huge $ cost AND a huge social and psychological cost in the precarious system the US has now. The US is the ONLY developed country w/o a universal health care system.. but that's because everyone else in the world is "otherwise intelligent" (i.e., stupid)?  Razztazz, you are right on re. the American attitude. If it's NIH they don't wanna know about it.

Poboy, I'm glad you were able to work hard and reach your "goal" of being able to pay for health insurance. But it just doesn't sound to me like something only a few should be able to attain. You make it sound like a hard-won prize (which indeed it is) but I find something intrinsically disturbing in that being the "normal" American situation.

 

[Martha]

Astro's idea has already been addressed but was suspisciously swetp under the rug. In about teh late 1990's there was a" medical care reform" type group headed by a doctor. The upshot of this program was have teh Gov cover all claims over (I belive it was 30,000 dollars at the time, and simply getting the insurance companeis off the hook for the huge "Sunday punch" type of claims would immediately make insurance for almost everybody affordable. They even had a funding mechanism that did not include some huge income tax increase or the usual suspects. The inicdents of that type of claim was well under 1%

Sorry I no longer have that link, but that was the gist of it
'

That was Kerry's proposal.

 

[Martha]

We've not had a truly private system in all that time ... all group health plans, insurance companies and employers are hobbled by various regulations and tax law. Interesting that as a physician some of your first comments in response are to recap the reimbursement policies.

I am not someone who buys the idea that the market takes care of everything. Instead, if insurance companies are allowed to operate free of regulation they insure healthy people. It is simple, they only make money if they don't have to pay out more than they bring in.

 

[Rich_by_the_Bay]

I am not someone who buys the idea that the market takes care of everything. Instead, if insurance companies are allowed to operate free of regulation they insure healthy people. It is simple, they only make money if they don't have to pay out more than they bring in.

I agree with Martha. There are some national or universal needs which are financially unattractive to the private sector, but which are vital to the national interest. These are services we deserve for our hard-earned taxes, and will help keep us competitive in the global market. As to where the gov spends our tax money is a whole other priority issue but clearly health care is a strong candidate IMHO.

You can't leave national defense to Brinks, and most wouldn't want the interstate system run by Halliburton (though the toll booths would be efficient ). Similarly, I prefer not to have catastrophic health insurance left to BC/BS, United, Aetna, etc. The only way to make them profitable under the current system is to cherry pick, heel drag on payments, and delay or deny payment for legitimate services.

 

[bpp]

Japan has nationalized health care, and privatized highways -- opposite of the US. Both systems are expensive, though they generally do what they are supposed to do. Nothing to lie awake fretting about, anyway. A matter of what one is willing to pay for.

Bpp

 

[Craig]

Life insurance companies don't insure only people who do not die, auto insurance companies don't insure only good drivers ... not adopting univeral / government health care does not translate ipso facto into no health insurance.  Though market forces do obviously cause pain and pleasure as they operate ... if I choose to smoke, my life insurance, and health insurance premiums should reflect that fact.

Tying health insurance to employers makes as much sense as having my employer pay for my auto insurance, or home insurance.  And, if they did, my employer would dictate those plans, and I'd lose that coverage when I lost my job.  The historical basis for employer/union-provider health insurance goes all the way back to the 19th century, though it really took off after WWII, due to wage and price controls, and accomodative tax policy.  Lots of reasons for this situation, but lots of downside as well.

My guess is that most folks that want to adopt the government approach have never carefully considered a market-based solution, nor how the current, heavily-regulated environment cripples market forces.  Interesting that when a heavily regulated system fails, the proffered solution is usually more regulation ... if something fails, let's not call for more.

This is a complex subject, but it seems usually driven by the classic "whose ox is gored", not by prudent public policy. 

 

[razztazz]

Tying health insurance to employers makes as much sense as having my employer pay for my auto insurance, or home insurance.

yes, but it was very efficient for the employers when they dreamed up that system and stuck eveyvbody else with it. Cheaper than just paying peoiple (Market forces) Neat tax break from Gov (Anti market forces) Golden handcuffs for workers bees. REALLY anti free market-in-labor. Yes, a really great move at teh time but now that it'scostly even its creators are whining about it with a whiff of "Blame the stupid workers" thrown in.

And how many of those regulations that "hobble" insurance companies were pulle dout of a ahat fo that reaso.? They might "hobble" the insur companies but they are ther for a modicum of protection for the customers which market forces werent providing.

And as far as the MA plan being Hillart Care.. why not? Let it get tested at the State level. The problem with a massive sudden change at the top is you dont know if wont work till its too late. But this is not what was wrong with Hillary's pla anyway. They wnated to take over the whole medical profession and run medical schools and this "funding of health care access" thing was the public veneer.

And that CATO plan.. BS Only benefits teh Rich. Mor etax code manipulations. AND THIS from teh same g/d group that is always harranguing for a FLAT tax, NO tax or TAx code simplification. So they coem up with more obscuria to teh tax codes taht only heps people who dont need it and still doesnt solve the problem of access for all. You still have to work to get money. Well, the won't but they already know that . How can we fool 'em today?

 

[perinova]

Humm
I have read on this thread that a universal health system run by the governement or private-universal would be expensive.
As you can see on this link the opposite might be true. We pay a very hihg cost yes but for subpar results here.
http://dll.umaine.edu/ble/U.S. HCweb.pdf

At any rate even if the cost would be higher, what would you rather get at your grovery store: Nice green lettuce or rotten cheap one?

Another comment: The current system is nice up until someone in YOUR familly looses coverage and gets sick. Ignoring the fact that everyone neds healthcare sends us to a third world country status with no middle class.

 

[cute fuzzy bunny]

Savings in overhead and paperwork alone are supposedly going to pay for MA's proposed plan. I'm sure it wont quite work out that way, but anyone who has actually looked at the data will see that a whole lotta cost goes to paperwork, overhead, bureaucracy, ass covering, excessive insurance, and throwing money at the nearly dead trying to squeeze another day/week/month of unconscious life out of them.

Would certainly solve some problems to lay out a course of standard coverage free of the paperwork, remove some of the ass covering and insurance requirements, and anything you want over and above that (improvements in speed, quality or optional treatments) you're more than welcome to pay for out of your own pocket.

 

[d]

As you can see on this link the opposite might be true.

if we start looking at comparative health costs and performance, we might also note that the US is #1 in obesity rates, #1 in plastic surgeries performed, #1 in per capita teen pregnancy, and #2 in abortions performed (perhaps understandably losing-out to Russia for #1).

 

[Rich_by_the_Bay]

Last estimate in today's paper: 45 million Americans uninsured.

 

[Craig]

How many go untreated ...

 

[d]

45 million Americans uninsured

about 15% ... twice that number are obese ... don't know what either might mean

 

[Rich_by_the_Bay]

How many go untreated ...

Or get treated in an ER or clinic and just don't / can't pay the bill.

 

[cute fuzzy bunny]

Last estimate in today's paper: 45 million Americans uninsured.

And about as many more went through part of the year uninsured.

 

[ladelfina]

sheesh, Charles, we have been through this before on other threads.  The Merck Manual is a big-ass book. There are umpteen million things that can go wrong with the human body that you can't chalk up to smoking or eating too many Big Macs. Not counting major traumas like car accidents or being caught in a drive-by shooting. Health has much to do with LUCK, and little to do with CHOICE.

Maybe Rich can help us out here but I get the impression that health problems are maybe 10% "responsibility" and 90% "sh*t happens".

When people "don't pay the bill" you just end up paying for them anyway, in higher insurance rates, higher taxes, higher hospital bills, whatever... so why not make the system less adversarial and less expensive with less overhead?

I agree with Charles that the answer is not in added regulation of a market system. But I don't understand anyone who thinks a "market system" is appropriate when one is confronted with serious illness.. that if you can't come up with a few hundred thousand bucks to treat your brain tumor/ kidney failure/ kid's leukemia you should just shut up, crawl off and die somewhere.

For-profit hospitals and insurance companies don't need to just pay their employees and CEOs and cover their overhead, they also need to generate another 5-10-15% to keep shareholders happy. Keeping that money in the health-care system could theoretically save a lot of lives.

Charles, there's nothing that makes you squeamish about a "profit center" of people who are desperately ill and terrified? Where they're not well informed? Where they can't pick & choose, anyway ("out of network", few or no choice in plans you can access via employer)? When it's their life on the line? Providing health care is not a "normal" business and can't follow the "normal" business model that a shoe factory or a restaurant chain would. They can't have a sale on dialysis when they're underbooked, or offer 2-for-1 appendectomies...

 

[lets-retire]

There have been many posts since my last time on here so I'm only responding to a few. The medical costs will not go down, unless the quality of care goes down with it. Your talking about a government program. These always seem to be more expensive than initial esitmates and anybody who works with the government knows there is way too much paperwork. The shareholders would be out of the loop, but replaced with many layers of burocracy. Unless the doctors were not allowed to be sued the insurance costs wouldl still be the same. If they are not allowed to be sued then the quality of care will go down as the incompetant doctors are not forced out of the system. Additionally the system would be overloaded as the people who typically forego treatment for the most minor problemsm, normally treated with over-the-counter treatments, start going to the doctor because it's free or very cheap. I've seen military and thier family with volumes of medical records, basically because it was free so lets go to the doctor for the sniffles.

Total billed to the insurance for the diagnosis/removal/follow up treatment for a oligodendroglioma brain tumor in my area was about $75,000. Insurance paid a lot less than that. I question the hundreds of thousands of dollars for a brain tumor.

 

[Craig]

ladelfina, if you thought I was making some kind of case that health problems were mostly choice, you misunderstood my post.

My "How many go untreated ... " comment is to focus for a moment on the statistical lie of "XX% of Americans are uninsured" argument. That stat is always drawn to maximize the number uninsured, and will pick up anyone who did not have insurance during a year. And ... it is not a figure representing how many American's literally go without the treatment they need ... which should be the point of discussion.

Charles, there's nothing that makes you squeamish about a "profit center" of people who are desperately ill and terrified? Where they're not well informed? Where they can't pick & choose, anyway ("out of network", few or no choice in plans you can access via employer)? When it's their life on the line? Providing health care is not a "normal" business and can't follow the "normal" business model that a shoe factory or a restaurant chain would. They can't have a sale on dialysis when they're underbooked, or offer 2-for-1 appendectomies...

The simple answer is "no", I'm not squeamish, because there are alternative ways of fundamentally changing our system to resolve your concerns on each point. Your comment is based upon misconceptions, and not carefully considering the flaws in the current system, and realistic, potential non-government alternatives to what we have now. I've cited one 'net resource above with Cato, and there are many others. Free / freer market alternatives are often solutions that are efficient and practical because they work with human behavior, not through coercion ... a subtle but critical difference.

Again, there are many participants in the current system who want you to believe there is no choice but a government system based on coercion and empty promises of better care, and lower cost. It is illusory. It requires you to suspend your belief in the reality many of us have learned over lifetimes ... that government has a purpose, but it is usually a blunt and inefficient tool. Government inefficiency is one of the oldest jokes in the book. And yet we can still cling to the belief that it is our savior for health care.

It's a shame we apparently don't have any physicians on the forum who hold an alternative view on this matter ... there are many.

This forum has a great deal of sophisticated discourse about investing, and the members here are better informed about capitalism, the wise use of resources to build value, and free markets than the average individual by far. How do you reconcile your depth of knowledge about value creation and efficient business with a belief that insurance company and / or health care provider profit is a bad feature of the current system that produces no value? And a belief that government can create and administer a more efficient system than those who would be motivated by an ability to profit from their efficiencies?

It is ironic, but predictable, that the complexities of the current system imposed by government programs such as medicare help bog it down, but then are used as an example of the failure of a private system ... helping to "prove" we need a larger government program.

Again, it may appear to be a radical suggestion that any free market alternatives could aid us in this challenge. But I would offer that these alternatives are being rejected by many not because they lack merit, but because they have not been carefully examined and considered.

Free markets don't always work, and they are not always appropriate ... but they work more often than not, and in more situations than most folks first believe.

Like so many things, it is often the premises and assumptions we bring to the debate that constrict our thought, and that applies to me as well. If you are open to real solutions, then at least honestly consider this path ... and when you do so, put everything you know about the current system up for debate, because many things need to change if we're to find a truly better way.

 

[Rich_by_the_Bay]

Maybe Rich can help us out here but I get the impression that health problems are maybe 10% "responsibility" and 90% "sh*t happens".

Sorry, don't have the numbers. But I can verify the gist of your statement as correct: there is a lot of self-induced illness and accidents but a lot more due to the frailty of the human condition.

My observation is that people (and I am not pointing at any individuals here or elsewhere - just in general) who argue against universal health care because "most" disease is self-inflicted are typically young, immature, or inexperienced in life. It just doesn't work that way.

All day, every day, I and my colleagues see a steady stream of 30 somethings with lymphoma or breast cancer, strokes from burst brain aneurysms, drunk driver victims, pneumonia, diabetes and on and on. Good folks. Nonsmokers, light drinkers, working hard for their families. Hello?! That's the human condition. To financially penalize them for "causing it" is ludicrous. Tomorrow, or next year, or 20 years from now your time will come. Not "might" come, but will come. You will be appreciative then of any system which lets you focus on getting better rather than avoiding impoverishment. Paying today for benefits tomorrow should not be a difficult concept for most on this board, regardless of political inclination.

Yes there are those who harm themselves (some can't help it), but that's what sin taxes are for, or a collective universal catastrophic system of coverage (of course, you hear "no one's gonna force me to wear a helmet" but that's another issue).

Charles: I believe the uninsured who don't happen to get treated in a given year remain part of the problem, since they are not paying in to the system directly while they are healthy. In essence they become "inisured" by the rest of us when they do get sick, without ever having paid their "dues." I don't think anyone wants to subsidize a health care policy where you don't have to pay premiums til you get sick, and then everyone else picks up the tab. In some ways, that's what we have. Please try not to be automatically dismissive of the "opposition" -- I am not a screaming liberal in many matters, but I also see the realities of where things are. We all have a lot to learn about this complicated matter.

 

[Craig]

I don't think anyone wants to subsidize a health care policy where you don't have to pay premiums til you get sick, and then everyone else picks up the tab.

I think you've just described your government program.

Please try not to be automatically dismissive of the "opposition"

And I would offer the same advice in response.

 

[Martha]

Charles, the life insurance model works because the insurance companies count on large numbers of people terminating their policies before they die.

The auto insurance model works because auto insurers don't cover intentional acts and rates go up or you get terminated based on your driving history.

Charles, what exactly do you propose as the health care solution? Leave as is? Remove all regulation? If you remove all regulation of health insurers do you realy believe that an insurance company would continue to insure someone with cancer or heart disease? Do you think that someone making $15,000 a year, who has asthma, depression, and high BP could buy insurance?

 

[unclemick]

Hmmmm

I would leap into this debate with both feet - but I have no freaking idea what to recommend as a solution.

I went 12 years without insurance(that or no ER). Now in a different state (and time in the market - portfolio wise) - have a 5k deductible policy.

I know shopping for coverage gave me a big headache.

heh heh heh heh - and keeping my emotions out of it is impossible.