Obama offers universal health care plan

[Cut-Throat]

Talk about the "standard Kool Aide" . . .


Nope. Everyone (rich, poor, stockholder, employee" entered into an agreement of their own free will. Lower wage workers wanted jobs, and they could sell their skills/labor anywhere in the world. They sold their labor to an employer, who paid them at the time (wages, maybe benefits) and may have offered them promises of other compensation later (a pension). That's it. The bargain was been made and everyone traded something and got something they wanted.

It is not the responsibility of the "rich" to "ensure that the people that made them wealthy are taken care of in illness or old age" unless that was part of the original deal. The folks owning the business made the workers "rich" in exactly the same way that the workers made the owners "rich."

The responsibility is society. The government shall levy taxes to provide for the society. The security and stability of the nation depends on it.

- So we agree to disagree!

 

[mykidslovedogs]

I'd be inclined to agree with you except that the
Perhaps some government nudges toward a freer-market solution could help, but it could make things worse if it suddenly disrupts things too much. If it unlocked additional wealth, maybe that could help provide baseline care for those who can't afford it. Not perfect, but possibly better than the status quo if done right.

Ziggy - I don't know how much of my other posts you have read, but I really like the HSA concept if we are going to continue to have employer-sponsored coverage. Many of our groups (clients) are able to save enough in premiums to set aside the ENTIRE deductible in HSA accounts for their employees as a BENEFIT. What a concept! Lower premiums, 100% coverage for the employees AND a savings account that they can keep and grow year after year tax free if they use the money wisely.

On the other hand, I think the ultimate solution would be to have a guaranteed issue gov't sponsored catastrophic plan with preventive care and BAN employer-sponsored coverage altogether, but encourage employers to REPLACE their health plans with tax advantaged HRAs (health reimbursement arrangements) or HSAs (health savings accounts) as a BENEFIT that employees could use towards their premiums, deductible or medical expenses as they wish. At the same time, allow private carriers to sell "buy-up" plans for anyone who wants one.

A plan like that could save employers millions, encourage smarter usage of healthcare dollars, bring back some sense of the cost of healthcare to employees, and still potentially give people Cadillac coverage, if they work for a company that fully funds their deductible in an HRA or HSA.

The overall concept should help flatten healthcare inflation, which would eventually lead to more people being able to obtain coverage on their own at an affordable price.

 

[ziggy29]

Ziggy - I don't know how much of my other posts you have read, but I really like the HSA concept if we are going to continue to have employer-sponsored coverage. Many of our groups (clients) are able to save enough in premiums to set aside the ENTIRE deductible in HSA accounts for their employees as a BENEFIT. What a concept! Lower premiums, 100% coverage for the employees AND a savings account that they can keep and grow year after year tax free if they use the money wisely.

HSAs are a good concept but they're not the whole picture. I'd agree it's a good starting point for people who can afford to self-insure minor problems and routine visits. And to the extent that employers remain in the picture, better to offer more options including HDHPs with (perhaps) some employer contribution to an HSA.

As much as business complains about health care costs, they have golden handcuffs on a lot of people -- people who can't afford to leave their jobs, not because of the income but because of the loss of group health insurance.

HIPAA is a start but it's not enough. For one thing, you need to exhaust 18 months of COBRA which is VERY expensive ($800-$1000 a month for many families). For another, although HIPAA gives "guaranteed issue" it doesn't guarantee affordable premiums. Without that guarantee the guaranteed issue is useless; if an insurer doesn't want people who have had X, they can just jack up their premiums for those who have had X to something ridiculously unaffordable.

At least some baseline degree of guaranteed-issue is needed, IMO. We can quibble about how to pay for it, and who pays -- individuals, businesses, government -- but this can not be solved unless we solve what I call the "affordable portability" problem. That is the first big thing to work on, IMO.

Most likely this is going to be something that has a burden shared by individuals, employers and government. I'd prefer to get employers out of the picture entirely at some point, though, other than to encourage them to "gross up" their employees with the much of amount they currently spend on health care and start giving people the ability to purchase their own policies in a competitive market; with the $8-10K employers often spend, people could instead channel that toward a decent health plan plus a few thousand in the HSA to cover the high deductibles. But insurability should not be tied to a specific job, and that would require that we eliminate adverse selection. Is "mandatory" coverage the answer? I don't know. There is no easy answer.

 

[mykidslovedogs]

Most likely this is going to be something that has a burden shared by individuals, employers and government. I'd prefer to get employers out of the picture entirely at some point, though, other than to encourage them to "gross up" their employees with the much of amount they currently spend on health care and start giving people the ability to purchase their own policies in a competitive market; with the $8-10K employers often spend, people could instead channel that toward a decent health plan plus a few thousand in the HSA to cover the high deductibles. But insurability should not be tied to a specific job, and that would require that we eliminate adverse selection. Is "mandatory" coverage the answer? I don't know. There is no easy answer.

HIPPA laws are rediculously confusing. I think you've got to have some sort of standardized, federally mandated, portable, at minimum, catastrophic coverage to help reduce, if not eliminate, adverse selection (ideally, these plans would be part of the mix of plans that private insurers would be required to offer). This plan could kind of be like the baseline medicare advantage plans offered by private carriers at no cost, because the gov't would pay the private carriers the complete premium in exchange for them to administrate and manage the distribution of basic plan. -- That would help flatten inflation...reason being is that insurance would pick up where healthcare users leave off in paying their bills (in other words, doctors wouldn't have to write off so much bad debt from people who fail to pay for services, because insurers would pay above the deductible, so less cost shifting would occur.)

I'd also like to see employers completely out of the picture, except for allowing them the freedom to contribute to HRAs as an employee benefit that employees can use to pay for deductibles.

 

[Freein05]

Ziggy - I don't know how much of my other posts you have read, but I really like the HSA concept if we are going to continue to have employer-sponsored coverage. Many of our groups (clients) are able to save enough in premiums to set aside the ENTIRE deductible in HSA accounts for their employees as a BENEFIT. What a concept! Lower premiums, 100% coverage for the employees AND a savings account that they can keep and grow year after year tax free if they use the money wisely.

On the other hand, I think the ultimate solution would be to have a guaranteed issue gov't sponsored catastrophic plan with preventive care and BAN employer-sponsored coverage altogether, but encourage employers to REPLACE their health plans with tax advantaged HRAs (health reimbursement arrangements) or HSAs (health savings accounts) as a BENEFIT that employees could use towards their premiums, deductible or medical expenses as they wish. At the same time, allow private carriers to sell "buy-up" plans for anyone who wants one.

A plan like that could save employers millions, encourage smarter usage of healthcare dollars, bring back some sense of the cost of healthcare to employees, and still potentially give people Cadillac coverage, if they work for a company that fully funds their deductible in an HRA or HSA.

The overall concept should help flatten healthcare inflation, which would eventually lead to more people being able to obtain coverage on their own at an affordable price.

Your program does make sense except for on thing. That is cost control. Insurance companies and the government to a lesser extent (Medicare) have been unable to control costs. Medical care costs are climbing at 8 to 10% a year. Individuals and businesses can not continue to have such high annual increases in health care costs.

 

[mykidslovedogs]

I'm suggesting cost control through market forces. How would you like to do it? In making consumers more responsible for their healthcare dollar expenditures by making sure that they have at least some out of pocket responsibility through deductibles while at the same time allowing them to receive company benes towards their deductible and giving them the control to spend that money as they wish should help flatten inflation.

 

[wildcat]

My view on this has been influenced by own situation. When I finished up graduate school I was w/o health insurance despite trying to obtain coverage. I have a pre-existing condition - mitral valve prolapse - that kept me from getting any afforable coverage. I knew what it was like to be "locked out" of the system.

Being on the other side of the equation, I can certainly empathize with people who can't get coverage and I absolutely think we need to implement some sort of universal coverage. Our healthcare is incredible - one of the best in the world - IF you have the bucks to pay for it.

To me, that's not right and it isn't right to take the high road. I don't really don't care to hear others talk about taxes going up either. We are spending an unbelievable amount of money on a war -- one we are not sure will produce any favorable results -- yet we can't come up with the money for a basic human need? With the deficit I think it is pretty safe to assume our taxes are going up no matter what. I just wish we could have spent the money on taking care of our first. I am a pretty politically neutral person and I am not here to promote political ideals. I do, however, believe in doing the right thing for the greatest good and in this case I do believe in some form of universal care.

 

[mykidslovedogs]

Free in '05...This is a follow up to the prior post that I submitted before finishing...In making consumers more responsible for their healthcare dollar expenditures by making sure that they have at least some out of pocket responsibility through deductibles while at the same time allowing them to receive company benes towards their deductible and giving them the control to spend that money as they wish (or keep if they don't use it) should help flatten inflation. (IMO costs are out of control, in-part, largely because people have been so divorced from the cost of their care for so very many years.)

There could still be some programs in place for poor people who can't afford their deductibles available to people on a sliding scale based on income and need. The dollars, IMO, should only be handed out on an as-needed basis though.

Maybe the gov't could even implement some kind of "tax credit" incentive program that anyone could have access to to receive "credits" towards their catastrophic deductible if they show that they are living a healthy lifestyle by joining an exercise facility or stop-smoking program or drug-rehab program, etc. There should be a certain amount of deductible that people must be forced to be responsible for if they choose to smoke or abuse drugs or alcohol that will not be reimbursed, even if they are poor. (theory - if they can afford to spend money on smoking, drugs, and alcohol, than certainly, they can be responsible for a good hunk of their deductible, too!)

The theory is that there is a baseline plan available to all that requires some out-of-pocket responsibility, but consumers would be allowed to buy-up if they wanted to (all through private carriers). The buy-up options would require medical underwriting, just like any other plans.

Your're going to be better able to control costs by utilizing market forces than you would if the gov't created an unlimited "free healthcare for all plan". That's when costs would really soar out of control, and once that happens, then queues will form as money runs out. (just like in Canada).

 

[mykidslovedogs]

My view on this has been influenced by own situation. When I finished up graduate school I was w/o health insurance despite trying to obtain coverage. I have a pre-existing condition - mitral valve prolapse - that kept me from getting any afforable coverage. I knew what it was like to be "locked out" of the system.

That's interesting...in Colorado, Mitral Valve Prolapse never results in a decline in the individual market. Did you try with more than one carrier? I've placed lots of clients who have that condition.

 

[wildcat]

Yeah, I did but it was either declined or outrageously expensive -- for an otherwise healthy person. Personally, I could not afford an expensive policy coming out of grad school with plenty of student loan debt on top of regular expenses. I got coverage when I got a job but I had to go without it for a period of time.

 

[mykidslovedogs]

Yeah, I did but it was either declined or outrageously expensive -- for an otherwise healthy person. Personally, I could not afford an expensive policy coming out of grad school with plenty of student loan debt on top of regular expenses. I got coverage when I got a job but I had to go without it for a period of time.

Yea, but nowadays, they don't even rate up for Mitral Valve Prolapse. (at least in CO.) Have to checked into it lately? Underwriting guidelines have really changed a lot over the years as treatments have changed and as carriers have begun to better understand risks. For example, Humana is now accepting asthmatics on plans with 2500 or higher deductibles with NO riders or rate-ups!

 

[Freein05]

I'm suggesting cost control through market forces. How would you like to do it? In making consumers more responsible for their healthcare dollar expenditures by making sure that they have at least some out of pocket responsibility through deductibles while at the same time allowing them to receive company benes towards their deductible and giving them the control to spend that money as they wish should help flatten inflation.

My point is if the big insurance companies with all of their negotiating power can not control costs how is an individual with little knowledge or barging experience going to negotiate better rates and control costs. I don't have dental or eye glass coverage and have tried to negotiate for better rates no deal. That is our rate take it or go someplace else. The next place will have almost the same rates. Look at fee schedules for hospitals they are basically the same. With fewer insurance companies and hospitals around health care has become a monopoly.

 

[wildcat]

kidslovedogs -

This was about 3 years ago. Things may have changed since then and I do have health insurance now but it doesn't change the premise of thread --- people should have access to healthcare.

 

[mykidslovedogs]

Free -

You are misguided as to why costs are so high. Insurance is expensive because HEALTHCARE is expensive. Contrary to popular belief, it's not the profits that are causing all of the inflation. Most healthcare inflation is due to high demand for high tech services combined with the willingness of people to pay for those services , cost-shifting (because of poor reimbursement levels for Medicare and Medicaid services and indigent care - IMO this is the biggest culprit!) and adverse selection - healthy people opting out of coverage because it's too expensive, and unhealthy people staying in because they need it.

Insurance companies already negotiate HUGE discounts. As a member of any insurance PPO or HMO insurance plan, you don't have to negotiate discounts for deductible expenses. You are already entitled to the insurance company's discounts - even when you have to pay a deductible expense - you cannot be balance billed if you stay in the network.

People will spend their $$ more wisely if they have some out of pocket responsibility. Right now, if you are a member of an employer sponsored HMO plan with no deductible, and your doctor orders an expensive MRI because you have some minor neck pain, you're not going to think twice about getting the MRI, because it costs you nothing. When people have to pay a deductible, they get more involved in their care. Give a catastrophic plan to everyone and they will plan for their deductibles, they will ask questions, and they will shop around, and this will help flatten inflation.

For example, when my daughter needed an ultrasound, her Dr ordered me to take her to the hospital for a $1000.00 Ultrasound test. (I called in advance to get the price.) When I called the Dr. office to ask if they knew a place where I could get a cheaper ultrasound test, he told me they had a machine in their Denver office that I could use for only a $200.00 fee. Well, you can bet I opted to drive to Denver and save the $800.00! This is the kind of behavior we will begin to see if we make people responsible for at least some of their healthcare costs.

As part of the trends towards consumer - directed healthccare (HSAs), doctors and hospitas are already beginning to working on improving price transparency so that consumers can shop around. Things are already beginning to happen. It just takes TIME!

 

[mykidslovedogs]

kidslovedogs -

This was about 3 years ago. Things may have changed since then and I do have health insurance now but it doesn't change the premise of thread --- people should have access to healthcare.

I agree - I just don't think it should be unlimited free access. I think people have got to have SOME out of pocket responsibility. I don't mind helping protect people from bankruptcy, but I don't want to give the entire country a blank check and unlimited access. The ramifications so a system like that, IMO, would be terrible. It would eventually have a negative impact on the quality of care and on the economy as a whole.

 

[ziggy29]

Insurance companies already negotiate HUGE discounts. As a member of any insurance PPO or HMO insurance plan, you don't have to negotiate discounts for deductible expenses. You are already entitled to the insurance company's discounts - even when you have to pay a deductible expense - you cannot be balance billed if you stay in the network.

About four years ago my wife had a bout of kidney stones so painful and sudden that it required a visit to urgent care overnight.

A couple of months later, after BCBS processed the claims, the hospital had billed BCBS about $3,400. The amount they paid -- per the negotiated rate -- was about $500.

Even if you have very high deductible insurance, just by having it you get the negotiated rate in network even if the insurance company doesn't pay one cent of it. You'd pay $500 in this case, whereas you'd be asked to pay $3,400 if you were uninsured.

 

[haha]

We are spending an unbelievable amount of money on a war -- one we are not sure will produce any favorable results -- yet we can't come up with the money for a basic human need?

So true. Actually, many people from the beginning made credible predictions that our entry into Iraq would produce the exact mess that is has, and at a staggering human and $ cost.

I saw a story yesterday, I think in WSJ, about impoverished Iraqi refugee families in Damascus being supported by the prostitution of their daughters and young mothers. Good going Mr. Family Values George!

This is without any doubt the worst debacle ever. One that we have created and are now mired in and one which will only end with us running in defeat.

We could have created a deluxe health insurance system and have money left over if we had just stayed out of this mess.

Ha

 

[bright eyed]

mkld -

you have got to be kidding me right?

healthcare is not as expensive as it is made out to be in the US because of the wacked out system we have. take your head out of the US sand and look at other countries...

it's a system based on people having health coverage - the people who don't still receive emergency care - we all pay for that (unless you of course, advocate for turning people out of the emergency room, refusing 911 calls w/out proof of insurance!). in order to recoup costs for servicing the uninsured the hospitals inflate prices out the yin yang. then getting the friggin insurance companies to pay for the things they say they would pay for takes forever and a day - so the cash flow thing is a total mess.

the reformists are simply pointing to the fact that fixing this will lead to an "adjustment" that you can't seem to get your head around. how about reducing or eliminating insurance agents and their commission? there's a cost savings there! you seem to value your role in this whole game, and perhaps that is what is keeping you from imagining a world without insurance agents (and nobody's even proposing that but geez, your pov is very self interested) my dad sells insurance mind you.

all of your examples about worst case scenarios can be mitigated with reasonable rules and regulations about when, who what is covered...and mindful doctors who aren't scared out of their minds that they will be sued or lose their friggin' insurance...

 

[haha]

I agree - I just don't think it should be unlimited free access. I think people have got to have SOME out of pocket responsibility.

They do. It's called co-pay, deductible, and capped cost sharing.

Why don't you give up? You make utterly no sense, and your motivation is transparent and not real attractive.

Do you really think that people will be flocking to get un-needed colonoscopies? How about cardiac catheriterizations? Pelvic exams, that is another real crowd pleaser!

Ha

 

[Freein05]

About four years ago my wife had a bout of kidney stones so painful and sudden that it required a visit to urgent care overnight.

A couple of months later, after BCBS processed the claims, the hospital had billed BCBS about $3,400. The amount they paid -- per the negotiated rate -- was about $500.

Even if you have very high deductible insurance, just by having it you get the negotiated rate in network even if the insurance company doesn't pay one cent of it. You'd pay $500 in this case, whereas you'd be asked to pay $3,400 if you were uninsured.

This is interesting. So the uninsured who probably have very little money would pay $3,400. If a hospital can afford to provide their services for $500 to a person that has insurance why can't they provide the same services to someone for that price who is paying cash? As has been said before our health care system is crazy.

 

[mykidslovedogs]

mkld -
it's a system based on people having health coverage - the people who don't still receive emergency care - we all pay for that (unless you of course, advocate for turning people out of the emergency room, refusing 911 calls w/out proof of insurance!). in order to recoup costs for servicing the uninsured the hospitals inflate prices out the yin yang. then getting the friggin insurance companies to pay for the things they say they would pay for takes forever and a day - so the cash flow thing is a total mess.

Bright eyed - did you READ my last post?

"You are misguided as to why costs are so high. Insurance is expensive because HEALTHCARE is expensive. Contrary to popular belief, it's not the profits that are causing all of the inflation. Most healthcare inflation is due to high demand for high tech services combined with the willingness of people to pay for those services , cost-shifting (because of poor reimbursement levels for Medicare and Medicaid services and indigent care - IMO this is the biggest culprit!) and adverse selection - healthy people opting out of coverage because it's too expensive, and unhealthy people staying in because they need it."

If everyone had at least a catastrophic plan, we wouldn't BE cost-sifting so much for indigent care, because INSURANCE would pay the Dr's above the deductible, instead of the Drs having to write off those expenses as bad debt and then passing it onto the insured. Geesh - why don't you try to get your head around what I have been saying all along?

 

[bright eyed]

don't get your panties all in a twist.

i did read what you wrote, unfortunately. but you said it's "healthcare that is expensive" then you said cost-shifting - that is not the same thing. i was replying to your first assertion - better yet i'm going to stop reading your posts until they reflect some - uh reflection? i always wondered why folks kept egging you along, and here i go falling into it...what a trap!

apparently you have a hard time realizing when a room full of people disagree with you maybe you should take a back seat and LISTEN or stop repeating yourself to death. you must be fun at cocktail parties...

 

[mykidslovedogs]

They do. It's called co-pay, deductible, and capped cost sharing.

Why don't you give up? You make utterly no sense, and your motivation is transparent and not real attractive.

Do you really think that people will be flocking to get un-needed colonoscopies? How about cardiac catheriterizations? Pelvic exams, that is another real crowd pleaser!

Ha

When people don't have to meet a good-sized deductible for expensive tests - yes - they do get unnecessary tests. They don't double check, they don't ask for second opinions, they don't even ask why they need the test in some cases. They don't look for competitive pricing..they just pay their $20 or $50 copay and they get the test at the nearest, most expensive hospital. When there's no reason for providers to compete for business, they keep inflating prices. Once providers know that people are shopping around, they will be more apt to make pricing more transparent and yes, they will have incentive to try to bring to their doors by keeping pricing competitive instead of continuing to inflate it year after year. Also, when consumers become more active in their care, perhaps this will keep over the top high tech services in check too, because there won't be
as much demand for that.

Sorry - that's just the way I feel. I really feel that admin costs and broker commissions have very little to do with the rapid inflation in the healthcare industry.

 

[SamHouston]

I think that universal health care would be a wonderful thing for all of us.

However, I don't think that it's realistic to expect the government to solve this problem or to fill this need. I can't think of a single person in Washington that I would trust with this...regardless of party affiliation.

If the government wants to bring some experts together and then butt out of the process, I'm all for it. But to have a bunch of congressmen tinker with the system scares the heck out of me.

 

[sgeeeee]

They do. It's called co-pay, deductible, and capped cost sharing.

Why don't you give up? You make utterly no sense, and your motivation is transparent and not real attractive.

Do you really think that people will be flocking to get un-needed colonoscopies? How about cardiac catheriterizations? Pelvic exams, that is another real crowd pleaser!

Ha

Ohhh. Ohhh. Could I have another colonoscopy please. It's only been a few months, but I really like the taste of that pink fluid.