Should we return to prior healthcare system

[samclem]

Folks that suggest "starting again". What specifically do you propose that is realistic and credible in our current political environment and has a significant effect on access to health care and insurance?

The "current political environment" reflects the will of the people, just like the last "current political environment" did. There are strong indications that the new health care law is also not realistic in the "current political environment", so it's not simply a case of "executing the present plan." We're learning (in accordance with some predictions) that is what happens when we try to enact sweeping legislation without a mandate from the people. Social Security had a strong bipartisan and popular mandate, Medicare had a strong bipartisan and popular mandate, but this thing never did.

In my view, it's a situation analogous in some ways to the US involvement in Vietnam. It was strongly favored by some political elements, executed based on shaky legislative action (the Gulf of Tonkin resolution) and then pursued despite lack of popular support (though Vietnam initially enjoyed much more public support than the health care law has now). I'm sure some boosters thought public and political support would grow once we got some victories. We got plenty of victories on the battlefield, but the national will and means of execution (on the cheap, based on incorrect assumptions) was always going to prevent a successful outcome. I see some big similarities with where we are now on healthcare.

It's better to have the national discussion first, accurately outline realistic limitations on what we are setting out to do, and go into it with strong public support. We have the opportunity to do that with health care, but basing it on this defective law is a bad idea. We've been sold a lot of things lately as items that must be done immediately--let's instead do this right. The "waste" isn't the time we'll spend now, it's the last two years of back-room dealing shady activity. Is anybody proud of this thing we've been given?

Our present "system" stinks. As we set out to make things better, let's not deliberately include the linkage between employment and health insurance that is the bane of the present setup. Cost control is a huge issue, let's address it. Let's treat people like adults and let them have choices, which can only work when their own resources are involved. Let's recognize that health care is a unique service, but not so unique that the same market forces that bring us cost control and continuous improvement in every other aspect of our lives some how don't apply to medical care.

 

[dex]

The "current political environment" reflects the will of the people, just like the last "current political environment" did. There are strong indications that the new health care law is also not realistic in the "current political environment", so it's not simply a case of "executing the present plan." We're learning (in accordance with some predictions) that is what happens when we try to enact sweeping legislation without a mandate from the people. Social Security had a strong bipartisan and popular mandate, Medicare had a strong bipartisan and popular mandate, but this thing never did.

In my view, it's a situation analogous in some ways to the US involvement in Vietnam. It was strongly favored by some political elements, executed based on shaky legislative action (the Gulf of Tonkin resolution) and then pursued despite lack of popular support (though Vietnam initially enjoyed much more public support than the health care law has now). I'm sure some boosters thought public and political support would grow once we got some victories. We got plenty of victories on the battlefield, but the national will and means of execution (on the cheap, based on incorrect assumptions) was always going to prevent a successful outcome. I see some big similarities with where we are now on healthcare.

It's better to have the national discussion first, accurately outline realistic limitations on what we are setting out to do, and go into it with strong public support. We have the opportunity to do that with health care, but basing it on this defective law is a bad idea. We've been sold a lot of things lately as items that must be done immediately--let's instead do this right. The "waste" isn't the time we'll spend now, it's the last two years of back-room dealing shady activity. Is anybody proud of this thing we've been given?

Our present "system" stinks. As we set out to make things better, let's not deliberately include the linkage between employment and health insurance that is the bane of the present setup. Cost control is a huge issue, let's address it. Let's treat people like adults and let them have choices, which can only work when their own resources are involved. Let's recognize that health care is a unique service, but not so unique that the same market forces that bring us cost control and continuous improvement in every other aspect of our lives some how don't apply to medical care.

Good post, especially about the mandate.

However, I don't think that health care is a unique service. A large factor in the health care insurance cost/confusion is the politicization of it in the states - where it is currently regulated. Like the tax code; heath ins. is used for politicians to address political issues - ultimately increasing the costs and decreasing participation.

Imagine a system where a health insurance company can not be mandated to pay for costs for the uninsured incurred by hospitals (some states), or other mandates. A person's insurance costs are based upon a minimum insurance requirement (nation wide) and options they choose. Health related companies did not pay federal income taxes. Fraud was taken seriously and reduced substantially. Insurance rates would be much more affordable.

 

[FinanceDude]

Here's a change I would like to see, don't MAKE people have to "buy" the govt healthcare or be penalized........ That's change number one. Get rid of the "death panel" provision in the bill from November 2009 that was "snuck in there". BOTH sides of Congress need to start listening to Paul Ryan more, he seems to be the only one who actually has figured out how to AFFORD all the unfunded liabilities we have now on the books.........

 

[ERD50]

If you recall, several times I have posted links to studies which show the number of people whose deaths are attributable to lack of access to health care due to lack of insurance. The numbers are increasing. It is a claim that is well supported and not merely a "bumper sticker slogan."

I was responding to the one linked in this thread, I don't recall if your sources were substantially different, but the conclusion in this article is extremely questionable. Just because these people didn't have insurance outside of Medicaid, and just because they died does not mean that every one of those deaths, or a majority, or even a significant number of them, were due to them not having insurance outside of Medicaid.

Maybe the number is significant, but that conclusion cannot be drawn from that study.

Again, this is not to diminish the problems that we have that need reform, I just don't accept that 45,000 pa number at face value.

-ERD50

 

[ERD50]

Fair enough. I’ll retract my earlier statement. Now, you advocate scrapping the reform and starting again. What specific healthcare regulatory improvements do you suggest that are both credible and feasible in our current political environment?

Thank you. I'm fine with the general outline that samclem posted months/years ago. I should have bookmarked it, maybe samclem has it handy, it's been repeated so I won't do it again here.

Wait a minute. You asked if people were dying due to lack of health insurance. You got the answer and the reference to the study. It doesn’t support your view so you challenge the conclusions? Here’s a link http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf

I responded to the first link and quote you provided. There was no mention of any adjustments in that article, and I don't see a reference link to the study you posted (I guess some googling would bring it up). I didn't read every word of that study, but they have a pretty long 'limitations' section, and some of their definitions seem pretty fuzzy to me. 'Uninsured' means uninsured at some X point in time (I guess when the study began), and doesn't factor if they got insurance later or not (to me, THAT would be the most relevant aspect). There was some talk here that some of these people might live far from a source of Medicaid treatment. OK, but would that mean they also live far from a source of 'in network' treatment with whatever private insurance they might be able to obtain? Would the outcomes be similar?

ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.

Yes, bad choices are just part of it, and wealthy people also make bad choices. But I suspect that more bad choices are made by those in a lower economic class than higher - as an observer of the world around me, I've seen that too.

On an emotional level, it's easy to say "one death is too many". But as a society, we can't realistically run our lives like that. I suppose we should have 3 FDA inspectors in kitchens of every food service establishment 24-7? And I've seen stats that more food poisoning takes place in homes than in restaurants - so should the govt provide an FDA inspector for every meal that every American prepares? Should we all have govt provided mechanics on staff to do a safety inspection of our car, furnace, dryer, etc, etc, every time we use them? That could save some lives, and it stands to reason we should do it if you stick to your "one death is too many" statement? You can't let money stand in the way of a preventable death, can you?.

You can say those are ridiculous examples, but without real numbers we can't say if there are better places to spend our money. Maybe something else would provide better overall quality of life for more people with the same expenditure. IMO, to not do that thing (whatever it may be) would be the real immoral choice.

-ERD50

 

[FinanceDude]

ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.

To me, this is a MUCH larger problem:

How Common Are Medical Mistakes? - WrongDiagnosis.com

 

[Texas Proud]

The "current political environment" reflects the will of the people, just like the last "current political environment" did. There are strong indications that the new health care law is also not realistic in the "current political environment", so it's not simply a case of "executing the present plan." We're learning (in accordance with some predictions) that is what happens when we try to enact sweeping legislation without a mandate from the people. Social Security had a strong bipartisan and popular mandate, Medicare had a strong bipartisan and popular mandate, but this thing never did.

In my view, it's a situation analogous in some ways to the US involvement in Vietnam. It was strongly favored by some political elements, executed based on shaky legislative action (the Gulf of Tonkin resolution) and then pursued despite lack of popular support (though Vietnam initially enjoyed much more public support than the health care law has now). I'm sure some boosters thought public and political support would grow once we got some victories. We got plenty of victories on the battlefield, but the national will and means of execution (on the cheap, based on incorrect assumptions) was always going to prevent a successful outcome. I see some big similarities with where we are now on healthcare.

It's better to have the national discussion first, accurately outline realistic limitations on what we are setting out to do, and go into it with strong public support. We have the opportunity to do that with health care, but basing it on this defective law is a bad idea. We've been sold a lot of things lately as items that must be done immediately--let's instead do this right. The "waste" isn't the time we'll spend now, it's the last two years of back-room dealing shady activity. Is anybody proud of this thing we've been given?

Our present "system" stinks. As we set out to make things better, let's not deliberately include the linkage between employment and health insurance that is the bane of the present setup. Cost control is a huge issue, let's address it. Let's treat people like adults and let them have choices, which can only work when their own resources are involved. Let's recognize that health care is a unique service, but not so unique that the same market forces that bring us cost control and continuous improvement in every other aspect of our lives some how don't apply to medical care.

Good post....

I will add... the goal of the law was to do something about costs.. at the time there was no mandate on universal coverage... if at the beginning it was stated 'we want to pass a universal coverage program and tax the Americans to a tune of $1 trillion' I think that it would not have gone anywhere....

To me, there are some good things in the bill... but very very little that you could say is cost containment... and a lot that you can call universal coverage....

Heck, keeping kids on policies until 26 make premiums go up... having no preexisting condition make premiums go up... paying 100% for normal screening etc. (can not remember the real name) makes premiums go up..

What in this bill makes premiums go down except the mandate that everyone has to pay in And since everyone at my work already pays in.... it does not do anything to our premiums...

 

[M Paquette]

To me, this is a MUCH larger problem:

How Common Are Medical Mistakes? - WrongDiagnosis.com

Yepper. Medical care is dangerous. You don't see barbers making mistakes like that.

 

[MichaelB]

Finance Dude: I agree with getting rid of the mandate. We need universal care and single payer. Other option is in some way unworkable. Now, as to “death panels” --- that again?

Dex & ERD: It is so easy to say no. Don’t do anything about this ... because other problems are so much bigger. People suffer and die anyway and all the time – so what’s a few more? Any reason to justify inaction. Why solve this problem when there are so many other problems we’re not solving? The challenge to the Harvard study is especially amusing. Didn’t read it but don’t agree anyway. They must have it wrong. When you choose your own facts I’m guessing they will always support with opinions and leave you quite reassured.

Samclem: Thanks for taking the time to answer and respond.

We had a national conversation. Everyone was invited to join, and many did. We all spent a lot of time yelling and fearmongering. Our political representatives then spent a great deal of time doing the same. Some chose to influence the final product in a positive way, others didn’t. Then they wrote, introduced, debated, obstructed, re-wrote and then passed legislation. Then it was signed into law.

Now it’s time to move on. Only 26% of the people want the reform repealed. The rest want it improved. Almost half (46%) are concerned about cost. What you propose does nothing to deal with that. So, back to what Martha suggested in post 58.

I would like our time spend on trying to figure out how to reduce costs, or at least stop the huge inflation in costs. Parts of the health care plan put in place mechanisms to study the cost issues. Let's do that.

 

[ERD50]

Dex & ERD: It is so easy to say no. Don’t do anything about this ... because other problems are so much bigger. People suffer and die anyway and all the time – so what’s a few more? Any reason to justify inaction.

MichealB - I'm going to bow out if your memory is this short. Just a few posts ago (quoted below), you finally agreed that you mis-characterized us as advocating "doing nothing", and now you are right back to that again. You read into this what you want, regardless of what we say.

It takes me a long time, and I like to give people the benefit of the doubt, but you are clearly a brick wall on this issue. You won't convince anyone if you see the need to twist their words and essentially call them heartless. I know you won't 'get this', but we are trying to understand the numbers so we can do the most good for the most people. That is the opposite of being heartless. Some might be satisfied with a 'feel good' statement ( we did something!)- I'd like to know that there is real substance behind it, and that it is truly an overall good, and hopefully something approaching optimal (w/o expecting perfection) - getting the most out of the effort.

Adios on this subject - ERD50

Originally Posted by ERD50
Repeating it doesn't make it true.

Show me the posts on this forum where people are saying we don't need any changes to the system. That claim was earlier applied to samclem, and that's certainly not true.

Fair enough. I’ll retract my earlier statement.

 

[dex]

Dex & ERD: It is so easy to say no. Don’t do anything about this ... because other problems are so much bigger. People suffer and die anyway and all the time – so what’s a few more? Any reason to justify inaction. Why solve this problem when there are so many other problems we’re not solving? The challenge to the Harvard study is especially amusing. Didn’t read it but don’t agree anyway. They must have it wrong. When you choose your own facts I’m guessing they will always support with opinions and leave you quite reassured.

The issue isn't inaction - it is what action.

Also, it isn't about "Why solve this problem when there are so many other problems we’re not solving?" it is about are the proposed solutions just moving the problem around, making the 'problem' worse and/or creating new ones and not addressing them, not identifying the underlying causes of health ins. costs and addressing them. Approaching the issue in this way is more difficult and challenging.

 

[obgyn65]

ok. We agree to disagree. This is America, and it's ok to disagree.

I am afraid I don't have much time to write (I am not retired yet !) to argue the pros of healthcare insurance.

People understand when THEY have to sell their house or go bankrupt because they lost their job and their kid, husband or wife has cancer or leukemia.

Please remember that health problems are not always caused by "bad" (vs. "good") behavior.

Take care everyone and good luck.

 

[GregLee]

Approaching the issue in this way is more difficult and challenging.

Yes, and of course, that's the point. Hey, we're not dummies. Make the issue seem so difficult and challenging that no one will want to pursue it. We've seen the tactic so many times.

 

[dex]

Yes, and of course, that's the point. Hey, we're not dummies. Make the issue seem so difficult and challenging that no one will want to pursue it. We've seen the tactic so many times.

Those that care about the needy will pursue the difficult and challenging because they are aware of the pitfalls of the law of unintended consequences and want to avoid it. Those that can not handle the interrelated variables will not. As someone previously stated the good intentions of government helped to destroy the black family. Learning from history and trying to avoid similar mistakes is a difficult and challenging task but one worth taking.

 

[Alan]

okay folks, this is getting way too political for a health thread, so Porky is going to have to apply some oinkment here.

YouTube - Porky Pig Cartoon Ending "That's All Folks!"