Health Care Politics

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SSJ_Jup81
August 17th, 2009, 3:41 am
Ever waited on line before boarding an airplane? No, not really. We wait at the terminal. When they open it, we get on, but then again, that's why you're supposed to get to airports at least an hour before your take off.Ever been the the DMV?Of course! Never had to really wait there, either, but just like with grocery shopping, I'd go either right before closing time or when it first opens so I never had to "wait" on anything DMV related.How about education - think kids today are smarter and more capable than they were 50 years ago? If anything, students are allowed to be lazier now. I wouldn't say they're dumber, but you also have to take time period into consideration. What was needed 50 years ago, wouldn't be needed in today's world. For my Educational History course I took a good while back, we had to look at a test from the late 1800s. It was pretty much an "end of year" test or a final, I guess you could call it. I think it was from 8th grade. It was very difficult for some parts (even the reading/writing), because of the different terminology and stuff that would be obsolete now. For math, most of it was connected to farming examples because that's what people did back then and I was thrown, because I didn't know anything about certain measurements dealing with crops and all that because I didn't grow up in a time where the majority of people farmed.

So, anyway, I don't feel the children are dumber now. It's the curriculum being made easier for them to get the material that's the problem.You don't have to buy the products offered by any corporation. You have no choice when it comes to the government - especially when it comes to government bureaucracy. And with this health care bill of the Democrats, not only will you not have a choice, but the government will fine you if you make a choice that doesn't meet their standards.They need to just ditch Medicare, because that sounds like what you described. At least Obama wants to have it so that citizens can join a plan out of choice, not force. I'm still waiting for someone to explain to me why that's an actual problem.

The only thing I can see wrong and actually worthy of discussion is the actual cost and how it's going to get paid for...not whether or not we should even have one.

Redhart
August 17th, 2009, 3:42 am
I met a woman at Senator Fienstein's office on Friday that I talked to a little bit. She was there, like me, to state her opinion on Health Care Reform.

At one point I mentioned in the meeting that I was interested in tort reform, that I was wondering why this wasn't being pursued.

The woman told me that tort reform already happened in California....did I notice any drop in medical or premium prices? I was a bit taken back. She went on to explain there in front of the Senator's representative, that "tort reform was a red herring." I looked at the aide, and she didn't reply one way or another. There was another group at the door and we didn't get to explore that.

If that's true, that brings up more questions. If tort reform happened, why didn't it affect costs and prices?

Did cost go down yet malpractice insurance to the doctors not...did the insurance companies pocket the money? Did malpractice insurance go down, and the doctors, hospitals and clinics not reflect that in their prices?

Did the woman have her facts wrong? She seemed very sure of herself and adamant as if she were in the legal field, but I didn't get the chance to investigate her credentials.

I'm going to look into this further, but have not had time yet. So, now I'm back on the fence about tort reform until I find some answers.

***Edit--taking a moment and googling it, it seems California did, indeed, already adopt tort reform:
Tort reform in California and Colorado primarily focused on capping victim compensation for noneconomic damages, also known as "pain and suffering" awards. Unlike economic damages, which include lost wages and medical costs, noneconomic damages are subjective and difficult to quantify. Both laws limit noneconomic damages in medical malpractice lawsuits to $ 250,000, but Colorado also imposes a total noneconomic damage cap of $ 500,000. If the court finds clear and convincing evidence of "derivative noneconomic loss or injury," it may award up to an additional $ 250,000. Derivative noneconomic loss or injury is nonpecuniary harm or emotional stress to people other than the person suffering the direct or primary loss or injury (Cal. Civil Code § 3333. 2 and Col. Stat. Ann. § 13-21-102. 5).

California additionally limits the amount attorneys in medical malpractice cases can collect under a contingency fee arrangement to 40% of the first $ 50,000, 331/3% of the next $ 50,000, 25% of the next $ 500,000, and 15% of any amount that exceeds $ 600,000. These limits apply regardless of whether the recovery is by settlement, arbitration, or judgment. If the contingency fee arrangement is based on an award of periodic payments, the court must place a total value on the payments based on the projected life expectancy of the claimant, and then calculate the contingency fee percentage (Cal. Bus and Prof. Code § 6146)...
http://www.cga.ct.gov/2002/olrdata/ins/rpt/2002-r-0782.htm
Hmmmmmmmmmm :huh:

And found this:
The experience of states with caps shows the answer to that question is a resounding NO. (See Chart) Study after study has shown that caps have failed to deliver promised reductions in insurance premiums. (See "Premium Deceit: The Failure of 'Tort Reform' to Cut Insurance Rates" by the Center for Justice and Democracy)

In June 2003, Weiss Ratings, an independent financial ratings company, found that doctors' premiums in Pennsylvania had risen more than

500 percent over the past decade, while payouts in malpractice cases had increased only 50 percent over the same time period. (See report) The Weiss study found that premiums in states with caps were slightly higher than in states without them. In a Scranton Times article (Read It) on the study, Pennsylvania Deputy Insurance Commissioner Randy Rahrbaugh said, "There is little evidence to show that caps solve the medical malpractice crisis." If you go to the site there are some pdf files with graphs.
http://www.saynotocaps.org/travestyofcaps.shtm (http://www.saynotocaps.org/travestyofcaps.shtml)

At an AMA site, they say that:
Research looks at caps' impact

The AMA's policy research perspective, "The Impact of Liability Pressure and Caps on Damages on the Healthcare Market: An Update of Recent Literature," drew upon findings of several tort reform studies published in 2006 and 2007.

Some of the research results showed:
•Internists' premiums in states with caps were 17% less than in states without caps. General surgeons' and ob-gyns' rates were 21% and 26% lower, respectively.
•A $250,000 award limit in states without effective reforms could result in premium savings of $1.4 billion.
•The number of physicians practicing in high-risk specialties is 4% to 7% higher in states with caps.

But add this input about California's rates in particular:
Joanne Doroshow, executive director of the Center for Justice & Democracy, a nonprofit consumer advocacy organization, said the studies the AMA analyzed ignored other factors at the state level. Caps vary from state to state, so comparing them is unreliable, she said.

In addition, "states that have successfully brought insurance rates under control have enacted strong regulatory reform on the industry," said Doroshow.

For example, California insurance regulators can mandate a public hearing when insurers request a rate hike greater than 15%. Illinois, which passed a $500,000 noneconomic damage cap in 2005, requires medical liability insurers to publicly disclose their rates.

Doroshow said award limits may reduce insurers' payouts.

"But that's money going into carriers' pockets, not to relieve doctors," and not to compensate patients seriously injured in legitimate cases, she said. "Reports like [the AMA's] continue to give doctors misleading information about what's impacting their premiums."
AMA torte reform research (http://www.tortreform.com/node/447)

As a Californian, I have to say--it seems like our health insurance premiums or medical costs do not reflect savings, and seem as high (or higher) than many other places in the country. Maybe this needs to be looked into further and see where the leaks in the "savings" are. They don't seem to be making it to the people. They are either going into the insurance pockets, the doctors/hospital profits or elsewhere.

Wab
August 17th, 2009, 6:31 am
Ever waited on line before boarding an airplane?

It's worse (and much more expensive to park) now that SYD has been privatised.

Ever been the the DMV?

Not for years. About once every five years I have to pop into our equivalent to get my photo taken. Just about everything else involved with registration etc. I do on-line.

ComicBookWorm
August 17th, 2009, 7:29 am
Ever waited on line before boarding an airplane? Ever been the the DMV? How about been audited by the IRS? Ever read the procurement integrity act and attempted to bill the government for services you or your employees have provided to it? How about education - think kids today are smarter and more capable than they were 50 years ago? Ever be a member of an HMO? My last two employers (before I became too ill to work) shifted to HMOs, where you do wait for approvals, have a bureaucrat make your medical decisions, wait months to get to a specialist, and then be put at the end of a long line with that specialist.

canismajoris
August 17th, 2009, 1:01 pm
How about education - think kids today are smarter and more capable than they were 50 years ago?
Actually I do... Between a 1959 Bachelor's degree and a 2009 Bachelor's degree I would bet on the 2009 every time. It also wouldn't surprise me to learn that overall kids (in the U.S.) have better quality of life and more access to information than they did 50 years ago.

You don't have to buy the products offered by any corporation..
Oh really? Of course you don't, you can simply go without...

monster_mom
August 17th, 2009, 2:28 pm
So, anyway, I don't feel the children are dumber now. It's the curriculum being made easier for them to get the material that's the problem.

Who do you think is behind the dumbed down curricula? (http://pwceducationreform.wordpress.com/2009/05/20/nsf-sends-more-money-down-the-drain/)

They need to just ditch Medicare, because that sounds like what you described.

I don't have a problem with Medicare or Medicaid. I'd actually expand enrollment to 1.5 times the poverty level rather than 1.33 (as it is now and will be under both the Democrats and the Republicans plans).

At least Obama wants to have it so that citizens can join a plan out of choice, not force. I'm still waiting for someone to explain to me why that's an actual problem.

Where does the Democrats plan give you a choice on anything?

If you qualify for Medicare / Medicaid you have to enroll in them or you'll face a fine.

If your employer sponsors a health care plan you have to enroll in it or an individual exchange plan or you'll pay a fine. If you make less than 4 times the poverty level the government will give you additional assistance in paying for it (to the extent that the premiums exceed 1/12 of your income).

You can't even choose what type of plan to purchase because your plan must meet the government's standard as a qualified health benefits plan. If you choose to enroll in just a catastrophic plan (one that has low premiums and very high deductibles), that plan won't be a qualified plan and you'll have to either enroll in a basic plan and pay higher premiums or pay a fine.

Lack of choice is a hallmark of the Democrats plan.

The Republican's plan, by contrast, is all about choice. It expands the individual market and allows anyone who purchases a plan from the individual market to deduct the cost of their premiums from their taxes. That means that your health plan will no longer be tied to employment but to the choices you make for you and your family.

It allows consumers to purchase plans from out of state providers if the cost of plans offered in their state are more than 10% above the national average and it requires the plan providers to meet the laws in every state in which they sell health insurance.

It provides a state backed and federally funded high risk pool for people whose family medical conditions result in premiums that are more than 150% of the national average.

Granted, the cost of the plan hasn't been estimated by the CBO yet, so we can't see if it would be more or less expensive than the Democrats plan. But the Republicans plan is all about giving consumers a choice as opposed to forcing them to do what the federal government says they have to.

Wab
August 17th, 2009, 3:02 pm
The Republican's plan, by contrast, is all about choice. It expands the individual market and allows anyone who purchases a plan from the individual market to deduct the cost of their premiums from their taxes. That means that your health plan will no longer be tied to employment but to the choices you make for you and your family.

But one assumes that to qualify the insurer would have to meet certain government mandated standards making them jump through any numbe of hoops and increasing premiums.

It allows consumers to purchase plans from out of state providers if the cost of plans offered in their state are more than 10% above the national average and it requires the plan providers to meet the laws in every state in which they sell health insurance.

It provides a state backed and federally funded high risk pool for people whose family medical conditions result in premiums that are more than 150% of the national average.

Talk about increasing bureaucracy. Do you realise how many extra people and regulatory bodies will be required to such a shatter-shot approach. It would be an administrative nightmare.

Redhart
August 17th, 2009, 4:19 pm
Where does the Democrats plan give you a choice on anything?
It gives me the choice of who *I* want to trust. It gives me a choice to *be able* to buy insurance on my own or not. Right now, I don't have that choice. It gives you a choice between various private corporation policies, as well, through the exchange (or the company that choice). It gives you the choice of keeping the policy you already have if you like it, or dumping it and going with one of the new policies.

If you qualify for Medicare / Medicaid you have to enroll in them or you'll face a fine.
Does that make sense for everyone to be a part of the pool to keep risk down? That has been one of the insurance companies contentions that people get insurance when they get sick, thus increasing prices.

If your employer sponsors a health care plan you have to enroll in it or an individual exchange plan or you'll pay a fine. If you make less than 4 times the poverty level the government will give you additional assistance in paying for it (to the extent that the premiums exceed 1/12 of your income).
That looks like a choice right there. I'm fine with this.

You can't even choose what type of plan to purchase because your plan must meet the government's standard as a qualified health benefits plan.
This is bad? Would you want the minimum standards removed so you could apply for a plan that might deny you on the bases of pre-existing conditions?

Would you want to buy a plan that has a clause to drop you or quadruple the price if you actually get sick and have to use it?

These "government standards" protect consumers from being unceremoniously dropped or forced out of plans when they need them the most, which has been a problem. There is no maximum standards and, once the plans have met the minimum standards, can vary in content for the extras they offer.

I'm good with the government standards.

But then, I haven't been able to chose a plan at all with the current system. Again, for many--this IS a choice we have not had. To me "a choice" is better than "no choice at all" every time.
If you choose to enroll in just a catastrophic plan (one that has low premiums and very high deductibles), that plan won't be a qualified plan and you'll have to either enroll in a basic plan and pay higher premiums or pay a fine.

The Republican's plan, by contrast, is all about choice. It expands the individual market and allows anyone who purchases a plan from the individual market to deduct the cost of their premiums from their taxes.

Tax credits to "Starve the beast" does not seem like the best idea for the economy right now when this country has such a huge deficit to pay off. Again, this sounds like a formula for deficit disaster.

Add to the fact that I crunched my own numbers and this plan doesn't personally help me much at all.

That means that your health plan will no longer be tied to employment but to the choices you make for you and your family.
If I'm not mistaken, even under the house plan one can opt out of employer coverage and go to an exchange coverage or public plan.

It allows consumers to purchase plans from out of state providers if the cost of plans offered in their state are more than 10% above the national average and it requires the plan providers to meet the laws in every state in which they sell health insurance.
This part I still need to research. There were some concerns raised about going over individual state regulation rule and crossing state boundries in the name of competition. I need to look into this further before I decide whether that is a good idea or not, and see what the possible ramifications are.

iolaus
August 17th, 2009, 4:29 pm
Haven't read all of this thread yet but wanted to say that I do believe in the NHS and think that while it may have a few flaws (mainly in terms of too many management) it is fntastic and I would never want it taken from us, and am proud to work for it (yes people from the UK may occasionally slag it off but the same way we'd have a go about our siblings, we don't actually want to get rid of it and woe betide any outsiders who say bad things about it)

I've always had good care from the NHS, as have my family.
The stories about waiting huge amounts of time for tests are generally tests when they aren't needed, at least not that quickly, more to rule something out that the doctors are pretty sure isn't there but need to check - if they think you have got to have something they get you in fast

When my daughter was born she had known renal problems and was meant to be having 2 tests soon after birth and someone did mess up and only booked one, when I mentioned it when I was there they fitted me in that day. (doubt I'd be able to get coverage for her at all in the US from what some on here have said)

My mother had vulval cancer earlier this year, she was seen and biopsied within a few days (I think she went to the GP on the Friday they had her seen by the gynaecologist and biopsied on the Wednesday - then she went back to get the results of the biopsy less than a week later and had an MRI within an hour to find out how far it had spread), then was seen by the oncologist at a specialist hospital within the next 5 days and booked in for surgery the following week - I think there was less than 3 weeks between thinking something *may* be wrong and surgery.

When I collapsed and had to go through A&E I was seen so fast, and treated effectively - the only test I had to wait for was a scan - where the person doing it fell and broke their leg an hour before I was meant to be seen.

leah49
August 17th, 2009, 5:45 pm
Isn't that an awfully sweeping gneralisation? How, in a world that contains corporations like Enron, can anyone trust corporations so much, and also distrust government so much? That's an awfully sweeping generalization, too.



Oh really? Of course you don't, you can simply go without...

In response to Mom's analogy about not having to go to any corporation. You have a choice. You don't have to do business with that business. You can go somewhere else. That's what she meant (or at least what I took out of it).

Redhart
August 17th, 2009, 5:57 pm
In response to Mom's analogy about not having to go to any corporation. You have a choice. You don't have to do business with that business. You can go somewhere else.

With all due respect, for millions of Americans, there is no where else to go right now. And, from having been one of those millions for a few years, I can tell you that if you don't have a plan/program/policy, you can't even get in to see a doctor where I live (even with cash). The only option is the one county ER...and, based on my personal experience and other friends in the area, even they have found ways to deny treatment and get around the laws (see my previous, personal stories earlier in the thread. I won't).

Wab
August 17th, 2009, 6:16 pm
That's an awfully sweeping generalization, too.



In response to Mom's analogy about not having to go to any corporation. You have a choice. You don't have to do business with that business. You can go somewhere else. That's what she meant (or at least what I took out of it).

And if none of those businesses will serve you, then what?

leah49
August 17th, 2009, 6:47 pm
With all due respect, for millions of Americans, there is no where else to go right now. And, from having been one of those millions for a few years, I can tell you that if you don't have a plan/program/policy, you can't even get in to see a doctor where I live (even with cash). The only option is the one county ER...and, based on my personal experience and other friends in the area, even they have found ways to deny treatment and get around the laws (see my previous, personal stories earlier in the thread. I won't).

The thing is it's not like that everywhere. I don't have health insurance but I've never had a hard time seeing a doctor. I do need health insurance, but I am afraid that it would cost more for it than it would be to just pay for my medicine every month. Yours is a bad situation, yes, but it isn't like that for everyone. You don't know everyone's experiences. I don't either, I know. But, you can't just use your experience to say that's how it should be for everyone.

You're very for the health care bill, so what specifically do you like about it?

Overdose
August 17th, 2009, 6:53 pm
http://www.youtube.com/watch?v=2c-JEx-Kfvc&feature=player_embedded

Apparently the NHS is also a terrorist breeding ground. Who knew?
Low wages and lack of prestige for doctors according to the video are one of the main things sited in this video. Obviously they fail to mention that General Practitioners can earn anything between £80'000- £150'000 simply on NHS without even figuring in their more lucrative private patients.

Wab
August 17th, 2009, 7:31 pm
Meh. It would have offed Stephen Hawking too.

According to Investor's Business Daily (http://www.ibdeditorials.com/IBDArticles.aspx?id=333933006516877) Hawking "wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless".

Note: The link points to the corrected editorial (the original having disappeared into the ether) which was released after the brains trust at IBD was informed that Hawking lived in the UK and was most appeciative of his treatment.

Says a lot about an argument when it's supporters resort to outright and pathetic lies to try and prove their case.

Melaszka
August 17th, 2009, 7:32 pm
http://www.youtube.com/watch?v=2c-JEx-Kfvc&feature=player_embedded

Apparently the NHS is also a terrorist breeding ground. Who knew?
Low wages and lack of prestige for doctors according to the video are one of the main things sited in this video. Obviously they fail to mention that General Practitioners can earn anything between £80'000- £150'000 simply on NHS without even figuring in their more lucrative private patients.

Don't get me started. I think it is very telling that every UK citizen who has so far commented in this thread on allegations made in the US media about the British NHS (from the left-leaning like me to Conservative voters like you) has pointed out that these stories are (a) totally untrue (b) completely ridiculous.

Even if the NHS were rubbish, it would have little bearing on the US debate, as Obama is not trying to introduce an NHS-style system, anyway.

Redhart
August 17th, 2009, 8:53 pm
The thing is it's not like that everywhere. I don't have health insurance but I've never had a hard time seeing a doctor. I have also heard it is not as bad elsewhere, like from relatives in Texas. But being able to pay cash for a doctor is not the only thing in consideration.
I do need health insurance, but I am afraid that it would cost more for it than it would be to just pay for my medicine every month. I'm glad you haven't needed it so far. For many young people in good health, this is the case. This being said, you are also leaving yourself very vulnerable to the unexpected. Just as I fell and busted a knee a couple years ago, a fall or sudden acute illness (like appendicitis is common) Happens all the time. I remember when I was in my 20's, good health--but no insurance for short time...then hit my head requiring ER care. The bill was in the hundreds (ah, the good old days!). I wasn't happy, but could reasonably pay such a bill in several installments. Today's prices in the ER are far and beyond anything we used to be able to pay. I know few young people who could afford an emergency appendectomy costing $10-30,000. A busted arm or leg due to a sporting accident (skiing, perhaps) would be thousands under today's medical prices.

Yours is a bad situation, yes, but it isn't like that for everyone. You don't know everyone's experiences. I don't either, I know. But, you can't just use your experience to say that's how it should be for everyone. No, mine is not like everyone's, but very typical for where I live. This being said, I've also heard enough other stories from other areas to know that there are problems everywhere, throughout the states. But, one could also point out that because you have had no bad situation and have done very well without insurance, that doesn't mean everyone else has, too.

I think we can all safely say that we have some serious problems in the nation's health care system (yes, some areas worse than others...but no area free of issues at all) that reform, of some sort, is going to have to be addressed.

You're very for the health care bill, so what specifically do you like about it? I like the proposals for new regulations that will stop companies from using pre-existing exculsions to deny/revoke policies. I like the idea of a public plan to A) offer a policy at a lower price that those in the "crack" (making more than medicaid qualifies for, but not so much as to be able to afford a reasonably, basic policy) might actually be able to actually buy some. B) adding a public plan that could possibly end up helping to lower premiums across the board for private policies.

I like the extra support that is proposed to new medical students to take some of the financial loan burden and make it, perhaps, easier to pay back (my eldest son is studying to be a pathologist).

And most of all, I like the whole idea that the uninsured will have choices to actually go to a doctor's office, rather than always being referred to an ER simply because they are not insured (at least in my area, but you were asking *me*, so there you go).

I like that *if* I or one of my family do have a true, medical emergency, they can go to an ER and actually get treated...and not have an ER factor in your insurance as to whether they can save money by not doing a diagnostic test that might confirm something serious (and being legally required to treat it at that point).

I like the idea I, as a patient, won't have to be sent to do the same blood test/X Ray/other diagnostic several times because medical entities aren't communicating to one another or have a way to pull it up on a system on a patient from anywhere (with permission from patient, of course).

I like the idea of 90% of the time in a medical emergency focused on how to get better with my doctor (or family member's doctor), getting treatment, discussing pertinent information during a crisis than spending sitting on a gurney spending 80% of the time worrying about if this was going to cost me our house.

And mostly, for me, I never want to have to decide if my family would be better off by cashing in my life insurance, or actually taking me to the ER again.

monster_mom
August 17th, 2009, 8:53 pm
And if none of those businesses will serve you, then what?

Then they've broken the law.

No medical provider can refuse to treat anyone in an emergency. If they do so they have broken the law.

No health insurance carrier can refuse to provide you coverage unless you've committed fraud. They can adjust your premiums based on your relative risk, but they can't refuse to provide you with coverage.

According to most studies, the uninsured in America fall into several broad categories:
- those who don't want heath coverage
- those who qualify for but haven't bothered to enroll in Medicare / Medicaid
- illegal immigrants who have not purchased an individual plan because of fear or the prohibitive cost
- those who can not afford the premiums on an employer sponsored plan
- those whose employers do not offer health coverage and they can not afford an individual plan because of pre-existing conditions or the high cost of a basic plan.

We can't do much about the top 2.

The Democrats plan disregards illegals. The Republicans plan simply states that it won't provide additional taxpayer assistance to illegals. Illegals who are members of an organization offering health coverage can purchase it.

The last two are addressed by both plans in different manners. The Democrats do it by nationalizing the health insurance industry, establishing mandates that will increase the cost of an individual plan (just like those mandates have in other states where they've been mandated), and providing payouts for the cost of premiums over 1/12 of your income for anyone with income below 4 times the poverty . The Republicans do it by expanding the individual and small business markets, giving cash to individuals living at less than 3 times the federal poverty level, and creating a state and federally backed high risk pool for anyone with high premiums.

Morgoth
August 17th, 2009, 9:12 pm
http://www.youtube.com/watch?v=2c-JE...layer_embedded


What a load of nonsense.

Redhart
August 17th, 2009, 10:08 pm
Then they've broken the law.

No medical provider can refuse to treat anyone in an emergency. If they do so they have broken the law.
And yet...they do! They have found ways and they do it. One word: "loopholes".

No health insurance carrier can refuse to provide you coverage unless you've committed fraud. They can adjust your premiums based on your relative risk, but they can't refuse to provide you with coverage.
And yet, it's widespread! "Loopholes". (Thus those minimum standards, new regulations needed).

The Democrats plan disregards illegals. The Republicans plan simply states that it won't provide additional taxpayer assistance to illegals. Illegals who are members of an organization offering health coverage can purchase it.
Yes, illegals are an issue and how to deal with them. By the same token, I understand you cannot jumanely allow Maria from Guatamala to bleed to death on the ER floor (that appears to be reserved for U.S. citizens http://articles.latimes.com/2007/jun/13/local/me-calls13 Perhaps this can be handled in immigration reform, which is something we also need...but for another thread.

The Democrats do it by nationalizing the health insurance industry, establishing mandates that will increase the cost of an individual plan (just like those mandates have in other states where they've been mandated),
whoa...whoa there, I was with you until "will increase the cost", because that seems to A) be an opinion and B) not taking into consideration that the minimum standards and new *regulations (see "loopholes" above) are one part of the legislation, leaving other parts of the plan to address costs. That's like a surgeon in an operation simply stating that the stitches at the end won't fix the patient (well, YEAH...it's all parts of the operation that produces the end result!).

The Republicans do it by expanding the individual and small business markets, giving cash to individuals living at less than 3 times the federal poverty level, and creating a state and federally backed high risk pool for anyone with high premiums.

I'm simply do not think that private competition, or expansion of, will bring down prices. This has been the system we have had and it isn't working. I do not see how "expanding" it, even across state lines to be competitive (and I'm researching that and finding that it's not quite as nice at it sounds at first...but, will save that for a later post when I'm done doing homework). And, I've stated my opinion on "tax credit giveaways". For one thing, it doesn't help people who are on tax-free type incomes (ie: disability) much at all and it seriously attacks income that the US needs right now to pay down the deficits. Increased spending: deficit goes up. Reduce Taxes/US income: deficit goes up.

If you are expanding medicare to close the hole AND giving tax credits in massive amounts to offset the costs...well, this has some serious issues and possible ramifications to the entire country just as much as not finding enough ways to offset spending of the house bill sufficiently.

Unless we go back to raising taxes on the top 2-3% to offset the tax credits to everyone else?

Can't have it both ways. I also do not think this will work as effectively to bring overall premium prices down for everyone, nor cover as many people as the house plan will because of the "tax credit" style of offsets.

leah49
August 17th, 2009, 11:16 pm
I have also heard it is not as bad elsewhere, like from relatives in Texas. But being able to pay cash for a doctor is not the only thing in consideration.
I'm glad you haven't needed it so far. For many young people in good health, this is the case. This being said, you are also leaving yourself very vulnerable to the unexpected. Just as I fell and busted a knee a couple years ago, a fall or sudden acute illness (like appendicitis is common) Happens all the time. Accidents happen. I know that. I am leaving myself vulnerable. I know that. You're not telling me anything new. I don't chose to go without health insurance, it's just that I am currently looking at purchasing it. I just don't understand what I'm looking at so I have yet to make my decision. Will this bill make it easier to understand what I should purchase? I think that's something they should work on. I remember when I was in my 20's, good health--but no insurance for short time...then hit my head requiring ER care. The bill was in the hundreds (ah, the good old days!). I wasn't happy, but could reasonably pay such a bill in several installments. I'm sorry that happened to you.

No, mine is not like everyone's, but very typical for where I live. This being said, I've also heard enough other stories from other areas to know that there are problems everywhere, throughout the states. But, one could also point out that because you have had no bad situation and have done very well without insurance, that doesn't mean everyone else has, too. No, but it does mean that there are people out there who don't have the problems that you have. Can you prove to me that your issue is common where you live and that it's not just the complainers speaking louder than the people who have no problems? My cousin just recently got health insurance and before that she was never denied health services anywhere and that includes the ER which she visited a lot (she has epilepsy). I have experience with people not getting denied help because they don't have insurance.

I think we can all safely say that we have some serious problems in the nation's health care system (yes, some areas worse than others...but no area free of issues at all) that reform, of some sort, is going to have to be addressed. Right, but it needs to be the right kind of change that we can afford not just change for the sake of change which is what I feel is happening here.

I like the proposals for new regulations that will stop companies from using pre-existing exculsions to deny/revoke policies. I like that, too, but that is one of the few things I actually like in the bill. I'm glad you answered my question. I really want to know why those supporting the bill like it or if they're just supporting the bill without knowing what's in it.

And yet...they do! They have found ways and they do it. One word: "loopholes".


And yet, it's widespread! "Loopholes". (Thus those minimum standards, new regulations needed).
So if this bill gets passed they're not going to be anymore loopholes where they can get around what they've been getting around for years?

Redhart
August 18th, 2009, 3:48 am
Can you prove to me that your issue is common where you live and that it's not just the complainers speaking louder than the people who have no problems?
Um...I dunno---seems like there are an awful lot of supporters of the bill who aren't happy with the current system. Go to whitehouse.gov and see all the stories. I sat in a room at Senator Fienstein's office with 15 other people, most had similar stories of either themselves or a family member (many, far worse than mine). But, there's always that newspaper article I posted above in the L.A. times.

I mean, the proof is all over the place. Why would we even be talking about health care reform if everything was working perfectly? Pick up any paper and look at the stats listed in the latest articles...like this one--claiming that 14,000 Americans lose their health insurance each day:

Obama claims 14,000 lose health insurance every day
http://www.tampabay.com/universal/politifact/rulings/tom-mostlytrue.gif
...Obama was very close to Holohan's calculations — in fact he was slightly low. But as Haislmaier pointed out, the stimulus COBRA provisions could reduce the numbers because more people will still be covered. We can't be sure until the data is in. So in the meantime, we find Obama’s claim Mostly True.
http://www.politifact.com/truth-o-meter/statements/2009/jul/24/barack-obama/obama-claims-14000-lose-health-insurance-every-day/

Wab
August 18th, 2009, 4:27 am
Then they've broken the law.

No medical provider can refuse to treat anyone in an emergency. If they do so they have broken the law.

No health insurance carrier can refuse to provide you coverage unless you've committed fraud. They can adjust your premiums based on your relative risk, but they can't refuse to provide you with coverage.

Which is about as disingenuous as it comes. Jacking up prices so that it is impossible for a person to pay is exactly the same as refusing a premium. (Not to mention the cases of rescission which have already been discussed.)

PLIMPY
August 18th, 2009, 4:35 am
No, but it does mean that there are people out there who don't have the problems that you have. Can you prove to me that your issue is common where you live and that it's not just the complainers speaking louder than the people who have no problems? My cousin just recently got health insurance and before that she was never denied health services anywhere and that includes the ER which she visited a lot (she has epilepsy). I have experience with people not getting denied help because they don't have insurance.
Redheart is not the only person with these issues.
This article talks about a study (http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm) from 2002 says more than 18,000 Americans die each year because of a lack of preventative health care or disease treatment largely attributed to lack of health insurance.
More than 18,000 adults in the USA die each year because they are uninsured and can't get proper health care, researchers report in a landmark study released Tuesday.
[...]
Overall, the researchers say, 18,314 people die in the USA each year because they lack preventive services, a timely diagnosis or appropriate care.

The estimated death toll includes about 1,400 people with high blood pressure, 400 to 600 with breast cancer and 1,500 diagnosed with HIV.
Some of the findings even talk about services in a hospital, and I could be mistaken, but I tend to assume that most people would consider coming in as a trauma victim an emergency.
Among the study's findings is a comparison of the uninsured with the insured:

* Uninsured people with colon or breast cancer face a 50% higher risk of death.
* Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.
* About 25% of adult diabetics without insurance for a year or more went without a checkup for two years. That boosts their risk of death, blindness and amputations resulting from poor circulation.
And on top of all of that, medical costs are one of the top reasons people declare bankruptcy in this country (http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm) (it was the top, but I am leaving room for the current economy status to have possibly altered it).
Harvard researchers say 62% of all personal bankruptcies in the U.S. in 2007 were caused by health problems—and 78% of those filers had insurance
These are major flaws. People shouldn't have to chose between death and paying their bills. If other countries can take care of the health of their citizens without everyone going bankrupt, we should be able to as well.

So if this bill gets passed they're not going to be anymore loopholes where they can get around what they've been getting around for years?
If more people had health insurance, there would be less of a need for loopholes. Will someone find a new loophole? Sure, but honestly, we can't stop passing legislation because someone might find a way around it. If we see the loopholes prior to passage, then obviously we should do something about it. Otherwise...

monster_mom
August 18th, 2009, 4:13 pm
And yet...they do! They have found ways and they do it. One word: "loopholes".

I can only tell you what the law says. I can not judge the accuracy of anecdotes alleging refusal of treatment in an emergency. If anyone was refused treatment in an emergency because of their inability to pay then that person really needs to contact an attorney because the medical facility broke the law.

And yet, it's widespread! "Loopholes". (Thus those minimum standards, new regulations needed). I highly encourage you to read HIPAA. It sets forth the rules regarding the so called loopholes you keep mentioning. The one you keep complaining about is the 12 - 18 month pre-existing condition exclusion. Under HIPAA, insurance companies can refuse to cover costs associated with treating a pre-existing condition for 12 - 18 months if and only if:

(a) the insured person hasn't had coverage for 63 or more days in the past 12 months

and

(b) the insured person received care for a known pre-existing condition or a diagnosis of an unknown medical condition in the past 6 months.

If you've had coverage for the past 12 months then you have nothing to worry about. If you had coverage and only gone without coverage for 63 of fewer days in the past 12 months, then you have nothing to worry about.

If you had coverage in the past 12 months but had a break in coverage that was more than 2 months, then your current insurer can refuse to pay for treatment associated with a pre-existing condition for up to 12 months, depending on when your break in coverage was.

If you had coverage for 3 months, then went without for 3 months, and then had 8 months of coverage before switching to a new job and new coverage, then you new insurer can refuse to pay for treatment for your pre-existing condition for 4 months (12 - 8).
If you had coverage for 3 months, then went without for 3 months, and then had 3 months of coverage before switching to a new job and new coverage, then you new insurer can refuse to pay for treatment for your pre-existing condition for 9 months (12 - 3).


If you don't currently have health coverage and you haven't had it for a while, then HIPAA does very little for you. It does limit the pre-existing condition exclusion period to 12 months, but during that 12 months you'll be on the hook for paying for any care associated with your pre-existing condition.

The 12 month exclusion for coverage of pre-existing conditions isn't really the bigger issue, in my opinion. For people who have purchased individual coverage, or who have their insurance through their employer in a small group plan, a significant illness can cause the premiums for their plan to increase to the point where they can no longer afford them. Allowing membership organizations or associations to provide health coverage for their members addresses that because the increased costs associated with one person's illness are spread out across a greater pool of people.

Yes, illegals are an issue and how to deal with them. By the same token, I understand you cannot jumanely allow Maria from Guatamala to bleed to death on the ER floor (that appears to be reserved for U.S. citizens http://articles.latimes.com/2007/jun/13/local/me-calls13 Perhaps this can be handled in immigration reform, which is something we also need...but for another thread.

I'd say that taxpayer assistance for illegal aliens ought not be provided, but that illegal aliens should not be prohibited for purchasing or enrolling in a non-government sponsored plan. The Democrats plan, because it allows the government to take over control of every plan, specifically prohibits coverage for illegals. The Republican's plan simply states that illegal aliens can't receive taxpayer assistance.

whoa...whoa there, I was with you until "will increase the cost", because that seems to A) be an opinion and B) not taking into consideration that the minimum standards and new *regulations (see "loopholes" above) are one part of the legislation, leaving other parts of the plan to address costs. That's like a surgeon in an operation simply stating that the stitches at the end won't fix the patient (well, YEAH...it's all parts of the operation that produces the end result!).

Not so much opinion as evidence based. What you refer to as minimum standards and I call government mandates will increase the cost of coverage. How can I say that? Because when those mandates have been effected in other states, that's exactly what's happened.

Take community rating (or community pricing).

Community rating requires that every person covered under the plan pay the same rates for their level of coverage as everyone else, no matter what their medical conditions they may have. The Democrats bill in the Senate (HR 3200's equivalent) bars insurance companies from charging more 2 times for one person vs. another person with the same coverage.

That's great for people with medical conditions but stinks for those without, and the net effect is prices increase for everyone. Say guy A is 22 years old and has coverage that runs about $1000 a year and guy B is a smoker and has coverage than runs $8000 a year for the exact same coverage. If you average the costs out, guy A has to pay at least $3000 for the same coverage while guy B can pay no more than $6000. That's great for Guy B because his costs come down, but stink for Guy A because his costs go up. Apply that example across a larger group, and costs are gonna go up.

And that's exactly what happened in the states which have mandated community rating. In those states the cost of coverage increased overall and the number of uninsured individuals rose.

Another example is what qualifies as a qualified plan (or a standard benefits package).

Under both the House and Senate versions of the Affordable Health Choices Act (HR 3200) the federal government sets minimum standards for what constitutes a basic plan and states are given the authority to build onto those minimums. A number of states already do this and covered mandated covered treatments include hair transplantation and in-vitro fertilization. The federal plan requires family planning as a covered treatment.

The net effect, increasing costs.

Another example is the requirement to purchase a qualified plan, something which is stipulated under both the House and Senate's versions of the Affordable Health Choices Act (HR 3200). That means that people who use Health Savings Accounts or who have chosen high deductible plans (known as catastrophic plans) won't be allowed to make those choices anymore. They'll be required to pay for a basic plan whether they want it or not or will be forced to pay a fine.

The net effect for those folks, increasing costs.

I'm simply do not think that private competition, or expansion of, will bring down prices. This has been the system we have had and it isn't working.

Yet someone argued that the competition in the public option of the Democrats plan would bring costs down to affordable levels - even beyond the increases due to additional mandates - and no one complained about that conclusion. It's rather odd - the competition the Democrats plan will create will bring costs down but the competition the Republican's plan creates won't. Perhaps someone can explain that.

And, I've stated my opinion on "tax credit giveaways". For one thing, it doesn't help people who are on tax-free type incomes (ie: disability) much at all

People on tax-free incomes below 3 times the federal poverty level will qualify to receive a refundable tax credit under the Republican's plan. People who are on tax-free incomes below 4 times the federal poverty level under the Democrats plan will be required to spend 1/12 of their family income on basic premiums before they'll see any sort of assistance.

and it seriously attacks income that the US needs right now to pay down the deficits. Increased spending: deficit goes up. Reduce Taxes/US income: deficit goes up.

If the US wants to cut the deficit then it needs to stop spending like a drunken sailor! Take back all the uncommitted stimulus dollars.

Increased spending always increases the deficit. Reduced taxes don't necessarily
increase the deficit because reduced taxes don't necessarily decrease revenue.

OldLupin
August 18th, 2009, 5:02 pm
I don’t know anything about this provision, so I am not conceding it exists or my support or lack thereof for it, but the mechanism of being held directly accountable by the people is oft talked about and rarely exercised. One, a person who is making individual medical decisions should not have to consider for a moment whether it would be politically supportable, and two a person who can be fired can a) be removed immediately if they do something that warrants it and b) would be subject to mechanisms of removal far greater and more simplistic than elections.

Elected officials can be fired and have to answer to more than an appointment authority. Insurance commisioners are elected in most states for this very reason, appointees are harder to get rid of than elected officials. Elected offices are less secure and the competition creates constant oversight by potential successors and media more than appointments as well.


Well, a specialist can be an important part of basic health care. A specialist could be necessary to save a person’s life depending on what sort of illness they have and even simply for preventative medicine or more common medical illnesses. I don’t think anyone would say a visit to a gynecologist shouldn’t be covered for women (or an obstetrician if pregnant), but that is a specialty.

I agree. I think the distinction should be clear though on what would be deemed "required" and what would be deemed "elective" in the area of medical treatment by specialists. Even cosmetic surgeries are sometimes required and not elective.


We’ve been talking about health care reform in this country my entire life and for my parent’s entire lives, it’s been what? 65 years? This isn’t a rush. This isn’t the first time law makers have considered it, so they probably had some provisions already written that they support. Either way, there is going back if it turns out to be a massive failure. Few things are permanent. We got rid of prohibition and that was a Constitutional Amendment…

We are still paying war taxes for the war of 1812. The idea of government control being repealed, just because of one prohibition being overturned is probably pretty hopeful. Prohibition didn't contain an inherent financial or power gain for the government, this legislation certainly will.

I’ll let you in on a secret, Democrats are not trying to take over every aspect of society. The fact that we tend to support a larger government has nothing to do with controlling you in any way, but rather has to do with the fact that we support things like ensuring everyone has access to basic health care and food and a place to sleep at night. And while we tend to concede that the government isn’t perfect and support changes where necessary, we aren’t afraid of the government, that’s why we don’t have a problem with making it bigger.

You trust the government to care enough about people to keep them alive? I don't. I don't "fear government" I just know that the greater the power allowed the greater the exercise of that power will be and I have never seen any indication that government's use of power has been effective or efficient. Is there some example of this effective or efficient government program that would make me have any indication that government is the least bit capable of running a massive program like healthcare? Current attempts are pretty indicative of the oposite, both Federal Medical assistance and government socialized healthcare in the military are notoriously poor.

Since we are sharing secrets, I'll share one as well. The more the government provides the more dependant we all are on the government. "From each according to their ability to provide, to each according to their need" makes for a lot of needy people and a small group of very powerful providers.

Taking away personal responsibility for basic provision and giving to the government is historically a failed means of providing anything. What is an individual responsible for if not their own substinance? We have always been willing to subsist our neighbors when they have been unable, but empowering the government to do this for us will inevitably make many unwilling. Why work hard, produce or take responsibility to advance if the net gain is neglible? This is the reason current entitlement programs become traps. If the difference between working and not working is actually a net negative, who would blame someone for not working?

We have a strong liberal democracy, and while Republicans have been going to chant at town halls that it “works for us” the truth is, it doesn’t “work” for all of us. People shouldn’t have to choose between their house and their health, people in this country shouldn’t die because of lack of health care.

We do not have a liberal democracy, on the contrary, internationally we are regarded as particualrly conservative.

As for Republicans, there are plenty of Democrats who "chant at town halls" and they aren't saying that it "works for us" they are saying they don't like the proposed reforms they are hearing about. Some of that is based on distrorted information, some on legitimate information, but the generalization that oposition to the proposed legislation is oposition to reform in total is inaccurate.


Who needs big profit margins when you work in a trillion dollar industry? That’s a pretty big 4.2%.

If my 401K only returned 4.2% over several years, I would change managers. O think too many people overlook the trillions that has to be invested (circulated in the economy) to make that very small margin of profit, which is devided to all investors. That isn't any bigger a 4.2% considering the investment and serious risk involved than any industry manages.

The question of central value that seems ignored is how can an idustry with above inflation rate increases and a strong profit motive only make 4.2% in actual net profit? Why aren't trial lawyers and tort law taking a beating? Why aren't Medicare and federal entities taking their lumps for their part in the costs? I think the shell game is pretty much working when we have people clammering for insurance comanys' heads for a 4.2% profit when I can guarantee that most large tort lawyers are making more than 5 times that much and using a good deal of that considerable profit to influence legislation that guarantees their continued oportunity.

Wab
August 18th, 2009, 5:19 pm
The net effect for those folks, increasing costs.


The net impression I get from posts like this is that money is more important than people's health.

monster_mom
August 18th, 2009, 5:27 pm
The net impression I get from posts like this is that money is more important than people's health.

Not at all. I'm merely pointing out that government mandates result in higher costs.

Klio
August 18th, 2009, 5:59 pm
Not at all. I'm merely pointing out that government mandates result in higher costs.

In your opinion.

I still haven't seen any evidence that this is a very likely scenario. US healthcare is so expensive, it would be hard to produce higher costs....

OldLupin
August 18th, 2009, 6:19 pm
In your opinion.

I still haven't seen any evidence that this is a very likely scenario. US healthcare is so expensive, it would be hard to produce higher costs....

Yes, but Federal involvement has been more a factor in rising costs than lessening them thus far, what in a federal program would posibly reduce costs by expanding federal involvement? Is there anything that would somehow point to that outcome? Wouldn't the incredible overhead and expected inefficiency make it almost a certain source of cost increases? Especially given the expansion of coverage and mandates for existing providers?

If current law and circumstances only nets 4.2% how could the costs be reduced by a federal program that seems unlikely to pay or provide better than existing programs and has no provision for tort or legal reform?

Klio
August 18th, 2009, 6:25 pm
Well, it seems pretty likely that individual costs have to go down if you make sure that hosipials don't have to 'make up' for the costs of giving at least minimal emergency treatment to the uninsured.

... and if some commercial interest were taken out of health care. Surely, if the main interest of several parties in the process of providing health care (insurance companies, hospitals, pharmazeutical companies) is making a profit on the side, that extra money (profit on top of actual cost) has to come from somewhere.

From what I can tell, it seems that that extra has been getting alltogether out of hand in the USA. How else would one explain the high cost for a substandard return (at least if you look at it overal - i.e. things like general life expectancy)?

Perhaps you have an alternative explanation. In fact, such an explanation should surely be the beginning of any suggestion of what needs doing?

Redhart
August 18th, 2009, 6:53 pm
I can only tell you what the law says. I can not judge the accuracy of anecdotes alleging refusal of treatment in an emergency. If anyone was refused treatment in an emergency because of their inability to pay then that person really needs to contact an attorney because the medical facility broke the law. Well, that's why I left the LA Times article to document the one case. The woman's family in that is still in court, indeed file a lawsuit...last I heard from her son, the family still had not received any money in that award (which was truly a non-frivolous suit) and it was still tied up in the court system.


The 12 month exclusion for coverage of pre-existing conditions isn't really the bigger issue, in my opinion...
From the Wendell Potter (ex executive at a major Health Insurance corporation) testimony before a Senate subcommittee last June:
...To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation's largest health insurers refused to end the practice of cancelling policies for sick enrollees....

...They also dump small businesses whose employees' medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether -- leaving workers uninsured. The practice is known in the industry as "purging." The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation.

An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust's members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage....
http://commerce.senate.gov/public/_files/PotterTestimonyConsumerHealthInsurance.pdf

Increased spending always increases the deficit. Reduced taxes don't necessarily
increase the deficit because reduced taxes don't necessarily decrease revenue.
Bush tax cuts. Enough said...don't want to go too far off topic, but part of how we got in this deficit situation in the first place.

You trust the government to care enough about people to keep them alive? I don't. I don't "fear government"
You trust Insurance corporations enough to keep people alive? I don't. After watching the difference between how medicare/aid treats patients and private insurance...I'll go with government. I'm not as likely to be cut because I'm no longer profitable to their stock holders (see Potter testimony above). Again, I have just come off the front lines and my personal experience has taught me that Corporate Insurance America will hang me out to dry (or die) faster than any issues with the Government system.

Since we are sharing secrets, I'll share one as well. The more the government provides the more dependant we all are on the government. "From each according to their ability to provide, to each according to their need" makes for a lot of needy people and a small group of very powerful providers. I'm currently on a full state subsidy for medical (expires in one year). Before that, I had nothing and no real access to medical care. Yet, it is not because I want to be dependent at all...it's because premiums are so high that the Corporate Insurance industry (and high prices/no cash access of our locality) has made it "impossible" for me to take responsibility myself at this point. There are many like me who would rather be independent and responsibly carrying some of the load...but it needs to be made "available" for us to do so. Up until we lost our group Aetna insurance with a job, we had always done so and were proud of us. Now, we find ourselves "locked out", even while employed, because of how things have gotten so out of control. While there will always be those people who are looking for a handout, there are so many more Americans that would rather pull their own weight and work hard to do so...but are just asking for reasonable options to be able to do that.
If my 401K only returned 4.2% over several years, I would change managers.
Too late, ours went from doing well in 2000 to "gone" during the Bush administration of 8 yrs. (not *all* because of economic and Bush policies, but partially due to that--I want to be honest there). This being said, many people's 401Ks got hit majorly during last years market plummets leaving many people who were close to retirement or already there, in a world of hurt.
The net impression I get from posts like this is that money is more important than people's health. It is hard not to take it that way sometimes, but it does feel like it often. I understand that costs/expense needs to be taken into consideration, but it certainly shouldn't be the "only" or first consideration in my opinion. It is important to consider when looking at all the options (as long as it actually moves us forward TOWARD reform and actually saving American lives caught in this broken system at some point--sooner better than later).

OldLupin
August 18th, 2009, 6:54 pm
Well, it seems pretty likely that individual costs have to go down if you make sure that hosipials don't have to 'make up' for the costs of giving at least minimal emergency treatment to the uninsured.

That isn't cost that "goes away" it is just changing the source of payment, not the amount, nor the eventual payer. The treatment costs what it costs, that insurance companies currently pick up the tab in extra cost in no way means the state won't have equal costs to pick up. I am not sure where the cost reduction comes from in that.

... and if some commercial interest were taken out of health care. Surely, if the main interest of several parties in the process of providing health care (insurance companies, hospitals, pharmazeutical companies) is making a profit on the side, that extra money (profit on top of actual cost) has to come from somewhere.

Any contention that would be based on the premice of government operation only raising overhead and operating costs by 4.2% would be faulty, IMO and fly in the face in all evidence of government operated organizations.

Government programs are notoriously expansive, especially in comparison to private counterparts and have far less incentive to be either efficient or frugal.

Of course I have repeatedly asked for any example of a government program being anywhere near as efficient as a for profit company and have as yet been given none. Is there one?


From what I can tell, it seems that that extra has been getting alltogether out of hand in the USA. How else would one explain the high cost for a substandard return (at least if you look at it overal - i.e. things like general life expectancy)?

Perhaps you have an alternative explanation. In fact, such an explanation should surely be the beginning of any suggestion of what needs doing?

There is no simple (post length) explination, but the basics are that we have to do things that in real terms reduce provision costs, not do things that in effect raise provision costs. That would start with tort reform to reduce overhead for providers. This will also require current government programs to provide prompter and more complete payment for already covered services that go delinquent routinely and are subject to partial payment and extensive difficulties to collect. Reducing overhead, using price controls for materials and incentives for competitive pricing is more likely to reduce costs than introducing a massive program that will have no real incentive for limiting spending.

In the end, the Actual Cost has to be minimized to make care more affordable. Things cost what they cost, and in most cases for very legitimate reasons. Any buisness that clears 4.2% in net profit isn't gouging, despite the need many feel to blame. The simple fact is, if we can't control the causes of costs, the primary causes appearantly not being price gouging in the insurance industry despite all the claims, then it is still going to be just as expensive as it is and will expand as quickly as it has. That the incredible costs will be paid by the government won't change the price nor the people who eventually pay it either.

Well, that's why I left the LA Times article to document the one case. The woman's family in that is still in court, indeed file a lawsuit...last I heard from her son, the family still had not received any money in that award (which was truly a non-frivolous suit) and it was still tied up in the court system.

You know, the only people actually making money on that suit, even legitimate, is the lawyers. We are paying them indirectly and directly, but in the end, thay are the sole benificiaries and the dollar figures have to be rediculous for the actual claimant to get much in deserved damages. Any idea why this is a primary cost increasing influence?



You trust Insurance corporations enough to keep people alive? I don't. After watching the difference between how medicare/aid treats patients and private insurance...I'll go with government. I'm not as likely to be cut because I'm no longer profitable to their stock holders (see Potter testimony above). Again, I have just come off the front lines and my personal experience has taught me that Corporate Insurance America will hang me out to dry (or die) faster than any issues with the Government system.

I have been under government provided healthcare and my experience is significantly less favorable. The government will kick people off the roles in a hurry and do everything in their power to avoid continued coverage. I jumped out of planes for years and sound like Rice Krispies every morning of my life, yet the MMRB offered no coverage. Of course the months and months the board actually takes, along with retreving records that "disappeared" was another nightmare. I have also seen the conditions in military hospitals when there is a real workload and again, no thanks. There is a reason you have to pass a physical to get into the military and some medical conditions that wouldn't prevent your ability to serve are still disqualifiers!


I'm currently on a full state subsidy for medical (expires in one year). Before that, I had nothing and no real access to medical care. Yet, it is not because I want to be dependent at all...it's because premiums are so high that the Corporate Insurance industry (and high prices/no cash access of our locality) has made it "impossible" for me to take responsibility myself at this point.

How will a federal program make those costs go down? The bills will still have to be paid and the increased overhead and lack of profit motive are far more likely to increase the cost than decrease it. In effect, last week I paid for our insurance, it was expensive, if the costs go up it will be even more expensive. In short, good insurance will be like private school and federal insurance will be like public school. We will all pay for it, it will be marginal and only the very wealthy will be able to get the better product, but the lesser product will still cost more.

There are many like me who would rather be independent and responsibly carrying some of the load...but it needs to be made "available" for us to do so. Up until we lost our group Aetna insurance with a job, we had always done so and were proud of us. Now, we find ourselves "locked out", even while employed, because of how things have gotten so out of control. While there will always be those people who are looking for a handout, there are so many more Americans that would rather pull their own weight and work hard to do so...but are just asking for reasonable options to be able to do that.

People only do for themselves as long as there is an incentive to do for themselves. If this so called "universal health care" comes into being, I will probably be left to use it as, again like private schools, I won't be able to afford both. Sure everyone gets coverage, but hasn't history and common sense taught us that when everyone is provided something by the government it usually isn't very good? Of course it will be better for some people, but at the costs of many more people. Education is the only program of similar scope and size I can see and if it is the model, again, no thank you.


Too late, ours went from doing well in 2000 to "gone" during the Bush administration of 8 yrs. (not *all* because of economic and Bush policies, but partially due to that--I want to be honest there). This being said, many people's 401Ks got hit majorly during last years market plummets leaving many people who were close to retirement or already there, in a world of hurt.

Again, 4.2% isn't gouging by any definition. Which obviously means that there is some other reason for costs to be as high and rising as they are. Userping the insurance industry and becoming a non-profit competitor isn't going to have a cost reduction impact, because it is pretty obvious that insurance isn't the source of the costs.


It is hard not to take it that way sometimes, but it does feel like it often. I understand that costs/expense needs to be taken into consideration, but it certainly shouldn't be the "only" or first consideration in my opinion. It is important to consider when looking at all the options (as long as it actually moves us forward TOWARD reform and actually saving American lives caught in this broken system at some point--sooner better than later).

It isn't a matter of money over life. It is a long term problem that by allowing our health to be a government concern we are sacrificing both money and quality of care. There seems to be an assumption that we can all count on government sponsored healthcare to somehow increase the quality of services or maintain them. That isn't a shared assumption with everyone. Reform is an almost universal agreement, but the manner of reform seems to be the sticking point.

monster_mom
August 18th, 2009, 10:00 pm
From what I can tell, it seems that that extra has been getting alltogether out of hand in the USA. How else would one explain the high cost for a substandard return (at least if you look at it overal - i.e. things like general life expectancy)?

I'd love to see your source for this statement.

According to the WHO in their global comparative assessments, the standardized life expectancies in the US are the highest at 76.9 years. The standardized life expectancy is the unadjusted life expectancy adjusted for premature death resulting from non-health-related fatal injuries.

Also according to the WHO, (http://mjperry.blogspot.com/2009/08/us-vs-europe-life-expectancy-and-cancer.html) 5 year survival rates in the US for various forms of cancer far outstrip those in other developed nations.


The 5 year survival rate for stage 1 - 4 breast cancer in the US is 88%, in the UK it's 78% and in Ireland it's 76%.
The 5 year survival rate for colon and rectal cancer is 66% in the US and 56% in the rest of Europe.
The 5 year survival rate for prostate cancer is 99.3% in the US and 78% in the rest of Europe.


Don't bother with infant mortality statistics because comparing them is like comparing apples and oranges. The WHO's definition is "all babies showing any signs of life, such as muscle activity, a gasp for breath or a heartbeat, should be included as a live birth." According to UNICEF, The US, Canada, and Australia strictly follow that definition. But many other countries do not. (http://www.eurocat.ulster.ac.uk/pdf/Report-8-Appendix-7.pdf) In some regions (like Dublin Ireland) a baby born at less than 24 gestational weeks who dies at 4 years of age won't count in mortality statistics because that child was, by definition, stillborn.

Going back to the OECD, “Taking into account such data-reporting differences, the rates of low-birth-weight babies born in America are about the same as other developed countries in the OECD. Infant mortality rates, adjusted for the distribution of newborns by weight, are about the same."

Wimsey
August 18th, 2009, 10:10 pm
Ever be a member of an HMO? My last two employers (before I became too ill to work) shifted to HMOs, where you do wait for approvals, have a bureaucrat make your medical decisions, wait months to get to a specialist, and then be put at the end of a long line with that specialist.My first job gave us an HMO. They warned us to carry our primary care physician's information on us at all time, as the HMO would and did deny coverage on emergency room care that was not approved by the primary care physician.

I'm not joking.

Redhart
August 18th, 2009, 10:26 pm
According to the WHO in their global comparative assessments, the standardized life expectancies in the US are the highest at 76.9 years. The standardized life expectancy is the unadjusted life expectancy adjusted for premature death resulting from non-health-related fatal injuries.

Also according to the WHO, 5 year survival rates in the US for various forms of cancer far outstrip those in other developed nations.

The 5 year survival rate for stage 1 - 4 breast cancer in the US is 88%, in the UK it's 78% and in Ireland it's 76%.
The 5 year survival rate for colon and rectal cancer is 66% in the US and 56% in the rest of Europe.
The 5 year survival rate for prostate cancer is 99.3% in the US and 78% in the rest of Europe. ...

Obviously, those figures are for the *insured* or Americans covered through public plans.
Patients who pay their own tab at California hospitals are 80 percent more likely to die there than patients with private insurance, according to a report released Tuesday by the Office of Statewide Health Planning and Development (OSHPD)...
http://www.bizjournals.com/sacramento/stories/2008/11/24/daily40.html

Health Insurance MattersThere is a strong relationship between health insurance coverage and access to medical services. Health insurance makes a substantial difference in the amount and kind of health care people are able to afford, as well as where they obtain care. Research has consistently shown that the lack of insurance ultimately compromisespersons’ health because they are less likely to receive preventive care, are more likely to be hospitalized for avoidable health problems, and are more likely to be diagnosed in the late stages of disease. Having insuranceimproves health overall and could reduce mortality rates for the uninsured by 10 to 15%...
http://74.125.155.132/search?q=cache:kx-LLSseYaAJ:www.kff.org/uninsured/upload/7451.pdf+uninsured+death+rate&cd=1&hl=en&ct=clnk&gl=us
Abstract
The absence of health insurance creates a range of consequences, including lower quality of life, increased morbidity and mortality, and higher financial burdens. This paper focuses on just one aspect of this harm—namely, greater risk of death—and seeks to illustrate its general order of magnitude.

In 2002, the Institute of Medicine (IOM) estimated that 18,000 Americans died in 2000 because they were uninsured. Since then, the number of uninsured has grown. Based on the IOM's methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006.
http://www.urban.org/publications/411588.html

Estimates of Excess Mortality among Uninsured Adults (http://books.nap.edu/openbook.php?record_id=10367&page=161) ....This is a 161 page item, but the summary states:
http://books.nap.edu/openbook/0309083435/gifmid/165.gif

Wab
August 19th, 2009, 12:11 am
Not at all. I'm merely pointing out that government mandates result in higher costs.

Which has been repeatedly disproved by the fact that the current US system costs more than NHS systems across Europe and other western nations and results in poorer outcomes.

Redhart
August 19th, 2009, 1:08 am
Which has been repeatedly proved by the fact that the current US system costs more than NHS systems across Europe and other western nations and results in poorer outcomes.

http://kelsocartography.com/blog/wp-content/uploads/2009/06/health-care-reform-screenshot.png
This is a screenshot of the graph, but you can go to an interactive graph and be taken through 9 more panels of information:
http://www.washingtonpost.com/wp-srv/package/health-care-reform09/index.html
As you can see, costs for public or private are skyrocketing and projected to go even further if something isn't done.

We are paying for the uninsured anyway through subsidies to cover their trips to the ER. Wouldn't it be less expensive for us to get them covered thus cutting the cost of unnecessary ER trips, get them less expensive treatment before it becomes an emergency and, in many cases, also get some of the paying at least part of the expense themselves through reduced premiums, partial subsidies and some out of pocket to bring the cost to the whole system down? Makes sense to me. Like I said, the government...and, in turn, the tax payer and private policy holders, are already paying this bill. This is one big thing the public plan can do to help cut some of these skyrocketing costs.
You know, the only people actually making money on that suit, even legitimate, is the lawyers. We are paying them indirectly and directly, but in the end, thay are the sole benificiaries and the dollar figures have to be rediculous for the actual claimant to get much in deserved damages. Any idea why this is a primary cost increasing influence?
Did you know we already have caps in California? I just found this out, but we already passed tort reform here. Didn't seem to help. By the same token, this case (if you read the article) should NEVER have happened, but is one an example on the worst end of what happens in this area all the time. Sure, these lawsuits are raising costs. But, practices of overcrowded, overworked county ER rooms who are losing money, even subsidized by the government to stay open, help foster these events.

If this woman had been able to get insurance, either private or public coverage, this woman may have never had this episode at all...her doctor could have arranged for treatment before it got to this point (she was having symptoms, but did not have a doctor to go to for preventative treatment), maybe she would not have bled to death on the ER floor, and maybe there would not have been a lawsuit at all or need for one.

These things ripple out to all areas --the family, of course, has been through heck and back, a woman is dead, the son (who was a coworker with my husband) missed a ton of work due to this and eventually had to take a leave of absence to go deal with all this...lost productivity, lost wages, who knows who he didn't pay from his loss of work and still had bills to pay, costs to the system in lawsuits, loss of trust of the community surrounding this hospital and so much more. All is connected at this level. The same thing is happening in families and communities (on varying levels) due to this ripple effect of the uninsured.
I have also seen the conditions in military hospitals when there is a real workload and again, no thanks. There is a reason you have to pass a physical to get into the military and some medical conditions that wouldn't prevent your ability to serve are still disqualifiers!
My husband is standing right behind my shoulder here. He is a veteran and is due to go into surgery at the VA on Thursday. He told me to tell you he's always gotten exemplary care at the VA, no matter what, and can't say enough about how they have treated him from his time in active duty years ago until now, as a vet. He's also asking me to express how impressed his is at the VA's ability to not only run such a wide operation within the states, but also internationally wherever active duty is located.
How will a federal program make those costs go down? The bills will still have to be paid and the increased overhead and lack of profit motive are far more likely to increase the cost than decrease it...
For one, if I had had this subsidy, I would have completely avoided a $30K hospital bill resulting from untreated source of the problem. $15K has already been picked up by the system. If I cannot pay the rest, the system will pick that up, too. Had I been on a public plan/gov plan/subsidized plan earlier, the cost to the state and federal government would be $30,000 cheaper and saved because I would have had access to preventative treatment. That's just one patient. Multiply that savings to thousands and millions others. That's something to put in the piggy bank.
People only do for themselves as long as there is an incentive to do for themselves. An opinion? I always want to do *better*, thanks. I know a lot of people like me. Sure, we have all met the ones who are sponging the system. They will always be around in any system, but I think it's unfair to classify anyone getting any hand up as someone who isn't motivated to go further. I am not a believer in that philosophy, although I do understand many conservatives believe this (which, apparently, includes you).
It isn't a matter of money over life. It is a long term problem that by allowing our health to be a government concern we are sacrificing both money and quality of care. There seems to be an assumption that we can all count on government sponsored health care to somehow increase the quality of services or maintain them. That isn't a shared assumption with everyone. Reform is an almost universal agreement, but the manner of reform seems to be the sticking point.
To me, life is sacred and precious...more so than money. That being said, I am pragmatic to the degree that I understand everything has a cost and price tag.

I also understand that you do not trust the government to handle things. This, I believe, is one of the great differences between the left and right. While you do not trust the government to handle something this large, I do not trust Corporate America to handle this further. In my experience, they have a long history of exploitation, profit before ethics and their existence above the public's or common interest of the U.S.. From slavery to exploitation of children and the poor in the early industrial revolution as a labor force, to poisoning the environment in the name of a broader profit, to the Savings and Loan debacle in the 70s and Enron manufactured "blackouts" to triple electrical prices in deregulated California...to now, the tricks that corporations pull to exploit loopholes even at the cost of human life to "purge" expensive clients around the laws.

No, I do not trust the Corporations. The U.S. Government is not perfect. Show me a government that is, but I would trust them with this far quicker than Corporate American who, in my opinion, is like a great beast. It is a hard worker and can produce and increase prosperity for us all and it's owner, but without regulation and rules (and a leash and harness), it is just as likely to turn on it's own masters with little care or feeling, just to get back to the feed trough.

Late edit:
this just came across my desk and backs up what I was saying earlier about Health Care Reform supporters are quiet, but coming out in greater numbers:
http://www.huffingtonpost.com/2009/08/18/reform-supporters-outnumb_n_262425.html
I would like to see it varified by more centrist sources, but I'm inclined to believe it at this point from what I'm seeing in my area of the country.

monster_mom
August 19th, 2009, 1:48 pm
Obviously, those figures are for the *insured* or Americans covered through public plans.

No. They are the overall mortality statistics collected by the National Institutes of Health and reported to the World Health Organization. Whether a person does or does not have health insurance plays is irrelevant.

And unless people are on Medicare, Medicaid, or SCHIP, they have a private health insurance plan, not a public plan.

For the record, for the millionth time......

No one has said that the current situation is acceptable. No one.

Most of us believe that something needs to be done to make health insurance more affordable for everyone, and that additional assistance needs to be provided to those whose medical conditions or income make purchasing health coverage too expensive.

We just disagree on the manner in which that should be provided. That doesn't make us evil, heartless, or uncaring. It just means we have a different opinion on how to best reduce the cost of health insurance and provide additional taxpayer assistance to those unable to afford health coverage.


Which has been repeatedly disproved by the fact that the current US system costs more than NHS systems across Europe and other western nations and results in poorer outcomes.

See my previous post. (http://www.cosforums.com/showpost.php?p=5395936&postcount=434)

US life expectancy, about the same as the rest of Europe.

5 yer cancer survival rates in the US - waaaaaay above Europe.

Infant mortality in the US - pretty much the same as the rest of Europe when adjusted for weight at birth.

OldLupin
August 19th, 2009, 2:27 pm
http://kelsocartography.com/blog/wp-content/uploads/2009/06/health-care-reform-screenshot.png
This is a screenshot of the graph, but you can go to an interactive graph and be taken through 9 more panels of information:
http://www.washingtonpost.com/wp-srv/package/health-care-reform09/index.html
As you can see, costs for public or private are skyrocketing and projected to go even further if something isn't done.

No one is denying costs are rising at an unacceptable rate, but the idea that an expansive government program will reduce them is unfathomable to me. I ask and ask, but no reply is ever given, yet I will ask again, what program or government operation is the example to justify my belief that this theory has any foundation in reality? Where is the example of the large government program that actually works that way? If that example doesn't exist, how does anyone have such faith that a new one will somehow be efficient or create cost savings of any kind?

We are paying for the uninsured anyway through subsidies to cover their trips to the ER. Wouldn't it be less expensive for us to get them covered thus cutting the cost of unnecessary ER trips, get them less expensive treatment before it becomes an emergency and, in many cases, also get some of the paying at least part of the expense themselves through reduced premiums, partial subsidies and some out of pocket to bring the cost to the whole system down? Makes sense to me. Like I said, the government...and, in turn, the tax payer and private policy holders, are already paying this bill. This is one big thing the public plan can do to help cut some of these skyrocketing costs.

Again, the premice is that costs would actually be reduced and I am completely unconvinced. We will be trading one massive expense for another and despite the fictional belief that medical resources aren't finite and defined by monetary backing, there is a requirement to actually buy medical care regardless of how the money is trafficed to pay the bill. Again, just like in a federal education system, the product we are buying has consistently declined in quality and increased in price and become a bottomless pit of federal spending.


Did you know we already have caps in California? I just found this out, but we already passed tort reform here. Didn't seem to help. By the same token, this case (if you read the article) should NEVER have happened, but is one an example on the worst end of what happens in this area all the time. Sure, these lawsuits are raising costs. But, practices of overcrowded, overworked county ER rooms who are losing money, even subsidized by the government to stay open, help foster these events.

Capping individual judgments alone isn't proposed as a silver bullet, but it is part of a cost reduction plan. California having one of the largest expenditures on illegal aliens in the world couldn't have an equal offset to raise costs could it? In addition, not unlike medicine, any reform will have to have a length of time to actually bear fruit, or cure the sympton or disease, if you will.


My husband is standing right behind my shoulder here. He is a veteran and is due to go into surgery at the VA on Thursday. He told me to tell you he's always gotten exemplary care at the VA, no matter what, and can't say enough about how they have treated him from his time in active duty years ago until now, as a vet. He's also asking me to express how impressed his is at the VA's ability to not only run such a wide operation within the states, but also internationally wherever active duty is located.

He may have had excellent care, but I didn't. I had several injuries while on active duty and while the medical professionals were very good and the immediate treatment was adequate, the treatment for my family was not very good. The clinics were slow, the diagnosis' were inept more than once I had to go to private doctors to actually get diagnosis and treatment. Then upon leaving active duty the MMRB was brutal and defiant. Persistent joint pain and orthopedic problems, not from a decade of parachuting injuries of course, riddle my life without any assistance from the VA.

The conclusion I have come to is pragmatic, I was well looked after when I was a military asset, my family somewhat less taken care of, but as soon as I ceased being an asset, I was discarded. I am not alone in this. Again, the military is very specific in its entry standards because, in part, of the medical liability that it has to incur.


For one, if I had had this subsidy, I would have completely avoided a $30K hospital bill resulting from untreated source of the problem. $15K has already been picked up by the system. If I cannot pay the rest, the system will pick that up, too. Had I been on a public plan/gov plan/subsidized plan earlier, the cost to the state and federal government would be $30,000 cheaper and saved because I would have had access to preventative treatment. That's just one patient. Multiply that savings to thousands and millions others. That's something to put in the piggy bank.

This is based on the assumption that all uncovered people will take advantage of the preventative medicine and that they will be diagnosed correctly. That is a falacy. A large number of covered people have extremely large bills and suffer long term illness without diagnosis because a good number of people, myself included, don't go to a doctor until there is a serious symptom to send them there. Where children are concerned, people insured and otherwise, again myself included, tend to overuse ERs because of parental panic over any symptom that could be serious.

An opinion? I always want to do *better*, thanks. I know a lot of people like me. Sure, we have all met the ones who are sponging the system. They will always be around in any system, but I think it's unfair to classify anyone getting any hand up as someone who isn't motivated to go further. I am not a believer in that philosophy, although I do understand many conservatives believe this (which, apparently, includes you).

I grew up in a city full of people who were "better off" unemployed. It wasn't that they had no motivation to do "better", but they would litterally have had to be worse off financially to start work at entry level to eventually do "better". I believe people will try to do what they believe is in there best interests and if working 40 hours a week only provides a $50 difference in income and invokes $100 in debt, they won't work. Who could blame them? If they are provided health insurance on someone else's dime for next to nothing, but higher income will bring them to a net negative, why would they persue a higher income? I have turned down a raise myself before when it would have reduced my take-home pay because of tax liability. People act on incentive. If you don't believe that, that is your perogative, but I have witnessed it all my life, and it is completely consistent with human behavior.


To me, life is sacred and precious...more so than money. That being said, I am pragmatic to the degree that I understand everything has a cost and price tag.

Life is precious, which is why I have to believe that anyone who would trust the same people who brought us the public education system and the Social Security system to handle medical care are either being misled into believing something that is incredibly unlikely or they are overlooking serious potential for disaster because of some percieved advantage. Either way, I am at a loss to see the basis for a belief that this is going do even part of what the proponents claim it will.

I also understand that you do not trust the government to handle things. This, I believe, is one of the great differences between the left and right. While you do not trust the government to handle something this large, I do not trust Corporate America to handle this further.

Not trusting the government doesn't mean a blind faith in corporate America. I believe in incentive and action. The government has no motive to reduce costs or in reality provide a quality product in anything they provide once it is funded and niether entity has any real compassion. The power of industry is more limited than government because it has to operate successfully and provide a marketable product to exist and has to provide it against competition. Government has no competition and doesn't have to do anything well to either continue to be funded or continue to exist.

Again, I believe in reform of markets and tort reform and legitimate federal intervention, but until someone can show me a government program even 1/4 the size of this proposal that isn't a certifiable money pit that provides anything near quality services consistently, I will not support massive government intervention.

In my experience, they have a long history of exploitation, profit before ethics and their existence above the public's or common interest of the U.S.. From slavery to exploitation of children and the poor in the early industrial revolution as a labor force, to poisoning the environment in the name of a broader profit, to the Savings and Loan debacle in the 70s and Enron manufactured "blackouts" to triple electrical prices in deregulated California...to now, the tricks that corporations pull to exploit loopholes even at the cost of human life to "purge" expensive clients around the laws.

The government has a better track record in what way? Again, in what way has the government proven this level of trust is justified in any way? I think this concept that I somehow aimlessly trust corporate entities any more than the government is inaccurate and probably bades more in defensive argument than in any indication on my part. I just believe we have greater ability to devide power and more recourse against industry than government and I believe thay are more capable of being regulated. Law can be used to penalize and control unethical behavior in industry, when does that happen with government entities? They may occationally scapegoat a member of government, but no government entity is ever penalized or controlled.


No, I do not trust the Corporations. The U.S. Government is not perfect. Show me a government that is, but I would trust them with this far quicker than Corporate American who, in my opinion, is like a great beast. It is a hard worker and can produce and increase prosperity for us all and it's owner, but without regulation and rules (and a leash and harness), it is just as likely to turn on it's own masters with little care or feeling, just to get back to the feed trough.

I don't trust them either and I am begining to become a little offended at the constant implication that I do. Reasonable government regulation has never been adverse to me, but government insurance as a competitive entity, especially when it would be as large and have the powers the proposed Bill is proposing definitely is. It would allow the government to monopolize healthcare. The difference is, we can choose to limit, control and/or desolve industrial entities and penalize them. Government would not be subject to that type of censure and once government has a power it is next to imposible to ever wrench it away again.

Klio
August 19th, 2009, 2:44 pm
Well, concerning the figures - here is my source:

http://news.bbc.co.uk/1/hi/health/8201711.stm


France - 81 years
Singapore - 79.7 years
UK - 79.1 years
US - 78 years

That's quite a difference.

For other comparisons look at the link above.

OldLupin
August 19th, 2009, 4:10 pm
Well, concerning the figures - here is my source:

http://news.bbc.co.uk/1/hi/health/8201711.stm


France - 81 years
Singapore - 79.7 years
UK - 79.1 years
US - 78 years

That's quite a difference.

For other comparisons look at the link above.

In what way does this account for lifestyle and statistical occurances of illnesses? Does it account for military action and criminal violence? Is there an offset for obesity? Is there an offset for traffic accidents? How much of this is actually due to lifestyle and not healthcare, especially when the U.S. has been a leader in medical science for the last 50 years and a hub of advancement in medicine over that time?

Mundungus Fletc
August 19th, 2009, 4:26 pm
In what way does this account for lifestyle and statistical occurances of illnesses? Does it account for military action and criminal violence? Is there an offset for obesity? Is there an offset for traffic accidents? How much of this is actually due to lifestyle and not healthcare, especially when the U.S. has been a leader in medical science for the last 50 years and a hub of advancement in medicine over that time?
Surely when the US is spending so much on healthcare - twice that of France and three time that of Britain such variables should be irrelevant. The US has been and still is a leader in medical science but since a large proportion of the population is excluded from benefiting those figures are self explanatory.

I must admit that I am at a loss to understand why people are opposed to a system that should prove cheaper (admittedly that is a supposition but one based on the experience of every other developed country)

alwaysme
August 19th, 2009, 5:14 pm
Well, concerning the figures - here is my source:

http://news.bbc.co.uk/1/hi/health/8201711.stm


France - 81 years
Singapore - 79.7 years
UK - 79.1 years
US - 78 years

That's quite a difference.

For other comparisons look at the link above.

I am not against nationalizing healthcare if it works but I honestly don't see how this argument can be used to describe how much worse the healthcare is in the United States compared to other countries.

We are talking about a year or twos difference in life span. Some of this could be difference in lifestyle.

Wab
August 19th, 2009, 5:20 pm
Three years is significant especially when you consider how much more the US spends.

And I personally would prefer to have my loved ones around and healthy for three more years than not.

alwaysme
August 19th, 2009, 5:34 pm
Three years is significant especially when you consider how much more the US spends.

And I personally would prefer to have my loved ones around and healthy for three more years than not.

Who wouldn't? That's not the point though.

How much of it is lifestyle? How much of it is violent crime (gun crime)? Which the United States has more of then Europe. How much of it is traffic accidents? United States has much more of that too. Those types of things need to be taken into consideration.

I am not disagreeing that we spend more or that we don't need healthcare reform. I just don't view this argument that I have seen floating around as a way to make the point that our healthcare system needs work.

Americans have known for a long time that our healthcare system needs work. Mainly to help control the costs and the aggravation that HMO's can bring. Which btw I have an HMO so I know personally how annoying it can be.

The idea though that America has bad quality of care is not the norm imo. Yes we have horror stories here, but most times the quality of care is excellent.

monster_mom
August 19th, 2009, 5:59 pm
Well, concerning the figures - here is my source:

http://news.bbc.co.uk/1/hi/health/8201711.stm


France - 81 years
Singapore - 79.7 years
UK - 79.1 years
US - 78 years

That's quite a difference.

For other comparisons look at the link above.

Are those the adjusted or unadjusted numbers?

Based on the WHO numbers I linked earlier, you can adjust the US life expectancy up about 1.5 years for non-health related deaths (interestingly due in large part to the fact that American's are really crummy drivers).

Overdose
August 19th, 2009, 6:35 pm
Which the United States has more of then Europe.

Please don't generalise. Europe includes a vast amount of ex-soviet block nations where the murder rate/gun-crime/corruption/crime in general is phenomenal. Not to mention vast differences in quality of healthcare, housing, wealth and general quality of life.

monster_mom
August 19th, 2009, 6:45 pm
Please don't generalise. Europe includes a vast amount of ex-soviet block nations where the murder rate/gun-crime/corruption/crime in general is phenomenal. Not to mention vast differences in quality of healthcare, housing, wealth and general quality of life.

I've been googling around on this, and yes, the former Soviet block nations do have more injuries and deaths due to violent crime than the rest of Europe.

When comparing the US with the UK, France, Germany (perhaps what we could call old Europe?), the US does have higher rates of injuries and deaths from non-health related incidents. Unsurprisingly to me, since I just got back from trip down I-95 (Yikes!), the most significant cause of the difference isn't gun violence but automobile accidents.

Apparently Americans are really crummy drivers.

Anyway, factoring out non-health related deaths, the life expectancy in the US is approximately the same if not slightly higher than in the rest of "old Europe". Five year survival rates in the US for the most common forms of cancer - breast, cervical, prostate, colon, lung - are sharply higher in the US than in the rest of "old Europe". The speculation was that the difference was due to more aggressive screening in the US and resulting earlier detection (one of the primary reasons health care is more expensive in the US).

alwaysme
August 19th, 2009, 6:47 pm
Please don't generalise. Europe includes a vast amount of ex-soviet block nations where the murder rate/gun-crime/corruption/crime in general is phenomenal. Not to mention vast differences in quality of healthcare, housing, wealth and general quality of life.

Going by the statistics that I have read. Not really including Soviet Nations.

I've been googling around on this, and yes, the former Soviet block nations do have more injuries and deaths due to violent crime than the rest of Europe.

When comparing the US with the UK, France, Germany (perhaps what we could call old Europe?), the US does have higher rates of injuries and deaths from non-health related incidents. Unsurprisingly to me, since I just got back from trip down I-95 (Yikes!), the most significant cause of the difference isn't gun violence but automobile accidents.

Apparently Americans are really crummy drivers.

Anyway, factoring out non-health related deaths, the life expectancy in the US is approximately the same if not slightly higher than in the rest of "old Europe". Five year survival rates in the US for the most common forms of cancer - breast, cervical, prostate, colon, lung - are sharply higher in the US than in the rest of "old Europe". The speculation was that the difference was due to more aggressive screening in the US and resulting earlier detection (one of the primary reasons health care is more expensive in the US).

And in my post those were the countries that I was mainly referring to. United Kingdom,France etc. I wasn't really considering Soviet Nations.

I-95 is a very scary interstate. :lol: Drive it often.

monster_mom
August 19th, 2009, 7:13 pm
I-95 is a very scary interstate. :lol: Drive it often.

I learned how to drive in the Springfield Mixing Bowl.

Wab
August 19th, 2009, 7:14 pm
Anyway, factoring out non-health related deaths, the life expectancy in the US is approximately the same if not slightly higher than in the rest of "old Europe". Five year survival rates in the US for the most common forms of cancer - breast, cervical, prostate, colon, lung - are sharply higher in the US than in the rest of "old Europe".

But worse than Cuba when it comes to breast cancer.

And while across the 5 most common cancers, the UK clearly lags but a recent CONCORD study of the UK, US, Australia Canada and NZ "found that no one country was the best at all of them. Australia, Canada, New Zealand and the US were all about equal on average."

http://seminal.firedoglake.com/diary/7278

HedwigOwl
August 19th, 2009, 7:21 pm
Surely when the US is spending so much on healthcare - twice that of France and three time that of Britain such variables should be irrelevant. The US has been and still is a leader in medical science but since a large proportion of the population is excluded from benefiting those figures are self explanatory.

I must admit that I am at a loss to understand why people are opposed to a system that should prove cheaper (admittedly that is a supposition but one based on the experience of every other developed country)

You aren't the only one at a loss. Some people are afraid of change in general, and others believe the hype about government "getting between medical decisions by doctor and patient"....the irony is that corporate executives in the for-profit healthcare industry are already doing that. If anyone's interested, here's a link with interviews/testimony from a 20-year healthcare executive that shows how little regard the companies have for providing healthcare to their customers. It's really all about revenue and shareholder value.

http://http://www.pbs.org/moyers/journal/07102009/profile.html

monster_mom
August 19th, 2009, 7:34 pm
But worse than Cuba when it comes to breast cancer.

What a huge difference - 83.9% in the US vs 84.0% in Cuba.

I'd say that 5 year breast cancer survival rates in the US are about equal to Canada (US 83.9, Canada 82.5), but Australia (80.7), France (79.8), and England (69.8) have a long way to go to catch up.

Your guy does agree what I found - aggressive screening, especially among those at high-risk, dramatically increased long term survival.

His statement that you can't judge the relative merit of a health care system by one statistic is also valid, and why I presented the survival rates for the most common forms of cancer where the differences aren't quite as pronounced but still favor the US.

Den_muggle
August 19th, 2009, 7:47 pm
I don't normally post in this area, but I have yet to get an answer to a suggestion I have had to improve health care.

If you look at the portion of the medical "industry" where people pay their own way and insurance and govt have mostly kept hands off, you will see a dramatic drop in costs. Look at elective surgeries such as LASIK and plastic surgery. Prices have dropped dramatically over the past 10-15 years. No speculation here, this is what has happened due to less overhead, less paperwork, faster payments, more patient involvement/oversight, price comparisons, etc.

Why wouldn't this be a better option for reforming the rest of health care? We already have HSAs. Why couldn't we provide aid to those who need it by helping (through govt if necessary) to fund the HSA accounts to handle the deductible? We could even (through tax credits or straight out payments) help cover the high-deductible insurance necessary.

Also, how will another govt program help when a goodly number of the uninsured now qualify for coverage that they haven't signed up for?

I apologize if these have been addressed, as I don't often come here and haven't read the entire thread, though I have checked on it now and again. I really would like to hear why this is such an unacceptable alternative. It seems to me to meet the stated goals of helping extend coverage without losing the good parts of the system many of us would like to keep.

Thank you.

USNAGator91
August 19th, 2009, 8:25 pm
What a huge difference - 83.9% in the US vs 84.0% in Cuba.

I'd say that 5 year breast cancer survival rates in the US are about equal to Canada (US 83.9, Canada 82.5), but Australia (80.7), France (79.8), and England (69.8) have a long way to go to catch up.

Your guy does agree what I found - aggressive screening, especially among those at high-risk, dramatically increased long term survival.

His statement that you can't judge the relative merit of a health care system by one statistic is also valid, and why I presented the survival rates for the most common forms of cancer where the differences aren't quite as pronounced but still favor the US.

I tend to have Mark Twain's perception on statistics, but there MAY be a slight misperception here. One should also look at relative populations when taking into account these survival rates:

Canada - 32,000,000
UK - 62,000,000
Australia - 21,000,000
France - 65,000,000
Cuba - 11,000,000
US - 307,000,000

Source: I apologize, I used Wikipedia for the sake of time

The relative population counts may tend to demonstrate that US system is caring and helping a larger raw number of cancer patients vis a vis the other countries.

This is my point around comparisons with other systems. None of the hallmarks have the sheer size of population that we're talking about here. British Columbia just experienced a shortfall on surgery budgets.

There isn't even a comparable system that has cared for a population even 1/3 that of the United States. This is what makes comparisons so impossible AND scares me about some monolithic bureaucracy to handle all health care in the United States.

monster_mom
August 20th, 2009, 1:07 pm
I don't normally post in this area, but I have yet to get an answer to a suggestion I have had to improve health care.

If you look at the portion of the medical "industry" where people pay their own way and insurance and govt have mostly kept hands off, you will see a dramatic drop in costs. Look at elective surgeries such as LASIK and plastic surgery. Prices have dropped dramatically over the past 10-15 years. No speculation here, this is what has happened due to less overhead, less paperwork, faster payments, more patient involvement/oversight, price comparisons, etc.

Why wouldn't this be a better option for reforming the rest of health care? We already have HSAs. Why couldn't we provide aid to those who need it by helping (through govt if necessary) to fund the HSA accounts to handle the deductible? We could even (through tax credits or straight out payments) help cover the high-deductible insurance necessary.

Also, how will another govt program help when a goodly number of the uninsured now qualify for coverage that they haven't signed up for?

I apologize if these have been addressed, as I don't often come here and haven't read the entire thread, though I have checked on it now and again. I really would like to hear why this is such an unacceptable alternative. It seems to me to meet the stated goals of helping extend coverage without losing the good parts of the system many of us would like to keep.

Thank you.

Pretty good points, Den. We haven't really talked about HSAs much, and the Democrats bills pretty much makes them useless. The Republican bill doesn't push them much but does expand the individual market so you might see more people choosing a privately purchased high deductible plan coupled with an employer funded HSA.

Even a plan with an 80/20 split (insurer pays 80% for procedures not done in a DR's office, patient pays 20%) will get people to pay more attention to costs because that 20% can add up fast.

One question about HSAs. A million years ago when they first began you had to use all the money in a year or you'd lose it. IS that still the case or can you keep the money from year to year? If you change jobs does the money come with you - even the employer match?

Den_muggle
August 20th, 2009, 7:39 pm
One question about HSAs. A million years ago when they first began you had to use all the money in a year or you'd lose it. IS that still the case or can you keep the money from year to year? If you change jobs does the money come with you - even the employer match?

That's an FSA (Flexible Spending Account). Those are use-it-or-lose-it types that have to be used by the end of the year or the money is gone. HSAs (Health Savings Accounts) are different in that the money is actually yours and remains in your account, rolling over to let you build up a nice fund if you're healthy and don't use it. You can do it through your employer, but unlike FSAs, HSAs can be done as an individual. The only requirement is that you have the high-deductible insurance plan for catastrophic illness. You administer it yourself and don't have to go to your employer for reimbursement. It is yours and has nothing to do with your employer...even if they match or somehow pay into it for you or if you have it automatically withheld from your pay. It can also work as an IRA in that if you hold it until you turn 59.5, you can withdraw it for uses besides medical without penalty. Some HSAs have options where you can invest if you choose to once the balance is above a certain limit. It gives you a lot of freedom of choice, but is a very nice safety net.

Chris
August 21st, 2009, 5:20 am
I'd love to see your source for this statement.

According to the WHO in their global comparative assessments, the standardized life expectancies in the US are the highest at 76.9 years. The standardized life expectancy is the unadjusted life expectancy adjusted for premature death resulting from non-health-related fatal injuries.

Also according to the WHO, (http://mjperry.blogspot.com/2009/08/us-vs-europe-life-expectancy-and-cancer.html) 5 year survival rates in the US for various forms of cancer far outstrip those in other developed nations.


The 5 year survival rate for stage 1 - 4 breast cancer in the US is 88%, in the UK it's 78% and in Ireland it's 76%.
The 5 year survival rate for colon and rectal cancer is 66% in the US and 56% in the rest of Europe.
The 5 year survival rate for prostate cancer is 99.3% in the US and 78% in the rest of Europe.


Don't bother with infant mortality statistics because comparing them is like comparing apples and oranges. The WHO's definition is "all babies showing any signs of life, such as muscle activity, a gasp for breath or a heartbeat, should be included as a live birth." According to UNICEF, The US, Canada, and Australia strictly follow that definition. But many other countries do not. (http://www.eurocat.ulster.ac.uk/pdf/Report-8-Appendix-7.pdf) In some regions (like Dublin Ireland) a baby born at less than 24 gestational weeks who dies at 4 years of age won't count in mortality statistics because that child was, by definition, stillborn.

Going back to the OECD, “Taking into account such data-reporting differences, the rates of low-birth-weight babies born in America are about the same as other developed countries in the OECD. Infant mortality rates, adjusted for the distribution of newborns by weight, are about the same."

I've been looking at their source data, and I have a few issues with their source data.

First, they fit a "semi-log" fit to the curve on page 9. This statistically fits, but at what point does the model defy common sense? They find a nonlinear relationship between GDP and health spending. At the logical extreme of this, their model then predicts that it'll double spending on health care for every dollar increase in GDP. That curve was pointed the wrong way...

On pages 12 and 13, they note "cost of life years gained" for increases in health spending. Convienently, their "comparison countries" are omitted from the slides. To me, that usually is suspicious, since on the slides immediately beforehand they are comparing to other countries.

On page 11, France has been dropped off the list. Again, this says to me that they're hiding something - they added in Sweden and japan.

On pages 16 and 17, they note a health disparity between blacks and whites in life expectancy, homicide, and traffic accidents. Yet, they don't break it down on page 18 (table 1.5, the one that ended up in the blog link you posted). Why?

The very next page (19), they show that there's massive disparity within the US system in life expectancy. This isn't acceptable to me. Why should the race of one's birth end up statistically giving a 10-16% difference in 5 year survival rates? I think that the explanation here is relative lack of health insurance. You know, the thing that Obama and Congress are trying to get - health insurance for all. Perhaps this disparity would tighten? One may hope.

Omitted from the blog posting, the entire text of slide 20:
•Given lack of precision in available outcome measures as system performance metrics:
–Cannot reliably conclude U.S. system performance “on average”is markedly worse than other large, high-income nations with diverse populations (a small league)
–But cannot conclude U.S. system performance is markedly better either, despite higher levels of spending.
•Greater variance in access to treatment related to large uninsured population in U.S. creates a “drag”on U.S. outcome performance metrics “at the mean.”

Note the last. The authors of the original presentation conclude that the US could be better if the uninsured were insured!

Slide 28:
The broad policy objective of “universal care”does not necessarily imply single-payer health systems.
•Nominal objectives of single-payer approach are to improve access, reduce administrative “waste,”and direct resources to where they are most needed.

They then go on to a pro and con argument, where they do conclude that they think that single payer might not be the best way. But they invoke "moral hazard" as a con, which I don't know what that means and to me it implies a larger agenda against reform that may have tainted their analysis.

My point of this whole thing is, I think that the blogger selectively parsed his data to suit the conclusion he wanted to make. As a scientist, this offends me. The two presenters of the original presentation did a bit better job of presenting the data itself as a neutral presentation, but they too invoked a couple things that I didn't appreciate as a scientist. The methodology they used to make the fancy graph that you liked hides an important aspect of health disparity that some of their other data showed, and it's this health disparity that health care reform seeks to address. There's a segment of the population that doesn't have access to the amazing health care resources that the rest of the population does. Yes, they *have* to be treated for immediately threatening conditions when they walk into the ER. But, there's nothing that says they have to fix the underlying issue, since the underlying issue isn't going to kill them right then and there.

The democrat bills aren't perfect, but they are a good start, and the talking, talking, talking I hope gets translated into action. Again, to draw an analogy from science, enough talking, and go try the idea.

canismajoris
August 21st, 2009, 12:54 pm
That's not to say that they don't support reform, because, if memory serves, more than 70% and maybe more than 80% of the population believes some sort of reform is necessary. It's just that the reforms proposed by the Democrats aren't sitting well with the population.
Or it could be that I've been right all along (if you recall my earlier posts) that people just have no idea what's even being proposed. I hear stories all the time about how people are actually surprised to learn that there won't be the infamous "death panels". I have a feeling it's no coincidence that the president is running all over the country talking about the plan, whatever it happens to be at the moment, because people seem to be largely misinformed about it.

USNAGator91
August 21st, 2009, 2:25 pm
The democrat bills aren't perfect, but they are a good start, and the talking, talking, talking I hope gets translated into action. Again, to draw an analogy from science, enough talking, and go try the idea.

Well and good, Chris, except for one thing. You don't "experiment" with $1.6 Trillion dollars. This would fundamentally alter the health care landscape in a way that many Americans do not want.

If you truly want to draw a scientific inference, look at Medicare as a subset of the greater whole. How's that working for everyone?

Unfortunately the day of reckoning is imminent. Sometime in the next President's first term, Medicare Part A (hospital insurance) will go cash-flow-negative, and it's all downhill from there. Medicare provides a wide range of services and subsidies to more than 40 million old and disabled Americans. As the country ages, Medicare and Medicaid (for those of any age with low incomes) will devour growing chunks of U.S. economic output. So will Social Security, but its cut of GDP should stop increasing around 2030. The federal budget has averaged about 18% of GDP over the past several decades. If that average holds and if the rules of our social insurance programs don't change, then by 2070, when today's kids are retiring, Medicare, Medicaid, and Social Security will consume the entire federal budget, with Medicare taking by far the largest share. No Army, no Navy, no Education Department - just those three programs.

But without changes to Medicare, they're meaningless. Medicare will eventually overwhelm everything else in the budget, except for the interest on the mushrooming debt to pay for it.

Source: CNN/Fortune Magazine - The $34 Trillion Problem - Medicare (http://money.cnn.com/2008/03/03/news/economy/104239768.fortune/index.htm?postversion=2008030405)

That's JUST Medicare - just covering the elderly and disabled, roughly 40 Million people. What does covering 300 Million do?

Cost is ballooning, just as a budget item.

In 1970, cost per enrollee was $1700 with 20 Million enrolled. In 2000, cost per enrollee was $6200 with 40 million enrolled.

Source: Medicare by the numbers - USA Today (http://www.usatoday.com/news/graphics/medicare_chartscroll/flash.htm)

Despite what the President promises in terms of being "Deficit" neutral, both the CBO and common sense tells us that putting something out there like Medicare for all, by definition, will inflate costs. If the government can't even run Medicare, how will they be able to run Obamacare?

monster_mom
August 21st, 2009, 2:36 pm
The democrat bills aren't perfect, but they are a good start, and the talking, talking, talking I hope gets translated into action. Again, to draw an analogy from science, enough talking, and go try the idea.

I disagree wholeheartedly. There is no try this idea when you're talking about nationalizing the health insurance industry and moving towards a single payer system - which, lets be honest - many many many Democrats have publicly stated that they'd prefer.

The Democrats bill have very little that I'd consider improvements. Heck - by CBO estimates they still won't cover a chunk of the uninsured despite spending more than $1 trillion.

I think there's a better and way that doesn't force dependence on the government, but highly doubt the Democrats will even consider it.

Chris
August 21st, 2009, 2:52 pm
Well, what's the better idea? And, how is it feasible? And what does it cost? Gator just busted out that it'll be 1.6 trillion (does this involve servicing of the debt? Otherwise that doesn't match the CBO). My suspicion is that HR 3400 is going to cost more than HR 3200, once the CBO scores it.

What I'd like added into the bills: more aggressive fraud detection and prosecution and modest tort reform.

What I like about the bills: it's trying to provide health care for everyone, which is a goal we really should have. And, I look at the lies going on out there combating the health care reform, and I think to myself "what are the opponents hiding". If all the opposition on TV, in ads, and by political figures actually was opposing what is actually in the bill, then i'd respect it a bit more. But, really, Obama and Congress are having the debate slip from their hands a bit because they've been shocked and appalled that the opponents have resorted to so many lies. They wanted to go with the truth, and it's hurting them. I at least take heart in noting that much of what's posted in the DoIMC seems to be actual debate about the bills, but that's not what's going on out in the larger world.

I'm not suggesting trying something without having studied it first. But, you know what? They're studying them now. That's why I think it's time to try. This isn't the "first club out of the bag", as a chemist would say - the first club out of the bag was in the 1940's. This is the fourth or fifth attempt, and by then, usually the people trying things know what they're doing.

Mundungus Fletc
August 21st, 2009, 3:19 pm
Huffington (http://www.huffingtonpost.com/ann-leary/britains-national-health_b_264454.html) has an interesting piece on the NHS by an American who has experienced it. Of particular note is the comparative costs of the two systems - the figures are rather old but I think the comparison is still valid. The events described btw were at a time when the NHS was at the nadir of its fortunes because of conservative cuts

monster_mom
August 21st, 2009, 3:20 pm
Well, what's the better idea? And, how is it feasible? And what does it cost? Gator just busted out that it'll be 1.6 trillion (does this involve servicing of the debt? Otherwise that doesn't match the CBO). My suspicion is that HR 3400 is going to cost more than HR 3200, once the CBO scores it.

Since the CBO is on vacation, we have no idea how much HR 3400 costs. But I thinkit has a better probability of controlling costs while which will make purchasing health coverage easier and more likely for those without coverage.

What I'd like added into the bills: more aggressive fraud detection and prosecution and modest tort reform.

While tort reform will keep the doctors happy, I'm not sure it'll save that much in costs. I think it should be done because the fear of lawsuits seems to dictate decisions doctors make and increases costs - Obstetrics is one area where the fear of lawsuits results in increased induction and c-section rates when they aren't necessarily warranted.

What I like about the bills: it's trying to provide health care for everyone, which is a goal we really should have.

I'm not sure if you're referencing HR 3200 or HR 3400, but both bills try to make health insurance more affordable for all. The Democrat's bill does this by nationalizing health insurance and providing taxpayer assistance to qualifying individuals once they've spent one months pay on premiums. The Republican's bill does this by expanding the individual and small business markets and providing taxpayer assistance to qualifying individuals for the first $2,000 - $5,000 of insurance premiums.

And, I look at the lies going on out there combating the health care reform, and I think to myself "what are the opponents hiding". If all the opposition on TV, in ads, and by political figures actually was opposing what is actually in the bill, then i'd respect it a bit more. But, really, Obama and Congress are having the debate slip from their hands a bit because they've been shocked and appalled that the opponents have resorted to so many lies. They wanted to go with the truth, and it's hurting them.

What lies? What truth? All I've heard is regurgitated talking points from Democrats. The Republicans haven't said a word. The opposition is the American people. The Democrats and the President are being taken to task because American's don't support they bill they've proposed.


**** Edit **** Moved from the Obama thread per Chris's request

Or it could be that I've been right all along (if you recall my earlier posts) that people just have no idea what's even being proposed. I hear stories all the time about how people are actually surprised to learn that there won't be the infamous "death panels". I have a feeling it's no coincidence that the president is running all over the country talking about the plan, whatever it happens to be at the moment, because people seem to be largely misinformed about it.

When I've heard the President speak about the proposal I have to wonder whether he's actually read the thing because the promises he's making have no bearing on what's actually proposed in the bill. Much of the misinformation, from what I've seen, is coming from him.

The people I've spoken with have done their research. They've read the bills and understand what's called for. While they think something needs to be done to reduce health care costs and provide affordable health insurance coverage for those who can not afford it, they think the Democrat's bill stinks and will ultimately increase costs rather than control them. Most of the people I've spoken with think there's a better way of addressing the problems in the heath care than what the Democrats have proposed.

And the concern over the death panels is valid. You just have to look at the examples in Oregon, where patients are denied treatment which might extend their lives because that money could be better spent elsewhere. Or you just have to, well, take the Presidnet and his advisers at their word on the subject.

Here's Ezekiel Emanuel, Rahm Emanuel’s brother and one of Obama’s health-care advisors, from a 2009 paper he wrote on *** subject of rationing care based on the public value the patient provides:

Services provided to individuals who are irreversibly prevented from being or becoming participating citizens in the body politic are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

And here's Barak Obama discussing whether certain care should be provided to terminal patients

Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. … And that’s part of why you have to have some independent group that can give you guidance.

What options do you have if that independent group decides you aren't worth it?

What if you have a child with downs who develops infant leukemia - a cancer children with downs develop more frequently than the general population. Kid has downs and may not contribute much to society. He'll probably need some sort of assisted care over the course of his life and will need expensive therapies and support to function. That's thousands, possibly hundreds of thousands of dollars for a person who probably won't ever contribute that much back. Do you treat his cancer? Do you give him bone marrow transplants and chemotherapy -treatments that can easily run into the millions, knowing that his probability of survival is relatively low and that if he survives he won't likely be a highly contributing member of the "body politic"?

When the government controls health care it has to make these decisions. It can't, and won't, just provide every treatment to every person. So who gets cut? Those at the "bottom" of society? Treatment for advanced lung cancer among smokers - cut. Pacemakers for people over 90 - cut. Chemo for kids with severe birth defects - cut.

Chris
August 21st, 2009, 3:38 pm
What lies? What truth? All I've heard is regurgitated talking points from Democrats. The Republicans haven't said a word. The opposition is the American people. The Democrats and the President are being taken to task because American's don't support they bill they've proposed.

Fortunately, this was an easy one for me to fact-check myself. I think you're thinking too optimistically about the Republican opposition, unless you dispute the factchecking behind each of these:

Roy Blunt (http://www.politifact.com/truth-o-meter/statements/2009/aug/19/roy-blunt/59-gop-congressman-says-he-couldnt-get-hip/)

Sarah Palin (http://www.politifact.com/truth-o-meter/statements/2009/aug/13/sarah-palin/palin-claims-obama-misled-when-he-said-end-life-co/) Palin (http://www.politifact.com/truth-o-meter/statements/2009/aug/10/sarah-palin/sarah-palin-barack-obama-death-panel/), take 2

Michelle Bachmann (http://www.politifact.com/truth-o-meter/statements/2009/aug/12/michele-bachmann/bachmann-says-obama-health-adviser-thinks-health-c/)

All these are on the first page of politifact, an easily accessible fact-checking page which is non-biased in that they are equally willing to call out Democrats.
On page 2 of their health section:
John Boehner (http://www.politifact.com/truth-o-meter/statements/2009/aug/07/john-boehner/boehner-says-democrats-health-care-plan-would-lead/)

Betsy McCaughey (http://www.politifact.com/truth-o-meter/statements/2009/jul/23/betsy-mccaughey/mccaughey-claims-end-life-counseling-will-be-requi/) (former Lt Gov of NY)

Ad campaigns:
Conservatives for Patient's Rights (http://www.politifact.com/truth-o-meter/statements/2009/may/11/conservatives-patients-rights/health-board-stimulus-bill-not-meant-imitate-brita/)
Senior Scare (http://www.factcheck.org/2009/08/more-senior-scare/) (at factcheck now)
CPR bad facts (http://www.factcheck.org/2009/08/cpr-administers-bad-facts-again/)
Family Research Counci (http://www.factcheck.org/2009/07/surgery-for-seniors-vs-abortions/)

All of these were found again within just a few minutes of searching. There's a lot of misinformation out there. These are the lies I am talking about, that are seeping in. I don't think that one should be able to look at this list and deny that there is a lot of misinformation out there. It's simply an unavoidable conclusion. Obama is perhaps being overly optimistic in some of his statements, and he's been guilty of misstating things, but he's also up against this tide of misinformation that has swamped the debate and taken it away from what it should be.

Wab
August 21st, 2009, 3:42 pm
When the government controls health care it has to make these decisions. It can't, and won't, just provide every treatment to every person. So who gets cut? Those at the "bottom" of society? Treatment for advanced lung cancer among smokers - cut. Pacemakers for people over 90 - cut. Chemo for kids with severe birth defects - cut.

It's happening now under the current model of a solely for profit system.

Having lived with an NHS system the only times I've seen treatment not given was after consultation in cases where aggressive treatment would not extend life to a point to justify the dimunition of quality of life or when the required procedure would more than likely kill the patient.

monster_mom
August 21st, 2009, 4:36 pm
It's happening now under the current model of a solely for profit system.

Your evidence for that is what?



Since we're posting misrepresentations.......

Obama's Top 5 Health Care Lies (http://www.forbes.com/2009/06/30/obama-health-care-reform-opinions-columnists-public-option-medicare.html)

They include:
- No one will be compelled to buy coverage.
- No new taxes on employer benefits.
- Government can control rising health care costs better than the private sector.
- A public plan won't be a Trojan horse for a single-payer monopoly.
- Patients don't have to fear rationing.

How about the much touted - if you like your insurance you can keep it line. Not so much truth there (http://www.factcheck.org/2009/08/keep-your-insurance-not-everyone/)

And those no cuts in Medicare. Not so much (http://www.politifact.com/truth-o-meter/statements/2009/aug/14/barack-obama/obama-claims-medicare-benefits-will-not-be-cut-und/), if you want to find a physician or facility willing to take Medicare.

And I'd put the claims by Blunt in the same category as Obama's GP's amputating diabetics feet because they can make more in fees and removing tonsils instead of giving a pill for a sore throat. Clueless ** to make a point. Unfortunately, while Blunt's rather in-eloquent point was that care in single payer systems is rationed and that waits for care are significantly longer, Obama's rather in-eloquent points are that Doctors are a bunch of money grabbers who'd rather cut you open than provide you with adequate care.

SSJ_Jup81
August 21st, 2009, 4:58 pm
Your evidence for that is what?Don't some insurance companies try to find loopholes to get out of paying for such things since it's an expense to them? Sorta like how they go out of their ways to not accept people with pre-existing conditions at a reasonable price.

Overdose
August 21st, 2009, 5:05 pm
Seriously I fail to see why we should have to prove to you that our NHS doesn't leave people out to dry or cancer patients on the streets or downs kids who might not contribute (looking after these people is after all the point of a socialised system since they cannot look after themselves). It's at best insulting.

More importantly, since we don't consider our good doctors who have the freedom to provide care as they please and do not deal with money/quotas personally and simply register treatments to be some sort of evil force, i highly doubt anybody's commissioned a study to see how many downs centres leave kids on the streets.

Besides all this if somebody really hates the idea of being looked after by the NHS then they are not barred from buying insurance from groups like BUPA (which I actually have right now since i wanted some additional cosmetic surgery after an accident), which has full coverage for £600 per year, a price that they charge since they are competing with National Insurance.

monster_mom
August 21st, 2009, 5:09 pm
Don't some insurance companies try to find loopholes to get out of paying for such things since it's an expense to them? Sorta like how they go out of their ways to not accept people with pre-existing conditions at a reasonable price.

Read HIPAA (http://www.dol.gov/ebsa/newsroom/fshipaa.html)

Under the law, insurance companies can refuse to subsidize the cost of medical care for pre-existing conditions (excluding pregnancy) for up to 12 months if you have not had continuous coverage for a condition you were diagnosed with in the last 6 months or received care for in the last 6 months. Continuous coverage is if you've had no more than a 63 day (2 month) break in coverage in the past 12 months.

You can buy a plan that covers pre-existing conditions from day 1, you just have to pay for it. Many employers provide plans that accept pre-existing conditions. Ever employer I've ever worked for has had a plan that covered pre-existing conditions.

OldLupin
August 21st, 2009, 5:17 pm
Well, what's the better idea? And, how is it feasible? And what does it cost? Gator just busted out that it'll be 1.6 trillion (does this involve servicing of the debt? Otherwise that doesn't match the CBO). My suspicion is that HR 3400 is going to cost more than HR 3200, once the CBO scores it.

What I'd like added into the bills: more aggressive fraud detection and prosecution and modest tort reform.

What I like about the bills: it's trying to provide health care for everyone, which is a goal we really should have. And, I look at the lies going on out there combating the health care reform, and I think to myself "what are the opponents hiding". If all the opposition on TV, in ads, and by political figures actually was opposing what is actually in the bill, then i'd respect it a bit more. But, really, Obama and Congress are having the debate slip from their hands a bit because they've been shocked and appalled that the opponents have resorted to so many lies. They wanted to go with the truth, and it's hurting them. I at least take heart in noting that much of what's posted in the DoIMC seems to be actual debate about the bills, but that's not what's going on out in the larger world.

I'm not suggesting trying something without having studied it first. But, you know what? They're studying them now. That's why I think it's time to try. This isn't the "first club out of the bag", as a chemist would say - the first club out of the bag was in the 1940's. This is the fourth or fifth attempt, and by then, usually the people trying things know what they're doing.

O.K., this again prompts me to ask the ever ignored, yet all too pertinent question of "Why would anyone, even an Obamacon, die hard Democrat, for one second have any belief that the government won't run healthcare right into the ground, reduce quality and increase cost when every other program they run does exactly that?"

This type of faith borders on religous faith, IMO as it has actual negative proof far more compelling than pretty much any other faith does. Hundreds of examples of government waist and inefficiency and no one has even attempted to site one program that actually costs less and provides even an adequate service. They studied education, they studied healthcare they studied entitlement and they have studied all manner of other occaision for government intervention. Which of these did they actually suceed at? We have education for all, yet it is much poorer and more expensive than it was when it wasn't state run. We already have government healthcare for some, it too is a financial black hole and has become a financial burden for providers and well as unsatisfactory for many who are forced to use it.

Let us get past what "sounds good" and get real on this very critical issue. We don't need the government to be a provider of healthcare on any grand scale. We should fear that if for no other reason than common sense. Hhealthcare provided by the same entities that currently bring us public education and the DMV is a nightmare scenario. Sold with good intentions and admirable compassion, but those things are no substitute for good old critical thinking and planning. Part of that thinking and planning is obviously to keep government in their element and healthcare in its own. Law and regulation, legal reform and policy shift to curb costs should be predicated by someone actually defining where the costs come from and how to minimize them without killing the industry. So far there is only a shell game called "The blame game" and it is sickening to me. If it is the insurance industry, the 4.2% profit would seem to prove otherwise. A real terms breakdown doesn't seem to exist in objective terms, so I would wholeheartedly start there.

Wab
August 21st, 2009, 5:26 pm
Your evidence for that is what?

Just testimony before the U.S. Senate Committee on Commerce, Science and Transportation.



"The average family doesn't understand how Wall Street's dictates determine whether they will be offered coverage, whether they can keep it, and how much they'll be charged for it. But, in fact, Wall Street plays a powerful role.

...

To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick."

http://www.pbs.org/moyers/journal/07102009/potter_testimony.html



You can buy a plan that covers pre-existing conditions from day 1, you just have to pay for it. Many employers provide plans that accept pre-existing conditions. Ever employer I've ever worked for has had a plan that covered pre-existing conditions.

SSJ specified at a reasonable price.

OldLupin
August 21st, 2009, 5:32 pm
Or it could be that I've been right all along (if you recall my earlier posts) that people just have no idea what's even being proposed. I hear stories all the time about how people are actually surprised to learn that there won't be the infamous "death panels". I have a feeling it's no coincidence that the president is running all over the country talking about the plan, whatever it happens to be at the moment, because people seem to be largely misinformed about it.

This reminds me of the protests in D.C. where Cheney was supposed to have actually ordered levis blown-up and Bush was secretly setting up the Afghanistan pipeline. Misinformation is all over the place on both sides whenever there is mass reaction.

The problem I have with this characterization is that all oposition is based on misnomer and not actual reasoned skepticism and rationale. My oposition is based on my belief that the government of the U.S. is incapable of effectively running any large program, least of which any large program so critical and intricate as healthcare. I am not alone. People may like President Obama, they may support him in general, but where their child's health and their parents' health is concerned they may not be as trusting of the package(s) being forwarded.

Who can really blame them, especially since many have already procured insurance, sometimes, like in my case, as oposed to higher pay to ensure good healthcare treatment for my children. If the government gets involved, all evidence is that by the time they are trying to get healthcare for their children (my grandchildren) it will be a massive, expensive and poor provider that they will have no option to avoid. For the record, their health means more to me than my own and a lot of people have their perceptions shaped by that type of greater concern. It is why many young liberals become older conservatives.

SSJ_Jup81
August 21st, 2009, 6:13 pm
Yep, exactly. A reasonable price. I already gave my sob story. I'm a Type II Diabetic. The insurance companies I called to try and get coverage, all had unreasonable prices. There was no way I was going to pay such a high premium for that. It was unaffordable for me, when I had other bills to worry about. Rent, food, student loans, etc. I didn't qualify for Medicaid (made too much), and way too young for Medicare ( :lol: )

As a diabetic, I need the care as I take medication. Right now, I'm unemployed, so what monster_mom proposed, wouldn't apply to me, nor can it apply to me. It's been way over 6 months. :P

Just to think, I'd probably still have my old job (even though my employer didn't offer insurance), if the housing mess didn't go all wrong. I lost it back when the housing market started to collapse.

Chris
August 21st, 2009, 6:15 pm
Lupe, I'm insulted that you think that I'm blindly putting my position forth without thinking. At least two neurons were firing in the making of that previous post. And, I am also insulted as a thinking man that so many opponents of legislation seem to have stooped to the lies that I laid out in my previous posts. I recognize that government is not always efficient, but you know what? The efficient plans don't get press because no one's complaining. Jon Stewart got Bill Kristol to admit, on TV, that the government can run a good health plan. Kristol's response, paraphrased? "Well, the military vets deserve better care than the rest of Americans". This isn't a satisfactory response to me!

Please don't label us as blind loyalists. I'm not labeling opponents as being blindly opposed. I'm instead noting the myriad of misinformation that has muddied the waters, and it makes me suspicious of the motives of those who are muddying the waters. If one opposes health care reform based on principles or on what's actually in the bills, fine. But, when people say "keep the government away from my medicare", that shows to me that fundamentally many people are unaware of the true facts of the debate. I seek to correct all that I can that's floating around that's incorrect, and I barely have enough time to look up 10% of what I bet is out there. And that's scary to me, since I think many people would be surprised to learn what's actually in the bills, instead of what they think is in the bills.

flimseycauldron
August 21st, 2009, 7:00 pm
I think many people would be surprised to learn what's actually in the bills, instead of what they think is in the bills.

This is my beef. Granted I haven't read through every link you posted but here is an excerpt from one of your own links of exactly what I am talking about.

Incredible Shrinking Benefits?

After celebrating the accomplishments of older Americans, the narrator gets straight to the scary stuff: "Congress plans to pay for health care reform by cutting $500 billion from Medicare." The ad doesn’t mention that the $500 billion is a gross figure that counts only proposed cuts while ignoring any increases, including a big increase the bill proposes in projected payments to doctors.

Bold mine. Firts off where, exactly in the bill does it say this? There are no direct links to the legislation. Secondly, is this increases to all Doctors and is exclusive to Medicare patients? Or is it increases for all patients? If the latter it's like cutting a hundred dollars from Medicare and then having the increases bring in twenty five dollars. That's still a net loss to Medicare of seventy five dollars. The increases would have to not only negate the cuts to Medicare but also cover all the extra people that will be forced on to Medicare.


The nonpartisan Congressional Budget Office has estimated that the House bill would result in "savings" of $219 billion after all increases and decreases are netted out.

Savings where and where will the savings go? If it is averaged out between all the programs they each take a loss. Medican itself is insolvent. I understand better care for less waste but none of this implies better care.

The House bill would trim projected increases in payments for hospitals, insurance companies, pharmaceutical companies and others, including home health care providers and suppliers of motor-driven wheelchairs.

Is it in the legislation that certain items will have to be covered by insurance? If so, where exactly does it say that and what items will be covered?

But it also proposes what CBO estimates is a $245 billion increase in spending for doctors, by canceling a scheduled 21 percent cut in physician payments.

Okay this just makes my head hurt. The inference here is that more doctors will be hired by using money cut to physician payments. And good thing because more doctors are going to be needed because care will compromised when patients are rushed in and out of the doctors office to make up the difference. And, again, where is this pointed out in the legislation? And which doctors are going to recieve the extra money? Geriatric doctors?

Chris it seems to me that all these links say what is in the bill but do not show where or how it will effect the day to day operations in hospitals and doctor's offices as how they directly relate to patient care.

And that is my problem all these links say "what's in the bill" but they don't show what's in the bill, nor how take into account how interdependant the varioys aspects of the bill are on one another.

Chris
August 21st, 2009, 7:40 pm
I believe you were referring to factcheck's "senior scare" one?

I think the takeaway message from that is that the bill doesn't cut 500 billion. The bill, in the GAO estimates, may save $500 billion in rising costs, but the bill itself does not explicitly say that. For instance, the "unchecked" increase in medicare spending could be, say, 1.5 trillion. The "with the bill" increase in medicare spending would then come up at an even $1 trillion. So, in a way, it's factually correct to say that $500 billion isn't cut from medicare, but also that there's no guarantee that $500 billion in "increased spending" would be avoided. If a pro-reform outfit came out with a commercial claiming that the bill guarantees that savings, it would also be inaccurate, and in fact I recall that politifact may have called out someone on a similar claim.

Example = mine; actual figures not looked up on account of time. But the senior scare does list their sources down bottom; factcheck usually writes a mini-essay and then puts their sources at the bottom. They direct link some things but I think politifact does direct linking a bit better.

OldLupin
August 21st, 2009, 7:41 pm
Lupe, I'm insulted that you think that I'm blindly putting my position forth without thinking. At least two neurons were firing in the making of that previous post. And, I am also insulted as a thinking man that so many opponents of legislation seem to have stooped to the lies that I laid out in my previous posts. I recognize that government is not always efficient, but you know what? The efficient plans don't get press because no one's complaining. Jon Stewart got Bill Kristol to admit, on TV, that the government can run a good health plan. Kristol's response, paraphrased? "Well, the military vets deserve better care than the rest of Americans". This isn't a satisfactory response to me!

Please don't label us as blind loyalists. I'm not labeling opponents as being blindly opposed. I'm instead noting the myriad of misinformation that has muddied the waters, and it makes me suspicious of the motives of those who are muddying the waters. If one opposes health care reform based on principles or on what's actually in the bills, fine. But, when people say "keep the government away from my medicare", that shows to me that fundamentally many people are unaware of the true facts of the debate. I seek to correct all that I can that's floating around that's incorrect, and I barely have enough time to look up 10% of what I bet is out there. And that's scary to me, since I think many people would be surprised to learn what's actually in the bills, instead of what they think is in the bills.

I'm sorry if you were offended, but that is a pretty dire interpretation of what I was saying. I could easily be as offended by the backhanded and sometimes direct accusations that people who opose this legislation care more about money than human life. That is a pretty offensive and inaccurate depiction of my objections and yet I have not gone so ar as to personalize it as a personal attack and claim offense. I have simply stated my objections and done my best to debate the support thus far.

In truth, I didn't accuse ignorance, just niavity and an overly hopeful denial of what all evidence of government intervention has ever shown, IMO. I note the very obvious ommision of that sucessful government program, despite what any pundit says, that would be the compelling argument that seems unable to be made. In effect the only real support I have heard for this legislation isn't actually about the proposed legislation at all. It has been philisophical support and ideological support and theoretical support, but no actual concrete support.

No one seems to argue the merits of the proposals, just the merits of everyone having health coverage and medical costs being reduced as if that is the actual debate or something. I don't think anyone is against that outcome on either side of this debate. I know I want both of those things to come to pass as much or more than anyone as I have children coming into adulthood as we speak. The point I have made thus far is that since the ideological is the support, I have an equally ideological, albeit based on significant history, oposition. It isn't just a matter of who you trust, it is a matter of realistic probability and the realistic probability of a sucessful U.S. government run health system is pretty slight.

Again, unless someone has that magical counter-example that would constitute a realistic basis for believing the odds are better than I believe they are.

ComicBookWorm
August 21st, 2009, 8:26 pm
Insurance companies now receive a large subsidy (in addition to normal reimbursements) for providing Medicare part C, which is essentially an HMO version of Medicare. I've seen reports that the cuts will come from there. The pay schedule for the public plan will be based on Medicare (plus 5%) since using the Medicare structure is easier than reinventing the wheel. Pharmaceutical companies receive subsidies as well. That's why you see ads from them generously offering to help you buy their expensive medications. And if the government was permitted to negotiate drug prices with them, there would be huge savings.

Home care providers are a big dark hole where money goes. I've had four different housekeepers tell me how they had also been home health care providers, and they encouraged me to apply for aid, so they could work for me in that capacity. Whenever they would tell me stories of what they did for the people, it was mostly housekeeping and some physical care. However, they billed for a shameless amount of time where they did little or nothing. Sometimes they billed when they weren't even there. The person receiving the care didn't mind what the caregiver billed, since the person receiving care didn't have to pay. And sometimes the person receiving care was too ill to really pay attention, but the caregiver billed for phony hours anyway. I'm not so ill that I can't care for myself, and it would have been a ripoff to get aid. However, I would have gotten my housekeeping for free if I had, which is why this benefit needs more scrutiny.

I haven't seen anything about cutting payments to mobility scooters and wheelchairs. I did see some idiot, who was against all insurance reform (and Medicare and Social Security), say that we pay too much providing scooters and wheelchairs to seniors, and they are often given to people who don't need them. I almost reached through the TV screen and strangled him. If someone has trouble standing for anything more than a short period of time, or they have trouble walking more than a block or two, they need mechanized help. Who is he to judge who needs that help or not! Scooters can help if the person is too weak to walk much or if the person falls over spontaneously (like I do). Actually, I listed all the reasons I need a scooter in this paragraph. But I'm hardly unique. My scooter has given museums, parks, and fairgrounds back to me. And they had been lost to me for several years before I got the scooter.

BTW, insurance companies ration scooters now. My scooter is seven years old. It has broken down three times. Each time the insurance company has insisted on repairing it instead of replacing it. The repairs have totaled much more than I paid for it. If any limitations are put on scooters, it would be the fancy "Cadillac" ones. Mine is a budget scooter that only cost $1500; there are some in the $6000 range. I just wanted a nice cushioned seat (to reduce my contact and pressure pain). But I was able to do that with an cheap one. The "Cadillac" ones are fancier and do have nice comfy seats. But I got a comfy seat anyway. In fact there were some under $1000, but they all had hard plastic molded seats.

And they recently denied my request for a walker with wheels and a seat (a rollator). I fall over spontaneously and need somewhere to sit while the worst of the vertigo dissipates. I also get very weak and my leg pain becomes excruciating, and I need time to recoup. However, the walker they approved--the bare-bones metal frame kind that you just push on the ground (usually with tennis balls on the bottom ends), actually cost more than the one I went out to buy for myself (with a seat and wheels). So we see insurance bureaucrats making very poor and financially wasteful decisions.

Finally, I'm not impressed that businesses offer policies that cover preexisting conditions--that's usually the case. However, individuals can't get coverage. That's the point. And no there isn't a 12-month exclusionary period. There is no coverage at all. They just flat reject you. My daughter, who has damaged lungs, was denied coverage, and the only special care she needed was periodic, but infrequent, checkups with a pulmonologist and the same inhalers that asthmatics use. Her condition is stable (the damage is old) and will not require expensive care.

HedwigOwl
August 22nd, 2009, 6:13 am
Finally, I'm not impressed that businesses offer policies that cover preexisting conditions--that's usually the case. However, individuals can't get coverage. That's the point. And no there isn't a 12-month exclusionary period. There is no coverage at all. They just flat reject you. My daughter, who has damaged lungs, was denied coverage, and the only special care she needed was periodic, but infrequent, checkups with a pulmonologist and the same inhalers that asthmatics use. Her condition is stable (the damage is old) and will not require expensive care.

Exactly. You can be denied coverage for the most minor things. A relative of mine is married with 2 kids. They applied for coverage with a major carrier (whom they currently had through COBRA), as her husband was going to try starting his own business. They are all young and healthy. She was denied because she once consulted a specialist on a pregnancy issue. Her husband was denied because ONE blood pressure reading at an annual checkup -- again, ONE reading -- was a little higher than perfect, even though all other readings over several years were normal. Her daughter was denied because of a doctor visit to check out an aching knee -- which was diagnosed be normal growth pains, nothing more. They agreed to cover the 1-year old. How ridiculous is that?

monster_mom
August 22nd, 2009, 4:42 pm
Here's (http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082103033.html?nav=rss_opinion/columns) a rather interesting column from former US DOJ attorney's David Rivkin and Lee Casey.

They argue that HR 3200 is unconstitutional with it's mandate that every person purchase a qualified health insurance plan or face an additional tax.

But can Congress require every American to buy health insurance?

In short, no. The Constitution assigns only limited, enumerated powers to Congress and none, including the power to regulate interstate commerce or to impose taxes, would support a federal mandate requiring anyone who is otherwise without health insurance to buy it.

They argue that the powers in the Constitution granting Congress the right to regulate inter-state commerce wouldn't allow Congress to mandate that every person buy qualified health insurance coverage.

The Constitution grants Congress the right to regulate the "production, distribution or consumption of commodities". The commodity Congress seeks to regulate in HR 3200 is health insurance. The Supreme Court has interpreted that clause pretty broadly by allowing Congress to regulate things like wheat and marijuana grown at home for home use and not resale.

Rivkin and Casey argue that the commerce clause doesn't apply because there are some people who choose not to purchase a qualified health insurance plan or who choose not to purchase health insurance coverage at all and those people would be forced, by Congressional mandate, to purchase health insurance.

Clearly people who choose not to purchase health coverage aren't engaged in the production or distribution of health insurance. But, because they choose not to purchase health insurance coverage, they also aren't engaged in the consumption of a commodity. Yet under HR 3200 they would be forced to purchase a plan that meets Congress' standards, not because they are consumers of a commodity but simply because they exist. The Supreme Court has stated that Congress doesn't have the authority to mandate that citizens do a specific thing - like buy a qualified insurance plan - when they choose not to do so.

It'd be like Congress mandating that every citizen buy a 10 speed bicycle, whether they want a 10 speed or not. The Supreme Court has, in the past, said that Congress can't issue such mandates because those mandates aren't covered by the commerce clause.

Congress can, however, tax us. And they can effect taxes that encourage behavior - like deductions for greening your home or business. Yet again, however, the Supreme Court has held that Congress can't tax us as a "means of controlling conduct that it could not otherwise control through the commerce clause or any other constitutional provision."

SSJ_Jup81
August 22nd, 2009, 10:54 pm
I just came across these, and felt it'd be interesting to discuss here.

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So, any opinions on these? It's the "infamous" (I'd call it that) interview that Jon Stewart had with Betsy McCaughey recently.

monster_mom
August 23rd, 2009, 2:15 pm
This is kind of interesting, what with all the talk of astro-turfing.

The guy who shot the video watched both the pro-Democrat's plan and the anti-Democrat's plan rallies in front of a Representatives office this past weekend. He asked the folks attending the rally how they made their signs and where they got them.

He found that the grandmas and grandpas protesting against the Democrats plan made their own signs but those protesting for the Democrats plan got their signs handed to them. Yet it's the grandmas and grandpas who made their own signs who are accused of being astroturf......No wonder they're angry.

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Mundungus Fletc
August 23rd, 2009, 3:00 pm
Why are the Grandmas and Grandpas who are already on socialised medicine trying to stop other people getting it?

monster_mom
August 23rd, 2009, 4:25 pm
Why are the Grandmas and Grandpas who are already on socialised medicine trying to stop other people getting it?

Perhaps because they know that the socialized programs are insolvent (http://online.wsj.com/article/SB124212734686110365.html) (also here (http://www.theepochtimes.com/n2/content/view/20892/) and here (http://www.washingtonpost.com/wp-dyn/content/article/2009/05/12/AR2009051200252.html))and tossing a lot more people into systems that are already insolvent is a great way to bring about a collapse. (http://www.breitbart.com/article.php?id=cp_x081502A.xml&show_article=1)

Wab
August 23rd, 2009, 6:09 pm
If that's how they feel they should have the principles to reject it and pay their own way.

canismajoris
August 23rd, 2009, 6:29 pm
Perhaps because they know that the socialized programs are insolvent (http://online.wsj.com/article/SB124212734686110365.html) (also here (http://www.theepochtimes.com/n2/content/view/20892/) and here (http://www.washingtonpost.com/wp-dyn/content/article/2009/05/12/AR2009051200252.html))and tossing a lot more people into systems that are already insolvent is a great way to bring about a collapse. (http://www.breitbart.com/article.php?id=cp_x081502A.xml&show_article=1)
I think nobody's probably surprised that Medicare is operating at a loss, but that's precisely why we're all trying to reform things, isn't it? So people on medicare who are against... "socialized programs" probably need to consider that a new program likely won't resemble one we already know to be unsustainable.

As for the USPS, that probably should be privatized, but I don't think it's really comparable to a health care/insurance industry, do you? I would like to add that Japan may not be a great example either, because the the postal agency did a lot more than deliver mail, and the process was hardly smooth (http://www.ft.com/cms/s/0/f164c3a0-07cb-11da-97a6-00000e2511c8.html).

And the article about Canada hardly said anything about tossing people into systems that are insolvent, so I think you've editorialized a bit. The only actual conclusion in the entire article is that one doctor believes something needs to be done, and others agree, but admittedly they have no idea what that can or will eventually happen. Hardly a doomsday piece about impending collapse. They will probably end up with a system that looks more like ours, just like ours will probably end up looking more like theirs. As the good doctor said, there are some "very good things" about Canada's health-care system.

SSJ_Jup81
August 23rd, 2009, 6:36 pm
If that's how they feel they should have the principles to reject it and pay their own way.

Well, if they didn't get something like Medicare, then they probably wouldn't be able to get any coverage at all from private insurers because of "age". -_- I actually agree with you, though. They don't want socialized-like medicine, then ditch the socialized program that they're a part of.

What we could use is a "Medicare" for everyone, but I still can understand where some are coming from as far as cost is concerned since we're already in so much debt, but something truly does needs to be done.

Den_muggle
August 23rd, 2009, 11:55 pm
If that's how they feel they should have the principles to reject it and pay their own way.
Who says the ones who are protesting aren't paying their own way?

canismajoris
August 24th, 2009, 1:20 am
Who says the ones who are protesting aren't paying their own way?
Since the way isn't really being paid (otherwise it wouldn't need to be fixed), I'd be comfortable saying that the protesters who receive government health care aren't paying their own way.

ComicBookWorm
August 24th, 2009, 3:03 am
I had to jump to Medicare when my insurance policy was jacked up to $1000 per month. I had been willing to pay until then.

Mundungus Fletc
August 24th, 2009, 6:59 am
What we could use is a "Medicare" for everyone, but I still can understand where some are coming from as far as cost is concerned since we're already in so much debt, but something truly does needs to be done.
But everywhere else in the world that has "Medicaire for everyone" spends less as a proportion of GDP than you do in the US. France, for example,which is consistently ranked best by the World Health Organisation spends 11.1% of GDP whilst the US spends 15.3%. See here (http://www.npr.org/templates/story/story.php?storyId=110997469)

SSJ_Jup81
August 24th, 2009, 7:21 am
But everywhere else in the world that has "Medicaire for everyone" spends less as a proportion of GDP than you do in the US. France, for example,which is consistently ranked best by the World Health Organisation spends 11.1% of GDP whilst the US spends 15.3%. See here (http://www.npr.org/templates/story/story.php?storyId=110997469)What I meant was starting it up in general. I guess you could say "start up funds" for it. It seems some people just aren't willing to compromise. People want stuff, but don't want to help pay for it. Seems some don't believe in helping out your neighbor in a bad time either. I just don't get it. I'm all for it and have been saying it for many years, even before I was "uninsurable" and before I even lost it after I found out how other countries did health care. I always wondered why we didn't have a tax to go towards a public health care plan for those who don't have private insurance or those who can't afford it.

Since I've worked, I've never had insurance, couldn't afford it, (and had to get bumped off of my parents' insruance since I was working and because of my age years ago as a newly diagnosed diabetic). I find it sad seeing how many people need insurance or health coverage or even how some places of employment can find ways to get out of offering insurance. For instance, as an assistant teacher (aside from no paid vacation days or sick days), I didn't get health benefits either, which is no surprise, since they have it so that you're just under the mark of work hours to be eligible for it, even if you work over that amount. For me, I was only allowed to work a certain amount of hours, even though I found myself staying over that amount, but, wasn't allowed to write that down on my time sheet.

My aunt is having trouble now with her daughter (she's 25, though). Due to her age, she can't carry her anymore on her policy and my cousin really needs health coverage, but for her issue, it's unaffordable, and I know my aunt can't afford to pay extra insurance for her. I think my aunt is thinking about selling her house because of how costly it's getting to care for my cousin, especially with her $200 meds.

alwaysme
August 24th, 2009, 12:59 pm
What I meant was starting it up in general. I guess you could say "start up funds" for it. It seems some people just aren't willing to compromise. People want stuff, but don't want to help pay for it. Seems some don't believe in helping out your neighbor in a bad time either. I just don't get it. I'm all for it and have been saying it for many years, even before I was "uninsurable" and before I even lost it after I found out how other countries did health care. I always wondered why we didn't have a tax to go towards a public health care plan for those who don't have private insurance or those who can't afford it.

Since I've worked, I've never had insurance, couldn't afford it, (and had to get bumped off of my parents' insruance since I was working and because of my age years ago as a newly diagnosed diabetic). I find it sad seeing how many people need insurance or health coverage or even how some places of employment can find ways to get out of offering insurance. For instance, as an assistant teacher (aside from no paid vacation days or sick days), I didn't get health benefits either, which is no surprise, since they have it so that you're just under the mark of work hours to be eligible for it, even if you work over that amount. For me, I was only allowed to work a certain amount of hours, even though I found myself staying over that amount, but, wasn't allowed to write that down on my time sheet.

My aunt is having trouble now with her daughter (she's 25, though). Due to her age, she can't carry her anymore on her policy and my cousin really needs health coverage, but for her issue, it's unaffordable, and I know my aunt can't afford to pay extra insurance for her. I think my aunt is thinking about selling her house because of how costly it's getting to care for my cousin, especially with her $200 meds.



I think many Americans in general just don't trust their government to run something as large and as personal as their healthcare. They look at medicare and they look at social security and they see that those programs are in serious debt. I really believe it is a trust issue.

I personally don't understand it myself. Morally the right thing to do would be to at least cover the poor who cannot afford it. We do have medicaid but that doesn't cover everyone.

monster_mom
August 24th, 2009, 1:34 pm
I think nobody's probably surprised that Medicare is operating at a loss, but that's precisely why we're all trying to reform things, isn't it? So people on medicare who are against... "socialized programs" probably need to consider that a new program likely won't resemble one we already know to be unsustainable.

Evidence, please.

What sort of reforms are included in the Democrats bills that will make Medicare and Medicaid sustainable?

As for the USPS, that probably should be privatized, but I don't think it's really comparable to a health care/insurance industry, do you?

Oh but the USPS is an example of what happens within a government bureaucracy and the choices a government agency has to make to control costs.

Here (http://www.usps.com/financials/_pdf/annual_report-2008.pdf) is a link to the USPS's 2008 annual report. Click over to page 3 where it shows operating revenue for 2008, 2007, and 2006. Notice the numbers?

Operating revenue has continued to increase each year, but not at the same rate as operating expenses. 2007 was a bad year and the postal service did a better job in 2008 than 2007, but the increase in operating expenses in 2008 continued to far outstrip the increase in operating revenues. Coupled with their now high debt burden and their net income is quite negative.

So what can they do to turn things around? They can increase the cost of postage stamp and cut costs. In 2008, despite a 4.5% decrease in the volume of mail carried, revenue increased. That's due largely to increases in the cost of postage. But that wasn't enough to make up for the increases in operating expenses so they have to cut costs.

How did they cut costs? Read the footnotes. They cut the hours their staff worked, cut a couple hundred administrative personnel, and made huge cuts in operations staff - close to 30,000 fewer clerks to process mail at post office and mail carriers. Even that wasn't enough and they'll have to make further cuts next year.

Now this is the postal serve and their job is to deliver the mail. What do they do when they're facing insolvency because revenues aren't keeping up with costs? They raise prices and cut services.

What do you think will happen when the Health Choices Administration faces those same challenges (and they will starting about 3 years after the program is enacted according to the CBO)? They can hike premiums and they can cut costs. How can they cut costs? By rationing care. By only providing so many beds in the NICU or allowing hospitals to provide a fixed number of cardiac catheterizations a year. By limiting the number of mammogram machines and dictating that mammograms can only be performed once every 3 - 5 years for low risk individuals. By refusing care for elderly patients.

You may think that this won't happen, but it's what government's do all the time to control costs in a government run health program. Part of the reason Medicare is facing insolvency is because they refuse to ration care and the number of healthy people paying into the system but not using it's services has decreased.

Chris
August 24th, 2009, 2:16 pm
The differences between the postal service and health care are quite numerable, I think. For instance, although many patients do look up information on the web about their condition, the advent of computers and the information age isn't making health care increasingly "outdated", like the postal service is rapidly becoming. So, holding it up as an example of why government-run things cannot work doesn't work for me, because the same factors that are KO'ing the postal service actually work in favor of the viability of cutting costs in health care - better sharing of research data and streamlining of bureaucracy within a system are both things computers can aid in, instead of the postal service's situation where computers and email are a competitor.

And, hearkening back a bit, I bet I could, with a law degree and too much time on my hands, fit the "equal protection clause" of the 14th Amendment into it being unconstitutional for there not to be universal health care. My point is, that I think it cheapens the meaning of "unconstitutional" when every time someone opposes something, it ends up being called unconstitutional at some point or another.

Final point: both sides are putting a lot of money and effort behind the grassroots campaigns. And both sides have very "not grassroots" funding, but for the people turning out to these things, with few exceptions they are doing so out of free will and they're not being paid (there are a few exceptions, which I would imagine get blown out of proportion in the press).

monster_mom
August 24th, 2009, 3:28 pm
The differences between the postal service and health care are quite numerable, I think. For instance, although many patients do look up information on the web about their condition, the advent of computers and the information age isn't making health care increasingly "outdated", like the postal service is rapidly becoming. So, holding it up as an example of why government-run things cannot work doesn't work for me, because the same factors that are KO'ing the postal service actually work in favor of the viability of cutting costs in health care - better sharing of research data and streamlining of bureaucracy within a system are both things computers can aid in, instead of the postal service's situation where computers and email are a competitor.

You just proved my point, Chris.

The issue isn't revenue, it's costs and controlling them. The Postal service's problem isn't that revenue is declining - because it's revenue has increased in the past 3 years despite decreased volumes- the Postal Service's problem is that costs have increased faster than revenue has. To control cost they cut service.

When it comes to health care, the real costs come from health care provided. Tort reform, automation, none of it comes close to the direct cost of providing health care. Both Medicare and Medicaid have had automation requirements for several years now but costs have continued to rise because the number of people receiving health care and the number of treatments and procedures they receive has increased.

When it comes to health care, the only way to control costs is to reduce or restrict the number of treatments and procedures people receive. In other words, to ration care.

And, hearkening back a bit, I bet I could, with a law degree and too much time on my hands, fit the "equal protection clause" of the 14th Amendment into it being unconstitutional for there not to be universal health care. My point is, that I think it cheapens the meaning of "unconstitutional" when every time someone opposes something, it ends up being called unconstitutional at some point or another.

The Constitution grants power to the branches of the federal government in an effort to control government. That's what all those checks and balances are all about - keeping one branch of government from getting too big for it britches and from overstepping the bounds placed on it by the people. Our founders, having tossed aside a Monarchy, knew what it meant for a government to dictate rules without taking the citizens into consideration. They know that governments were power and force that had to be controlled.

As it is, the Equal Protection clause is another reason the Democrats health care mandates are unconstitutional.

The Equal Protection Clause states "No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."

This clause has been cited when defending abortion rights - as in no state can establish laws which deny women the right to demand medical treatment, in this case abortion. But the law clause has not been interpreted to mandate that the state pay for abortion.

The clause has also been cited in defending the rights of incompetent people to receive the same medical care as competent people and has been cited in cases allowing people to refuse medical care (the doctrine of informed consent).

In the case of the Democrats health reform bills, the Congress will be establishing laws mandating that every citizen must obtain health coverage that Congress deems acceptable. In doing so Congress will deny every citizen the right to choose an insurance plan that they want or to choose not to have insurance. Congress, in demanding that every citizen must participate in a set manner will be abridging the right of every citizen to choose how he or she wants to participate, if at all.

Using the doctrine of informed consent, the equal protection clause says Congress can't do that. Congress can't pass laws that require that people purchase medical coverage just like it can't pass laws requiring that people must accept certain types of medical care. Congress can't force people who don't want health insurance to purchase it.

Final point: both sides are putting a lot of money and effort behind the grassroots campaigns. And both sides have very "not grassroots" funding, but for the people turning out to these things, with few exceptions they are doing so out of free will and they're not being paid (there are a few exceptions, which I would imagine get blown out of proportion in the press).

And yet it's the Democrats complaining that the uprising against government controlled health care is fake.

Chris
August 24th, 2009, 3:59 pm
You just proved my point, Chris.

I'd argue that you just twisted my words into supporting the position you'd already arrived at. The famous thing where two people can read the same words and reach different conclusions. Same with the equal protection bit - besides my larger point, which is that I think people throw around "unconstitutional" so much it has lost its real meaning, I can read that portion and make an argument that to not provide health care for people is to deprive people of life and liberty and therefore it's unconstitutional not to provide it.

flimseycauldron
August 24th, 2009, 5:41 pm
I officially despise large bills!

Page 844 talking about home visitations:


Originally posted by hr 3200 (http://energycommerce.house.gov/Press_111/20090714/aahca.pdf)

‘‘(VI) skills to recognize and seek
help for issues related to health, developmental delays, and social,
emotional, and behavioral skills; and ‘‘(VII) activities designed to help
parents become full partners in the
education of their children;

Bolding mine. What a broad and sweeping umbrella of healthcare! Supposedly these visitation programs are voluntary I have to wonder if the healthcare bill is the place to address these issues.

Pages 768–769 of H.R. 3200 provide that eligible first-time pregnant woman and families with children less than 2 years old will receive home visitation services “improving maternal or child health…increasing birth intervals between pregnancies, reducing the incidence of child abuse…increasing economic self-sufficiency, employment advancement, school-readiness, and educational achievement, or reducing dependence on public assistance.”

And isn't child abuse already covered under CAPTA (http://www.acf.hhs.gov/programs/cb/laws_policies/cblaws/capta03/capta_manual.pdf)? Why are we spending money on CAPTA and the health-bill? Aren't school readiness and educational achievement covered under NCLB? Isn't employment advancement covered under TANF?

My question? Why are things that are covered by other current legislation being also covered under the healthcare umbrella? Not only is it a waste of money but it appears with child abuse and education falling under the same part of the bill that if you don't educate your children as mandated by the state you may be charged with abuse or neglect. Why is this stuff in the healthcare bill?!

Apparently these are voluntary home visits but do you honestly think that it is going to be sold to young mothers or families with young children in a manner that describes how far the visitations are authorized to go?

Redhart
August 24th, 2009, 5:49 pm
Well, deeper than just unconstitutional but unethical and (my opinion) immoral.

It is my belief that services that have such a life-threatening consequence (ie: police protection, fire departments, medical care) should never have been privatized for profit in the first place. The first two are social services as they should be, provided and administered by varying levels of goverment (local to national). These basic services can be added to if one has enough money...like private security guards can be added for those who wish to pay for it. But, basic service exists. To not do so and only cater to those who could pay the price (only put out houses on fire if one has payed for the private fire fighting service, or only come to a house being burglurized if one has payed a for-profit-security company, to stop the crime) would be considered an outrage. Yet, our country has gone that route for medical care. Even when laws have been put into place to try to force medical entities to give treatment, privatized medicine has found loopholes in laws to serve it's bottom line, rather than human beings.

It's time, in my opinion, that this error that was made is corrected through reform.

This is not something new, but being done in nearly every first world country already. Of course the private insurance company (and their spokespeople) are fighting it, they've had a cash cow for a very long time now and full power over this country's health care. Power never concedes willingly.

OldLupin
August 24th, 2009, 7:28 pm
Why are the Grandmas and Grandpas who are already on socialised medicine trying to stop other people getting it?

This is the most dishonest and self-serving argument that is pushed by proponents of this legislation. Let us be clear, the oposition to the current course isn't a demand for people to be uninsured, nor is it a desire to "trade lives for money" or to deny anyone anything. The fact that the proposed means are undesirable doesn't mean the stated goals are.

There is also the issue of many elderly finding the socialized healthcare they already recieve to be pretty poor and they truly don't want everone placed under such care.

The differences between the postal service and health care are quite numerable, I think. For instance, although many patients do look up information on the web about their condition, the advent of computers and the information age isn't making health care increasingly "outdated", like the postal service is rapidly becoming. So, holding it up as an example of why government-run things cannot work doesn't work for me, because the same factors that are KO'ing the postal service actually work in favor of the viability of cutting costs in health care - better sharing of research data and streamlining of bureaucracy within a system are both things computers can aid in, instead of the postal service's situation where computers and email are a competitor.

Why then is public education not an analogous example? I see it as singularly comparable and have mentioned it many times. Is there a disqualifier for that comparison? I ask this simply because it is continually ignored when I ask for an example of the government operation that inspires belief that government can run healthcare.

Well, deeper than just unconstitutional but unethical and (my opinion) immoral.

It is my belief that services that have such a life-threatening consequence (ie: police protection, fire departments, medical care) should never have been privatized for profit in the first place. The first two are social services as they should be, provided and administered by varying levels of goverment (local to national). These basic services can be added to if one has enough money...like private security guards can be added for those who wish to pay for it. But, basic service exists. To not do so and only cater to those who could pay the price (only put out houses on fire if one has payed for the private fire fighting service, or only come to a house being burglurized if one has payed a for-profit-security company, to stop the crime) would be considered an outrage. Yet, our country has gone that route for medical care. Even when laws have been put into place to try to force medical entities to give treatment, privatized medicine has found loopholes in laws to serve it's bottom line, rather than human beings.

It's time, in my opinion, that this error that was made is corrected through reform.

This is not something new, but being done in nearly every first world country already. Of course the private insurance company (and their spokespeople) are fighting it, they've had a cash cow for a very long time now and full power over this country's health care. Power never concedes willingly.

Medical care a public service? You truly believe that will make it favor human beings instead of its own interests? How? What is supposed to indicate this is even posible? I understand the rhetorical cry for all people to have healthcare, I agree that all people should have healthcare, but I absolutely don't believe the government can provide it let alone would even if they could.

This isn't a debate about whether or not people should be cared for or whether or not life and health were important to protect, or if it is more important than money as has been again and again proffered by proponents. This is a debate of the merits of government involvement in general and of the merits of the Bills being proposed specifically. That being said, who has any real support for the proposed Bills or any proof that the U.S. government is either willing or able to provide quality healthcare, especially at a sustainable cost?

Redhart
August 24th, 2009, 8:33 pm
This is the most dishonest and self-serving argument that is pushed by proponents of this legislation. Let us be clear, the oposition to the current course isn't a demand for people to be uninsured, nor is it a desire to "trade lives for money" or to deny anyone anything. The fact that the proposed means are undesirable doesn't mean the stated goals are.
The opposition seems to be varied as to reason. I disagree that it is a dishonest and self-serving argument as there truly are many uninsured, many of which have limited to no access to care. That is a real problem.

Likewise, the Wendell Potter testimony (posted numerous times on this thread) has shown that privitized health insurance corporations have been contributing to this issue with their practices...increasing the "people's" burden through either having to have the government subsidize health care for the uninsured anyway and higher medical costs (thus increasing private premium prices at a much higher rate than increase in income in this country).

It cannot continue because of the cost to everyone: citizens, medical industry and government.

There is also the issue of many elderly finding the socialized healthcare they already recieve to be pretty poor and they truly don't want everone placed under such care.
It strikes me as odd that on one hand opposition claim that the elderly don't want their medicare messed with because they like it so much, and that our level of care is so good they don't want it threatened by reform...then on the other hand claiming it isn't good, thus reform won't be good because it'll end up like medicare. Which is it? You can't have it both ways.


Medical care a public service? You truly believe that will make it favor human beings instead of its own interests? How? What is supposed to indicate this is even posible? I understand the rhetorical cry for all people to have healthcare, I agree that all people should have healthcare, but I absolutely don't believe the government can provide it let alone would even if they could.
Look around at the rest of the world. Other countries seem able to do this. It is not some abstract, absurd idea--it's operating already in most of the world.

We have tried the corporate form of health care and we are finding that it isn't working. In my opinion, a failure of an experiment that needs to be corrected.

And yes, I just spent the better part of a week at the VA with my husband who had surgery. I nearly lived in the ICU at VA/West Los Angeles, and I can tell you he got the best care and their system of doing things seemed very advantageous to the patients. Their first thought was always of his care, not of whether an insurance company would authorize this or that, or rationing what he got. I was most impressed with the system. It's going to be hard to convince me the government can't handle something like a public option type program after the care I've seen this week in action.

This is a debate of the merits of government involvement in general and of the merits of the Bills being proposed specifically. That being said, who has any real support for the proposed Bills or any proof that the U.S. government is either willing or able to provide quality healthcare, especially at a sustainable cost?
After what I've seen this week, I'm sold on it :tu:

monster_mom
August 25th, 2009, 3:17 pm
I'd argue that you just twisted my words into supporting the position you'd already arrived at. The famous thing where two people can read the same words and reach different conclusions. Same with the equal protection bit - besides my larger point, which is that I think people throw around "unconstitutional" so much it has lost its real meaning, I can read that portion and make an argument that to not provide health care for people is to deprive people of life and liberty and therefore it's unconstitutional not to provide it.

But I can cite case law where the Supreme Court has upheld the view I argued.

I can only find 3 cases where the statement "Life, Liberty, and the Pursuit of Happiness" were referenced and not one of them was decided based on that statement but rather on interpretations of the 14 Amendment. The youngest of those three is a case from 1967. The others are from 1923 and 1883.

The first was a 1967 case where the Supreme Court ruled a law prohibiting inter-racial marriage to be unconstitutional under the 14 Amendment (that pesky equal protection clause).

The second (http://en.wikipedia.org/wiki/Meyer_v._Nebraska) was a case in 1923 where states were required to provide instruction in foreign languages in public schools because failing to do so violated the right of due process to those whose native language isn't English (again, citing that pesky 14th Amendment).

The third case hails back to 1883 when the Supreme Court rules that the right to "the pursuit of happiness" was an economic right, not an emotional one.

It's time, in my opinion, that this error that was made is corrected through reform.

Where do any on the bills correct for this "error"?

The law currently states that if you are in a life threatening emergency you can not be denied care. Now, what constitutes a life threatening emergency might be subject to debate, but the law is quite clear on that point.

I tend to think, and this is my personal opinion here, that some of the debate around denial of care in an emergency stems from differing interpretations of a life threatening emergency.

From what I can tell, that won't change under any of the bills currently proposed - either the Democrats or the Republicans. You'll be covered by a plan that has authorized providers and will be expected to receive care from those providers, unless you're in a life threatening emergency. If you aren't in a life threatening emergency (which is defined as including being unconscious, bleeding profusely, broken bones sticking outside the skin, in cardiac arrest or having a stroke) then you have to go to an authorized facility.

The opposition seems to be varied as to reason. I disagree that it is a dishonest and self-serving argument as there truly are many uninsured, many of which have limited to no access to care. That is a real problem.

I agree. I think that we need to do something to make health insurance affordable to everyone (as does Lupin if I read his statement correctly). I disagree that the federal government is the only means by which to provide affordable coverage for all. I believe that there are alternatives available which will provide far better care and be far more cost effective for all.

We have tried the corporate form of health care and we are finding that it isn't working. In my opinion, a failure of an experiment that needs to be corrected.

I have coverage through my employer and I think it's just fine. According to a CNN poll, more than 74% of people living in the US are satisfied with the coverage they have (other polls have it higher). Why does the federal government have to take over my coverage so that the 6-8% who can not afford coverage but don't qualify for government assistance can afford it? Isn't there a better way of making coverage affordable for those folks - like the refundable tax credit in the Republican's plan coupled with access to group plans through membership organizations or associations and a high risk pool backed by the states?

Ignoring the Constitution, Like Lupin said, the debate seems to be those who believe the federal government can best provide health care for the masses while others believe the government needs to stay the heck away. I think the government screws up just about everything it touches and makes things lower quality, more complicated, and more expensive. Like Lupin I'm still waiting for an example of some service the federal government provides which is high quality, easily accessible, and affordable.

Redhart
August 25th, 2009, 6:57 pm
The law currently states that if you are in a life threatening emergency you can not be denied care. Now, what constitutes a life threatening emergency might be subject to debate, but the law is quite clear on that point.

I tend to think, and this is my personal opinion here, that some of the debate around denial of care in an emergency stems from differing interpretations of a life threatening emergency.
My opinion comes from experience: being there. Yes, there are laws as we have discussed, but there are also loopholes that allow them to get around the laws. But, we keep going around and around on this point.

One of the things I've learned (experience again) is that a law does not always make things so, especially if they are not enforced. Making continued laws that are not enforced complicates things further.

For instance: It is illegal to enter the country without going through the proper channels and having the proper papers. Yet, we have an estimated 12 million illegal aliens in the country. Clearly, there is a law and clearly enforcing that law is not the same thing as simply having it.

The same applies to many of the medical care laws on the books, though not quite as clearly seen as in the immigration example.

For instance, if an ER is not denying treatment if a doctor actually looks at a patient. If the ailment is not absolutely obvious (ie: severed limb, cardiac arrest) he can pretty much *treat* for anything if he has no absolute proof via testing of what is wrong and if it is indeed debilitating or life threatening. Simply withholding a test can do that, which is not against the law. At that point, if the doctor treats for something less serious and the patient dies later...the worst he is liable for is a bad call/judgement. Talk to a lawyer...it's very difficult to prosecute and prove that it was done on purpose. This is how it is done here. I've seen it. Yes, that's my experience. I've also had a doctor validate that view of what is going on at the ER, a doctor who does not wish to send his patients there because he knows, too. The system's broken here.

Laws are nice, but do no good if they cannot be enforced or the law also protects enforcement from having any real teeth.

From what I can tell, that won't change under any of the bills currently proposed - either the Democrats or the Republicans. You'll be covered by a plan that has authorized providers and will be expected to receive care from those providers, unless you're in a life threatening emergency. If you aren't in a life threatening emergency (which is defined as including being unconscious, bleeding profusely, broken bones sticking outside the skin, in cardiac arrest or having a stroke) then you have to go to an authorized facility.
"Facilities" would be helpful to drain off the non-emergency cases off the ER load. And it will change because the medical facility would be guaranteed payment because all would have some sort of coverage. At our county ER, they are happy to take and process the medicaid/cal or medicare patients or the private coverage people. The problem is the uninsured people who no one else will take and have a high probability of never paying anything once they leave. With Juanita on Medicaid, the ER at least knows the government will back the bill. Not so with George who lost his job last week and has no insurance and no way to pay the bill, but does have an infected gall bladder that will kill him without prompt ER measures.

If George was covered by the expanded medicaid plan or had enough to pay for a subsided private or public plan while on unemployment, George could go to either a "facility" and actually have the proper diagnostic testing ordered. If he showed up directly at the ER, the ER doctor's would no longer have an issue running the tests and doing his surgery to save him.

Also, Francesca's daughter with an ear ache would probably be better off at a "facility" for a shorter period of time than sitting in an ER for several hours in great pain with her mother worrying about her child for so long and if the guy sitting next to her for the last 6 hours coughing up blood had TB.

I see this as a good thing...medical facilities like doctor's offices and urgent care units are often the best places to get those sudden, but non-life threatening medical issues dealt with efficiently and effectively while leaving the ER for those who truly need it. The cost is much less at an office or urgent care facility, too. Everyone wins. I have no problem with it and see them as a plus.

Since I received my subsidy, I go to a authorized facility...I can't tell you how happy I am to have it. I now have another choice than the county ER and prayer. So far, they have given me excellent care and seem very efficient.

And, again, those that already have insurance they like can keep it and their doctors. Those who have nothing or don't like what they have will now have a choice they didn't have before...other than prayer (which can be good with any plan, public or private, anyway).
I have coverage through my employer and I think it's just fine. According to a CNN poll, more than 74% of people living in the US are satisfied with the coverage they have (other polls have it higher). Why does the federal government have to take over my coverage so that the 6-8% who can not afford coverage but don't qualify for government assistance can afford it? Isn't there a better way of making coverage affordable for those folks - like the refundable tax credit in the Republican's plan coupled with access to group plans through membership organizations or associations and a high risk pool backed by the states?I'm glad you have coverage through your employer. That's getting rarer and rarer these days because of the cost, you know. You should count yourself lucky. The last three employers I've been with offered no such thing. I was down at the community hospital in town asking about jobs...I was surprised to find the hospital does not offer its employees health care benefits. Can you imagine that? My 29 year old son is the only one in our family that has an employer health plan benefit, and he is likewise happy and I, for him.

You can keep your plan if you like it as my son can with the house bill. If, for some reason, your company drops coverage or you lose coverage by loss of job (heaven forbid, of course, and knocking on wood that does not happen), the new private plans will still be available from most likely the same private insurance companies...but now with guarantees that you will not have your rates skyrocketed to push you off if you get sick, or a rescission because they are claiming you had a pre-existing condition you didn't tell them about later.

Again, this is not a government takeover of insurance companies. There will be new regulation of companies so they aren't as likely to exploit loopholes that have been causing much heartache and trouble.

What you call government take over, I welcome as new regulation and safeguards in the system to protect everyone's insurance and medical care.

As far as government able to run a public plan, I definitely differ from your opinion and Lupins. Like I said earlier, I just spent the better part of a week camped out at the West L.A. Veteran's hospital for my husband's surgery and couldn't be more impressed with their care and operation. Their staff was totally dedicated to their patients rather than what the insurance companies would pay for, allow or approve. If that is an example of a government run plan, I'm in.

USNAGator91
August 25th, 2009, 7:35 pm
Redhart, I'm sure your situation differs from mine which differs from others on this board. That is the problem with a "one size fits all" solutions. What works in HR3200 for you and your family may be an absolute disaster for those of us that have coverage.

I can't believe I'm going to say this, but I actually agree with Russ Feingold (D-WI) when he said at a recent town hall meeting:

"Lindsay Graham and I sponsored legislation to have pilot programs in five states," Feingold told the audience. "Maybe we should try some different things. There might be a single-payer state. There might be a co-op state. Let's get some evidence on the ground. This thing right now is not going in the right direction. We might be in a situation where there won't be a bill worth passing."

Source: Lakeland Times (http://www.lakelandtimes.com/print.asp?SectionID=9&SubSectionID=9&ArticleID=10027)

To provide context, Senators Feingold and Graham sponsored a bill in 2007 that set up five year pilot projects to determine what works and what doesn't and to provide a federalist approach instead of a federal approach to health care.

A Federalism Solution to Healthcare (http://www.professorbainbridge.com/professorbainbridgecom/2009/08/a-federalism-solution-to-health-care.html)

Here's Senator Feingold's description of the proposal:

Feingold-Graham Health Bill (http://feingold.senate.gov/statebased.html)

and the Summary (http://feingold.senate.gov/issues_statebasedheafacts.html) from his website.

For those of you who can't get enough of reading Health Care bills, here is the text of:

S.1169 (110th Congress) (http://www.aishealth.com/HealthReform/Fed_State-Based_Health_Care.html)

The bottom line is that we are talking about fundamentally changing 1/6th of our economy. Many of us have completely divergent ways of approaching this and it's led to some very hard feelings. Here was a proposal to actually do some experimentation and to find what works for different states and different regions.

What works where I live in Florida may not be the same solution for California. Why not take a more cautious and fact-based approach to this?

OldLupin
August 25th, 2009, 7:37 pm
The opposition seems to be varied as to reason. I disagree that it is a dishonest and self-serving argument as there truly are many uninsured, many of which have limited to no access to care. That is a real problem.

Who said it wasn't? The dishonest part is asserting that oposing government as the answer and especially the proposed bills somehow mean that you don't believe reform is needed or that you don't care if people have healthcare. The fact that there are uninsured doesn't in any way make asserting the oponents of this strategy don't care about the uninsured less dishonest or inaccurate.


Likewise, the Wendell Potter testimony (posted numerous times on this thread) has shown that privitized health insurance corporations have been contributing to this issue with their practices...increasing the "people's" burden through either having to have the government subsidize health care for the uninsured anyway and higher medical costs (thus increasing private premium prices at a much higher rate than increase in income in this country).

That couldn't be because the cost, not due to their practices is stagering and they can only turn a 4.2% profit even with cost controls tactics, could it? 4.2% profit barely puts them out if range to be considered a non-profit entity and somehow they are supposed to be able to stay solvent with higher risk and higher outlay?


It cannot continue because of the cost to everyone: citizens, medical industry and government.

Where does that cost come from? Partially the current government programs are part of the reason for them. Saying "It can't continue" isn't any type of support for the proposed legislation. On the contrary it is as applicable as a point of oposition. It is this use of nothing but rhetoric to show support that makes me believe that the idea is "just do something" when that is potentially far more dangerous than doing nothing.


It strikes me as odd that on one hand opposition claim that the elderly don't want their medicare messed with because they like it so much, and that our level of care is so good they don't want it threatened by reform...then on the other hand claiming it isn't good, thus reform won't be good because it'll end up like medicare. Which is it? You can't have it both ways.

Who's having it both ways? My parents have to use medicare and it isn't good. They don't want it messed with because they fear something even worse if the government expands its influence in healthcare. It isn't that the service is so great that they fear loosing it, on the contrary, fear of loosing government healthcare is completely at odds with any Bill proposing increased government healthcare.



Look around at the rest of the world. Other countries seem able to do this. It is not some abstract, absurd idea--it's operating already in most of the world.

Other countries do it so why can't we? That is a specious and incomplete argument that is a mainstay of supporters of this type of program as well as other potential government actions. I will give the top 3 pragmatic reasons that is flawed to keep things brief.

1. We are much larger in population, more economicly diverse and geographicly seperated than any of these countries that might be a model. If the entire EU went to a single program it might pass as a model, but that will never happen as it would become unwieldy and expensive and many countries would opose being the benefactor for poorer countries. There is no currently working comparable model and the assertion is invalidated by this simple fact alone. It isn't the same only bigger, despite the wishful or hopeful desire to say that it is. The logistics are exponentially more difficult and the beuaracracy would be incredible and dwarf that of other nations.

2. We have greater civil adversion to government run programs than many other countries. This is for good reason. We have had a horrible track record of decline in services and rise in cost for every large scale national program we undertake. (See public education). Again the smaller size and more concentrated populations of other nations have facilitated programs that would be much more difficult to run sucessfully in the U.S. There is also more of an attitude of self-reliance in the U.S. that creates distrust for over-expansion of government, especially in quick undefined or poorly defined ways.

3. The total lack of any tangible example of government doing anything even remotely this lage well at all. The use of the governments of other nations who have passed us in education, only since we socialized it, as an example of the posibilities is exactly why oposition is so well founded. They might do it well, but we don't and until something government run is at least available to point at and say it is a domestic example of sucess, what difference does their having done it really make?


We have tried the corporate form of health care and we are finding that it isn't working. In my opinion, a failure of an experiment that needs to be corrected.

More rhetorical commentary? The system currently in place isn't being defended here, so while admirable in sentiment, this is not in any way a support for the propositions currently being decided or compelling that the state won't proceed to make things worse and not better. And the "it can't get any worse" rhetoric is completely untrue as well. It can get worse, much worse and history is full of examples of this.

And yes, I just spent the better part of a week at the VA with my husband who had surgery. I nearly lived in the ICU at VA/West Los Angeles, and I can tell you he got the best care and their system of doing things seemed very advantageous to the patients. Their first thought was always of his care, not of whether an insurance company would authorize this or that, or rationing what he got. I was most impressed with the system. It's going to be hard to convince me the government can't handle something like a public option type program after the care I've seen this week in action.

I am glad things went well, but this isn't even typical of VA, let alone military healthcare in total. I have lived on high occupancy bases and have almost watched a child die waiting for treatment while on active duty. I have also seen the disregard for liability after active duty from this arm of the government. He is fortunate that he wasn't in a high volume trama area. Fort Bragg, N.C. or Ft. Campbell, Ky. or heaven forbid Ft. Polk, LA. These were Army hospitals and the treatment of my dependants was not so stellar or timely. The clinics had long waits, the doctors were very busy and active duty bumped timetables for procedures because they had priority. I wonder who would have priority in a civilian medical treatment system?


After what I've seen this week, I'm sold on it :tu:

You weren't sold before? I will point out that military treatment is a job benifit and part of the reason pay is so poor for active duty military and even with that, I didn't see dependant care as being as good while on active duty as private care has been since.
I find all of this somewhat ironic, to be honest. It was the proponents of this bill that were outraged at Walter Reed Army hospital just a few short years ago and now they are singing the praises of VA medical care? Is that short memories or political leanings facilitating this change of position?

monster_mom
August 25th, 2009, 9:25 pm
One of the things I've learned (experience again) is that a law does not always make things so, especially if they are not enforced. Making continued laws that are not enforced complicates things further.

In the cases cited thus far I'd argue that the life threatening nature of the emergency was probably subject to debate. You can call that whatever you want, but the law is the law. If you were denied treatment while in a life threatening emergency, then you should contact an attorney and sue the heck out of the facility that denied you care because they broke the law. There are attorney's who will take these cases pro-bono and will make sure the facility is held accountable.

Laws are nice, but do no good if they cannot be enforced or the law also protects enforcement from having any real teeth.

Sometimes enforcing the law means being willing to stand up against a medical facility that is openly violating it. The law has teeth when it comes to denying care to a person in a life threatening emergency - it's called jail. If a medical provider refuses to treat a person in a left threatening emergency, he / she can be sent to jail.

And it will change because the medical facility would be guaranteed payment because all would have some sort of coverage.

Not necessarily. In a non-life threatening emergency, if you show up at their door and they aren't in your list of authorized providers then you have to go elsewhere or pay out of pocket.

When we were in Baltimore several years ago my son fell and split his head. He needed stitches and we called the insurance company to find out where to take him. The authorized facility they had in Baltimore was more than an hour away - past several other perfectly acceptable but not participating hospitals. We could have stopped at one of those hospitals but his treatment wouldn't have been covered by the insurance company. We chose to go the closest facility even though we'd have to pay out of pocket because (a) he was bleeding (b) I was freaking (c) we knew where it was. We paid the full cost with our Visa.

If George was covered by the expanded medicaid plan

None of the plans expand medicaid eligibility. It stays at 1.33 times the federal poverty level in every plan - Democrat or Republican.

or had enough to pay for a subsided private or public plan while on unemployment,

COBRA. You only have to pay for it if you use it.

Also, Francesca's daughter with an ear ache would probably be better off at a "facility" for a shorter period of time than sitting in an ER for several hours in great pain with her mother worrying about her child for so long and if the guy sitting next to her for the last 6 hours coughing up blood had TB

Francesca's Mom could take her to a pediatrician or urgent care center and the fee she'd pay for getting the ear looked at would be much less than the fee paid in a hospital.

I had a really bad ear infection several months ago and it popped up on a Saturday. Half my face and neck were swollen and red. I went to the local urgent care center which doesn't participate in my health insurance program and paid with my Visa.

And, again, those that already have insurance they like can keep it and their doctors.

Not entirely, at least not under the Democrats plan.

Under the Democrats plan the insurance plan I have now will have to be modified to be in compliance with federal mandates. That will likely increase the cost of my coverage. Additionally, my employer will no longer be able to deduct the cost of providing health coverage for his employees from the company taxes and to make up those additional expenses he'll be incurring I'll either get hit with a wage cut or the price I pay for coverage will increase. My employer pays upwards of 30% in taxes and contributes about $4800 a year towards my family medical coverage. That $4800 will no longer be deductible, so I'm looking at an increase of at least 30%, or $1440 in the cost of my coverage. And that's just the beginning. Factoring in the additional cost of all the federal mandates and $1,440 is likely the tip of the iceberg.

So while technically I'll still have the "same" coverage, less the federal mandates, the cost I pay for it will be considerably higher.

Like Lupin said, and I've said repeatedly, no one is arguing that there are problems that need to be addressed. I just don't think allowing the federal government to take over control of private health insurance is the best way of addressing those problems.

The reason the Democrats plan calls for the federal government to take control over private health insurance is so that there will be a pool of young healthy people covered by basic insurance who don't make use of medical services. The savings from their lower use of health services will be used to offset losses from older individuals increased use of medical services.

ComicBookWorm
August 26th, 2009, 4:51 am
COBRA. You only have to pay for it if you use it. COBRA doesn't last forever. And then HIPAA can kick in, and when it did for me my insurance went to $1000 per month.

USNAGator91
August 26th, 2009, 1:37 pm
COBRA doesn't last forever. And then HIPAA can kick in, and when it did for me my insurance went to $1000 per month.

Okay, I know I'm going to regret this, but are you saying that any plan should last in perpetuity? That anything should last forever? Where's the choice in that?

Wab
August 27th, 2009, 9:28 am
Like Lupin said, and I've said repeatedly, no one is arguing that there are problems that need to be addressed. I just don't think allowing the federal government to take over control of private health insurance is the best way of addressing those problems.

Giving the private industry more power will only make those problems worse.

ComicBookWorm
August 27th, 2009, 11:22 am
Okay, I know I'm going to regret this, but are you saying that any plan should last in perpetuity? That anything should last forever? Where's the choice in that?
:hmm: Okay... then what is a person to do when they can't get insurance when the COBRA runs out? Yes, I do think it should last forever, and I think it should be reasonably priced. If the insurance company was satisfied with the premium paid when I was employed, why should it jump to ten times the amount when I was unemployed and less likely to have much money? My COBRA was two times the rate I paid when employed, and I was able to manage that. But here is the progression for my monthly premium: $100 while employed. $200 while under COBRA. Then $1000 under HIPAA. Same insurance company, only the policy covered less and less every time the premium rose, with higher and higher deductibles and copays.

I have no idea where choice comes in here. I had no choice. I couldn't go to another insurance company until I qualified for HIPAA (after COBRA ran out). And there were more expensive plans with other companies, so I had a choice to pay even more than $1000 per month. Is that the choice you mean?

Den_muggle
August 27th, 2009, 11:23 am
I don't normally post in this area, but I have yet to get an answer to a suggestion I have had to improve health care.

If you look at the portion of the medical "industry" where people pay their own way and insurance and govt have mostly kept hands off, you will see a dramatic drop in costs. Look at elective surgeries such as LASIK and plastic surgery. Prices have dropped dramatically over the past 10-15 years. No speculation here, this is what has happened due to less overhead, less paperwork, faster payments, more patient involvement/oversight, price comparisons, etc.

Why wouldn't this be a better option for reforming the rest of health care? We already have HSAs. Why couldn't we provide aid to those who need it by helping (through govt if necessary) to fund the HSA accounts to handle the deductible? We could even (through tax credits or straight out payments) help cover the high-deductible insurance necessary.

Also, how will another govt program help when a goodly number of the uninsured now qualify for coverage that they haven't signed up for?

I apologize if these have been addressed, as I don't often come here and haven't read the entire thread, though I have checked on it now and again. I really would like to hear why this is such an unacceptable alternative. It seems to me to meet the stated goals of helping extend coverage without losing the good parts of the system many of us would like to keep.

Thank you.

With all this insistence on reform, I don't think anyone has told me why my reform--already proven in the real world marketplace of health care--isn't better than the govt getting more involved. You are all debating a theoretical reform and whether it will be an improvement, but why won't anyone address a proven success in this country (not one that is very different in many ways from our own) that has brought costs down, service up and gives everyone more choice, not less? This would require so much less govt involvement, more individual choice, more individual responsibility, less reliance on insurance companies...it seems to me to be a small change that would reap huge benefits without hurting anyone but people who want power over our lives they have no right to have.

Please explain what is wrong with this alternative.

ComicBookWorm
August 27th, 2009, 11:32 am
With all this insistence on reform, I don't think anyone has told me why my reform--already proven in the real world marketplace of health care--isn't better than the govt getting more involved.Because if your medical care goes to $50,000 then you need one hell of a medical savings account to pay it off.

I had a ruptured appendix which also gave me peritonitis (which can be fatal--my uncle died from it). I was hospitalized for a week on intravenous drips of incredibly powerful (and incredibly expensive) antibiotics. There was some fancy surgery to clean me out too, along with several CT-scans and endless lab work. My bill ran to over $50,000 and because of insurance I didn't pay a penny. How many people can put that kind of money into a medical savings account?

Medical savings accounts have always been used to sound like some cure all for medical expenses. But that's only if you don't have to see the doctor for anything more serious than a case of the sniffles.

OldLupin
August 27th, 2009, 2:01 pm
Because if your medical care goes to $50,000 then you need one hell of a medical savings account to pay it off.

I had a ruptured appendix which also gave me peritonitis (which can be fatal--my uncle died from it). I was hospitalized for a week on intravenous drips of incredibly powerful (and incredibly expensive) antibiotics. There was some fancy surgery to clean me out too, along with several CT-scans and endless lab work. My bill ran to over $50,000 and because of insurance I didn't pay a penny. How many people can put that kind of money into a medical savings account?

Medical savings accounts have always been used to sound like some cure all for medical expenses. But that's only if you don't have to see the doctor for anything more serious than a case of the sniffles.

A couple of questions, please. First, what in the government plan will reduce the bill from $50,000 to something more managable? Is there anything? Second, if the bill is still $50,000 under the government plan who pays that bill? Third, if the government is involved, isn't it more likely that by the time that care is paid for the treatment will cost more and not less? That again takes us back to who will pay for it?

I don't see how the proposed healthcare act does anything except increase the individual cost of medical treatment and divert the means of payment to higher government spending which translates to higher personal financing of the government. In short, more expensive healthcare in total coupled with a large, by all indications slow and inefficient beuracracy. How will that benifit anyone, even the uninsured after healthcare goes the way of public education? Sure everyone gets an education, but hardly anyone can now afford the private version which is far superior and it is a privledge for the privledged few. Why wouldn't healthcare be the same way? In short we all have it, but it isn't a very good service, and it costs most of us as much or more than the privately provided service that was superior.

monster_mom
August 27th, 2009, 2:48 pm
Giving the private industry more power will only make those problems worse.

Evidence, please.


Because if your medical care goes to $50,000 then you need one hell of a medical savings account to pay it off.

I had a ruptured appendix which also gave me peritonitis (which can be fatal--my uncle died from it). I was hospitalized for a week on intravenous drips of incredibly powerful (and incredibly expensive) antibiotics. There was some fancy surgery to clean me out too, along with several CT-scans and endless lab work. My bill ran to over $50,000 and because of insurance I didn't pay a penny. How many people can put that kind of money into a medical savings account?

Medical savings accounts have always been used to sound like some cure all for medical expenses. But that's only if you don't have to see the doctor for anything more serious than a case of the sniffles.

HSA's from what I recall, are generally used in conjunction with some sort of high deductible "catastrophic" health insurance plan. My sister has a HSA with a 50% employer match up to $4000 a year for just her coupled with a health insurance plan that has a deductible of $12,000.

Had your medical emergency happened to her, she would have been on the hook for the first $12,000 of costs but her insurance would have kicked in for the rest. She could have paid that $12,000 she was responsible for from her HSA.

She has to pay for routine care - like her annual tune up and tire rotation. If she uses a preferred provider she gets to take advantage of her insurance companies negotiated discounts and the cost of exam goes against her deductible.

HSA's, in my opinion, are great for generally healthy people who can't afford full basic coverage because the premiums are really low. The savings, especially when combined with an employer match, can really add up over time. My husband and kids would probably do great in one of these type plans.

The problem with HSA's and high deductible plans is if you have some sort existing illness. My Mom has RA and the medication she takes to treat it costs upwards of $10,000 a year. Add Dr visits and lab test that come with the medication, and she'd be hitting or exceeding her catastrophic maximum each year. From a financial standpoint, an HSA with a high deductible isn't a good choice for her.

And if she didn't have an employer sponsor that offered group plans with negotiated, set premiums, flipping from a high deductible to a basic plan would cause her premiums to spike big time.

That's why, in my opinion, allowing more groups, like the Republican plan does, would improve the situation.

How? Because you could join an organization whose list of available plans includes lots of different options like high deductible, basic, and premium plans, and each plan would have a set negotiated premium. You could enroll in a high deductible plan with an HSA and then flip to a basic or premium plan when the need arises and rather than seeing your premiums skyrocket, because you were a member of the organization, you'd pay the group premium rate and not an individual premium rate.

Wab
August 27th, 2009, 3:01 pm
Evidence, please.

Besides the oft-quoted Potter testimony it's simple common sense.

The current system dominated by corporate interests has created the mess, it stands to reason that allowing them more power will make things worse.

Chris
August 27th, 2009, 3:32 pm
Den - with maybe one or two exceptions, the things you noted were elective procedures. Thus, after the initial cost of development, to get people to even use the procedures, they had to drop the prices. Otherwise no one would use lasik, etc. I think that for elective procedures that aren't "essential treatment" it probably is fine to let the free market take its course. But, contrast this with a drug or procedure that's immediately life-saving or significantly prolonging. When an orphan drug for a new indication hits the market, if a private insurer won't cover it because of cost or because they claim it's unproven (despite the phase III clinical trials the FDA requires, the entire point of whom is to prove efficacy), then if it gives someone another 10 years of life I think that there should be a government option to support that. Drugs tend to go down less in cost than medical equipment, too, because there's different economics at play. I think that the primary factor at play is that elective procedures need to be priced "right" for people to do them, while life-critical procedures and drugs often have a small enough patient base and a higher development cost so they won't come down in price, whether or not they are covered by insurance. Thus, it may work to let the free market work on lasik, but it won't work to just let the free market work on a new drug to treat Lou Gehrig's Disease or a new procedure to treat cystic fibrosis, etc. Insurance of some sort via the government or private insurers (who often balk at the newest treatments under the grounds I listed above) should step into that void to provide enhanced quality of life or a longer life.

OldLupin
August 27th, 2009, 6:36 pm
Den - with maybe one or two exceptions, the things you noted were elective procedures. Thus, after the initial cost of development, to get people to even use the procedures, they had to drop the prices. Otherwise no one would use lasik, etc. I think that for elective procedures that aren't "essential treatment" it probably is fine to let the free market take its course. But, contrast this with a drug or procedure that's immediately life-saving or significantly prolonging. When an orphan drug for a new indication hits the market, if a private insurer won't cover it because of cost or because they claim it's unproven (despite the phase III clinical trials the FDA requires, the entire point of whom is to prove efficacy), then if it gives someone another 10 years of life I think that there should be a government option to support that. Drugs tend to go down less in cost than medical equipment, too, because there's different economics at play. I think that the primary factor at play is that elective procedures need to be priced "right" for people to do them, while life-critical procedures and drugs often have a small enough patient base and a higher development cost so they won't come down in price, whether or not they are covered by insurance. Thus, it may work to let the free market work on lasik, but it won't work to just let the free market work on a new drug to treat Lou Gehrig's Disease or a new procedure to treat cystic fibrosis, etc. Insurance of some sort via the government or private insurers (who often balk at the newest treatments under the grounds I listed above) should step into that void to provide enhanced quality of life or a longer life.

Given what is stated here, how will government intervention lower the cost? I mean cost controls may be feasible, but not through government actively becoming a provider or via the standards being presented in the Bills. I am somewhat confused about how the money is supposed to work, even in theory, to be honest. I know costs are hogh and care is expensive, but there seems to be nothing that even proposes a way to reduce those costs.

I think there is agrement on the desired net outcome of all people having access to good healthcare, but no real connection from that goal to the proposed actions, is there? If the costs don't go down, but most likely go up and the availibility is less restricted and the amount of treatment is increased and a number of insurance providers will loose funding due to the availability of a government option (I mean we all have to pay for it whether we use it or not how can most of us pay twice?), which will effectively minimize competition, how does the cost become reduced in any forseeable way?

If costs aren't reduced and they still have to be paid, where will that money come from? Will all services still be available? Will strict controls have to be applied to what the government program will actually cover and how will that be determined once a funding problem arises? If this program is to be in any way similar to every other federal program that funding problem will be almost immediate and will be virtually permanent.

In addition, insurance providers face liability for products if they approve the use for their clients by funding them. Some objection is raised by providers because of previous legal liability for using newer drugs and being listed as co-defendants in law suits after long term use side effects come to light. There is also the generic to "name brand" cost comparison. A lot of times it is too expensive, given premiums to use expensive name brand drugs and there is the wait for generic comparables to be marketed. At 4.2%, one drug approval could break a company if both legal action and high cost/use of the drug overwhelms income. The government will face the same decisionmaking process if they insure people. They may not make a profit, but they will definitely have to stay within financial guidelines to stay solvent and a bad decision on a drug could have a similar net negative effect if it saps too much from the operating budget.

Chris
August 27th, 2009, 6:53 pm
I'm more noting the vast difference between elective and "necessary" treatments. There's a large subset of the marketplace where I am opining that letting the free market take its course wouldn't work to drive down costs; and in fact by having insurers cover the drug(s) that costs get lowered because more people would take them. This subset is primarily drugs targeted towards smaller patient sets, where the Orphan Drug laws would give extended patent protection to the "First in class" drug. Without the orphan drug laws, no company would pursue these drugs, since the "me too" drugs would rapidly make the program unprofitable. But, the costs of these drugs are often high enough that some form of insurance is required for all but the rich to afford it - but, once insurance companies start reimbursing for the drugs, then the full patient set gets the drug, instead of just those who can pay out-of-pocket. So, a one-size-fits-all let the marketplace take its course won't work for drugs like these, and in fact the negotiating power of medicare / medicaid / etc can act as a cost control in these instances.

Whoops, would write more, but gotta run...this type of analysis is right in my comfort zone, having worked in pharma myself...

USNAGator91
August 27th, 2009, 6:54 pm
Den - with maybe one or two exceptions, the things you noted were elective procedures. Thus, after the initial cost of development, to get people to even use the procedures, they had to drop the prices. Otherwise no one would use lasik, etc. I think that for elective procedures that aren't "essential treatment" it probably is fine to let the free market take its course. But, contrast this with a drug or procedure that's immediately life-saving or significantly prolonging. When an orphan drug for a new indication hits the market, if a private insurer won't cover it because of cost or because they claim it's unproven (despite the phase III clinical trials the FDA requires, the entire point of whom is to prove efficacy), then if it gives someone another 10 years of life I think that there should be a government option to support that. Drugs tend to go down less in cost than medical equipment, too, because there's different economics at play. I think that the primary factor at play is that elective procedures need to be priced "right" for people to do them, while life-critical procedures and drugs often have a small enough patient base and a higher development cost so they won't come down in price, whether or not they are covered by insurance. Thus, it may work to let the free market work on lasik, but it won't work to just let the free market work on a new drug to treat Lou Gehrig's Disease or a new procedure to treat cystic fibrosis, etc. Insurance of some sort via the government or private insurers (who often balk at the newest treatments under the grounds I listed above) should step into that void to provide enhanced quality of life or a longer life.

Chris, using your criteria, would you consider knee or hip replacement "elective" surgeries? Wouldn't LASIK be "life critical" for a pilot or anyone else that relies on their sight to live?

What you are saying is precisely the reason why government options don't work. By design, you are prioritizing and categorizing procedures or drugs by their relative "importance" based on what you or some other third party would determine.

In a free market environment, pricing and availability as well as innovation are not centrally planned and so decisions about "life-critical" procedures are not left to someone else's discretion.

I do not believe the CURRENT system is a free market system. I think many people do not truly understand what Den's HSA plan would do in conjunction with a free market scenario.

First, you offer HSA's with pre-tax contributions. Some companies may match what's paid in, others will not. HSA's are NOT designed to pay for a so-called "$50,000" procedure. What they do is allow consumers to purchase high deductible and low premium health insurance.

Next, you tear down the minimum mandates and cross-state restrictions, and allow the consumers to pick and choose their plans based on what works for them. No more plans that have in vitro coverage for 55 year olds. In fact, you allow plans to be offered with a la carte choices.

Third, in order to cover those who are unemployed or at or near the poverty level, you offer tax credits up to $5,000 to start those HSA's. Currently, Social Security takes 6% of your income with an employer match, why not devote 1% of that collected to your HSA?

Fourth, you make the plans that consumers buy portable, owned by the insuree and not by the company. You eliminate open enrollment periods and allow consumers to opt out of their current plan with thirty days notice.

Lastly, to cover those with pre-existing conditions, you create a high risk insurance pool. This will be the bulk of the government cost because those with pre-existing conditions are costs that will not be recovered by the insurer. Therefore, something should be done to mitigate the cost and incentivize insurers to cover that population.

The power of consumer choice goes a long way. Who is the government, or anyone else to decide what is "life-critical" and what isn't? In a free market the choice is moot.

ETA: Oh and Chris, I've also worked for a large pharmaceutical firm and can tell you that the ED drugs we developed might not be considered "life-critical", but the profits helped pay for the development of those that were.

monster_mom
August 27th, 2009, 7:40 pm
Besides the oft-quoted Potter testimony it's simple common sense.

The current system dominated by corporate interests has created the mess, it stands to reason that allowing them more power will make things worse.

What mess?

Well more than 70% of American's are happy with their health care - more than 80% if you look outside liberal media polls. US life expectancy is pretty much the same as within Europe and long term survival from cancer is much higher. Infant mortality, when adjusted for weight is also about the same as Europe.

Chris
August 27th, 2009, 8:49 pm
What mess?

Well more than 70% of American's are happy with their health care - more than 80% if you look outside liberal media polls. US life expectancy is pretty much the same as within Europe and long term survival from cancer is much higher. Infant mortality, when adjusted for weight is also about the same as Europe.

Links, please. Especially the liberal media polls swipe. Not all polls from liberal media sources are unbiased, you know.

Gator - I'm mostly talking life-critical drugs that target small patients sets - like <50,000 patients (I forget what the orphan drug cutoff is). The orphan drug rules provide the only incentive to make a drug for that patient set, and it's by reducing competition. For a lifestyle drug like an ED drug, I'm fully supportive of letting there be "me too" drugs and generic competition, and I am quite aware that the profits from drug A are used to fund the development of drugs B, C, and D. The so-called lifestyle drugs also have much, much larger possible patient sets and therefore can be priced cheaper in order to reach more of the market.

Though you do allude to an important point many people don't realize - the cost of producing a pill for any of those drugs really is pennies, but much of the money charged for each pill is recouping development costs and funding the development of other drugs. A typical lifestyle drug can cost up to $1 billion to develop and that $$ has to come from somewhere.

I do refer wayyyy back to another idea I had a while back that garnered some support - ban drug advertising on tv and severely curtail it elsewhere. It'd cut a big chunk of out of the drug company budget (up to 7-10%) and it'd also reduce the demand for truly unneeded drugs.

Redhart
August 27th, 2009, 8:55 pm
The mess that caused my emergency surgery to be rejected at a *county* hospital. The mess that raised my friend's husband's insurance from $400/month to $1400/mo causing them to be unable to pay it, after he was diagnosed with a brain tumor. The mess that causes even our community hospital in town to not even offer their own employees insurance benefits...at a hospital!

The mess that causes thousands a day to lose their insurance. The mess that has county ERs crowded to such levels waits are hours and hours for those that have no other choice.

The mess that the uninsured can't even get a doctor's appointment with cash in my county (which, btw, is a republican county) because of the liability (don't bother trying to save cash in an account).

The mess that has premium prices growing three times faster than the inflation rate.

That mess.

This is why we are here...this is why there is such a cry for change, and has been a cry for change.

You can't just label any report you don't like the numbers of as "liberal".

You know, I've been gone for a bit and, yes, you're going to hear another personal experience story. It's amazing how they are just all over the place and have been hitting me from all sides.

While my husband was at the VA hospital getting his surgery last week, my friend's husband committed suicide in Bakersfield. He had been diagnosed with a terminal illness as a result of several months of testing (causing his insurance rates to skyrocket at the age of 60). According to my friend, he was very upset at the prospect of them possibly losing their house due to out of pocket expenses, even with insurance. It was killing them financially. Apparently, after getting confirmation of his diagnosis, he went off and did the deed to save his family from the financial burden of trying to treat him.

The funeral was yesterday. His wife is devistated and his 16 yr old daughter (who he was so close to) has had her teen years, which should be some of the happiest and carefree of her life, chopped short.

This mess.
I don't personally agree with what her husband did. But, the point is, people shouldn't even have to think about treatment vs. financial destitution.

The corporate insurance system and medical structure that is currently in place is destroying families every day.

Please keep their family in your prayers and thoughts.

USNAGator91
August 27th, 2009, 8:56 pm
I do refer wayyyy back to another idea I had a while back that garnered some support - ban drug advertising on tv and severely curtail it elsewhere. It'd cut a big chunk of out of the drug company budget (up to 7-10%) and it'd also reduce the demand for truly unneeded drugs.

I agree with that. The advertising and pitches is heavily regulated anyway. I'd go a bit further, I'd ban sales reps from doctor's offices. Look, I was a pharmaceutical sales representative and I can tell you the sales forces are way to big. Each has a computer, a car, samples, and detail pieces as well as their giveaways. That's a huge amount of overhead. Either ban the reps from the offices or at the very least from the hospitals.

ETA: Redhart, I am extremely sorry for both you and your friend. My concern is that the proposal as is will not ameliorate the problem, but will, in fact, make it worse.

The Telegraph (http://www.telegraph.co.uk/health/healthnews/6092658/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed.html)

I do not doubt that your experience is horrible, and I completely understand your desire to change the system. I don't know anyone that doesn't want to change the system, but I do not want a change that will make it worse.

My prayers are with your friend. As a veteran, I know the pain of loss is greater at home than abroad.

Den_muggle
August 27th, 2009, 9:56 pm
I'm more noting the vast difference between elective and "necessary" treatments. There's a large subset of the marketplace where I am opining that letting the free market take its course wouldn't work to drive down costs; and in fact by having insurers cover the drug(s) that costs get lowered because more people would take them. This subset is primarily drugs targeted towards smaller patient sets, where the Orphan Drug laws would give extended patent protection to the "First in class" drug. Without the orphan drug laws, no company would pursue these drugs, since the "me too" drugs would rapidly make the program unprofitable. But, the costs of these drugs are often high enough that some form of insurance is required for all but the rich to afford it - but, once insurance companies start reimbursing for the drugs, then the full patient set gets the drug, instead of just those who can pay out-of-pocket. So, a one-size-fits-all let the marketplace take its course won't work for drugs like these, and in fact the negotiating power of medicare / medicaid / etc can act as a cost control in these instances.

Whoops, would write more, but gotta run...this type of analysis is right in my comfort zone, having worked in pharma myself...

I'm not an expert in this field and don't really understand "orphan drugs" and "first in class" and such terms.

You still have competing companies and competition is what drives down the cost. Benedryl was the only antihistamine (at least the only one most people knew of) for how long? Then, all of a sudden, we have Zyrtec and Claritin and Allegra and they have to compete. That drives the costs down for the consumer. Cialis and Levitra and Viagra are another example. True, none of these are life-saving meds, but they aren't exactly elective, either. At least not the allergy meds. I'm not feeling especially well today, so I'm not sure if I can make a thoroughly coherent argument, but even life-saving meds/procedures can have competition introduced or at least considered. If my insurance pays the same, am I really going to care what brand of stent my doctor puts in or if he does a stent at all or just a balloon? If I have to pay at least a portion, I might. Insurance used to cover any labwork at any lab, but now we have to check to see that the doctor sends it to the correct lab so it's covered...which the insurance company requires to keep costs lower. When it hits our wallet/pocketbook, we care about the pricing; when it doesn't (or doesn't immediately, at least), we don't.

In 1995, I broke my leg in the spring. By the time that was treated completely, I had reached my out of pocket stop loss for the year. When I had bronchitis and the doctor wanted to do a whole battery of tests on me, I didn't protest or question because it wasn't costing me a dime to let him run every test in the world. At times when I've had to pay (or similarly for my cats), I questioned the necessity of every test and have refused unnecessary tests.

Gator had great things to add about the plan I proposed, so I won't detail that again.

Redhart, could it be that your experience of having so much trouble finding a job with medical benefits comes from California's burdensome regulations? In Indiana, I don't know of anyone who has a job where there are more than a dozen employees where health insurance isn't offered as a benefit. Certainly no hospital around here refuses to provide it as a benefit. Even small town hospitals such as where my sister worked for years provide their own self-coverage. And they aren't so burdened that you can't get seen. We also have immediate care centers that don't care if you have insurance at all if you have the cash. It is possible to find doctors here that will take you without insurance as long as you prepay each visit. Most will work with you on larger dollar amounts so you can prepay some and finance the rest. (I know, as we've had to have a couple of fairly expensive procedures done for my husband...who is uninsured.) To me, it indicates how more govt means less availability. Now that's my opinion and I can't prove it, but it certainly seems logical to me.

Again, I apologize if this seems a little rambling and incoherent, but since I kind of jumped in this, I wanted to respond at least a little.

monster_mom
August 27th, 2009, 10:46 pm
Links, please. Especially the liberal media polls swipe. Not all polls from liberal media sources are unbiased, you know.

Links to polls can be found in here (http://www.americanhealthsolution.org/fact-check-americans-are-satisfied-with-their-health-plans-2/) and in one of my previous posts. The polls were conducted within the same general time frame and polled either respondents, registered voters, or likely voters. CNN polls show 74% satisfaction, The New York Times showed 77% satisfied, the Washington Post showed 81% satisfied, and Fox news showed 84% satisfied - all polled within the same time period. Looking outside the media you have Zogby with 84% satisfied and Gallup with a rather confusing either 83% or 67% satisfied. Note that I chose to report the poll showing the lowest satisfaction from CNN rather than deal with scoffing because I reported Fox or Zogby's numbers.

Life expectancy numbers, including cancer survival rates and infant mortality statistics can be found at the link in this (http://www.cosforums.com/showpost.php?p=5395936&postcount=434) post of mine from several days ago.

I do refer wayyyy back to another idea I had a while back that garnered some support - ban drug advertising on tv and severely curtail it elsewhere. It'd cut a big chunk of out of the drug company budget (up to 7-10%) and it'd also reduce the demand for truly unneeded drugs.

I agree. Do we honestly have to have a advert for Cialis during Sponge Bob? My 6 year old asked what ED was a few weeks ago. I told him to ask his father.

Redhart, could it be that your experience of having so much trouble finding a job with medical benefits comes from California's burdensome regulations? In Indiana, I don't know of anyone who has a job where there are more than a dozen employees where health insurance isn't offered as a benefit. Certainly no hospital around here refuses to provide it as a benefit. Even small town hospitals such as where my sister worked for years provide their own self-coverage. And they aren't so burdened that you can't get seen. We also have immediate care centers that don't care if you have insurance at all if you have the cash. It is possible to find doctors here that will take you without insurance as long as you prepay each visit. Most will work with you on larger dollar amounts so you can prepay some and finance the rest. (I know, as we've had to have a couple of fairly expensive procedures done for my husband...who is uninsured.) To me, it indicates how more govt means less availability. Now that's my opinion and I can't prove it, but it certainly seems logical to me.

Den, we have the same thing here in Virginia as you do in Indiana. My husband's shop offered medical benefits to their full time employees - and they only had 5! My neighbor is an ER nurse at the local community hospital and she said they've never turned a patient away because of inability to pay or lack of insurance. She was appalled when I described Red's experience and said it sounded criminal to her.

The health care system in California is struggling - I'm not sure if it's the regulatory burdens there or the large influx of undocumented aliens who lack coverage.

Pearl_Took
August 27th, 2009, 10:56 pm
The Telegraph (http://www.telegraph.co.uk/health/healthnews/6092658/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed.html)

That Telegraph article is certainly not fun to read. :no: It is worth noting, however, this quote:

They cite patient surveys which show the vast majority of patients highly rate their NHS care - but, with some ten million treated a year, even a small percentage means hundreds of thousands have suffered.

Of course 'even a small percentage' is totally unacceptable. Nurses who are uncaring or unprofessional should not be in that profession. Period.

Nonetheless, the quote bears repeating: a vast majority of patients highly rate their NHS care. I would be one of them. My father would be another, and I quote his case below.

Yes, our NHS has faults, I would never deny that. However, I cannot put this strongly enough, there is no way -- NO WAY -- for all its flaws, I would ever exchange what we have here in the UK for what you have in America. Your medical insurance companies scare me.

For ways in which to reform our NHS (and I am the last person to deny it needs reform), I would look, rather, to Canada or to France ... France in particular has an excellent reputation re: its health care.

Here's a useful table of comparison of healthcare around the world from the BBC:
http://news.bbc.co.uk/1/hi/health/8201711.stm

You find our NHS scary. I confess to finding your system scary. Very scary. I have read too many stories now of Americans whose monthly medical insurance payments go through the roof to absurd levels and whose insurance companies put conditions on what they will pay out for. It is clear where the insurance companies' priorities lie: in their profits, not in your health. I find that outrageous. I would not want these fat cats in charge of my healthcare, thank you very much.

Four years ago my father had a heart attack. He was given a powerful drug by the paramedics who treated him and then he was taken by ambulance to a NHS hospital which has an excellent reputation for heart surgery. The hospital was so clean and efficient you would have thought it was privately run. My dad made a great recovery. That was the NHS at its best. As it should be. As it often is.

Of course the medical insurance companies in the US have a vested interest in portraying our national health care as nothing more than one big horror story. 'Socialised medicine', LOL -- I'd never heard of this phrase before I joined messageboards and started talking to people from all over the world. ;)

leah49
August 27th, 2009, 11:41 pm
Why does our medical insurance scare you? I don't think our health coverage is THAT bad. I do think the media is blowing this out of proportion. Does it need to be changed? Sure, but not that much.

Den_muggle
August 28th, 2009, 1:58 am
Four years ago my father had a heart attack. He was given a powerful drug by the paramedics who treated him and then he was taken by ambulance to a NHS hospital which has an excellent reputation for heart surgery. The hospital was so clean and efficient you would have thought it was privately run. My dad made a great recovery. That was the NHS at its best. As it should be. As it often is.


Emphasis mine. I found this an extremely telling statement coming from someone talking about how much better govt-run health care is when compared to that run by private companies...by saying the govt hospital was so well-run you would have thought it was private, not run by govt. Amazing what the free market and competition can do. Govt can sometimes do well, but not as a rule. The govt has little to no incentive to improve without competition; insurance companies would go out of business if they treated too many customers badly because people would switch to a company that gives better treatment.

Redhart
August 28th, 2009, 3:35 am
Four years ago my father had a heart attack. He was given a powerful drug by the paramedics who treated him and then he was taken by ambulance to a NHS hospital which has an excellent reputation for heart surgery. The hospital was so clean and efficient you would have thought it was privately run. My dad made a great recovery. That was the NHS at its best. As it should be. As it often is.
Stephen Hawkin agrees with you ;)

Our current insurance system has been scaring me for years here.

ComicBookWorm
August 28th, 2009, 3:41 am
I fail to understand why the private health market is held in such high esteem, considering how many people are left behind. There's nothing wrong with having both options--a private market for those who can afford it and public option for those who can't. The public option won't be public hospitals and government employed doctors. It will just be another insurance option, except this one will be provided by the government.

I have Medicare. I go to private doctors and my choice of medical groups and hospitals. But instead of Blue Cross paying my bills, the government does. That's what "socialized" medicine looks like in the US. In other countries the hospitals and doctors are government employees; here they will remain private but the government will pay the bills.

Wab
August 28th, 2009, 3:51 am
insurance companies would go out of business if they treated too many customers badly because people would switch to a company that gives better treatment.

People only find out how little private insurers are willing to offer after they are sick by which stage they are locked in because they are then deemed to have a pre-existing condition which makes finding another insurer almost impossible, and if another is found, the premiums would be unpayable.

ComicBookWorm
August 28th, 2009, 4:24 am
People only find out how little private insurers are willing to offer after they are sick by which stage they are locked in because they are then deemed to have a pre-existing condition which makes finding another insurer almost impossible, and if another is found, the premiums would be unpayable.Which was exactly what happened to me--I was stuck.

DancingMaenid
August 28th, 2009, 4:46 am
I'm fortunate enough to have good insurance that mostly covers my needs (though I will need to get new insurance in the next couple years). I haven't suffered from lack of medical care.

And I still find the American system extremely disturbing, and would be more comfortable with an NHS-type system. I'm not comfortable leaving my health in the hands of a company whose profits depend on paying out as little as necessary. I know that my health coverage is based largely on good fortune and the willingness of insurance companies, and that bothers me.

Alastor
August 28th, 2009, 5:48 am
Life expectancy numbers, including cancer survival rates and infant mortality statistics can be found at the link in this (http://www.cosforums.com/showpost.php?p=5395936&postcount=434) post of mine from several days ago.Didn't Chris already show how those sources are questionable? I've been looking at their source data, and I have a few issues with their source data.

WHO statistics of 2009 can be found here: http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf.

Morgoth
August 28th, 2009, 7:36 am
The Telegraph

Yeah, now find the news articles where the overwhelming majority give their full support to the NHS with detailed stories on their experiences. If you find one, it'll be buried so far beneath the plethora of bad news stories, you'd be a hardened cynic by the time you got to it. The damn media in my country are so bloody negative about everything. I mean sure, the Telegraph is a Conservative newspaper & naturally anything that makes the sitting center-left government look bad is print-worthy in their eyes, but you'd think we were a third-world country the way people go on. I've got a 91-year old grandmother who has had first-class treatment on the NHS. I can't sing their praises high enough, it's just positive news stories don't sell newspapers.

If you collated all the bad news stories on the current US health system, would that be a fair & accurate picture of the system you've come to use and know over the years? It doesn't do any good to constantly have a system represented by bad news stories, which is why some in this thread are defending the system of health care in the US, because they don't buy into all the bull that's spoken of the present system.

- My Aunt who is an American citizen, lived in the US for 45 years now, has had breast cancer and her treatment has been first-rate, top quality. She's worried about her coverage when she retires, but she's working out the sums as I suppose all people reaching retirement may do. So, her experience of the medical system is good. I'm going to take her word over the many horror stories I hear because you don't know what drives some people to say the things they do about a system. In other words, I won't judge.

Likewise, the UK NHS may have some issues but it's not representative of the system as a whole. I just get angry at the way my country's system is so mis-characterized by the US media & politicians. You know for a nation of 61 million people, the majority of us are pretty healthy & doing okay for ourselves.

Mundungus Fletc
August 28th, 2009, 9:09 am
I've got a 91-year old grandmother who has had first-class treatment on the NHS. I can't sing their praises high enough, it's just positive news stories don't sell newspapers.

I think it the case that almost everyone knows of people who have received excellent care under the NHS yet there is an overall picture (produced by the media as you say) that it is failing. It is of course not perfect but I think many Brits having had their eyes opened by all the publicity about the US system are worried about it changing in that direction.

Pearl_Took
August 28th, 2009, 9:55 am
Why does our medical insurance scare you? I don't think our health coverage is THAT bad. I do think the media is blowing this out of proportion. Does it need to be changed? Sure, but not that much.

Your system scares me because I have American friends who tell me that their monthly medical insurance takes insane leaps, from something like $200 a month (a reasonable amount) to $2,000 a month. That is insane. My friends are either middle-class professionals, in the middle wage earning bracket, not particularly wealthy, or else they are struggling to make ends meet. This to me is like having an albatross slung round your neck, like mortgage payments you can't meet. Sorry, but there is no way I would ever want all of my healthcare in the hands of some fat cat insurance company. :no:

And I still find the American system extremely disturbing, and would be more comfortable with an NHS-type system. I'm not comfortable leaving my health in the hands of a company whose profits depend on paying out as little as necessary. I know that my health coverage is based largely on good fortune and the willingness of insurance companies, and that bothers me.

Exactly. :tu:

Emphasis mine. I found this an extremely telling statement coming from someone talking about how much better govt-run health care is when compared to that run by private companies...by saying the govt hospital was so well-run you would have thought it was private, not run by govt.

I said that, Den Muggle, because our govt-run health care has got such a hysterical slagging off by by the American media and apparently has terrified many Americans into thinking that our patients are left dying on the streets, or some such nonsense.

Like this gem of misinformation and stupidity:

"People such as scientist Stephen Hawking wouldn't have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless."

LOL! Professor Hawking has lived in the UK all his life. :err: Here is his smackdown, in The Daily Mail (or Daily Wail :D ), of all places, one of our more right-wing tabloids:

http://www.dailymail.co.uk/news/article-1205953/NHS-branded-evil-Orwellian-high-level-US-politicians.html

Amazing what the free market and competition can do. Govt can sometimes do well, but not as a rule. The govt has little to no incentive to improve without competition; insurance companies would go out of business if they treated too many customers badly because people would switch to a company that gives better treatment.

As other posters have pointed out in this thread, like Redhart and Comic Bookworm, what about pre-existing conditions? :huh: What about Americans who get caught out by that and are now trapped because their insurance companies, who have been perfectly happy to take their thousands of dollars, will not pay out for a pre-existing condition? That is a monstrous behemoth in charge of your healthcare. Thanks, but no thanks. :no:

As I already said: the NHS is not perfect. Our own media criticises the NHS frequently: which means that bad stories sell, and good stories don't, of course. I am committed to the principle of the NHS. Therefore I am coming from a very different place from someone who has no experience of our NHS and somehow believes that UK citizens are oppressed by the iron hand of socialism or whatever.

If the NHS needs reforming, I would rather look to Canada and those European countries which operate a mix-and-match system. But not the US.

Likewise, the UK NHS may have some issues but it's not representative of the system as a whole. I just get angry at the way my country's system is so mis-characterized by the US media & politicians. You know for a nation of 61 million people, the majority of us are pretty healthy & doing okay for ourselves.

Thank you. :tu: :agree: :agree: :agree: :agree:

Hysteria
August 28th, 2009, 10:59 am
Originally Posted by leah49
Why does our medical insurance scare you? I don't think our health coverage is THAT bad. I do think the media is blowing this out of proportion. Does it need to be changed? Sure, but not that much.
This wasn't directed at me, but the #1 reason I would never live in the US is because of the health care. My health care is astronomically loser (from what others have said theirs is on this thread) and I'm covered for everything. I have private health insurance but that's only because I have so many health needs (glasses, braces, various health problems) :rolleyes: and I'm still covered by my parents anyway, being a student. Our public system is very, very good and quite inexpensive.

Pearl_Took
If the NHS needs reforming, I would rather look to Canada and those European countries which operate a mix-and-match system. But not the US.
Australia also has private and public options.

Melaszka
August 28th, 2009, 12:01 pm
The Telegraph (http://www.telegraph.co.uk/health/healthnews/6092658/Cruel-and-neglectful-care-of-one-million-NHS-patients-exposed.html)

I do not doubt that your experience is horrible, and I completely understand your desire to change the system. I don't know anyone that doesn't want to change the system, but I do not want a change that will make it worse.


It frustrates me when people in the US automatically jump to the conclusion that if there are problems with the NHS, those problems must arise directly because it is a government-run healthcare programme. No healthcare system in the world, private or public, is perfect. Do you have any evidence that the problems with nursing care that the Telegraph highlights are the result of our NHS being publicly administered?

My mother, who used to nurse in the NHS in the 50s and 60s (and who, like a lot of Conservative voters in the UK, is totally committed to the ideals of a publicly-run NHS, free at the point of access, despite being pro-small government in almost every other field), is scathing about the quality of nursing care today and how it has declined since her era - when the NHS was also publicly run and indeed was far less governed by market principles than today. If the problems with nursing care stemmed directly from the UK's system being a "socialist" one, surely the nursing care would have been bad then, as well?

I concur with everything my compatriots have said about the majority of NHS patients being satisfied with their care and the problems arising in only a minority of cases. Even amongst the people who complain about our system, the vast majority want to see the NHS improved, not replaced with a private insurance system.

The Telegraph itself has published a lot of articles supporting the NHS against groundless attacks by the US anti-government healthcare lobby, so it is not true that the Conservative papers in the UK are generally anti- "socialist" healthcare.

I'm not going to slag off the US system or argue that you guys ought to have our system, as yours is a much bigger country with different traditions, and what works for us might not work for you. But I do take issue with the UK system being held up as an example of the "evils" of "socialist" medicine, because it's not a picture which I (or, I think, most Brits) would recognise.

alwaysme
August 28th, 2009, 1:09 pm
Your system scares me because I have American friends who tell me that their monthly medical insurance takes insane leaps, from something like $200 a month (a reasonable amount) to $2,000 a month. That is insane. My friends are either middle-class professionals, in the middle wage earning bracket, not particularly wealthy, or else they are struggling to make ends meet. This to me is like having an albatross slung round your neck, like mortgage payments you can't meet. Sorry, but there is no way I would ever want all of my healthcare in the hands of some fat cat insurance company. :no:


What you have said here is the main issue with healthcare in my country. Very very expensive in some cases for people. Good quality but high costs.

SSJ_Jup81
August 28th, 2009, 1:32 pm
I agree. The US does have good health care. The problem is that not everyone has access to it for a reasonable price, which is why I feel that maybe having a public option and a private option might work out for the best in the long run. At least those who can't afford the unreasonable prices for private, can go another route and go with the lower-cost public system. I'm all for an NHS-like system, and I too am sick of people only focusing on the negative cases as opposed to pointing everything that's good with the NHS system. I've read quite a bit, and I seem to come across more positive than negative. Of course, I've never has NHS-type care since I am in the US, but I'd rather have some type of insurance than what I'm going through now with no insurance.

alwaysme
August 28th, 2009, 1:40 pm
I agree. The US does have good health care. The problem is that not everyone has access to it for a reasonable price, which is why I feel that maybe having a public option and a private option might work out for the best in the long run. At least those who can't afford the unreasonable prices for private, can go another route and go with the lower-cost public system. I'm all for an NHS-like system, and I too am sick of people only focusing on the negative cases as opposed to pointing everything that's good with the NHS system. I've read quite a bit, and I seem to come across more positive than negative. Of course, I've never has NHS-type care since I am in the US, but I'd rather have some type of insurance than what I'm going through now with no insurance.

Basically this sums up how I feel too. Even if their was a public option I think there still needs to be reform to the private insurance companies too. You will have some people who will always prefer private over something government run. As it stands the Insurance companies in some cases charge so much that it is just horrendous.

As far as the NHS goes I don't want to judge their system because as an American I don't feel that it is my place. I don't know enough and have never used it.

OldLupin
August 28th, 2009, 2:53 pm
Yeah, now find the news articles where the overwhelming majority give their full support to the NHS with detailed stories on their experiences. If you find one, it'll be buried so far beneath the plethora of bad news stories, you'd be a hardened cynic by the time you got to it. The damn media in my country are so bloody negative about everything. I mean sure, the Telegraph is a Conservative newspaper & naturally anything that makes the sitting center-left government look bad is print-worthy in their eyes, but you'd think we were a third-world country the way people go on. I've got a 91-year old grandmother who has had first-class treatment on the NHS. I can't sing their praises high enough, it's just positive news stories don't sell newspapers.

If you collated all the bad news stories on the current US health system, would that be a fair & accurate picture of the system you've come to use and know over the years? It doesn't do any good to constantly have a system represented by bad news stories, which is why some in this thread are defending the system of health care in the US, because they don't buy into all the bull that's spoken of the present system.

- My Aunt who is an American citizen, lived in the US for 45 years now, has had breast cancer and her treatment has been first-rate, top quality. She's worried about her coverage when she retires, but she's working out the sums as I suppose all people reaching retirement may do. So, her experience of the medical system is good. I'm going to take her word over the many horror stories I hear because you don't know what drives some people to say the things they do about a system. In other words, I won't judge.

Likewise, the UK NHS may have some issues but it's not representative of the system as a whole. I just get angry at the way my country's system is so mis-characterized by the US media & politicians. You know for a nation of 61 million people, the majority of us are pretty healthy & doing okay for ourselves.

You mean the bad news is over-reported and sucess is ignored?
I don't doubt that people with a NHS are satisfied, or at least not so dissatisfied as to want it done away with, just as private competition and medical care in America is not so bad as it is painted and that it has to be done away with.

Reform and correction would do both systems good, from the sound of it and that should be an ongoing process perpetually, IMO, which it usually is in buisness, not so much in government, at least not U.S. government.

I agree. The US does have good health care. The problem is that not everyone has access to it for a reasonable price, which is why I feel that maybe having a public option and a private option might work out for the best in the long run. At least those who can't afford the unreasonable prices for private, can go another route and go with the lower-cost public system. I'm all for an NHS-like system, and I too am sick of people only focusing on the negative cases as opposed to pointing everything that's good with the NHS system. I've read quite a bit, and I seem to come across more positive than negative. Of course, I've never has NHS-type care since I am in the US, but I'd rather have some type of insurance than what I'm going through now with no insurance.

The problem with any significant changes is that it has such terrible potential. The known is always more comfortable than the unknown, especially with no evidence to instill confidence or reassurance of sucess.

As I have stated before, the U.S. is a large and unwieldy entity and its government has proven less capable to run large national programs than others partially because of it. It isn't a genetic failing of the U.S. or some cultural failing of some kind, but simply a realistic matter of logistics and operation. The U.S. has 400,000,000 people and 50 seperate states. It also has the largest non-urban population in the Western world. It also has significant lifestyle differences, economic differences and cultural differences just state to state, let alone in any comparison to other nations.

In short, the only similar scaled example of state offering "both a private and a public option" is in education, where originally it would stay a choice. In just a few short years, there was no choice and the vast majority were economically bound to use the state option, while the elite were able to opt for a better option in private services. The masses can't afford both and the costs for private were prohibitive, an easily seeable course for government healthcare to follow. If the use becomes that great, the expansion has to follow and unfortunately many, including myself, are completely unable to accept a public healthcare that is in any way similar to public education.

While doctors may be private at first, the cost if there is a massive expansion would all but mandate the state hiring their own unionized medical force and becoming the sole financial support for the vast majority of providers and hospitals. If a state option is paid for with taxation and everyone must pay taxes, to avoid using it you would have to pay for both public and private and how can that happen when private alone is expensive? In short, there really won't be an option for most people despite availability.

Who would rather send their child to public school if they could attend a private one? Similarly who wouldn't want the expensive private care if they could have it? Also similarly, who can afford private school? In short order the very same elite that will be able to afford private care, IMO. Not a solution I have any desire for, especially given tha track record of our "benevolent" government.

SSJ_Jup81
August 28th, 2009, 3:51 pm
I feel that using private and public school isn't too good an example since no matter how you look at it, the parents have a choice on whether or not to send his/her/their child/children to a public school or a private school. Either way, the child will get an education. Of course there are some schools that are better than others (for example, the schools I went to were public, but known for its high achievers and ranked decently). With Health Insurance, we have no competition and we have no choices outside of private. The ones who are uninsured (and not by choice) are probably the ones who are too young for Medicare, or make too much for Medicaid.

Of course I don't know if an NHS-style will work or help, I'll admit that, but at least it's something. Our old way isn't working very effectively. I'd rather give something new a chance than to keep going with the same old thing which has failed, imo.

OldLupin
August 28th, 2009, 4:49 pm
I feel that using private and public school isn't too good an example since no matter how you look at it, the parents have a choice on whether or not to send his/her/their child/children to a public school or a private school. Either way, the child will get an education.

Why then isn't it the ideal example of what is being proposed for healthcare? It is analogous in most ways, isn't it?


Of course there are some schools that are better than others (for example, the schools I went to were public, but known for its high achievers and ranked decently). With Health Insurance, we have no competition and we have no choices outside of private. The ones who are uninsured (and not by choice) are probably the ones who are too young for Medicare, or make too much for Medicaid.

That choice is extremely limited by the fact that to exercise it you have to pay for both options and that isn't practical for the vast majority, wouldn't you agree?

In addition, the tax base of an area is a deciding factor on how good the schools are. In short, all kids get "an education" but it isn't of very high quality and it costs more than it would to get one privately if the public option is available. The majority is basicly provided a much reduced and inferior service to accomodate the few. Healthcare shouldn't go that same way, IMO, especially if there are other ways to reform without that posible/probable outcome.


Of course I don't know if an NHS-style will work or help, I'll admit that, but at least it's something. Our old way isn't working very effectively. I'd rather give something new a chance than to keep going with the same old thing which has failed, imo.

With something as important and potentially devistating as healthcare, "Just do something" is not the attitude I can share. As for the "same old way which failed" that is an extreme overstatement. It isn't perfect and has glaring need for reform, but it hasn't "failed" by any realistic measure as a whole. The vast majority of Americans recieve medical care through insurance and are not "failed" by it. If any system that doesn't perfectly meet all expectations and goals has "failed" then please show me a sucess in anything.

Healthcare reform is critical and a mistake could be devistating, so real consideration and planning, with real controls and realistic goals has to be developed. I have seen none of this in the proposed legislations and I am curious if anyone would argue that the legislations have such considerations. If so, that would be actual support as oposed to theoretical support and that would definitely raise the debate on this subject, IMO.

Redhart
August 28th, 2009, 5:15 pm
Not passing reform could be devistating at this point. In my opinion, the system cost and funtionability is out of control and will implode if not given serious adjustment. I said it before Obama even was campaigning for the Presidency, that if changes are made, the current medical system will self-destruct on it's own taking the portion of those who do have functional insurancance and medical care, with it. While this seems like a new issue to some, my family has been dealing with it for several years now.

Wab
August 28th, 2009, 6:22 pm
On the oft-mentioned belief that the government screws up everything. Here's a response from one of our leading conservatives:

"Government does do good things, and government can provide a platform for people to do terrific things. The view that government is the problem and not part of the solution is, I think, old-fashioned. It's 1980s rhetoric. Liberal Party* policy, Liberal Party principles are about competition, and competition is all about delivering better services, better outcomes for the public … and if at times that means the public sector should stay in an area, then so be it."

http://www.smh.com.au/national/out-of-the-ordinary-20090828-f2ic.html?page=-1

* The Liberal Party in Australia is actually our mainstream conservative party. It's a long boring story. However, as it was a Liberal PM (by his own admission our most conservative PM) who instituted some of the strictest gun-control laws in the world and the party backs nationalised healthcare they would seem pretty liberal to Americans.

leah49
August 28th, 2009, 6:52 pm
I agree. The US does have good health care. Thank you for saying that. Health care in and of itself is not the problem. It's insurance and everything surrounding that. I think the picture that's getting painted in this thread is a very overdramatic and exaggerated one. Things do need to change, but it is not THAT bad. To the ones who said they don't want to move here because of our health care, fine. I'm sorry it scares you that much. I'm sorry that the media has manipulated you into believing we have some awful frightening health care (and of course this isn't related to SSJ since he wasn't the one who stated that).

If things were as bad as the picture that's getting painted people would not be coming for care. Canadians wouldn't cross the border for care. Our life expectancy would be lower. Things do need to change, but like I've been saying, I think we're making this seem a lot worse than it is.

Wab
August 28th, 2009, 7:01 pm
If things were as bad as the picture that's getting painted people would not be coming for care. Canadians wouldn't cross the border for care.

Balances up all the elderly Americans going north for affordable pharmaceuticals.

leah49
August 28th, 2009, 7:05 pm
Balances up all the elderly Americans going north for affordable pharmaceuticals.

How? Do they go north for cheaper prices (sometimes) or for drugs the FDA won't allow in the US (sometimes)?

Den_muggle
August 28th, 2009, 7:11 pm
People only find out how little private insurers are willing to offer after they are sick by which stage they are locked in because they are then deemed to have a pre-existing condition which makes finding another insurer almost impossible, and if another is found, the premiums would be unpayable.

I had my last employer change insurance companies for the entire company because of the poor treatment on one employee. All employees were automatically covered on the new health insurance, as the pre-existing condition clause only counts if you haven't been insured previously. So that company lost a lot of money for their bad service. That is the incentive for insurance companies to treat people well: they don't just deal with individuals and can lose dozens or even hundreds of customers by treating people badly.

Not passing reform could be devistating at this point. In my opinion, the system cost and funtionability is out of control and will implode if not given serious adjustment. I said it before Obama even was campaigning for the Presidency, that if changes are made, the current medical system will self-destruct on it's own taking the portion of those who do have functional insurancance and medical care, with it. While this seems like a new issue to some, my family has been dealing with it for several years now.
My husband is also uninsured and has had back problems and other medical problems not considered necessary or life-threatening, but like your knee/leg, needed to be fixed. We've never had any problem getting him seen and treated by making payment arrangements with doctors and hospitals. That's not just one doctor or one type of treatment. Your experience is so different from that around here, I truly have to believe it is due to the level of govt intervention in CA...which is what the rest of us want to avoid.

OldLupin
August 28th, 2009, 8:08 pm
On the oft-mentioned belief that the government screws up everything. Here's a response from one of our leading conservatives:

"Government does do good things, and government can provide a platform for people to do terrific things. The view that government is the problem and not part of the solution is, I think, old-fashioned. It's 1980s rhetoric. Liberal Party* policy, Liberal Party principles are about competition, and competition is all about delivering better services, better outcomes for the public … and if at times that means the public sector should stay in an area, then so be it."

http://www.smh.com.au/national/out-of-the-ordinary-20090828-f2ic.html?page=-1

* The Liberal Party in Australia is actually our mainstream conservative party. It's a long boring story. However, as it was a Liberal PM (by his own admission our most conservative PM) who instituted some of the strictest gun-control laws in the world and the party backs nationalised healthcare they would seem pretty liberal to Americans.


Again, show me the U.S. example that somehow proves this to be more than conjecture and opinion and I will be compelled to re-evaluate. Until then, why would this compell me to disregard the entire history of my country and all the evidence to the contrary?

I am begining to think that the counter-example doesn't exist. If it doesn't, why on earth would anyone want our government to run healthcare?

Not passing reform could be devistating at this point. In my opinion, the system cost and funtionability is out of control and will implode if not given serious adjustment. I said it before Obama even was campaigning for the Presidency, that if changes are made, the current medical system will self-destruct on it's own taking the portion of those who do have functional insurancance and medical care, with it. While this seems like a new issue to some, my family has been dealing with it for several years now.

It isn't a new issue, it is just an incredibly difficult issue to navigate and while it has been considered and reconsidered for years, the current offering is not adequate and is more likely to do harm than good, IMO. The type of reform is pretty important, despite urgent calls, and bad reform will indeed do more harm than good and for a lot more people than adequate reform would help. So it isn't prudent to "just do something" when the situation is so dangerous and potentially devistating, long and short term.

MadMagic
August 28th, 2009, 9:51 pm
I am begining to think that the counter-example doesn't exist. If it doesn't, why on earth would anyone want our government to run healthcare?


As a counter example at a Town Hall meeting the President used the example of the US Postal Service, UPS, and FedEx as an illustration of how the public option would be able to compete with private insurance companies saying that, "My answer is that if the private insurance companies are providing a good bargain, and if the public option has to be self-sustaining…then I think private insurers should be able to compete. They do it all the time. I mean, if you think about it, UPS and FedEx are doing just fine, right? No, they are. It's the Post Office that's always having problems."If government run health care is going to be like the post office, which is notorious for long lines, disgruntled employees, and for losing billions of dollars a year, then I think they need to rethink things.

People talk about how the price of health insurance has skyrocketed and therefore reform is needed immediately, but I have yet to hear of any actual plan to lower the costs, and definitely not if reform is based on Medicare or the USPS. Whether the government pays for it through raising taxes on the rich or insurance companies pay through raising premiums, good health care is expensive.

I personally think that part of the cost problems are because people expect to have health insurance and then get everything health related for free. I have car insurance in case I get into an accident; I am perfectly willing to pay to get my oil changed every 3 months out of my own pocket. Similarly when I get health insurance (its on my to do list....I want to be a responsible citizen!) I really would just want it to cover major medical. I'm personally perfectly willing to pay for annual check ups on my own.

Redhart
August 28th, 2009, 9:55 pm
My husband is also uninsured and has had back problems and other medical problems not considered necessary or life-threatening, but like your knee/leg, needed to be fixed. We've never had any problem getting him seen and treated by making payment arrangements with doctors and hospitals. That's not just one doctor or one type of treatment. Your experience is so different from that around here, I truly have to believe it is due to the level of govt intervention in CA...which is what the rest of us want to avoid.
I don't know what to say other than this is how it is here. I've lived in the Bay Area of California and did not have these issues in the past. My thinking was that it is a very conservative county where I live now...I live in a very "red" area of california...which would, of course, lead me to a different conclusion.

In California, doctors don't have to take medicare/aid patients if they don't want to. They also don't have to take cash payments clients if they don't want to (and we have found that they don't). I tend to think that deregulation might be more of an issue than increased government.


Right now, I have care due to a one year subsidy plan. Otherwise, we had discussed travelling out of the state. Of course, in an emergency, that isn't always an option. But, on the other hand, if you are uninsured where I live, it may be the only viable chance.

Be that as it may, things are not right here in a big way. It could be we are simply on the beginning edge of a very bad wave of medical disfuction that has been building for some time. When we can, we are talking seriously about moving out of this county.
personally think that part of the cost problems are because people expect to have health insurance and then get everything health related for free. I have car insurance in case I get into an accident; I am perfectly willing to pay to get my oil changed every 3 months out of my own pocket. Similarly when I get health insurance (its on my to do list....I want to be a responsible citizen!) I really would just want it to cover major medical. I'm personally perfectly willing to pay for annual check ups on my own.
I think if you look at what our nation pays for health care compared to every other nation, the cost problem is quite evident...I would beg to differ that everyone who wants health reform is expecting free. I think what most are asking for is "reasonable" and accessible without threat of tens of thousands of dollars in bills for a simple leg break or an emergency appendectomy, sometimes even with insurance depending on the policy.

http://kelsocartography.com/blog/wp-content/uploads/2009/06/health-care-reform-screenshot.png
from the Washington post, graph of rising cost of both public and private medical care. (SOURCES: Centers For Medicare and Medicaid Services, Office of Management and Budget, Kaiser Family Foundation, Alliance for Health Reform, Organization for Economic Co-operation and Development, Senate Finance Committee, Commonwealth Fund)
http://www.washingtonpost.com/wp-srv/package/health-care-reform09/index.html

Japan: $2,578.00 spent on health care per capita (2006)
Britain: $2,760.00
Germany: $3,371.00
Canada: $3,678.00
USA: $6,714.00
again, source: http://www.washingtonpost.com/wp-srv/package/health-care-reform09/index.html

monster_mom
August 28th, 2009, 10:24 pm
I agree. The US does have good health care. The problem is that not everyone has access to it for a reasonable price, which is why I feel that maybe having a public option and a private option might work out for the best in the long run. At least those who can't afford the unreasonable prices for private, can go another route and go with the lower-cost public system. I'm all for an NHS-like system, and I too am sick of people only focusing on the negative cases as opposed to pointing everything that's good with the NHS system. I've read quite a bit, and I seem to come across more positive than negative. Of course, I've never has NHS-type care since I am in the US, but I'd rather have some type of insurance than what I'm going through now with no insurance.


Define what you consider to be a public option, please.

Is it one similar to Medicaid? This could be accomplished by expanding Medicaid beyond 1.33 times the federal poverty level with some expectation of reimbursement to the government if your income exceeds 1.33 times the poverty level. If so then why is the Democrat's bill necessary?

Is it one where the government serves as a group sponsor and offers a list of plans with negotiated premiums and coverage which would be available to everyone and provides additional taxpayer assistance to people whose income is less than 4 times the poverty level? This could be accomplished by simply allowing everyone access to the Federal Employee Health Benefits Plans. If so, then again, why is the Democrats bill necessary?

Didn't Chris already show how those sources are questionable?

No.

Chris's post (which you can find here (http://www.cosforums.com/showpost.php?p=5397987&postcount=459))expressed concerns with some of the conclusions expressed in the article - conclusions I neither listed nor quoted. He didn't seem to have any concern with the actual life expectancy numbers which I pulled from the WHO data.

Wab
August 29th, 2009, 4:13 am
How? Do they go north for cheaper prices (sometimes) or for drugs the FDA won't allow in the US (sometimes)?

Price: "It may come as no surprise that the pharmaceutical industry is the most profitable business in the country. American drug prices are the highest in the world, so more than a million Americans now buy their medications in Canada."

http://www.cbsnews.com/stories/2004/03/12/60minutes/main605700.shtml

leah49
August 29th, 2009, 6:42 pm
Well, that is one problem in America, but I just don't see that as being the same as Canadians coming here for healthcare. Those Americans go to Canada for medicine, but not to see a doctor or have surgery. Canadians come here to see doctors, have operations, and stuff like that. I heard on the news the other night one of the reasons Canadians come here is because they will be seen faster here than in Canadia. That's one thing about having nationalized healthcare that worries me. I don't want the waits to get longer. That's not beneficial to good health.

ComicBookWorm
August 29th, 2009, 7:12 pm
That's one thing about having nationalized healthcare that worries me. I don't want the waits to get longer. That's not beneficial to good health.But we aren't going to have nationalized health care. All we're going to have is a non-profit insurance plan paid by the government. Nationalized health care has hospitals and doctors that are actually government employees. Our doctors and hospitals will always remain private.

Medicare is run like that. I go to whatever doctor or hospital I want, and instead of Blue Cross paying the bills the government pays. This is called single-payer (meaning the government pays and not some insurance company), and it is not the same as nationalized health care.

It would be nearly impossible for our system to become like Canada or UK. How could we put all insurance companies practically out of business by taking over their function? And hospitals and doctors would suddenly have to give up their profits and autonomy and become agencies and employees of the government. Can you see some of our high-paid specialists giving up their cushy salaries? It can't happen.

It could have happened when I was kid (50 odd years ago). That was when we had still had doctors that made house calls. I remember our doctor visiting me when I caught the Asian flu in 1957. And they didn't make all that much money (far fewer specialists), so a change in the funding wouldn't have cause such an upheaval. The stability of a salary might have been welcomed for struggling General Practitioners.

BTW, people in the US who have HMOs already have long waits for doctor appointments and procedures.

Fawkesfan1
August 29th, 2009, 7:31 pm
I agree. The US does have good health care. The problem is that not everyone has access to it for a reasonable price, which is why I feel that maybe having a public option and a private option might work out for the best in the long run. At least those who can't afford the unreasonable prices for private, can go another route and go with the lower-cost public system. I'm all for an NHS-like system, and I too am sick of people only focusing on the negative cases as opposed to pointing everything that's good with the NHS system. I've read quite a bit, and I seem to come across more positive than negative. Of course, I've never has NHS-type care since I am in the US, but I'd rather have some type of insurance than what I'm going through now with no insurance.
For the rich of course. As for anyone who is of a lower class -- not so much. They're lucky if they can even get a check up and all that. I know some friends and family who have a heck of a time when it comes down to health care. It's a joke -- really. One person in particular, my cousin -- had a hard time even being able to get to a doctor -- and to make matters that much more of a pain... he got stuck with a doctor who doesn't seem to be doing that much for him. He's had some issues with his throat as of late -- and the doctor said that they couldn't find anything wrong with it. It was just a joke there -- since it wasn't even enough testing TO find anything wrong there.

There are times when further testing is required to find something that can't be found using ordinary methods. My mom had this happen with her awhile ago too... and luckily for her -- her doctor was aware enough to test somemore and found what was the issue there.

But I do agree about costs in general. It costs WAY too much in terms of prices for any health care that's worth a nickle. As for medicines -- they can cost an arm and a leg if someone doesn't have good enough health coverage.

It's truly become a joke in a lot of ways :no:.

Wab
August 29th, 2009, 7:34 pm
It would be nearly impossible for our system to become like Canada or UK. How could we put all insurance companies practically out of business by taking over their function? And hospitals and doctors would suddenly have to give up their profits and autonomy and become agencies and employees of the government. Can you see some of our high-paid specialists giving up their cushy salaries? It can't happen.

Although that hasn't happened in countries with a dual system like Australia and the UK anyway.

Private insurers exist, although mainly to provide ancilliary services and non-essential services in private hospitals which would require a wait in the public system.

My GP has a practice and also works in the local public hospital tending to patients she has admitted either through her practice or while on call for casualty.

leah49
August 29th, 2009, 7:41 pm
But we aren't going to have nationalized health care. All we're going to have is a non-profit insurance plan paid by the government. Nationalized health care has hospitals and doctors that are actually government employees. Our doctors and hospitals will always remain private. I don't know if we aren't going national. To be completely honest, I don't think anyone knows. If we add more people to the pool, it gets crowded. Waits are going to get longer. Yes, people need healthcare (care not insurance, I say) and I don't want to deny them of that, but it will add to the waiting. Is that a good thing? Wait another week. You could be dead or permanently injured or uncurable or have to take even more chemo... (although some people wait another week and all will be cured).


It would be nearly impossible for our system to become like Canada or UK. Why is it nearly impossible?


BTW, people in the US who have HMOs already have long waits for doctor appointments and procedures.

Right, so let's make it worse, by adding more people to the pool. Those without insurance are careful about when they go to the doctor. They don't go for a scratch or a sniffle. If you give them the ability to go for more of the lesser some will take advantage of that. That equals longer waits.

Redhart
August 29th, 2009, 8:33 pm
Well, the current system can't continue as it is, in my opinion. I think it will eventually collapse under it's own, bloated weight.

My speculation is that this is probably the last chance for some sort of hybrid, privatized/capitalistic fix. If we can't get something through that addresses the issues, I fully expect the next attempt will be for a fully public, nationalized system.

If the system does collapse at some point in the future (if something isn't passed this time), then a total cleaning of the board may take place, eliminating the private element from the system all together.

I think it really would behoove the insurance industry to not try to get a hybrid system done now that is workable than to wait too long and risk losing it all.

Den_muggle
August 30th, 2009, 12:22 am
But we aren't going to have nationalized health care. All we're going to have is a non-profit insurance plan paid by the government. Nationalized health care has hospitals and doctors that are actually government employees. Our doctors and hospitals will always remain private.

Medicare is run like that. I go to whatever doctor or hospital I want, and instead of Blue Cross paying the bills the government pays. This is called single-payer (meaning the government pays and not some insurance company), and it is not the same as nationalized health care. Although for 1 year, it was illegal for you to go to your doctor who accepted Medicare and pay them out of your own pocket for something Medicare did cover. It was ILLEGAL to make your own choice and pay out of your own pocket!! That's what we don't want to risk happening again by allowing govt to decide what should/should not be covered or allowed.

It would be nearly impossible for our system to become like Canada or UK. How could we put all insurance companies practically out of business by taking over their function? And hospitals and doctors would suddenly have to give up their profits and autonomy and become agencies and employees of the government. Can you see some of our high-paid specialists giving up their cushy salaries? It can't happen.

It could have happened when I was kid (50 odd years ago). That was when we had still had doctors that made house calls. I remember our doctor visiting me when I caught the Asian flu in 1957. And they didn't make all that much money (far fewer specialists), so a change in the funding wouldn't have cause such an upheaval. The stability of a salary might have been welcomed for struggling General Practitioners. I remember reading feature article in Reader's Digest many years ago (no, I can't cite it now) that talked about how this family used to have the country doctor make house calls when they were sick and they'd pay him $5. Then the father got health insurance..as did most other families in the area. Now the doctor had to pay an assistant to file the paperwork, so he had to charge $10 for the house call, only $5 of which was covered by insurance. Then he was sued for malpractice for not having some instrument or something along on a house call (I can't remember the exact details as it's been many years since I read the article) and though he won the case, it convinced him that it was too risky for him to make house calls anymore. It continued on talking about how the more insurance, lawyers and govt got involved, the less he was able to help people and the more he had to charge for doing less for them.

That's what conservatives would like to get back to...the thing you admitted was routine BEFORE insurance and lawyers and the govt caused prices to raise and quality to decline. If we could have HSAs, tort reform, more competition, perhaps we could get back to these. I have heard of (but not found) doctors who refuse any insurance/Medicare/Medicaid and work only on a cash basis...with MUCH lower office calls and expenses. Not just in elective fields, but GPs and Internists. For my husband's treatments, we get cash discounts most places...in some cases, paying a third or less than the originally stated price just by relieving them of the hassle of dealing with insurance companies.


BTW, people in the US who have HMOs already have long waits for doctor appointments and procedures.And what the govt is wanting to push us into is more of that. HMOs have been declining in popularity for that very reason. It results in delays and rationing...which people don't want. HSAs encourage much more frugality so people don't run to the doctor for every cough or sniffle but have the money to pay deductibles when they need medical care.

canismajoris
August 30th, 2009, 1:00 am
Although for 1 year, it was illegal for you to go to your doctor who accepted Medicare and pay them out of your own pocket for something Medicare did cover. It was ILLEGAL to make your own choice and pay out of your own pocket!! That's what we don't want to risk happening again by allowing govt to decide what should/should not be covered or allowed.
So you'd prefer to allow a profit-driven corporation to make that decision? Because that's the alternative you're advocating.

Den_muggle
August 30th, 2009, 1:12 am
So you'd prefer to allow a profit-driven corporation to make that decision? Because that's the alternative you're advocating.

No, I'm advocating HSA's that allow me and no one else to make that decision. No corporation, no govt panel, just me and my husband and my doctor. Read the rest of what you quoted from me about paying my own way out of my own pocket...not having an insurance company pay or decide what to pay. We've had much better experiences dealing with doctors/clinics/etc for my husband dealing on a purely cash basis than for me where they have to coordinate with insurance companies.

canismajoris
August 30th, 2009, 1:59 am
No, I'm advocating HSA's that allow me and no one else to make that decision. No corporation, no govt panel, just me and my husband and my doctor. Read the rest of what you quoted from me about paying my own way out of my own pocket...not having an insurance company pay or decide what to pay. We've had much better experiences dealing with doctors/clinics/etc for my husband dealing on a purely cash basis than for me where they have to coordinate with insurance companies.
I read it, I just don't think that's a real solution. Pretty much nobody can pay out of pocket for chemotherapy or a lung transplant.

Mundungus Fletc
August 30th, 2009, 6:40 am
Under the British system doctors still make house calls - when my father was alive I could get a doctor out in the middle of the night. (Not his GP but a locum - many of them come from elsewhere in the EU because the pay is so good) And of course it was free at the point of need.

DancingMaenid
August 30th, 2009, 7:09 am
I read it, I just don't think that's a real solution. Pretty much nobody can pay out of pocket for chemotherapy or a lung transplant.

Even a lot of more routine procedures could be difficult for a lot of average-income families to pay out of pocket for.

And if you don't make enough, then you can forget about being able to afford more basic things like checkups out of pocket.

I'm not impoverished, and I have pretty decent insurance. But I've been waiting for a couple years to get braces and other dental work done because I haven't been able to afford what my insurance doesn't cover. I'm just finally in a position now where I think I might be able to do it soon. I also need to get my eyes checked, and probably need glasses. I should be able to afford what my insurance doesn't cover, but it would be hard for me to pay for the entire exam and the whole cost of new glasses.

If people can afford to pay out of pocket, and there's a private option, then great. But it's not a viable option for a lot of people, and in some cases it's not viable at all for most.

ComicBookWorm
August 30th, 2009, 8:20 am
Although for 1 year, it was illegal for you to go to your doctor who accepted Medicare and pay them out of your own pocket for something Medicare did cover. It was ILLEGAL to make your own choice and pay out of your own pocket!! That's what we don't want to risk happening again by allowing govt to decide what should/should not be covered or allowed.Could you please explain where you got the idea that it would be illegal for me to pay for something out of pocket? But why would I want to pay things out of pocket? Most people welcome the financial assistance since their money can be spent elsewhere. How many people with private insurance (i.e. not on Medicare) pay for things out of pocket when they can have insurance companies pay for them? I suspect it would be only the very rich.

People on Medicare are retired or disabled (or as in my case--both). Odds are they aren't floating in money. I have a fixed income. I need all the help I can get. That's true of most retirees.

Wab
August 30th, 2009, 9:09 am
Right, so let's make it worse, by adding more people to the pool. Those without insurance are careful about when they go to the doctor. They don't go for a scratch or a sniffle. If you give them the ability to go for more of the lesser some will take advantage of that.

Can't trust those poor people, fancy wanting to see a doctor if they feel unwell.

That equals longer waits.

A bit of a wait is a small price to pay compared to the 18,000-20,000 unnecessary deaths each year due to uninisured people not seeing a doctor until it is too late, if at all.

http://www.iom.edu/CMS/3809/4660/17632.aspx

http://www.urban.org/UploadedPDF/411588_uninsured_dying.pdf

ComicBookWorm
August 30th, 2009, 1:15 pm
Right, so let's make it worse, by adding more people to the pool. Those without insurance are careful about when they go to the doctor. They don't go for a scratch or a sniffle. If you give them the ability to go for more of the lesser some will take advantage of that. That equals longer waits.I like this assumption. It openly articulates why health care reform is truly opposed. Instead of arguing costs or government involvement, it clearly indicates the real reason--not everyone deserves it.

Den_muggle
August 30th, 2009, 1:34 pm
I read it, I just don't think that's a real solution. Pretty much nobody can pay out of pocket for chemotherapy or a lung transplant.
Ok, now you're either deliberately ignoring or deliberately misunderstanding the entire concepts of HSAs. They are coupled (as I and others have pointed out several times) with a High Deductible Health Plan (insurance) that kicks in to pay everything once you hit the high deductible. So you wouldn't be paying out of pocket for the entire cost of chemo or a lung transplant. You would be paying the deductible only, then insurance would pay the rest. But because insurance is seldom used (most people don't get chemo or lung transplants) it is much cheaper, more like home owner's insurance. So please stop saying these things as an argument that has already been repeatedly rebutted. (See below)

Could you please explain where you got the idea that it would be illegal for me to pay for something out of pocket? But why would I want to pay things out of pocket? Most people welcome the financial assistance since their money can be spent elsewhere. How many people with private insurance (i.e. not on Medicare) pay for things out of pocket when they can have insurance companies pay for them? I suspect it would be only the very rich.

People on Medicare are retired or disabled (or as in my case--both). Odds are they aren't floating in money. I have a fixed income. I need all the help I can get. That's true of most retirees.
That was supposedly the point when govt stepped in to make it illegal to pay out of pocket for people on Medicare then. There was no need for them to ever do that because Medicare covered all their needs. But what about someone who had a family history of heart disease, cancer or something relatively rare and wanted a test that Medicare wouldn't cover...or would only cover every few years? For their peace of mind, they found it worthwhile to spend the money out of pocket for a test Medicare wouldn't pay for. But for awhile, they couldn't. I'm not saying it is in the current bill...yet, but it has been tried before for people relying on the govt to pay their health care, so I don't think it unreasonable to fear it might be slipped in again.

And with my HSA/HDHP combo, there are times I find it worthwhile to get the cash discount (which I've explained before can be QUITE substantial) and neither of us (me or the doctor) have to deal with any insurance company. Now if I have to go to the hospital or have chemo and will blow through my deductible, then it becomes worth it to turn it over to insurance. But if the govt tries to "protect us" as they did before, HSAs go away (which I believe is in the bill because of the qualifying plan provision; high deductible health plans wouldn't fit in the qualifications of the bill), then I have to go through insurance for everything because I don't have money to pay for anything. Which means prices for services go up which means the cost of the insurance goes up.

I suggested earlier that we could expand HSAs and give the poor or those on fixed incomes help funding those HSAs. Then they could afford the HDHP (which is a lot cheaper than "normal" insurance) and have the money to pay the deductible. That idea was floated before (see www.hsacoalition.org (http://www.hsacoalition.org/) S173, I believe) even for Medicare recipients.

Please, before you keep knocking down HSAs when it is clear you don't know how they work at all, please do a little research, then I'll be happy to debate them with you, but I'm getting very tired of repeating myself as to what HSAs entail. If you don't want to rely on a partisan website, check out the govt website: http://www.ustreas.gov/offices/public-affairs/hsa/

Now this isn't for everyone, but what they're proposing isn't, either. All I'm asking is for the "party of choice" to actually let us have some in something besides abortion.

flimseycauldron
August 30th, 2009, 1:40 pm
I like this assumption. It openly articulates why health care reform is truly opposed. Instead of arguing costs or government involvement, it clearly indicates the real reason--not everyone deserves it.

:sigh: I'm so tired of this arguement. Because it's not an arguement at all. It's a pot shot at dissenters. That somehow we are uncharitable. And it's to put dissenters on the defensive rather than the offensive. If supporters are scared perhaps they ought to look at the tactics they employ before trotting out the selfish card.

On this board the conservatives/independents are outnumbered three to one. Yet we have posted language directly from the only currently active proposed legislation (my last post of such was completely igonred, btw) arguing quite successfully for those "unreal" reasons of government intrusion and costs. I say successfully for I have yet to see alternative interpretations of the actual language in the bill other than "that's not what that means" and "I'm better than you because I'm willing to give up my money for the betterment of the people."

Den_muggle
August 30th, 2009, 2:11 pm
Those who keep saying that Leah meant poor don't deserve care are deliberately twisting her words. If I say poor people don't deserve care they don't pay for and don't need (she did specify going for a scratch or sniffle, not a broken leg), that doesn't mean I don't think they deserve care that they NEED. That's the difference. They get the care they NEED by law now. If care is "free," then a lot of people will use it when it's not needed. There are seniors I know who have regular doctor appointments, not for health problems, but it is free social interaction. That's what we don't want to happen even further. People who need no medical care, just selfish attention (the equivalent of a kiss on a boo-boo), will be more likely to use up limited resources if it doesn't cost them, but not if it does.

canismajoris
August 30th, 2009, 4:06 pm
Ok, now you're either deliberately ignoring or deliberately misunderstanding the entire concepts of HSAs. They are coupled (as I and others have pointed out several times) with a High Deductible Health Plan (insurance) that kicks in to pay everything once you hit the high deductible. So you wouldn't be paying out of pocket for the entire cost of chemo or a lung transplant. You would be paying the deductible only, then insurance would pay the rest. But because insurance is seldom used (most people don't get chemo or lung transplants) it is much cheaper, more like home owner's insurance. So please stop saying these things as an argument that has already been repeatedly rebutted. (See below)
No no, it is not a lack of understanding, I simply don't agree that what you're suggesting would work on a large scale, because the logical result would be that poor people with existing health problems would derive no benefits at all from HSAs. I've read arguments that HSAs would actually make everything worse. I don't necessarily believe that, but I don't think it's a real alternative.


:sigh: I'm so tired of this arguement. Because it's not an arguement at all. It's a pot shot at dissenters. That somehow we are uncharitable. And it's to put dissenters on the defensive rather than the offensive. If supporters are scared perhaps they ought to look at the tactics they employ before trotting out the selfish card.
I'm not going to suggest for a moment that dissenters or conservatives are uncharitable, because I have no way of knowing, however there's a great deal of rhetoric coming from them that is. I told monster_mom the other day that I literally can't believe some of the things I hear from people at work, on the street, in the mall, etc.; things that make me quite concerned.

You may point whatever fingers you like, but each side of this debate has been somewhat petulant lately.

On this board the conservatives/independents are outnumbered three to one. Yet we have posted language directly from the only currently active proposed legislation (my last post of such was completely igonred, btw) arguing quite successfully for those "unreal" reasons of government intrusion and costs. I say successfully for I have yet to see alternative interpretations of the actual language in the bill other than "that's not what that means" and "I'm better than you because I'm willing to give up my money for the betterment of the people."
Well I must have missed it, but I love interpreting language, so feel free to try again and I'll give it an honest look.

flimseycauldron
August 30th, 2009, 4:27 pm
I'm not going to suggest for a moment that dissenters or conservatives are uncharitable, because I have no way of knowing, however there's a great deal of rhetoric coming from them that is. I told monster_mom the other day that I literally can't believe some of the things I hear from people at work, on the street, in the mall, etc.; things that make me quite concerned.

Quite frankly it appears that this is trotted out when nothing constructive is thought of. You claim on one hand that you have no way of knowing but you jump to conclusions about why people think the way they do. So, instead of attributing them with good intentions, you instead attribute bad intentions? Why is that? Because they disagree with how best to provide for the uninsured? How is anyone supposed to reconcile that?



You may point whatever fingers you like, but each side of this debate has been somewhat petulant lately.

Perhaps. ;)

Well I must have missed it, but I love interpreting language, so feel free to try again and I'll give it an honest look.

It is in this post. (http://www.cosforums.com/showpost.php?p=5400788&postcount=500)

ComicBookWorm
August 30th, 2009, 4:58 pm
Please, before you keep knocking down HSAs when it is clear you don't know how they work at all, please do a little research, then I'll be happy to debate them with you, but I'm getting very tired of repeating myself as to what HSAs entail. I think I'm in a better position to assess what I know or don't know than you are. And generally I'll decide when I need to do research, but thanks for the advice.

I have had several HSAs, so yes I do know how they work. And I do know how limited they are. To begin with, most people don't have enough savings to make the accounts help sufficiently, even with catastrophic insurance. HSAs are useful for someone to cover their normal copays and deductibles with standard health insurance, but they are far less practical as a means of real health care coverage.

I would like a link demonstrating when it was illegal to pay for something out of pocket for Medicare recipients.

Those who keep saying that Leah meant poor don't deserve care are deliberately twisting her words. If I say poor people don't deserve care they don't pay for and don't need (she did specify going for a scratch or sniffle, not a broken leg), that doesn't mean I don't think they deserve care that they NEED. That's the difference. They get the care they NEED by law now. If care is "free," then a lot of people will use it when it's not needed. There are seniors I know who have regular doctor appointments, not for health problems, but it is free social interaction. That's what we don't want to happen even further. People who need no medical care, just selfish attention (the equivalent of a kiss on a boo-boo), will be more likely to use up limited resources if it doesn't cost them, but not if it does.People don't get the care they need in an emergency room. They get hurried impersonal care, where they are likely to be seen by interns, assuming they don't get turned away if their lives aren't in danger. There is no continuity of care where a family practitioner can recognize health patterns that are indicative of serious conditions. They don't get preventative care. They don't get diagnostic blood work that can indicate problems with cholesterol or blood sugar, kidney function. They don't get their high blood pressure diagnosed, monitored, or treated. All of these can lead to much more expensive problems that will cost all of us money. They may get amputations performed for them, but if they need bypass surgery they won't get it, unless they're having a heart attack--because it wouldn't be emergency surgery. They'll get some heart medicine and be sent away. However I get heart scans and other imaging, and if I show enough blockage I could get surgery based on my cardiologist's recommendation, so I wouldn't have to risk dying from a heart attack or suffering significant heart tissue damage.

As for seniors, they need more frequent checkups since they have quite a few health issues that need to be diagnosed, monitored or tracked. They need more diagnostic tests to prevent more serious problems. I happen to know quite a few seniors (since I am one) and not a single one of them goes to the doctor to socialize. A lot of the seniors have mobility issues and don't go to the doctor as often as they should because of it.

monster_mom
August 30th, 2009, 5:27 pm
Well, the current system can't continue as it is, in my opinion. I think it will eventually collapse under it's own, bloated weight.

My speculation is that this is probably the last chance for some sort of hybrid, privatized/capitalistic fix. If we can't get something through that addresses the issues, I fully expect the next attempt will be for a fully public, nationalized system.

If the system does collapse at some point in the future (if something isn't passed this time), then a total cleaning of the board may take place, eliminating the private element from the system all together.

I think it really would behoove the insurance industry to not try to get a hybrid system done now that is workable than to wait too long and risk losing it all.

Why is it that considering an alternate to a government option means you don't support reform? I support reform. Everyone who posts here supports reform. We're split on whether the Democrats proposal is the best method for reform.

I think the Republican's have a good proposal that ought to be considered. It won't be unless Pelosi deems it worthy of consideration, but I think it ought to be considered because it directly addresses the problems facing American's with health care while the Democrats bill just makes those problems worse.

If you think about it, the number one problem in the health care industry is cost - the cost of care and the cost of premiums. The cost of health care is rising for a multitude of reasons. Those increases in costs are passed along to consumers and businesses as higher premiums which make affording health coverage so expensive that some people and businesses can't afford it. To make health coverage more affordable we have to lower costs. There are lots of different ways to affect costs which will increase, decrease, or have no effect on the cost of premiums and make obtaining health coverage more or less affordable - let's look at those and see what each plan offers.

Tort Reform. I'm not convinced that tort reform will control costs as much as some are, but it keeps popping up so I listed it. The Democrats bill doesn't contain any provision for tort reform while the Republican's bill does.

Fraud and Abuse Protection. Both bills contain provisions to help reduce and prevent fraud.

Community Rating Community rating is where an insurance company is required to set a standard fee for coverage no matter what medical issues an individual may or many not have. The net effect is that the 22 year old kid with no medical conditions and the 75 year old life long smoker with diabetes will pay the same premiums. Community rating depends on a larger pool of healthy people to help offset the cost of people with medical issues in order to keep the premiums for each covered individual low. A few states have mandated community rating and the cost of insurance coverage in those states has increased. The net effect of the community rating was that more people with high-cost medical conditions enrolled in community rated plans because the premiums come down for them but a larger number of low income individuals dropped out of their plans because the cost of premiums for them went up to such an extent that they could no longer afford health coverage.

The Democrats bill in the Senate calls for community rating across all plans, government or private, while the Republican's bill does not. However, the Democrats bill attempts to remedy the concerns with increases in premiums resulting from community rating by mandating that every individual must have health coverage that meets the government's standards or face a fine, whether they want coverage that meets the government's standards or not. In theory, by mandating that every individual have coverage that meets the government's standards, then the pool of healthy people across would remain large enough that cost increases from the high-cost individuals medical care would be mitigated.

The Republican's plan does provide for community rating within a group plan, but it does not mandate it. Right now only employers are allowed to sponsor health plans. Employers negotiate with insurance companies to get the most affordable coverage for their employees with the greatest benefit. Every employee pays the same cost no matter what medical conditions they may or may not have. Because the price is set for the group, the price that group pays is based on how the community within the group is rated.

The Republican plan allows more groups to form outside of the employer - employee relationship. Each group would have contracts with insurance companies and would have a set premium that would be paid by each member. The net effect is that there would be more groups and each would have pricing based on how the community within that group was rated.

Guaranteed Issue. Guaranteed issue requires that a plan will be provided to an individual no matter what medical conditions that person has. The net effect of guaranteed issue is that people with medical conditions pay exponentially higher premiums than those without medical conditions.

The Democrats plan mandates guaranteed issue. The Republican plan allows states to continue guaranteed issue but doesn't mandate it. However, guaranteed issue can't be discussed without discussing community rating.

The Democrat's bill combines guaranteed issue with community rating. That means that every person must be offered a plan and the price they pay for that plan will not vary depending on the medical conditions that person has. A 55 year old smoker with stage 4 lung cancer will be able to obtain coverage and pay the same fee as a 22 year old with no medical conditions.

The Republican's bill does not explicitly mandate guaranteed issue. Many employer sponsored plans already have guaranteed issue for their employees. Associations offering coverage to their member companies are required to offer that coverage to every member company and membership organizations which offer coverage are required to offer it to every member who chooses to participate. Whether prices would vary depending on medical conditions would depend on the plans the group sponsor negotiates.

For instance, many employer sponsored plans have incentive plans to get their employees to stop smoking and lose weight by providing discounts on the cost of insurance for non-smokers and people whose weight is within an acceptable range. With community rating combined with guaranteed issue, the Democrats plan prohibits this practice while the Republican plan allows the practice to continue.

Rationing of Care This is a huge issue, so I'll save it for a later post.

Sources:

http://fixhealthcarepolicy.com/research/rigging-the-system-with-new-regulation/
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=928067
http://www.ahipresearch.org/pdfs/Individual_Market_Survey_December_2007.pdf

ComicBookWorm
August 30th, 2009, 5:46 pm
"I'm better than you because I'm willing to give up my money for the betterment of the people."I won't be giving up any money since I'm retired and have no taxable income. But that accusation is very unfair since that's not what people are saying. They're saying that even the middle class gets screwed by the insurance companies, and we need a different approach. Even the middle class goes bankrupt from medical costs. Even the middle class loses its insurance when they get ill. Even the middle class finds that things they thought were covered aren't. Even the middle class is choking under expensive insurance.

This isn't just a plan to help the poor get health care. In fact the poor can usually get Medicaid. It's the middle class and working poor that have problems affording health care.

Klio
August 30th, 2009, 6:19 pm
Just came across this useful cautious tale (http://www.fivethirtyeight.com/2009/08/poll-most-dont-know-what-public-option.html) (relevant to both sides of the argument, whenever polls about this issue are used by either side)

leah49
August 30th, 2009, 6:26 pm
I like this assumption. It openly articulates why health care reform is truly opposed. Instead of arguing costs or government involvement, it clearly indicates the real reason--not everyone deserves it.

Where do you get that I think not everyone deserves it? Everyone deserves it, I believe I actually said that. It's just that going to the doctor because you have a runny nose is dumb, but when some people have health insurance (for instance my sister) they'll do stuff like that because their insurance will cover it (or they think it will).

Those who keep saying that Leah meant poor don't deserve care are deliberately twisting her words. THANK YOU! I have experience with this. My sister, my grandmother, and my grandfather. My grandfather wanted to take medication just so he'd think he was solving a problem he never even had. My grandmother goes to the doctor at least every other week just for him to say she doesn't have this disease or to try out some new medication that she really doesn't need. She had some problems with her face (long story short during surgery they hit a nerve and the left side of her face is paralyzed). I think she's had fourteen surgeries on her eye so it'll close or match her right eye/eyebrow. She's told me repeatedly if she had to pay for it out of pocket she wouldn't have had most of the surgeries. I believe she's on Medicare, but I also want to say she's on whatever it is that Veterans get (her late husband was in the army). My sister goes whenever she has a slight ache. Oh, she has a headache she needs to see a doctor. Oh, her nose is running, gotta see the doctor (I took her when she had stomach pains and the doctor said "Has your runny nose cleared up?" I was embarrassed she went to the doctor for that. Needless to say, they found no reason for her stomach pains).

I have experience with people "abusing" the system like this. Go when you have the flu, break a bone, need surgery, have cancer, have a funny pain that you really can't live with or need to know why it's happening, but don't go just because you woke up today not feeling 100% or you heard about a new drug that you'd like to try for no reason than it's new or you just want to be told your healthy. That's what makes the lines at the doctor's offices too long. Our economy is down right now. We can't afford to pay for people to just go to the doctor willy-nilly. It needs to be for peple who really need the doctor. They need to know they can get timely healthcare for something important.

It scares me when something comes along saying they want to give everyone health insurance. I don't think that's exactly what could happen, but I have seen things thrown like not having insurance is illegal or we'll be fined. So, we really are throwing more people into this pool. My sister didn't have health insurance for a while due to not going to school, but she went back for a semester, and during this time she was covered under my parents' plan. Before she went back she rattled off this long list of doctors she wanted to see. Most of it was unnecessary. It's just an example of what some people do when they get health insurance. Some want to get everything taken care of whether they need it or not. It just adds to the long lines.

I don't believe there's anything we can do to stop it. I'm just saying we have to realize this is going to happen. Our waits are going to get longer when more people get insurance. It's the reason why Canadians come to the US. They wait less here. I learned on the news that some hospitals on the border in Canada have it worked with US hospitals on the border to bring patients and their ambulances can bypass security (or whatever it's called) crossing the border.

ComicBookWorm
August 30th, 2009, 7:09 pm
Everyone should have the right to see their doctors regardless of whether they are desperately ill or not. Mostly doctors do tend to discourage patients from just coming in for no reason. And they cut short office visits for those who are not really ill. They're too busy to deal with them.

But the reason that everyone should have a chance to see the doctor when they want to is that sometimes there is something seriously wrong and only the doctor can know. And sometimes the doctor can identify a problem even if the patient is there for something entirely different.

I just don't think that worrying about additional people in the system is a valid reason to not provide them the access.

Frankly, I have quite a few medical problems, but I don't see my specialists as often as I should since I hate going to the doctor. I've had every type of invasive and obnoxious (and often painful) test possible. And I've had my fill of doctors.

leah49
August 30th, 2009, 7:11 pm
That's your perogative. What we need are more doctors, but I don't see that happening right now.

Maybe I am being negative, but it truly is how I feel. Economically, we cannot afford as taxpayers to pay for people to visit doctors for no reason. When our economy gets better maybe we will be able to afford it, but we can't right now. I know that for many we aren't now and won't be paying their insurances, but there will be government insurance, like Medicare and Medicaid, that our taxes will be covering (or not covering putting us in debt).

I love my sister, don't get me wrong, but she does a lot of things without thinking. On top of seeing the doctor unnecessarily, she also didn't check to see if she had to pay anything. He recently prescribed massage therapy on her back. She goes, because he prescribed it, and hey, who doesn't want a massage? She's been a handful of times. She thinks insurance will cover it. She got chewed out by my parents for not checking the cost and finding out that insurance doesn't cover most of it. She has to pay over $500. In the grand scheme of things that's not a lot and it's out of her pocket not ours, but it's an example of not caring about the cost of things when you believe insurance will cover. When insurance covers things cost becomes less important to some. If that insurance is government we, the taxpayers, are paying for it. I know my example is a little off because insurance didn't cover it, but the point is since she thought it did she didn't care how much it did cost and she went more than was prescribed.

That's two things we have to think about. I didn't say worry, I said think. More people added to the pool means we're going to have to wait more. This is someone going in for testing on stomach pains having to wait longer while someone is seeing the doctor for a runny nose. More people on government insurance means either we go deeper in debt or we raise taxes. With our economy, we can't afford much of either.

I think if someone is ill we shouldn't deny them care. I strongly advocate going to the doctor when you do need to see him/her. I'll drive you there. But, when you don't need to see him don't go.

ComicBookWorm
August 30th, 2009, 7:57 pm
Actually they do prioritize which patients see doctors sooner. When my gall bladder went bad and caused pancreatitis, I got in to see the gastroenterologist the next day. And the surgeon saw me the day after that. And I had surgery a few days later, despite it being Memorial Day weekend.

However, when I was having generic stomach pains, I waited a month to to see the same doctor. It did turn out to be simple acid reflux, and a pill cured it.

And we aren't talking about people getting free healthcare. The poor already get free healthcare. We're talking about lower cost insurance via the public option since it will be nonprofit. We're talking about a set of minimum standard benefits. We're talking about guaranteed coverage for everyone (at a fair price).

I pay $200 per month for Medicare. Most people don't realize they pay for Medicare since it comes out of their Social Security check. I paid $100 per month for my employer health plan when I worked. And I paid $200 per month for COBRA. I also have had copays and deductibles for all my insurance benefits including Medicare. Any public option will probably have premiums, copays and deductibles. It won't be free, except for the poor. It's the middle class that is suffering the most under our current system.

DancingMaenid
August 30th, 2009, 11:23 pm
Right, so let's make it worse, by adding more people to the pool. Those without insurance are careful about when they go to the doctor. They don't go for a scratch or a sniffle. If you give them the ability to go for more of the lesser some will take advantage of that. That equals longer waits.

I get what you're saying here, and I agree that people shouldn't abuse the medical system.

However, just because something is "mild" does not mean that a person doesn't need to go to the doctor, or that their lives won't be improved if they do. A lot of people go without treatments that aren't strictly necessary but that would improve their quality of life. I have.

And there are a lot of serious medical conditions that need to be treated early-on, and that sometimes manifest with symptoms that don't always scream out that there's an emergency. If someone doesn't go to the doctor until they're seriously ill because they couldn't afford to earlier, then that can be a serious problem.

When my dad got sick, we thought he had a persistent sinus infection. A check-up at an inexpensive clinic didn't reveal anything wrong. Thankfully, we had decent insurance and were able to get him in to see an internist--and it turned out he had lung cancer. In his case, he got in pretty soon and it still wasn't enough to save him. In other cases, people die from things that probably could have been successfully treated.

canismajoris
August 31st, 2009, 12:34 am
Quite frankly it appears that this is trotted out when nothing constructive is thought of.
What is trotted out? I believe my analysis of what I was referring to is more than equitable.

You claim on one hand that you have no way of knowing but you jump to conclusions about why people think the way they do. So, instead of attributing them with good intentions, you instead attribute bad intentions? Why is that? Because they disagree with how best to provide for the uninsured?
Well I don't know exactly what has been hashed out before, but I believe I said I have no way of knowing how charitable people are. I do on the other hand have every right and ability to interpret things they actually say. Whether I agree with them or not is irrelevant here. Despite living in a strongly Democratic region, the overwhelming majority of inflammatory rhetoric I hear comes from, as you put it, the dissenters. Inflammatory rhetoric, not inflammatory ideas. The two shouldn't really be confused, and for the purposes of my post I wanted to clarify this.

But this is all moot, because I haven't posted the kinds of comments I'm talking about and I have no intention to, because they're crude, fallacious, and destructive. Rest assured I haven't jumped to any conclusions.

How is anyone supposed to reconcile that?
Hopefully I've explained that satisfactorily. I don't agree with most of the things people have come out with, even in this very thread. I agree with you that the criticisms you were originally responding to are rather tired and partisan, and I don't feel the supporters of the current plan are being especially constructive either. However, I don't take this site or this thread as a microcosm of the country, so I stand by my original conclusion.

It is in this post. (http://www.cosforums.com/showpost.php?p=5400788&postcount=500)
I have read this post now, but I am a bit unclear about some of the referents of your comments. I didn't see anything in the quoted text about child abuse... So I went looking at the copy itself, and the next bit after what you quoted read:
(C) does not include any expenditure with respect to which a State has submitted a claim for payment under any other provision of Federal law.

Wab
August 31st, 2009, 12:50 am
Those who keep saying that Leah meant poor don't deserve care are deliberately twisting her words...If care is "free," then a lot of people will use it when it's not needed.

I never assumed it was a matter of denying what they deserve but, as is also illustrated here, that they are feckless and can't be trusted to use it wisely. A paternalistic attitude rolled out whenever progressive rights legislation is proposed.

Den_muggle
August 31st, 2009, 1:55 am
No no, it is not a lack of understanding, I simply don't agree that what you're suggesting would work on a large scale, because the logical result would be that poor people with existing health problems would derive no benefits at all from HSAs. I've read arguments that HSAs would actually make everything worse. I don't necessarily believe that, but I don't think it's a real alternative.

How is that the logical result? Your earlier arguments showed a total misunderstanding of HSAs in saying that the entire cost of chemo or a lung transplant would have to be paid out of pocket. Now you say that wasn't a misunderstanding so are you admitting to deliberately twisting the benefits of an HSA/HDHP? How would poor people not benefit from having tax free savings (perhaps even supplemented by the govt) to use to pay deductibles, cheaper health insurance for catastrophic illnesses/accidents, and more choice? :hmm: You'll have to explain that one to me.

I think I'm in a better position to assess what I know or don't know than you are. And generally I'll decide when I need to do research, but thanks for the advice.

I have had several HSAs, so yes I do know how they work. And I do know how limited they are. To begin with, most people don't have enough savings to make the accounts help sufficiently, even with catastrophic insurance. HSAs are useful for someone to cover their normal copays and deductibles with standard health insurance, but they are far less practical as a means of real health care coverage.

They are working quite well for my husband (uninsured) and me as a means of "real" health care coverage. I've said they aren't for everyone and if you don't want it, fine, but don't take mine away from me when it is working quite well for me. And as I said, this bill will take that away due to the minimum coverages required.

I would like a link demonstrating when it was illegal to pay for something out of pocket for Medicare recipients.I doubt I can find it as that was during the Clinton years and was only for a short time. (I think it was one year.) I remember it because several elderly family members were on it at the time and complained about not being able to get a couple of different kinds of tests/procedures even if they were willing to pay for it because it was legally forbidden for their doctor to do it and still continue taking Medicare payments. So technically, it wasn't illegal, but if a doctor accepted money out of pocket from someone on Medicare, the doctor was no longer legally able to accept Medicare patients. So you could get that test, but not from the doctor who knew you. There was such an uproar, that it was rescinded fairly quickly.

This was supposedly the govt trying to protect seniors from "unscrupulous, greedy" doctors trying to get them to pay for extra tests the govt feels they don't need. That was the paternal attitude, not our saying if someone wants to go to a doctor when they don't need to, they should have to pay for it themselves. We're not choosing when they should go or what they should have done...just saying that if they have something to lose in going to the doctor unnecessarily, they might think twice before doing so.

People don't get the care they need in an emergency room. They get hurried impersonal care, where they are likely to be seen by interns, assuming they don't get turned away if their lives aren't in danger. There is no continuity of care where a family practitioner can recognize health patterns that are indicative of serious conditions. They don't get preventative care. They don't get diagnostic blood work that can indicate problems with cholesterol or blood sugar, kidney function. They don't get their high blood pressure diagnosed, monitored, or treated. All of these can lead to much more expensive problems that will cost all of us money. They may get amputations performed for them, but if they need bypass surgery they won't get it, unless they're having a heart attack--because it wouldn't be emergency surgery. They'll get some heart medicine and be sent away. However I get heart scans and other imaging, and if I show enough blockage I could get surgery based on my cardiologist's recommendation, so I wouldn't have to risk dying from a heart attack or suffering significant heart tissue damage.A lot of times you don't get that from your family doctor because he/she's in a practice with several other doctors and you might not see the same one twice or not see a doctor at all, just a nurse practitioner. That is a frequent problem here. If you have a doctor who is in practice by himself, it may take time to get in to see him for even serious problems. That may or may not happen. You're talking the best possible scenario, which doesn't often happen.

As for seniors, they need more frequent checkups since they have quite a few health issues that need to be diagnosed, monitored or tracked. They need more diagnostic tests to prevent more serious problems. I happen to know quite a few seniors (since I am one) and not a single one of them goes to the doctor to socialize. A lot of the seniors have mobility issues and don't go to the doctor as often as they should because of it.Some do; some don't. If they're paying, they can go as often as they like; if I'm paying (through taxes), then I can object to people going for attention and socializing (maybe you don't know any, but I promise you that I do) when they don't need medical care. Again, if it costs them something (even on a sliding scale or from a taxpayer funded HSA), they might think twice about it. That's all we're asking. Some type of consequence to avoid abuse.

Just came across this useful cautious tale (http://www.fivethirtyeight.com/2009/08/poll-most-dont-know-what-public-option.html) (relevant to both sides of the argument, whenever polls about this issue are used by either side) This is another thing we're complaining about. No one knows the details of the bill (including Congress and the President) but they are trying to rush it through and pass it before people have time to even fully understand it, let alone evaluate it and decide if it's what we want/need. That's why we're asking for some time so everyone (including those voting on it or signing it) to fully understand the bill and all the consequences...both intended and unintended. As people have said, it took Obama months to choose a dog for his daughters but they want to rush this bill through in a couple of weeks despite the fact that the cost and ramifications are obviously FAR more serious.

Everyone should have the right to see their doctors regardless of whether they are desperately ill or not. Mostly doctors do tend to discourage patients from just coming in for no reason. And they cut short office visits for those who are not really ill. They're too busy to deal with them.

But the reason that everyone should have a chance to see the doctor when they want to is that sometimes there is something seriously wrong and only the doctor can know. And sometimes the doctor can identify a problem even if the patient is there for something entirely different.

I just don't think that worrying about additional people in the system is a valid reason to not provide them the access.

Frankly, I have quite a few medical problems, but I don't see my specialists as often as I should since I hate going to the doctor. I've had every type of invasive and obnoxious (and often painful) test possible. And I've had my fill of doctors.
Your experiences aren't the same as everyone else's. I also don't like going to doctors and have been through batteries of painful, invasive and obnoxious tests, exploratory surgeries, unnecessary surgeries, etc. I tend to avoid doctors as much as possible. Not everyone does. And no one said everyone shouldn't have the right to see a doctor every day if they wish...as long as they pay for it and I don't.


I never assumed it was a matter of denying what they deserve but, as is also illustrated here, that they are feckless and can't be trusted to use it wisely. A paternalistic attitude rolled out whenever progressive rights legislation is proposed.

Paternalistic is trying to tell me what is right for me as if I don't know. Saying I want people to see consequences for their actions is responsibility. I didn't say anyone couldn't be trusted to use things wisely. I said when people see no cost or consequences, they tend more toward abusing something. That's not just poor, liberal or seniors. That's everyone...including you and me. It is simple fact that MOST people will tend more toward waste or abuse if they don't see any cost or consequence for it.
I've said my piece and made my arguments. I'm done with this.

canismajoris
August 31st, 2009, 2:40 am
How would poor people not benefit from having tax free savings (perhaps even supplemented by the govt) to use to pay deductibles, cheaper health insurance for catastrophic illnesses/accidents, and more choice? :hmm: You'll have to explain that one to me.
Where to begin. First, "tax free savings" isn't a particularly huge advantage for extremely poor people. Why would they enroll in such a system simply for tax protection?

Second, because the main attractive feature of such a plan when discussing the millions of currently uninsured would be a very low premium. But, you know, I find it unlikely that people who could only afford such a low premium for health care would have any means to fund their accounts in the first place.

Third, the involvement of a high deductible plan would seem to suggest that people will forego necessary care because of the high out-of-pocket cost. This is already an established trend when you compare the choices people with low deductibles make compared to people with high deductibles.

Fourth, people with very low incomes and people who are already in poor health will end up using a much larger portion of their income for health care compared to alternative plans, and they are much more likely to go into medical debt with an HSA paired with HDHP.

Fifth, the administrative costs of millions of individuals on their own HSA plans would likely be sky-high compared to that of group plans.

Sixth, well, do I really have to continue?

ComicBookWorm
August 31st, 2009, 4:31 am
A lot of times you don't get that from your family doctor because he/she's in a practice with several other doctors and you might not see the same one twice or not see a doctor at all, just a nurse practitioner.
Actually they all keep notes on your same chart and every practice I've been associated with has assigned a primary care physician for me, and I've only seen someone else if I needed to come in on a day when the doctor wasn't there (like I was feeling very ill and couldn't wait for an appointment). They also have a detailed history of all my tests and illnesses.

They tend to use the nurse practicioner for sniffles and triage. Then the doctor comes in afterward. I don't see why anyone should be denied the chance (and dignity) to be seen by primary care doctor in a medical practice.

As people have said, it took Obama months to choose a dog for his daughters but they want to rush this bill through in a couple of weeks despite the fact that the cost and ramifications are obviously FAR more serious.This is just a frivolous and nasty snipe. And Congress has had plenty of time to read the bill.

Wab
August 31st, 2009, 4:49 am
A lot of times you don't get that from your family doctor because he/she's in a practice with several other doctors and you might not see the same one twice or not see a doctor at all, just a nurse practitioner.

I get to my doctor almost all the time. About the only exceptions is when she's sick. Like last week when I got to see one of her practice partners the morning after I called.

That is a frequent problem here.

Hmm.

Den_muggle
August 31st, 2009, 11:01 am
Where to begin. First, "tax free savings" isn't a particularly huge advantage for extremely poor people. Why would they enroll in such a system simply for tax protection? Extremely poor people (if they work) still will pay Medicare/SS taxes and save that with an HSA. And I have several times said there could be a provision to help extremely poor fund this HSA.

Second, because the main attractive feature of such a plan when discussing the millions of currently uninsured would be a very low premium. But, you know, I find it unlikely that people who could only afford such a low premium for health care would have any means to fund their accounts in the first place. Again, part of my plan was to help extremely poor people fund the HSA and/or the premium, which would cost much less if it were a high deductible plan. Besides, who said the only people who would sign up would be only those who could only afford the lower premiums. I could afford the higher premiums of my buy-up plan at work, but it would be more expensive and I'd rather save that money. Who wouldn't?
Third, the involvement of a high deductible plan would seem to suggest that people will forego necessary care because of the high out-of-pocket cost. This is already an established trend when you compare the choices people with low deductibles make compared to people with high deductibles.
Why should it if they have the HSA to cover the out-of-pocket costs?
Fourth, people with very low incomes and people who are already in poor health will end up using a much larger portion of their income for health care compared to alternative plans, and they are much more likely to go into medical debt with an HSA paired with HDHP.
Go to the website I linked to earlier. It shows costs of traditional vs HSA total out of pocket costs and HSA is lower when you figure in the lower premiums. And I've repeatedly said it may not be for everyone, but neither is this plan. HSA has worked wonderfully for my family and I don't want it taken away. I think it would benefit more people than this plan now being proposed. No plan will work for absolutely every single person without exception. So allow us choice. Don't take it away. HSAs work fabulously for millions and could work for many more with a bit of help.
Fifth, the administrative costs of millions of individuals on their own HSA plans would likely be sky-high compared to that of group plans.
What administrative costs? You administer it yourself. Govt doesn't administer the account in any way. All they would do would be to possibly, for some, help fund it. Nothing more. I am talking HSAs here, not FSAs.
Sixth, well, do I really have to continue?No, because your arguments don't stand up to scrutiny.

SSJ_Jup81
August 31st, 2009, 11:13 am
A lot of times you don't get that from your family doctor because he/she's in a practice with several other doctors and you might not see the same one twice or not see a doctor at all, just a nurse practitioner.:hmm: I can't wrap my mind around this one. Since I was a kid, I've always constantly gone and seen the same doctor, 'cept for when we moved to where we are now, or if I go in without an appointment and have to see like a nurse practitioner because I couldn't be fit in to see my regular physician. When I became an adult, same thing, especially since I became diabetic. It's important to stick with the same doctor consistently because of the condition. Sucks that I don't have that luxury now. My visits are so inconsistent and so is my medication. The doctors I see that don't know my history prescribe whatever they want for me.l

canismajoris
August 31st, 2009, 1:09 pm
No, because your arguments don't stand up to scrutiny.
They were never "my arguments." This is not some personal matter to me, I think it's important that people understand why HSAs are not going to work as an alternative to universal health care. I think it would be just fine as an adjunct to whatever our new system ends up being, but to say that we should not proceed with a new bill and we should give everyone these savings accounts is irresponsible. That is all I have to say on the matter.

USNAGator91
August 31st, 2009, 1:32 pm
:hmm: I can't wrap my mind around this one. Since I was a kid, I've always constantly gone and seen the same doctor, 'cept for when we moved to where we are now, or if I go in without an appointment and have to see like a nurse practitioner because I couldn't be fit in to see my regular physician. When I became an adult, same thing, especially since I became diabetic. It's important to stick with the same doctor consistently because of the condition. Sucks that I don't have that luxury now. My visits are so inconsistent and so is my medication. The doctors I see that don't know my history prescribe whatever they want for me.l

Well and good for you, and for the most part, I think most large practices attempt to accomodate their patients, but as a practical matter, doctors are people too. They get sick, they go on vacations and they have family matters, so that does not ensure that they will be available when you need or want them to be.

Because of liability, as seen in a post I made last week, many specialties like Pediatrics and General Practice (family medicine) doctors are suffering from a lack of doctors while the population, especially in the geriatric side goes up.

My wife runs a pediatric residency program here and continually suffers from a lack of qualified candidates. That puts a run on those specialties in certain areas and leads to the situation Den describes.

This factor is NOT addressed by HR3200. There is no provision for adding more doctors through education or tort reform. So you tell me, the number of pediatricians and family practitioners is going down and HR3200 wants to add 47 Million people to the rolls of the insured...how is there no wait or no rationing?

monster_mom
August 31st, 2009, 4:19 pm
I won't be giving up any money since I'm retired and have no taxable income. But that accusation is very unfair since that's not what people are saying. They're saying that even the middle class gets screwed by the insurance companies, and we need a different approach. Even the middle class goes bankrupt from medical costs. Even the middle class loses its insurance when they get ill. Even the middle class finds that things they thought were covered aren't. Even the middle class is choking under expensive insurance.

Unfortunately the polls just don't support your allegation that the middle class is getting screwed by their insurance companies. The polls are showing that upwards of 74% of the country is more than satisfied with their health insurance coverage. I know my husband and I are.

I'm not convinced we need a different approach. I think we need to take action to make purchasing coverage more affordable and address Medicare and Medicaid's fast approaching insolvency, but I absolutely do not believe that tossing the current system in favor of a government controlled one is the best solution.

Extremely poor people (if they work) still will pay Medicare/SS taxes and save that with an HSA. And I have several times said there could be a provision to help extremely poor fund this HSA.

The extremely poor - those with incomes less than 1.33 times the federal poverty level - qualify for Medicaid. The children of families up to 2 times the poverty level, and pregnant or nursing mothers women in the same families, qualify for SCHIP. That won't change in either the Democrats or the Republican's plans - the Medicaid qualification level will remain unchanged. Under the Democrats plan the SCHIP qualification level will be increased while under the Republican's plan state will be allowed to increase their SCHIP income qualification level only after they've enrolled 90% of the children eligible for SCHIP at the current income level.

Studies have demonstrated that a significant portion of those eligible for Medicaid or SCHIP don't enroll in the program (according to the Kaiser Foundation survey, close to 14 million of the uninsured qualify for SCHIP or Medicaid but have not enrolled in it). That implies some degree of choice as enrollment in Medicaid / SCHIP is automatic if you show up at a hospital or other medical facility.

Taking the 14 million who qualify for Medicaid / Medicare / SCHIP but have not enrolled out of the equation, that leaves us with 33 million uninsured who need help. But we have to know who they are and why they don't have coverage if the solution we develop will actually address the problems without making things worse.

A chunk of the uninsured are illegal aliens. The numbers I've seen vary, but it there seem to be about 9 million uninsured illegal aliens. The Democrats plan will prohibit anyone who is here illegally from enrolling in an government backed plan. That means that unless their employer offers coverage they won't be able to purchase it. The Republican's plan, interestingly, prohibits illegal aliens from obtaining taxpayer assistance to purchase coverage but doesn't prohibit illegal aliens for obtaining coverage from a trade association or membership organization.

Taking those 9 million uninsured illegal aliens out of the equation, and we're down to 24 million uninsured - either temporarily or chronically. According to the Kaiser survey, about half of those folks have jobs but their employers don't offer coverage - because they are self employed or they work for small companies and the cost of providing a medical benefit is too expensive for their company. The other half, according to the survey, "are employed by firms that provide coverage but where the worker is ineligible for coverage (20 percent) or by firms that offer coverage but where the worker declines to participate (30 percent)."

Who are they? Looking back at the Kaiser survey we see that, for the most part, they are people with incomes below $40,000. The survey does note that the percentage of people with incomes above $50,000 without coverage is increasing.

For these people cost and eligibility seem to be the hurdles to obtaining coverage. Bringing down the cost of coverage for these individuals seems to be the solution.

The Democrats bill, with guaranteed issue and community rating, will cause the cost of coverage go up. Every state with guaranteed issue combined with community rating has seen the cost of coverage increase. Additionally, the Democrats plan prohibits companies from deducting the cost of providing their employees with coverage from their taxes. With an average corporate tax rate of about 40% (http://www.taxfoundation.org/publications/show/22917.html), that means that the cost of providing coverage will increase 40% for every employer. That additional cost will be passed along to their employees as either increased premiums or reduced pay.

So, under the Democrats plan, rather than making the cost of coverage lower the cost of coverage will be at least 35 - 40% higher. That means, at a minimum, that more companies will be forced to drop coverage, more people will be unable to afford the coverage offered by their employer, and the percentage of people covered by an employer sponsored plan will decrease.

The answer from the Democrats for this, is to offer the government option. Companies who find that the cost of providing coverage to their employees exceeds 8.5% of their annual salaries can drop their coverage and pay a per employee fee of 8.5% to the federal government. Their employees would then be forced to purchase coverage from the government exchange. The cost of coverage from the exchange may not be more affordable than it was from their employer because many employers subsidize their employees coverage.

For instance, my company pays a portion of our premiums for us. If my employer were to drop coverage and pay the fine, the fine would go to the pool as opposed to me and I'd be on the hook for the full cost of my premiums. If my employer was paying 10% of my salary as a health benefit and now he only pays 8.5% as a fine, that's a 1.5% savings for him and he may pass that savings onto me as a salary increase. But I still lose 8.5%.

The Republican's plan continues to allow employers to deduct the cost of coverage from their taxes. It also allows individuals who are self employed or have private coverage to deduct the cost of their coverage from their taxes. Of course, if you don't pay much in taxes, deducting the cost of coverage doesn't make it any more affordable. So the Republican plan provides a $2000 - $5000 refundable tax credit to anyone with income less than 3 times the poverty level ($66,000 for a family of 4 - who comprise the majority of the uninsured according to the Kaiser report referenced above) so that they can purchase private insurance or enroll in their employer sponsored plan. So that there are more options available, the Republican plan allows membership organizations and associations to offer health coverage to their members as a benefit and provides a state sponsored high risk group for individuals whose medical conditions result in premiums that exceed 1.5 times the national average.

The bottom line:

The 31% of the population covered by SCHIP, Medicare, or Medicaid will see no change in the cost of their coverage under either plan.

The 3% of the population that's uninsured illegal aliens won't be able to obtain coverage unless it's through the employer under the Democrat's plan but will be able to purchase coverage from a membership organization or association under the Republican's plan.

The 8% of the population (the 24 million from above) who don't currently have coverage, don't qualify for Medicaid, Medicare, or SCHIP, and aren't illegal aliens, will be able to enroll in coverage through the government option under the Democrats plan and may be able to afford it with the additional assistance provided, and will be able to enroll in coverage through membership organizations or associations under the Republican's plan and may be able to afford it with the additional assistance provided.

The remaining 59% of the population (the 178 million with private or employer sponsored insurance) will see a 35 - 40% increase in the cost of their coverage under the Democrats plan, at a minimum, while the cost of their coverage under the Republican's plan will be unchanged.


It is worth noting that the increase in government spending as a result of the Republican's plan hasn't been estimated by the CBO. Employers are currently allowed to deduct the cost of providing their employees with coverage, so continuing to allow that deduction will be revenue neutral. There are no changes to Medicare, Medicaid, and SCHIP enrollment or benefits, so that will be revenue neutral. Illegal aliens won't be eligible to receive federal assistance in purchasing health coverage like they are now, so that will be revenue neutral. The increased cost will come with providing a refundable tax credit to the 24 million uninsured people, assuming they qualify. If each of them takes the full individual credit of $2000, that'll be an increase in government spending of about $48 billion a year - at a minimum.

Sources:


http://hotair.com/archives/2009/08/08/cbo-missed-obamacare-cost-by-1-trillion/
http://www.taxfoundation.org/publications/show/22917.html
http://www.google.com/publicdata?ds=uspopulation&met=population&tdim=true&q=population+of+the+US
http://www.nchc.org/facts/coverage.shtml
http://newsbusters.org/stories/40-million-uninsured-myth
http://hotair.com/greenroom/archives/2009/07/13/debunking-some-healthcare-propaganda/

Wab
August 31st, 2009, 4:35 pm
Unfortunately the polls just don't support your allegation that the middle class is getting screwed by their insurance companies. The polls are showing that upwards of 74% of the country is more than satisfied with their health insurance coverage. I know my husband and I are.

Which is less than the number who actually have insurance (84.2% and falling rapidly according to the Census Bureau (http://www.medscape.com/viewarticle/567737)).

It's unclear whether the polls you cite without links refer to Americans as a whole or Americans with insurance.

If it's the former, than the number is less than the 84% who have insurance. Any business that has a 10% dissatisfaction is in trouble.

If the number is only a poll of Americans with insurance then the industry is really in trouble.

If the issue is money, which it always seems to be, there are cutbacks that can be made. An easy one is to stop paying for expensive mercenaries when the US has a large standing military.

monster_mom
August 31st, 2009, 5:01 pm
Which is less than the number who actually have insurance (84.2% and falling rapidly according to the Census Bureau (http://www.medscape.com/viewarticle/567737)).

It's unclear whether the polls you cite without links refer to Americans as a whole or Americans with insurance.

How may times do I have to provide the same freaking links with the same freaking statistics?

See my most recent previous post citing the same statistics here (http://www.cosforums.com/showpost.php?p=5403411&postcount=527).

Links to polls can be found in here and in one of my previous posts. The polls were conducted within the same general time frame and polled either respondents, registered voters, or likely voters. CNN polls show 74% satisfaction, The New York Times showed 77% satisfied, the Washington Post showed 81% satisfied, and Fox news showed 84% satisfied - all polled within the same time period. Looking outside the media you have Zogby with 84% satisfied and Gallup with a rather confusing either 83% or 67% satisfied. Note that I chose to report the poll showing the lowest satisfaction from CNN rather than deal with scoffing because I reported Fox or Zogby's numbers.

Taking the average of those polls you have about 81% reporting that they are satisfied with their coverage. Using your data, if 84% have coverage that means that about 3% are dissatisfied.

If the number is only a poll of Americans with insurance then the industry is really in trouble.

The numbers, as I explained in my previous posts, are the people who responded to the poll, not just insured individuals.

If the issue is money, which it always seems to be, there are cutbacks that can be made.

The issue is providing the best quality of care at the lowest cost. I'm not convinced that a government controlled plan would provide the same quality of coverage we have now.

I'm ignoring your comment about the US hiring mercenaries because it's off topic - but I find the comment highly offensive, which I'm sure is no shock to you.