So what I'm reading is that our "free market" solution discourages primary care, Medicare has imposed some regulations meant to decrease "gaming the system" that need to be reassessed, and that UHC the world over invests heavily in primary care.
A compelling argument to bring Thunderdome to health care.
Haha yeah, the current situation needs some Thunderdoming.
I think his part about Medicare illustrates that Washington is a bit too clumsy and out of touch to make healthcare policy that really works. They're not exactly nimble, either, so fixing a system that they devise might take decades. I didn't see anything about UHC, except their worries that a government single payor would be worse.
I've said it before, I think the patients should deal with their insurance directly for reimbursement. They would rapidly migrate away from the ones that stay profitable despite inefficiency by bullying, and to the ones who have well-run businesses. There are, in fact, some of those. In our experience, Aetna has been straightforward, fair, and well managed. Our patients like Aetna as well. Everyone switching to more efficient insurance carriers will decrease that per-capita spending figure that makes us look so bad. Currently the feedback loop is broken.
I think the other part of the puzzle is standardizing the interface between doctors and the health insurance industry so that doctors don't need so many support staff (currently it's ~2-3 per doctor on average, including receptionist, nurses, billers) to keep up with getting paid for their work. This would allow them to spend more time with each patient while still remaining profitable. Currently many have to see a patient every 15 minutes or so to stay profitable, since they do have employees to support. Through a combination of a custom tech infrastructure and mostly dealing with the insurance companies that are fair, our practice can do half hour visits for the same price as most charge for 15-30 minute visits, as we only have a receptionist and a part-time biller to deal with the Blue Cross problem cases. If we stopped supporting Blue Cross, we wouldn't have any need for even a part-time biller, but almost half of our patients have Blue Cross, which is why we put up with their shit. Without a biller, we could further increase the amount of time spent with each patient. In our practice, the patient is with the doctor for 100% of the visit.
Sorry for being so long-winded.
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So what I'm reading is that our "free market" solution discourages primary care, Medicare has imposed some regulations meant to decrease "gaming the system" that need to be reassessed, and that UHC the world over invests heavily in primary care.
A compelling argument to bring Thunderdome to health care.
Haha yeah, the current situation needs some Thunderdoming.
I think his part about Medicare illustrates that Washington is a bit too clumsy and out of touch to make healthcare policy that really works. They're not exactly nimble, either, so fixing a system that they devise might take decades. I didn't see anything about UHC, except their worries that a government single payor would be worse.
I've said it before, I think the patients should deal with their insurance directly for reimbursement. They would rapidly migrate away from the ones that stay profitable despite inefficiency by bullying, and to the ones who have well-run businesses. There are, in fact, some of those. In our experience, Aetna has been straightforward, fair, and well managed. Our patients like Aetna as well. Everyone switching to more efficient insurance carriers will decrease that per-capita spending figure that makes us look so bad. Currently the feedback loop is broken.
Insurance companies in pretty much every other industry - life insurance, auto insurance, homeowners insurance - have shown every willingness to bully consumers. Hell, I recently had a break-in and got back 40% of what I claimed with really no opportunity for redress short of hiring a lawyer. Somehow I don't think that shoving the administrative burden onto the consumer is going to do anything except free up doctors for a few more rounds of golf.
I think the other part of the puzzle is standardizing the interface between doctors and the health insurance industry so that doctors don't need so many support staff (currently it's ~2-3 per doctor on average, including receptionist, nurses, billers) to keep up with getting paid for their work. This would allow them to spend more time with each patient while still remaining profitable. Currently many have to see a patient every 15 minutes or so to stay profitable, since they do have employees to support. Through a combination of a custom tech infrastructure and mostly dealing with the insurance companies that are fair, our practice can do half hour visits for the same price as most charge for 15-30 minute visits, as we only have a receptionist and a part-time biller to deal with the Blue Cross problem cases. If we stopped supporting Blue Cross, we wouldn't have any need for even a part-time biller, but almost half of our patients have Blue Cross, which is why we put up with their shit. Without a biller, we could further increase the amount of time spent with each patient. In our practice, the patient is with the doctor for 100% of the visit.
Physicians organizations like the AMA and insurance companies currently have every incentive in the world to standardize patient records and transactions - it's their own overhead that's being burned with all this inefficiency. So what's it going to take? Gummint mandates and regulation?
Insurance companies in pretty much every other industry - life insurance, auto insurance, homeowners insurance - have shown every willingness to bully consumers. Hell, I recently had a break-in and got back 40% of what I claimed with really no opportunity for redress short of hiring a lawyer. Somehow I don't think that shoving the administrative burden onto the consumer is going to do anything except free up doctors for a few more rounds of golf.
But you as a consumer have no incentive to stay with a shitty insurance company like that. You can take your money elsewhere very easily. It very hard for doctors to drop the big insurance companies in their area if they are bullying them, because then the doctors lose a big chunk of their patient base. And if there are no patient visits, then they can't afford to pay their support staff. In many cases it is hard for one to switch health insurance, though, if your job provides it and you are the only one calling for it in your organization. I guess the only way it would work in the current system is with some cooperative effort by the doctors to drop a bullying insurance company, which would cause a cooperative effort by employees to get their employers to switch.
Physicians organizations like the AMA and insurance companies currently have every incentive in the world to standardize patient records and transactions - it's their own overhead that's being burned with all this inefficiency. So what's it going to take? Gummint mandates and regulation?
Standardization is a huge problem, because health care is so different from patient to patient. Efficiency isn't something that health care is very well suited to by nature, I think. This is one of the reasons I think that general preventative health care should be like going to a mechanic for a tuneup, where the insurance companies aren't involved at all, and the doctor shows you their fees, and if you don't think the doctor is worth it, you go to a different doctor who will charge something else, and there would once again be price competition among doctors.
I think insurance only has a place in mitigating unlikely but crippling costs like cancer, an AIDS treatment regimen, emergency surgery, and so forth. Insurance should cover those fully.
If insurance only got involved in the high-end cases, there would be no middleman for the vast majority of healthcare cases, and the cost per patient would drop by a good bit.
Just as some employers are now giving out what are essentially prepaid debit cards for preventative health care, the government could give the poor the healthcare equivalent of food stamps, which would be as good as cash for healthcare, and this would cover the cost of preventative healthcare, vaccines, and so forth. For the high-end costs, they could provide insurance that would pay for emergency medical care. I think it would be ideal if the insurance system, which is inherently high overhead, was used for as small a number of cases as possible. For every transaction it gets involved in, it adds overhead.
In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests.
This figure is entirely irrelevant unless we can compare it with the median wait time for the insured in the United States.
I'll agree with that but you have to use PPO stats since that's kinda the whole point of them. Better quality and better service. People telling me their HMO sucks isn't news.
But people who go with a PPO pay a huge amount more out of pocket and only slightly less in premiums. By which I mean a procedure that an HMO would cover 100% of a PPO will cover 80%. And that's for routine stuff. The specialist procedures they usually only cover 50%.
The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
In most UHC countries, the organization that represents doctors negotiates salaries, payment schedules, and basically every fee you can think of with the government on an annual basis. If the government tried to reduce doctors' salaries or "take away their paycheck" or other such nonsense without consultation, the doctors would get extremely pissed off and withdraw services, and the government would lose assloads of credibility. Kind of like what you're doing by not researching the topic at all and just coming in here and parroting 40-year-old right-wing talking points that have no factual basis. Why don't you go listen to your Ronnie Reagan records some more.
It's capitalism, dude. Sorry, but making doctors lives more miserable, be it through decreased pay, decreased prestige, greater annoyance, or what have you, WILL MAKE FEWER PEOPLE BECOME DOCTORS. That's not a right-wing talking point, that's common sense. Where my college friends in previous years might have gone to become doctors, instead, they've gone to become investment bankers, traders, and consultants. Even my friends who majored in CS have largely abandoned their chosen field and have gone on to more lucrative fields.
My example used hyperbole - ie "take away their paycheck". Sorry, I'll be more exact next time. Of course they would erode it slowly, so as not to cause too many waves. As long as it's only a little less than last year, no one is going to bother complaining, until they get used to it, and they can decrease it some more.
And what are you talking about, researching the topic? Do you work in healthcare? Do you have any contact with the US healthcare system, even as a patient? I am coming at this from the idea of the US making a UHC system, not looking at how things are in other, more socialist countries. I am looking at the US's track record with socialist programs, and the fact is, we're bad at making programs that don't suck/hemorrhage money.
It's unreasonable and a considerable leap in logic to suggest that moving to a universal healthcare system, which would simply replace the vast multitude of different insurance policies with a single, integrated, tax-funded insurance program, would lead to doctors being paid less. Doctors would, in all likelihood, continue to collect the fees and salaries and regular pay raises to which they have grown accustomed, because medical associations wield considerable political clout and bargaining power, and it's also a really bad idea to cut doctors' salaries. I think this is clearly evidenced by the fact that doctors have remained among the highest-paid professionals in Canada, the UK, and other developed countries, despite their "socialist" approach to public health.
It's capitalism, dude. Sorry, but making doctors lives more miserable, be it through decreased pay, decreased prestige, greater annoyance, or what have you, WILL MAKE FEWER PEOPLE BECOME DOCTORS. That's not a right-wing talking point, that's common sense. Where my college friends in previous years might have gone to become doctors, instead, they've gone to become investment bankers, traders, and consultants. Even my friends who majored in CS have largely abandoned their chosen field and have gone on to more lucrative fields.
UHC just doesn't have this effect. I'm sorry. You're wrong. There is simply no evidence to support this point of view. UHC countries have either similar or better doctor to patient ratios. All the evidence suggests that UHC does not have this effect.
And what are you talking about, researching the topic? Do you work in healthcare? Do you have any contact with the US healthcare system, even as a patient? I am coming at this from the idea of the US making a UHC system, not looking at how things are in other, more socialist countries. I am looking at the US's track record with socialist programs, and the fact is, we're bad at making programs that don't suck/hemorrhage money.
This is nonsense. What "socialistic programs" are you talking about? Our federal welfare programs are run on the cheap and have been continually undermined by conservative politicians; is it any wonder that they don't always fix the problem they're intended to solve? What about Social Security? It's been in place for around 70 years and only recently, due to the baby boom, is in any danger of "sucking/hemorrhaging money". That's a great track record. Medicare isn't doing particularly poorly, either.
Besides, are you really going to argue that France, the UK, and Canada can do something and we can't?
This is an example of how the free market can fix the situation. Right now, the free market is stuck in a rut, and it will need some shaking up to correct itself. The government needs to see that the industry is rotten, think about how it got itself into this position, and then right it and let it go on its merry way.
This is hilarious. The free market is in a rut and the government needs to intervene? You have such faith in the free market, and yet you seem to be admitting that it's what got us into this problem in the first place.
Insurance companies in pretty much every other industry - life insurance, auto insurance, homeowners insurance - have shown every willingness to bully consumers. Hell, I recently had a break-in and got back 40% of what I claimed with really no opportunity for redress short of hiring a lawyer. Somehow I don't think that shoving the administrative burden onto the consumer is going to do anything except free up doctors for a few more rounds of golf.
But you as a consumer have no incentive to stay with a shitty insurance company like that. You can take your money elsewhere very easily. It very hard for doctors to drop the big insurance companies in their area if they are bullying them, because then the doctors lose a big chunk of their patient base. And if there are no patient visits, then they can't afford to pay their support staff. In many cases it is hard for one to switch health insurance, though, if your job provides it and you are the only one calling for it in your organization. I guess the only way it would work in the current system is with some cooperative effort by the doctors to drop a bullying insurance company, which would cause a cooperative effort by employees to get their employers to switch.
No, you cannot switch health insurance easily. It's very, very difficult to do so because your employer provides you with said insurance and would have to completely revamp their program.
Moreover, your purported solution doesn't solve the problem at all. Consider the incentives of an insurance company when they receive a large claim. If they can get away with paying less (that is to say, if it doesn't drive customers away from their company), they should do so. If they can delay the procedure until the patient dies, and so escape paying for it, they should do so. If they can try and avoid paying for the procedure by arguing that it's not covered (it's "experimental" or whatever else), they should do so. If they do these things on an institutional basis, this allows them to lower premiums and thus outcompete their competitors. Think Wal-mart. Crappy products at low cost tend to beat good products at high cost, particularly when it's difficult for the consumer to differentiate between high and low quality products.
TL;DR: No matter who insurance companies deal with, they're going to try and get out of paying claims.
Look, the reason insurance is broken is the free market. The insurance industry had an antitrust exemption. They can share data and essentially collude on prices. The government doesn't allow any other industry that kind of freedom to fuck with customers. The free market is the problem.
Kevin, what is your response to people who are unable to get healthcare because all of the local businesses won't employ them past forty hours and it's not economically feasible for them to work anywhere else?
You can answer this question too. I'm particularly concerned about minors.
Kevin, what is your response to people who are unable to get healthcare because all of the local businesses won't employ them past forty hours and it's not economically feasible for them to work anywhere else?
You can answer this question too. I'm particularly concerned about minors.
I think medi-care at the state level is a valid solution to those who simply can't afford health-care, but what I'd really like to see are Medial Savings Accounts where money is deferred into a personal account tax free that can be used for health-care for your entire family. The money could be used to pay insurance premiums directly, co-pays, out of pocket payments, prescription drugs or maybe even OTC purchases and supplements (within reason).
When individuals die the money is passed on to their family.
The benefit of an MSA over UHC is there are still market incentives to get the lowest cost possible and there would never be triage or rationing. What I also don't like about UHC or even our current system is that we are subsidizing people who live unhealthy lifestyles or hypochondriacs who demand they get a cat-scan when they have a headache. MSA's incentivize frugal spending and reward healthy living but also allow you to drop big sums when necessary since it's always in the account. If MSA's were in place we'd see lower premiums and higher deductibles but since the money is already set aside almost everyone would have resources to pay for it.
If the account runs dry then medicare picks up the rest, but if you have anything in your MSA, you always spend from that first. This would alleviate the burdens on medicare, keep medicine relatively free-market and at the same time basically guarantee the entire country is covered.
I think medi-care at the state level is a valid solution to those who simply can't afford health-care, but what I'd really like to see are Medial Savings Accounts where money is deferred into a personal account tax free that can be used for health-care for your entire family. The money could be used to pay insurance premiums directly, co-pays, out of pocket payments, prescription drugs or maybe even OTC purchases and supplements (within reason).
When individuals die the money is passed on to their family.
The benefit of an MSA over UHC is there are still market incentives to get the lowest cost possible and there would never be triage or rationing. What I also don't like about UHC or even our current system is that we are subsidizing people who live unhealthy lifestyles or hypochondriacs who demand they get a cat-scan when they have a headache. MSA's incentivize frugal spending and reward healthy living but also allow you to drop big sums when necessary since it's always in the account. If MSA's were in place we'd see lower premiums and higher deductibles but since the money is already set aside almost everyone would have resources to pay for it.
If the account runs dry then medicare picks up the rest, but if you have anything in your MSA, you always spend from that first. This would alleviate the burdens on medicare, keep medicine relatively free-market and at the same time basically guarantee the entire country is covered.
If people can't afford insurance, why would we suppose they would be able to put aside a significant amount of money every month into this savings account? Moreover, what's the incentive to do so? If Medicare covers everything above and beyond your MSA, why should you put any money into an MSA?
I think medi-care at the state level is a valid solution to those who simply can't afford health-care, but what I'd really like to see are Medial Savings Accounts where money is deferred into a personal account tax free that can be used for health-care for your entire family. The money could be used to pay insurance premiums directly, co-pays, out of pocket payments, prescription drugs or maybe even OTC purchases and supplements (within reason).
When individuals die the money is passed on to their family.
The benefit of an MSA over UHC is there are still market incentives to get the lowest cost possible and there would never be triage or rationing. What I also don't like about UHC or even our current system is that we are subsidizing people who live unhealthy lifestyles or hypochondriacs who demand they get a cat-scan when they have a headache. MSA's incentivize frugal spending and reward healthy living but also allow you to drop big sums when necessary since it's always in the account. If MSA's were in place we'd see lower premiums and higher deductibles but since the money is already set aside almost everyone would have resources to pay for it.
If the account runs dry then medicare picks up the rest, but if you have anything in your MSA, you always spend from that first. This would alleviate the burdens on medicare, keep medicine relatively free-market and at the same time basically guarantee the entire country is covered.
If people can't afford insurance, why would we suppose they would be able to put aside a significant amount of money every month into this savings account? Moreover, what's the incentive to do so? If Medicare covers everything above and beyond your MSA, why should you put any money into an MSA?
Because it would be mandatory just like social security. Maybe even with an employer match. Only it's your money and it earns interest. The government regulates how you spend it, but they don't have ultimate control over how it's spent.
Also the money is tax free if it goes into an MSA just like a 401k is, so there will be more of it going to your health-care and less going to the fed.
The amount that people would realistically have to set aside would be too great with todays tax burden so if I'm dictator taxes would be slashed and social security probably gutted so people can afford to do it.
Because it would be mandatory just like social security. Maybe even with an employer match. Only it's your money and it earns interest. The government regulates how you spend it, but they don't have ultimate control over how it's spent.
So it's not really a savings account at all. It's a tax that sets up a semi-private account. And it's not really a private account if you can't spend it, shift it, or liquidate it. Besides, under the plan you described before, the government would have ultimate control over how it's spent, in the sense that you couldn't have access to Medicare without exhausting the account.
Also the money is tax free if it goes into an MSA just like a 401k is, so there will be more of it going to your health-care and less going to the fed.
It wouldn't make much sense to tax a tax. That'd be like taxing the Social Security tax.
The amount that people would realistically have to set aside would be too great with todays tax burden so if I'm dictator taxes would be slashed and social security probably gutted so people can afford to do it.
You've basically just described a UHC system funded by a regressive tax. The chief difference between my proposal (single payer, funded by the income tax) and yours is that mine doesn't shift the tax burden from wealthy to poor.
This is an example of how the free market can fix the situation. Right now, the free market is stuck in a rut, and it will need some shaking up to correct itself. The government needs to see that the industry is rotten, think about how it got itself into this position, and then right it and let it go on its merry way.
This is hilarious. The free market is in a rut and the government needs to intervene? You have such faith in the free market, and yet you seem to be admitting that it's what got us into this problem in the first place.
Yes, I never said that the free market is flawless... it definitely isn't. For example, there are corner cases where it can't right itself, and in that case, I think that the government should intervene. I have little faith in the ability of our governors, and I think this would be a simpler solution than a UHC system.
On an unrelated note, I take back what I said earlier about increasing overall efficiency by making it so that insurers aren't involved in standard preventative care, because the companies use that to subsidize the people with chronic conditions. If they didn't, healthy people would jump ship, premiums would rise, more healthy people would jump ship, until only the sickest were left and they would carry the full burden of their illness, getting rid of the point of insurance. Sooo that doesn't necessarily work in theory.
I think medi-care at the state level is a valid solution to those who simply can't afford health-care, but what I'd really like to see are Medial Savings Accounts where money is deferred into a personal account tax free that can be used for health-care for your entire family. The money could be used to pay insurance premiums directly, co-pays, out of pocket payments, prescription drugs or maybe even OTC purchases and supplements (within reason).
When individuals die the money is passed on to their family.
The benefit of an MSA over UHC is there are still market incentives to get the lowest cost possible and there would never be triage or rationing. What I also don't like about UHC or even our current system is that we are subsidizing people who live unhealthy lifestyles or hypochondriacs who demand they get a cat-scan when they have a headache. MSA's incentivize frugal spending and reward healthy living but also allow you to drop big sums when necessary since it's always in the account. If MSA's were in place we'd see lower premiums and higher deductibles but since the money is already set aside almost everyone would have resources to pay for it.
If the account runs dry then medicare picks up the rest, but if you have anything in your MSA, you always spend from that first. This would alleviate the burdens on medicare, keep medicine relatively free-market and at the same time basically guarantee the entire country is covered.
If people can't afford insurance, why would we suppose they would be able to put aside a significant amount of money every month into this savings account? Moreover, what's the incentive to do so? If Medicare covers everything above and beyond your MSA, why should you put any money into an MSA?
Because it would be mandatory just like social security. Maybe even with an employer match. Only it's your money and it earns interest. The government regulates how you spend it, but they don't have ultimate control over how it's spent.
Also the money is tax free if it goes into an MSA just like a 401k is, so there will be more of it going to your health-care and less going to the fed.
The amount that people would realistically have to set aside would be too great with todays tax burden so if I'm dictator taxes would be slashed and social security probably gutted so people can afford to do it.
That is what Bush tried to pull with Social Security, which would have sent us all to the poor house had it passed judging by what's happening in the economy.
The largest downsides are for the doctors, because for them, suddenly, capitalism can be made illegal. The government can mandate that there can be no fee-for-service models (like at a car shop, if they repair something, you pay them on the spot). Even if it is legal, not taking the governmental provider means that you have to do fee for service: there are no other insurance companies to support. Your patient base could leave you. The government can decrease fee reimbursement to balance their own budget. The government can take away their paycheck based on their desire to buy more guns. Fewer people go through the hassle of becoming doctors, and in a few years, there are longer and logner wait times to see a doctor. Based on what I've seen in my mother's practice, there already is a dearth of doctor selection, because the waitlist to become a patient is years long.
In most UHC countries, the organization that represents doctors negotiates salaries, payment schedules, and basically every fee you can think of with the government on an annual basis. If the government tried to reduce doctors' salaries or "take away their paycheck" or other such nonsense without consultation, the doctors would get extremely pissed off and withdraw services, and the government would lose assloads of credibility. Kind of like what you're doing by not researching the topic at all and just coming in here and parroting 40-year-old right-wing talking points that have no factual basis. Why don't you go listen to your Ronnie Reagan records some more.
It's capitalism, dude. Sorry, but making doctors lives more miserable, be it through decreased pay, decreased prestige, greater annoyance, or what have you, WILL MAKE FEWER PEOPLE BECOME DOCTORS. That's not a right-wing talking point, that's common sense. Where my college friends in previous years might have gone to become doctors, instead, they've gone to become investment bankers, traders, and consultants. Even my friends who majored in CS have largely abandoned their chosen field and have gone on to more lucrative fields.
My example used hyperbole - ie "take away their paycheck". Sorry, I'll be more exact next time. Of course they would erode it slowly, so as not to cause too many waves. As long as it's only a little less than last year, no one is going to bother complaining, until they get used to it, and they can decrease it some more.
And what are you talking about, researching the topic? Do you work in healthcare? Do you have any contact with the US healthcare system, even as a patient? I am coming at this from the idea of the US making a UHC system, not looking at how things are in other, more socialist countries. I am looking at the US's track record with socialist programs, and the fact is, we're bad at making programs that don't suck/hemorrhage money.
It's unreasonable and a considerable leap in logic to suggest that moving to a universal healthcare system, which would simply replace the vast multitude of different insurance policies with a single, integrated, tax-funded insurance program, would lead to doctors being paid less. Doctors would, in all likelihood, continue to collect the fees and salaries and regular pay raises to which they have grown accustomed, because medical associations wield considerable political clout and bargaining power, and it's also a really bad idea to cut doctors' salaries. I think this is clearly evidenced by the fact that doctors have remained among the highest-paid professionals in Canada, the UK, and other developed countries, despite their "socialist" approach to public health.
Well, you raise good points. I don't use socialist as a dirty word, and I don't like how the system is run now either. I don't propose doing nothing, I just think that if there was more of a feedback loop between private insurance company quality and subscription, and there was work to prevent price fixing, then the market would work more like other free markets. It is not true that primary care providers are accustomed to huge amounts of pay. In the US, it is the specialists that are well paid and wield the political clout. In my experience, the primary care physicians are too busy to participate in the American Medical Association. I haven't looked at the statistics, though (anecdotal evidence).
I am not completely opposed to government involvement, even though I think the US government is full of bunglers. I think the number of them who got into it for the "right reasons" is pretty small, though. I don't know if it's the same way in Canada. As such, I would like them to be involved as little as possible. Some involvement is necessary to correct some of the shortcomings of the free market system as it applies to healthcare, though (it is not acceptable in my opinion to have no health care available to those who cannot afford it at all. I am a believer in free clinics, but there should be a fallback in place where that is not available.)
And when I type here, I am fully conscious of the fact that I have not necessarily thought through everything, and that it is truly impossible to have a perfect worldview. I'm looking to be educated as well. I'm just putting my views forth so you can poke holes in them and I can see if I was in error.
I am fairly convinced of the part about Washington being full of bunglers and thieves, though. The 08 presidential debates have not helped dispel this belief, as the candidates repeatedly insult the intelligence of the viewers by giving nice sounding non-answers to every question they're asked, at least on the Democratic side. Their answers about how they propose to implement Universal Health Care involve no mention as to how they will fit it into a budget that already outstrips their tax revenue, while at the same time, there is bipartisan approval in congress on tax cuts to spur the economy. Would you be confident in letting these people construct a national health care system? I hear nothing about UHC on the republican side, so I can only assume that they will try their damndest to gimp it when it comes to a vote. So, I doubt that a UHC is even realistic in the US, at least right now. With a Democratic-controlled congress and White House, it could be feasible, however.
Insurance companies in pretty much every other industry - life insurance, auto insurance, homeowners insurance - have shown every willingness to bully consumers. Hell, I recently had a break-in and got back 40% of what I claimed with really no opportunity for redress short of hiring a lawyer. Somehow I don't think that shoving the administrative burden onto the consumer is going to do anything except free up doctors for a few more rounds of golf.
But you as a consumer have no incentive to stay with a shitty insurance company like that. You can take your money elsewhere very easily. It very hard for doctors to drop the big insurance companies in their area if they are bullying them, because then the doctors lose a big chunk of their patient base. And if there are no patient visits, then they can't afford to pay their support staff. In many cases it is hard for one to switch health insurance, though, if your job provides it and you are the only one calling for it in your organization. I guess the only way it would work in the current system is with some cooperative effort by the doctors to drop a bullying insurance company, which would cause a cooperative effort by employees to get their employers to switch.
No, you cannot switch health insurance easily. It's very, very difficult to do so because your employer provides you with said insurance and would have to completely revamp their program.
Moreover, your purported solution doesn't solve the problem at all. Consider the incentives of an insurance company when they receive a large claim. If they can get away with paying less (that is to say, if it doesn't drive customers away from their company), they should do so. If they can delay the procedure until the patient dies, and so escape paying for it, they should do so. If they can try and avoid paying for the procedure by arguing that it's not covered (it's "experimental" or whatever else), they should do so. If they do these things on an institutional basis, this allows them to lower premiums and thus outcompete their competitors. Think Wal-mart. Crappy products at low cost tend to beat good products at high cost, particularly when it's difficult for the consumer to differentiate between high and low quality products.
TL;DR: No matter who insurance companies deal with, they're going to try and get out of paying claims.
OK, maybe company-provided health insurance is part of the problem? Maybe they should just pay you what they would have spent on your health insurance. Then it would be easy to switch.
OK, maybe company-provided health insurance is part of the problem? Maybe they should just pay you what they would have spent on your health insurance. Then it would be easy to switch.
Except that group insurance (employer-provided insurance) is almost invariably the only way for sick or at-risk people to get coverage at a reasonable price. That's the whole reason it exists - to spread risk.
Besides, if you want to find a way to get as many people uninsured as possible, ending group insurance is probably the best way to do that. Nobody wants that.
I just don't understand the reluctance to go with a national, government-funded system. It spreads risk more effectively than a private solution could and, the evidence suggests, would cost less for the average American. Do you think our politicians are more corrupt or less competent than those in other countries (Canada, France, the UK, etc.)? I don't.
I have heard from solo practitioners in Pennsylvania that they receive reimbursement of $31.90 per visit from Medicaid, on a ~$100 charge. The AMA isn't exactly protecting these doctor's interests. It is hard to maintain an office, a slew of fees including sky-high malpractice, and a staff of two to three plus doctor on $60 per hour spent seeing patients. Remember that the entire revenue of the office comes from the patient visits and must cover all expenses and salaries for everyone involved. Expenses for doctor-only practices with no support staff average roughly $7000 per month across the nation according to Ideal Medical Practices. This assumes that the doctor is doing all of the support work in addition to seeing patients... it is impossible to see patients for 8 hours a day if one must also do the billing and so forth and one wants to see the family at some point.
The piss-poor compensation from seeing Medicaid patients may be because of underfunding due to the Repubs trying to gut it, but I don't see why they wouldn't do the same thing once the UHC system was in place. The AMA either hasn't been lobbying to increase this funding, or the congress hasn't listened to them.
I think lobbyists are evil and unnecessary, but they were mentioned as a safeguard for doctors under a UHC system.
OK, maybe company-provided health insurance is part of the problem? Maybe they should just pay you what they would have spent on your health insurance. Then it would be easy to switch.
Except that group insurance (employer-provided insurance) is almost invariably the only way for sick or at-risk people to get coverage at a reasonable price. That's the whole reason it exists - to spread risk.
Besides, if you want to find a way to get as many people uninsured as possible, ending group insurance is probably the best way to do that. Nobody wants that.
I just don't understand the reluctance to go with a national, government-funded system. It spreads risk more effectively than a private solution could and, the evidence suggests, would cost less for the average American. Do you think our politicians are more corrupt or less competent than those in other countries (Canada, France, the UK, etc.)? I don't.
Good point about the group insurance allowing people to sign up for negotiated rates regardless of history or risk factors. I believe in my state it is illegal for health insurance companies to deny anyone coverage, but I don't know how the companies try to get around that. I also don't know if that is common.
Perhaps this could be mitigated with nondiscrimination policies? That might discourage people from signing up before they get sick, however, which would increase everyone's premiums.
I don't think the US politicians are competent, but I doubt it's different elsewhere. If I'm not mistaken, of the first world countries, we have far and away the largest population, and the difficulty of making a system tends to increase nonlinearly with size and especially with diversity of requirements. So I would say it's a much harder problem than designing the Canadian UHC system was.
Good point about the group insurance allowing people to sign up for negotiated rates regardless of history or risk factors. I believe in my state it is illegal for health insurance companies to deny anyone coverage, but I don't know how the companies try to get around that. I also don't know if that is common.
OK, instead of denying you coverage, I'll charge $8000 monthly. Oh, you can afford that? Now it's $10000. You get the idea.
Perhaps this could be mitigated with nondiscrimination policies? That might discourage people from signing up before they get sick, however, which would increase everyone's premiums.
This is the equivalent of a government-run healthcare system. You mandate that the companies can only charge X per person, and must pay out X, which eliminates competition, etc., etc.
I don't think the US politicians are competent, but I doubt it's different elsewhere. If I'm not mistaken, of the first world countries, we have far and away the largest population, and the difficulty of making a system tends to increase nonlinearly with size and especially with diversity of requirements. So I would say it's a much harder problem than designing the Canadian UHC system was.
France does a great job of getting this sort of thing done. Much better than the private US system does.
And look at Amtrak.
Hardly relevant. Of course Amtrak is losing money - public transportation isn't profitable at the current price of gasoline.
OK, maybe company-provided health insurance is part of the problem? Maybe they should just pay you what they would have spent on your health insurance. Then it would be easy to switch.
Except that group insurance (employer-provided insurance) is almost invariably the only way for sick or at-risk people to get coverage at a reasonable price. That's the whole reason it exists - to spread risk.
Besides, if you want to find a way to get as many people uninsured as possible, ending group insurance is probably the best way to do that. Nobody wants that.
The United States gives massive tax breaks to companies to purchase insurance for their employees. Individuals get no such break.
They should. If individuals could by their own health-care and weren't tethered to their job that would be a vast improvement. Your medical insurance bill should be just like paying your car insurance, electricity, or your cable.
I just don't understand the reluctance to go with a national, government-funded system. It spreads risk more effectively than a private solution could and, the evidence suggests, would cost less for the average American. Do you think our politicians are more corrupt or less competent than those in other countries (Canada, France, the UK, etc.)? I don't.
Because removing competition in the marketplace makes the services suck and government involvement is already responsible for crappy health-care. Rationing sucks, which is what happens in socialized systems. All of them. Lack of choice also sucks, which is also what happens under UHC.
If we could guarantee a UHC system that didn't diminish the quality of health-care for individuals that can afford it I would be ok with it, but since no country has proven that to be the case I will continue to reject the notion that it's acceptable.
There are other options to fixing the health-care system in the US than shoving more government and tax dollars at it. I'd like to see the politicians explore them.
So people would be forced by the government to give up money from their pay.
Which is different from a tax how?
Because you control the money, you can choose how it is spent within certain parameters, and you pass it along to your family if you don't use all of it.
It's a mandatory user-fee designated for you, not a tax which the government can raid when they decide they need to take out another contract with Blackwater.
Also, when you die the government doesn't get the difference in the account, your family does, with interest.
The United States gives massive tax breaks to companies to purchase insurance for their employees. Individuals get no such break.
They should. If individuals could by their own health-care and weren't tethered to their job that would be a vast improvement. Your medical insurance bill should be just like paying your car insurance, electricity, or your cable.
Not even close to comparable. Group insurance spreads risk. If you did this, people who got chronic illnesses would almost never be able to provide themselves with care. The whole idea of insurance is that the healthy subsidize the sick. If you have a problem with that, you have a problem with insurance, public or private.
Because removing competition in the marketplace makes the services suck and government involvement is already responsible for crappy health-care. Rationing sucks, which is what happens in socialized systems. All of them. Lack of choice also sucks, which is also what happens under UHC.
Rationing happens in our system. The only difference between their systems and ours is that in their system, rationing is done fairly and spread across society. In ours, the poor receive the brunt of the "rationing" that results from being unable to afford insurance. If you only provide care for a subset of your population, of course you can provide better care more quickly. The really amazing thing is how inefficient the US system is, considering how many people are excluded. We should be shocked and embarrassed that our private system, which excludes large numbers of our population, is even remotely comparable in quality and speed of care, and is far more expensive than government run systems.
If we could guarantee a UHC system that didn't diminish the quality of health-care for individuals that can afford it I would be ok with it, but since no country has proven that to be the case I will continue to reject the notion that it's acceptable.
Our system provides for inferior care, on average, than most UHC systems. On that basis, we should shift immediately.
There are other options to fixing the health-care system in the US than shoving more government and tax dollars at it. I'd like to see the politicians explore them.
Almost every system that has a better record than we do is a UHC system. Unless you're proposing some kind of revolutionary new system, which you're not, we should imitate those countries which are doing a better job than we are.
The United States gives massive tax breaks to companies to purchase insurance for their employees. Individuals get no such break.
They should. If individuals could by their own health-care and weren't tethered to their job that would be a vast improvement. Your medical insurance bill should be just like paying your car insurance, electricity, or your cable.
Not even close to comparable. Group insurance spreads risk. If you did this, people who got chronic illnesses would almost never be able to provide themselves with care. The whole idea of insurance is that the healthy subsidize the sick. If you have a problem with that, you have a problem with insurance, public or private.
I'm not sure what you're saying here. Just because you are buying insurance individually and not through your employer doesn't mean it isn't a "group". You're just grouped with other consumers who don't necessarily work with you but happen to like the same insurance company that you do.
Rationing happens in our system. The only difference between their systems and ours is that in their system, rationing is done fairly and spread across society. In ours, the poor receive the brunt of the "rationing" that results from being unable to afford insurance. If you only provide care for a subset of your population, of course you can provide better care more quickly. The really amazing thing is how inefficient the US system is, considering how many people are excluded. We should be shocked and embarrassed that our private system, which excludes large numbers of our population, is even remotely comparable in quality and speed of care, and is far more expensive than government run systems.
I don't like corporate care and I'm not defending the US system entirely. I'm simply advocating less government intervention in health-care instead of more.
If we could guarantee a UHC system that didn't diminish the quality of health-care for individuals that can afford it I would be ok with it, but since no country has proven that to be the case I will continue to reject the notion that it's acceptable.
Our system provides for inferior care, on average, than most UHC systems. On that basis, we should shift immediately.
There are other options to fixing the health-care system in the US than shoving more government and tax dollars at it. I'd like to see the politicians explore them.
Almost every system that has a better record than we do is a UHC system. Unless you're proposing some kind of revolutionary new system, which you're not, we should imitate those countries which are doing a better job than we are.
I don't consider MSA's the same as UHC. If you consider them UHC then fine, we agree.
As long as we retain market forces, choice, and don't let the government spend the money I'm fine with it.
I'm not sure what you're saying here. Just because you are buying insurance individually and not through your employer doesn't mean it isn't a "group". You're just grouped with other consumers who don't necessarily work with you but happen to like the same insurance company that you do.
The chief difference between group and individually bought insurance is that, in a group system, the insurance company doesn't get to set specific rates for different people. They set what's called a "group rate", which is offered to everyone in the group (all covered employees). If you buy insurance individually, the insurance company is free to look at your medical history and set a specific rate based on the risk they assess of you getting a chronic condition or whatever. Sick people cannot buy individual insurance. It's basically impossible, even in states where it's illegal to deny coverage.
TL;DR: If you're sick, or have a history of illness, or a family history of serious chronic illness, the only realistic way to get affordable coverage is via an employer-provided plan.
I don't like corporate care and I'm not defending the US system entirely. I'm simply advocating less government intervention in health-care instead of more.
The evidence suggests that more intervention works. If you can provide an example of a non-government system in a large nation that works better than that in the US, I'd be perfectly happy to check it out, but so far as I know, it doesn't exist.
I'm not sure what you're saying here. Just because you are buying insurance individually and not through your employer doesn't mean it isn't a "group". You're just grouped with other consumers who don't necessarily work with you but happen to like the same insurance company that you do.
The chief difference between group and individually bought insurance is that, in a group system, the insurance company doesn't get to set specific rates for different people. They set what's called a "group rate", which is offered to everyone in the group (all covered employees).
Yeah, exactly.
And I wish I could say this in a way without sounding like a bitch, but if you don't know the difference between a group plan and an individual plan, you're not qualified to talk about this subject. It's like talking about politics in the Middle East without knowing the difference between Palestine and Pakistan.
If you buy insurance individually, the insurance company is free to look at your medical history and set a specific rate based on the risk they assess of you getting a chronic condition or whatever. Sick people cannot buy individual insurance. It's basically impossible, even in states where it's illegal to deny coverage.
Yeah. If you have a condition, even if insurance companies are mandated to offer you insurance, they aren't mandated to cover your condition. This is a little like leasing a car and telling the salesperson, "I want it to drive to work and the grocery store," and the salesperson tells you, "You can't use it to drive to work or the grocery store. That would put too much wear and tear on the car. You can drive it anywhere but the grocery store and work."
That's what I ran into when I had sleep apnea. Most of the individual plans I looked at denied me entirely; a small handful wanted to charge me over $300 per month and exempt my sleep apnea - my primary reason for getting insurance at all - from coverage.
I don't like corporate care and I'm not defending the US system entirely. I'm simply advocating less government intervention in health-care instead of more.
Care to suggest a workable system that does not rely on either corporations or the government to spread risk, and also does not leave the sick and/or the poor to suffer?
Feral on
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
Posts
Haha yeah, the current situation needs some Thunderdoming.
I think his part about Medicare illustrates that Washington is a bit too clumsy and out of touch to make healthcare policy that really works. They're not exactly nimble, either, so fixing a system that they devise might take decades. I didn't see anything about UHC, except their worries that a government single payor would be worse.
I've said it before, I think the patients should deal with their insurance directly for reimbursement. They would rapidly migrate away from the ones that stay profitable despite inefficiency by bullying, and to the ones who have well-run businesses. There are, in fact, some of those. In our experience, Aetna has been straightforward, fair, and well managed. Our patients like Aetna as well. Everyone switching to more efficient insurance carriers will decrease that per-capita spending figure that makes us look so bad. Currently the feedback loop is broken.
I think the other part of the puzzle is standardizing the interface between doctors and the health insurance industry so that doctors don't need so many support staff (currently it's ~2-3 per doctor on average, including receptionist, nurses, billers) to keep up with getting paid for their work. This would allow them to spend more time with each patient while still remaining profitable. Currently many have to see a patient every 15 minutes or so to stay profitable, since they do have employees to support. Through a combination of a custom tech infrastructure and mostly dealing with the insurance companies that are fair, our practice can do half hour visits for the same price as most charge for 15-30 minute visits, as we only have a receptionist and a part-time biller to deal with the Blue Cross problem cases. If we stopped supporting Blue Cross, we wouldn't have any need for even a part-time biller, but almost half of our patients have Blue Cross, which is why we put up with their shit. Without a biller, we could further increase the amount of time spent with each patient. In our practice, the patient is with the doctor for 100% of the visit.
Sorry for being so long-winded.
Insurance companies in pretty much every other industry - life insurance, auto insurance, homeowners insurance - have shown every willingness to bully consumers. Hell, I recently had a break-in and got back 40% of what I claimed with really no opportunity for redress short of hiring a lawyer. Somehow I don't think that shoving the administrative burden onto the consumer is going to do anything except free up doctors for a few more rounds of golf.
Physicians organizations like the AMA and insurance companies currently have every incentive in the world to standardize patient records and transactions - it's their own overhead that's being burned with all this inefficiency. So what's it going to take? Gummint mandates and regulation?
But you as a consumer have no incentive to stay with a shitty insurance company like that. You can take your money elsewhere very easily. It very hard for doctors to drop the big insurance companies in their area if they are bullying them, because then the doctors lose a big chunk of their patient base. And if there are no patient visits, then they can't afford to pay their support staff. In many cases it is hard for one to switch health insurance, though, if your job provides it and you are the only one calling for it in your organization. I guess the only way it would work in the current system is with some cooperative effort by the doctors to drop a bullying insurance company, which would cause a cooperative effort by employees to get their employers to switch.
Standardization is a huge problem, because health care is so different from patient to patient. Efficiency isn't something that health care is very well suited to by nature, I think. This is one of the reasons I think that general preventative health care should be like going to a mechanic for a tuneup, where the insurance companies aren't involved at all, and the doctor shows you their fees, and if you don't think the doctor is worth it, you go to a different doctor who will charge something else, and there would once again be price competition among doctors.
I think insurance only has a place in mitigating unlikely but crippling costs like cancer, an AIDS treatment regimen, emergency surgery, and so forth. Insurance should cover those fully.
If insurance only got involved in the high-end cases, there would be no middleman for the vast majority of healthcare cases, and the cost per patient would drop by a good bit.
Just as some employers are now giving out what are essentially prepaid debit cards for preventative health care, the government could give the poor the healthcare equivalent of food stamps, which would be as good as cash for healthcare, and this would cover the cost of preventative healthcare, vaccines, and so forth. For the high-end costs, they could provide insurance that would pay for emergency medical care. I think it would be ideal if the insurance system, which is inherently high overhead, was used for as small a number of cases as possible. For every transaction it gets involved in, it adds overhead.
But people who go with a PPO pay a huge amount more out of pocket and only slightly less in premiums. By which I mean a procedure that an HMO would cover 100% of a PPO will cover 80%. And that's for routine stuff. The specialist procedures they usually only cover 50%.
UHC just doesn't have this effect. I'm sorry. You're wrong. There is simply no evidence to support this point of view. UHC countries have either similar or better doctor to patient ratios. All the evidence suggests that UHC does not have this effect.
This is nonsense. What "socialistic programs" are you talking about? Our federal welfare programs are run on the cheap and have been continually undermined by conservative politicians; is it any wonder that they don't always fix the problem they're intended to solve? What about Social Security? It's been in place for around 70 years and only recently, due to the baby boom, is in any danger of "sucking/hemorrhaging money". That's a great track record. Medicare isn't doing particularly poorly, either.
Besides, are you really going to argue that France, the UK, and Canada can do something and we can't?
This is hilarious. The free market is in a rut and the government needs to intervene? You have such faith in the free market, and yet you seem to be admitting that it's what got us into this problem in the first place.
No, you cannot switch health insurance easily. It's very, very difficult to do so because your employer provides you with said insurance and would have to completely revamp their program.
Moreover, your purported solution doesn't solve the problem at all. Consider the incentives of an insurance company when they receive a large claim. If they can get away with paying less (that is to say, if it doesn't drive customers away from their company), they should do so. If they can delay the procedure until the patient dies, and so escape paying for it, they should do so. If they can try and avoid paying for the procedure by arguing that it's not covered (it's "experimental" or whatever else), they should do so. If they do these things on an institutional basis, this allows them to lower premiums and thus outcompete their competitors. Think Wal-mart. Crappy products at low cost tend to beat good products at high cost, particularly when it's difficult for the consumer to differentiate between high and low quality products.
TL;DR: No matter who insurance companies deal with, they're going to try and get out of paying claims.
You can answer this question too. I'm particularly concerned about minors.
I think medi-care at the state level is a valid solution to those who simply can't afford health-care, but what I'd really like to see are Medial Savings Accounts where money is deferred into a personal account tax free that can be used for health-care for your entire family. The money could be used to pay insurance premiums directly, co-pays, out of pocket payments, prescription drugs or maybe even OTC purchases and supplements (within reason).
When individuals die the money is passed on to their family.
The benefit of an MSA over UHC is there are still market incentives to get the lowest cost possible and there would never be triage or rationing. What I also don't like about UHC or even our current system is that we are subsidizing people who live unhealthy lifestyles or hypochondriacs who demand they get a cat-scan when they have a headache. MSA's incentivize frugal spending and reward healthy living but also allow you to drop big sums when necessary since it's always in the account. If MSA's were in place we'd see lower premiums and higher deductibles but since the money is already set aside almost everyone would have resources to pay for it.
If the account runs dry then medicare picks up the rest, but if you have anything in your MSA, you always spend from that first. This would alleviate the burdens on medicare, keep medicine relatively free-market and at the same time basically guarantee the entire country is covered.
If people can't afford insurance, why would we suppose they would be able to put aside a significant amount of money every month into this savings account? Moreover, what's the incentive to do so? If Medicare covers everything above and beyond your MSA, why should you put any money into an MSA?
Because it would be mandatory just like social security. Maybe even with an employer match. Only it's your money and it earns interest. The government regulates how you spend it, but they don't have ultimate control over how it's spent.
Also the money is tax free if it goes into an MSA just like a 401k is, so there will be more of it going to your health-care and less going to the fed.
The amount that people would realistically have to set aside would be too great with todays tax burden so if I'm dictator taxes would be slashed and social security probably gutted so people can afford to do it.
So it's not really a savings account at all. It's a tax that sets up a semi-private account. And it's not really a private account if you can't spend it, shift it, or liquidate it. Besides, under the plan you described before, the government would have ultimate control over how it's spent, in the sense that you couldn't have access to Medicare without exhausting the account.
It wouldn't make much sense to tax a tax. That'd be like taxing the Social Security tax.
You've basically just described a UHC system funded by a regressive tax. The chief difference between my proposal (single payer, funded by the income tax) and yours is that mine doesn't shift the tax burden from wealthy to poor.
Yes, I never said that the free market is flawless... it definitely isn't. For example, there are corner cases where it can't right itself, and in that case, I think that the government should intervene. I have little faith in the ability of our governors, and I think this would be a simpler solution than a UHC system.
On an unrelated note, I take back what I said earlier about increasing overall efficiency by making it so that insurers aren't involved in standard preventative care, because the companies use that to subsidize the people with chronic conditions. If they didn't, healthy people would jump ship, premiums would rise, more healthy people would jump ship, until only the sickest were left and they would carry the full burden of their illness, getting rid of the point of insurance. Sooo that doesn't necessarily work in theory.
That is what Bush tried to pull with Social Security, which would have sent us all to the poor house had it passed judging by what's happening in the economy.
Which is different from a tax how?
Well, you raise good points. I don't use socialist as a dirty word, and I don't like how the system is run now either. I don't propose doing nothing, I just think that if there was more of a feedback loop between private insurance company quality and subscription, and there was work to prevent price fixing, then the market would work more like other free markets. It is not true that primary care providers are accustomed to huge amounts of pay. In the US, it is the specialists that are well paid and wield the political clout. In my experience, the primary care physicians are too busy to participate in the American Medical Association. I haven't looked at the statistics, though (anecdotal evidence).
I am not completely opposed to government involvement, even though I think the US government is full of bunglers. I think the number of them who got into it for the "right reasons" is pretty small, though. I don't know if it's the same way in Canada. As such, I would like them to be involved as little as possible. Some involvement is necessary to correct some of the shortcomings of the free market system as it applies to healthcare, though (it is not acceptable in my opinion to have no health care available to those who cannot afford it at all. I am a believer in free clinics, but there should be a fallback in place where that is not available.)
And when I type here, I am fully conscious of the fact that I have not necessarily thought through everything, and that it is truly impossible to have a perfect worldview. I'm looking to be educated as well. I'm just putting my views forth so you can poke holes in them and I can see if I was in error.
I am fairly convinced of the part about Washington being full of bunglers and thieves, though. The 08 presidential debates have not helped dispel this belief, as the candidates repeatedly insult the intelligence of the viewers by giving nice sounding non-answers to every question they're asked, at least on the Democratic side. Their answers about how they propose to implement Universal Health Care involve no mention as to how they will fit it into a budget that already outstrips their tax revenue, while at the same time, there is bipartisan approval in congress on tax cuts to spur the economy. Would you be confident in letting these people construct a national health care system? I hear nothing about UHC on the republican side, so I can only assume that they will try their damndest to gimp it when it comes to a vote. So, I doubt that a UHC is even realistic in the US, at least right now. With a Democratic-controlled congress and White House, it could be feasible, however.
OK, maybe company-provided health insurance is part of the problem? Maybe they should just pay you what they would have spent on your health insurance. Then it would be easy to switch.
Except that group insurance (employer-provided insurance) is almost invariably the only way for sick or at-risk people to get coverage at a reasonable price. That's the whole reason it exists - to spread risk.
Besides, if you want to find a way to get as many people uninsured as possible, ending group insurance is probably the best way to do that. Nobody wants that.
I just don't understand the reluctance to go with a national, government-funded system. It spreads risk more effectively than a private solution could and, the evidence suggests, would cost less for the average American. Do you think our politicians are more corrupt or less competent than those in other countries (Canada, France, the UK, etc.)? I don't.
The piss-poor compensation from seeing Medicaid patients may be because of underfunding due to the Repubs trying to gut it, but I don't see why they wouldn't do the same thing once the UHC system was in place. The AMA either hasn't been lobbying to increase this funding, or the congress hasn't listened to them.
I think lobbyists are evil and unnecessary, but they were mentioned as a safeguard for doctors under a UHC system.
Good point about the group insurance allowing people to sign up for negotiated rates regardless of history or risk factors. I believe in my state it is illegal for health insurance companies to deny anyone coverage, but I don't know how the companies try to get around that. I also don't know if that is common.
Perhaps this could be mitigated with nondiscrimination policies? That might discourage people from signing up before they get sick, however, which would increase everyone's premiums.
I don't think the US politicians are competent, but I doubt it's different elsewhere. If I'm not mistaken, of the first world countries, we have far and away the largest population, and the difficulty of making a system tends to increase nonlinearly with size and especially with diversity of requirements. So I would say it's a much harder problem than designing the Canadian UHC system was.
And look at Amtrak.
OK, instead of denying you coverage, I'll charge $8000 monthly. Oh, you can afford that? Now it's $10000. You get the idea.
This is the equivalent of a government-run healthcare system. You mandate that the companies can only charge X per person, and must pay out X, which eliminates competition, etc., etc.
France does a great job of getting this sort of thing done. Much better than the private US system does.
Hardly relevant. Of course Amtrak is losing money - public transportation isn't profitable at the current price of gasoline.
The United States gives massive tax breaks to companies to purchase insurance for their employees. Individuals get no such break.
They should. If individuals could by their own health-care and weren't tethered to their job that would be a vast improvement. Your medical insurance bill should be just like paying your car insurance, electricity, or your cable.
Because removing competition in the marketplace makes the services suck and government involvement is already responsible for crappy health-care. Rationing sucks, which is what happens in socialized systems. All of them. Lack of choice also sucks, which is also what happens under UHC.
If we could guarantee a UHC system that didn't diminish the quality of health-care for individuals that can afford it I would be ok with it, but since no country has proven that to be the case I will continue to reject the notion that it's acceptable.
There are other options to fixing the health-care system in the US than shoving more government and tax dollars at it. I'd like to see the politicians explore them.
Because you control the money, you can choose how it is spent within certain parameters, and you pass it along to your family if you don't use all of it.
It's a mandatory user-fee designated for you, not a tax which the government can raid when they decide they need to take out another contract with Blackwater.
Also, when you die the government doesn't get the difference in the account, your family does, with interest.
Not even close to comparable. Group insurance spreads risk. If you did this, people who got chronic illnesses would almost never be able to provide themselves with care. The whole idea of insurance is that the healthy subsidize the sick. If you have a problem with that, you have a problem with insurance, public or private.
Rationing happens in our system. The only difference between their systems and ours is that in their system, rationing is done fairly and spread across society. In ours, the poor receive the brunt of the "rationing" that results from being unable to afford insurance. If you only provide care for a subset of your population, of course you can provide better care more quickly. The really amazing thing is how inefficient the US system is, considering how many people are excluded. We should be shocked and embarrassed that our private system, which excludes large numbers of our population, is even remotely comparable in quality and speed of care, and is far more expensive than government run systems.
Our system provides for inferior care, on average, than most UHC systems. On that basis, we should shift immediately.
Almost every system that has a better record than we do is a UHC system. Unless you're proposing some kind of revolutionary new system, which you're not, we should imitate those countries which are doing a better job than we are.
I'm not sure what you're saying here. Just because you are buying insurance individually and not through your employer doesn't mean it isn't a "group". You're just grouped with other consumers who don't necessarily work with you but happen to like the same insurance company that you do.
I don't like corporate care and I'm not defending the US system entirely. I'm simply advocating less government intervention in health-care instead of more.
I don't consider MSA's the same as UHC. If you consider them UHC then fine, we agree.
As long as we retain market forces, choice, and don't let the government spend the money I'm fine with it.
The chief difference between group and individually bought insurance is that, in a group system, the insurance company doesn't get to set specific rates for different people. They set what's called a "group rate", which is offered to everyone in the group (all covered employees). If you buy insurance individually, the insurance company is free to look at your medical history and set a specific rate based on the risk they assess of you getting a chronic condition or whatever. Sick people cannot buy individual insurance. It's basically impossible, even in states where it's illegal to deny coverage.
TL;DR: If you're sick, or have a history of illness, or a family history of serious chronic illness, the only realistic way to get affordable coverage is via an employer-provided plan.
The evidence suggests that more intervention works. If you can provide an example of a non-government system in a large nation that works better than that in the US, I'd be perfectly happy to check it out, but so far as I know, it doesn't exist.
Yeah, exactly.
And I wish I could say this in a way without sounding like a bitch, but if you don't know the difference between a group plan and an individual plan, you're not qualified to talk about this subject. It's like talking about politics in the Middle East without knowing the difference between Palestine and Pakistan.
Yeah. If you have a condition, even if insurance companies are mandated to offer you insurance, they aren't mandated to cover your condition. This is a little like leasing a car and telling the salesperson, "I want it to drive to work and the grocery store," and the salesperson tells you, "You can't use it to drive to work or the grocery store. That would put too much wear and tear on the car. You can drive it anywhere but the grocery store and work."
That's what I ran into when I had sleep apnea. Most of the individual plans I looked at denied me entirely; a small handful wanted to charge me over $300 per month and exempt my sleep apnea - my primary reason for getting insurance at all - from coverage.
Care to suggest a workable system that does not rely on either corporations or the government to spread risk, and also does not leave the sick and/or the poor to suffer?
the "no true scotch man" fallacy.