Health Care Reform - Universal/Public Option

[JPhillips]

Originally Posted by lynchjm24

You can find 3 trillion dollars to cut over 10 years when you have >10% unemployment?

It's not even feasible to do that.

If Obama's plan is as likely as finding a unicorn in my backyard, your plan is as likely me following a rainbow to a pot of gold.

This stuff is great in theory, the dollars to pay for it don't exist.

Where do you come up with 3 trillion over ten years? The CBO just scored the House plan at 1 trillion over tens years, which if it's made a priority, is easily doable. Hell eliminating farm subsides would cover twenty percent of the cost.

And +1 to Swaggs on the public option/single payer question.

[lynchjm24]

Originally Posted by RainMaker

If I could go back in time, I'd say stop the Iraq War which will cost us $3 trillion dollars over these 10 years.

With some massive government reform, we could get $3 trillion. It won't happen with any of the parties we have in office, but in theory with the right people it could be done.

The right people to do that can't get elected. That 3 trillion feeds a lot of voters.

You've got to find a way to pay for it in the here and now, not with monopoly money printed in Al Gore's first term.

[lynchjm24]

Originally Posted by RainMaker

I just don't see how you can say that having more people have more access to doctors in this country wouldn't have any impact on life expectancy or infant mortality rates. We suck at preventable deaths as it is and rank last amongst top industrialized nations.

http://www.reuters.com/article/lates.../idUSN07651650

Do you really feel that doctors have that little impact on health? That giving people more access to them would have zero impact on their life expectancy? Do you practice what you preach and not see your doctor regularly because they clearly won't help you live longer? I highly doubt that.

I agree with you on a lot of the things you mentioned above. Our education of young kids is flawed horribly. We don't teach them how to be healthy or how to be responsible about their sexual activities. Those are some good areas to start and will pay off well down the road with a healthier and more productive population.

The problem is that we're going to pay for those people one way or the other. They're going to end up in an ER one day for something they could have gotten at their family doctor for 1/100th the cost.

Different countries count infant mortality differently:

Pajamas Media » The Doctor Is In: Infant Mortality Comparisons a Statistical Miscarriage

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

In Belgium and France — in fact, in most European Union countries — any baby born before 26 weeks gestation is not considered alive and therefore does not “count” against reported infant mortality rates.

Note about her which is funny, nobody is leaving their practice over $ right...:

Dr. Linda Halderman was a Breast Cancer Surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice's closure. She now serves as a policy advisor in the California State Senate.

That is some of the issue. You are also ignoring how treatments like artificial insemination lead to multiple premature births. Are the people having zygote transplants not seeing enough doctors?

I disagree that people don't have access to doctors now. There are dozens of public programs and services available especially to the poor. If you are a poor pregnant woman, prenatal care is available to you.

The infant mortality rate is tied to drug problems. Do you really think that pregnant women addicted to crack and heroin are missing out on prenatal care because they don't have health insurance?

The problem for the ignorant uneducated people who don't use these services isn't access. The problem is that they are ignorant and uneducated.

[lynchjm24]

Originally Posted by JPhillips

Where do you come up with 3 trillion over ten years? The CBO just scored the House plan at 1 trillion over tens years, which if it's made a priority, is easily doable. Hell eliminating farm subsides would cover twenty percent of the cost.

And +1 to Swaggs on the public option/single payer question.

There are certainly people in this thread who are advocating a single payer.

If the US spends 2.4 trillion per year right now and healthcare trend is 8-10%, how exactly are 48 million uninsured going to be covered for a decade for 1 trillion?

[SteveMax58]

Originally Posted by lynchjm24

There are certainly people in this thread who are advocating a single payer.

If the US spends 2.4 trillion per year right now and healthcare trend is 8-10%, how exactly are 48 million uninsured going to be covered for a decade for 1 trillion?

Funny money FTW!!!

I have enjoyed the debate over the past few pages and while I am not informed enough to debate the intracacies of U-HC, I will say that my biggest concern is "How are we going to pay for it?" I know that sounds redundant and simple...and it probably deserves its own thread...but I think it's a fundamental question we tend to ask, but dont tend to care what the answer is...or we accept vague and imprecise answers.

Let's assume it is $1Tril over 10 years for arguments sake (IDK...but doubt seriously that anybody could really know...all things considered). Are we going to add this to the long list of other "necessary" debt spending? Do we think the goodwill from other countries during this worldwide recession will continue? I'm speaking to how they turn their head right now as we keep printing and devaluing their investment in the dollar so that we (i.e. US consumers) can continue buying everything on borrowed money. At what point do you suppose they will stop turning their head to this? And should we not be prepared for it? Or should we solve the "issue of the day" with no regard for the future as we have always done? Do we expect a major resurgence of US technology developments that are so vital to the world that this pays our way through our debt? Is that technology our medical system?

[JPhillips]

Originally Posted by SteveMax58

Funny money FTW!!!

I have enjoyed the debate over the past few pages and while I am not informed enough to debate the intracacies of U-HC, I will say that my biggest concern is "How are we going to pay for it?" I know that sounds redundant and simple...and it probably deserves its own thread...but I think it's a fundamental question we tend to ask, but dont tend to care what the answer is...or we accept vague and imprecise answers.

Let's assume it is $1Tril over 10 years for arguments sake (IDK...but doubt seriously that anybody could really know...all things considered). Are we going to add this to the long list of other "necessary" debt spending? Do we think the goodwill from other countries during this worldwide recession will continue? I'm speaking to how they turn their head right now as we keep printing and devaluing their investment in the dollar so that we (i.e. US consumers) can continue buying everything on borrowed money. At what point do you suppose they will stop turning their head to this? And should we not be prepared for it? Or should we solve the "issue of the day" with no regard for the future as we have always done? Do we expect a major resurgence of US technology developments that are so vital to the world that this pays our way through our debt? Is that technology our medical system?

In the House bill there are taxes that will cover the cost over the next decade. You may not like the idea of tax increases, but the one bill that's been written so far has a revenue mechanism so as to not add to the deficit.

[molson]

Originally Posted by JPhillips

In the House bill there are taxes that will cover the cost over the next decade. You may not like the idea of tax increases, but the one bill that's been written so far has a revenue mechanism so as to not add to the deficit.

That's true, but the fear people have expressed is that 1 trillion will only get things rolling to the point where we HAVE to spend at least triple that. That's what happened in Massachusetts. There was an estimated cost, a tax for that, and then when the actual cost was double the estimated cost, another tax for that.

And that's a pretty small state. The people advocating the bill are going to be WAY LOW on what this will cost, that's how they get support for it. And since no future congress is ever going to take it away, we'll just be locked in forever, its basically a blank check.

I'm all for reform, and think universal health care is a goal worth working towards. Let's figure out how to more affordably cover who we're trying to cover now first.

[flere-imsaho]

Originally Posted by lynchjm24

There is no collusion, there is competition. The reason why your rates are the same between companies is because the vast majority of the premium is spent on your groups claims. Those don't drastically change because you changed carriers.

There can be collusion without the relevant parties actively meeting to set prices. For an example, look at how airlines did pricing in, say, the 1990s (after deregulation, but before the airline industry took a nosedive). The industry as a whole (the major players, at least) eschewed competition on price on most routes to guarantee their own profits. One could argue that the group of biggest health insurance companies do the same thing.

Originally Posted by gstelmack

And a lot of that amount goes toward dealing with all the paperwork at your medical provider associated with attempting to recover those claims. There is gross inefficiency in the system, not to mention fraud.

Absolutely. Anyone who's spent any time wading through claim paperwork knows how disorganized, difficult to understand, and often just plain wrong it is. Frankly, it's harder to understand than tax paperwork. And the industry has made no moves to streamline it, unless it's been at the government's urging. If one wanted to be cynical, one could propose that this is because the current morass of paperwork allows them to continue to obfuscate their claims processes.

[RainMaker]

Originally Posted by lynchjm24

Different countries count infant mortality differently:

Pajamas Media » The Doctor Is In: Infant Mortality Comparisons a Statistical Miscarriage

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

In Belgium and France — in fact, in most European Union countries — any baby born before 26 weeks gestation is not considered alive and therefore does not “count” against reported infant mortality rates.

Note about her which is funny, nobody is leaving their practice over $ right...:

Dr. Linda Halderman was a Breast Cancer Surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice's closure. She now serves as a policy advisor in the California State Senate.

That is some of the issue. You are also ignoring how treatments like artificial insemination lead to multiple premature births. Are the people having zygote transplants not seeing enough doctors?

I disagree that people don't have access to doctors now. There are dozens of public programs and services available especially to the poor. If you are a poor pregnant woman, prenatal care is available to you.

The infant mortality rate is tied to drug problems. Do you really think that pregnant women addicted to crack and heroin are missing out on prenatal care because they don't have health insurance?

The problem for the ignorant uneducated people who don't use these services isn't access. The problem is that they are ignorant and uneducated.

Not that I don't believe a failed doctor writing a bitter post on a heavily conservative blog, but where is she getting her data from? One interesting statement was that when applying our statistics to Canada's number, it raised their rate from 6.1 to 6.4. That 6.1 to 6.4 statistic is from 1993 (when ours was well over 7). Using 16 year old statistics is just not as convincing when we're discussing the advances in medicine.

If you are worried about discrepencies in the statistics between countries, UNICEF creates one that adjusts the data so they match. The U.S. gets a little closer but still falls behind other countries that have universal health care. It's also worth noting that we have a higher abortion rate in the U.S. than many of those countries which means less unwanted children and potentially less children with birth defects.

It is unfortunate that she was not good enough to make it as a doctor, but using her as some martyr for the health industry is kind of silly. Doctors have one of the highest average salaries in the country (surgeons even higher) and one of the lowest unemployment rates.

To tie infant mortality deaths to drugs goes against what most medical professionals say. The leading cause is premature births, and those are caused moreso by age (which is the biggest), genetics, health issues (diabetes, etc), and number of children being carried to term. Drugs I'm sure play a role, but it's not anywhere near the leading cause of premature babies in this country. The fact that drug use and smoking have been in decline while premature births have been going up is a sign that your theory is way off.

[RainMaker]

Originally Posted by lynchjm24

The right people to do that can't get elected. That 3 trillion feeds a lot of voters.

You've got to find a way to pay for it in the here and now, not with monopoly money printed in Al Gore's first term.

Like I said, avoiding a certain war a few years back would have saved us the $3 trillion to get this thing rolling for a decade or two.

One thing you aren't factoring in is that a universal health care system would also increase salaries as businesses will not have to foot the bill for insurance policies. Individuals would have more disposable income that would be able to go into the economy and help raise tax revenues. You throw a few hundred bucks a month back into the pockets of Americans and it would do wonders for the economy and our overall tax revenues.

[JPhillips]

Originally Posted by molson

That's true, but the fear people have expressed is that 1 trillion will only get things rolling to the point where we HAVE to spend at least triple that. That's what happened in Massachusetts. There was an estimated cost, a tax for that, and then when the actual cost was double the estimated cost, another tax for that.

And that's a pretty small state. The people advocating the bill are going to be WAY LOW on what this will cost, that's how they get support for it. And since no future congress is ever going to take it away, we'll just be locked in forever, its basically a blank check.

I'm all for reform, and think universal health care is a goal worth working towards. Let's figure out how to more affordably cover who we're trying to cover now first.

This is the CBO score, not congressional Democrats. Regardless, I think there's a legitimate concern that costs could escalate and that discussion should be part of the debate. However, I don't think it's legitimate to throw out a 3 trillion number just so the plan looks extra scary when there's no analysis that can provide a foundation for that number.

[sterlingice]

Originally Posted by RainMaker

One thing you aren't factoring in is that a universal health care system would also increase salaries as businesses will not have to foot the bill for insurance policies. Individuals would have more disposable income that would be able to go into the economy and help raise tax revenues. You throw a few hundred bucks a month back into the pockets of Americans and it would do wonders for the economy and our overall tax revenues.

I'm a pretty optimistic guy but even I know that's not what's going to happen. Unless there's business reform, and we're not talking about that, then salaries stay in the crapper while the profits get pocketed.

I'm not saying universal coverage isn't a goal worth going for. I'm just saying that's probably not a valid justification.

SI

[JPhillips]

Given their past opposition to health care reform, the AMA surprised me:

The American Medical Association just sent a letter to House Ways and Means Chairman Charles Rangel, endorsing the health reform proposal put forward by three House committees. [...]

[Galaxy]

Originally Posted by RainMaker

One thing you aren't factoring in is that a universal health care system would also increase salaries as businesses will not have to foot the bill for insurance policies. Individuals would have more disposable income that would be able to go into the economy and help raise tax revenues. You throw a few hundred bucks a month back into the pockets of Americans and it would do wonders for the economy and our overall tax revenues.

The money to fund a system has to come from some place. Salaries won't increase. Businesses will either be taxed or individuals would be taxed.

The problem with our system is Medicare underpays. A lot of doctors/surgeons either make a very, very small profit, break even, or lose money on Medicare/Medicaid patients. Where do they have to make up that money? Charging insurance patients more. They can't turn away anyone, even those who can't/won't pay.

The problem is that Medicare/Medicaid is going to get very, very costly in 10-20 years when you have such a huge baby boomer population on it. Throw in a smaller population, with lower incomes (and tax revenue), to fund that, something has got to give.

I hate the whole stats thing. It's useless unless you look beyond the numbers. If not, it's not worth arguing about.

Personally, I don't think health care costs will change much as long as demand top doctors, hospitals, drugs, and technology regardless of who pays for it. The socialized systems are starting to feel the strains of funding it.

[RainMaker]

I don't see why salaries wouldn't go up. Benefits are an extension of your salary and employers would demand more money. Perhaps not in this economy, but in a normal economy with normal unemployment rates, salaries would have to go up.

[SteveMax58]

Originally Posted by Galaxy

The problem with our system is Medicare underpays. A lot of doctors/surgeons either make a very, very small profit, break even, or lose money on Medicare/Medicaid patients. Where do they have to make up that money? Charging insurance patients more. They can't turn away anyone, even those who can't/won't pay.

This is exactly the issue with comparing Medicaid-type programs to a UHC system. Today...many doctors do not accept Medicaid due to the lowball negotiated costs. So as Americans see it as beneficial to use the U-HC plan vs. their employer's sponsored plan...it stands to reason that doctors will:
(a) begin cutting costs...i.e. staff(adding to unemployment), technical investments(reducing overall business revenue & taxes), etc.
(b) only accept private insurance patients (i.e. "the rich") due to getting better rates (unless forced to accept U-HC patients, so see item a or c)
(c) go out of business trying to maintain staff & operational costs thus leading to more consolidation of medical corporations (who might end up too big to fail...see the correlation of government here?)
(d) some combination of the above

In any one (or more) of those impacts...it doesn't provide a net benefit to people who have private insurance...and in fact, could negatively impact them due to the unintended consequences. I'm sure my speculation is just silliness...but this is how the banking industry, airlines, auto-makers, etc. ALL end up when government begins to believe it needs to stave off the evil profit-seekers that actually create wealth. I'm not advocating for anarchy, no laws, etc...just pointing out that every bad government program starts out for the same good reasons...to help the little guy...and at some point, it just ends up costing more money to everybody and still screwing little guys in the end....just in different ways than they get screwed today.

[lynchjm24]

Originally Posted by JPhillips

In the House bill there are taxes that will cover the cost over the next decade. You may not like the idea of tax increases, but the one bill that's been written so far has a revenue mechanism so as to not add to the deficit.

The taxes don't cover the actual cost. There are all sorts of savings assumptions that will not come to fruition on top of they underestimate medical inflation, which runs almost in the double digits regardless of the economy.

[lynchjm24]

Originally Posted by RainMaker

Like I said, avoiding a certain war a few years back would have saved us the $3 trillion to get this thing rolling for a decade or two.

One thing you aren't factoring in is that a universal health care system would also increase salaries as businesses will not have to foot the bill for insurance policies. Individuals would have more disposable income that would be able to go into the economy and help raise tax revenues. You throw a few hundred bucks a month back into the pockets of Americans and it would do wonders for the economy and our overall tax revenues.

Sure they would. You think that they are going to move the entire burden from industry to individuals? There has never been a proposal that even hinted at that.

Look at the backlash against Walmart because they are supporting businesses funding the majority. Almost every business leader across the board is against every option in Congress because they all increase taxes and none of them create any savings.

I wish I had had forum access today at work, there were six good articles in the mainstream press today that I would have liked to link to. Sure I could have emailed the links home, but I'm a lazy American.

[lynchjm24]

Originally Posted by RainMaker

Not that I don't believe a failed doctor writing a bitter post on a heavily conservative blog, but where is she getting her data from? One interesting statement was that when applying our statistics to Canada's number, it raised their rate from 6.1 to 6.4. That 6.1 to 6.4 statistic is from 1993 (when ours was well over 7). Using 16 year old statistics is just not as convincing when we're discussing the advances in medicine.

If you are worried about discrepencies in the statistics between countries, UNICEF creates one that adjusts the data so they match. The U.S. gets a little closer but still falls behind other countries that have universal health care. It's also worth noting that we have a higher abortion rate in the U.S. than many of those countries which means less unwanted children and potentially less children with birth defects.

It is unfortunate that she was not good enough to make it as a doctor, but using her as some martyr for the health industry is kind of silly. Doctors have one of the highest average salaries in the country (surgeons even higher) and one of the lowest unemployment rates.

To tie infant mortality deaths to drugs goes against what most medical professionals say. The leading cause is premature births, and those are caused moreso by age (which is the biggest), genetics, health issues (diabetes, etc), and number of children being carried to term. Drugs I'm sure play a role, but it's not anywhere near the leading cause of premature babies in this country. The fact that drug use and smoking have been in decline while premature births have been going up is a sign that your theory is way off.

I'm sure she has her biases. She is far from the only person telling the story that low reimbursements have driven her out of practice. It's a common story from many places in the country. She's not a martyr, just one example of many.

You continue to ignore the huge amount of advanced reproductive technologies that I can only imagine are more widespread in the US then anywhere else. They cause huge amounts of premature multiple births to women who many times would not be able to conceive naturally.

[lynchjm24]

Originally Posted by JPhillips

This is the CBO score, not congressional Democrats. Regardless, I think there's a legitimate concern that costs could escalate and that discussion should be part of the debate. However, I don't think it's legitimate to throw out a 3 trillion number just so the plan looks extra scary when there's no analysis that can provide a foundation for that number.

I've seen the number estimated at 3 Trillion published somewhere, don't remember off the top of my head whose estimate it is.

1 Trillion is absurd though.

There are say 50 million uninsured. If they cost $5,000 each to insure for year one that is 250 billion dollars. If they somehow miraculously hold down medical trend to 8% that's:
250B
270B
291B
315B
340B
367B
397B
428B
463B
499B

That's 3.7 Trillion without any 'savings' and it assumes low trend and an uninsured population that doesn't grow higher then 50 million.

1.2 Trillion is a pipedream.

Anyone who wants to leave this to Congress is insane. Today I saw how a few months before he left Ted Stevens was able to pass a PERMANENT 35% increase in medicare reimbursements for Alaska.

Chris Dodd's comments are hilarious, I'll try to dig those up. I also have to find the quotes that compared health insurers profits to oil companies. Yeah, those are similar numbers.

[lynchjm24]

Originally Posted by SteveMax58

This is exactly the issue with comparing Medicaid-type programs to a UHC system. Today...many doctors do not accept Medicaid due to the lowball negotiated costs. So as Americans see it as beneficial to use the U-HC plan vs. their employer's sponsored plan...it stands to reason that doctors will:
(a) begin cutting costs...i.e. staff(adding to unemployment), technical investments(reducing overall business revenue & taxes), etc.
(b) only accept private insurance patients (i.e. "the rich") due to getting better rates (unless forced to accept U-HC patients, so see item a or c)
(c) go out of business trying to maintain staff & operational costs thus leading to more consolidation of medical corporations (who might end up too big to fail...see the correlation of government here?)
(d) some combination of the above

In any one (or more) of those impacts...it doesn't provide a net benefit to people who have private insurance...and in fact, could negatively impact them due to the unintended consequences. I'm sure my speculation is just silliness...but this is how the banking industry, airlines, auto-makers, etc. ALL end up when government begins to believe it needs to stave off the evil profit-seekers that actually create wealth. I'm not advocating for anarchy, no laws, etc...just pointing out that every bad government program starts out for the same good reasons...to help the little guy...and at some point, it just ends up costing more money to everybody and still screwing little guys in the end....just in different ways than they get screwed today.

Steve understands some of the issues with a monsopoly.....

[lynchjm24]

Originally Posted by molson

That's true, but the fear people have expressed is that 1 trillion will only get things rolling to the point where we HAVE to spend at least triple that. That's what happened in Massachusetts. There was an estimated cost, a tax for that, and then when the actual cost was double the estimated cost, another tax for that.

And that's a pretty small state. The people advocating the bill are going to be WAY LOW on what this will cost, that's how they get support for it. And since no future congress is ever going to take it away, we'll just be locked in forever, its basically a blank check.

I'm all for reform, and think universal health care is a goal worth working towards. Let's figure out how to more affordably cover who we're trying to cover now first.

Tennessee's program has been even worse then Mass'. Mass' estimates were not even in the ballpark of the actual costs.

[lynchjm24]

Originally Posted by Galaxy

The problem with our system is Medicare underpays. A lot of doctors/surgeons either make a very, very small profit, break even, or lose money on Medicare/Medicaid patients. Where do they have to make up that money? Charging insurance patients more. They can't turn away anyone, even those who can't/won't pay.

It's even worse then that. It's a system totally manipulated by select Congresspeople to curry favor with an important base in their home states. They refuse to turn it over to a centralized authority, because they use that power to get reelected.

[RainMaker]

Originally Posted by lynchjm24

I'm sure she has her biases. She is far from the only person telling the story that low reimbursements have driven her out of practice. It's a common story from many places in the country. She's not a martyr, just one example of many.

You continue to ignore the huge amount of advanced reproductive technologies that I can only imagine are more widespread in the US then anywhere else. They cause huge amounts of premature multiple births to women who many times would not be able to conceive naturally.

The people that have the highest infant mortality rates are not the ones engaging in advanced reproductive technologies. The ones raising that number are the poor and minorities who don't have the kind of access others do.

I have no doubt that we have elements of our health system that is more sophisticated than other parts of the world. But lets not act like stepping across the Canadian border enters you into the Stone Age of medicine. For the most part they have the same equipment, same medicines, and same procedures.

Their system is far from perfect, and if you dig deep enough has some annoying warts. But it far exceeds what we have here for healthcare. I've lived in both countries and experienced both systems. I also speak as someone who has always been able to afford insurance and had it (and I still hate our system).

I don't get what your point of view is here. Are you trying to say our system is fine? That the fact we pay double what most other countries pay per person is just an odd coincidence. Do you truly believe we are getting twice the health care? The system is flawed and I don't necessarily think a universal health care system is the complete answer. But I do think it's better than what we've got.

[Galaxy]

Originally Posted by RainMaker

I don't see why salaries wouldn't go up. Benefits are an extension of your salary and employers would demand more money. Perhaps not in this economy, but in a normal economy with normal unemployment rates, salaries would have to go up.

I guess I'm confused why you think salaries would go up.

Even if they did, the taxes to cover an universal health care system would have to go up.

[lynchjm24]

Originally Posted by RainMaker

The people that have the highest infant mortality rates are not the ones engaging in advanced reproductive technologies. The ones raising that number are the poor and minorities who don't have the kind of access others do.

I have no doubt that we have elements of our health system that is more sophisticated than other parts of the world. But lets not act like stepping across the Canadian border enters you into the Stone Age of medicine. For the most part they have the same equipment, same medicines, and same procedures.

Their system is far from perfect, and if you dig deep enough has some annoying warts. But it far exceeds what we have here for healthcare. I've lived in both countries and experienced both systems. I also speak as someone who has always been able to afford insurance and had it (and I still hate our system).

I don't get what your point of view is here. Are you trying to say our system is fine? That the fact we pay double what most other countries pay per person is just an odd coincidence. Do you truly believe we are getting twice the health care? The system is flawed and I don't necessarily think a universal health care system is the complete answer. But I do think it's better than what we've got.

The system is far from perfect, but the system is driven by the people, not the other way around. People aren't unhealthy because of the healthcare system, the healthcare system is unhealthy because the people are sick.

The system is expensive because people are unhealthy, have expectations that don't exist in other countries and people have access to technology that people in other countries can only dream of.

While there are flaws in our system, moving to their system CRIPPLES our economy. The costs being bandied about in Congress do not even come close to what the reality of those costs will be.

I understand that your solutions are:
A. Tax more
B. Pay a lower level of benefits

It doesn't work like that forever, there comes a point where you tax the economy to the point where it can't generate the revenue anymore and it circles the drain.

Adding more entitlement programs only pushes the country to the brink of economic disaster that much faster.

[lynchjm24]

I dug up my favorite tid-bits from today:

AIG douchebag Chris Dodd: "It guarantees that you'll be able to find an insurance plan that works for you, including a public health insurance option if you want it.''

That's a big promise Mr. Dodd...

More Dodd: "ensures that your out-of-pocket costs will never exceed your ability to pay.''

Great, means testing, hopefully they tell me soon where to hide what assets they didn't tax away.

From the Medicare article:
At the same time President Obama is asking members of Congress to take one of the most politically difficult votes of their careers, he is also pressing lawmakers to give up one of their most valued perks of office: boosting Medicare payments to benefit hometown providers.

Setting reimbursement rates for local hospitals, doctors, home health-care centers and other providers is a legislative ritual that amounts to one of the most effective and lucrative forms of constituent service. Delivering federal money through Medicare, the country's largest insurance program, can be a powerful tool on the campaign trail, allowing lawmakers to argue that they are creating jobs and improving the quality of health care for voters.

Longtime members of Congress have become masters at dominating the tug of war between keeping providers flush and trying to rein in the entitlement program's dramatic growth. House Ways and Means Chairman Charles B. Rangel (D-N.Y.) champions New York City's teaching hospitals. Charles E. Grassley (Iowa), the Senate Finance Committee's ranking Republican, makes sure rural health-care services are amply funded. Months before Sen. Ted Stevens (R-Alaska) left office, he secured a permanent 35 percent increase in Medicare payments for Alaska physicians.

The long-term cost challenge has emerged as a major point of contention as new health-care legislation creeps closer to becoming a reality. White House officials and Democratic fiscal hawks worry that Congress could provide coverage to millions of uninsured people, expand the government's role in health care, and yet fail to "bend the cost curve," creating a fiscal disaster for the nation and a political disaster for their party.

Ah yes, these people are looking out for what's best for people...

Another gem:
"That profitability is enough to make big oil companies blush," said Sen. Charles E. Schumer (D-N.Y.).

Exxon Mobil made 36 billion dollars last year alone. Aetna made 1.9 billion. United made 2.9 billion. Wellpoint 2.4 billion. Cigna made 428 million. Coventry 300 million. Healthnet 150 million. Humana made 776 million.

Those 7 companies combined to make 1/4 what ExxonMobil made. Yes, that really should make Big Oil blush.

In the House, members prepared to begin work today on their version of a comprehensive health-care overhaul. Like the bill approved in the Senate Health, Education, Labor and Pensions Committee, it would for the first time require both businesses and individuals to contribute to the cost of health insurance.

"It's going to cost jobs. It's pretty simple," said Bruce Josten, executive vice president of the U.S. Chamber of Commerce, which represents three million employers and opposes both the House and the Senate bills

Wal-Mart Stores Inc., the nation's largest employer, has broken with the retail industry by supporting an employer mandate and is encouraged by that requirement in both bills, says spokesman Greg Rossiter, but he added that the retail giant isn't yet able to throw its support behind any particular piece of legislation. "We don't see enough cost savings in the bills," he said.

So much for those rising salaries...

[RainMaker]

Originally Posted by Galaxy

I guess I'm confused why you think salaries would go up.

Even if they did, the taxes to cover an universal health care system would have to go up.

Benefits are essentially an extension of your salary. If companies no longer need to provide health insurance to an employee, salaries will adjust upwards.

[RainMaker]

Originally Posted by lynchjm24

The system is far from perfect, but the system is driven by the people, not the other way around. People aren't unhealthy because of the healthcare system, the healthcare system is unhealthy because the people are sick.

The system is expensive because people are unhealthy, have expectations that don't exist in other countries and people have access to technology that people in other countries can only dream of.

While there are flaws in our system, moving to their system CRIPPLES our economy. The costs being bandied about in Congress do not even come close to what the reality of those costs will be.

I understand that your solutions are:
A. Tax more
B. Pay a lower level of benefits

It doesn't work like that forever, there comes a point where you tax the economy to the point where it can't generate the revenue anymore and it circles the drain.

Adding more entitlement programs only pushes the country to the brink of economic disaster that much faster.

You've given these nightmare scenarios of how it will destroy our country, but have no response to how every other major industrialized country has been able to do it without dying off. We're the only major country not doing it. This isn't a radical idea.

I also never said anything about raising taxes. I'd rather see cuts in other areas. I also have a different plan than the one Washington is proposing.

So what is your solution here?

[Galaxy]

Originally Posted by RainMaker

Benefits are essentially an extension of your salary. If companies no longer need to provide health insurance to an employee, salaries will adjust upwards.

What makes you think companies will make those adjustments?

[Swaggs]

I would like to see how much, in total yearly compensation, the top 10 or 20 executives in each of those companies make.

A quick check on Wellpoint's shows that 7 published executives each made between $3M-$23M per year in '06 and '07. That could pay for a lot of ineffecient government workers (which would, at least drive prices down a little bit).

[lynchjm24]

Originally Posted by Swaggs

I would like to see how much, in total yearly compensation, the top 10 or 20 executives in each of those companies make.

A quick check on Wellpoint's shows that 7 published executives each made between $3M-$23M per year in '06 and '07. That could pay for a lot of ineffecient government workers (which would, at least drive prices down a little bit).

Most of that income is generated on stock grants and options which isn't exactly the same thing. The money is big in a sense for upper management, but peanuts when the big picture is considered.

[lynchjm24]

Originally Posted by RainMaker

You've given these nightmare scenarios of how it will destroy our country, but have no response to how every other major industrialized country has been able to do it without dying off. We're the only major country not doing it. This isn't a radical idea.

I also never said anything about raising taxes. I'd rather see cuts in other areas. I also have a different plan than the one Washington is proposing.

So what is your solution here?

You can't do it without raising taxes. It's an impossibility. You can't realistically cut 3 trillion dollars from the budget ever, nevermind when unemployment is about to peak at 11-13%.

It's a radical CHANGE. Had we started in that direction after World War II it may have worked well. It's too late to move in that direction without destroying the economy.

How a reasonable person can't see that there is no way for Congress to go in this direction without spending obscene amounts of money is confusing. Your cuts and your plan aren't an option. The nonsense they are kicking around in Congress is.

I'd start by getting the 10MM + people eligible for Medicaid and SCHIP signed up.

Then I'd open up competition in the individual marketplace by allowing companies to compete across state lines.

I'd get rid of the ridiculous state mandates that have added huge costs to the programs that can't realistically be expected to be provided by your employer. Why in NJ does your employer have to fund 3 attempts at a zygote transfer for you?

I'd take away Congress' control of Medicare reimbursements, and I'd probably end Medicare-Advantage.

I'd offer tax breaks to employers that provide at least an HSA compatible plan and contribute at least 75% of the employees cost and 50% of the family cost.

I'd incent industry to innovate and develop cost-effective best practices.

I'd offer additional tax breaks to individuals who purchase HSA compliant plans in the marketplace.

Then I'd wait 2 years and see what happened. Incremental steps are feasible. A magic wand isn't.

[RainMaker]

It's impossible then. The United States is not capable of doing something that every major industrialized country is able to accomplish.

[SteveMax58]

Originally Posted by RainMaker

It's impossible then. The United States is not capable of doing something that every major industrialized country is able to accomplish.

I think the point that most who are skeptical of U-HC are making is that yes...in a vacuum, you can make a very valid argument that every other country has some form of U-HC, so why not us? The problem is that (ignoring the debate of whether they truly have "better" coverage and treatment, all things being equal) we (Americans as a whole) have a lot of "other" issues and associated costs that the rest of the world does not necessarily have.

Some of those "other" costs are associated to our own diet, exercise, and lifestyle choices. Some of these are associated to our country's acting role as a military superpower. Couple that with the fact that we already consume more than we make...and at some point there is a very real possibility that the entire house could cave in at some point. Add in the fact that the federal gov has not shown the ability to remove itself, or extraneous costs, from the federal budget and you get a bloated government that will continue to serve the individual agendas of those in it (or with a dog in it) until it collapses (i.e. what nearly happened in October).

I guess maybe we all have gotten over that and think everything is fine now? I mean...I'm all for reforming health care, but first things first here. Health care is an (primarily) internal cost to the country. If you want to get out of debt, you have to reduce costs for things that you get externally. When you successfully do that...then I think you can decide how to spend those savings.

[Galaxy]

Originally Posted by SteveMax58

I think the point that most who are skeptical of U-HC are making is that yes...in a vacuum, you can make a very valid argument that every other country has some form of U-HC, so why not us? The problem is that (ignoring the debate of whether they truly have "better" coverage and treatment, all things being equal) we (Americans as a whole) have a lot of "other" issues and associated costs that the rest of the world does not necessarily have.

Some of those "other" costs are associated to our own diet, exercise, and lifestyle choices. Some of these are associated to our country's acting role as a military superpower. Couple that with the fact that we already consume more than we make...and at some point there is a very real possibility that the entire house could cave in at some point. Add in the fact that the federal gov has not shown the ability to remove itself, or extraneous costs, from the federal budget and you get a bloated government that will continue to serve the individual agendas of those in it (or with a dog in it) until it collapses (i.e. what nearly happened in October).

I guess maybe we all have gotten over that and think everything is fine now? I mean...I'm all for reforming health care, but first things first here. Health care is an (primarily) internal cost to the country. If you want to get out of debt, you have to reduce costs for things that you get externally. When you successfully do that...then I think you can decide how to spend those savings.

We also have a mounting debt load that will be called at some moment. Not to mention we other budget costs other countries don't have (or to the degree we do).

[molson]

R&D and illegal immigration are two other huge expenses that the U.S. has that other countries don't. It's pretty easy to have universal health care when you can leach off the R&D of the US.

And aside from all that - we DO have national healthcare. It's not 100% universal, but we have both state and federal programs that cover the poor, and the elderly. There are free, state funded health clinics all over the U.S. Anyone can go into any emergency room the country and get treatment. The health care system we have is pretty flawed of course. Reform is needed. But the idea that we can just wave a magic wand and cover everyone overnight is insane. Let's fix medicaid and medicare, and let's expand their reach. And let's try to make health costs more affordable for everyone.

The idea that we're going to take this flawed system and turn it into universal health care is pretty terrifying and it has disaster written all over it.

[lynchjm24]

Originally Posted by RainMaker

It's impossible then. The United States is not capable of doing something that every major industrialized country is able to accomplish.

Quite honestly it might be. Medicare and Social Security obligations already risk running the country straight into the ground even without these new obligations.

I'm certainly no Republican and never supported the War in Iraq, but this country does defend freedom around the world and that costs us a hell of a lot of money. Do we sacrifice domestic programs to fund our military? Of course we do, but if not us then who will?

[lynchjm24]

Originally Posted by molson

R&D and illegal immigration are two other huge expenses that the U.S. has that other countries don't. It's pretty easy to have universal health care when you can leach off the R&D of the US.

R&D and security. It's easy for Canada to spend money on health care, they don't need to worry about protecting their huge borders. They have our military to protect them.

If the US becomes a place where drug companies can't make money, innovation will slow greatly. You'll get a steady diet of less expensive drugs that are already on the market, but research will die. It's already dying as it is, R&D and the FDA are expensive propositions and there are few breakthroughs in the pipelines. Without the potential of huge revenue drugs in the United States there is little reason for a company like Pfizer to come up with the next Lipitor.

[lynchjm24]

Originally Posted by Galaxy

We also have a mounting debt load that will be called at some moment. Not to mention we other budget costs other countries don't have (or to the degree we do).

There is almost no way to avoid some high inflation in the medium-term which as the dollar is devalued only leads to medical expenses rising even faster.

The more I think about a $1T pricetag the funnier it gets.

Back to doctor shortages and them being underpaid.. I guess this guy is just bitter too...

Peter Smulowitz, an ED physician at Beth Israel Deaconess Medical Center, said, "We have to pay primary care doctors what they're worth and increase the network for primary care from doctors and other providers," adding, "It's going to take a lot of money up front to change this. But do we have any other choice?"

More on Mass and how the expectations are dangerous:

More people are seeking care in hospital emergency rooms, and the cost of caring for ER patients has soared 17 percent over two years, despite efforts to direct patients with nonurgent problems to primary care doctors instead, according to new state data.

Visits to Massachusetts emergency rooms grew 7 percent between 2005 and 2007, to 2,469,295 visits. The estimated cost of treating those patients - including salaries for caregivers, tests such as X-rays and CT scans, and medicines - jumped from $826 million to $973 million, according data provided to the Globe.

The large portion of visits in which the patient didn't require immediate treatment, or could have been treated in a doctors' office, remained essentially unchanged over those years at 47 percent.

Massachusetts officials yesterday cautioned against drawing conclusions about whether the state's new insurance mandate has failed to ease overuse of the emergency room, saying more years of data are needed to measure the law's impact. But the numbers may provide an early view of how difficult it will be to meet the high expectations for the law.



Massachusetts' health insurance law will not be sustainable over the next five to 10 years unless the state takes significant steps to reduce health care spending growth, government and industry officials say, the New York Times reports. Architects of the 2006 law said that it would not have been feasible to include heavy cost control measures in the legislation. According to the Times, "Now those stakeholders and the state government have a huge investment to protect. But the task of cost-cutting remains difficult in a state with a long tradition of heavy spending on health care."

It's not nearly as simple as give people insurance and all the problems go away.

[RainMaker]

Originally Posted by lynchjm24

Quite honestly it might be. Medicare and Social Security obligations already risk running the country straight into the ground even without these new obligations.

I'm certainly no Republican and never supported the War in Iraq, but this country does defend freedom around the world and that costs us a hell of a lot of money. Do we sacrifice domestic programs to fund our military? Of course we do, but if not us then who will?

No one has a problem with protecting our borders and keeping our citizens safe. I think the issue in spending comes down to dropping $3 trillion on a war in Iraq that really didn't do anything. Cutting out unnecessary wars and focusing on our own protection instead would save us trillions over the next couple decades.

And as I mentioned a couple pages back, this over dramatization of every program driving the country into extinction is just silly. Social Security isn't driving anyone into the ground. We'll have an issue in 2042 when we may have to cut back on the amount we give people. But that's 33 years away and there is a lot of time to reform and adjust our retirement system. Social Security isn't failing, it's just changing.

[Arles]

Originally Posted by RainMaker

It's impossible then. The United States is not capable of doing something that every major industrialized country is able to accomplish.

We can do it, we just have to tax a majority of the working public at a 50-65% overall rate to do it.

It's not impossible, it just doesn't make a lot of sense. Over 90% of people between the ages of 25 and 50 have access to a solid health care plan. Nearly all kids under the age of 18 and most seniors also have access. So, why not figure out where that small sliver of uncovered people are located and figure out some targeted solutions. Maybe we setup a subsidized plan for people making less than $25,000 who don't have insurance as a start.

When an overwhelming majority of people have access to strong health care plans, universal coverage seems like a waste. It's like saying because we have 10% unemployment, everyone in the country should get a $1000 welfare check (including Bill Gates). Then, we'll soak the rich to pay for it.

Fix the problem, don't throw the baby out with the bath water.

[RainMaker]

Originally Posted by lynchjm24

R&D and security. It's easy for Canada to spend money on health care, they don't need to worry about protecting their huge borders. They have our military to protect them.

If the US becomes a place where drug companies can't make money, innovation will slow greatly. You'll get a steady diet of less expensive drugs that are already on the market, but research will die. It's already dying as it is, R&D and the FDA are expensive propositions and there are few breakthroughs in the pipelines. Without the potential of huge revenue drugs in the United States there is little reason for a company like Pfizer to come up with the next Lipitor.

I have no problem with drug companies making money. But we are footing the bill for the rest of the world. The drug companies want a free market system when it comes to health insurance, but they don't want a free market system when it comes to where their products are sold. You can't have it both ways.

[RainMaker]

Originally Posted by Arles

We can do it, we just have to tax a majority of the working public at a 50-65% overall rate to do it.

It's not impossible, it just doesn't make a lot of sense. Over 90% of people between the ages of 25 and 50 have access to a solid health care plan. Nearly all kids under the age of 18 and most seniors also have access. So, why not figure out where that small sliver of uncovered people are located and figure out some targeted solutions. Maybe we setup a subsidized plan for people making less than $25,000 who don't have insurance as a start.

When an overwhelming majority of people have access to strong health care plans, universal coverage seems like a waste. It's like saying because we have 10% unemployment, everyone in the country should get a $1000 welfare check (including Bill Gates). Then, we'll soak the rich to pay for it.

Fix the problem, don't throw the baby out with the bath water.

Would you really call it a solid health care plan? I'm completely fine with a private/public hybrid. Private for those who can get it with a public option available for those who can't (must prove you are working a full time job and/or have been rejected due to pre-existing conditions).

But one of the major problems is the private sector. If you've ever spent time in a hospital before, you know what an absolute disaster health insurance can be. There needs to be some regulations put in place to clean up that system.

[RainMaker]

Originally Posted by Galaxy

What makes you think companies will make those adjustments?

Because employees are ultimately paid what they are worth in the economy. Just because you enact a universal health care plan doesn't mean that everyone will take a paycut (which removing a benefit is).

[Galaxy]

Originally Posted by RainMaker

Because employees are ultimately paid what they are worth in the economy. Just because you enact a universal health care plan doesn't mean that everyone will take a paycut (which removing a benefit is).

It doesn't mean a company is going to increase your compensation package because they don't have to cover that.

[Arles]

Originally Posted by RainMaker

Would you really call it a solid health care plan?

I think most people with company-provided health care have very strong plans. I work for a company that isn't exactly cutting edge on benefits and have the same plan as guys working machinery in our fab making 35K a year. We can see a ton of family doctors, see specialists without a referral, have good pregnancy/hospital coverage and very good prescription drug plan. I don't think we are outside of the norm (in fact, our co-pays are about $5-10 more than some other plans for people I know). Yet, I really don't have a major complaint and whatever complaints I have wouldn't be solved by a national plan.

I'm completely fine with a private/public hybrid. Private for those who can get it with a public option available for those who can't (must prove you are working a full time job and/or have been rejected due to pre-existing conditions).

I think the best thing to do is really discover who the uncovered people with no affordable coverage options are and find a way to help as many of them as we can.

But one of the major problems is the private sector. If you've ever spent time in a hospital before, you know what an absolute disaster health insurance can be. There needs to be some regulations put in place to clean up that system.

We have too many people (not to mention those undocumented) to ever have a perfect system for health care. California is going bankrupt trying to pay for immigrant school/health care.

The big issue I have with the current health care plans from the White House come down to this central theme. They would rather pay $1 million to fully cover 20 people than $1000 to just have 18 covered. We have a good system in place - the focus needs to be on finding the groups without health care options and resolving some of the rising costs, not on shoehorning the 90% with solid coverage into a public plan.

[RainMaker]

Originally Posted by Arles

I think most people with company-provided health care have very strong plans. I work for a company that isn't exactly cutting edge on benefits and have the same plan as guys working machinery in our fab making 35K a year. We can see a ton of family doctors, see specialists without a referral, have good pregnancy/hospital coverage and very good prescription drug plan. I don't think we are outside of the norm (in fact, our co-pays are about $5-10 more than some other plans for people I know). Yet, I really don't have a major complaint and whatever complaints I have wouldn't be solved by a national plan.

It's good on paper, but I'm talking about actually needing it for something major. Spending a few days in a hospital or going into long term treatment. Maybe I'm just soured from my personal experience, but dealing with insurance companies and hospitals in general was hell. I had to dedicate probably 40 hours to just getting my bill sorted and the proper people to pay what they were supposed to.

Pretty much everyone I know has some shitty insurance story too. They aren't the easiest people to deal with

Originally Posted by Arles

I think the best thing to do is really discover who the uncovered people with no affordable coverage options are and find a way to help as many of them as we can.

My mom falls under the category of virtually uninsurable. She has psoriatic arthritis which a couple years ago her doctor told her she needed to stop working. That knocked her off insurance. Now she has the money to pay for insurance, but there isn't a single insurance company out there that will take her on. She doesn't need to see a doctor that often (especially now that she isn't working and avoiding flare-ups from it), but she is on a double dose of Humira which costs around $30,000 a year. Life would be much easier if she could get it from out of the country, but our government and those "free market" Pharma companies won't allow that.

Ultimately the solution was for me to throw her on as an employee at my company and just get her on my group plan. Not ideal, but we didn't have great options.

Now I'm not even demanding that we cover the lazy poor people in this country. But I do think as a country of our stature, we should give those who didn't win the genetic lottery a chance at quality health care. Whether that's cancer, cerebral palsy, or any other condition that an insurance company will reject your application for. I do think there needs to be something in place for people like that which allows them to pay what they can for insurance and get it. This isn't an issue of affordability, it's an issue of them not being able to get it period.

Originally Posted by Arles

We have too many people (not to mention those undocumented) to ever have a perfect system for health care. California is going bankrupt trying to pay for immigrant school/health care.

California is going bankrupt because they get back $0.75 for every $1 of federal income tax they pay in. If other states didn't leach off them for their money, they'd be able to handle their budget with ease.

Originally Posted by Arles

The big issue I have with the current health care plans from the White House come down to this central theme. They would rather pay $1 million to fully cover 20 people than $1000 to just have 18 covered. We have a good system in place - the focus needs to be on finding the groups without health care options and resolving some of the rising costs, not on shoehorning the 90% with solid coverage into a public plan.

I agree to an extent although I wouldn't call our system good. It's bloated beyond belief and has a lot of corruption in it. Insurance companies dictate treatment over doctors which is wrong. Doctors prescribe drugs because companies sent their family on vacation or took them out to dinner. We have semi-monopolies and non-competitive rules in place that allow everyone to get rich at the consumers expense.

[Arles]

Agreed with your final paragraph and I would certainly put "uninsurable" conditions as one of the top groups for supplemented coverage. I think some kind of "catestrophic/safety net" coverage for those without coverage may even be a decent idea. I'm much more worried about a 24-year old with cerebral palsy than a 24-year old who declined coverage in his first job to have more beer money on the weekends.

[lynchjm24]

Originally Posted by RainMaker

No one has a problem with protecting our borders and keeping our citizens safe. I think the issue in spending comes down to dropping $3 trillion on a war in Iraq that really didn't do anything. Cutting out unnecessary wars and focusing on our own protection instead would save us trillions over the next couple decades.

And as I mentioned a couple pages back, this over dramatization of every program driving the country into extinction is just silly. Social Security isn't driving anyone into the ground. We'll have an issue in 2042 when we may have to cut back on the amount we give people. But that's 33 years away and there is a lot of time to reform and adjust our retirement system. Social Security isn't failing, it's just changing.

It doesn't matter if the war in Iraq was right or wrong. It's not a choice between the war in Iraq and health care. That ship has already sailed.

'Reform' = raising taxes and lowering benefits. That's the same thing as failing. The combination bomb of medicare and SS happens well before 2042.