Health Care Reform - Universal/Public Option

[SackAttack]

Originally Posted by Swaggs

For the most part, the doctors who are getting "Paid" are very good businessmen (as well as very good physicians). I would venture to guess that the majority of physicians work in rural locations and/or for universities and get paid considerably less than most people would suspect (and practice for the love of their craft rather than for the money).

I think a mass exodus of doctors, due to a public option, is a Chicken Little scenario. The profession is so well respected/prestigious, reliably pays well, and offers a pretty good lifestyle (for the most part), so I wouldn't expect the quantity or quality of med school applicants to be hurt at all (what you might see is a considerable influx of foreign doctors coming to the U.S. to help offset the increase in patients).

That's kind of what I'm saying. The idea that we'd see a mass outflux of doctors makes no sense to me.

[lynchjm24]

Originally Posted by SackAttack

Destroy Wall Street? Chase ambulances? Drive Fortune 500 companies into the ground?

I mean, this is the vibe I'm getting from you here, that nobody would ever be a doctor unless mad bank is involved. What, precisely, are the people who would leave medicine if they aren't getting Paid (with the capital P, natch) going to go do instead?

Then there's the other half of the equation - if they start getting compensated for their treatment of people who, historically, have been uninsured, isn't that going to create a release valve in terms of costs passed on to other people?

Look, doctors put long hours doing work that generally only gets remembered if they fuck up. I get that. They deserve to get paid for that work. I don't argue with that. But there has got to be a better way to get them that compensation than to work the system through tests and other commission-like shenanigans because there's a leak somewhere else in the system that's costing them money.

Not all of them. There will always be altruistic people who do it for your reasons.

My wife is 31 years old, went to a decent private college and left with 20k in student loans. She works stress free in finance from 7-4 Monday-Friday and she makes 25-30k more then the average doctor according to the last numbers I saw.

You are going to lose talented people to other industries for more money, it's that simple.

[lynchjm24]

Originally Posted by SackAttack

That's kind of what I'm saying. The idea that we'd see a mass outflux of doctors makes no sense to me.

Do a little research. It's already happening. Many others are going their own way to concierge care and don't see Medicare and Medicaid patients.

[lynchjm24]

Originally Posted by JPhillips

How do you square this doomsday scenario with the fact that the rest of the industrialized world has universal healthcare and there are still doctors, people aren't terribly unhealthy, and they still have hospitals? Even if you disagree with a single payer system, this Chicken Little routine just rings hollow.

I guess we'll see if it happens. Be prepared to watch your standard of living drop, this same government had purchasing power and still managed to spend thousand of dollars each for toilet seats.

You've plain got to be crazy to see a system with waste, and think... you know what will fix that? Government.

[Swaggs]

Originally Posted by lynchjm24

Do a little research. It's already happening. Many others are going their own way to concierge care and don't see Medicare and Medicaid patients.

...and, many also avoid working with private insurance companies. Instead, they print out a list of the procedures completed, make you pay, and then make the patient deal with the insurance company.

If you are in private practice, you can turn away whoever you want and try to collect whatever you want. If you are a good enough business person (which includes choosing the right location and discipline to practice in), you can turn away medicaid, medicare, or private insurance and still earn very well.

What does that have to do with doctors leaving the profession? If anything, it indicates displeasure with dealing with the beauracracy of the current state of healthcare coverage.

[lynchjm24]

Originally Posted by Swaggs

...and, many also avoid working with private insurance companies. Instead, they print out a list of the procedures completed, make you pay, and then make the patient deal with the insurance company.

If you are in private practice, you can turn away whoever you want and try to collect whatever you want. If you are a good enough business person (which includes choosing the right location and discipline to practice in), you can turn away medicaid, medicare, or private insurance and still earn very well.

What does that have to do with doctors leaving the profession? If anything, it indicates displeasure with dealing with the beauracracy of the current state of healthcare coverage.

Doctors don't typically leave health plans because of administration issues. They leave because they don't want to get paid the discounted negotiated rates and they have patients who can pay.

A single payer system will drive down reimbursements. Leading to:
A - Good doctors only treating rich people in special deals
B - Mediocre doctors driven out of practice

Spend some time looking at the balance sheets of hospitals. They make AIG look good.

I've spent the last 7 years immersed in pricing health insurance. I've seen every article, every opinion, every study. A single payer system will be an unmitigated disaster. Higher cost lower quality. You can take that to the bank.

[Swaggs]

Originally Posted by lynchjm24

I guess we'll see if it happens. Be prepared to watch your standard of living drop, this same government had purchasing power and still managed to spend thousand of dollars each for toilet seats.

You've plain got to be crazy to see a system with waste, and think... you know what will fix that? Government.

The U.S. is currently 45th in the world in life expectancy. A number of nations with government sponsered healthcare are well ahead of us on the list (and, I assume there are healthcare professionals, that are compensated well enough to stay within their respective fields, providing care).

Big government has waste likes toilet papers, Blackwater, etc. Big insurance corporations have waste like excessive executive bonuses, providing vacations or other "rewards" to attract agents (I know one company that built its own 36-hole golf course, with a high dollar inn, in order to provide an attraction for agents and employees), expensive retreats for employees, profit sharing, etc.

I think a lot of us see very little difference between corporate and government waste.

[lynchjm24]

Originally Posted by Swaggs

The U.S. is currently 45th in the world in life expectancy. A number of nations with government sponsered healthcare are well ahead of us on the list (and, I assume there are healthcare professionals, that are compensated well enough to stay within their respective fields, providing care).

Big government has waste likes toilet papers, Blackwater, etc. Big insurance corporations have waste like excessive executive bonuses, providing vacations or other "rewards" to attract agents (I know one company that built its own 36-hole golf course, with a high dollar inn, in order to provide an attraction for agents and employees), expensive retreats for employees, profit sharing, etc.

I think a lot of us see very little difference between corporate and government waste.

How many of those nations have a marginal tax rate like the United States and how is their standard of living. The government runs public schools... how's that working out for everyone? How do we do on standardized tests against other countries? If you think the most talented American doctors are going to work for what doctors in other countries are paid you are in for a rude awakening.

American's life expectancy isn't going to go up with a single payer, it's going to go down. End of life care is going to be rationed and there isn't going to be any incentive for people to be healthy. The life expectancy here is lower because people don't take care of themselves, not because of a lack of government sponsored health care.

Listen, you might get what you want. After about 3 months of a single payer system people will be begging to go back to this flawed system.

If I didn't have a newborn daughter, I'd say let's go to single payer just so I could witness the disaster and get a good laugh, but I hope they don't screw the country up any worse for her sake.

[Swaggs]

Originally Posted by lynchjm24

Doctors don't typically leave health plans because of administration issues. They leave because they don't want to get paid the discounted negotiated rates and they have patients who can pay.

A single payer system will drive down reimbursements. Leading to:
A - Good doctors only treating rich people in special deals
B - Mediocre doctors driven out of practice

Spend some time looking at the balance sheets of hospitals. They make AIG look good.

I've spent the last 7 years immersed in pricing health insurance. I've seen every article, every opinion, every study. A single payer system will be an unmitigated disaster. Higher cost lower quality. You can take that to the bank.

I would suggest that those things are happening now, under the current system. Personally, I have no problem and encourage good doctors to do whatever they can to make as much money as they possibly can. I might argue that I would not necessarily equate good or talented (or good care, for that matter) with the ability to see 40 or 50 patients in an 8-hour day.

As an aside, I know my wife was offered a job where she could essentially sit at her desk, write Rxs, and duck her head into a room to "see" a patient (so that insurance would pay). She could have made about $70K more than she makes at the job she ended up taking, but she wanted to actually work with patients, rather than using her 9-years of training to write prescriptions for patients that nurses or social workers saw. Again, there was an administrator at that particular clinic that was a great businessman (who knew how to work the system), but I'm not sure that I would consider the level of care to be very good there.

Still, under your scenario, if the very wealthy want to pay extra for "talented" physicians and the physicians can make tons of money, isn't that capitalism at its finest?

If the "mediocre" doctors don't have the skill, talent, work-ethic or business skills to carry their own practice, there are (and I presume, will be) a number of community, rural, and/or education-based positions in under-served fields and areas.

BTW, I appreciate and respect your opinion and knowledge in your field (hopefully, I don't sound as if I don't, but with the internet, you never know ). I just disagree (question may be a better phrase in some cases) with the neccessity, intentions, and benefits of private health insurance and feel that the current situation is poor enough for both patients and physicians to seriously consider drastic changes.

[RainMaker]

Originally Posted by lynchjm24

5 is an issue? How many do you think can exist? It's a low margin business with a high cost of entry. There aren't that many employers in Maine how many do you think could build enough membership to sustain a reasonable risk pool and an economy of scale?

California has Blue Cross of CA, Blue Shield of CA, Pacificare (United), Aetna, Kaiser, CIGNA plus others.

I'm not as familiar with Chicago or what you were looking for but I can assure there are more then 3 companies doing business there.

The bigger companies have been growing their marketshare every year. In most regions, only a couple insurance companies own well over half the market. That's not competition to me.

And why couldn't more exist? We have over 300 million people living in this country. Just about everyone needs health insurance. Somehow other industries in this country like auto insurance find ways to co-exist and still reap in massive profits.

And enough with the margins crap. United Healthcare made $5 billion in profits in 2007. Who gives a fuck what the margins are when you're posting $5 billion dollars in profits?

[RainMaker]

Originally Posted by lynchjm24

Health insurance companies generally don't pay dividends to shareholders. The large American insurance companies have moved towards focusing on wellness and preventative services.

They don't? Aetna, Cigna, United, Assurant do. And others that don't do so because they invest within their business to try and grow the stock and overall value of the company. Dividend payouts aren't a good judge of a company as it's based on their overall goals (growth vs stability).

[RainMaker]

Originally Posted by lynchjm24

How many of those nations have a marginal tax rate like the United States and how is their standard of living. The government runs public schools... how's that working out for everyone? How do we do on standardized tests against other countries? If you think the most talented American doctors are going to work for what doctors in other countries are paid you are in for a rude awakening.

American's life expectancy isn't going to go up with a single payer, it's going to go down. End of life care is going to be rationed and there isn't going to be any incentive for people to be healthy. The life expectancy here is lower because people don't take care of themselves, not because of a lack of government sponsored health care.

Listen, you might get what you want. After about 3 months of a single payer system people will be begging to go back to this flawed system.

If I didn't have a newborn daughter, I'd say let's go to single payer just so I could witness the disaster and get a good laugh, but I hope they don't screw the country up any worse for her sake.

Many of those nations are comparable to our tax rates, especially when you factor in that they are getting health care from it (which is one of the largest expenses a family has).

As for the life expectancy, don't you think people would take better care of themselves if they saw their doctor regularly? If they had a doctor give them advice or warnings about their health? What about regular tests like colonoscopies and mammograms that someone without health insurance would certainly avoid? Or simple pre-natal care that those without health insurance avoid and leads to our embarassingly high infant mortality rate?

A lot of countries have it and those countries almost unilaterally kick our ass in every major health statistic. You can claim that it'll lower our life expectancy rates, but note the statistics don't back up that claim.

[lynchjm24]

Originally Posted by RainMaker

The bigger companies have been growing their marketshare every year. In most regions, only a couple insurance companies own well over half the market. That's not competition to me.

And why couldn't more exist? We have over 300 million people living in this country. Just about everyone needs health insurance. Somehow other industries in this country like auto insurance find ways to co-exist and still reap in massive profits.

And enough with the margins crap. United Healthcare made $5 billion in profits in 2007. Who gives a fuck what the margins are when you're posting $5 billion dollars in profits?

Everyone who invests in a company cares what the margins are? Making $5 billion on 100 billion of revenue is much different then if it's $5 billion on $20 billion in revenue. The sum total of the private insurer profits are peanuts in the grand scheme of things. Wellpoint/Aetna/United maybe make ... $12 billion dollars annually? Thats tenths of a percent when you are looking at the dollars Congress is tossing around.

You don't have any idea the scale at which a health insurance company is run. You need to have a solid membership base in order to have enough scale to contract with providers, pay claims, spread risk and grow your reserves to a point where you pass regulatory statues.

Auto insurance companies don't have to contract with providers all over the country. Auto insurance companies do not have the types of reserves that health insurance companies do (last I checked hemophilia is more expensive then a cracked bumper). Auto insurance companies do not deal with thousands of different types of claims that can be paid, antiquated systems which add complexity. Auto insurance companies don't have to deal with a deluge of state and federal legislation.

Comparing auto insurance to health insurance is downright idiotic. If you think they are similar you have no grasp of the issues.

The funny thing is that everything auto insurers do is what upsets people about health insurance.
They rate men and women differently.
They charge much more for certain age groups
They jack up your rate the first time there is any bad experience
They charge more for 'pre-existing conditions'

[lynchjm24]

Originally Posted by RainMaker

They don't? Aetna, Cigna, United, Assurant do. And others that don't do so because they invest within their business to try and grow the stock and overall value of the company. Dividend payouts aren't a good judge of a company as it's based on their overall goals (growth vs stability).

Meaningful dividends sorry. Aetna and Cigna pay 4 cents. United paid 3 cents.

They are much more likely to repurchase shares then pay a direct dividend.

[lynchjm24]

Originally Posted by RainMaker

Many of those nations are comparable to our tax rates, especially when you factor in that they are getting health care from it (which is one of the largest expenses a family has).

As for the life expectancy, don't you think people would take better care of themselves if they saw their doctor regularly? If they had a doctor give them advice or warnings about their health? What about regular tests like colonoscopies and mammograms that someone without health insurance would certainly avoid? Or simple pre-natal care that those without health insurance avoid and leads to our embarassingly high infant mortality rate?

A lot of countries have it and those countries almost unilaterally kick our ass in every major health statistic. You can claim that it'll lower our life expectancy rates, but note the statistics don't back up that claim.

You act like 90% of the country has no health insurance. The vast vast majority does. There are many more eligible for Medicaid and SCHIP who are too lazy or too stupid to sign up.

Our infant mortality rates are high because there are lazy stupid people in this country, not because there is a population of uninsured.

Check the obesity rates. Is that because they lack health insurance and a doctor didn't tell them to lose weight too? America spends many more dollars on end of life care prolonging life at the end stages. When that care gets rationed it's going to immediately lower life expectancy. People don't get that care in Europe.

People act like a single payer is going to eliminate rationing from the health insured. Ha. It's going to increase, not decrease.

[RainMaker]

Originally Posted by lynchjm24

Everyone who invests in a company cares what the margins are? Making $5 billion on 100 billion of revenue is much different then if it's $5 billion on $20 billion in revenue. The sum total of the private insurer profits are peanuts in the grand scheme of things. Wellpoint/Aetna/United maybe make ... $12 billion dollars annually? Thats tenths of a percent when you are looking at the dollars Congress is tossing around.

You don't have any idea the scale at which a health insurance company is run. You need to have a solid membership base in order to have enough scale to contract with providers, pay claims, spread risk and grow your reserves to a point where you pass regulatory statues.

Auto insurance companies don't have to contract with providers all over the country. Auto insurance companies do not have the types of reserves that health insurance companies do (last I checked hemophilia is more expensive then a cracked bumper). Auto insurance companies do not deal with thousands of different types of claims that can be paid, antiquated systems which add complexity. Auto insurance companies don't have to deal with a deluge of state and federal legislation.

Comparing auto insurance to health insurance is downright idiotic. If you think they are similar you have no grasp of the issues.

The point about margins is that people use it as a crutch to make people believe that these poor insurance companies are barely scooting by. They aren't. They are making billions. Sure they have to put forth a lot of capital, but most large companies do.

Auto insurance is just an example of an industry that has a lot of competition and consumers have benefitted from it. I have no doubt that health insurance is a different ballgame and much tougher. Which is why I'd rather see the government step in and help bring out more competition in the space. Forcing them to split up companies that carry more than 25% marketshare in any one region. These mini-monopolies are what's driving up costs.

Originally Posted by lynchjm24

The funny thing is that everything auto insurers do is what upsets people about health insurance.
They rate men and women differently.
They charge much more for certain age groups
They jack up your rate the first time there is any bad experience
They charge more for 'pre-existing conditions'

But with auto insurance, it's not life or death. You aren't playing games with someone's heart tests or whether they have to spend an extra couple days at the hospital. While it sucks, it's still just about a car and some damages. We aren't talking about an insurance company refusing to cover a procedure that you need to live and your doctor wants.

[Swaggs]

Originally Posted by lynchjm24

How many of those nations have a marginal tax rate like the United States and how is their standard of living. The government runs public schools... how's that working out for everyone? How do we do on standardized tests against other countries? If you think the most talented American doctors are going to work for what doctors in other countries are paid you are in for a rude awakening.

American's life expectancy isn't going to go up with a single payer, it's going to go down. End of life care is going to be rationed and there isn't going to be any incentive for people to be healthy. The life expectancy here is lower because people don't take care of themselves, not because of a lack of government sponsored health care.

Listen, you might get what you want. After about 3 months of a single payer system people will be begging to go back to this flawed system.

If I didn't have a newborn daughter, I'd say let's go to single payer just so I could witness the disaster and get a good laugh, but I hope they don't screw the country up any worse for her sake.

Again, the argument is there that end of life care is already rationed, under the current system, and there is currently the incentive for people to assume that they are healthy by avoiding the doctor, save the money, and hope for the best. I don't disagree about people not taking care of themselves, but I think you will have a tough sell trying to convince me that the number of people who have no insurance + the number of people who have bad insurance is not a factor.

I have a child on the way, as well, so I am hopefull for his future. But, I also have parents that are in their early sixties that have their own business and are paying over $2000/month for coverage that doesn't do anything to reduce their prescriptions and only provides major medical coverage for over $10K. So, if my dad or mom need routine, preventitive procedures (mammogram, colonoscopy, etc.), they have to pay another another grand or two to see that they hopefully do not have breast or colon cancer every year. So, if he wants major medical health insurance + prescriptions + routine checkups he is paying the first $30K a year he makes for health care that is pretty pathetic. He is doing his best to keep it up, but I would argue that private insurers do their best to ration care (hopefully well before "end of life" care time) by attempting to price people over their 60s out of their exposure.

If the current system was perfect, or even good, I would share your fears. As it is now, I'm obviously considerably more optimistic that a public option (not a single payer system) would be a risk worth taking.

[lynchjm24]

Originally Posted by RainMaker

The point about margins is that people use it as a crutch to make people believe that these poor insurance companies are barely scooting by. They aren't. They are making billions. Sure they have to put forth a lot of capital, but most large companies do.

When you don't have big margins, you don't have much room for error. The insurance companies aren't crying poverty, just relaying the reality of the situation.

The few billions that insurers extract from the system is a tiny percentage of the outlay. You guys are hammering on the negatives of for-profits while ignoring the positive aspects of have for profit options.

I'll leave you guys to your single payer fantasies, this is the ultimate the grass is greener on the other side issue.

[RainMaker]

Originally Posted by lynchjm24

You act like 90% of the country has no health insurance. The vast vast majority does. There are many more eligible for Medicaid and SCHIP who are too lazy or too stupid to sign up.

Our infant mortality rates are high because there are lazy stupid people in this country, not because there is a population of uninsured.

Check the obesity rates. Is that because they lack health insurance and a doctor didn't tell them to lose weight too? America spends many more dollars on end of life care prolonging life at the end stages. When that care gets rationed it's going to immediately lower life expectancy. People don't get that care in Europe.

People act like a single payer is going to eliminate rationing from the health insured. Ha. It's going to increase, not decrease.

It's not just about having health insurance, it's about how the insurance industry is fucking broken. They dictate your treatments, decide what they want to pay and what they want you to pay. I will guarantee you that you'll have a hard time finding many people who haven't had some health insurance nightmare story. When your doctor says we need you to stay an extra 2 days in the hospital because we're worried about infection and your insurance company says "no fucking way", something is broken.

Are you honestly telling me that there are 50 million uninsured people who can all be insured but are just too lazy too? That the rejection letters they get because they have diabetes or had cancer 10 years ago are just made up? I don't doubt that there are people who don't realize they can get it, but there are also a lot of people who don't have it because they can't. Because unfortunately they didn't win the genetic lottery and have a pre-existing condition that forces most insurance companies to reject them.

The obesity argument is just plain silly. There are so many causes for obesity that tying it to "laziness" is just ridiculous. Poverty, ethnicity, environment, etc all play roles in this. It's not a simple "laziness" answer.

I don't know about Europe, but I know Canada's system works and is real nice. Why not use something like that down here?

[lynchjm24]

Originally Posted by Swaggs

Again, the argument is there that end of life care is already rationed, under the current system, and there is currently the incentive for people to assume that they are healthy by avoiding the doctor, save the money, and hope for the best. I don't disagree about people not taking care of themselves, but I think you will have a tough sell trying to convince me that the number of people who have no insurance + the number of people who have bad insurance is not a factor.

I have a child on the way, as well, so I am hopefull for his future. But, I also have parents that are in their early sixties that have their own business and are paying over $2000/month for coverage that doesn't do anything to reduce their prescriptions and only provides major medical coverage for over $10K. So, if my dad or mom need routine, preventitive procedures (mammogram, colonoscopy, etc.), they have to pay another another grand or two to see that they hopefully do not have breast or colon cancer every year. So, if he wants major medical health insurance + prescriptions + routine checkups he is paying the first $30K a year he makes for health care that is pretty pathetic. He is doing his best to keep it up, but I would argue that private insurers do their best to ration care (hopefully well before "end of life" care time) by attempting to price people over their 60s out of their exposure.

If the current system was perfect, or even good, I would share your fears. As it is now, I'm obviously considerably more optimistic that a public option (not a single payer system) would be a risk worth taking.

I can certainly empathize with your parents. However, that's the reality of treating people their ages, it's that expensive.

I guess it's 'pathetic', but that's part of the demographic issue this country faces. As the population ages, if you shift their healthcare expenses to the young it cripples the economy. You cripple the economy and government entitlement programs crash and burn.

People need to understand they need to save for their heathcare, like they save for retirement, or save for their kid's college education. Either way it's getting spent. You'll either be taxed back to the stone age, or you'll have to spend your own money. That's the reality people don't want to deal with.

[RainMaker]

Originally Posted by lynchjm24

I can certainly empathize with your parents. However, that's the reality of treating people their ages, it's that expensive.

I guess it's 'pathetic', but that's part of the demographic issue this country faces. As the population ages, if you shift their healthcare expenses to the young it cripples the economy. You cripple the economy and government entitlement programs crash and burn.

People need to understand they need to save for their heathcare, like they save for retirement, or save for their kid's college education. Either way it's getting spent. You'll either be taxed back to the stone age, or you'll have to spend your own money. That's the reality people don't want to deal with.

So how are countries like Canada able to do this relatively well while we can't? They aren't taxed back to the Stone Age.

[sterlingice]

(Interesting read from pretty much all comers, btw)

SI

[lynchjm24]

Originally Posted by RainMaker

It's not just about having health insurance, it's about how the insurance industry is fucking broken. They dictate your treatments, decide what they want to pay and what they want you to pay. I will guarantee you that you'll have a hard time finding many people who haven't had some health insurance nightmare story. When your doctor says we need you to stay an extra 2 days in the hospital because we're worried about infection and your insurance company says "no fucking way", something is broken.

Are you honestly telling me that there are 50 million uninsured people who can all be insured but are just too lazy too? That the rejection letters they get because they have diabetes or had cancer 10 years ago are just made up? I don't doubt that there are people who don't realize they can get it, but there are also a lot of people who don't have it because they can't. Because unfortunately they didn't win the genetic lottery and have a pre-existing condition that forces most insurance companies to reject them.

The obesity argument is just plain silly. There are so many causes for obesity that tying it to "laziness" is just ridiculous. Poverty, ethnicity, environment, etc all play roles in this. It's not a simple "laziness" answer.

I don't know about Europe, but I know Canada's system works and is real nice. Why not use something like that down here?

The government that you so want to save you says themselves that there are over 10 million people eligible for government programs like Medicaid who just haven't signed up. I can only attribute that to two things: Laziness and stupidity.

You don't think obesity has an effect on healthcare costs and life expectancy. Yes, it's more complicated then just 'laziness', but everything is an excuse. Except for some with medical conditions being overweight is something that can be fixed by exercise and diet.

Universal care here is going to cost much more then any other country. It's the attitude of the people combined with the overall poor health and diet.

Americans aren't sick because of the insurance industry. Americans are sick because they don't take care of themselves and that reality plays out in the insurance industry.

[RainMaker]

Originally Posted by lynchjm24

The government that you so want to save you says themselves that there are over 10 million people eligible for government programs like Medicaid who just haven't signed up. I can only attribute that to two things: Laziness and stupidity.

You don't think obesity has an effect on healthcare costs and life expectancy. Yes, it's more complicated then just 'laziness', but everything is an excuse. Except for some with medical conditions being overweight is something that can be fixed by exercise and diet.

Universal care here is going to cost much more then any other country. It's the attitude of the people combined with the overall poor health and diet.

Americans aren't sick because of the insurance industry. Americans are sick because they don't take care of themselves and that reality plays out in the insurance industry.

Obesity is also a result of poverty. It's much cheaper to eat crap. It's a result of having to work longer hours or multiple jobs to get health insurance. Ethnicity plays a role as hispanics are genetically built to be more obese (we have a much higher hispanic population than most countries).

I have no doubt that laziness is a huge factor, but I don't see how having a better health system wouldn't help that. Wouldn't seeing a doctor once a year for a checkup and being able to discuss diet, exercise, etc be good for obese people?

[lynchjm24]

Originally Posted by RainMaker

So how are countries like Canada able to do this relatively well while we can't? They aren't taxed back to the Stone Age.

Pittsburgh has more MRI machines then the entire nation of Canada. You think it will be a similar expenditure?

When comparing Canada’s single-payer health insurance system with the pluralistic system in the United States, many people mistakenly assume that Canadians enjoy universal coverage while receiving the same quality and quantity of medical goods and services as Americans, but at lower costs. The reality is that, on average, Americans spend more of their incomes on health care, but get faster access to more and better medical resources in return for the money spent.

The Hidden Costs of Single Payer Health Insurance: A Comparison of the United States and Canada

[lynchjm24]

Originally Posted by RainMaker

Obesity is also a result of poverty. It's much cheaper to eat crap. It's a result of having to work longer hours or multiple jobs to get health insurance. Ethnicity plays a role as hispanics are genetically built to be more obese (we have a much higher hispanic population than most countries).

I have no doubt that laziness is a huge factor, but I don't see how having a better health system wouldn't help that. Wouldn't seeing a doctor once a year for a checkup and being able to discuss diet, exercise, etc be good for obese people?

Obesity is not a result of poverty. Obesity is a result of eating more calories then you burn. Obesity might be a by-product of poverty, because the poor might not get this simple concept, but obesity is the result of eating too much.

If we have a population that is more prone to obesity doesn't that also make it harder to compare to a place like Canada?

If you think that seeing a doctor once a year is going to get the majority of people to lose weight, then it will probably be those magical doctors that don't care how much they make.

[RainMaker]

Originally Posted by lynchjm24

Pittsburgh has more MRI machines then the entire nation of Canada. You think it will be a similar expenditure?

When comparing Canada’s single-payer health insurance system with the pluralistic system in the United States, many people mistakenly assume that Canadians enjoy universal coverage while receiving the same quality and quantity of medical goods and services as Americans, but at lower costs. The reality is that, on average, Americans spend more of their incomes on health care, but get faster access to more and better medical resources in return for the money spent.

The Hidden Costs of Single Payer Health Insurance: A Comparison of the United States and Canada

MRIs are used much more liberally here. A doctor who owns his MRI machine is 4 times more likely to order the scan than one who doesn't. That's more a factor of doctors abusing the system in place and trying to squeeze as much as they can out of insurance comapnies and Medicare.

It's also silly to compare countries as Canada is 1/10th our size and much healthier overall.

The opinions you stated come from a conservative think tank that pushes free market ideas. Not exactly the most unbiased source in the world. As for return on investment, Canadians live longer than us (by 3 years) and have a much better infant mortality rate. It's tough to argue our health care industry is better when everyone else is healthier than us.

I lived in Canada and it's a pretty nice system. Has some problems but for the most part functioned well. The way they setup their clinics is great but they need some work with how they handle specialists.

[lynchjm24]

Just in conclusion, I'm all for some of the ideas to get the uninsured covered. I think it was Chief Rum on page 2 that talked about a safety net for those who slip through the cracks.

Starting with getting people enrolled in the programs they already qualify for is a big start.

I think that the individual marketplace should be opened up to allow competition across state lines which is currently not allowed.

I haven't seen it proposed often, but some chronic conditions becoming Medicare primary claims I think would help. That's how End Stage Renal Disease is currently handled. After a period of months from diagnosis, your claims aren't paid by your employer any longer, they are paid by Medicare.

Mandating coverage at the state level is interesting to me, I think the jury is still out on the Mass legislation.

I'm not totally against a public option without knowing what the parameters would be it's hard to have a strong opinion either way.

A single payer system would be the biggest disaster in American legislative history. Medicare and Social Security already are going to bankrupt the Feds, why speed it up with a single payer system.

[RainMaker]

Originally Posted by lynchjm24

Obesity is not a result of poverty. Obesity is a result of eating more calories then you burn. Obesity might be a by-product of poverty, because the poor might not get this simple concept, but obesity is the result of eating too much.

If we have a population that is more prone to obesity doesn't that also make it harder to compare to a place like Canada?

If you think that seeing a doctor once a year is going to get the majority of people to lose weight, then it will probably be those magical doctors that don't care how much they make.

There is an undeniable link between poverty and obesity. It is expensive to eat healthy, it is cheap to eat crappy. The poor aren't worried about getting lean meats and whole wheat bread, they are worried about just getting enough food to stay within their budget.

Fixing obesity doesn't have to be about seeing a doctor every year. There can be more of an effort put into education and youth athletic programs. There are a lot of ways to combat obesity in this country and seeing a doctor regularly for advice is one of them.

[CamEdwards]

Originally Posted by Swaggs

The U.S. is currently 45th in the world in life expectancy. A number of nations with government sponsered healthcare are well ahead of us on the list (and, I assume there are healthcare professionals, that are compensated well enough to stay within their respective fields, providing care).

Big government has waste likes toilet papers, Blackwater, etc. Big insurance corporations have waste like excessive executive bonuses, providing vacations or other "rewards" to attract agents (I know one company that built its own 36-hole golf course, with a high dollar inn, in order to provide an attraction for agents and employees), expensive retreats for employees, profit sharing, etc.

I think a lot of us see very little difference between corporate and government waste.

I don't have much to add to this discussion, but did want to point out that the life expectancy rate in the United States is 78.06 years of age. The European Union average is 78.7. Yes, some countries may be as high as 80.6 (Switzerland), but I don't consider that to be a huge difference.

If I die at 78 as opposed to 80, I don't think there'll be much gnashing of teeth and wailing from my family and friends that I died too young.

[lynchjm24]

Originally Posted by RainMaker

MRIs are used much more liberally here. A doctor who owns his MRI machine is 4 times more likely to order the scan than one who doesn't. That's more a factor of doctors abusing the system in place and trying to squeeze as much as they can out of insurance comapnies and Medicare.

It's also silly to compare countries as Canada is 1/10th our size and much healthier overall.

The opinions you stated come from a conservative think tank that pushes free market ideas. Not exactly the most unbiased source in the world. As for return on investment, Canadians live longer than us (by 3 years) and have a much better infant mortality rate. It's tough to argue our health care industry is better when everyone else is healthier than us.

I lived in Canada and it's a pretty nice system. Has some problems but for the most part functioned well. The way they setup their clinics is great but they need some work with how they handle specialists.

I get that they aren't unbiased. You are the one who brought up Canada, saying they weren't taxed back to the stone age. I'm just pointing out why that is the case, and we would be taxed much higher then they are.

They are healthier, they don't have the technology we use and people demand and they don't have some of the demographic issues we do.

Can you even compare the life expectancy? What's the murder rate in Canada? How about deaths in automobiles? While Canada overall might be 3 years higher, white Canadians and white Americans are within about 1 year. You want to play the ethnicity card when making obesity excuses but want to ignore ethnicity when comparing life expectancy.

[RainMaker]

Originally Posted by lynchjm24

A single payer system would be the biggest disaster in American legislative history. Medicare and Social Security already are going to bankrupt the Feds, why speed it up with a single payer system.

That's bull. Social Security isn't bankrupting the Fed. The system actually works really well and people have been getting checks on time for decades. The issue is with an older population and that in 30+ years, we'll have issues with funding. That doesn't mean bankrupt, it just means they'll only be able to pay out 3/4ths of what you should get.

It also leaves about 30 years for us to change the system. Whether it's raising the amount that FICA caps out at or adding it on to those who make over $500k. Or perhaps giving more tax breaks for those to build up their 401K or IRA. The system isn't bankrupt and isn't going to be anytime in the near future. It needs some work and may ultimately turn into a supplementary income instead of someone's primary retirement income.

[miked]

Originally Posted by CamEdwards

I don't have much to add to this discussion, but did want to point out that the life expectancy rate in the United States is 78.06 years of age. The European Union average is 78.7. Yes, some countries may be as high as 80.6 (Switzerland), but I don't consider that to be a huge difference.

If I die at 78 as opposed to 80, I don't think there'll be much gnashing of teeth and wailing from my family and friends that I died too young.

That's why people invented statistics (not that I know the significance of these data).

[lynchjm24]

Originally Posted by RainMaker

There is an undeniable link between poverty and obesity. It is expensive to eat healthy, it is cheap to eat crappy. The poor aren't worried about getting lean meats and whole wheat bread, they are worried about just getting enough food to stay within their budget.

Fixing obesity doesn't have to be about seeing a doctor every year. There can be more of an effort put into education and youth athletic programs. There are a lot of ways to combat obesity in this country and seeing a doctor regularly for advice is one of them.

There is also an undeniable link between ice cream consumption and drownings. That doesn't mean that ice cream causes you to forget how to swim.

The obese poor are obese for the same reason they are poor.

[lynchjm24]

Originally Posted by RainMaker

That's bull. Social Security isn't bankrupting the Fed. The system actually works really well and people have been getting checks on time for decades. The issue is with an older population and that in 30+ years, we'll have issues with funding. That doesn't mean bankrupt, it just means they'll only be able to pay out 3/4ths of what you should get.

It also leaves about 30 years for us to change the system. Whether it's raising the amount that FICA caps out at or adding it on to those who make over $500k. Or perhaps giving more tax breaks for those to build up their 401K or IRA. The system isn't bankrupt and isn't going to be anytime in the near future. It needs some work and may ultimately turn into a supplementary income instead of someone's primary retirement income.

Well yeah, if you stop paying the same level of benefits then it won't bankrupt the government.

Is that going to be your solution on the single payer system when that is going to run out of money in the future as well? Just start paying 3/4s of the health care expenditure?

[RainMaker]

Originally Posted by lynchjm24

I get that they aren't unbiased. You are the one who brought up Canada, saying they weren't taxed back to the stone age. I'm just pointing out why that is the case, and we would be taxes much higher then they are.

They are healthier, they don't have the technology we use and people demand and they don't have some of the demographic issues we do.

Can you even compare the life expectancy? What's the murder rate in Canada? How about deaths in automobiles? While Canada overall might be 3 years higher, white Canadians and white Americans are within about 1 year. You want to play the ethnicity card when making obesity excuses but want to ignore ethnicity when comparing life expectancy.

But wouldn't that also be a factor of minorities being uninsured at much higher clips than white Americans? Perhaps their lower life expectancy is a factor of them not being able to see a doctor on a regular basis? The income vs life expectancy has shown that those who can pay for quality health care live longer.

[RainMaker]

Originally Posted by lynchjm24

Well yeah, if you stop paying the same level of benefits then it won't bankrupt the government.

Is that going to be your solution on the single payer system when that is going to run out of money in the future as well? Just start paying 3/4s of the health care expenditure?

Adjustments are made. Reagan doubled the FICA back in the 80's. There are a lot of other political solutions that can help bring back social security to where we need it.

There are always ways to fund health care expenditures. If we treat it with the same importance that we treat other areas such as our military, it can be done. I would prefer no increase in taxes and a budget cut in other areas. Regardless, if we make health care expenditures a priority, we will find a way to fund it.

[lynchjm24]

Originally Posted by RainMaker

But wouldn't that also be a factor of minorities being uninsured at much higher clips than white Americans? Perhaps their lower life expectancy is a factor of them not being able to see a doctor on a regular basis? The income vs life expectancy has shown that those who can pay for quality health care live longer.

According to Jet Magazine, homicide is a large reason for the difference between white males and black males.

White women outlive white men of the same socio-economical status. Some genders/races are just destined to live longer.

Less health insurance may be some of the difference, but there are probably dozens of reasons.

[lynchjm24]

Originally Posted by RainMaker

Adjustments are made. Reagan doubled the FICA back in the 80's. There are a lot of other political solutions that can help bring back social security to where we need it.

There are always ways to fund health care expenditures. If we treat it with the same importance that we treat other areas such as our military, it can be done. I would prefer no increase in taxes and a budget cut in other areas. Regardless, if we make health care expenditures a priority, we will find a way to fund it.

Your solution to everything seems to be to raise taxes. That only works for so long. Check out the exodus of wealthy people from the state of New York and the impact that is going to have on their tax receipts. By raising taxes they are potentially lowering their revenue.

I'm certainly not a supply sider, but your 'solutions' aren't as simple as they seem. Every time you raise taxes on a subclass you disincentive them to generate the income you are looking to tax.

There aren't always ways to fund things. If there were then California wouldn't be issuing IOUs.

[RainMaker]

Originally Posted by lynchjm24

According to Jet Magazine, homicide is a large reason for the difference between white males and black males.

White women outlive white men of the same socio-economical status. Some genders/races are just destined to live longer.

Less health insurance may be some of the difference, but there are probably dozens of reasons.

So you believe that the fact that we rank behind every top industrialized country which has universal health care in life expectancy and infant mortality is just a huge coincidence? That the fact we rank at the bottom of top industrialized countries in preventable deaths is just dumb luck too?

I guess I might look into statistics too much. But when every country that has universal health care is kicking our ass in health care, I start to wonder if maybe they are doing something better than we are.

[Swaggs]

Originally Posted by lynchjm24

Just in conclusion, I'm all for some of the ideas to get the uninsured covered. I think it was Chief Rum on page 2 that talked about a safety net for those who slip through the cracks.

Starting with getting people enrolled in the programs they already qualify for is a big start.

I think that the individual marketplace should be opened up to allow competition across state lines which is currently not allowed.

I haven't seen it proposed often, but some chronic conditions becoming Medicare primary claims I think would help. That's how End Stage Renal Disease is currently handled. After a period of months from diagnosis, your claims aren't paid by your employer any longer, they are paid by Medicare.

Mandating coverage at the state level is interesting to me, I think the jury is still out on the Mass legislation.

I'm not totally against a public option without knowing what the parameters would be it's hard to have a strong opinion either way.

A single payer system would be the biggest disaster in American legislative history. Medicare and Social Security already are going to bankrupt the Feds, why speed it up with a single payer system.

Interesting thoughts in the bolded. I take it the insurance companies like it when the government takes the chronically ill off of their hands (and, more importantly, off their books), but then complain that Medicare is going bankrupt and use it as a talking point for government inefficiency. Of course they are, they are covering all of the folks that are too old, too poor, or too risky for the private companies.

I agree about the single payer system, but I will be disappointed if a public option is not made available under this administration.

[lynchjm24]

Originally Posted by RainMaker

So you believe that the fact that we rank behind every top industrialized country which has universal health care in life expectancy and infant mortality is just a huge coincidence? That the fact we rank at the bottom of top industrialized countries in preventable deaths is just dumb luck too?

I guess I might look into statistics too much. But when every country that has universal health care is kicking our ass in health care, I start to wonder if maybe they are doing something better than we are.

I do not think the the healthcare system is the reason we lag. We have access to the best technologies in the world and our hospitals do not turn people away who can't pay.

We lag behind because we have an unhealthy population. It's an unhealthy population because they are ignorant on how to take care of themselves. We have an obese population because of ignorance and laziness.

Look at the rise of childhood diabetes. That is flat out a product of a bad educational system combined with ignorant parents and lazy kids.

We have more homicides and vehicle accident victims then other countries which drives down our life expectancy.

We have high infant mortality because we have a high teenage pregnancy rate. We have a high rate of teenage pregnancy because we have a stupid uneducated population.

Also, the quality of our healthcare system is part of the reason there is high infant mortality. We lead the world in reproductive technology which leads to a lot of multiple, premature births which don't end well.

You may get your single payer system. You'll get no improvement in those stats and a strangled economy. Enjoy it.

[RainMaker]

Originally Posted by lynchjm24

Your solution to everything seems to be to raise taxes. That only works for so long. Check out the exodus of wealthy people from the state of New York and the impact that is going to have on their tax receipts. By raising taxes they are potentially lowering their revenue.

I'm certainly not a supply sider, but your 'solutions' aren't as simple as they seem. Every time you raise taxes on a subclass you disincentive them to generate the income you are looking to tax.

There aren't always ways to fund things. If there were then California wouldn't be issuing IOUs.

I'm not for raising taxes at all. I'd rather it come out of other parts of our budget. I think you can cut back some on welfare programs now that many of the poor won't have to worry about health insurance. I think a cut to military expenses and not going into meaningless wars would be a big step in the right direction. I'm also sure there are a lot of programs out there that can use a good trimming.

If you make something like health care a priority like we make military spending or your local police force, it can be done. It means some budget cuts that are sorely needed in this country.

I truly believe we all have a right to go to a doctor and get care. Same as our right to have a police department and military to protect us. Same as our right to have roads to drive on and a government agency that tests the food and drugs we eat. I'm opposed to the Obama plan because it does call for an increase in taxes and doesn't cut back on our current expenses. Just because I support a universal health care system doesn't mean I support the way it's going forward now as.

[Swaggs]

Originally Posted by CamEdwards

I don't have much to add to this discussion, but did want to point out that the life expectancy rate in the United States is 78.06 years of age. The European Union average is 78.7. Yes, some countries may be as high as 80.6 (Switzerland), but I don't consider that to be a huge difference.

If I die at 78 as opposed to 80, I don't think there'll be much gnashing of teeth and wailing from my family and friends that I died too young.

I agree. That was pretty much the point I was making -- that the nations with government healthcare have as good of or better "quality of life" than we do (you can argue that life expectancy and quality of life are not completely or strongly tied to one another, but that is an argument for another day ) and are presumably still capable of developing/retaining a solid healthcare workforce.

[lynchjm24]

Originally Posted by Swaggs

Interesting thoughts in the bolded. I take it the insurance companies like it when the government takes the chronically ill off of their hands (and, more importantly, off their books), but then complain that Medicare is going bankrupt and use it as a talking point for government inefficiency. Of course they are, they are covering all of the folks that are too old, too poor, or too risky for the private companies.

I agree about the single payer system, but I will be disappointed if a public option is not made available under this administration.

Medicare kicks in on end stage renal disease after 36 months now I think. I do not know the reasoning behind that legislation but it really doesn't save the insurance company money. It saves the employers money.

That's what people don't get about health insurance companies. They could stop moving ESRD patients to Medicare, it wouldn't make a difference to the insurers. It keeps costs down for the plan sponsor in the long run.

[lynchjm24]

Originally Posted by RainMaker

I'm not for raising taxes at all. I'd rather it come out of other parts of our budget. I think you can cut back some on welfare programs now that many of the poor won't have to worry about health insurance. I think a cut to military expenses and not going into meaningless wars would be a big step in the right direction. I'm also sure there are a lot of programs out there that can use a good trimming.

If you make something like health care a priority like we make military spending or your local police force, it can be done. It means some budget cuts that are sorely needed in this country.

I truly believe we all have a right to go to a doctor and get care. Same as our right to have a police department and military to protect us. Same as our right to have roads to drive on and a government agency that tests the food and drugs we eat. I'm opposed to the Obama plan because it does call for an increase in taxes and doesn't cut back on our current expenses. Just because I support a universal health care system doesn't mean I support the way it's going forward now as.

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.

[RainMaker]

Originally Posted by lynchjm24

I do not think the the healthcare system is the reason we lag. We have access to the best technologies in the world and our hospitals do not turn people away who can't pay.

We lag behind because we have an unhealthy population. It's an unhealthy population because they are ignorant on how to take care of themselves. We have an obese population because of ignorance and laziness.

Look at the rise of childhood diabetes. That is flat out a product of a bad educational system combined with ignorant parents and lazy kids.

We have more homicides and vehicle accident victims then other countries which drives down our life expectancy.

We have high infant mortality because we have a high teenage pregnancy rate. We have a high rate of teenage pregnancy because we have a stupid uneducated population.

Also, the quality of our healthcare system is part of the reason there is high infant mortality. We lead the world in reproductive technology which leads to a lot of multiple, premature births which don't end well.

You may get your single payer system. You'll get no improvement in those stats and a strangled economy. Enjoy it.

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.

[Swaggs]

Originally Posted by lynchjm24

I do not think the the healthcare system is the reason we lag. We have access to the best technologies in the world and our hospitals do not turn people away who can't pay.

We lag behind because we have an unhealthy population. It's an unhealthy population because they are ignorant on how to take care of themselves. We have an obese population because of ignorance and laziness.

Look at the rise of childhood diabetes. That is flat out a product of a bad educational system combined with ignorant parents and lazy kids.

We have more homicides and vehicle accident victims then other countries which drives down our life expectancy.

We have high infant mortality because we have a high teenage pregnancy rate. We have a high rate of teenage pregnancy because we have a stupid uneducated population.

Also, the quality of our healthcare system is part of the reason there is high infant mortality. We lead the world in reproductive technology which leads to a lot of multiple, premature births which don't end well.

You may get your single payer system. You'll get no improvement in those stats and a strangled economy. Enjoy it.

There are not enough votes for a single payer system (and if there aren't under this president and congress, there likely never will be), but you keep focusing on one. There is a distinction between a public option and a single payer system, but you seem to be lumping them together a lot. Again, I think there is nearly 0% of a single payer option happening --- there is very little support for it and, to the best of my knowledge, no one in this thread is advocating one, so there isn't much use in focusing on it or blurring the lines between it and the public option.

[RainMaker]

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.

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.

[Swaggs]

Originally Posted by lynchjm24

Medicare kicks in on end stage renal disease after 36 months now I think. I do not know the reasoning behind that legislation but it really doesn't save the insurance company money. It saves the employers money.

That's what people don't get about health insurance companies. They could stop moving ESRD patients to Medicare, it wouldn't make a difference to the insurers. It keeps costs down for the plan sponsor in the long run.

...but, at the expense of the taxpayers (and helping to make Medicare a big loser that we can all beat up on).