Health Care Reform - Universal/Public Option

[lynchjm24]

Originally Posted by RainMaker

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.

The drug companies don't have any choice in those other countries. They are stuck with a single payer.

If you take away the American market from drug companies you'll pretty much end innovation in drugs. They get a single payer in the US and you'll get nothing, there will be no possible way to get an ROI on R&D. Already there is less R&D, just look at what Pfizer alone has been doing to their development staff.

[lynchjm24]

Originally Posted by Galaxy

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

There is no possible way in the world that universal health care will lead to higher wages.

Either your employer will directly pay higher taxes leading to lower wages, or you will directly pay leading to lower real wages even if your top line is higher.

The cost can only go up and the only outcome can be lower wages and fewer jobs.

[lynchjm24]

Originally Posted by 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.

24 year olds with CP are already eligible for Medicaid. Almost every state requires them to be extended on their parent's plan too.

The only way any government plan can even have a chance of working is getting the 24 year old male covered and contributing. A good amount of the uninsured are just young people who don't want to pay.

[lynchjm24]

Originally Posted by RainMaker

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.

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.

Would life be easier if the drug didn't exist? That's what you get with no markets available to profit in.

Drug companies aren't even allowed to bring in lunch for doctor's offices in a lot of places anymore. You are talking about the past.

If you think your problem is semi-monoplies and non-competitive rules, which is mostly untrue... somehow you think you'll solve that by starting the ultimate monopoly.

You don't think people are going to spend time sorting out hospital bills if Medicare is paying? You don't think that any system is going to have to dictate to the provider what they will and won't pay for?

If you have a fee for service system with no controls on what gets paid for then 3 trillion won't get you started. If doctor's could order anything they want, the Ted Stevens' of the world will jack up reimbursements on popular procedures and the doctors will order MRIs and CT Scans when you fall and scrape your knee.

There has to be a mechanism for ensuring that procedures are medically necessary. No system can work otherwise.

[miked]

Originally Posted by lynchjm24

The drug companies don't have any choice in those other countries. They are stuck with a single payer.

If you take away the American market from drug companies you'll pretty much end innovation in drugs. They get a single payer in the US and you'll get nothing, there will be no possible way to get an ROI on R&D. Already there is less R&D, just look at what Pfizer alone has been doing to their development staff.

I would just like to point out that industry is not the only place (or the real place) where innovation comes from. They have high-throughput screens that take the shotgun approach to drug development. Pfizer has cut development staff because they realized it was cheaper and easier to acquire smaller companies and merge than to spend so much on R&D. Basically, a lot of companies sat on their statin sales so long and didn't put much else through, now statins are set to come off patent. There are still plenty of drug companies making and testing drugs and a single payer system won't affect that.

Sometimes innovation is creating a drug for blood pressure and realizing the mouse/rat gets a boner. Most of the innovation comes from academia where the causes and potential cures for the diseases are researched.

[JPhillips]

Let me see if I get this.

People want to pass a single payer healthcare plan and are going to do so by passing a bill that doesn't create a single payer system

To get there the government will have to spend trillions of dollars(see Ass,my for reference)

To pay for that the government will have to tax us back to the stone age

Unfortunately those taxes won't help as the deficit spending will destroy the country

Our economy will lose millions of jobs and businesses will shut down

Doctors will change professions or decide to be engineers in college(joke's on them as the economic crash eliminates the need for so many engineers!)

Hospitals shut their doors all across America

People, especially poor, stupid ones, flood hospitals and doctor's offices to get free care even though their are no doctors or hospitals left

No new drug is ever invented again

People get much more unhealthy and die at a much younger age

Ted Steven's shuffles billions to his friends

Wow, I can see why you're against this.

[molson]

Originally Posted by JPhillips

Let me see if I get this.

People want to pass a single payer healthcare plan and are going to do so by passing a bill that doesn't create a single payer system

To get there the government will have to spend trillions of dollars(see Ass,my for reference)

To pay for that the government will have to tax us back to the stone age

Unfortunately those taxes won't help as the deficit spending will destroy the country

Our economy will lose millions of jobs and businesses will shut down

Doctors will change professions or decide to be engineers in college(joke's on them as the economic crash eliminates the need for so many engineers!)

Hospitals shut their doors all across America

People, especially poor, stupid ones, flood hospitals and doctor's offices to get free care even though their are no doctors or hospitals left

No new drug is ever invented again

People get much more unhealthy and die at a much younger age

Ted Steven's shuffles billions to his friends

Wow, I can see why you're against this.

And from the other perspective, let me see if I get this.

Even though we can't cover a portion of this country's population very well currently, we can wave a magic wand and have high-quality, universal health care while decreasing costs, increasing worker salaries, improving treatment, and reducing the federal deficit, all without taxes that will damage the economy (the taxes will only keep the rich from remodeling the kitchen in the 12th house, and we hate and are jealous of the rich). This is all EASY because every other industrialized country in the world has a perfect system and those countries are in all ways exactly like the US so it has to work here!

I can definitely see why they're for it.

[gstelmack]

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.

Instead they are going to be taxed to death to pay for it. One way or another, the employers will still be paying for healthcare.

[JPhillips]

Originally Posted by molson

And from the other perspective, let me see if I get this.

Even though we can't cover a portion of this country's population very well currently, we can wave a magic wand and have high-quality, universal health care while decreasing costs, increasing worker salaries, improving treatment, and reducing the federal deficit, all without taxes that will damage the economy (the taxes will only keep the rich from remodeling the kitchen in the 12th house, and we hate and are jealous of the rich). This is all EASY because every other industrialized country in the world has a perfect system and those countries are in all ways exactly like the US so it has to work here!

I can definitely see why they're for it.

You see, the difference is that I haven't been making these over the top claims that lower my credibility. Other than that it's exactly the same.

[albionmoonlight]

I think that de-linking health care from employment has advantages beyond the cost savings (which savings, I know, are disputed).

First, I think that linking two such important things to most people (employment and health) creates a huge risk--when you lose one you lose the other. In addition, some people stay in a job almost entirely because of the health care provided. I think that mobility of the workforce is good for the workers and for the market in general.

So, however it is done, I would love it if we started the process of unwinding the two.

(And I say that as a guy working for a large employer with good health benefits).

edit: And I do think that costs are increased by the linking. Most of the time, when the true cost of a product is hidden from the consumer of the product, it ends up costing more than it would if the consumer was paying for all of the cost in an easy to understand way.

Second edit: I just looked at my pay stub. I pay X for health insurance for my family. My employer pays 3X. So when someone asks how much my health insurance is, I say X. When, really, it is 4X. I know that any reform may or may not make 4X smaller. But I think that we could all be discussing the issue from a more informed place if we talked in terms of 4X and not just X.

[molson]

Originally Posted by JPhillips

You see, the difference is that I haven't been making these over the top claims that lower my credibility. Other than that it's exactly the same.

But what you did is collect every fear, across different posters, exagerated them, and implied that everyone opposed to the current plan felt all of those things collectively. Which was misleading, so I made little parody of your silly post (where I did exactly the same thing - collected together all the ridiculous optimism, exagerated it, and attributed it to everyone for the current health plan)

Nobody said all of the things you attributed to them, and a lot of the things in your list weren't claimed by anyone. Mine were actually more accurate, in terms of what people here are saying.

Read your post again - you don't think that lowers your credibility? Do you even think there's ANY risk, ANY downside to this plan? That's where this kind of liberal loses credibility with me. At least I'm acknowledging that universal health care would be awesome if it were possible. The response is that none of those fears are justified or possible. You never hear an argument like, "ya, that's a concern, but I think the possible reward outweighs that risk because X". All the concerns and risks are immediately rejected. Which tells me that people aren't even thinking about this. If someone thinks spending trillions (taxing billions, and making up the balance out of thin air) doesn't carry some risk, if they're not concerned at all about that, that's not a credible response, IMO.

[JPhillips]

I think I can find all of those claims(admittedly not quite as exaggerated) in lynchjm's posts.

On a serious note, I don't think changing the system will be easy or pain free, but if it's done well I do think we can at least lower costs without sacrificing care standards. Sure, we aren't exactly like Western Europe, but we aren't so different that we can't learn something from how they handle healthcare. We spend a lot more per capita than most other industrialized countries, and it's in our interests to see if we can at lessen lessen that gap.

For me, I'm less worried about universal coverage than I am about portability and continuing coverage. It's insane that families all over America have to declare bankruptcy due to illness. It's insane that I have a month where I either pay @1500 dollars or hope I stay healthy because my new job doesn't start up exactly when my old when stopped. It's insane that my HR Director friend spends as much time on health benefits as employee training.

[SteveMax58]

Originally Posted by albionmoonlight

I think that de-linking health care from employment has advantages beyond the cost savings (which savings, I know, are disputed).

Agreed on this...at least in principle.

[flere-imsaho]

Originally Posted by lynchjm24

People aren't unhealthy because of the healthcare system, the healthcare system is unhealthy because the people are sick.

That's logically not true. The customers of the healthcare system are people who are either a) unhealthy or b) potentially unhealthy. If people are not sick or not in danger of being sick, the healthcare system has no reason to exist.

We can argue about the details from whatever angles we may choose, but I would hope the one thing everyone in the debate could agree on is that the key indicator that the healthcare system is "unhealthy" is that there is demonstrable evidence that it does not serve its customers with a high (or even reasonable) level of efficiency or efficacy.

Originally Posted by Galaxy

We also have a mounting debt load that will be called at some moment.

No it won't. If our debt is called in suddenly it will lead to a complete collapse of the U.S. financial system, which will then take the rest of the world with it. Everyone knows this, especially China and the wealthy middle east petro-kingdoms. That's not to say that our debt won't get called at some point (presumably when it's more safe for our creditors to do so), but we'll have plenty of warning (years, even decades) before it happens.

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.

I'll address the R&D issue below, but I don't think it's correct to say that, for instance, Europe does not have an immigration (legal and illegal) problem with which to deal.

Originally Posted by lynchjm24

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'm sorry guys, but this just isn't true. First of all, the reason why pharmas hype up R&D costs is because pure pharmas (like Pfizer) operate on a very fragile economic model which requires them to produce a succession of blockbuster drugs to survive. They're completely undiversified. As others have noticed, this is why a new model is starting to emerge in the industry, where small start-ups come up with the breakthroughs (on a high risk/reward model) and are then bought by the bigger companies who can effectively market/manufacture the products.

The idea that non-US companies won't pay for innovation is also overhyped. I can tell you right now that a number of my clients have drugs in the R&D pipeline for which there is great demand (and willingness to pay) in Europe and the Far East. Contrary to popular belief, non-US countries do not automatically pay only cost for their pharmaceuticals.

"Few breakthroughs in the pipeline"? I'm sorry, unless you're a serious industry insider, you can't make that statement factually. R&D is highly secretive, but even what public pronouncements exist indicate that there are plenty of real breakthroughs in the pipeline and they are in the pipeline because they will command real money, throughout the world, if they pan out.

Real breakthroughs aren't the problem. The problem is that pharmas want to make $500 billion off of the next slightly improved statin drug (and convince doctors to prescribe it instead of Lipitor). While we should certainly expect to pay more for an improved product, it's not realistic, nor is it especially "free market" to expect customers to pay in multiples for a slightly improved product (safety or efficacy). That's like saying you should pay $20,000 for a 2WD Ford F-150 and $80,000 for a 4WD Ford F-150.

Originally Posted by Galaxy

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

No, your company won't pay you 10% more (or whatever) instantly. What will happen, however, is that companies, with more money to spend, will offer higher salaries to high performers in order to keep them. This will raise average wages and will also necessitate an inflation in salary for average or above-average performers. It wouldn't happen overnight, but it would happen.

There are real-world examples for this. Take any industry that has experienced rapid, industry-wide growth in earnings & profits and you'll see a corresponding rise in wages for all workers (on average) in that industry.

[molson]

Originally Posted by flere-imsaho

No, your company won't pay you 10% more (or whatever) instantly. What will happen, however, is that companies, with more money to spend, will offer higher salaries to high performers in order to keep them. This will raise average wages and will also necessitate an inflation in salary for average or above-average performers. It wouldn't happen overnight, but it would happen.

There are real-world examples for this. Take any industry that has experienced rapid, industry-wide growth in earnings & profits and you'll see a corresponding rise in wages for all workers (on average) in that industry.

1. Won't employers still offer health care as a benefit? They'll offer better plans than what the government offers, at cheaper, collectively-purchased rates than they can get themselves. Or will this somehow be forbidden in the new plan?

2. Even if employers aren't paying for health care, won't they be paying taxes to pay for the government to pay for the health care? And presumably, the taxes will be higher than what they paid in health care, because not only are they paying taxes for their own health care, they now also have to subsidize the health care of the poor, the unemployed, the illegal immigrants, and the elderly (I know they do this to some degree now, but the amount will be many times higher with truly "universal" health care)

[CamEdwards]

Originally Posted by JPhillips

It's insane that families all over America have to declare bankruptcy due to illness.

Why? I think it's insane to think we could ever afford a system in which everyone, even those with catastrophic illnesses, gets the care they need at a price they can afford.

[molson]

Originally Posted by JPhillips

It's insane that families all over America have to declare bankruptcy due to illness.

It sucks that someone who's otherwise been financially responsible to be wiped out by a medical issue, but trying to solve that problem by providing free, quality healthcare to every American is a bit overkill. Throwing out the baby with the bathwater maybe.

Maybe there should be a "medical bankrupcy", with its own rules. A seperate chapter, where medical bills are more easily discharged, and have less of an effect on one's other assets and credit worthiness. You're only elligible for it if you've never declared regular bankrupcy. Medical providers, insurance companies, and taxpayers somehow split the cost of discharged medical debt.

[JPhillips]

Originally Posted by CamEdwards

Why? I think it's insane to think we could ever afford a system in which everyone, even those with catastrophic illnesses, gets the care they need at a price they can afford.

We could afford a single payer system tomorrow if that was deemed a priority. Yes, there are costs involved, but the reason we can't afford it is that other spending has been deemed more important. If we went back to the Clinton era tax rates most of the problem would be solved.

[sterlingice]

Originally Posted by lynchjm24

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

(just an aside)

No. No. No. No. and No. I'm tired of everyone lumping in SS and Medicare like somehow they're at all related. The only thing they have in common is that they are government programs that pay out.

If we decreased payouts on SS or, more practically, increased the payout age to 70 instead of 65 with a justification of longer life and job expectancy, it's 100% solvent. Hell, the only reason why it's an issue is because we kept borrowing the surplus funds from it.

Social security is a good program that can easily be fixed with a little tweak. It's fair and works efficiently despite how everyone wants to crucify it.

SI

[JPhillips]

Originally Posted by molson

1. Won't employers still offer health care as a benefit? They'll offer better plans than what the government offers, at cheaper, collectively-purchased rates than they can get themselves. Or will this somehow be forbidden in the new plan?

2. Even if employers aren't paying for health care, won't they be paying taxes to pay for the government to pay for the health care? And presumably, the taxes will be higher than what they paid in health care, because not only are they paying taxes for their own health care, they now also have to subsidize the health care of the poor, the unemployed, the illegal immigrants, and the elderly (I know they do this to some degree now, but the amount will be many times higher with truly "universal" health care)

What's being left out is that we currently pay more and cover fewer people than the rest of the industrialized world. The idea behind universal coverage is to bring our costs per person in line with what other countries pay. The burden of expenses will change from premiums to taxation, but if done well(I know a big if) overall healthcare costs can be reduced.

In short, you can't look at it as adding X number of extra people at the same per person cost.

[JPhillips]

Originally Posted by sterlingice

(just an aside)

No. No. No. No. and No. I'm tired of everyone lumping in SS and Medicare like somehow they're at all related. The only thing they have in common is that they are government programs that pay out.

If we decreased payouts on SS or, more practically, increased the payout age to 70 instead of 65 with a justification of longer life and job expectancy, it's 100% solvent. Hell, the only reason why it's an issue is because we kept borrowing the surplus funds from it.

Social security is a good program that can easily be fixed with a little tweak. It's fair and works efficiently despite how everyone wants to crucify it.

SI

+ bajillion

[molson]

Originally Posted by JPhillips

If we went back to the Clinton era tax rates most of the problem would be solved.

We'll surely go higher than that soon - do you think all the problems will then be solved?

[Arles]

Originally Posted by albionmoonlight

I think that de-linking health care from employment has advantages beyond the cost savings (which savings, I know, are disputed).

First, I think that linking two such important things to most people (employment and health) creates a huge risk

I would say it creates a huge incentive to work. IMO, the great thing about America is that people can work hard and achieve a great deal of personal success. In order to have the system, you also need to have a certain degree of risk for people who are not able to stay employed.

Now, I am certainly in favor of looking into the current poverty coverage options out there and tweaking them to provide better coverage. Still, if you are under 18, make the poverty level or have a medical hardship you do have affordable coverage options right now. The issue is just making sure those options improve - which is a much different situation than creating options where they didn't exist before (which is the scenario painted by the universal proponents).

So, however it is done, I would love it if we started the process of unwinding the two.

Keeping employment and health care joined is the best way to keep costs down for the individual and the government. When health care is a "benefit", companies will provide it to attract better workers. When it is a "right", the entire burden is on the government (which means it is on us).

Right now, the number one goal for companies is to make money and keep good workers. So, that's a huge incentive to keep health care costs down. Our company shops all kinds of plan options with the understanding that they need solid benefits to keep the good people, but also can't afford to pay huge benefit premiums for each employee. It takes some effort and most larger companies do this.

When the government runs it, where's the risk of not keeping costs down? It's not like the government is going to go out of business. Do we really think the US government will be as persistent and dedicated to cost savings as companies who need to keep a 5% profit rate to survive?

I just looked at my pay stub. I pay X for health insurance for my family. My employer pays 3X. So when someone asks how much my health insurance is, I say X. When, really, it is 4X. I know that any reform may or may not make 4X smaller. But I think that we could all be discussing the issue from a more informed place if we talked in terms of 4X and not just X.

And because it's 3X for the company, they have a vested interest in keeping that cost down (which keeps X down for you). They also have a vested interest in keeping good benefits as their top workers will leave if they don't. If you take these companies out of the equation and say you will always pay Y and they will always pay 3Y, where's the incentive to keep the cost down?

[molson]

Originally Posted by JPhillips

What's being left out is that we currently pay more and cover fewer people than the rest of the industrialized world. The idea behind universal coverage is to bring our costs per person in line with what other countries pay. The burden of expenses will change from premiums to taxation, but if done well(I know a big if) overall healthcare costs can be reduced.

We pay more because we subsidize their R&D and our federal government is bigger and more wasteful than theirs. I'm all for trying to reduce those costs (though you'll never be at what other countries are), but it makes no sense to do that AND to offer everyone free care at the same time. How is that not insane? Let's reduce costs first, THEN gradually increase coverage.

[Arles]

I agree with Molson. This idea that not only will we cover more people, but we will reduce the overall cost in the process is completely non-nonsensical. The only way that happens is if quality of care significantly decreases for currently covered people (which I don't think is the end-game most universal proponents want).

I still come back to the idea that we need to find the problems and solve them. If the concern is coverage, let's find the people who do not have decent, affordable coverage options and try to rectify it. If the problem is cost, let's look at where the costs are and see what initial steps can be done.

This universal coverage idea in regards to fixing our current system is like cutting off someone's arm when they have a deep cut on their forearm. Why not stitch the cut and then work on other issues (potential infection, keeping the wound clean) as they appear?

[JPhillips]

Originally Posted by molson

We'll surely go higher than that soon - do you think all the problems will then be solved?

Nobody has advocated going above the Clinton tax rates and no one has introduced such legislation. Other than fear of the evil Dems, why are you sure this will happen?

Originally Posted by molson

We pay more because we subsidize their R&D and our federal government is bigger and more wasteful than theirs. I'm all for trying to reduce those costs (though you'll never be at what other countries are), but it makes no sense to do that AND to offer everyone free care at the same time. How is that not insane? Let's reduce costs first, THEN gradually increase coverage.

How do you reduce costs within the current system? The public option, which I think is the most doable plan, will provide a means for cost reduction. Yes, that will mean less money for healthcare providers and/or pharmaceutical companies and/or insurance companies, but regardless of the system that's where the money's spent so that's were costs have to be reduced

[JPhillips]

Originally Posted by Arles

I agree with Molson. This idea that not only will we cover more people, but we will reduce the overall cost in the process is completely non-nonsensical. The only way that happens is if quality of care significantly decreases for currently covered people (which I don't think is the end-game most universal proponents want).

I still come back to the idea that we need to find the problems and solve them. If the concern is coverage, let's find the people who do not have decent, affordable coverage options and try to rectify it. If the problem is cost, let's look at where the costs are and see what initial steps can be done.

This universal coverage idea in regards to fixing our current system is like cutting off someone's arm when they have a deep cut on their forearm. Why not stitch the cut and then work on other issues (potential infection, keeping the wound clean) as they appear?

If you can cut costs for medical care, especially end of life care, I'm all ears, but I haven't heard any plan, even theoretical, that significantly reduces those costs other than government intervention.

And again, if greater coverage and lower costs is an impossible combination, how does that happen in most of the industrialized world?

[CamEdwards]

Originally Posted by JPhillips

We could afford a single payer system tomorrow if that was deemed a priority. Yes, there are costs involved, but the reason we can't afford it is that other spending has been deemed more important. If we went back to the Clinton era tax rates most of the problem would be solved.

House Panels Approve Health Legislation - NYTimes.com

This is from Chris Dodd:

"it eliminates annual and lifetime caps on coverage and ensures that your out-of-pocket costs will never exceed your ability to pay.”

The only thing missing is a "happy ending" with every annual physicial! And I still don't see how we're going to afford to add this new program on top of things like cap-and-trade.

[molson]

Originally Posted by JPhillips

Nobody has advocated going above the Clinton tax rates and no one has introduced such legislation. Other than fear of the evil Dems, why are you sure this will happen?

The Clinton tax rate was part of the campaign, right, that was going to happen no matter what. Now we'll have $320 billion in new taxes on top of that for the new health care plan. Many of us assume/fear that we'll ultamitely need double or triple that in taxes (because that's what has happened when states have attempted this, and obviously the European countries that have universal health care have far higher tax rates than the Clinton rates). And that's before we figure out where the money for the stimulus is going to come from. And many dems want a SECOND stimulus package. And Obama also promised to reduce the federal defecit. I'm wondering if it's even POSSIBLE to for the current administration to want to apply the breaks at some point? Why not just spend a thousand septillion dollars, surely that will be enough to get everything we want.

[molson]

Originally Posted by JPhillips

And again, if greater coverage and lower costs is an impossible combination, how does that happen in most of the industrialized world?

People have tried to explain the difference between the U.S. and Sweden. If it were possible to "go Swedish" tomorrow, surely it would have happened already, and we wouldn't need to spend many times the entire Swedish GNP to make it happen.

[molson]

Originally Posted by JPhillips

II'm all ears, but I haven't heard any plan, even theoretical, that significantly reduces those costs other than government intervention.

I'd be all for any plan, government internvention included, to reduce end-of-care costs. What exactly is the plan for that though, other than "free health care for everyone" which doesn't seems to address that problem.

What would REALLY be interesting and worthwhile if there were proposals that attempted to exclusively reduce costs, not just throw billions (eventually trillions) at the problem so the reduce cost/cover everybody goals are blended together and indistinguishable. Let's see if that's possible on its own. If it's not, we're not in a place where universal healthcare is possible. If it's possible to reduce costs - then we can cover MORE people, for the same amount we're paying now. That would be great! The fact that this isn't considered tells me nobody in power thinks it's possible. It's easier to just throw up a smokescreen of trillions and then brag about any apparent marginal improvement of the system (because nobody can really comprehend the trillions)

The arguments for spending money always seem to focus on the great stuff the money will buy. I don't think anybody would disagree that if you spend enough money, you can eventually get what you want. But the advocates of spending never directly address the concern of the other sides. The spenders never explain why the spending won't have negative impacts, why it won't cause a double-dip recession, how we'll get the money back in these ways. The only brunt of the argument is always "universal health care is good and people shouldn't go bankrupt because of medical bills, and small European countries can do it so we should to". Great. The risks/concerns about that plan are never addressed though.

[CamEdwards]

Originally Posted by JPhillips

Nobody has advocated going above the Clinton tax rates and no one has introduced such legislation. Other than fear of the evil Dems, why are you sure this will happen?

The Clinton tax increase took effect in a very different economy than this one. Other than blind optimism, why are you sure that a massive tax increase for healthcare, coupled with the tax increases contained in cap and trade, won't delay, retard, or kill any hope of a sustained economic recovery?

Like I said when I first popped in this thread, I don't know enough about the issue to offer an informed opinion. My uninformed opinion, however, is that before this administration decides to "fix" healthcare, let's see if they can fix the economy.

[molson]

If Obama, in his first term, could manage to cover more people while spending less money, I would vote for him in 2012, donate heavily to his camapign, and donate to the campaigns of every congressperson that helped make it happen. Of course that wouldn't matter much, because there'd be zero resistance to any broader, universal health care plans that Obama wanted to attempt after that.

[SportsDino]

I think the topic is sort of drifting away from 'Universal Healthcare' to more of a question on 'how do you pay for everyone's care and lower costs at the same time?' At least, that is the question I am particularly interested in.

As a sort of economics driven thinker, and a vicious opponent of the private healthcare system (I feel it is broken entirely, for some of the same reasons discussed here and others involving failed notions of capitalism)... should I create a new thread targeting 'why private health care sucks and if we were to keep them, what must they do to become truly competitive?'... or try to merge that discussion with this thread.

I don't want to threadjack or distract from the question of whether obama-care is going to pass and its consequences, but I do think that creative thought on the alternative... identifying what is broken in healthcare and mechanisms for fixing it... well I think that is a valid line of thought to consider because how else can you design a universal healthcare system without not only solving the same problems currently being faced... but addressing positive economic mechanisms for driving down costs. Since we are still 'capitalist' country whether the healthcare is universal or not, and even in Europe it comes down to dollars per person... I am concerned that obama-care is just another government boondoggle like TARP, to like you are doing something while transferring wealth to some big corporation somehow.

So anyway, bring this up here, or start a new thread, or shut my trap?

[molson]

Originally Posted by SportsDino

I think the topic is sort of drifting away from 'Universal Healthcare' to more of a question on 'how do you pay for everyone's care and lower costs at the same time?' At least, that is the question I am particularly interested in.

As a sort of economics driven thinker, and a vicious opponent of the private healthcare system (I feel it is broken entirely, for some of the same reasons discussed here and others involving failed notions of capitalism)... should I create a new thread targeting 'why private health care sucks and if we were to keep them, what must they do to become truly competitive?'... or try to merge that discussion with this thread.

I don't want to threadjack or distract from the question of whether obama-care is going to pass and its consequences, but I do think that creative thought on the alternative... identifying what is broken in healthcare and mechanisms for fixing it... well I think that is a valid line of thought to consider because how else can you design a universal healthcare system without not only solving the same problems currently being faced... but addressing positive economic mechanisms for driving down costs. Since we are still 'capitalist' country whether the healthcare is universal or not, and even in Europe it comes down to dollars per person... I am concerned that obama-care is just another government boondoggle like TARP, to like you are doing something while transferring wealth to some big corporation somehow.

So anyway, bring this up here, or start a new thread, or shut my trap?

Whatever you do, don't shut your trap, I think you're addressing my concerns in a far more educated and coherent way than I could.

[flere-imsaho]

Originally Posted by molson

1. Won't employers still offer health care as a benefit?

Yeah, that's a good point, and the answer is: "Who knows?" I imagine it will vary from employer to employer, with some offering it as a perk, some offering it to only high performers/potentials, some offering it as a choice between coverage & lower salary vs. no coverage & higher salary, etc....

2. Even if employers aren't paying for health care, won't they be paying taxes to pay for the government to pay for the health care? And presumably, the taxes will be higher than what they paid in health care

These are corporations we're talking about. The likelihood they'll pay the full, originally-intended tax contribution is not high.

Originally Posted by CamEdwards

Why? I think it's insane to think we could ever afford a system in which everyone, even those with catastrophic illnesses, gets the care they need at a price they can afford.

It's not insane to think we could afford such a system, since affording such a system is simply a matter of numbers and I find it highly likely that this country, if it wanted to, could find a way to make the numbers work.

It might be insane (or perhaps overly optimistic) to think this country (or, more specifically, the citizens of this country) would be willing to actually make those numbers work.

Is that what you meant?

Originally Posted by Arles

I would say it creates a huge incentive to work. IMO, the great thing about America is that people can work hard and achieve a great deal of personal success. In order to have the system, you also need to have a certain degree of risk for people who are not able to stay employed.

So Bill Gates, Jack Welch, Steve Jobs, Jamie Dimon, et. al., are motivated to personal success primarily because of the risk of personal poverty?

And are we to presume that people in every country but the U.S. do not achieve "a great deal" of personal success, not matter how hard they work?

Really?

For the record, I don't think that's what you meant. Perhaps you could restate it.

[JPhillips]

Originally Posted by molson

I'd be all for any plan, government internvention included, to reduce end-of-care costs. What exactly is the plan for that though, other than "free health care for everyone" which doesn't seems to address that problem.

What would REALLY be interesting and worthwhile if there were proposals that attempted to exclusively reduce costs, not just throw billions (eventually trillions) at the problem so the reduce cost/cover everybody goals are blended together and indistinguishable. Let's see if that's possible on its own. If it's not, we're not in a place where universal healthcare is possible. If it's possible to reduce costs - then we can cover MORE people, for the same amount we're paying now. That would be great! The fact that this isn't considered tells me nobody in power thinks it's possible. It's easier to just throw up a smokescreen of trillions and then brag about any apparent marginal improvement of the system (because nobody can really comprehend the trillions)

The arguments for spending money always seem to focus on the great stuff the money will buy. I don't think anybody would disagree that if you spend enough money, you can eventually get what you want. But the advocates of spending never directly address the concern of the other sides. The spenders never explain why the spending won't have negative impacts, why it won't cause a double-dip recession, how we'll get the money back in these ways. The only brunt of the argument is always "universal health care is good and people shouldn't go bankrupt because of medical bills, and small European countries can do it so we should to". Great. The risks/concerns about that plan are never addressed though.

The idea, and why I believe European countries offer us a decent example, is that the bargaining and regulatory power of a single payer system lowers costs by reducing profit margin, eliminating redundancy and yes, rationing some healthcare. If you get that bargaining power, which I think the public option can start, prices for healthcare as a percentage of GDP will decrease or at worst hold steady.

That's what happens in European countries that most certainly can happen here. To argue that all of the difference in %of GDP spent on healthcare has to do with regional or national differences outside of the bargaining power of the government is to ignore how a single payer system works.

I believe the public option is the best compromise for our system as I don't think we can suddenly switch everything and expect it to work. I also don't think the public option is hat radical as it can be scaled back or killed by a Republican President/Congress if they so choose. Finally, costs are an issue, but if it's done right the % of GDP spending can be lowered and really if the % of GDP spent on Medicare isn't lowered somehow a couple of percentage points of marginal tax rates doesn't mean shit anyway.

[Arles]

Originally Posted by JPhillips

If you can cut costs for medical care, especially end of life care, I'm all ears, but I haven't heard any plan, even theoretical, that significantly reduces those costs other than government intervention.

And again, if greater coverage and lower costs is an impossible combination, how does that happen in most of the industrialized world?

A. They don't have quality of health care the US does.
B. They don't fit the bill for research and innovation like the US does.
C. They don't have the responsibility of being the military super power the US does.
D. They don't have the enormous expense (esp in the border states) that the US does in regards to covering illegal/non-tax payers.

Finally, the countries often cited (Canada, Sweden, other Europeans) don't have near the population of the US. Canada has a population of 30 million - the US is 300+ million. Just the sheer complexity in covering that number of people is immense. If Canada had 300 million people, there's no way they would have public health care. And, even with only 30 million, their quality is below what most have in the US.

[Arles]

Originally Posted by flere-imsaho

So Bill Gates, Jack Welch, Steve Jobs, Jamie Dimon, et. al., are motivated to personal success primarily because of the risk of personal poverty?

I would state that the reason we have traditionally had lower unemployment than numerous European countries (despite having orders of magnitude more in population) is that fact that people need to have a job to have a good health care plan.

I think that's healthy and creates incentive to work. Maybe some view that as "unfair", but I'm not sure we are better off if people can have free education, free health care and retirement benefits if they don't have to work.

And are we to presume that people in every country but the U.S. do not achieve "a great deal" of personal success, not matter how hard they work?

No, but much of the innovation, entrepreneurial success comes from the US. I'm think the system of government/taxation plays a part in that.

[JPhillips]

A. They don't have quality of health care the US does.
In many measures the US has a lower quality healthcare system. At best I think you'd be hard pressed to give our care more than equal footing to many other industrialized countries.

B. They don't fit the bill for research and innovation like the US does.
I think this is overstated, but assuming it's accurate, why do we do that? There was a time long ago when conservatives didn't want us to foot the bill for the rest of the world. Why can't our costs come down while Europe pays their share?

C. They don't have the responsibility of being the military super power the US does.
That's a different discussion. That argument is about prioritizing spending, not a general impossibility of changing the healthcare system. I'll give you that the past few decades have clearly shown a greater appetite for defense spending than any other government spending.

D. They don't have the enormous expense (esp in the border states) that the US does in regards to covering illegal/non-tax payers.
Again, I think that enormous cost is overstated. Do you have any numbers?

[flere-imsaho]

Originally Posted by Arles

I would state that the reason we have traditionally had lower unemployment than numerous European countries (despite having orders of magnitude more in population) is that fact that people need to have a job to have a good health care plan.

That's too focused. More people are more desperate to work in the U.S. because we have less of a safety net, so people need to work to obtain food and shelter and, once the basics are taken care of, a health care plan.

No, but much of the innovation, entrepreneurial success comes from the US. I'm think the system of government/taxation plays a part in that.

That's a bit different from "a great deal of personal success", though.

Anyway, if the U.S. has more innovation (another claim that is often overblown and anyway hard to quantify) I'd suspect it has less to do with taxation and more to do with a) people who self-select to be in the U.S., b) generally more ready access to capital and c) generally less regulation than other first world countries.

[Galaxy]

Originally Posted by JPhillips

On a serious note, I don't think changing the system will be easy or pain free, but if it's done well I do think we can at least lower costs without sacrificing care standards. SWe spend a lot more per capita than most other industrialized countries, and it's in our interests to see if we can at lessen lessen that gap.

For me, I'm less worried about universal coverage than I am about portability and continuing coverage. It's insane that families all over America have to declare bankruptcy due to illness. It's insane that I have a month where I either pay @1500 dollars or hope I stay healthy because my new job doesn't start up exactly when my old when stopped. It's insane that my HR Director friend spends as much time on health benefits as employee training.

Let me ask you this, how exactly do you lower costs without sacrificing care standards (and the quality of care we do have)?

[flere-imsaho]

Originally Posted by JPhillips

C. They don't have the responsibility of being the military super power the US does.
That's a different discussion. That argument is about prioritizing spending, not a general impossibility of changing the healthcare system. I'll give you that the past few decades have clearly shown a greater appetite for defense spending than any other government spending.

This may also be overblown.

[Arles]

Originally Posted by JPhillips

The idea, and why I believe European countries offer us a decent example, is that the bargaining and regulatory power of a single payer system lowers costs by reducing profit margin, eliminating redundancy and yes, rationing some healthcare.

Reducing profit margin for health-related companies in the US = lesser privately funded research. I'm all for eliminating redundancy, but I have a hard time believing the bureaucracy created to manage public health care will be any less expensive than the one currently used by private insurance companies. And I'm not a big fan of rationing health care services so that a small percentage of people not currently covered can be covered. Let's make 90% suffer so that 6% can get different coverage options. Why not just find a way to get those few without coverage into a plan that fits their needs (maybe that can be subsidized, instead of all 100%)?

I believe the public option is the best compromise for our system as I don't think we can suddenly switch everything and expect it to work. I also don't think the public option is hat radical as it can be scaled back or killed by a Republican President/Congress if they so choose.

That's what everyone said about social security. There is no way a political party will be able to "close the barn door" on a public health care system once it is instituted. They would be plastered as heartless bastards on every newspaper, network and internet page for years. Unless this becomes even more of a clusterf*ck than I think is possible, the political capital needed to undo it will never be there.

Finally, costs are an issue, but if it's done right the % of GDP spending can be lowered and really if the % of GDP spent on Medicare isn't lowered somehow a couple of percentage points of marginal tax rates doesn't mean shit anyway.

Well, if that's the case - why not go to a 50% tax rate like Sweden has to pay for it. It's just a few more percentage points and I'm sure we will see a much better health care system than we have now to justify that expense, right? I mean, the plan is so clear how a 50% tax rate gets us to health care Camelot. Well, that is if we could just pair down the US from $300 million people to around $9 million.

[flere-imsaho]

Originally Posted by Arles

Reducing profit margin for health-related companies in the US = lesser privately funded research.

How, exactly? R&D costs are an operational budget item, not set by yearly (or quarterly) profit levels. And since these companies need new products and new innovations in order to keep making money why, exactly, would they stop trying to develop these?

And I'm not a big fan of rationing health care services

How do you feel about HMOs?

[Galaxy]

Originally Posted by JPhillips

The idea, and why I believe European countries offer us a decent example, is that the bargaining and regulatory power of a single payer system lowers costs by reducing profit margin, eliminating redundancy and yes, rationing some healthcare. If you get that bargaining power, which I think the public option can start, prices for healthcare as a percentage of GDP will decrease or at worst hold steady.

That's what happens in European countries that most certainly can happen here. To argue that all of the difference in %of GDP spent on healthcare has to do with regional or national differences outside of the bargaining power of the government is to ignore how a single payer system works.

I believe the public option is the best compromise for our system as I don't think we can suddenly switch everything and expect it to work. I also don't think the public option is hat radical as it can be scaled back or killed by a Republican President/Congress if they so choose. Finally, costs are an issue, but if it's done right the % of GDP spending can be lowered and really if the % of GDP spent on Medicare isn't lowered somehow a couple of percentage points of marginal tax rates doesn't mean shit anyway.

The bargaining power the European countries have with drug companies come at our expense. Say we did the same thing with drug companies? What do the drug companies do? They surely will do something to maintain their profit margins and try to keep R&D going.

I hate states like per capita spending. You can't just throw that out. You have to look deeper and understand why they are lower or higher.

[gstelmack]

Originally Posted by Galaxy

Let me ask you this, how exactly do you lower costs without sacrificing care standards (and the quality of care we do have)?

You get rid of the inefficiencies in paying for healthcare. Right now we pay lots of people at insurance companies and in doctor's offices to manage claims. If you can streamline that, you can save costs.

Medical malpractice is another area were costs could be saved. Also keep in mind that malpractice leads to unnecessary tests being ordered to cover all bases.

We could also cut out all the TV advertising drug companies are spending billions on

The big giant question is whether or not the government can do that while expanding the number of people covered.

[Galaril]

Beck and a caller "discussing" health care reform. Wow Beck pulled a Jack Nicholson. Good stuff regardless of your view on this:

The Buzz Log - Get Off Glenn Beck's Phone! - Yahoo! Buzz

[Galaxy]

Originally Posted by gstelmack

You get rid of the inefficiencies in paying for healthcare. Right now we pay lots of people at insurance companies and in doctor's offices to manage claims. If you can streamline that, you can save costs.

Medical malpractice is another area were costs could be saved. Also keep in mind that malpractice leads to unnecessary tests being ordered to cover all bases.

Wouldn't you need a total reform in the insurance, Medicare/Medicaid, and non-insurance people to get reduce claims?

The question is, how much of a reduction in savings would those things bring?

[gstelmack]

Originally Posted by Galaxy

Wouldn't you need a total reform in the insurance, Medicare/Medicaid, and non-insurance people to get reduce claims?

The question is, how much of a reduction in savings would those things bring?

On the first question, yes. On the second, no idea.

Frankly the problem is so many issues are intertwined here. Is all we're after healthcare for all? Then that's just expanding Medicare/Medicaid. If we're after healthcare reform, that's a MUCH bigger picture, including things like:

• Combine Medicare/Medicaid and expand to cover all.
• Split the FDA. Put food safety oversight into Department of Agriculture, and drug oversight into the new Department of Covering Everybody or whatever and expand it to do oversight of all medicine. Someone needs to track how well doctors and hospitals are doing. This should include transparent publication of things like infection rates.
• Streamline the claims process. Better to have someone doing regular inspections to check for fraud than have the detailed breakdown and difficulty of submitting claims and having them paid that we do now.
• Medical research should be included here and perhaps beefed up to cover the big issues that are resulting in claims.
• Get rid of marketing departments at drug companies. Not only do we save money on ads, we get rid of all the freebies to doctors to prescribe certain medications that aren't necessarily in the best interests of the patient.
• Now that everyone is covered, we don't have to worry about the price of meds at pharmacies being different depending on whether or not you have insurance or which provider you happen to be with. It's all government-subsidized anyway now, so much easier / simpler for both the patient and the pharmacy to fill a prescription.
• Now that everyone is covered, we can turn folks away from emergency rooms for the sniffles. Or at the least the triage nurses can direct folks to appropriate places within the hospital to help true emergencies get emergency treatment in a timely manner.

Now, given the issues at the VA and various mental health facilities (especially locally) I doubt government-run healthcare will really make any of this better, but the topics are worth discussing because we have real problems in all of those areas.