Health Care Reform - Universal/Public Option

[RainMaker]

Originally Posted by Arles

So, I'll have to pay a higher tax rate to get "public health care". Then, I will find the quality of care is much lower than I am used to so I will have to hope my company continues to offer a private option so I can pay for that as well. If they don't, not only will I be paying higher taxes, but I will be paying more in premiums to find an independent broker to get me private insurance like I was self employed.

Hard to find fault in this plan...

Private insurance would be much cheaper since the public plan handles most basic health issues. This would act as a supplementary plan for those who don't want to have to wait.

Not sure how that's different from any other service in this country that is public/private. We all pay for police protection in this country but have to pay extra for private security if we want someone posted outside our house all night.

[RainMaker]

Originally Posted by Arles

If not wanting to wait 2 months for cancer surgery and 4 months for orthopedic surgery makes me a cold-hearted ass, guilty as charged.

You don't have to wait. You have every right to go to a private doctor and get the surgery.

[Arles]

I'm not against the principle of a private/public setup. I just wish the public part can be kept as small and targeted as possible. We have solid coverage options for over 90% of people in the US. I think baby steps taken to try and get that to 92%, then 94% and so forth is a good first step. Then, once coverage options are defined, we can start looking at what aspects of our current health care system lead to cost issues and tackle them individually.

In the end, I fail to see why a major public initiative is needed to start this process.

[RainMaker]

Originally Posted by Arles

I'm not against the principle of a private/public setup. I just wish the public part can be kept as small and targeted as possible. We have solid coverage options for over 90% of people in the US. I think baby steps taken to try and get that to 92%, then 94% and so forth is a good first step. Then, once coverage options are defined, we can start looking at what aspects of our current health care system lead to cost issues and tackle them individually.

In the end, I fail to see why a major public initiative is needed to start this process.

The problem is that a public initiative probably wouldn't have been needed if politicians had stood up for people over the last couple decades. They've let doctors, insurance companies, and drug companies build a system that is beneficial to themselves while fucking the consumer. Like a giant circle jerk between themselves while we just sit in the middle.

Now what this did was just piss off a lot of people in this country. Just about everyone has a health care horror story. Everyone is seeing their costs skyrocket. So when they get fed up, they just point the other direction and say "let's try that". The system seems like such a clusterfuck right now that just blowing it up feels best.

Not saying that's right, but I do know that our current system is pretty fucked and can't sustain itself for much longer. There are a lot of good ideas put out in this thread to help fix it and I have a feeling if some of those had been implemented 10 years ago or so, we may not have this sour taste in our mouth about the health care industry.

[fpres]

From the Texas Medical Association (July 17, 2009)...

http://www.texmed.org/Template.aspx?id=7557

The guiding principles the select committee developed are:

1. Promote portable and continuous health care coverage for all Americans using an affordable mix of public and private payer systems.
2. Promote patient safety as a top priority for reform, recognizing an effective mix of initiatives that combine evidence-based accountability standards, committed financial resources, and rewards for performance that incent and ensure patient safety.
3. Adopt physician-developed, evidence-based tools for use in scientifically valid quality/patient safety initiatives that incentivize and reward the physician-led health care delivery team, and include comparative effectiveness research used only to help patient-physician relationships choose the best care for patients.
4. Preserve patient and physician choice and the integrity of the patient-physician relationship.
5. Incorporate physician-developed, evidence-based measures and preventive health and wellness initiatives into any new or expanded health benefit package as a means to promote a healthier citizenry.
6. Recognize and support the role of safety net and public health systems in delivering essential health care services within our communities, to include essential prevention and health promotion public health services.
7. Support the development of a well-funded, nationwide emergency and trauma care system that provides appropriate emergency and trauma care for all Americans.
8. Support public policy that fosters ethical and effective end-of-life care decisions, to include requiring all Medicare patients to have an advance directive that a Medicare enrollee can discuss as part of a covered Medicare visit with a physician.
9. Provide sustainable financing mechanisms that ensure the aforementioned affordable mix of services and create personal responsibility among all stakeholders for financing and appropriate utilization of the system.
10. Invest needed resources to expand the physician-led workforce to meet the health care needs of a growing and increasingly diverse and aging population.
11. Provide financial and technological support to implement physician-led, patient-centered medical homes for all Americans, including increased funding and compensation for services provided by primary care physicians and the services provided by non-primary care, specialist physicians as part of the patient-centered medical home continuum.
12. Through public policy enactments, require accountability and transparency among health insurers to disclose how their premium dollars are spent, eliminate preexisting condition exclusions, simplify administrative processes, and observe fair and competitive market practices.
13. Reform the national tort system to prevent nonmeritorious lawsuits, keeping Texas reforms in place as enacted by the Texas Legislature and constitutionally affirmed by Texas voters.
14. Abolish the Medicare Sustainable Growth Rate annual update system and initiate a true cost of practice methodology that provides for annual updates in the Medicare Fee Schedule as determined by a credible, practice expense-based, medical economic index.
15. Support the implementation of an interoperable National Electronic Medical Records System, financed and implemented through federal funding.
16. Require payers to have a standard, transparent contract with providers that cannot be sold or leased for any other payer purposes without the express, written consent of the contracted physician.
17. Support efforts to make health care financing and delivery decision-making more of a professionally advised function, with appropriate standard setting, payment policy, and delivery system decisions fashioned by physician-led deliberative bodies as authorized legislatively.

[lynchjm24]

Originally Posted by flere-imsaho

Look, I mean this in the nicest way possible, but I think you're biased here.

Oh I'm biased. I don't deny that for a second. I make a lot of money and I'd to use that money to take care of my wife and daughter. I paid over $100k in taxes last year between the feds, the state and my town and I'm not looking to increase that number.

You guys that think your 'elected officials' are looking out for anyone but themselves, I feel sorry for you. Let the Chris Dodd's of world spend your great grandchildren's money so he can run for President. I'm not interested in allowing that without a fight.

[lynchjm24]

Originally Posted by RainMaker

That's not necessarily true. If you stay at a hospital for an extended period of time, the insurance company will try to get you out faster. They will threaten to not pay for extra days or set a predetermined number. I dealt with this on my own when my insurance company stated they wanted me out on a certain date while the surgeon wanted me to wait since he was worried about an infection. New Mothers are being pushed out of the hospital much faster than they ever have been against the advice of doctors.

My Mom was on a regular dose of Humira every month which costs around $1500. Her doctor who is one of the leading voices in the entire world on Psoriatic Arthritis wanted her to double the dose as he had had exceptional results with it with other patients. The insurance company refused to pay for the second dose and we had to cover it out of pocket for about 4 months until upon numerous appeals and calls, they reversed their decision. She never got reimbursed on the $6000 dished out for a treatment a top doctor in that profession prescribed that worked wonders on her.

Now maybe I've just had bad luck, but I do know this happens a lot. There are stories everywhere about insurance companies pushing for shorter stays, less drugs, and less tests. It's a completely fucked up industry as it's not in the best interest of your insurance company for you to get the best treatment possible. They are better off if you go home early from the hospital and die than to stay an extra two days under supervision of medical professionals. That has to be an area of the insurance industry that must be fixed. The doctors are in charge, not the insurance companies.

In the same vain, doctors do take advantage often times and do unnecessary tests. As I stated earlier, a doctor who owns his own MRI machine is 4 times more likely to use it. There has to be some enforcement of doctors as well.

What the fuck do you think the government is going to do? Let you stay in the hospital for months on end?

Do you not get that insurance companies actually attempt to figure out what the most cost effective way of treating people is? Do you really believe that your doctor doesn't do things that maximize their revenue and that everything they do is in your best interest?

Do you really think the insurance company hasn't studied the incidence rates for infection and knows what percentage of people need to be readmitted?

Do you really believe the best doctors are going to take what the government dictates as reimbursements? All of a sudden the doctors who don't contract with insurance companies are going to sign up to take less money from the government?

It's pretty simple. IF YOU HAVE COVERAGE NOW THERE IS NO WAY IT'S GOING TO BE BETTER IF THE GOVERNMENT PROVIDES IT.

Zero. Fucking. Chance.

[lynchjm24]

Originally Posted by RainMaker

It's based on necessity though. If you needed immediate brain surgery to stop a clot, you'd get it. If you have a bum shoulder that you need a minor surgery for, you're going to wait a few months (depending on where you live). It sucks, but it's also the price you pay to have everyone covered and not have to deal with begging your insurance company to pay their share months down the road.

Does anyone have a definitive wait time on US and surgeries? The study is from the first doctor visit till the procedure. In the U.S, minor issues can take a long time too between initial visit, testing, some less invasive options, and finally the surgery. I'd be curious to see how it compares to our time table (which I'm guessing is shorter on average, though much more expensive).

It's also worth noting that if you have the money, you can get the procedure done privately. You are in now way forced to go the government route. I'm a fan of the public/private hybrid.

No one in this country is going to wait 18 weeks for surgery.

Pretty much in the US you get operated on when the swelling goes down.

Great a public/private hybrid. Do I get to tell the people I'm subsidizing to stop smoking and eating at Wendy's? They can wait 18 months for surgery, I'm getting my shit fixed ASAP.

[Swaggs]

Originally Posted by Eaglesfan27

I'm trying to remember, is your wife a psychiatrist? I was offered a very similar deal when I first finished residency, but it did not appeal to me either. One of the most satisfying things for me is that patients come to the public clinic I work at and almost always say, "I can't believe how much more time you spent with me than Dr. [on of a few local private child psychiatrists] and how much better you are getting to know my child." I don't trust myself not to fall to the pressure of constantly trying to see more patients if I wasn't working at a state clinic, which makes me hope that this system doesn't get screwed up any time soon. Oh yeah, almost every single child psychiatrist in this area doesn't take any insurance and they are all generally thriving. However, as others have mentioned, many doctors make an amount that is low and would surprise people. I haven't looked at the numbers recently, but I think the average pediatrician still makes under 6 figures or in the very low 6 figures.

My wife is a child and adolescent psychiatrist, too. I think she is much happier in this environment than if she had taken the position at the private clinic (at the direction of the administrator, she spoke to another "younger" physician that had taken a similar position at that clinic and she heard nothing but horror stories, w/ the girl telling her that she was currently interviewing for new jobs b/c of how bad it was).

I think that, if we had stayed in the Raleigh-Durham-Chapel Hill area, she could have easily opened a practice w/o accepting insurance, and she would have done very well. Around here, there is not enough wealth/population to risk it.

[RainMaker]

Originally Posted by lynchjm24

What the fuck do you think the government is going to do? Let you stay in the hospital for months on end?

Do you not get that insurance companies actually attempt to figure out what the most cost effective way of treating people is? Do you really believe that your doctor doesn't do things that maximize their revenue and that everything they do is in your best interest?

Do you really think the insurance company hasn't studied the incidence rates for infection and knows what percentage of people need to be readmitted?

Do you really believe the best doctors are going to take what the government dictates as reimbursements? All of a sudden the doctors who don't contract with insurance companies are going to sign up to take less money from the government?

It's pretty simple. IF YOU HAVE COVERAGE NOW THERE IS NO WAY IT'S GOING TO BE BETTER IF THE GOVERNMENT PROVIDES IT.

Zero. Fucking. Chance.

A doctor should have the final say in your treatment, not an accountant at an insurance company. They are the ones who went to medical school for years and have the experience to diagnose and treat you.

I'm sure doctors do try and milk it, just as insurance companies try and cut back on procedures to save a buck. Both are wrong and both should be regulated by the government. An insurance company is just going to play percentages. They don't care about the patient. If it's more cost effective for them to have 5% of patients come down with life threatening infections because they were sent home early, they'll do it.

[RainMaker]

Originally Posted by lynchjm24

No one in this country is going to wait 18 weeks for surgery.

Pretty much in the US you get operated on when the swelling goes down.

As I've said a dozen time sin this thread, you don't have to wait for anything. You have every right to see a private doctor and get the surgery as fast as they'll let you.

Originally Posted by lynchjm24

Great a public/private hybrid. Do I get to tell the people I'm subsidizing to stop smoking and eating at Wendy's? They can wait 18 months for surgery, I'm getting my shit fixed ASAP.

I don't drive to work or use major highways at all, so why should I have to pay taxes that go toward the building of roads? Why should I have to pay for a fire department when I don't start fires? Why should I have to pay for a police department when I rarely ever need one when others use them a lot?

Our society isn't an ala carte system. We don't get to pick and choose what services we use and like and then decide to only pay for those.

[lynchjm24]

I had some posts eaten by the database errors, but I'm just going to let it go.

You are ignoring some pretty simple facts such as the things that people hate about insurance companies are still going to exist, and most of us are going to spend more and get less... and somehow you think that is better.

[Arles]

Originally Posted by lynchjm24

most of us are going to spend more and get less... and somehow you think that is better.

This is pretty much the crux of the argument for me. In a public/private hybrid, I'm sure some people will have better coverage (I would contend many already have access to coverage, but don't know). But everyone currently housed in an insurance plan (around 90% of the country) will pay more to get less.

I think there's a ton of guilt in the healthcare area that's being exploited. No one likes to hear about a person laid off who doesn't have good health care options or a person in poverty without decent health care options. So, they decide to look at a public system to make sure the two above cases don't happen. We will never be able to properly cover 100% of people at current quality of care we expect - it's a pipe dream. Now, we can improve coverage for people without good options through new plans for poverty/recently unemployed - but they quality will not match that of someone working at a 70K a year job with good benefits.

Instead of worrying about things difficult to control, let's focus on solving the problem (increasing coverage options for the 25-40 million without health care). In the end, we still may end up with 20 million people still not covered, but atleast most will have options for basic care. Then, we can start looking at the cost for everyone and picking away at issues there.

[RainMaker]

Originally Posted by Arles

This is pretty much the crux of the argument for me. In a public/private hybrid, I'm sure some people will have better coverage (I would contend many already have access to coverage, but don't know). But everyone currently housed in an insurance plan (around 90% of the country) will pay more to get less.

Where are you getting the number that 90% of the country has insurance?

[Arles]

Originally Posted by RainMaker

Where are you getting the number that 90% of the country has insurance?

There are numerous sources for this, but here's one to read:

RealClearPolitics - How To Lie With Statistics -- Again

It is true that the 46 million figure is based on unreliable Census Bureau data. But even the less unreliable Congressional Budget Office puts the number at about 31 million. And even that number, former CBO Director Douglas Holtz-Eakin claims, is an "incomplete and potentially misleading picture of the uninsured population."

For one reason, the uninsured figure counts all Americans (and illegal immigrants) who have been uninsured for any amount of time during a year, even if they happen to be between jobs or changing insurance plans or on family visits to Guatemala.

According to the CBO, 45 percent of the uninsured are uninsured for four months or less, which seems like a pretty positive number to me.

Then, another portion of uninsured Americans already qualify for existing government health insurance programs -- and government already controls 46 percent of spending on health care -- for which they have not signed up.

The CBO estimates that as many as 15 percent of the chronically uninsured are already eligible for help. The Urban Institute (hardly an advocate of free market fundamentalism) found that 25 percent of the uninsured qualify for some program.

Surely, most citizens would concur that health care is too expensive (though most citizens likely would concur that everything is too expensive) and something should be done. So when President Obama tells us that 46 million Americans are uninsured, he is implying that 46 million people can't afford health insurance. That, too, is absurd.

In a study for the National Bureau of Economic Research called "Is Health Insurance Affordable for the Uninsured?," Stanford economists say, "Based on a plausible range of definitions and assumptions health insurance is affordable for between one quarter and three quarters of adults who are not insured."

Turns out that 8.4 million uninsured Americans are making $50,000 to $74,999, and 9.1 million more are making more than $75,000. Health insurance is just incompatible with their lifestyles, I guess.

In essence, you start with 46 million per the CBO (~14+ percent). Then you factor in that 15-25% are eligible for existing insurance but haven't signed up for some reason (don't know they qualify - probably). Next, you have another 20% of uninsured making over 75K and 17% making 50-75K. Even if you just count those eligible for existing programs and those making over 100K, you are down to around 30 million people (in a country of 300 million). And that's not even counting the fact that 12 of the remaining 30 million end up without insurance for a period of less than 4 months.

That's why I use the 10% number for those without insurance options. And that's also why I think a great first step would be to seek out those without insurance (who qualify) and make an effort to enroll them while also extending insurance benefits for 2-3 months for those who loose their jobs. By the data I've seen in the CBO and numerous outlets, those two action would reduce the number uninsured from 46 to around 20 million.

According to a CBO estimate last week, the Senate health committee's proposal would cost $611 billion over 10 years and add less than 5% of current uninsured to the insured group:
Health Care Reform and the Public Health Plan - Health Blog - WSJ
Health-Care Overhaul Goals Prove Challenging - WSJ.com

I'm guessing that educating the 9-10 million people who qualify for existing programs for coverage and don't know combined with adding a 2-3 month buffer on unemployment insurance would cost a lot less than $600 billion - and (per the CBO numbers, as well as other outlets) it would cover over double (almost triple) the uninsured that the current bill would do.

[RainMaker]

Are people on only Medicare considered having health insurance?

[lynchjm24]

Of course people on Medicare are considered having insurance.

Here is a blurb from Friday's stories:

The director of the nonpartisan Congressional Budget Office said Thursday that the health care legislation proposed so far would not curb the federal government's runaway spending on medical care, and that lawmakers would need to take more forceful action to meet President Obama's goal of controlling costs.

The testimony by the director, Douglas W. Elmendorf, before the Senate Budget Committee drew criticism from Democratic leaders, highlighting their rising frustration over the difficulty of paying for an overhaul.


The government-run health plan is among the components of the health care legislation that Mr. Elmendorf suggested did not have sufficient muscle to slow the federal spending on health care, which he called ''unsustainable.''

''In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount,'' Mr. Elmendorf said. ''And on the contrary, the legislation significantly expands the federal responsibility for health care costs.''

Under the bill, the government plan would initially pay health care providers at rates pegged to Medicare rates, which are on average lower than what private insurers pay. Some Democrats joined Republicans in objecting to this provision.

Representative Earl Pomeroy, Democrat of North Dakota, said: ''I have a serious problem with the public plan in this bill because it's based on Medicare rates.''

[JPhillips]

Shorter Rep. Pomeroy: This plan is too expensive and I oppose efforts to make it less costly.

[Raiders Army]

Pick any two: fast, good, and cheap.

That's the problem with the health care bill.

Also, where are all of these additional health care providers going to come from so our quality and quickness of service doesn't go down?

[flere-imsaho]

Originally Posted by JPhillips

We're not risking that because no bill is proposing a single payer system.

As much as I'd like a single-payer system, and as much as I think it would be a net benefit to society, I know it's not going to happen in the U.S. anytime soon, perhaps ever because a) I just don't see Americans changing their mindset strongly enough from "every man for himself" and b) the forces arrayed against it are just too great.

Obama's proposals of a public option and filling the gaps are very good, though, and perhaps the best we can expect.

Originally Posted by CamEdwards

It's an interesting column, but the fact remains that the phrase "rationing your health care" sounds like a bad freaking idea to the tens of millions of Americans who are already insured. It may be cold-hearted of them, or short-sighted of them, but it's also a fact.

Insurance companies already ration health care. The fact that most Americans don't want to wake up to this fact is just yet another example of our collective obliviousness. A few of you guys need to start to read the fine print on your insurance agreements.

[flere-imsaho]

Originally Posted by lynchjm24

I had some posts eaten by the database errors, but I'm just going to let it go.

Good choice. You've been displaying an unexplainable amount of vitriol on this topic, and it's not doing your credibility a lot of good.

[flere-imsaho]

Originally Posted by lynchjm24

It's pretty simple. IF YOU HAVE COVERAGE NOW THERE IS NO WAY IT'S GOING TO BE BETTER IF THE GOVERNMENT PROVIDES IT.

Zero. Fucking. Chance.

Calm down. Those of us who want health care reform want it mostly for the large number of uninsured, underinsured or uninsurable people in America. We're under no illusions that, if we already have a decent plan, it's somehow going to get better.

You know what I think your problem is? Given your statement on the amount of money you make I suspect you have a terrific health care plan, because you can afford it. And so you, like so many who can't see the need for health care reform, can't understand why it needs reform when it works out so well for you.

It's like Arles' suggestion that 90% of the people have access to OK health coverage. It's simply not true, in the slightest.

[albionmoonlight]

Hmmm.

I think that (1) Something will pass. The President has basically staked his credibility on doing "something" in regards to health care, and with a House and 60 Senators who like having a popular Democrat in the White House, some stack of papers called a health-care bill will go through Congress and get signed by him and become a law. See, e.g., Schoolhouse Rock.

I also think that (2) it won't be a good law. As the push to make a law gets stronger and stronger, too many good ideas (taxing employer provided health care to pay for it; doing something to control costs) are getting left on the floor and too many bad ideas (not acknowledging that real reform will require some drastic short-term changes and costs on people other than "the rich;" keeping people locked into employer-provided health care) are getting put into the law.

I agree that something needs to be done. I just don't think that what appears to be coming will end up being a good thing. Will it be better than doing nothing? I think so. What we have right now--way too expensive health care that still manages to leave a lot of people uncovered--is really really bad. But that's a pretty low bar for reform to hurdle. Instead of comparing what we will get to what we had, I think that I will compare it to what we could have gotten, and end up a little sadder at the end of the day.

This is subject to change, of course, b/c I really am still trying to learn about the issue.

[JPhillips]

I think the public option is the key. With it there's a chance that costs can be controlled, without it there's no mechanism to slow the growth of spending, both private and public, on healthcare. A bill without a cost reducing mechanism isn't worth doing, IMO.

[albionmoonlight]

Originally Posted by JPhillips

I think the public option is the key. With it there's a chance that costs can be controlled

How? I've seen this explained and refuted and whatnot. But always in some oblique way. How does the public option control costs? What incentives will it have to be more cost-effective than private insurance? (Or is that even the right question?)

[JPhillips]

Originally Posted by albionmoonlight

How? I've seen this explained and refuted and whatnot. But always in some oblique way. How does the public option control costs? What incentives will it have to be more cost-effective than private insurance? (Or is that even the right question?)

1) Less overhead. Medicare runs at about 3% overhead while private insurance is well into double digits.

2) No profit needed for shareholders/executives.

3) Reimbursements will be at Medicare rates instead of private insurance rates.

These are all without any savings from preventive care, which really has more to do with getting people insured rather than cost reducing mechanisms.

I believe the public option, if well done, can achieve savings, but it doesn't have to be an all or nothing approach. Give it a few years and see where things stand and if it isn't working convert the plan to vouchers for private insurance, hell it might even be worth it to start with equivalent vouchers if private insurance companies will accept them.

I think the fear that if we do something our healthcare system will be third world in a few years is way overblown.

[CamEdwards]

Originally Posted by flere-imsaho

As much as I'd like a single-payer system, and as much as I think it would be a net benefit to society, I know it's not going to happen in the U.S. anytime soon, perhaps ever because a) I just don't see Americans changing their mindset strongly enough from "every man for himself" and b) the forces arrayed against it are just too great.

Obama's proposals of a public option and filling the gaps are very good, though, and perhaps the best we can expect.



Insurance companies already ration health care. The fact that most Americans don't want to wake up to this fact is just yet another example of our collective obliviousness. A few of you guys need to start to read the fine print on your insurance agreements.

You're right, they do. But that's the devil people know, as opposed to the devil people don't. I wasn't saying it was particularly rational, only that it's going to be tough to sell government-rationed health care.

[flere-imsaho]

Originally Posted by CamEdwards

You're right, they do. But that's the devil people know, as opposed to the devil people don't. I wasn't saying it was particularly rational, only that it's going to be tough to sell government-rationed health care.

We're in 100% agreement here.

[CamEdwards]

An interesting article in Ad Age discussing the possibility of our airwaves being consumed by this debate in August.

Obama Wants to Avoid Health-Care-Reform Ad War - Advertising Age - News

Also of interest from the story.

Just 40% of voters are for the 1,018-page health-care bill introduced by the House Ways and Means Committee on July 14, according to a recent study by Zogby International in conjunction with the University of Texas Health Science Center at Houston. That study also revealed that while four in five Americans agree that mounting health-care costs are hurting businesses, they have not reached consensus on how to raise funds for the estimated $1 trillion over the next 10 years that reform is expected to cost.

I left out the next paragraph because it quoted RASMUSSEN!!

[flere-imsaho]

Originally Posted by CamEdwards

An interesting article in Ad Age discussing the possibility of our airwaves being consumed by this debate in August.

Makes sense, given that August is usually a slow news month anyway....

I left out the next paragraph because it quoted RASMUSSEN!!

PARTISAN HACK!!!!11ONEONEoneone

[RainMaker]

Originally Posted by lynchjm24

Of course people on Medicare are considered having insurance.

That's a bit of a problem then. Medicare sucks and you really need a supplementary plan to go along with it to get quality health care.

[Arles]

Originally Posted by flere-imsaho

It's like Arles' suggestion that 90% of the people have access to OK health coverage. It's simply not true, in the slightest.

Pretty compelling argument. The reality is that of the 46 million uninsured referenced in the CBO, 9-10 million have options and just don't know. Another 9 million make over 75K and have the cash to pay for a brokered health care plan (like my dad does). Now, maybe you don't think the lower private plans equate "OK" coverage, but they're certainly on par with what anyone would receive in a public plan.

Just check out Massachusetts for an example of how public does not equal better.

It costs more (not less):

Healthcare cost increases dominate Mass. budget debate - The Boston Globe

Over the next three years, the Patrick administration has projected, Commonwealth Care will double in size and cost. Some analysts suggest that the cost projections, produced last fall, may have been inflated in an attempt to get more funding.

Spending on other components of healthcare reform are expected to decline over the next few years, but probably not enough to pay all the bills.

Meanwhile, healthcare costs statewide are rising by about 10 percent a year. A council established by the health reform law has developed some proposals to reduce cost growth, and several bills are pending in the Legislature. But the task is daunting.

"Expanding coverage is easy compared to controlling healthcare costs," said Nancy Turnbull, a Commonwealth Health Insurance Connector board member and associate dean at the Harvard School of Public Health. "Nobody has to give much up to expand coverage, but in controlling cost there will always be losers."

Puts more stress on doctors and increases wait times:

http://www.physicianspractice.com/in...197/page/4.htm

But patients and physicians are discovering that access to insurance doesn’t always equal easy access to care. The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked, overstressed primary-care physicians who were in short supply in Massachusetts (as elsewhere) even before the legislation.

Patricia Sereno, a primary-care physician in Malden, points out that “in other countries with universal coverage, they have extensive networks of PCPs. We don’t have that. We have a shortage of PCPs and have to find a way to build the PCP base to make this work.”

The newly insured are waiting as long as 10 months for a new-patient or well-patient appointment, when they can find a primary-care doctor willing to accept new patients at all. Physicians are feeling the pressure, too. “I’m now seeing 24 patients a day, and it’s a heck of a lot busier than it used to be,” says Sereno. “But the patients are being squeezed on all ends — they can’t find a doctor, they have to wait, then, when they finally get to come in, they come with a list of 10 things to address, and yet they are not getting the time with a physician that they used to.”

The increase in patient load and paperwork has become so stressful that some primary-care physicians are choosing other paths, opting out of office-based medicine for jobs as ER docs and hospitalists, says Magee.

And that’s not all. “There are a number of PCPs between 50 and 65 years old who are considering retiring early because of the increased stress,” says family physician Dennis M. Dimitri, president of the Massachusetts Academy of Family Physicians. “We need to work to retain the PCPs we have by making sure people don’t leave because of the difficult environment in which they are practicing — low reimbursements, heavy patient loads, and administrative details having to do with insurance requirements for getting paid.”

And the current problem we have of people eligible not registering (~9 million nationwide) remains with even more serious consequences on our ERs and safety net hospitals:

Safety net hospitals strained by reform - The Boston Globe

Officials at many so-called safety net hospitals said that as the new system - which requires all residents to buy health insurance - phases out payments for free care provided to the uninsured, hospitals are facing budget shortfalls and have been forced to cut back on investing in new equipment.

"This is a very serious concern for hospitals that provide bread-and-butter healthcare services," said Ellen Murphy Meehan, executive director of the Alliance of Massachusetts Safety Net Hospitals, a trade group. "This has put the safety net hospitals in critical condition."

At the center of the problem, said Meehan, has been relatively slow enrollment in Commonwealth Care, the state's new subsidized insurance plan for those who can't afford commercial health plans.

She and several hospital executives said a large percentage of patients at safety net hospitals remain uninsured, despite the law.

At the end of the day, care quality has decreased (esp for lower income), wait times for doctors have increased and the cost for health care has significantly increased . And what was the net result? Mass went from having 9% uninsured to 5% uninsured.

Sure looks like a well-worth effort to me. Mass was saved by a massive federal bailout of $1.5 billion, who's going to bail out the federal government when these same issues happen nationally?

The reality is that we lack the medical infrastructure (not enough primary care physicians), cost structure, patient expectation (rationing, wait time) and massive amounts of initial cash needed to setup an environment where this system has a chance of working. What we are doing now in Mass (and with parts of Obama's plan) is akin to taking a Diesel truck, investing $1 million in new tires/engine and then hoping we can win a Nascar race to pay back our investment. It's a fool's errand and the signs are everywhere for those willing to look. Until we make drastic changes in how private health care operates (from doctor professions and cost to a process to ensure enrollment plus more changes), a public effort is doomed to failure.

[albionmoonlight]

FiveThirtyEight: Politics Done Right: Rumors of the Demise of ObamaCare Have Been Greatly Exaggerated

The beltway consesnsus seems to be that the Democrats' prospects of passing meaningful health insurance reform this year have become much slimmer, if they haven't already entirely evaporated. Like Ezra Klein, however, I'm not really sure what everyone was expecting. There is a lot of money -- and political capital -- at stake here. Were opponents of health care reform going to roll over and play dead? Has anything proceeded that differently from how we might have expected it to proceed ahead of time?

Over at Intrade, the bettors currently assign a 43 percent chance that a health care bill with a public option will be passed by the end of the year. There is no market, unfortunately, on the prospects for passage of a bill without a public option (something which could still happen under any number of scenarios). What's interesting about this contract, though, is that it's not particularly higher or lower than it has ever been. Sure, health care has had a bit of a rough go of things of late, but perhaps not a particularly rougher go than we should have been "pricing in" to our expectations:



I had argued previously that Obama should have done more to frame the debate and put a particular health care bill in front of Congress, rather than letting Congress handle it themselves. Maybe health care would be in a little bit better shape right now if he had done that and maybe it wouldn't; we'll never really be able to test the counterfactual. But because he didn't do that, Obama still has most of his tactical flexibility intact. And there are at least four scenarios under which health care reform could still pass this year:

1. Whip Democrats Into Submission. This is probably the closest thing to the default approach. So long as there are a dozen or a half-dozen different iterations of health care floating around Capitol Hill, individual Democratic Congressmen can afford to bargain for their preferred version. "Progressive" Democrats from rich districts can object to the plan of raising taxes on the very wealthy to pay for expanded coverage. Labor-backed Democrats can try and play hardball on any proposal to remove the benefits tax exemption. The Blue Dogs can howl at the moon for whatever it is they want -- probably some kind of sweeteners for rural districts, like the ones given to farm-state Democrats on the climate bill. And advocates of the public option can continue to treat it as a sine qua non and threaten to oppose any bill that doesn't include one.

Once a particular bill is put up to a vote, however, the overwhelming majority of Democrats are going to have a difficult time voting against it. Health care reform remains quite popular in theory and at least marginally popular in practice. It will probably do the most good for those districts where conservative Democrats tend to reside.

And then there is the oldest motivator of all: survival. The failure of health care reform in 1994 may have damaged Bill Clinton -- but it really damaged the Congressional Democrats, who lost 54 seats in the House and another 8 in the Senate. Of the 36 incumbent Democrats who lost that year, only four (North Carolina's David Price, Ohio's Ted Strickland and Washington's Maria Cantwell and Jay Inslee) would ever return to the Congress (whereas Clinton, of course, was re-elected). Any Democrat who votes against health care, moreover, can expect to be permanently shut off from the Obama-run DNC and from most or all grassroots fundraising drives, and many of them can probably expect a primary challenger.

There are probably some Democrats who would be better off if health care went away. But once it comes up to vote, I'd imagine there will be very few who are actually better off voting against it.

2. Reconciliation. This is not necessarily mutually exclusive with the other scenarios, but Obama could try and use the reconciliation process to pass health care, which would mean Republicans would lose the ability to filibuster in the Senate and Democrats would need only need 50 votes for passage. This is risky: the extent to which the bill remained intact would depend upon the rulings of the obscure Senate Parliamentarian, and going through reconciliation would cause mayhem on the Hill with somewhat unpredictable political consequences. And it would certainly look overtly partisan -- especially now that Democrats have gained their 59th and 60th seats in the Senate. But if Obama decides that health care is too big to fail, reconciliation is an option.

3. Wyden-Bennett and Other "Bipartisan" Approaches.. I don't see any particular reason why the Administration couldn't press the reset button and push for a different sort of health care bill -- particularly Ron Wyden's, which already has a half-dozen Republican supporters. In fact, it might make Obama look somewhat good to "acknowledge the political realities" (yadda yadda) and adopt a more "bipartisan" approach. A lot of Republicans claim to support health care -- just not the particular approach being put forth by the Democratic Congress. Shifting gears, particularly to a bill like Wyden-Bennett that is strong on cost containment, would reveal many of them to be hypocrites, but probably also secure enough of their votes to make passage a likelihood.

4. Hope the Economy Gets Better (or Some Other Secular Change in Momentum). In general, I'm pessimistic about the state of the economy insofar as it will affect Obama's political capital. Even if the economy formally pulls out of a recession -- some economists think we're already out of the recession -- it will take some time before the employment picture turns around. The past week, however, has brought some relatively good economic news and the Dow is now hovering at about 8,800 points, around its 6-month highs. If the next monthly jobs report is better than expected, if the Dow somehow rallies past 10,000, or if the recession is declared over, that might give Obama a little bit of actual momentum which may be amplified by the Washington press corps, which by that point will have tired of the "Obama is melting!" storyline and may be looking to describe his "comeback" instead.

* * *

I'm not about to go out on a limb with some sort of prediction that health care is going to pass this year. It could very easily fail. But it's not going to fail without the White House fighting like mad for it, and with most or all of its options being exhausted. The fundamental weakness of the White House press corps is that they can rarely see beyond the current 24-hour news cycle -- there are still a lot of news cycles ahead before ObamaCare can be put to rest.

[Edward64]

A timeline for implementing the plan.

Health overhaul to take nearly a decade - White House- msnbc.com

The timeline, prepared by Democratic staff members, reflects the proposed expansion of government responsibilities. Here's a look at how some of the parts would unfold:

2010: The government sets up a Health Benefits Advisory Committee led by the surgeon general to recommend a basic benefits package. Community health centers serving low-income people get a funding boost. Insurance companies are barred from engaging in "rescissions" — the cancellation of existing policies. A campaign is launched to reduce health care paperwork. Doctors serving Medicare patients are spared a 20 percent cut in fees.

2011: The benefits committee unveils a recommended package for adoption by the Health and Human Services Department. HHS sets rules requiring insurance companies to spend a minimum percentage of premiums on medical costs. Medicare recipients get relief from the 'doughnut hole' coverage gap in their prescription benefits.

Tax hikes on upper-income earners take effect.

2012: In the presidential election year, low-income seniors get additional financial assistance with their Medicare prescription plans.

2013: The year of heavy lifting and major coverage changes. Insurance companies are barred from discriminating against people with health problems. The government opens the health insurance exchange — a new purchasing pool — to individuals and businesses with fewer than 10 workers. A government-sponsored plan is among the options available through the exchange, with premiums estimated 10 percent lower than private coverage. All plans in the exchange offer at least the basic benefits package. Individuals and families making up to four times the federal poverty level get subsidies to help pay for insurance. Individuals are required to get coverage — and employers to offer it — or face financial penalties. Businesses with payrolls under $250,000 are exempt from the mandate. Medicaid eligibility is expanded.

2014: The health insurance exchange is expanded to include companies with up to 20 employees and people who can't afford premiums under their employer's plan.

2015: The government decides whether to open the health insurance exchange — and the government-sponsored plan — to all employers.

2018: Employers who continue to provide coverage outside the exchange must offer at least the same basic benefits available through the government-regulated purchasing pool.

Also, interesting part on taxing the wealthy ...

First comes the pain. In 2011, the government would start collecting higher taxes on upper-income people to pay for the overhaul. The uninsured would have to wait until 2013 before they started receiving the benefits — after the 2010 and 2012 elections.

Collecting the taxes up front — and paying for the benefits later — would help to keep costs manageable over the 10-year window Congress uses for budget estimates. Still, it's not yet adding up. The Congressional Budget Office says the plan would increase the government's deficit by about $240 billion over that period. Long-range forecasts could turn out worse.

[molson]

So....

"The Congressional Budget Office says the plan would increase the government's deficit by about $240 billion over that period."

But...

"I want to be very clear: I will not sign on to any health plan that adds to our deficits over the next decade"

President Obama
Weekly Address
July 19, 2009

Obama's quote seems so wrong I think I must be misunderstanding something.

[RainMaker]

They should just tax it like they take Medicare. Everyone has to pay 3% toward health plan instead of the 1.5% to Medicare.

[Edward64]

Originally Posted by molson

So....

"The Congressional Budget Office says the plan would increase the government's deficit by about $240 billion over that period."

But...

"I want to be very clear: I will not sign on to any health plan that adds to our deficits over the next decade"

President Obama
Weekly Address
July 19, 2008

Obama's quote seems so wrong I think I must be misunderstanding something.

Lets not be too cynical right now and give him an opportunity to address the issue. I believe the CBO 'judgement' came out last week.

[molson]

Originally Posted by Edward64

Lets not be too cynical right now and give him an opportunity to address the issue. I believe the CBO 'judgement' came out last week.

Ooops - edited now but I should have said that Obama made that quote just a couple of days ago, on July 18, 2009.

I guess he's just making some kind super-optimistic prediction about the economy as a whole.

[Edward64]

Originally Posted by RainMaker

They should just tax it like they take Medicare. Everyone has to pay 3% toward health plan instead of the 1.5% to Medicare.

I was thinking that they should be able to leverage the $1-3T (take your pick!) overhaul and help alleviate Medicare oncoming disaster. I've not seen any analysis how/if the propose plan would help.

[Edward64]

Originally Posted by molson

Ooops - edited now but I should have said that Obama made that quote just a couple of days ago, on July 18, 2009.

I guess he's just making some kind super-optimistic prediction about the economy as a whole.

His statement is on record (and has been for several months). I only heard about the CBO projections last week. Lets see what the proposed revised versions before calling his character into question. He should be given an opp to revise.

[CamEdwards]

Originally Posted by Edward64

His statement is on record (and has been for several months). I only heard about the CBO projections last week. Lets see what the proposed revised versions before calling his character into question. He should be given an opp to revise.

This might be the funniest thing I've read on the board in months.

[lynchjm24]

Originally Posted by flere-imsaho

Calm down. Those of us who want health care reform want it mostly for the large number of uninsured, underinsured or uninsurable people in America. We're under no illusions that, if we already have a decent plan, it's somehow going to get better.

You know what I think your problem is? Given your statement on the amount of money you make I suspect you have a terrific health care plan, because you can afford it. And so you, like so many who can't see the need for health care reform, can't understand why it needs reform when it works out so well for you.

It's like Arles' suggestion that 90% of the people have access to OK health coverage. It's simply not true, in the slightest.

Actually my plan as far as employer plans go isn't very good. I've got an HSA with a $2,000 deductible.

I'll tell you exactly what my problem is. Being taxed to death by a legislature that thinks that it's ok to spend my money, my daughter's money and the money of the generations that come after. Their lack of foresight and their clear desire to serve themselves instead of the people of this country.

Do you think Chris Dodd cares if you have health insurance? Chris Dodd is clearly using this legislation to set himself up to run for President in 2016.

In this country it is very possible to fix your situation. Don't like your health insurance? 90% of the people who don't like their insurance have only themselves to blame.

Medicare isn't good enough insurance? For fuck's sake what is going to count as good insurance? 1 trillion dollars? If Medicare isn't good enough it's going to be 20 trillion dollars.

Even some of the shitheads in Congress have realized in the past few days that if Medicare dictates the reimbursements across the board there isn't going to be hospitals for people to stay in or doctor's to visit.

[lynchjm24]

Originally Posted by RainMaker

They should just tax it like they take Medicare. Everyone has to pay 3% toward health plan instead of the 1.5% to Medicare.

You'd make a great Congressperson. Just tax and spend. Better yet just tax the rich and spend. I'm sure that won't have any long term effects on the economy.

It would be wonderful if somehow people in this country were rewarded for being fiscally prudent with more then just paying higher taxes.

[lynchjm24]

Originally Posted by molson

"I want to be very clear: I will not sign on to any health plan that adds to our deficits over the next decade"

Obama's quote seems so wrong I think I must be misunderstanding something.

If he sticks to that he can't sign a health plan bill. Either the bill itself will be deficit spending, or the tax increases will help slow the economy which will lower tax receipts which will create deficit spending.

[RainMaker]

Originally Posted by lynchjm24

You'd make a great Congressperson. Just tax and spend. Better yet just tax the rich and spend. I'm sure that won't have any long term effects on the economy.

It would be wonderful if somehow people in this country were rewarded for being fiscally prudent with more then just paying higher taxes.

Tax and spend is better than borrow and spend. It's been 3 Republican Presidents who ran up this massive deficit. At least with taxing it like Medicare, everyone pitches in instead of just taxing the wealthy. Most people already pay a percent of their income on health insurance as it is.

[JPhillips]

Originally Posted by lynchjm24

Actually my plan as far as employer plans go isn't very good. I've got an HSA with a $2,000 deductible.

I'll tell you exactly what my problem is. Being taxed to death by a legislature that thinks that it's ok to spend my money, my daughter's money and the money of the generations that come after. Their lack of foresight and their clear desire to serve themselves instead of the people of this country.

Do you think Chris Dodd cares if you have health insurance? Chris Dodd is clearly using this legislation to set himself up to run for President in 2016.

In this country it is very possible to fix your situation. Don't like your health insurance? 90% of the people who don't like their insurance have only themselves to blame.

Medicare isn't good enough insurance? For fuck's sake what is going to count as good insurance? 1 trillion dollars? If Medicare isn't good enough it's going to be 20 trillion dollars.

Even some of the shitheads in Congress have realized in the past few days that if Medicare dictates the reimbursements across the board there isn't going to be hospitals for people to stay in or doctor's to visit.

RRAAAAAAAWR!

[Edward64]

Originally Posted by lynchjm24

If he sticks to that he can't sign a health plan bill. Either the bill itself will be deficit spending, or the tax increases will help slow the economy which will lower tax receipts which will create deficit spending.

Based on your stipulations, I would agree. However, I would be satisfied that he fufilled his claim by making it revenue neutral. He has said months ago that he would tax the wealthy (e.g. I think $250K+) and tax businesses that don't offer health insurance to offset the $1T.

[Edward64]

Originally Posted by CamEdwards

This might be the funniest thing I've read on the board in months.

Okay.

[Mizzou B-ball fan]

Originally Posted by Edward64

Based on your stipulations, I would agree. However, I would be satisfied that he fufilled his claim by making it revenue neutral. He has said months ago that he would tax the wealthy (e.g. I think $250K+) and tax businesses that don't offer health insurance to offset the $1T.

In the current economy, they're going to have to increase the tax on the wealthy just to match what they got before at a lower rate. Everyone's income is suffering at this point. There is a limit to what increasing taxes can do in a recession. The big drop in tax revenue this year is a big indicator of that.

[SportsDino]

I think Arles brought up a good point a few posts back... despite ever increasing expenditure on health (by percentage growth, raw volume of dollars, you name it)... the actual quality and quantity of health infrastructure has been in decline (or relative decline to demand).

This is something I've noticed and why I think the current health care system is completely broken. This market, with these attributes, should be booming under a self organizing private economy... instead it is stagnating.

At the lowest level I think this is because it is too obvious that the incentives for the source of money in the system (the health insurance providers) are completely misaligned. Not just with the patients' best interests, but worst, they are not aligned properly for the expansion of the health care industry (and have not been for years). Particularly troubling with this whole baby boom phenomenon they keep harping about in the news.

Just like with banks, just like with cars, the short term profit motive pushes the firms towards resource allocations that are suboptimal for the long term health of these companies, yet alone your medical health! This is encouraged by the way compensation mechanisms work at all these companies, and the trends prevalent in business 'thinkers' of the day.

My stance, despite loathing the private health care companies, is that this latest 'plan' does not solve the problem. It increases expenditure into a broken system, besides being a potential massive waste of money, so much money with so little intelligence behind it often has the tendency to flow to and promote the very problems that necessitated the need for reform in the first place.

Rather than giant sums of money tied to a parallel system that will just encourage trouble (namely, the chief cost control mechanism will likely be socialized prices which as mentioned by others has the potential to cause chaos in the supply of health care.... fixed prices in a supposed market economy ALWAYS cause chaos, but people keep misreading their Keynes and turn a blind eye...

...

Well that thought is just so mind boggling I lost track, but I know there has to be something better than 1 to 3 trillion being fed into a black hole engine (maybe it will suck down the problem, but either way it will suck down the money). I just can't stand the other side of the debate (sorry lynchjim) that acts like its not broken because they don't see past the 'rah rah capitalism' cheer line. Capitalism is hard work... that is how it helps economies to flourish, by causing hard work and the need for constant vigilance on changing market conditions and innovation to expand your individual wealth. Instead we have complacent, exploitation based, stagnation causing companies that have spent most of their time promoting increased litigation and bureacracy (I'm talking about the insurers here, their actions have grown those problems as much or more than anyone else).

They have invested in activities like denial of service, price collusion/fixing, and complex contract design to try and shave a few more pennies onto their margin, and although its hard to build the case that they would make more money if they had invested elsewhere... its easy to see if they piss off everyone so much that the entire private system is abolished or attacked, that they made a strategic mistake.

-----

Back to bolded statements though, sorry for the digression.

On numero 3, subsidy for providing health insurance. I believe the cost to benefit ratio would be higher than the same amount of dollars spent on a public system. The assumption is that generally health coverage is so overly complicated because those are the best fit plans on the market based on what companies are willing to pay... and my tendency to assume a company will cut corners on costs wherever possible... leads me to think that poorly designed but cheap plans would dominate.

My opinion is that those are ultimately bad for this economy, it encourages more expense on bureaucratic procedures, and less dollars in the hands of doctors and hospitals (which effects investment rates in those hospital and doctors, impacting the entire supply and demand equation).

I believe a massive subsidy, as long as it is tied to a stricter standard of health care packages, has the potential of creating a differentiated product in that market place that serves two goals. If companies are relatively cost neutral between two substitutes, one side involving a cheap cutt-throat health insurance plan, or one side involving a higher-quality government subsidized plan... they will generally tend towards the subsidized plan in order to get a fringe benefit of happier employees.

By setting that standard, something more in the realm of government bureaucracy's ability (IMO), the government impacts the make up of health care in this country in a more direct fashion than creating a big engine to provide that same standard... but being on the hook for the full expense.

So my theory is there is a much bigger lever in the toolbox than the one being considered, it can be used to encourage some private companies towards good behavior, and in my opinion market forces will take over from there to shake up the market away from a bad business model (charge high premiums and screw your customers as much as possible) to closer to where I think the model needs to be (charge higher premiums, because this shit is expensive, but don't screw your customers, and cut out bureaucracy as much as possible on the mainstream services).

The subsidy basically offsets this on the consumer side in a way that also allows employers to offer slightly more valuable compensation to employees, so we get a net benefit towards the middle class that often seems the last to receive anything from government programs (i.e. most dollars go to supporting the super rich, then the rest goes to the poor, the middle class is often left holding the difference in my opinion).

It does not directly impact raw insurance percentage I guess, although if the perception that no fuss health care takes hold I could see a small percentage of the 50K to 100K crowd going off the uninsured side and paying in. I think a lot of those people are just looking at what they are getting for what they are paying and saying 'no thanks', and if I wasn't getting it as part of my company I would probably be with them. I don't like the idea of paying a lot of money to someone and having to go to court anytime I might actually need to use their service... (like my sister had to just a couple years ago in a drop-dead simple as it gets auto/health insurance case).

So anyway, that is enough babble, I'm more than welcome to discuss any holes in this theory (I admit its all hypothetical after all). Note, I'm aware we probably can't trust the government to do anything right, but that applies to creating a public system as much if not more than setting my public standard I have discussed... so I think that line of discussion is pretty much pointless to follow (I know the 'government is useless' is often used by right-leaning as the central point of every debate already, but lets try and paint outside the numbers for once guys). Similarly, despite what the left may say, there are many businesses out there that only need the slightest encouragement to do the right ethical thing, so the notion that dollars + standards will inevitably be exploited away to zero by a loophole is also nonsense. (granted loopholes will sneak away some percentage of dollars, that is inevitable... again that percentage is the same or higher for a full public system).