Should the US Start with the Premise that it WILL Provide Universal Healthcare?

[padren]

We have a mixed system, and everybody claims to be unhappy. I have not yet heard a convincing argument that a [true] free market system couldn't provide much better care and coverage than socialized system.

 

The problem is while everyone is unhappy with the current mixed system, the other systems that have a mix that is lower in free market factors and higher in government interference consistently provide better service more equitably for less money.

 

The only place where the US does well is in "luxury level" health services that cost far more than what average people could ever spend but attracts specifically the clients who have enough money to happily spend that for a four star hospital. (Those micro clinics look promising, I'd have to check them out, but that is also a very small facet of the medical industry)

 

 

 

Considering new ideas such as health savings account, where small things are paid out of pocket, and the private insurance covers the rest.

 

Except private insurance companies don't have to cover the rest. They make more money by finding more ways to get out of covering you. How in a free market do you get them to cover the rest?

 

You get sick in one state - you become a surf to that state.... you want to move you can't - you have to hold onto your current provider or you'll get slammed with a ton of preexisting conditions.

 

Even when one company exists in both states they'll "transfer" your policy for you and tell you it'll be "a very easy transition" but then they'll hit you with a whole list of things you can't be covered for - experienced that one personally.

And if you are informed enough to catch that before you move? You have to choose between moving or protecting your health.

 

I've never had employer insurance (only had 1 job for 2 years and it had no benefits, I've always been self employed otherwise) so I don't know how all the differences are - I understand they have to cover more - but you then get locked into a job.

 

The thing too is you get slammed with huge bills for no reason. You go under anesthesia and right before you pass out to get cut open the anesthesiologist asks "Do you want the nerve numbed?" and if you nod, you get a separate $800 bill because they know insurance won't cover it. It is predatory and disgusting - how do you prevent that? When that happened to my ex-wife it's not like we could have sued him - we were dealing with medical bills and insurance bills and medical related downtime.

 

So when you say "and the private insurance covers the rest." exactly how is this supposed to happen in a free market solution?

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[The Bear's Key]

Damn. Walk away for a bit, and you miss all the fun.

 

My interpretation of his point is that the free market alone must be coupled with other approaches to EVER have a chance at working to adequately care for those in poverty or with chronic issues...

iNow's a mind reader -- woo!

 

 

 

We know that, in our system, technology innovations drives costs up - and so reduces coverage - but please explain how costs would be kept low in a universal system?

Wholesale, bulk quantities. Every purchaser has the option, and the most largest purchaser (and thus biggest saver) would be government.

 

 

@ecoli: From here on, I'm just going to respond by quoting previous statements and/or responses (both in red).

 

I'm wrong that universal health care has particularly special flaws?

 

Originally Posted by

ecoli

The same can be said about any system...

Originally Posted by

The Bear's Key

Correct.

 

Originally Posted by

ecoli

ESPECIALLY universal care.

Originally Posted by

The Bear's Key

Wrong (solely on the ESPECIALLY part. Notice how I said 'correct' directly above?).

...

 

 

How can costs be lowered if people never shop around (there's no incentive to do so when everything is covered).

 

Originally Posted by

The Bear's Key

 

2.

Japan: Universal Coverage, No Gatekeepers

...see any specialist they want, and their costs are low.

 

 

4.

Taiwan: A New System They Copied From Others

...free choice of doctors, no wait, lots of competition among providers, and gov't runs financing.

...

 

 

I have no idea what point you're trying to make with this statement.

 

The answer's a doozy...

 

 

Originally Posted by

The Bear's Key

 

John Stossel.....the way he plays it: those examples of nations with quality health in a mixed system just don't exist.

 

Originally Posted by

The Bear's Key

 

My point is that Singapore gets top-notch healthcare with a mixed system of public/private.

 

.

Originally Posted by

The Bear's Key

 

...Siamese twins joined at the head

went to Singapore in 2001 to be separated

.

 

The operation was the fifth and most complicated of its type, of which only one has succeeded.

Before the operation...

 

....surgeons will have to determine which part of the brain belongs to which girl to ensure they get the correct speech and logic centres.

 

 

Originally Posted by

The Bear's Key

 

....28 specialists from all over came to help -- meaning: not just from the U.S....

http://www.voanews.com/english/archive/2003-07/a-2003-07-07-54-Iranian.cfm

 

28 specialists, including experts from Singapore, the United States, France, Japan, Switzerland and Nepal....

 

.

Originally Posted by

The Bear's Key

 

....the technology is pretty advanced as you can see below.

http://www.wired.com/wired/archive/11.10/twins_pr.html

 

...planned this operation using a new generation of virtual reality anatomical models. Rather than depending solely on transparencies, they fed CT scans, MRIs, and angiograms into a software package released by Stanford's Image Guidance Laboratories in 2002. The software synthesizes hundreds of 2-D "slices" and renders them into a 3-D model that can be viewed on a PC screen.

 

.

Originally Posted by

The Bear's Key

 

The public hospital was successful (and the private one wasn't, ironically).....Thus it really shows us: either hospital is as good as the other.

 

.

Originally Posted by

The Bear's Key

 

International Patient Service Centres

<*

link

*>

 

....

Healthcare providers with International Patient Service Centres are listed below.

 

Alexandra Hospital

East Shore Hospital

.... ....

.... ....

.... ....

.... ....

 

Over half the names they list are public facilities (with the rest obviously private). That lends credibility to public health, considering Singapore's ranking in the world.

 

 

 

Originally Posted by

The Bear's Key

 

More tourist info...

http://www.singaporemedicine.com

 

Singapore is a leading destination, not only for business and leisure, but also for world-class, affordable and safe healthcare.

 

....a global reputation as a medical convention and training centre, a fast-growing basic and clinical research hub

 

Singapore is just one of the many nations with quality healthcare that's mixed largely with public health. And it wasn't even part of the 5 nations on iNow's link.

 

 

 

Originally Posted by

The Bear's Key

 

http://www.singaporemedicine.com

/healthcaredest/sg.asp

 

with internationally-accredited facilities and renowned physicians trained in the best centres in the world. Singapore's healthcare system was ranked as the sixth best in the world

[ParanoiA]

No, because apparently you're too damn lazy to watch the link in the OP which has begun this entire conversation. Your question is explicitly answered there, and additionally has been answered by numerous posters to this thread.

 

You mean like how ecoli has provided links to mises.org on a number of different papers to address your free market ignorance, over and over again?

 

He isn't taking issue with "centralized price controls" - believe me, we've heard the freaking left wing mantra chanting centralization and efficiency like republicans mumbling tax cuts. Yes, iNow, we understand why you all find socialism so fascinating.

 

But try to peel your eyes away from the moral glory of spending other people's money for a second and imagine his point might be about competition. He's asking how lack of competition can be afforded by your centralized price controls. Can one really exist without the other? And instead of ignoring the concept of competition, how about dealing with it?

 

This is my problem with universal approaches. You just want to repeat what someone else has already done. That's why you answer these free market questions with ridicule for asking them in the first place (WTF?), instead of answering them.

 

I'm open to all suggestions. Not just socialist guilt trip movements or screw-the-rich-guy logic.

 

Health insurance is entirely out of hand and WAY TOO DAMN necessary. The more we handed over to insurance, the more socialistic the system has been. Some of us don't even know the name of our insurance carrier without looking at our card. Same as any government office. It's a nameless, faceless entity that covers my healthcare, or most of it anyway. I get mail from it from time to time trying to squirm out of paying for stuff, trying to get away without giving me any service. Like my taxes, their money comes out of my check, no matter how pissed I am at them or not. Doesn't matter if they've screwed me - I have no choice but to use them.

 

Maybe ecoli opened his eyes once to blink in the last few decades and noticed this miserable lack of competition and heavy price we're paying and is asking how retaining this situation will be better? How will we deal with the lack of competition between carriers and their customers? Hint: One way is to not need them.

 

Health insurance works because everyone is conditioned to have to have them. Ecoli is prompting us to think about how we can lower this inherent demand on their service, that causes us to have to spend so much. When we stop accessing them for everything, we stop needing them so badly, and they start competing to get us back.

[Saryctos]

I think the first step towards any plan, in either a more central, or wider market option, would be to ween all health insurance agencies over to non-profit. Insurance IS the problem. If you can't replace it immediately at least start to take the bite off the cost.

Can anyone speculate what would happen to the insurance structure in the short term if they were required to be non-profit? Would coverage shrink, would premiums increase?

[ecoli]

Strange how it's working elsewhere. Controls don't lead to shortages, and when they do, it's because they were set too low.

 

Oh really??

 

http://online.wsj.com/article/SB123811121310853037.html

http://www3.interscience.wiley.com/journal/111090722/abstract?CRETRY=1&SRETRY=0

http://www.jpands.org/vol13no1/larson.pdf

http://books.google.com/books?hl=en&lr=&id=R1txRRv4EgIC&oi=fnd&pg=PR7&dq=universal+health+care+price+controls+rationing&ots=W4uofQAZcp&sig=jHhHg_6viWKsEelUY8SDYGwavDY#PPP1,M1

 

Price controls don't work over a long timeline because governments react slowly to changing consumer demand and are too invested in the status quo to change things. What happens in universal care systems when new tech transforms the industry, prices SHOULD be changing, but politicians don't want to change prices, because they'll bad to voters??

 

Maybe price controls in Singapore work ok, but they don't really have a democracy and so politicians don't need votes to stay in power. Is this what you would prefer?

 

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Can anyone speculate what would happen to the insurance structure in the short term if they were required to be non-profit? Would coverage shrink, would premiums increase?

I'm not sure... I think Blue Cross is non-profit. do they get more business than their 'for-profit' counterparts?

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Health insurance works because everyone is conditioned to have to have them. Ecoli is prompting us to think about how we can lower this inherent demand on their service, that causes us to have to spend so much. When we stop accessing them for everything, we stop needing them so badly, and they start competing to get us back.

Precisely. How can consumers force health care providers to keep costs down, when they don't even bother to find out how much a procedure costs before getting one.

 

I suppose you could have consumers choose hospitals based on waiting time (the PBS video - which I DID watch, iNow - seemed to suggest this was being done in the UK) but I'm not sure if this is a better system than price signals. Or rather, maybe it's not exclusively a good system.

 

Price signals convey lots of different information about quality. If a hospital has a long waiting time, maybe that just means they're the busiest, and therefore best. It could mean that they're the least organized. If you also know how much procedures cost, it tells you more about the quality of service. (in a market system, at any rate).

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Except private insurance companies don't have to cover the rest. They make more money by finding more ways to get out of covering you. How in a free market do you get them to cover the rest?

 

The same reason a restaurant will go out of business if it continually causes its patrons to get food poisoning.

 

Companies that have a history of denying coverage will lose business to those that don't. Granted, insurance markets are a lot less liquid than going to a restaurant (harder to change, esp. if you've gotten sick right away).

 

However, this is a big problem mostly because health care is tied to your job. If you lose your job, lose coverage, and then get sick, you're screwed.

 

If you were able to shop around on your own, find the best coverage for you, it doesn't matter as much if you go through unemployment stages, because you've already got coverage.

 

Insurance tries to dump you? That's will just hurt them, because healthy people will hear about it and find a company that doesn't stop coverage when people get sick. That provides a large incentive not to deny coverage.

 

(if you really want the government to have a role, how about collecting and publishing information about what companies are giving the worst coverage??)

Edited April 9, 2009 by ecoli
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[ParanoiA]

Insurance tries to dump you? That's will just hurt them' date=' because healthy people will hear about it and find a company that doesn't stop coverage when people get sick. That provides a large incentive not to deny coverage.

 

(if you really want the government to have a role, how about collecting and publishing information about what companies are giving the worst coverage??)[/quote']

 

I guess this is the part that concerns me the most and is the strongest, most valid argument by the universal crowd, which I'm increasingly becoming an advocate for.

 

I'm in 100% complete agreement about Healthcare being tied to your job, that is just insane. However, I have also learned that since this has become the status quo, people can actually be denied coverage unless they're employed, which I guess forces the carrier to cover you.

 

How does the market deal with this? To shame them doesn't seem effective enough. I know I'd personally hold disdain for that kind of insurance company, but I'd probably not switch or go to the trouble to shop anywhere over it.

 

There's something inherently asymmetrical about the Healthcare service business to the rest of the market, and I think it has to do with the nature of demand (everybody, as opposed to a select group) and the fact that everyone will receive the service, regardless.

 

This undermines two natural dynamics of a free market solution, which is the same unnatural condition the government puts markets in, as well. So, I guess I question the idea that Healthcare could ever enjoy anything resembling a free market solution, in reality. I don't think we have the stomach to let someone die for not having the cash, so I just don't see it.

[Mr Skeptic]

He's asking how lack of competition can be afforded by your centralized price controls. Can one really exist without the other? And instead of ignoring the concept of competition, how about dealing with it?

 

Well, with universal health care, insurance is no longer the same. I mean, there would have to be someone to determine what procedures are covered, and whether they are necessary (the latter could be done by the doctors, with some oversight). You could have different private groups providing this determination, letting them compete based on operating cost, satisfaction, and minimization of unnecessary procedures.

 

You would have competition between doctors and hospitals based on quality. If the coverage were for a certain amount only, below that you have competition based on quality, and above that competition based on both costs and quality.

 

Just because the government pays for something, doesn't mean that they have to pay for it stupidly/corruptly.

[ecoli]

This undermines two natural dynamics of a free market solution, which is the same unnatural condition the government puts markets in, as well. So, I guess I question the idea that Healthcare could ever enjoy anything resembling a free market solution, in reality. I don't think we have the stomach to let someone die for not having the cash, so I just don't see it.

Inasmuch as I see government unable to stay out of the health insurance game, for political reasons, I suppose you're right. Free market principles aren't working because the government is getting involved. Which is weird because, I also buy the argument that more government intervention is less bad than what we have now.

 

I might also buy the argument that no intervention is politically impossible.

 

However, we have no real world evidence that a free market solution wouldn't work (there are none in a developed nation).

[Mr Skeptic]

Companies that have a history of denying coverage will lose business to those that don't. Granted, insurance markets are a lot less liquid than going to a restaurant (harder to change, esp. if you've gotten sick right away).

 

That is not true. Companies that have a reputation of denying coverage will lose business, if the consumer bothers to check on that instead of just going for the cheaper choice (and has a choice).

 

The idealized free market has perfect information. The amount spent on advertising suggests that we are extremely far from perfect information. An insurance company that cheats its customers will spend some of that on "damage control" and advertisement to downplay the bad reputation.

[ecoli]

You would have competition between doctors and hospitals based on quality. If the coverage were for a certain amount only, below that you have competition based on quality, and above that competition based on both costs and quality.

Without an actual price system though, how are signals sent about quality?

 

I illustrated above, that waiting times is not enough.

 

Just because the government pays for something, doesn't mean that they have to pay for it stupidly/corruptly.

No, but this is government's trend. Especially on a long enough timeline. Market forces tend to change faster than political ones. Markets are therefore better at dealing with price changes than politicians.

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That is not true. Companies that have a reputation of denying coverage will lose business, if the consumer bothers to check on that instead of just going for the cheaper choice (and has a choice).

 

The idealized free market has perfect information. The amount spent on advertising suggests that we are extremely far from perfect information. An insurance company that cheats its customers will spend some of that on "damage control" and advertisement to downplay the bad reputation.

Which is why we have things like consumer reports, and 3rd party assessments.

 

At any rate, the problem you describe is just as valid in a universal care system (assuming some amount of health care choice is preserved). It's why we need strong property rights and legal channels in any type of system - capitalist or communist.

 

In universal care, collusion with politicians and corruption becomes the primary problem, however. Do we really think we would be stopping payoffs/corruption/rent-seeking by giving politicians more say over how health care works??

Edited April 9, 2009 by ecoli
Consecutive posts merged.

[Mr Skeptic]

(if you really want the government to have a role, how about collecting and publishing information about what companies are giving the worst coverage??)

 

Oops, missed this part. This is an extremely good idea, and would be far cheaper than providing the healthcare itself. It fits right in with what I said on a different thread about a major role of government being to cover the weaknesses of the free market (in this case, of imperfect information).

[jackson33]

For some interesting statistics on the currently insured, uninsured and the reasons you might read this;

 

http://www.nchc.org/facts/coverage.shtml

 

One often mis-quoted fact is that when you lose your job, you lose your policy, which under law is your choice, but you will have to pay for it...Being employed for a job, which includes GROUP (operative word) Health Insurance Coverage is a benefit offered by that Company and can be maintained for certain periods of time, no more than 102% of what the Company paid, after being fired, laid off or the demise of the Company.

 

There are thousands of forms of available coverage under health and hundreds that can be adapted to group coverage. Example; A person in one community can gather 20 or more families, already insured or not and present an Insurance Company those profiles and will be offered a price per on a particular plan. If say a $1k, annual deductible and for 100 healthy families, they would be offered premiums dwarfing many Company Policies, far below what any may be paying. If and it's possible a few have existing problems or several are elderly, those same premiums would be equal to less than that of many Company policies.

 

If you become ill, are injured or in some manner disable while under any coverage, according to State Laws, that coverage MUST be maintain, not necessarily for new problems or for family members, but rarely are they discontinued.

 

 

http://www.dol.gov/dol/topic/health-plans/cobra.htm

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

..........................

 

If you become ill, are injured or in some manner disable while under any coverage, according to State Laws, that coverage MUST be maintain, not necessarily for new problems or for family members, but rarely are they discontinued.

 

As for Government vs. Private Sector coverage, it is really not comparable.

Private Sector will take your premiums, invest, put to work and create some incomes, traditionally 6-10%/year, where government can do nothing but hold the cash or spend hoping for an increased GDP (annual revenues, on ave. 1-2%/per). The private sector, especially in the US is extremely efficient where Government is notoriously inefficient.

 

Don't kid yourself, when it becomes an issue of cost/effective (it will), as Insurance Companies do today, government will be forced to do later and there will be no alternative. Government today is that alternative (safety net) if no other alternative is available. Flood insurance along the gulf cost or along major unprotected water ways, made financing homes, impractical without flood insurance, when insurance companies became unable to pass on cost to not flood prone home owners. Government stepped in and backed or offered the coverage. Same for fire insurance in or near forest, particularly in California.

 

Government, working with the Medical and Pharmaceutical Industry in the US, TODAY have programs traveling the US and in fact the world, to inform, treat and dispense medications/treatments for all kinds of things. I hardly think anyone is going to be left to die from a curable problem in the US, so long as the last resort is not government. Wal Mart, with its purchasing power (truck load/rail car orders), a distribution system and Store Locations already is furnishing medications at fractions of previous cost and is now testing diagnostic centers/clinics around this country. We have Medical Facilities that have closed, gone specialized, profitable today and would go National at the first sign of a Private Medical System.

[ParanoiA]

At any rate' date=' the problem you describe is just as valid in a universal care system (assuming some amount of health care choice is preserved).

 

In universal care, collusion with politicians and corruption becomes the primary problem, however. Do we really think we would be stopping payoffs/corruption/rent-seeking by giving politicians more say over how health care works??[/quote']

 

That's a great question. I think we, as in the modern republic, don't have the fortitude and will to hold them accountable. Politicians only get busted enough to satisfy political scores, or to say they're sorry for screwing a gay hooker after voting 'no' on gay marriage.

 

So I think the answer is, no.

 

Now, 150 years ago? Sure, you bet. But then, these are the same people who went to war over unfair taxation. Today? Shit, you can ignore the will of the american people and pass the largest spending bill in the history of the country - no one even has to read the ****ing thing, and no one even lies about reading it. And we don't give two shits either, do we?

 

This is government ON the people. And I'm not sure how you combat corruption in that atmosphere.

[padren]

 

The same reason a restaurant will go out of business if it continually causes its patrons to get food poisoning.

 

Companies that have a history of denying coverage will lose business to those that don't. Granted, insurance markets are a lot less liquid than going to a restaurant (harder to change, esp. if you've gotten sick right away).

Okay, that addresses the first part of the quote - but the second - how do you force these companies to cover everyone in a free market?

 

To the less important first part - what causes (I assume you feel they are regulatory ones) prevent this from happening now? As of right now, all insurance companies avoid losses by avoiding coverage.

 

However, this is a big problem mostly because health care is tied to your job. If you lose your job, lose coverage, and then get sick, you're screwed.

I think everyone agrees with this, though we have a ton of other issues, and I can't say for sure that is the biggest problem. In addition to that, insurance companies do regionally break up their coverage to their advantage and use a customer's need to move as yet another opportunity to stop covering a customer. Blue Cross covers you in both AZ and CO, but when you make the move you get a list of things that will no longer be covered - and that is for personal plans, not employer based insurance.

 

If you were able to shop around on your own, find the best coverage for you, it doesn't matter as much if you go through unemployment stages, because you've already got coverage.

You can shop around, if you get tests that turn up nothing, they can claim you have an unknown condition if you change providers and exempt you from any procedures arising from that unknown cause. It happened to my ex wife, so I do have personal experience with this.

Insurance tries to dump you? That's will just hurt them, because healthy people will hear about it and find a company that doesn't stop coverage when people get sick. That provides a large incentive not to deny coverage.

That only works when there is at least one alternative on the market. Keep in mind if they don't dump you they loose a ton of money, or force everyone's premiums to go up until everyone drops them and they are really screwed - hence we don't see those alternatives on the market.

 

The big issue I see is any insurance pool is going to be selective - you do have some responsible people that are paying more than they get out of their plans for the long term safety, but a lot of people that also just don't get coverage because they are healthy.

 

The problem right now is the market has "run itself up a tree" and is stuck there - there is no simple way to get from here to where you are talking about without all companies making a change, as any one would go bankrupt.

 

 

I will say this:

 

1) I do like the idea that routine care involves shopping around on part of the consumer. I am not sure how best to ensure this market force exists in a universal plan, but I think it should. HSA is one option, but I am not sure if it's the best. Having some sort of two-part premium (one for catastrophic/chronic coverage, and one for routine care) and have the routine care cost per policy flex with consumer savings may provide enough consumer pressure to keep this pressure on that side of the market.

 

2) I don't think you can apply that logic to catastrophic care - emergency procedures and such. You could be anywhere, anytime and suffer any injury, and be unable to shop or make decisions. Other pressures must exist to enforce market performance.

 

3) Universal coverage: This is one thing I still haven't heard any decent arguments on how to solve in a free market solution. Without it, we have selective insurance pools, ERs used where preventative care would be better, and all kinds of ethical, social, and secondary cost problems.

 

 

Regarding the risk pool - I have one question:

 

I heard we have 45m uninsured Americans, which implies we have about 255m insured Americans. How many of those 255m are under private policies (not medicaid or medicare) and thus, how large is the pool? My thinking is say, 200m are in policies, and 45m are not - if an average policy cost x than if we all paid for the uninsured the average cost would be 1.225x.

 

That is not a huge increase to cover the cost of the uninsured's policies - considering the high costs in this country we should be able to save that much somewhere and still cover everyone.

Of course, that pays for the policies of the uninsured, which would give the Health Insurance companies a non-selective pool. If the reason those people are uninsured is largely because they would cost more than their policies bring in - we have a much larger problem that a non-selective pool can solve.

That would indicate the health insurance companies are overly selective in their attempts to compensate for the selective pool - and even a government mandate to ensure everyone is covered would lead to high increases, even if every one did pay in.

 

Do we have any numbers on the health care costs of the uninsured?

[jackson33]

 

Regarding the risk pool - I have one question:

 

I heard we have 45m uninsured Americans, which implies we have about 255m insured Americans. How many of those 255m are under private policies (not medicaid or medicare) and thus, how large is the pool? My thinking is say, 200m are in policies, and 45m are not - if an average policy cost x than if we all paid for the uninsured the average cost would be 1.225x.

 

That is not a huge increase to cover the cost of the uninsured's policies - considering the high costs in this country we should be able to save that much somewhere and still cover everyone.

Of course, that pays for the policies of the uninsured, which would give the Health Insurance companies a non-selective pool. If the reason those people are uninsured is largely because they would cost more than their policies bring in - we have a much larger problem that a non-selective pool can solve.

That would indicate the health insurance companies are overly selective in their attempts to compensate for the selective pool - and even a government mandate to ensure everyone is covered would lead to high increases, even if every one did pay in.

 

Do we have any numbers on the health care costs of the uninsured?

 

The average cost per person in the US for medical care is about 7,800/person/year. Based on total cost ($2.4T in 2007) and 306M people. Since illegal make up a said 20 million+, I'll assume a great deal are not covered. Then the US Insured are under Medicare, Medicaid, VA, CHIPS and Government Employees.

 

http://www.pnhp.org/blog/2008/08/26/census-bureau-on-the-uninsured/

Highlights

Both the percentage and number of people without health insurance decreased in 2007. The percentage without health insurance was 15.3 percent in 2007, down from 15.8 percent in 2006, and the number of uninsured was 45.7 million, down from 47.0 million.

The number of people with health insurance increased to 253.4 million in 2007 (up from 249.8 million in 2006). The number of people covered by private health insurance (202.0 million) in 2007 was not statistically different from 2006, while the number of people covered by government health insurance increased to 83.0 million, up from 80.3 million in 2006.

The percentage of people covered by private health insurance was 67.5 percent, down from 67.9 percent in 2006. The percentage of people covered by employment-based health insurance decreased to 59.3 in 2007 from 59.7 percent in 2006. The number of people covered by employment-based health insurance, 177.4 million, was not statistically different from 2006.

----------------------------

 

Keep in mind, folks that are laid off etc., do not choose to buy insurance or maintain their previous group insurance, then become ill are not likely to qualify for NEW coverage or very expensive could increase the cost of the uninsured...

[bombus]

No.

 

I think the correct approach is exactly what Obama is doing -- overhaul and reform the system, but maintain private enrollment. Deal with the cost problem through regulation. Force the insurance companies to obey accounting and behavior standards that every other company in America is held to. Force drug companies to either spread the research cost, marketing cost, and PROFIT to ALL customers, or allow us to participate in the same deals that Canada et al get and STFU about their profit margin.

 

Socialism is not an answer, it's a cop-out.

 

I think socialism is the answer, and capitalism (in this case a private health system) is a cop out. Good Health Care is a right that should be guaranteed to the people by the government. The British NHS is fab! I have had treatment that that would have otherwise cost tens of thousands of pounds, all for 'free'. Go for it USA, it really is great.

Edited April 9, 2009 by bombus

[jackson33]

I think socialism is the answer, and capitalism (in this case a private health system) is a cop out. Good Health Care is a right that should be guaranteed to the people by the government. The British NHS is fab! I have had treatment that that would have otherwise cost tens of thousands of pounds, all for 'free'. Go for it USA, it really is great.

 

WAS IT FREE?. Who paid for those Doctors/Surgeons Educations, the Hospitals or the high tech equipment in the. Who paid for your office calls, medications, your hospital stay and no doubt some cost while recovering?

 

If Good Health is a right, then doing anything not considered healthy should be a criminal offense. Playing some sport (you might get injured), driving a car (might be involved in an accident), working (pick a problem) eating/drinking (pick the product) over indulging per your personal physical structure. Top this off with parental responsibility who should have aborted you, knowing some genetic combination might have given a 10% possibility of this or that. Your health issues are personal and the responsibility should be yours (once 18 or so) to get the best of what you were born with, in the world you live in...

IMO.

[ecoli]

Oops, missed this part. This is an extremely good idea, and would be far cheaper than providing the healthcare itself. It fits right in with what I said on a different thread about a major role of government being to cover the weaknesses of the free market (in this case, of imperfect information).

 

I think this is a perfectly reasonable, and underutilized, role for government. There's lots of regulatory agencies that do a reasonably good job (FDA, EPA...). If we think we need the government to supply information to consumers in other cases, health care is a pretty big sector that could use it.

[ParanoiA]

You know, I didn't give it much thought first time through. But thinking about it, you guys are absolutely right.

[iNow]

So, each of you are arguing that those in poverty deserve lesser care than those financially stable. Is that not the logical outcome of the last several posts and points contained therein?

[Pangloss]

I think socialism is the answer, and capitalism (in this case a private health system) is a cop out. Good Health Care is a right that should be guaranteed to the people by the government. The British NHS is fab! I have had treatment that that would have otherwise cost tens of thousands of pounds, all for 'free'. Go for it USA, it really is great.

 

I respect your opinion on it. Just to clarify my opinion (that you were replying to), though, I wasn't advocating a pure-capitalist approach, but rather a mixed approach.

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So, each of you are arguing that those in poverty deserve lesser care than those financially stable. Is that not the logical outcome of the last several posts and points contained therein?

 

Just speaking for myself, I don't advocate that anybody deserves health care. It comes at a cost, and nobody deserves something that only comes at another person's expense. I may support that expense, because I feel it's an investment that also benefits me, or because I think it's worth it on some moral level to support those who can't support themselves, but not because I think they deserve it.

[iNow]

Just speaking for myself, I don't advocate that anybody deserves health care. It comes at a cost, and nobody deserves something that only comes at another person's expense. I may support that expense, because I feel it's an investment that also benefits me, or because I think it's worth it on some moral level to support those who can't support themselves, but not because I think they deserve it.

 

I understand your point, but you are more arguing about a poor word choice on my part than anything else. "Deserve" calls to mind too many biases...

 

 

The intended thrust of my point is that the logical outcome of the approach supported in the previous several posts is the mandate that those in poverty get lesser (or zero) care, whereas those who are financially stable will receive great care. This includes people in poverty through no fault of their own, as well as people in poverty as a direct result of their medical issues (also, no fault of their own in many/most cases).

 

Or, you know... we could just tell all of those diabetics and cancer patients out there that they'll just have to live with the financial consequences of being ill and having a condition requiring medical attention... That it's nobody else's problem. Sucks to be you....

 

Yeah... I suppose that's one approach that an "advanced" civilization might select.

Edited April 10, 2009 by iNow

[Saryctos]

I understand your point, but you are more arguing about a poor word choice on my part than anything else. "Deserve" calls to mind too many biases...

 

 

The intended thrust of my point is that the logical outcome of the approach supported in the previous several posts is the mandate that those in poverty get lesser (or zero) care, whereas those who are financially stable will receive great care. This includes people in poverty through no fault of their own, as well as people in poverty as a direct result of their medical issues (also, no fault of their own in many/most cases).

 

Or, you know... we could just all of those diabetics and cancer patients out there that they'll just have to live with the financial consequences of being ill and having a condition requiring medical attention... That it's nobody else's problem. Sucks to be you....

 

Yeah... I suppose that's one approach that an "advanced" civilization might make.

For what reason should I be legally bound to pay for someone else's problem? Simply because it affects their health in a more explainable way? All sorts of economic problems relate to stress induced conditions, psychological problems, etc.., all having adverse affects on people's health. How is someone's problem specifically my obligation on the premise that it is related to their health?

 

On that note however, I would much rather pay for medical care for the less fortunate than any of the current redistribution schemes we finance. I don't however like the idea of doing both, which is an unfortunate problem in that there will be no trade off, there will be no compromise. Ontop of that, I certainly wouldn't want to start paying for it before fixing the broken financial structure of health "insurance", or the dependence we have upon this silliness.

 

• Insurance keeps people tied to employers.
  Businesses get a benefit for paying healthcare, making their dollar stronger than yours, simply because it's paying medical costs. Why can't the gov't make your medical dollar stronger on it's own? Let the employer pay you that much more, and allow you to find your own coverage that fits your needs better than the only option you have available through your workplace?
   
   
  
• Insurance beats down freedom of service provider through "in-service" providers.
  Just more limitation on choice, another assault on competition. Sure you could shop around and find a less expensive doctor, but unless they're in your network you're already starting 'down' the difference in copay. So if you wanted to find a better doc it has to be more than just a better deal, it has to be a better deal plus a little extra.
   
   
  
• Insurance draws in more money than is required for service.
  I wish I could find some numbers on how much is paid annually to health insurance plans and cross reference it against how much money is further paid to the healthcare industry. When more money is pumped into a market than is being spent there's bound to be inflation.
   
   
  
• Technology drives the cost of care UP through new techniques.
  Not necessarily because they want to, but when it's an ethics question of allowing older cheaper techniques to be used simply for the cost benefit people cry foul! Shouldn't it be up to the patient to determine if they want to pay $2,000 dollars for that extra 3% effectiveness? They're the one paying for it (there's the whole argument about informed consent or what have you, but still, what other industry do we restrict choices so much on 'ethical' grounds?). Would we force people to pay for the new "healthier hamburger", now with 0 fat, 0 calories and only $25! what a bargain for being healthy!
   
   
  
• Massive regulation structure.
  What would be wrong with running a simple MRI shop out of a small business complex? Just nab one off Ebay for a couple hundred grand. Probably only take a few hundred customers at today's prices to break even on that investment. Oh wait, you're gonna have to deal with an assload of red tape, and not to mention insurance coverage restrictions depriving you of customers that would love to pay less for a procedure if they were actually paying for it.
   
   
  
• Prescription drugs.
  Costs are pretty hefty to the consumer considering the actual cost of development and manufacture. If anything, I'd say this is a perfect place for gov't spending. By up the rights to produce commonly prescribed medications(through offering the developers an amount equal to what they might lose from not selling it themselves for those X years where they have exclusive rights. Hell maybe just throw in some deal where they still make residuals so they can still throw the billions of advertising dollars that they do. I'm not a contract negotiator, but I know that some form of reimbursement would be required to allow this to happen), contract out the manufacturing and then offer it to the citizenry at a significantly reduced cost. It don't cost much to manufacture the stuff once the patent runs out.
  

 

We just have to list out the problems in the system and attack them head on (apply directly to the forehead). Think of a problem in healthcare and follow it to the logical end of what causes this problem. NOT what these problems cause, but what allows them to continue. Don't worry about if the problem is solvable, just find out what is the core "problem" with any situation. What feeds these problems? Are they getting worse? Staying the same?

[iNow]

For what reason should I be legally bound to pay for someone else's problem? Simply because it affects their health in a more explainable way? All sorts of economic problems relate to stress induced conditions, psychological problems, etc.., all having adverse affects on people's health. How is someone's problem specifically my obligation on the premise that it is related to their health?

 

Is this the same argument you make when discussing our relatively uncorrupt police force, our fire departments, and the protections we have against dangerous drugs and foods?

 

You are not "legally bound" to pay for anything in particular, except, of course, your taxes. The distribution of those tax dollars is decided upon by our congress. That is expressly articulated in our founding documents (Article I, Sections 2 & 8), the articulated motivations and support of which can be found in the Federalist papers (specifically, numbers 30 through 36). The congress shall have the ability to levy taxes.

 

The issue here is how said taxes get spent. We spend it on weapons. We spend it on infrastructure. We spend it on police and fire departments, and we spend it on intelligence, and farms, and clean water. We spend it on safety inspections for our foods and drugs, and we spend it on things which make our society better as a whole.

 

Regardless of what we spend it on, we are legally bound to provide those funds. Congress shall have the ability to levy taxes, as well as the power to determine how that money gets spent.

 

 

Why then, when we begin to discuss healthcare, an existential requirement for many, a moral imperative for some, does the argument become about "my dollar" and "my obligation," yet those same arguments aren't levied when discussing all of the other expenditures resulting from the collection of our tax dollars?

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On that note however, I would much rather pay for medical care for the less fortunate than any of the current redistribution schemes we finance.

 

Would you rather do that so much that you'd be willing to stand up and support that alternative approach in the face of opposition?