US Healthcare Reform Bills Don't Address Cost

[iNow]

I am completely against the current idea of health care reform. For me it is not if the bill lowers the cost of health care or not; I simply do not feel that the government should interfere with health care. It is not the government's job to provide health care for me, my family, or any other person in this country.

Yet, that's precisely what our government does already for our veterans, our military, our congressmen and women, as well as our elderly. Your comment suggests that the government should no longer provide benefits to veterans, to the elderly, or to our military personnel. Is that what you intended, or perhaps you can clarify?

[bascule]

It is not the government's job to provide health care for me, my family, or any other person in this country.

 

Do you have any supporting reasoning for why it's "not the government's job" to supply healthcare? Do you feel the private insurers do a better job than the government could? Are you unconcerned about being denied coverage by your insurer in the event of a catastrophic health crisis?

[JohnB]

Nope. Typical turnaround time for me, among many GPs, is typically a week, having booked an appointment in advance.

 

Mate, that's unreal. To quote myself from the UHC thread.

I'm afflicted by skin tags' date=' most are small but occasionally 1 becomes objectionable and gets removed. The one on the back of my neck needed cutting as it had got too big. Roughly 4 cm long and 1 cm wide and high.

 

I decided this last Friday and made an appointment at my local private practice clinic for saturday morning. I had the consult but due to time constraints had to schedule the removal for this morning.

 

Cost of consult to me: $67.00

 

This morning (Tuesday) I went in and after a 15 minute wait (which I think is not excessive) I had the tag and another removed. This took about 30 minutes.

 

Cost of this visit to me: $105.00

 

With my two receipts I drove a couple of suburbs over (about 10 mins) to the Medicare office where I got my queue number.

 

When I arrived they were serving number 151 and I was number 188.

 

After a 20 minute wait I was served. Again I don't think this wait is excessive as they served some 40 people in that time.

 

I handed over my Medicare card and the two receipts and was then given my rebate of $97.30.

 

It's calculated in this fashion. We have what we call a "Scheduled Fee" for proceedures and the rebate is based on this figure.

 

The scheduled fee for the first visit was $33.55 so that's my rebate. Note that my Dr charged me $67.00.

 

The sceduled fee for the proceedure is $63.75, so that's my rebate for todays visit. Again note the actual charge was $105.00.

 

So 2 Drs visits and a minor proceedure cost me, in total, $74.70. Which is also not unreasonable, and I was home around 1 PM.[/quote']

 

Wait a week? Not on your nelly.

 

DJBruce, your system is badly broken. Reform is required. I suggest you learn to deal with that. If you read the UHC thread, you'll see most if not all of your arguments refuted.

 

One thing I find amazing about Americans is their attitude sometimes. If it hits the fan anywhere in the world you lot are there to help out. Without fail. You are an amazingly generous nation when it comes to helping others in need, and asking nothing in return. Yet as soon as somebody suggests maybe looking after your own people in some way, there is immediate resistence. You're sometimes very strange.

[Realitycheck]

88,000 dollar base on imposing 'premiums'? The math sounds totally skewed but what do I know about how they arrived at that number.

 

I really expect the final tally to come in at closer to a trillion once baby boomers finish retiring but it has to be done. The machine must be built, no questions asked. If they can print money for a 'temporary fix to the financial system', then they can definitely do it for something as important as this. Big quality companies are not built on low budgets if you expect to get any returns on them. You just have to bite the bullet and accept that another trillion in debt is what it is going to cost, what we knew all along.

[bascule]

JohnB,

 

When I talk about a week turnaround, that's just for scheduling the initial consult.

 

If you intend to have a procedure done, it's typically a few days to a week after the initial consult. If you have insurance you'll pay copay on both. Depending on your deductible you might end up paying for a portion of the procedure.

 

Just as an estimate of what you're describing in America, you can expect a few weeks turnaround and at least $100 of out-of-pocket costs.

[JohnB]

bascule, if I seem incredulous, I suppose I am a bit.

 

I've lived with the sort of service I described in the last post all my life.

 

I just find it hard to believe that your health service is so bad. I've seen the stats, but having to wait a week for a consult drives home the point.

 

I'm sorry, but I can't think of any other way to describe the way your system is except to say it's second rate at best. There are villages in the New Guinea jungles with faster access to Drs than waiting a week.

 

Why have you put up with it for so long?

[bascule]

bascule, if I seem incredulous, I suppose I am a bit.

 

Well, it's not always that bad. I had an optometrist squeeze me in for an instant appointment the other week, and did a follow up appointment where he dilated my eyes a few days later.

 

Once when I cut my hand, a plastic surgeon was able to squeeze me in for an instant appointment.

 

What I'm describing has been my typical experience though. Wait and wait and wait. Then get to the doctor's office and wait some more. Did I mention we sit in the examination room from anywhere to 10-30 minutes before the doctor will show up? That's after waiting 10-20 minutes in the lobby.

 

I've lived with the sort of service I described in the last post all my life.

 

I just find it hard to believe that your health service is so bad. I've seen the stats, but having to wait a week for a consult drives home the point.

 

I'm sorry, but I can't think of any other way to describe the way your system is except to say it's second rate at best. There are villages in the New Guinea jungles with faster access to Drs than waiting a week.

 

Why have you put up with it for so long?

 

I think the problem is a lot of people don't realize or don't care it's broken.

[CharonY]

Did I mention we sit in the examination room from anywhere to 10-30 minutes before the doctor will show up? That's after waiting 10-20 minutes in the lobby.

I have to say that this is basically the same also in Germany (which has a mixed public/private system). I do tend to believe that this is less a matter of health care system but rather how efficient and overbooked the given MD is. And of course what kind of patients he/she got the given day.

[JohnB]

Interesting.

 

We also wait in the lobby for around the 10-30 minute mark. This is generally because while appts might be scheduled every 30 minutes (or whatever) some will run overtime. Nobody cares about this wait.

 

A very big difference here is that the Dr comes out, gets your file from the nurse and walks you to the examining room. There is no waiting at this point.

 

I think the problem is a lot of people don't realize or don't care it's broken.

Do you think there is an element of "This is America, the greatest country in the world and we therefore have the best healthcare in the world"?

 

I ask because in conversations with Americans here, it is not an uncommon line of thinking. Up to and including accusing the WHO of being politically motivated to make the US look bad.

[iNow]

Do you think there is an element of "This is America, the greatest country in the world and we therefore have the best healthcare in the world"?

 

Yes. It's far too common in our country for nationalism to overtake rationalism.

[CharonY]

Maybe to a part. Also it depends on how much exposure the individual has with foreign nations. I found this kind of attitude to be less prevalent in the academia. A surprising number of US grad students here have been abroad for quite some time. And I can easily pick them up visually, as they cringe when someone makes a statement like that:

This is America, the greatest country in the world and we therefore have the best healthcare in the world

[Pangloss]

Today "progress" was made in the House, when a compromise was reached with conservative Democrats. They did this by -- and this cracks me up -- watering down the one and only portion of the bill that actually attempts to impact the cost of health care in America: Government competition. They took away the government program's ability to set rates the way medicare does! So now the reforms *cannot* tackle the cost issue even if they do create competition with private industry, because the competing government company will have to pay the same rates as private insurers.

 

Um, so why are we doing this again? Oh yeah, because 47 million people aren't covered. So we're going to cover them, right? Er, no, because as part of the compromise the two sides also agreed that that was no longer necessary! No. Really. The bill no longer requires people to have health insurance, join the government plan, or pay a fine.

 

"It will not be mandated on anyone; it will simply give consumers more choices," he said.

 

But lack of choice has never been a problem. The problem is that the available choices are too expensive or don't cover sufficient risks, but this plan addresses neither of those issues.

 

Crazy.

 

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/29/AR2009072902894.html?hpid=moreheadlines

[iNow]

Actually, those conservative democrats found $1B in cost reductions, bringing the cost of the plan below a trillion. I'd say that your suggestion that they "took away the only cost saving portion of the bill" is a bit misrepresentative.

 

http://www.npr.org/templates/story/story.php?storyId=111322055

[bascule]

My opinion of the present bill is that I don't think the changes it makes are radical enough to address the problem.

 

It is unfortunate that the Blue Dogs and various other groups will prevent a single payer solution from ever reaching mainstream consideration. I personally believe that is the best solution to the problem.

[Pangloss]

Actually, I think it was more on the order of $100 billion in reductions, wasn't it? But that doesn't refute either of my points, and I think it just goes to show how little $100 billion matters when you're talking about spending a trillion.

 

I agree with you, bascule, but I think you're overlooking the fact that single payer isn't what the Blue Dogs are standing in the way of at the moment. Single payer isn't even on the table -- it isn't what these debates were about. What's on the table is an insurance industry-driven pay-us-whatever-we-want-to-charge-you-or-we-won't-contribute-to-your-campaigns-anymore plan.

[iNow]

Actually, I think it was more on the order of $100 billion in reductions, wasn't it?

Ah... good call. You're right. I was posting in a hurry and messed that up.

 

 

One thing I like about the changes they made is that they are basically mandating all of August for review/reading of the entire bill. That might help.

 

I also agree with Bascule... without single payer, this thing might be a band-aid on a heart-attack. Then again, maybe it's a "foot in the door" and we can make it better later, although, I'm not optimistic about that considering the recent history of our congress.

[Pangloss]

That's interesting, I hadn't heard that.

[iNow]

Yeah... and, according to George Stephenopoulos, he's hearing from some key folks at the negotiating table that we shouldn't be surprised if this thing doesn't land on the President's desk until December... roughly, the Christmas time-frame.

 

Should be interesting. My hope is that we actually freakin' accomplish something for a change, instead of all of this grandstanding which wastes our time, our money, and our ability to become better as a nation.

 

As I referenced recently in another post... It's time for us to start focusing less on nationalism and more on rationalism. We're killing our people, we can change that, and we can leverage the lessons learned by others who have already implemented such enlightened practices.

[Pangloss]

I agree with that as well, and share your hope.

 

I am also mindful of the old adage about sausage manufacturing and law-making. It's pretty ugly at the moment, but it's the only process we have, and in the end we might get lucky and squeeze some kind of progress out of this Iraq.

[DJBruce]

I apologize for my delayed response but I became slightly disillusioned when I accidentally deleted my original reply as I was spell checking it, and then became quite busy with school and work.

 

Yet, that's precisely what our government does already for our veterans, our military, our congressmen and women, as well as our elderly. Your comment suggests that the government should no longer provide benefits to veterans, to the elderly, or to our military personnel. Is that what you intended, or perhaps you can clarify?

 

In clarification of my opinion I think there is a large difference between the government providing healthcare as an entitlement for citizens and the government providing healthcare as part of a benefit plan for its employees. When the government provides a healthcare plan for congressional representatives, military personnel, or military veterans they are simply providing a benefits package to their current and retired employees like most private companies do. This in my opinion is perfectly fine, reasonable, and should be expected. On the other hand, when the government starts to provide or create healthcare for citizens I feel that the government has overstepped its boundaries. I am against plans like Medicaid and Medicare, but they are now so deeply entrenched into our society that they cannot be removed.

 

In summary the government, providing healthcare plans for employees, like congressional representatives, military personnel, or military veterans, is completely fine, but the government should not provide healthcare for ordinary citizens.

 

Do you have any supporting reasoning for why it's "not the government's job" to supply healthcare? Do you feel the private insurers do a better job than the government could? Are you unconcerned about being denied coverage by your insurer in the event of a catastrophic health crisis?

 

As I stated in my previous post the idea that it is not the government’s job to supply healthcare is simply my opinion. This opinion is rooted in the ideas that the government can only do what is enumerated in the Constitution and that when discussing the constitutionality of an issue it is necessary to consider the thoughts on issue in question.

 

That said when I consider the constitutionality of Congress creating a national healthcare program I find the two parts of the Constitution that might be used to justify the program to be found in Article 1, Section 8; more specifically:

 

The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defense and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;

 

To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.

 

With regards to the first quote it seems that the crux of the issue comes down to the term “general welfare.” When I consider what term the meant to the founders I find that Thomas Jefferson said it best when he said, “Congress has not unlimited powers to provide for the general welfare, but only those specifically enumerated.” Then since I do not see the power to provide healthcare enumerated anywhere in the Constitution I would hold that Congress does not have the power or the duty to provide health care.

 

When I consider the “elastic clause”, I believe that the key words of the clause to be, “carrying into Execution the foregoing Powers.” To me the clause can only be used to create legislation to carry out Congress’ existing power. Since as stated above that Congress does not have the power to create a healthcare system I do not see how this clause could be used to justify the creation of a national healthcare system.

 

As for your other questions Bascule, currently I am completely satisfied by the health insurance and do feel that the private insurers provide better coverage than the government could. I am not scared that my health insurance could be cancelled during a catastrophic health crisis.

[iNow]

As I stated in my previous post the idea that it is not the government’s job to supply healthcare is simply my opinion. This opinion is rooted in the ideas that the government can only do what is enumerated in the Constitution and that when discussing the constitutionality of an issue it is necessary to consider the thoughts on issue in question.

So... what about the Ninth Amendment then? It sure appears to me that you are simply ignoring that rather critical bit.

[DJBruce]

So... what about the Ninth Amendment then? It sure appears to me that you are simply ignoring that rather critical bit.

 

I am not quite sure what your point is the ninth amendment simply states that just because certain right are not enumerated in the Constitution does not mean they do not exist. The amendment was adopted to stop the government from infringing on rights simply because they are not enumerated.

 

It has been said, by way of objection to a bill of rights....that in the Federal Government they are unnecessary, because the powers are enumerated, and it follows, that all that are not granted by the constitution are retained; that the constitution is a bill of powers, the great residuum being the rights of the people; and, therefore, a bill of rights cannot be so necessary as if the residuum was thrown into the hands of the Government. I admit that these arguments are not entirely without foundation, but they are not as conclusive to the extent it has been proposed. It is true the powers of the general government are circumscribed; they are directed to particular objects; but even if government keeps within those limits, it has certain discretionary powers with respect to the means, which may admit of abuse.

James Madison

[iNow]

My post was in response to this comment:

 

the government can only do what is enumerated in the Constitution

 

 

You stated that as if the constitution precluded our governments ability to offer healthcare for its citizens. The ninth shows such an assertion to be baseless. If perhaps I've misinterpreted the point you wanted to make, then please clarify.

[Severian]

I'm confused so, if everyone has to pay for the GOVO (I made that up ) insurance, why would someone get private insurance? wouldn't taxing them cause them to raise prices?

 

In Germany (where I used to live), there is a state health insurance and private health insurance. The state has to insure anyone who wants it for a pre-specified price (so they can't just say to a cancer patient that they have to pay $1,000,000 in premiums to make them go away), while private insurers can refuse to insure people or just set their premiums to be high enough to cover them.

 

Therefore, it is easier for private insurers to make money, and competition can often force their insurance to be cheaper than the state's. Now, that sounds great, but the government doesn't want everyone to go private since then they will have no money in the pot to cover the chronic, expensive cases the private insurers won't take. So they force people who earn less than a certain cut-off to have state insurance.

 

Strange system...

[Pangloss]

Thanks for sharing that; I hadn't heard of Germany's system before.