the democratic health care proposals

[Etoille]

I'll be honest I don't know much about hillary care or obama's plan.

is there anyone here who might be able to fill in the blanks as dispassionately as possible?

(edit the only things I know is that hillarys plan is compulsory and would give tax breaks in some way to compensate those who would have trouble affording it)

[Soriak]

Quickly summarized: the congressional health plan would be open to everyone, the government would help pay (through whatever means, like tax rebates) the premium for those who can't afford it. Insurance companies would no longer be allowed to turn down people with pre-existing conditions or charge them an extraordinarily high premium.

The difference is that Clinton wants to make it mandatory for everyone to have health insurance, Obama doesn't.

This is a significant difference: if you currently don't have health insurance, you can still get treatment in emergency rooms. If you're unable to pay, either the government will have to pay for it, or the hospital has to eat the loss, depending on the circumstances. If the hospital has to take the loss, they'll increase prices on everyone to make up for it. (basically, you either pay for the treatment of someone without insurance through taxes or your insurance premium)

The idea is that if everyone has health insurance, the emergency room problem goes away. People also no longer get routine treatment at the emergency room (where it's more expensive), but instead can afford to see a doctor.

Under Obama's plan, someone without insurance would continue to get the treatment at the emergency room, but may afterwards be forced to back-pay the premium for some as of yet unknown length. This does create an incentive not to get insurance until after you actually need it, at which point you can just pay up and still save possibly years of premiums. It'll also lead to fewer healthy individuals with insurance and yes, this is a social system: young, healthy people help keep premiums lower.

No word on what happens if you can't afford the back-pay under Obama's plan, or refuse to get any insurance under Clinton's plan. I imagine Clinton could copy the Swiss solution to it and simply start deducting the premium from your wages if you refuse to get insurance yourself. (assuming you make too much to qualify for aid, otherwise simply deduct the difference)

This should reduce the pressure on emergency rooms and hospitals, leading to better service at a lower cost.

[Ashes Emberblade]

In a nutshell: The Democrats want to socialize healthcare. The Republicans want to eat babies for stem cells.

[Soriak]

Socialized health care = Universal Health Care = government provided health care (examples: UK, Germany, France, Canada, most countries actually)

Democratic proposal = Universal Health Insurance = private insurance companies acting under regulation. (Sweden, Switzerland - not aware of any other countries with that model)

The latter costs more, the sample of countries who have it is too small to see if the system leads to better service or if it's just the way its regulated. It does preserve the market spirit though and companies are free to offer for-profit anything that goes beyond the mandated basic coverage. (which they have to offer not-for-profit) As opposed to a single model for everyone, where you don't have the option to go to some exclusive resort instead of a hospital in the city.

Interestingly, the best doctors are found at state-run hospitals - I've noticed quite a few leaving the prestigious private facilities because the state can afford to always have the most up-to-date equipment. It just doesn't make sense for every private clinic to have that around as well. So patients at private resorts are usually treated at the state hospitals and just stay at the expensive place to recover.

Health insurance is mandatory here as well.

[Khorum]

Originally Posted by Soriak

Interestingly, the best doctors are found at state-run hospitals - I've noticed quite a few leaving the prestigious private facilities because the state can afford to always have the most up-to-date equipment. It just doesn't make sense for every private clinic to have that around as well. So patients at private resorts are usually treated at the state hospitals and just stay at the expensive place to recover.

That WOULD be interesting if it had the vaguest resemblance to the truth. But as always, your rosy eurosocialist goggles have fogged up your long view of reality in the states yet again. The BEST surgeons aren't found in private OR public hospitals, unfortunately, they're found in cosmetic surgery boutiques that don't even accept state or insurance reimbursements. The really good doctors are found in private university hospitals like Hopkins or Northwestern or University of Chicago. The other hospitals will just have to contend with the expatriate Canadian, British and Indian doctors who migrate to the US to pursue a living outside of a government stipend.

And no, there isn't even the barest hint of a sensible actuarial-regulation based remedy in ANY democratic solution. Your confusing hilarycare2.0 and Obama's ridiculous monkeycare1.0 with Kerry's 2004 plan, which WAS sensible.

[Phelps McManus]

Soriak, what kind of coverage do you get in Switzerland? Is the patient responsible for anything: copay, deductible, coinsurance, etc? If so, how much for routine checkups vs surgery vs medications?

I would say a lot of the problems here stem from the fact that all costs are hidden behind population-shared premiums. Why decline xrays, MRIs, blood work, or medications I don't really need if it costs me the same (or a negligible amount more)? Why go to the hospital that charges less when it is the same out-of-pocket expense?

You mentioned preserving market spirit. I am interested in how they manage that.

[Sunder]

Originally Posted by Phelps McManus

I would say a lot of the problems here stem from the fact that all costs are hidden behind population-shared premiums. Why decline xrays, MRIs, blood work, or medications I don't really need if it costs me the same (or a negligible amount more)? Why go to the hospital that charges less when it is the same out-of-pocket expense?

Because if you ask anyone who has gone both to a doctor's office and the ER for something, they will tell you that doctor's office gives much more personal and speedy service than an ER ever can. The problem right now is that doctors are not forced to see each and every patient that comes through their door like the ER. If people could afford it, I'm sure they'd much rather go to a doctor's office that can see them within a few minutes of walking in the door rather than going to the ER and waiting for hours before getting care.

[The Ancient]

Originally Posted by Sunder

go to a doctor's office that can see them within a few minutes of walking in the door

Wow, I wish I had your doctor.

[Sunder]

Pay out of pocket for everything, don't lean on some corporate health insurance company to make your decisions for you, and you could.

[Tolanin]

both plans seem to involve most people paying more money for insurance while still getting to hemorrhage money into malpractice and stupid shit like people who just dont take care of themselves.

Not being able to turn down super expensive patients is gonna fuck over insurance companies hard. Lawl you are a diabetic smoker with 500k per year in expenses that are entirely your fault. welcome to a 5k/year healthcare plan that hillary is all to glad to make healthy responsible people pay for.

ER at public hospitals is shit and has been for a long time. Retards going there with minor injurys or a bad cough is the entire problem. Its not like you cant get a primary care doctor without insurance either cause I had one for awhile but dumbass poor people arent responsible at all.

[Lithose]

Originally Posted by Sunder

Pay out of pocket for everything, don't lean on some corporate health insurance company to make your decisions for you, and you could.

Hope you don't get cancer if your making an middle class income.

Seriously, I am against socialized health-care but I do see a need for basic coverage..Basic coverage to me is almost a "public good". When strep throat, which would take a round of 5$ anti-biotics turns into a massive body infection that requires a week of IV treatment costing 3 or 4 grand, you can see how the system is not efficient.

Medicine is one of those fields where preventing is just a ton more efficient then dealing with problems. Low level preventative care would probably lower taxes and costs in general, allowing for a more robust private industry.

Hell though, medicine is one of those places that is touchy..When my brother was in (He had military benefits, active.) his precision radiation treatment and new chemo cost 10 grand a month and had to be maintained for 4 months. 3 Cat scans, 1 grand each, a month and multiple other tests.

Before he passed away, his total bill was like 300k? (One surger, 70k).

Anyway, a lot of those costs were billed because he "could" pay for it..The hopsitals had to reallocate charges from eating unpaid bills they accumulated from having the cat scan some dumbass who let a sore on his foot become some organ eating flesh bacteria. Had the dumbass had low level medical coverage, he might have gone and gotten a check up and saved everyone 2k.

[Astrocreep]

I think some people think that if we had communist healthcare that every american would become like those "healthy" skinny chain smoking europeans overnight. americans will still be a bunch of fatasses, why? because we want to and unless you ban free will nothing is going to change that.

[Kaio]

Originally Posted by Sunder

Pay out of pocket for everything, don't lean on some corporate health insurance company to make your decisions for you, and you could.

Hrm, here in dublin ohio it's not hard to see your doctor with copayments for as low as $20 bucks. I was injured last month nothing major but it was a substantial facial cut and i saw a within 10 minutes of filling out a form. Didn't go to our normal family doc but the urgent care place near my house (NOT ER).

The perfect system would have the competition and tech from a capitalistic type of system with active practices of low cost and preventative medicine. I might be wrong but the primary drawback i see in some places is that state run places can lag behind or not be cost effective while capitalistic systems seem to try to squeeze as much money out of you as possible. Semi-normal people taking 4-5 different psychiatric drugs and or 3-4 more health related drugs (blood pressure, sure levels, etc.) for close to a thousand a month is pretty crazy.

[Etoille]

Originally Posted by Sunder

Pay out of pocket for everything, don't lean on some corporate health insurance company to make your decisions for you, and you could.

[Soriak]

Originally Posted by Khorum

That WOULD be interesting if it had the vaguest resemblance to the truth.

I was talking about Switzerland, not the US - and of course meant the best doctors in their respective fields.

Soriak, what kind of coverage do you get in Switzerland? Is the patient responsible for anything: copay, deductible, coinsurance, etc? If so, how much for routine checkups vs surgery vs medications?

We set our own annual deductible (mine is CHF 2,000 - or about $1800), the higher that is the lower the premium. There's also a 10% co-pay up to an annual cap of CHF 700. (20% for brand name drugs if a generic is available)

A couple things are exempt from deductible and co-pay, pregnancy exams and cancer screenings amongst them.

There's the mandatory basic coverage that every insurance has to offer, all of them cover the same thing. It includes a free choice of doctors - but you can save quite a lot (up to 20% I think) if you restrict yourself to seeing a general practitioner first. People would otherwise run to a specialist for the most common ailment and that costs a lot more. Of course if your general practitioner isn't sure, he can still send you to a specialist and the insurance covers that.

Insurances can't make a profit from any of this, but they offer top-up services for profit. Recovering at private facilities, as mentioned, or a private room/larger selection of food at a hospital. It's usually bundled together somewhat and at the highest level you will be briefed on your surgery by the whoever runs the clinic, instead of a normal doctor. (the surgery is done by the same people though - everyone gets the same actual medical care) There's quite a lot of competition on those (over 100 insurance companies) and the basic insurance profits as well when they work to make the for-profit ones more efficient.

It also takes some restraints from doctors though, they'll not recommend an MRI before an x-ray unless it's really necessary. That and there's a ban on advertising prescription medicine, which really helps to cut costs. (If people see an advertisement of some ambiguous symptom - restless leg syndrome, IBS, couple others - they'll freak our and demand to get over-tested.)

On the upside, you never have to wait for the insurance to approve something. If your doctor prescribes it, the insurance covers it without asking questions.

Originally Posted by Tolanin

Not being able to turn down super expensive patients is gonna fuck over insurance companies hard. Lawl you are a diabetic smoker with 500k per year in expenses that are entirely your fault. welcome to a 5k/year healthcare plan that hillary is all to glad to make healthy responsible people pay for.

Until you find a study that shows the effect of malpractice lawsuits, don't bring it up. There is however one (I'll see if I can dig it up) that shows that premiums did not go down after a cap on malpractice awards was introduced. I think that cost is blown way out of proportion - no way it's even a billion per year, and the medical industry is hundreds of billions.

This is the new "welfare mom" exaggeration that lacks any basis in reality. Diabetes also doesn't cost $500k, surely even less than $50k. Again, pocket change and mitigated by healthy people also having to have insurance. BTW: that diabetic smoker can already get insurance through his employer's health plan, so you pay for him anyway. Except the diabetic is prevented from quitting his job to start his own business, for example, because he can't get private insurance.


The Swiss system is the second most expensive system in the world (behind the US) and I think it would be worth trading longer waiting times for a lower cost... Sweden does that and it seems to work well for them. But it shows that with this system, you can have any level of care you wish and distribute the cost equally so nobody is burdened too much. I think the biggest raging capitalistic cheerleader becomes a socialist when his insurance refuses to cover some lifesaving procedure... besides, it lives a lot easier if you never have to worry about receiving health care, regardless of what happens in your life.