Health Care Thread II

[Malaki]

I heard this a few months ago, and it rings true to me: for the left, healthcare reform is about signing everyone up for insurance and then doing tricks to pay for it, while for the right it is about lowering the cost of healthcare while trying to reduce the number of uninsured as a secondary priority.

Basically, what are the cost-saving methods that are being implemented? How are these plans going to lower our consumption of healthcare in the future?

To me, it seems like we're simply extending coverage, taxing to pay for it (and a lot of those taxes will hit the middle class, ie cadillac tax, mandating insurance coverage -> all insurance premiums will rise across the spectrum), and waving our hands that medicine will get cheaper with innovation when it clearly hasn't in the past, due to the exact system that we're working with.

A couple articles by intelligent people (read: dean of columbia b-school, dean of harvard med, not politicians) on the right that get to my main concern - here and here

also, preventive medicine is not going to be a cost saver - here's a good article from the CBO

[Aamina]

Health insurance should be catastrophic. There should be no hidden 500 dollar fee for seeing a doctor for 5 minutes as a checkup or for the flu or some pain.

Price pressure would cause Doctors to compete, 20-40 dollars for a checkup: no billing an insurance company. He directly pockets it. He wins, I win.

I pay a premium 1/5th of what it is now. If I need a stay in a hospital, or I get cancer or whatever, the insurance pays for it. Added up with me paying for checkups, you're spending less and its less of a headache for everyone.

Of course, getting the Health Care Industry to go along with this, shafting insurance companies, would be like pulling teeth. Plus there'd be the 6 months + while everyone adapts to the new system...which would suck for some people. But it needs a massive overhaul.

[Draegan]

Originally Posted by Malaki

I heard this a few months ago, and it rings true to me: for the left, healthcare reform is about signing everyone up for insurance and then doing tricks to pay for it, while for the right it is about lowering the cost of healthcare while trying to reduce the number of uninsured as a secondary priority.

Basically, what are the cost-saving methods that are being implemented? How are these plans going to lower our consumption of healthcare in the future?

To me, it seems like we're simply extending coverage, taxing to pay for it (and a lot of those taxes will hit the middle class, ie cadillac tax, mandating insurance coverage -> all insurance premiums will rise across the spectrum), and waving our hands that medicine will get cheaper with innovation when it clearly hasn't in the past, due to the exact system that we're working with.

A couple articles by intelligent people (read: dean of columbia b-school, dean of harvard med, not politicians) on the right that get to my main concern - here and here

also, preventive medicine is not going to be a cost saver - here's a good article from the CBO

There are a lot of assertions in your post that are wrong, or half right.

I could care less about the D/R who wants what debate. Everyone has a different angle and most of them are wrong, or dumb. But Democrats are for making AFFORDABLE healthcare available for everyone (a mandate is not a sure thing, though you need one for a system like the Public Option to work). The Republicans want healthcare reform but they havn't come up with anything other than "reforms" and keeping the government out of healthcare. Why they keep saying it's a takeover is retarded gibberish. As soon as you hear a politician or a lobbyist or talking head say "government take over of healthcare" you should either change the channel or throw your remote at the TV.

First the plans are not magically extending coverage, then taxing for it. That would be a single payer/universal healthcare system. Which actually would be the best option in my opinion.

There are no tax increases planned for "middle class americans" in most of the plans, if any. The only tax that is brought up is this Cadallaic Plan tax. That hardly effects anyone in the middle class.

Mandating insurance coverage does not increase taxes, it actually increases profits. It forces everyone to get insurance which automatically gives insurance companies more customers. It doesn't mean it increases premiums. And if you believe the insurance companies when they say it'll happen with the current Baucus bill then you're very gullable.

Also please list what taxes are proposed that hit the middle class. I have not heard any.

I'm not sure if medicine will get cheaper automatically but it can't get any worse. However cancer medicine will now be covered for most people so then it becomes affordable for you and me.

Now to your links.

The WSJ has a lot of factual errors from mandates to man assumptions, like your post, about premium increases. It's sited studies without sourcing them. According to a study I just looked up, the Public Option will be bankrupt in 5 years because the budgeting for lollipops will exceed funding and therefore will bankrupt this country.

The second article had this quote:

Second, in health care as in other markets, real progress depends on innovation. Yet health care markets rarely conduct successful experiments with new ways of paying for and organizing health care delivery. Why? Although health care markets have some unique attributes, these are not the explanation for lack of successful innovation. Rather, health insurance markets suffer from overregulation, which limits innovation in both insurance and new ways of delivering medical care.

I've never heard that the health care market is stifled on innovation at all. Which regulations is he talking about? I'm assuming he means selling across state lines?

It's an opinion piece. Just because he's a Dr. doesn't mean he's an expert. I'm also not sure what his point is. Sounds like he thinks he knows how Washington and the legislation process works, but I don't think he does.

Shrug. He makes some good points though about employer based health insurance. He sounds like a "Free Market Wizard" towards the end of the article. With this paragraph:

Second, identify and eliminate the many barriers to entry and innovation in the health care and insurance marketplace. Eliminating what are often hidden barriers to competition will encourage entrepreneurs to offer lower-cost ways of financing and delivering health care, approaches that will deliver greater health care value for the dollars spent.

Because it's just that easy.

[Malaki]

Here is a (obviously right-wing) bit about cadillac taxes. If there is a better analysis of who that tax hits, I would love to see it, but this is what I've seen.

Here is a paper by Larry Summers about a mandate - "Essentially, mandated benefits are like public programs financed by benefit taxes." So that's where I'm getting the mandate-as-tax idea.

As to increasing premiums, the idea is that insurance profit will stay fixed at whatever %, but now they have to care for all the expensive people that they denied before. It won't hurt their profit, or how much doctors are paid, or drug companies - you'll pay for it in increased premiums as they have to make more profit off you to pay for the loss on the new sick customers. Basically, it's more efficient economically than a straight tax because you have a free market deciding the rates rather than bureaucrats, but the effect on the individual is the same as a tax.

The only way you as a normal person don't pay more is if there are so many healthy uninsured people that are now paying in that there is no effective change, which a) is doubtful and b) really sucks for those healthy people who are suddenly subsidizing the entire expansion.

Pretty sure being the dean of harvard med school means you're as close to an expert on health policy as it gets. You don't get there just by being a good researcher and a nice guy. If you're wondering what barriers he specifically was talking about, you should have read this paper (great survey of the issues, even if it is from 94) in his bibliography - go to where it says "regulatory barriers" and read the paragraph, my copy-paste out of acrobat isn't working for some reason.

And I don't think he said it would be "that easy". He said the entire thing is going to be a politicized lobby-fest government fiasco just like medicare is (btw, here is the link to the trustees saying medicare is going to run out of trust assets to sell beginning in 2017 - no lollipops mentioned!), and that getting out of that paradigm is the way to go. Which I, and most on the right, would agree with.

[Zeste]

Well, I just learned today I can't get personal health insurance because I carry a diagnosis of Aspergers Syndrome. A mental health condition with no health symptoms of it's own. I see a psychiatrist for depression meds.

Pretty bummed out about this right now. Can't get coverage for it I get real sick or injured because of a very ambiguous mental health diagnosis? I honestly am feeling pretty devestated. I've got a family and kids to take care of for many, many more years, yet I denied health insurance because of something that isn't even a disease?

I honestly have no idea what to do here. It's like being denied coverage because you got diagnosed with ADD.

And my 3 year old autistic son? Yeah he'll never be able to get private health insurance either. How do some of you defend that? An autistic 3 year old can't be covered if he gets sick or has to have an unrelated surgery or procedure?
Seriously WTF. I get that we might be "higher risk" on a profit viewpoint. But really, it's just cool with Americans that people can be denied coverage for ambiguous, unrelated issues?

Private health insurance is really a fucked up system.

[Dumar]

private health insurance makes absolutely no sense on any level, even a theoretical one shows the complete fucked up nature of it.

do you want private police response, fire? let's privatize everything and let the market take care of it! even in theory it doesn't work. it's stupid.

the only reason it is in this country is because greedy fucks did and will continue to buy congress and every politician from washington to palin's milf ass in alaska. that's it. and that's the way it will continue to be because of it.

[chaos]

I never thought I would type this: Dumar, you're right. Shit, now I have to reevaluate my position on the Diablo 3 art direction.

[Tred]

Originally Posted by Zeste

Well, I just learned today I can't get personal health insurance because I carry a diagnosis of Aspergers Syndrome. A mental health condition with no health symptoms of it's own. I see a psychiatrist for depression meds.

Pretty bummed out about this right now. Can't get coverage for it I get real sick or injured because of a very ambiguous mental health diagnosis? I honestly am feeling pretty devestated. I've got a family and kids to take care of for many, many more years, yet I denied health insurance because of something that isn't even a disease?

I honestly have no idea what to do here. It's like being denied coverage because you got diagnosed with ADD.

And my 3 year old autistic son? Yeah he'll never be able to get private health insurance either. How do some of you defend that? An autistic 3 year old can't be covered if he gets sick or has to have an unrelated surgery or procedure?
Seriously WTF. I get that we might be "higher risk" on a profit viewpoint. But really, it's just cool with Americans that people can be denied coverage for ambiguous, unrelated issues?

Private health insurance is really a fucked up system.

I do apologize this is a bit long.

First a bit of history/setup. I had my colon removed due to Gardner's Syndrome in 1993 and I've had several treatments for a desmoid tumor that showed up in 1996 and various other surgeries and complications related to it. For several years I was in and out of the hospital with one 4 month stay due to a blood clot. I was never able to hold a real job. I was never able to attend any steady form of college.

With my diagnoses in 1996 I was able to get SSI with Medicaid until 4 years ago when I got married. I lost it because they said my wife makes too much money. As a teacher...figure that one out. Thankfully I was able to pick up Medicare while on Medicaid a few years before that so I still have that. There is no fucking way I am doing anything to lose my Medicare. From what they've told me that means barely working part time for some extra cash to help with bills which we are able to handle ok.

Right now am I able to and would I love to have a full time job? Absolutely. But I witnessed second hand this year what happens when you have an illness like mine with my sister. She has the same diagnosis of Gardner's and colon removal (same week as mine in 1993) and she worked full time and had health insurance. She gets diagnosed with thyroid cancer. Has surgery to remove it and everything's fine. But she had to take time out of work to get treated obviously. Whats that? You took too much time out of work to use your health insurance to get treated for a health illness? Oh well. Sorry *yoink* you no longer have medical insurance. That fucking blew my mind and reinforced my don't fucking lose Medicare train of thought. Just last year I had another round of chemo that lasted 8 months. Thankfully it worked amazingly well and it shrank about 70%. I just can't afford to have a full time job the way things work.

[Erumaron]

Not nearly as bad of a horror story but my girlfriend has Cystic fibrosis and about two years ago Social Security forced her to go through all sorts of medical reviews to make sure she still had it (laughable to say the least if you click the link). More related though is that she's a 22 year old with some hopes and dreams, like anybody that age should have, but she can never work any kind of real job because if she does she'll lose her health insurance which is a quick death sentence for somebody with Cystic Fibrosis.

[Christo]

I realise the 3 posts above are anecdotal at best, but can someone please explain to me how private health care is good for these people and the nation.

How is it that denying Zeste health insurance is good for your country? I live in socialist Sweden where health care is basically free. I cannot fathom that making a profit is somehow more important than the well-being of the country's citizens.

Please tell me, in mono-syllabic words how this improves the standard of living in the US and how this is a good thing for Zeste and his family. The fact that Tred doesn't dare work too much for fear of losing the insurance he has. Do they deserve this for past sins or something? Is this karma catching up to them?

Zeste, you should maybe look into emigrating. With your degree and current work i'm sure you could move to Australia, New Zealand or Canada.

[Mario Speedwagon]

Originally Posted by Christo

I cannot fathom that making a profit is somehow more important than the well-being of the country's citizens.

Clearly, you aren't American. Profit trumps EVERYTHING in this country. We only do things for profit.

[Malaki]

Clearly the solution to this unabated greed is to make all of healthcare managed by the government. Let them set the prices for drugs and doctor salaries as the only payer, let them dictate what they will and will not buy and at what price. I'm sure that will not only get our best and brightest headed into medicine, but also be a really efficient solution that makes every special interest happy while at the same time improving quality of care and reducing cost! Business is just that bad compared to the wizards in Washington!

Seriously though, you are all sort of right. The reason the system is as it stands is because healthcare is a business in a capitalist nation. Doctors invest hundreds of thousands of dollars into education expecting to be compensated - not to be public servants. You can say they should do it purely out of the goodness of their hearts, not to actually make money, and that the rich should pay for the costs of the rest of us to have medical care because we're entitled to it and they can afford it - but that's a huge paradigm shift from where medicine was in the past.

As to "how it's good to deny people coverage" - obviously it isn't. It's a question of money. The costs of our current system are already insane. We could sign everyone up, but then either we'd pay a ton more, be forced to limit coverage to some people, compensate our doctors/hospitals less, or some combination of the above.

Of course, nobody is willing to tone down their own medical spending. Hospitals are already going bankrupt right and left - compensating less is only popular if you're talking about those evil moneygrubbing drug companies (but keep taking your pills so you stay normal!). So that's out. Paying more seems to be really popular these days - mainly because 70% of our nation is convinced that they wouldn't have to spend a dime, we'd either have those greedy fat cats pay for it, or just sink harmlessly into more debt.

There are a lot of problems with the way health insurance is structured. Lack of competition, stupid tax rules, required inclusion of certain benefits. It encourages the spending levels we have, creates retarded situations like healthcare depending on employment, and it needs fixing.

The problem with these debates is that the issues get confused. People wanting to provide insurance for those with pre-existing conditions propose measures that are horribly cost-ineffective and anathema to anyone who thinks that a free market can determine the value of something better than a government panel. Yes, if we have a public plan then everyone would be covered. Yes, we already have a medical program that costs around a trillion, can't be reformed since it's a special interest quagmire, and is going bankrupt in 8 years. But that shouldn't stop us!

Fix the obvious problems with our healthcare system first, the ones that are making our government go bankrupt. Then we can talk about what to do about the chronically ill, or the uninsured illegals, or whatever.

Let's see, what else - your health care in Sweden is not free, you just set a specific target of how much you're willing to pay and that's that. Rationing of the first degree, fixing the cost at an arbitrary number. I guess we could control runaway costs too if we just said "Ok, we refuse to pay more than x, tough luck". Right-wing view here.

[Lleauaric~EW]

CBO came in with a very positive estimate.

House CBO Finds Dem Bill With Public Option Reduces Deficit

Robust public option is all but a sure thing at this point.

[Tolanin]

So CBO says it saves money, all evidence from every country that has tried it shows it saves money, yet i bet the Rs still are gonna complain that its more new taxes, while neglecting to tell anyone that its two bucks saved in private spending near mandatory spending for an extra buck in taxes.

I was listing to the radio today and one of the jackasses was talking about how we should listen to krugman when he says single payer is just a step towards not having private insurance at all and the host talks up krugman saying he is an important economist so a credible source.. but the fucking clip is mostly krugman talking about how much better single payer is.. but we are supposed to ignore that part.

I really think I am gonna change party affiliations over this shit, I mean i hate dem policy on so much but its getting pretty blatant how badly the republicans are trying to screw us on this with their bullshit... and i have been listening to Rush since i was 15 and never really had a crisis of faith til this BS.

[AladainAF]

Originally Posted by Aamina

Price pressure would cause Doctors to compete, 20-40 dollars for a checkup: no billing an insurance company. He directly pockets it. He wins, I win.

And what happens when the doctor makes a relatively minor error (Because hes human too), and the patient sues the living fuck out of him. Do you think that 20-40 here and there that he directly pockets is going to help him when hes getting sued for millions?

I cannot fathom that making a profit is somehow more important than the well-being of the country's citizens.

I cannot fathom how people will sue left and right over errors made by other human beings - which is completely unavoidable.

The Republicans want healthcare reform but they havn't come up with anything other than "reforms" and keeping the government out of healthcare.

One thing I heard recently, which actually surprised me, was the fact that health insurance companies are not allowed to compete across state lines. Living in Texas, for example, I cannot buy health insurance from a company in California. Thats messed up and greatly screws competition. I never knew that.