Everybody in America gets healthcare. The insured (the salaried and unionized employed, the retired, the veterans, and the indigent) walk in the front doors of clinicc, emergency rooms, and hospitals, and the uninsured (working poor, illegal immigrants, young/healthy self-employed) walk in to emergency rooms. The uninsured meet with a social worker in the ER, who explores how they might pay, and if they are eligible for some government payment. What isn't paid gets written off, and the expenses absorbed by the hospital, and eventually paid by the local community (county hospital tax assessments on residential property taxes). The biggest differentiator in quality of care is not income or insurance, but rather the knowledge level the patient brings, used to determine which doctor he seeks care from. The interesting thing here is that although local communities pay for the uninsured, the care provided them seems to be constant around the US. That speaks to the character of our people. Another interesting thing is that if an uninsured should be determined to need a liver transplant, he or she will go on the organ waiting list, with placement independent of their ability to pay or quality of insurance for others. Again, this speaks well for our society. It seems to me that the debate we are not having is what level of healthcare should be provided to all, and what level should only go to those who can pay. Currently, the only level of healthcare not available to uninsured, or poor, is cosmetic procedures and experimental treatments. I think that this can't stay this way, because medical advances will create more and more advanced (and expensive) treatments. If scientists can "grow" organs at a six or seven figure cost, can the government afford to provide that service to all who need it but can't afford it, for example? There are two solutions to this problem. The first is that adopted by Europe- everybody gets care and insurance from the government, with no group getting more services than another. This creates a ceiling on the care provided, leaving to situations as seen in the movie "The Barbarian Invasions", where cancer patients have to wait for treatments that come quicklt to all in the USA. Another problem with this system is that when services are limited by nature (organ transplants), qeue orders have to be based on parameters that are unfavorable to the elderly. If society is determining who is most valuable, non-working retirees with no more significant tax payments to make (until death) will always rank behind young, working tax-payers. This is opposite of what we currently have, where the elderly are all insured, and many have significant savings to pay with. Another observation about Euro and Canadian HC- the dissatisfied with wealth can seek other care, in other countries. The middle class can't. A tremendous number of Euros have their cancer treated in the US. A significant number of wealthy from the world over go to Asia for organ transplants, because a market for purchasing organs (outside of a qeue) exists. The alternative is to have the discussion we have been avoiding- how much healthcare should be provided by US society to all? It seems to me that there are three tranches of social healthcare: 1. Tranche 1- level of communal good. Immunizations and vaccinations help us all, and no sane person argues with the government providing this for all. 2. Tranche 2- Level of decency. We, as a society, don't want people dying in the streets, and we don't want people going without treatment because they lost in the great game of American enterprise. Currently, this level does not have a ceiling in America, which leads to the predictions of skyrocketing healthcare costs engulfing our economy. 3. Tranche 3- Level of exception. This would start with cosmetic procedures of vanity (are we all in agreement that society owes nobody a boob job, nor a tattoo removal), and add high cost procedures. Would you add to this extremely expensive drugs? Advanced expensive treatments? This is a debate nobody wants to have, because you start out talking about medicines and procedures with long latin names, and end up talking about real, dying people in need. I can see how the lack of a means to deal with Tranche 3 leads us towards nationalized medicine. I don't think that's the greatest good for us all. I think the greatest good is that which makes the best HC available. I am unhappy with the president's bill, because it will spend a bunch of money insuring some uninsured, without actually improving their care (it does allow them to walk i the front door of clinics). There will still be uninsured, at first (illegal immigrants), and the locall community will still provide their HC. I think local control of costs and spending will always be more efficient than national control. What reforms would I suggest? 1. Tort- cap on punitive damages, allowing enough to hurt the offensers without creating a toll on the whole system. 2. Explore clinic vouchers for the working poor (including illegal immigrants). Provide every SS number with two clinic visit vouchers so their strep and flus are handled in clinics (like the rest of us) instead of in ERs. 3. Create HSAs, and make every insurance payment fund an individual's HSA a little. The HSAa would cover Tranche 3, and create an incentive for all to get insurance. 4. Make sure there are no barriers to cost competition among insurers. 5. Have that debate about Tranche 3 that nobody wants. In nationalized HC systems, Tranche 3 is real, and it's big. We should discuss it now, and see what as a society we want to deal with. Thoughts?
1. if the uninsured goes to the ER, they will get treated, but they will also get a HUGE bill. way bigger than you get with healthcare. one they can't pay, and will likely go on their credit and cause tons of bill collectors etc. lots of these people are not the "wanting a handout" that many people believe. they simply can't afford insurance and they are really sick. 2. to add to point one, you say that when you are sick you go to the doctor (clinic/er) etc. i know i do when i get the flu, a serious cold, even more serious stuff.... but doesn't require the ER.... like i broke my finger once... waited. stepped on a nail.... waited until the next day. the impact on cost to the uninusred person and to the system (the ER is much more expensive than almost any other care) is astounding. for a lot of people, it can literally bankrupt them. for those that decide not to pay the bill (most) your above scenarios work. but what about that other person? the person that may be poor, but have no other "flaws" in your estimation. a person that may not have **** (cars/flat screens/etc.) and actually tries to stay out of debt and pay their bills with what little money they have. they get another blow to what is already a ****** life (financially). it works basically like the 3rd world. these are decisions these people have to make every day. your walmart workers, construction workers, tons of people that you see working hard every day. i get it, people don't ike taking care of other people on their own dime. neither do i. non smoking advocates will call for illegality on smoking, others will call for fat people to pay double. but none of that matters. people should be able to pursue their lives in this, the greatest county on earth, without having to worry about taking their child to the ER... a thousand dollar experience.... for what "may" be a broken bone. we can pay for it and we can do it. but we can't do it under this free market system. not saying "a free market system", just not this free market system. it is simply out of control. the mix between health and profit has proven to given us breakthroughs in treatment that are by no doubt the best in the world. at the expense of $1000 toothbrushes, $10 bandaids, and $42 plastic drinking cups (i actually had the drinking cup one myself on my last hosptial stay for a biopsy). it will take major reform and a lot of rich people will need to find another way to get rich, plain and simple. but it i s a moral question. if other countries can do it, we can too. but there might be some sacrifices. i have a regular old HMO. i get good care, as far as i can tell, and have no complaints for the $300 a month i pay through my employer. so i understand the fear that our care will go down the toilet and those of us with good plans are going to pay for it, through quality of care and through the wallet. but that has not proven to be true in other countries and it is something we have to look at. it is the morally right thing to do.
notreally, what is more moral- a working poor with a large bill (btw, these get worked out without destroying credit. I know from friends' experience) or... a 65 year old retiree being told that she can't have a digital mammogram for two months, to check out that lump, because of equipment rationing (as happens in UK and Canada)? You have to move past this idea of moral people wanting nationalized healthcare vs. evil people wanting to horde their money. Every person who owns a home is paying for healthcare for the working poor, through their hospital district assessment. They aren't complaining. That says a good thing about them, not a bad thing.
Taylor, Tranche 1 is all society owes anybody. And society really doesn't owe any individual that level of care, it is done and should be paid by all because it is for the preservation of the society itself. It is done because it must be done to prevent societal decay from rampant disease, etc. Anything beyond that is a luxury afforded to us by our modern technological advances, and is in no way to be considered a birthright. If I get a boo-boo, I'll put alcohol and a band-aid on it. If the boo-boo gets infected I will either pay to see a doctor or not. I have no right to impose any cost on society just because I got an infected boo-boo and I think some ER is supposed to GIVE me free care for it. If I choose to pay a fixed cost to mitigate the risk of unaffordable medical procedures, then I should be free to seek out an insurance company that has a risk pool into which I can join. And that company should be free to deny me the right to join (though not free to kick me out afterwards as long as my premiums are paid). Simple. Straightforward. And nowhere in this is any governmental oversight necessary, save for courts to settle contractual disputes between an insurance company and an insured. If society wants to throw in the equivalent of the Texas Dept. of Insurance to provide regulatory oversight and insure standard contractual forms are available to all citizens, that's OK by me too. What the hell else do we need the government's incompetent involvement for?
Sangre, what is owed is a more fundamental question. The founding fathers never considered it because health care at the time consisted of amputations and leachings. Our society has developed the consensus that we don't want people dying in the streets, we don't want children suffering because their parents don't earn enough, and we want advanced treatments to be available to all, even if the costs are shared. Everybody doesn't agree with that, but most do, and we are a representative republic. My feeling? I want very good care available to all, and am willing to contribute to that. I want no limits on the care available to my family, understanding that I may have to go into debt if necessary. It would be cold comfort to keep my savings and lose a loved one prematurely. I wish the national debate would take a few steps back, and address the public's concerns about cost and quality, rather than treat it as a good vs. evil issue, or greedy vs. selfless, or American vs. western Europe systems. That's what we want, isn't it? The greatest quality healthcare for the cost?
Madoro, was the lady not a citizen? I was trying to understand your post. triple, I certainly think reform is needed. I like the president's ideas on pre-existing condition coverage. I don't like the bill as a whole, but there are some kernels in there. I think that the problem is that the bill was created by people with an end goal in mind, and we have never discussed just what works and doesn't work.
The most long-lasting reform would come from people simply paying their own money for the services they receive. It is the third party, whether insurance company or the feds, that causes the prices for services to be completely unrealistic.
You guys know that large companies self-insure, right? My employer uses BCBS to manage the health insurance for its employees, but it is funded by the company.
Just one more thought on health care. Link Let's start with a real-life example of the true state of affairs in "healthcare," a.k.a. sickcare. A young couple of our acquaintance just had a baby. Labor had to be induced, the baby was delivered via C-section, and there was a brief period of worrisome complication (fluid accumulating in the mother's lungs) which was resolved with a simple diruretic. All this led to a five-day hospital stay as opposed to the usual two or three-day stay. The bill topped $140,000. In our completely distorted perception, this number is now "normalized" as "typical" in healthcare; $80,000 for this procedure, $120,000 for that, $250,000 for this--we have lost the ability to be surprised. Perhaps we should ground our analysis of simulacrum reforms by starting with the typical annual household income in the U.S. According to the U.S. Census Bureau, the median household income in 2008 was $50,303. (This number has undoubtedly fallen due to the Great Recession.) Even assuming a mortgage deduction and a dependent child in the household, after all taxes (income, Social Security, property, sales, vehicle, local and state, etc.), we can reckon that the typical household is doing quite well to end up with $40,000 net income (a 20% total tax rate--higher income households pay much more). So having a baby with a few extra days of care costs 3.5 years of net income. A few hours in the recovery room was $17,000. An MRI was $4,000. The list goes on and on, until the five days total over $140,000. "This is just what it costs now," we're told with a sigh, as if Heaven designed the system and the cost structure, and we mere mortals are incapable of adjusting it. If you have a credit card with a balance, then you've seen the wondrous results of banking/credit card "reform." There is now a little box on the statement revealing the unspeakable: that if the cardholder pays the minimum balance, they will pay off the balance in 33 years. This level of "reform" is truly heartwarming. I find it refreshing to have my debt-serfdom spelled out so clearly. Does anyone really think that tweaking the parameters of the sickcare fiefdoms' swag (currently 16.5% of the entire GDP, with 45 million uninsured and tens of millions of citizens with declining health due to "lifestyle" diseases) will "reform" a system this catatonically disconnected from reality? As the economy devolves/shrinks and the sickcare fiefdoms tighten their grip, we shall soon see 20% of the GDP devoted to sickcare--as if that is sustainable. Does anyone really think that the parasitic banking/mortgage/financial cartels have been neutered by the laughably tepid "reforms" which have been put in place? One of the key concepts in the Survival+ analysis is integrated understanding. What this means in "healthcare" is rather obvious: "refoming" the system means reforming the way food is grown, packaged and sold, reforming the American diet, reforming the "entitlement" that everyone "deserves" to eat out often, that they "deserve" to be "repaired" (if you can't repair me, I'm gonna sue you!), preferably at no cost to themselves, that the sad state of our fractured communities, lax fitness, education systems and mental health have no bearing on our deteriorating health as a nation--and so on. We are what we eat, and we are what we do (and borrow) every day. Here are two charts of the results: The only way to truly "reform" the American sickcare system is to revolutionize our understanding of health from the ground up, and carry that revolution all the way through governance, as the State is currently captured by cartels and unions of "special interests." I have laid out the case that such real reform is impossible in the status quo, and so the eventual "reformation" of the failed sickcare and financial systems must await the insolvency of the State and the nation. Only when the bills are no longer paid and the ability to borrow money cheaply are gone will true reform be possible. Until then, our best option is to grasp control of our own lives by avoiding debt and the sickcare system as much as possible--by "opting out" as much as possible.
That's interesting. My newborn (2 weeks old) had some nasty infections and spent 11 dayd in the children's hospital. I expected a six figure cost, and was surprised to see an expense of $25k, of which I had to pay a little over 10% with the rest covered by insurance. That was 11 days in a private room, on an IV the whole time, several blood cultures and tests, daily doctor visits, and nurses coming in every 2 hours. BTW, in our time at the hospital, we encountered many uninsured who were getting their children treated. There was no differentiation between the insured patients and the uninsured. My understanding is that the hospital reaches a write off agreement with the uninsured who can't pay. I have no sympathy for the uninsured who can afford insurance and opt to not get it. Does the government have a say in insurance? Sure, as long as it subsidizes it by not taxing it. A good thing about our system is that it encourages people to work. I wonder if this is a big reason why unemployment is usually significantly less in the US than in developed countries with nationalized medicine.
I’d like to see what assumptions are used to calculate what this bill will actually cost. I have a fear that everyone’s decision making process would change when it comes to making an appointment or not. Not just the uninsured that see it as ‘free’ but also those of us that pay a flat/income related amount. Surely my little extra visit can’t cost much more if it’s spread over millions of taxpayers. Why take the chance especially when the cost is immaterial. We need to separate preventive, routine and catastrophic medical care if that is even possible. Pooling risks so that we are all covered should something bad happen would be reasonable. Even universal funding for preventive check-ups sounds ok. I just don’t want to pay for every Susan that needs Prozac for depression because her son Tommy needs Ritalin since he can’t concentrate in class. New ailments will always be discovered, old ailments will not go away, new drugs will always claim to treat all and the population will continue to expand and age. It’s just not sustainable.
Thanks. Covering the non-citizens is a funny issue. I assume she didn't have insurance in her home country to cover it. I know our DFW ERs are full of non-citizens getting care. I don't know of anybody proposing a system that will overtly cover the non-citizen uninsured (remember the whole "You lie" incident, where the president said his plan wouldn't cover illegal aliens?). Doing so is a pure act of community charity. If someone wants to argue that an illegal alien working in the US should receive such care, this right-wing reactionary is willing to listen (again, I see a link between working and health insurance as a good thing). That, to me, is an argument against nationalized health insurance- in the border states we get cheap roofs (due to cheap labor), but have higher hospital district tax assessments. It's not fair for Minnesotans to pay a premium to support uninsured illegal aliens in Texas. If somebody comes across the border, with only the intention of receiving medacal care, well- there needs to be some kind of gatekeeper process. I'm curious as to what you would like to see.
If she bought a policy which stated up front she could be dropped, she didn't choose very wisely. If she was dropped in violation of her policy, the insurance company should be dealt with harshly. But buying insurance for something you already have experienced isn't buying insurance at all: it is being given money. Charity is great, and I think we should all practice it. Granting coverage for a known condition is charity. Hospitals and physicians formerly were able to provide a great deal more charity before the federal government got so involved. Much charitable care is now, in fact, illegal.
Here's what it boils down to for me: I don't want these folks, whom I pay every month for insurance, deciding whether or not I should get treatment that these folks say that I need.
You are overlooking the fact that no one is owed anything, yet we still pay for their care now. When Leslie was found laying unconscious on a sidewalk with a head injury, he was sent to Brackenridge and received good health care at Travis County taxpayer expense (no, I don't know this for sure, just assuming he did not have health insurance). Even if he did, a lot of others do not, and the example would be valid. Yes, a large bill is always sent to these people, but they have no money, and they can't pay it. So the taxpayers pay it. That is where we are, and why some form of health care reform is absolutely necessary. If done properly, dollars would be saved. But that's a big if. It could be another super expensive plan. I would favor a basic coverage plan for all, and anything above that would have to be covered by supplemental private plans if you can afford them. There could be different levels of coverage according to what you can afford. That way there wouldn't be an MRI everytime someone gets a headache and things like that. This would be practically impossible to do though, because someone would have to draw the line as to what any plan covers, and the political opponents will immediately start saying you have killed grandma by denying some coverage. It's a tough issue, but the status quo is very costly and poor coverage-many other nations spend less per capita on health care. Why do you think it's working now-we are paying for all the non-covered people at huge expense.
This is the debate that needs to be had. The Democrats in my opinion constantly lie about the health care debate because they continue to state that it is about controlling health care costs. The senate bill, which is apparently the platform we will use moving forward, does basically NOTHING to to regulate or contain costs. It isn't directed at providers or pharmaceuticals where the costs are actually contained. Rather, they have attacked the insurance companies with the usual vigor. People like doctors, they never like insurance. The argument is ulimately flawed because the nature of insurance at its root IS a voluntary socialistic risk pool. Insurance from its very founding has been a collection of individuals who pool resources together to form a large pool, wherein each one that contributes to the pool can ultimately withdraw if needed. The evil "insurance company" is the administrative agency that meets the standards for the pool for entry (underwriting) and payment of money from the pool (claims). Thus, when Donna Brazile wails over the weekend about the evil insurers denying people coverage because of a pre-existing condition, just think about that for a moment. Under federal law, if you have had continuous insurance coverage, you policy is generally portable already. In other words, if you have been insured, you can get insurance if you switch jobs, et cetera - without a pre-existing bar. Thus, the only people to whom this applies are people who had no coverage for sometime (in other words - no Medicaid) and decided to get coverage - usually because they are sick. When you ask people to consider whether or not they desire to have a recently diagnosed cancer patient added to their risk pool, they universally say hell no. After all, they have paid premiums for years and now the new guy shows up, throws a little money in the pot and expects tens of thousands in return. This is the heart of the pre-existing condition clause. It is to protect existing insureds from the inherent exposure to premium increases that result from people who try and jump into a risk pool after they have learned that they are at risk. The heart of effective insurance underwriting is the actuarial projection. A premium is assessed for a POTENTIAL risk. Adding certain risks into the pool will not cause costs or premiums to decrease, but rather, they will skyrocket. Quite honestly, that is what I believe the bill is intended to do. After all, it never gets to the issue at hand, which is supposedly cost reduction. Rather, it is insurance reform that will quite frankly destroy the health insurance industry - which is the intended effect. After the collapse of the insurance industry, single payor becomes the only viable option - which Obama said was the goal all along in his campaign. They can say what they want - and it is easy to use the insurance companies as the strawmen here - this is the first step to socialized medicine. That is how they sold this to Pelosi and her people who wanted single payor now.
Wesser, I am trying to wrap my head around your first two paragraphs, which seem to state that the insurance companies are under an unfair attack. Am I reading that correctly? More specifically: ----- Ins. Co. & CEO With 2008 Total CEO Compensation Aetna-- Ronald A. Williams: $24,300,112 Cigna-- H. Edward Hanway: $12,236,740 Coventry-- Dale Wolf: $9,047,469 Health Net-- Jay Gellert: $4,425,355 Humana, Michael McCallister: $4,764,309 U. Health Group-- Stephen J. Hemsley: $3,241,042 Wellpoint-- Angela Braly: $9,844,212 ----- This is for ONE year's salary for ONE person within each company. The last company, Wellpoint, which is the parent company of BC/BS, hiked rates THIRY NINE PERCENT in California at the same time that it paid bonuses of at least million dollars to 39 different executives. CEO Braly, who took home almost 15 million dollars in 2007, testified to a House committee that the rate hike was necessary in light of "problems caused by many younger and healthier policyholders dropping or reducing their coverage during tough economic times." Take a second to read that sentence again and then tell me how big that lady's balls must be. The insurance and drug companies have spent something like 600 or 700 MILLION dollars fighting the current round of healthcare reform. Again, this money came from people's outrageous premiums, and their insurers turned around and pocketed vast amounts of wealth, and spent another vast amount trying to make sure that the corruption was left intact.
Expecting a new federal entitlement, even when there are good intentions involved, and expecting it to control costs and operate deficit neutral was best summed up by Albert Einstein. " Insanity: Doing the same thing over and over and expecting different results."...
Well, you may know better than I do exactly what the bill says and does. I've gotten disgusted with the whole process and don't follow it all that closely anymore. I do know that the drug and insurance lobbies were vehemently against early versions of the bill, which did, in fact, clip their wings. But after spending the better part of a billion dollars (of their customers' money) greasing the wheels of Congress and filling re-election coffers, the bill has been modified in ways that drug and insurance companies can live with. It seems to have turned into a bill that is utterly devoid of actual cost-cutting measures. There seems to be no substantive debate anymore. Yesterday, I took care of a severely demented 80-something-year-old guy who was non-verbal (for years), covered in bed sores, fed through a g-tube and kept in a diaper. He has already been admitted to the ICU once this year. He was transported from the nursing home yet again to the ER where I work-- this time with urosepsis (a urinary infection that has spread to the bloodstream). This guy is the poster child for spending a half-million dollars of POINTLESS care at the end of life. Clearly, we are prolonging his death, not his life. But at the beginning of this debate, when the bill had a clause about asking old people to review and make note of their own wishes (lest they end up like this guy), one of the main Republican talking points against any reforms was "Obama's death panels." How freaking absurd is that? I mean, we can't even get close to a rational, reasonable discussion about OBVIOUS problems (end-of-life expenses). We can't even mention the fact that we're spending vast sums of money on layers and layers of beauracrats and bean counters -- money that's NOT getting spent on actual care. From my perspective, the current system is bursting at the seams with waste and corruption, but the dialogue can't get past "Obama's death panels" and charges that reformers are attacking the American dream. All that said, I agree with you that we should debate what the bill actually says and does. I don't think it's an elaborate plot to destroy insurance companies. I see it all in much more cynical terms (which is sad for me, I guess). There's no doubt that our healthcare system is broken (and getting worse). I think Democrats started the process trying to win points with the American people. Then the corporations who saw their profits at-risk used some of their vast wealth to make sure the status quo was maintiained -- which is what happens in all kinds of arenas. Those companies managed to reduce the dialogue to "SOCIALISM!" and "death panels." And now we're not going to get any real reforms at all. I'm against the bill just like you are, but I'm against it because it doesn't give the radical reforms that we need. I think you mean "scapegoat" and not "strawman," btw. Apologies to all for my rambling, repetitive posts.
Thanks for the response, and I don't disagree with much of what you say. I believe that the insurance industry is being suckered with the prospect of the individual mandate to account for the pre-existing condition requirement. Problem is, I do not believe that the individual mandate with survive constitutional scrutiny - because.... it's unconstitutional. The government has never reached this far before literally forcing consumers to purchase a product regardless of their desire to do so. The auto insurance analogy is a bad one because the government forces no one to own auto insurance, it simply requires it to operate a car on public roads. You can choose to avoid that expense if you see fit. I imagine that the Supreme Court as currently constituted would strike this part of the bill down. FWIW, several lawmakers on both sides of the aisle believe that the individual mandate will be struck down. The GOP will be against it because the government overreach. The Dems will be ostensibly for it, but be content to see it go because they would have gotten their pre-existing coverage clauses written into the law anyway. The rest of the citizens will have to kick in dramatically higher premiums to compensate for the additional high risk participants without the additional premium generated by the mandate. The climate will be perfect for single payor.
AustinBat, do you really think the Democrats are secretly plotting for single payor? I think they want to pass something ... anything ... so they can go beat their chest to millions of Americans and proudly say, "Look what we did for you!" Meanwhile, the big companies with skins in the game want to keep the money flowing their way. It looks like both sides are going to get what they want. It's not any different from the prescription drug bill of 2004, passed just before an election, where the Republicans and drug companies entered into the same de facto alliance.
