Seriously thoughtful US Health Care Plan

[GeoffC]

Am I right in thinking that to some (many) US citizens, the issue is more one of "freedom of choice" than any other?
Not wanting the government to make the choice on their behalf?

As someone who has greatly benefited from the UK's NHS, I shudder at the vast expense that health costs may have on those in need.

[Spoon Man]

The Straven, I agree with what you are saying about possible state run options, they sound like they would be the most efficient of government run health care options.

Pietvo, those mutual funds are definitely what I would like to see more of. From what I understand they work, and work well for most people. I've looked into some for myself.

GeoffC, that is exactly what I see people upset about, and its why I disagree with this health care bill that was passed and I support what the Georgia House is trying to pass. No person should be compelled to pay for anything. I understand taxes for living in certain areas and receiving certain benefits, but this (I believe) takes that too far. I personally don't want the expense of health insurance right now because my income to health ratio (not an actual number, just something I personally look at) is not conducive of health insurance right now.

However, if states wish to have a tax funded state health care system I don't see any problems with it. If I don't want to pay for it, I don't have to live there but I can still live in the US.

[Elfwreck]

Originally Posted by GeoffC

Am I right in thinking that to some (many) US citizens, the issue is more one of "freedom of choice" than any other?
Not wanting the government to make the choice on their behalf?

The claim is mostly that it unfairly taxes people who shouldn't have to pay for other people's health care. Issues of choice exist, but aren't what the noise is about here.

As someone who has greatly benefited from the UK's NHS, I shudder at the vast expense that health costs may have on those in need.

Many US residents have no idea what it'd be like to assume that you'll have health care when you're sick or injured. One of the big changes that this bill has, is to deny insurance companies the right to cut off coverage of sick people. (They covered annual checkups and normal treatments just fine--and some of them would remove coverage of people who got cancer or kidney disease or any other kind of long-term care illnesses.)

[Rich_D]

Basically, I am for the health care reform. I haven't read the full text, but I have downloaded it and have skimmed it. I actually spent an hour going through it disproving the "facts" that were sent to me in an email.

I believe that additional policy holders will cover most of the expenses that the insurance companies will have to pay and I believe that if hospitals are writing off fewer losses from treating people that can't pay, then hospital costs will come down.

I don't think it is the best solution but like our constitution, I think it'll be a living document that grows and improves. Something needs done and once the first and biggest change is implemented, it's easier for the growth to happen.

What I really don't like are the lies surrounding the bill. If you're a conservative or republican and don't like the bill because you think it's fiscal irresponsibility or because you don't like big government, I disagree but I respect your opinion. If you don't like the bill because a talking head on TV or an email told you that you shouldn't like it, then I feel sorry for you.

Learning politics from watching any political opinion show is like learning physics from watching Wile E. Coyote and the RoadRunner. BeepBeep!

[The Straven]

GeoffC, my objection is not based on freedom of choice whatsoever. The problem is cost, but the new law has chosen to address insurance. Insurance is a weak tool with which to reduce costs. The big private insurers have no interest in doing so, and the federal government is too wasteful to do so. My comment on state-run programs was not driven by the want for choice but from my mistrust of federal power. Don't get me wrong, I'm no anti-federalist, but I recognize it as a necessary evil. Economies of scale don't apply where the federal government is concerned. Also, absolute power corrupts absolutely.

But the heart of the problem is costs. Health care is too expensive. More people should have it. People should not be denied it because they are sick (oh, the irony!). People should not be denied it because they were born sick. But I say "health care" and I mean "health care", not insurance. From the risk and insurance standpoint, expanding insurance to cover more sick people does not reduce costs. It increases them. That's not a political judgment: that's how insurance (and supply and demand) works. Insurance is the wrong way to approach the problem.

I've tied this together poorly, so you may care to read this Aussie. Maybe I don't agree with everything he writes, but he makes a lot of sense.

[pietvo]

What other options then a good insurance system do you have? There are basically 2 options for paying the health care system:
(1) Everybody pays his/her own expenses. This is probably what most `pure-capitalist' people would like. The problem is that most people do not have enough money for very expensive treatments. So high end health care would only be available to the rich, and the poor especially would have to do with substandard health care.
(2) Insurance. But if not everybody will be accepted they fall back to case 1 with all the problems that causes.
(3) Some other way to pay for health care where people don't have to pay all expenses themselves but the expenses will be paid from some kind of common budget. This is similar to insurance but then not run by an insurance company, but probably by the government or some semi-government or government controlled organization. This might give same savings because it cuts out the profit of the insurance companies. On the other hand it misses competition which usually lowers prices.
Of course mixes are also possible, like people having to pay there own expenses up to a certain level (probably related to their income) and the top expenses paid by the insurance company or the government.
I myself think that the second option isn't that bad, maybe with some mixture from the others.

With regard to the mutual: my bank also started as a mutual. It was founded by farmers who wanted to save their money in good times and be able to borrow in bad times or when they had to make investments without being at the whims of commercial banks. They just formed a cooperation, usually in their local communities, and later these banks worked together in a national organisation. The same model was formed in Germany. The bank now has many more customers that are not farmers (me for example). When you are a customer, you can also become a member of the bank which means you have voting rights. The bank does not have shareholders; all the profit stays with the bank and part of it is invested in the local communities (like giving money to a charity), and is decided upon by the members.
The bank is the only private bank in the world with a AAA status and it was the only one of the national banks that didn't need government help for the financial crisis. So it appears to be an effective model.

Some people say they don't want to have tp pay for other people's expenses. Do you not pay for the police and the fire brigade then? You may not see this explicitely on your bill but you still pay for it, probably through your taxes.

And finally, why is USA health care so expensive? An article I read this week noted that one of the reasons is the claim culture in the USA. Doctors are so scared about possible legal claims that they do every conceivable test, even when they think it is unnecessary. Because otherwise they might get sued later for omitting such a test. This makes it very expensive. Maybe Americans should rethink about the foundations of their society! (But so should we.)

[Spoon Man]

Pietvo, I you hit the nail on the head about our culture. We all want "something for nothing" and it does get out of hand. People will find a way to sue a doctor, because its a way to get a lot of cash in a relative short period of time. Sure, there is malpractice sometimes, but not all of the time that people say there is. So yes, our expenses go up because doctors need to have malpractice insurance, and they more people file malpractice suites, the more the malpractice insurance costs, which gets filtered into the cost of your doctor visits and whatnot.

However, there is another reason. Doctors have to pay their entire way through school (just like most everyone else in the US) and that is a lot of money. Most of them pay through loans, and this path would not be worth while for them if they couldn't make enough to pay it all back in a relatively decent amount of time. Whereas in a lot of other developed nations that I have seen a large portion of a doctor's college and so forth is covered by the government.

I would like to say something about those families who just can't afford health care (don't we love that blanket term? in the US its not really health care so much as sick care that people do.) I've seen too many families who claim that they "cannot afford health care" and use food stamps, WICK, and other amenities provided by the government, but walk around on their iPhones with unlimited data packages and have a huge 50" LCD HD tv in their living room and have $100+ articles of clothing on.
Yes, there are some people who do not go to the doctor because it honestly doesn't fit into the budget, and that is unfortunate. I would like to see some people get together to help those individuals out and I think it could happen because the number is not large. We here in the US are so concerned with what others in other countries think about us, and how much we give to help starving children in Africa and Asia (noble causes that I support, don't get me wrong here) but we do not seem to care about the people on our soil quite so much. I think we should fix what we have here before we fix whats in the world. But I don't think that this bill is the right way to go about doing it.

[wodin]

All bottom lines result in the question, how will this affect me?

My wife and I have spent two lifetimes working to insure that we would have adequate health care coverage in our retirement, resulting in our being over insured. In my case triply and in my wife’s, doubly. And when she becomes eligible for Medicare, she will also be triply insured.

It’s sometimes amusing watching the various insurance plans vying to see which one will pay, and how much, but that aside; how does the health care reform act affect us?

A half trillion dollar cut in already overextended Medicare, and the threat of an extra tax on “Cadillac” policies, to pay for insurance for 32 million people who have not spent their lives securing their golden years threaten two of my three hard earned safety nets. That’s how!

I’m reminded of Aesop’s fable of the ant and the grasshopper. It would seem that I’m the ant!

[Elfwreck]

Originally Posted by Spoon Man

PPeople will find a way to sue a doctor, because its a way to get a lot of cash in a relative short period of time.

It's not just greed.

When people are hurt and grieving, they want it to be *somebody's* fault, and it's soothing to be able to say to the doctor, "if YOU had done your job right, this wouldn't have happened." Whether or not it's true.

Medicine is a limited resource, has always been a limited resource. We have never had enough money to run all the tests, enough skilled surgeons to perform all the surgeries, enough nurses at all hours to make sure all the right questions get asked and all the symptoms get identified. Some of the could-have-beens are a result of those limitations, and some are not--and everyone wants to believe that their own loss should've been less.

That their leg was amputated because the doctor was rushing to get done in time for his golf game, not because the crime rates in the city make it impossible to hire enough doctors to cover all the gunshot wounds that hit the emergency rooms. That the cancer wasn't treated because the doctor was careless & didn't notice it early enough, not because the seven hundred possible early symptoms are the same as many other diseases, and we can't afford to run CAT scans & MRIs on every patient who's got a headache.

Sometimes it's obviously malpractices; sometimes it's obviously not; sometimes it's not obvious (the hospital is understaffed *and* the doctor was trying to get to a golf game 'cos he'd been working for 36 hours straight; which fact is more important?)

[Nakor]

I have to say that I totally agree on the point about doctors being sued too often. I'm sure there are cases where it's warranted, but the sheer amount of cases of doctors being sued seems to be excessive. And while I know it sucks... people cannot be expected to have a 35-year career and never make the slightest mistake. So if there's a serious mistreatment then maybe it's warranted, but I don't think that's the case in the sheer amount of lawsuits faced by the medical community.

For example, when I was three I broke my femur. From age 3 to age 18 my right leg (the one I broke) grew longer than the left -- this is normal for a major break. My orthopaedic surgeon monitored this until I was 18, at that point having determined I was done growing. He gave me the all clear; he said the leg length difference (which he measured to be 1cm using a tape measure from hip to ankle) would not cause me any real difficulties.

Well, he was wrong. My spine slowly curved over time to compensate and at age 25 -- a little over four months ago in fact -- the spinal curve resulted in nerve problems in my right arm. A chiropractor had an x-ray done and found that the leg length difference was actually 15mm (1.5cm), and said that I should absolutely have been wearing a built-up left shoe to compensate and prevent the damage from worsening all this time.

It was an error on the part of the orthopaedic surgeon. My chiropractor and GP both agree on this. However, that doesn't mean I need to sue him. He made an error, it happens. Fortunately in my case, a few months of chiropractic care as well as slowly building up lifts under the left heel are correcting the problem; my back is very close to straight again. The nerve problem is mostly gone as well. So why go for vengeance and money? At most the orthopaedic surgeon should be made aware of the mistake I think... but that's all.

Obviously many cases are much worse than mine. Some mistakes can result in permanent injury or even death. In cases like that, I think before any legal action takes place it's important to note the extent of the mistake. Was the problem likely to happen anyway? If a real mistake -- one that absolutely should not have happened -- results in a major injury of some sort, then yes, compensation is perhaps warranted. That compensation, however, still shouldn't exceed any losses, and often what we see is lawsuits in the millions of dollars which seems utterly absurd to me.

So yes, I totally agree that lawsuits against the medical community are out of hand. Obviously they shouldn't totally be quashed, but at least to some extent they certainly need to be toned down, both in quantity and in value.

[The Straven]

pietvo, if I'm a bit slow responding to you, it's because I'm making something of an effort to choose my words (not succeeding as well as I've hoped, as my last post seems too emphatic to me now).

Insurance isn't evil per se, but the US seems to be at the point where the insurance companies dictate who gets what treatment. That makes me very uncomfortable. Why can they do that? Well, if an insurance company denies coverage, in many (most?) cases the cost is prohibitive enough to cause the patient to forgo treatment--and that's even setting aside the deductible barrier. Costs are too high, and a focus solely on insurance doesn't address them, and even increases the role of the insurance provider as the deciding authority.

Why are costs too high? You brought up one possible cause which I've had my eye on, but Elfwreck put a finger on what's probably a bigger cause, namely that demand is through the roof, putting great stress on the market. Why is demand so high? Well, it's difficult to avoid the conclusion that the American way of life is highly unhealthy, but another possible factor is that Americans would seemingly rather solve their problems with a pill that by correcting their behavior (of course this is a broad statement; but before you jump on me, stop and think how many people you know that would blame anything or anyone than themselves if given half an excuse; I won't presume to guess at the rest of the world, but it's an all too common trait of Americans). The problem of doctors prescribing unnecessary treatments has an equal effect.

That all feeds into another major contributing factor to costs: the fact that the pharmaceutical industry has the United States over a barrel. What I understand of the new law is that it presented to big pharma everything that it wanted, on a silver platter.

Of course, many costs are artificial. It's been in the news over here how hospitals charge insurance companies one rate and uninsured patients a higher rate for the same treatment--price discrimination. It's not illegal, but it ought to be. Here, again, I think we run into the fact that almost all hospitals in the US are now run by big for-profit corporations. I don't believe that most doctors, because of conscience, would price-discriminate, but the only conscience a US corporation is expected to have in this brave new world is "shareholder value". Take a hospital that is oriented on "shareholder value", let it talk to an insurance company that is oriented on "shareholder value", and I don't think a reasonable man would say that the end result is oriented on the patient's best interests. And the NYT ran an article recently on the trend of doctors to stop private practice and join hospitals.

I was going to write something about who pays, but that's quite enough. Again, the focus on insurance is wrong because the issue is cost. Insurance has it's place, but to expand insurance without controlling costs is asking for trouble. Sorry for being a broken record--don't get me started on the Wall Street bailout!

[Spoon Man]

Does anyone have information on the taxes that the Insurance companies face? I'd imagine that its not a low percentage. Those taxes, like any other expense, also would get passed on to the consumer.

The Straven, you are correct about the the pharmaceutical industry having us over a barrel. But there is a lot of R&D costs for what they produce. If, however, people in the US wanted to change the cause to the issues rather than add a "band aid" fix, we might not be in this situation.
As for hospitals charging different for people with Insurance than people without, the insurance companies have agreements with hospitals (at least they do in GA) where they are charged less due to the volume of payments to the hospital. Its similar to wholesale or buying in bulk, or walmart. If your buying a lot, you pay less per item because the hospital will still make a sizable enough profit.

[Logseman]

I come from Spain, and it happens to be that both my parents work in the health sector (my father as a doctor, my mother as supporting staff), so I would like to give my two cents as well.

Spain has a full-fledged state-run health sector, though it allows private hospitals as well. Health care is considered one of the columns of Spain's welfare state, alongside with education, and a privatisation of any kind is something unthinkable. However, the health care system is not run by the central state itself, but it's been decentralized to the Autonomous Communities (I'll shorten them as regions for clarity's sake)

The results of such policy are the following:

• underpaid doctors: since the state has a huge market power and there is no competition between regions, it can pay less... but Medicine egresates go to other EU countries where they have salaries thrice as high or higher than the Spanish ones, forcing Spain to bring less expensive workers from Latin America and East Europe. Still, there is a patent scarcity of health care workers and the issue won't be solved soon;
• the remaining doctors are burnt out, for they're overloaded with work, or are prone to fall to similar mental health conditions, as I have sadly lived at home with my father's burnout syndrome;
• that scarcity of human ressources causes long waiting lists for operations which lead patients to use tricks to circumvent them (though bribes are not used as far as I can tell);
• subsidies on medicines eat up the budget, more so when we have large colonies of ancient European citizens living as "residential tourists", receiving their payments from their home countries but causing the expenses in Spain. A clearing compensation fund for this issue has been vetoed repeteadly by said home countries, mainly the United Kingdom and Germany;
• suppliers are paid "late, bad and never" as we say in my country: it's the easiest form in which state hospitals can obtain financing, by delaying payments to suppliers;
• private hospitals are run by people connected to the political clique, if not by politicians themselves: we have an egregious case in my home region where many politicians are stockholders of the main regionwide private health care company;
• said private hospitals will definitely not treat anyone without an insurance or whose cost of treatment is suspected to rise a bit, since they can always dump the patients in the state-run hospital and cash in the money for "compensation" on treatments that may or may not have been given to the patient;
• patients are not provided the health care they ask for, thus they may resort to other choices outside of the system, which are usually dangerous. While this is not a problem in my opinion (as my view is that you should be allowed to take the health care you wish or none at all), some will find it disturbing that people can choose to take regular doses of two aminoacids to cure their cancer instead of going to their oncologist (said aminoacid case happened in my home region);
• efforts are made, however, to encomprise patients in the health care system as much as possible, and to maintain them living beyond any sort of reason. People with common flus are brought to urgency rooms instead of being encouraged to treat themselves or bear the flu, while patients with huge records who refuse to follow their treatment (your typical junkie who keeps smoking crack, or the old drunkard who'll never die from his cyrrhosis) are still admitted in the system as if they wouldn't be happier dying in the street as they deserve.

I needn't go on to keep enumerating my thoughts on steps which imply bringing more of the state and big pharma inside health care. I hope that my point has been made sufficiently.

[wodin]

Originally Posted by Spoon Man

The Straven, you are correct about the the pharmaceutical industry having us over a barrel. But there is a lot of R&D costs for what they produce.

While it true that big pharma has us over the barrel, it’s also true that they have their own barrel in the form of over regulation. While caution is admirable, especially as regards meds. Why does it take five to ten years, and tens or hundreds of millions of dollars to bring a new miracle cure to market?

The same is true across the entire spectrum of medicine. A piece of furniture, for example a chair or a stool, costs four or five times as much if the distributer can somehow attach the moniker “medical equipment” to it.

[Solitaire1]

Originally Posted by recluse

The post before mine said that several states filed suit, saying the bill is unconstitutional. No explanation of why. I don't believe that such claims will stop this bill, even if true. Do I believe it is? I can't say yet. Haven't read it. Okay?

One of the objections on a constitutional basis to the heath care bill is that it's not allowed per the 10th Amendment to the U. S. Constitution which says (text taken from the U.S. Constitution Online at http://www.usconstitution.net/):

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

My understanding is that reason national health care is unconstitutional is that the Federal Government was not granted that power in the U.S. Constitution by the states. It doesn't mean that the individual states can't set up state health care programs, its just that the Federal Government doesn't have the power per the 10th Amendment.