Healthcare "reform"?

[InfiniteNow]

Originally Posted by InfiniteNow

Donkeylicious: The Flowchart

Originally Posted by Southtown

Donkeylicious? I must ask how you can be so sure.

Because somebody who knows far more about this than you and me combined has signed off on it (in fact, that's where I first heard about it... from this dude who, you know... won a Nobel Prize in economics... and I subscribe to his RSS feed).

Nick Beaudrot explains it all - Paul Krugman Blog - NYTimes.com



Either way, if you're not sure, or you don't trust my word, or feel I was too quick to trust Krugman, then look it up yourself. This is, after all, a science site, and nothing is stopping you from checking out the numbers yourself. They appear remarkably accurate based on everything I've been reading these last several weeks, and the flow chart is well inline with the proposals in the bills.

[Southtown]

Alright, that's fair enough. Say it's reliable. My point relates to funding. Two-thirds of the bill is said to be funded by waste cutting (say that's enough and tax hikes are in order) as determined by a 27-head, non-partisan, medical committee. Sounds great, I'm all for efficiency, but we must still take all that on faith. First, appointed committees have been prone to conflicted interests. And second, what happens if they don't meet the %66 quota? Rationing?

[InfiniteNow]

Your question seems to ignore the fact that a great number of people will still be using employer provided insurance with the new protections.

Second, is not rationing PRECISELY what we are receiving right now from the private insurers? I mean... really. This talk of rationing and fear about the government doing it seems to ignore the enormous magnitude of rejected claims we're getting now from insurance companies.

Rejected claims = rationing.

[Southtown]

Originally Posted by InfiniteNow

Your question seems to ignore the fact that a great number of people will still be using employer provided insurance with the new protections.

I don't understand how that applies to what I said. I'm all for a cheap option and certain mandatory compensation from the big guys, but where's the money coming from (in this economy?) And as I said before Obama himself admitted that Social Security, Medicare, and Medicaid were by far the biggest leaches of our budget. And are these not entitlement programs? Why are they leaching our treasury?

Originally Posted by InfiniteNow

Second, is not rationing PRECISELY what we are receiving right now from the private insurers? I mean... really. This talk of rationing and fear about the government doing it seems to ignore the enormous magnitude of rejected claims we're getting now from insurance companies.

Rejected claims = rationing.

Yes, ok, so considering my question of funding, I'm still struggling with how this bill will allay any current 'rationing' because of some appointed committee. I think this can all be handled concretely by simply regulating insurance companies, and banks, and car manufacturers, etc. but god-forbid we should go against these abominable lobbyists that go as far back into our national heritage as say world wars one and two.

[InfiniteNow]

I'm not sure I follow. Money comes from the insured. If a business chooses not to pay for insurance for their employees, they pay a tax. Savings come from other arenas. This all adds together to a larger pool. Seems clear to me.

Medicare is bleeding money because of the prescription drug benefit passed in 2003 under the Bush administration, who wrote into law a gigantic handout to the pharmaceutical industry by disallowing cost negotiation options for bulk purchase of meds. Basically, government pays full retail instead of lower costs due to volume purchase as a result of the law. They passed this (Medicare Part D) without having any way to pay for it. This is part of the reason we are in so much debt with China.

The current plans being discussed are mandated to be budget neutral. Budget neutral means that the bill won't pass if they have not identified ways to pay for all identified expenditures. If you want to spend money on something in healthcare, you must have a way to pay for it (whether that entail a new source of revenue or a new cost reduction somewhere else). Why is that a problem?

Medicare and others are also losing money because of a failure to pass more taxes on goods which lead to more health problems... soda machines and candy machines in schools, as a small example... Taxes on products with corn syrup as another. Also, a failure to pass taxes like cap and trade, which in addition to helping us to pay for these programs has the added benefit of helping the environment... with the long term benefit of better health (poor environment leads to higher frequency of dangerous health issues and cancer).

A single payer system is the only way to get the leverage we need to cover everyone at low cost. It's the only way to ensure that everyone pays into the system instead of gaming it... where "gaming" equals not having insurance, then ... when they get really really sick... signing up at the last minute... reaping the benefit of everyone elses payments to the system without ever having made their own.


We are all required to have insurance on our vehicles. Why do so many people have a problem with mandating insurance for our health? Are cars more important than our families or something? That just doesn't make much sense to me, but I guess YMMV.

[freeztar]

Originally Posted by InfiniteNow

We are all required to have insurance on our vehicles. Why do so many people have a problem with mandating insurance for our health? Are cars more important than our families or something? That just doesn't make much sense to me, but I guess YMMV.

[Devil's Advocate]

Where do we draw the line wrt mandated insurance? It seems to be a slippery slope. Will individuals next be required by the gov't to own life insurance, job insurance, tornado insurance, etc.

What if I don't want to pay for health insurance at all? Will the system allow me to "opt-out" and not pay any taxes, regardless of income bracket?

Also, when we eliminate the ability of private health insurance companies to deny insurance based on pre-existing conditions, what does that do to the costs of health insurance? Surely the health insurance companies must raise premiums all around to cover the added costs? Is there a plan for off-setting these costs?

[/devil's advocate]

[InfiniteNow]

Originally Posted by freeztar

[Devil's Advocate]

Where do we draw the line wrt mandated insurance? It seems to be a slippery slope. Will individuals next be required by the gov't to own life insurance, job insurance, tornado insurance, etc.

We draw the line in the most sensible places. For example, people in Nebraska don't need hurricane insurance, but people in Florida do... so, it's mandated in Florida. While I know you're playing devils advocate, you're still relying on a slippery slope position to make the point, so it's a pretty weak foundation on which to build an argument (even though it's not yours, that doesn't mean I can't call it for what it is). This is about healthcare, not other forms of insurance. Earlier I was simply making the point that we all accept mandated auto insurance, so why not mandated health insurance? I just don't get the extreme opposition here for something which benefits us all collectively in such a profound manner, ya know? ... Mr. Advocate?

Originally Posted by freeztar

What if I don't want to pay for health insurance at all? Will the system allow me to "opt-out" and not pay any taxes, regardless of income bracket?

No, that is one choice you will lose, much like you don't get to "opt out" of paying cigarette taxes, or you don't get to "opt out" of paying tax on your beer or anything else in the market place.

Originally Posted by freeztar

Also, when we eliminate the ability of private health insurance companies to deny insurance based on pre-existing conditions, what does that do to the costs of health insurance? Surely the health insurance companies must raise premiums all around to cover the added costs? Is there a plan for off-setting these costs?

I don't think this is about new costs for insurance companies. It's about reduced profits.

Health insurance is a business where profit should be severely restricted, if not removed entirely. The way health insurance providers make profits is to raise premiums and reduce claims payments (costs). Taken to its logical end, they would charge you as much as possible and never pay out a single claim. They've been heading more and more in this direction for years now.

By putting these protections in place for consumers, we're not so much adding costs to private insurance providers as we are reducing their profits... which are freakin' enormous right now. I'm good with that. Not everything in the US needs to make a profit. Some things we need to do for the greater good.


[EDIT]
Perhaps a stronger argument than profit is one of the operating overhead. Private insurers spend roughly 20-30% of every dollar they take in on administrative costs. That is so high because they have so many staff trying to find ways to prevent claims from being paid, and so many staff trying to explain to customers what is and what is not covered.

However, when the government does it (with programs such as Medicare, for instance), overhead costs are only 2-3%. So, we can keep wasting money spending 30 cents of every dollar on overhead/administrative operations, or we can change toward a government system and spend only 2 cents of every dollar on overhead/administrative operations. You start adding up the vast number dollars involved in healthcare and coverage, and saving those cents makes sense.
[/EDIT]

Originally Posted by freeztar

[/devil's advocate]

And you did a fine job of it, my good man.

YouTube - Weekly Address: Real Conversations...

[freeztar]

Originally Posted by InfiniteNow

We draw the line in the most sensible places. For example, people in Nebraska don't need hurricane insurance, but people in Florida do... so, it's mandated in Florida.

[DA]

Why should people be mandated to have insurance of any kind? If you opt not to pay for insurance, and you get screwed, well, you get screwed.

I opt not to have fire insurance because I've never had a fire in my home and I'm very careful with fire. Statistically, it's not worth the money. If the government mandated fire insurance, then I'd be paying for insurance (the cost of which is figured in a large part based on statistics of fires) which I will probably never need.

While I know you're playing devils advocate, you're still relying on a slippery slope position to make the point, so it's a pretty weak foundation on which to build an argument (even though it's not yours, that doesn't mean I can't call it for what it is). This is about healthcare, not other forms of insurance. Earlier I was simply making the point that we all accept mandated auto insurance, so why not mandated health insurance?

It seems we're both on the slope then.

I just don't get the extreme opposition here for something which benefits us all collectively in such a profound manner, ya know? ... Mr. Advocate?

There's extreme opposition for lots of collective benefits, such as social security and medicare. It's important to be wary of such programs as the long-term effects may not be readily obvious now.

No, that is one choice you will lose, much like you don't get to "opt out" of paying cigarette taxes, or you don't get to "opt out" of paying tax on your beer or anything else in the market place.

But cigs and beer are things I can choose not to buy. A stronger point might be that one cannot "opt out" of paying social security.

Though, I would still argue that point on certain grounds. For example, a person finds out at the age of 20 that they have a weird disease that will kill them by the time they are 50. Should they be able to "opt out" of paying social security for working? They will never see that money back. Shouldn't it be more of a social investment rather than a social obligation?

I don't think this is about new costs for insurance companies. It's about reduced profits.

Indeed. Since profits drive their business, it seems that they would have to either take huge hits in profit or charge considerably more to maintain their current profit margin.

Health insurance is a business where profit should be severely restricted, if not removed entirely.

Then why would they be motivated to provide the best service?

The way health insurance providers make profits is to raise premiums and reduce claims payments (costs). Taken to its logical end, they would charge you as much as possible and never pay out a single claim. They've been heading more and more in this direction for years now.

They wouldn't be in business if they charged as much as possible and never paid a single claim. We have to keep in mind that healthcare costs have also risen. We're in the baby boomer era and that has an effect as well. To keep their profit margins, the industry must raise its own costs along with healthcare costs and all the other factors considered.

Your link seems to agree with this point.

Originally Posted by NCHC.ORG

In 2008, total national health expenditures were expected to rise 6.9 percent -- two times the rate of inflation. Total spending was $2.4 TRILLION in 2007, or $7900 per person. Total health care spending represented 17 percent of the gross domestic product (GDP).

U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.3 TRILLION in 2017, or 20 percent of GDP.

In 2008, employer health insurance premiums increased by 5.0 percent – two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,700. The annual premium for single coverage averaged over $4,700.

I'm curious about the numbers here. How can 6.9 and 5.0 both be two times the rate of inflation? I only raise the question because the article raises skepticism.

By putting these protections in place for consumers, we're not so much adding costs to private insurance providers as we are reducing their profits... which are freakin' enormous right now. I'm good with that. Not everything in the US needs to make a profit. Some things we need to do for the greater good.

Some people might not be willing to do things for the greater good if there is no reward. Sure, there's a warm fuzzy feeling and scraping by on rice and beans everyday, but some people need stronger motivators.
[/DA]

And you did a fine job of it, my good man.

Thanks, it's quite exhausting and quite a challenge.
"You sir, are a formiddable opponent." (Colbert reference)

YouTube - Weekly Address: Real Conversations About Health Insurance Reform

LIES! ALL LIES!!!

[InfiniteNow]

Originally Posted by freeztar

I opt not to have fire insurance because I've never had a fire in my home and I'm very careful with fire. Statistically, it's not worth the money. If the government mandated fire insurance, then I'd be paying for insurance (the cost of which is figured in a large part based on statistics of fires) which I will probably never need.

But actually, you DO pay fire insurance in the form of taxes which help support the local fire department. Whether or not you think you will ever need/use it, the taxes you pay (which we all pay collectively) allow all of us to have the services of the fire department at an extremely low personal cost. We combine our taxes to support them, they are always there to the entire community whenever needed, and the individual price to each of us is minimal. Same with healthcare. By combining our payments, we each obtain greater protection for lower personal prices.

Originally Posted by freeztar

But cigs and beer are things I can choose not to buy. A stronger point might be that one cannot "opt out" of paying social security.

A very good point. I like your argument better on this one. Please note that I was about 5 minutes away from falling asleep when I wrote that post last night, so I readily concede my example was poor.

You cannot opt out of paying social security.
You cannot opt out of paying medicare.

From that perspective, this is just like Medicare for everyone. We bring our payments together, prevent people from "opting out," and the individual cost goes down for each of us. This model has proven enormously successful in countries like Australia, Taiwan, Japan, the UK, Germany, and elsewhere.

Originally Posted by freeztar

Then why would they be motivated to provide the best service?

I disagree with the implicit suggestion that private health insurance companies are providing the best service now, or that they are motivated to provide us with the best service, as opposed to being motivated to provide us with the least amount of service possible at the highest possible premium (their bottom line is dollars, not care... it's just smart business). With that said, health insurance companies are not really driven by traditional supply/demand fundamentals, instead focusing almost solely on maximizing revenue and minimizing costs (as evidenced by the enormous overhead/administrative support they have in place to deny claims... roughly 20-30% of every dollar they spend goes to serving this purpose).

It's important for everyone to remember that health insurance is not a regular commodity like televisions and cars. Payments are made by third parties, patients don't see true costs, and they also don't get to "choose" when they will want/need healthcare. One can choose whether or not to buy a television, but they cannot choose whether or not to have a health related emergency that's going to bankrupt them (from my previous link, you will see that roughly half of every single bankruptcy in the United States is a result of medical costs... even more disturbingly, out of those who are bankrupt as a result of medical costs, roughly 70% of them had existing insurance coverage... Yes, folks... they had coverage, and still went bankrupt... 70% of them did).



Either way, before I get too far off point, currently the insurance companies are making more money by reducing claims payments and denying coverage than they are making by providing "better coverage" and drawing in new customers as a result of that quality service. They tend to profit less when providing a "best service" unless they charge prices 98% of us cannot afford (the golden Cadillac plans), and they earn/save more by denying claims en masse. That business model has proven itself to be the most effective time and again, and my point is directly supported by recent history with these companies. They are making profits hand over fist... improving their bottom line by denying claims rather than do paying more of them and attracting additional customers as a result.

Originally Posted by freeztar

We have to keep in mind that healthcare costs have also risen. We're in the baby boomer era and that has an effect as well. To keep their profit margins, the industry must raise its own costs along with healthcare costs and all the other factors considered.

I tend also to disagree with this suggestion since cost increases in healthcare are not local to the US. Healthcare costs have risen around the globe, but it's only here in the US that consumer costs have risen the way they have. From my perspective, the suggestion that our costs have risen mostly due to the rise in healthcare costs is basically a lie. If recent cost increases to the consumer were driven by increased cost of the healthcare itself, then this increase would be seen globally... And yet, countries outside the US have not seen the growth in costs that we have, ergo some other factor (like insurance companies raising premiums while providing the exact same "services") must be the true cause of the cost increase to US consumers.

One might read these points and then choose to argue that we pay more in the US because we have higher quality of care, but reality simply doesn't bear that out. According to the World Health Organization who studied healthcare outcomes in 191 countries, the US ranks only 37th (between Slovania and Costa Rica). From a life expectancy standpoint, according the the CIA, we rank only 50th. Also, according to the CIA, in terms of infant mortality rate, we rank only 180th.

While there are certainly some noteworthy islands of excellence in US healthcare quality, we are all sinking in a sea of mediocrity, and it's time to change that.

Originally Posted by freeztar

Some people might not be willing to do things for the greater good if there is no reward. Sure, there's a warm fuzzy feeling and scraping by on rice and beans everyday, but some people need stronger motivators.

Well, that's just it. There IS a reward for them, they just can't seem to see it. We humans are not good at realizing true costs, nor long term benefits. We have evolved to realize short term gain, often at the expense of long term health.

Case in point:
Short-term: Yummy! A Big Mac with bacon, greasy fries, a milkshake, and a fried twinkie.
Long-term: Oh crap, I've having a freakin' heart attack.

Short-term wins out practically every time, and it's the same mindset here.

People are mistaken to assume that there is no benefit to them. They cannot predict a need for catastrophic care. They cannot guarantee they will have their own funds to cover unexpected illnesses if they ever get really sick. As the WHO report summarized, part of the problem is that so many people don't have care, and this has a cascade effect on the rest of the system.

Besides just the simple spread of infection and virulence, the cascade applies to the economics of it, too. Lack of coverage across so many people is part of the reason current costs are so high... people don't have insurance, so minor/fixable problems become major ones since they did not seek treatment early... they then get really sick and wind up in emergency rooms, with no coverage, and those ER costs are absorbed by the insurance industries, resulting in higher premiums for the rest of us. By simply covering everyone under a collective system, early care is possible, illness is treated before it becomes catastrophic, that illness is less likely to spread to others, costs are balanced out, and we each get more while paying less individually. The logic is inescapable.

Now... that is not to mention the fact that anybody who wants to can still purchase supplemental private care on their own dime if they are not happy with what is being covered/not covered by the single payer system. It's a win win.

Originally Posted by freeztar

[/DA]
Thanks, it's quite exhausting and quite a challenge.
"You sir, are a formiddable opponent." (Colbert reference)

Yeah... I totally agree, but I must say... This devil's advocate crap is exhausting!

[freeztar]

Originally Posted by InfiniteNow

This devil's advocate crap is exhausting!

As a science forum, we must strive to be objective. Objectivity, necessarily, must consider dissenting points of view.

Shall I continue? Or is it too rough on your psyche?