Because that's what you've been, and are, all about.

I have never been in the FEHB plan (I was in the Congressional plan for two years more than 20 years ago)..but friends and colleagues who have been in both FEHB and private sector plans cite greater choice in FEHB at comparable premium prices. I currently have a choice from among three plans at varying premiums....feds in FEHB have 8-10 plans (I think) from which to chose.

I assume by independent plans, you mean plans in which an uninsured person purchases insurance on the open market, with no employer contribution. the biggest difference, particulary for workers in small business who dont provide insurance, would still be a shared cost with employer (but less for the employer than if he had to go to the independent market - a matter of risk size and diversity). The other difference, independent plans are able to cherry pick their risks. YOu have a pre-existing condition or approaching medicare eligibility in a few years...forget it, no independent plan will touch you.

I think it was part of the Clinton plan..but the whole plan was so disjointed and poorly presented in the first months of the administration, with Hillary as as the point person, that they were completely unprepared for and underestimated the backlash and just fucked it up.

Instead, Clinton focused on uninsured children of working class families and created the SCHIP program, which covered 6 million kids....funding through a dedicated tax (cigarette tax)

The other issue is the screwed up regulatory environment at the state level, where in many states, small employers cannot join together to create a shared risk pool.

Why didnt Bush/Republicans consider it in the six years when they had control? You would have to ask a Republican.

The fact is, they didnt seriously consider any health care reform as costs continued to go up and access to go down. Hell, Bush twice vetoed SCHIP expansion to cover more kids of working families.

We dont need another government run program like Medicare.

But a government administered public/private program, primarily for small businesses and those uninsured who are above the Medicaid eligibility, as well as making it an option for those with employer-based plans, will provide more choice and affordability through greater competition with the existing private (independent) plans.

It would provide an incentive for those private insurance companies to be more efficient and more responsive to consumers. They are not hurting for profits...the top 5-10 private health care providers made $10+ billion in profits last year. Profits are determined in part (and in some states) based on a percentage of premiums....the higher the premiums, the greater the profit.

They have a choke-hold on the current system and it is a money making machine that they control in near absolute terms.....to their interests, not the health care consumers.

added:
What is your alternative for the 45+ million uninsured and the rising costs and fewer choices for those who are insured?

I have no alternatives. Thats primarily why I asked the questions.
followup - Would it be easier or more efficient to expand medicare/caid qualifications to include more of the uninsured instead of creating another plan? I wonder if this program, whatever it will be, will have all independent administration and employees. Seems like it would be a duplication of responsibilities. By expanding one of the existing plans it would seem to be more efficient and less costly.

Just a though - - - or replace one/both with this new plan.

Isn't there a way to change how the Gov't contracts for care and/or prescriptions. IIRC they were/are restricted in the negotiating process in some way that seemed insane to me at the time.

I don't worry to much about that any more. "So you heard what you expected to hear, and assumed my intent."

A few thoughts on the healthcare situation

"There is a place with unlimited funds called health insurance Company that will take care of everything."

Is this a joke? In what fantasy world does this guy live? Has he never heard of deductibles and co-pays and limits? My employer pays the majority of my insurance premium, but not all, and my employer pays zero of my family's. I pay all of that.

And what's the betting that when you most need the payout they'll find a reason not to do so?

I'm in the same boat.

Which countries are these where the employer pays for housing/rent?

Dunno - I found the comments after reading an article on "the Economist" site. I never said I agreed with them.

Just realized I didn't link the article... that would have helped.

The future of health-care reform

Wait times to see doctor are getting longer

http://www.usatoday.com/news/health/...aittimes_N.htm

Surveys are still the weakest form of statistical measure. The article was interesting anyway.

Nah PFA statistics are much weaker.

From the WSJ

I don't think we should be "forced to" carry insurance. This is beginning to look bad. Apparently there are no tangible details of their "plan" and they are floating this out there with little to no transparency. That or they have no real plan.

I am still struggling with exactly how we are going to increase the number of insured by around 50 million or 15%-20% while decreasing costs and not having the long lines or rationed care that other countries have.
Unless we are going to get taxed out the ass, this isn't logically feasible.

Lack of a specific plan aside, I'm curious: do you think it is fair that drivers are forced to carry auto insurance?

Yes I do. Do you equate the two somehow?

Obama: It's OK to borrow to pay for health care
Obama-proposed budget rules allow deficits to swell to pay for health care plan
From where? I think thats something we should know beforehand.

I do think there are parallels. If you cause a wreck, it would be unjust for the other guy's car to go unrepaired. The car has to get repaired, it's just a question of who is going to pay for it. If you come down with a severe disease or injury, it would be unjust to simply let you die when we have the knowledge to save you. Again, the doctors are going to treat you, it's just a question of who is going to pay for it.

Now, I'd be all for limitations on that sort of thing--like, if you were only required to carry very-high-deductible catastrophic medical coverage. Cover the big things, save your life, but that's about it. That would seem to me to be pretty similar to the idea that you are only required to carry a minimum of liability coverage on your car, even though more insurance coverage is certainly available.

I see your point.

All I can say is that you all are about to be butt fucked and you have no idea it is coming. Some will win, some will lose. But in the end you will get what you asked for and only time will tell exactly what that will be.

Very inspirational merc. Thanks.

If some will win and some will lose, then how are all about to be buttfucked? Surely those who are going to 'win' won't be?

Also... some are doing fine under the current system and some are left behind. So surely some are currently being buttfucked by the system who may be a little less buttsore under the new?

Dana, IMHO when it comes to HC in the US the Americans want their choices, I suspect we will be losing a lot of personal control over what we currently get out of the system. In some cases that can be good, in some cases it could be bad. I see the potential to do some really good stuff. The question is will they do it. And more importantly, can they do it. The various factions who have a finger in the economic pie are large and wide, and in most cases very rich and powerful with deep pockets. Given our history of reform in this country it will take nothing short of a governmental take over of the whole system to enact real change. And that is where the chips will begin to fall. Because I have seen very few examples of where the gov dove in with both feet and the system did not come out being further bloated, inefficient, and less user friendly to those it set out to help. There are so many variables. And currently we have nothing more than Obama admins "floating" ideas to the press and gauging the reactions. There have not been any concrete plans that people can sink their teeth into. That leaves all the real experts, and talking heads on TV, to speculate. And then don't forget all of this will have to make it through congress, who may or may not rubberstamp what ever they come up with. It's is just a big mess. I could go on but....

*nods* fair points.

IMHO it will take nothing short of a complete take over of the system to start with a new clean slate. Without that, and I suspect, the political darlings of the Demoncratic party will come out smelling like a rose, and that is the Insurance Industry. Everyone else, including patients, will be taking it in the shorts.

Major changes are coming to the health care industry in the US - Fact.
Governmental intervention is inevitable - Fact.
Inefficiency, cost INCREASES and rationing of care/supplies is sure to follow. That is what happens with every gov't controlled ... anything. Name one thing the Gov't "controls" that isn't.

I would be much more in favor of the administration rectifying the problems with Medicare and medicaid FIRST.
Who Does Medicare Cover?
Who Does Medicaid Cover?
Given the current situation, wouldn't it make more sense to revise/overhaul/modify the programs that we already put in place. Instead of creating an entirely new program? It would seem more prudent to fix what is wrong instead.

Can anyone agree on what is wrong?

I dunno, seems like the option of fixing the programs that are already in place isn't even on the table. Seems like the D's just want to create some new shiny healthcare program.

It really depends on whom you talk with.

The among the few things that is agreed on by healthcare providers is that we have to figure out a way to cover the uninsured, we have to figure out a way to cover the costs of catastrophic care that does not place the burden on the insured, and we have to find a way to stem the tide of ever decreasing reimbursements for care that does not cover costs. Actually the providers list is much different than one that the end user or hospital administrator would make.

We don't have enough preventative care.
Insurance companies have gotten between providers and patients.
Trauma care is breaking some hospitals.
Insurance companies will not let the system provide cheaper care to patients.

God the list is just to long.

I guess the short answer is "no" then.

I tend to look at the insurance companies when I'm looking at the problems with healthcare. They provide a service of redistributing money, but they skim a hell of a lot of that money off for themselves. I don't think they are worth what we pay to have them as part of the system.

In other words, if I look at what my employer and I have paid into the system compared to what I've received in return, it's orders of magnitude off. Granted, I'm young, and haven't needed a lot of medical attention, but we did have two births in my household, and those costs were high.

I'd love to see a simple pie chart of what the total costs of health care in this country are, and where that money goes. How much of each dollar spent on health care goes to the running of the insurance companies, how much goes to cover the ER visits of the uninsured, how much goes to the administration of the hospital or dr. office, how much goes to supplies, how much goes to doctors, lab work, medication? Then I'd like to see another pie chart that shows how much of that funding comes from insurance premiums, how much from out of pocket, how much from the government?

I do know that this country pays a lot for its health care, and I don't think it gets its money's worth.

Insurance companies by their very nature take in as much as they can and pay out as little as they can. So obviously they're skimming off significant portion of the money that goes into healthcare. That's their job: to make as much profit as they can for their shareholders and to continue to increase their profit levels, just like any company.

http://cellar.org/2009/medcostgraph.jpg

via

Lot of information there UT. This was interesting "we [Americans] overpay by about $477 billion per year, or $1,645 per capita."

I'm surprised that the administrative and insurance costs appear so low on that chart. It's easy for me to blame the insurance companies, I don't want to have to give that up.

Edit: Although if I'm reading the chart correctly, even though the biggest savings are not to be found in the insurance companies and administration, that is where the greatest rates of waste are located. According to this chart.

The chart is interesting in that it says there is only 15% waste in the public funding sector. Does that mean Medicare and Medicaid? Apparently those government programs are one of the areas that are not so bad.

That is completely misleading. There are vast differences among the states.

I read somewhere (???) that most states do relatively well with the medi- but states with huge cities do REALLY poorly. Can't find that link/article tho

Differences in costs of Medicaid spending by state. Some are obvious, largely populated states will spend more. but when you compare them in the more compareable population centers there are vast differences. Why? Again, it is multifactorial.

http://www.statehealthfacts.org/comp...?ind=177&cat=4

Vast differences among the states programs accounts for many of cost differences.

http://www.kff.org/medicaid/upload/T...ate-Survey.pdf

An example of one states experiences with costs of Medicaid that also shows where the waste goes and the differences between the states:

http://healthcare.ncpa.org/commentar...-york-medicaid

The one thing that the article does not show is that Medicaid pays the least amount of all insurance programs and I think it encourages providers and organizations to attempt to recoup costs by ordering many more tests than they would on a cash paying patient or one with insurance.

The fight begins.

Industry Groups Push Back on Kennedy's Health Bill

continues:

http://online.wsj.com/article/SB124467520516103947.html

House Health-Care Bill to Include $600 Billion in Tax Increases

http://www.bloomberg.com/apps/news?p...d=aqLNecbH0dcg

Remember how I said the politico's are in bed with the healthcare industry?

Key health care senators have industry ties


http://apnews.myway.com/article/20090612/D98PBGU03.html

Actually, if you spend some time tooling around the Senate website, they're ALL basically owned by big pharma.

The system we have isn't perfect. We all agree on that. But to me, to dismantle it and replace it with a system that is a complete unknown without a VERY SPECIFIC design (which we are not getting now) It will more than likely be worse and cost more, much much more - especially in a recession.
This is very unwise and is a dangerous proposal. Why are we rushing into this? I think we should take care and study the alternatives very carefully. I agree to we should do something, but increasing the number of insured by as much as 25% and reducing the overall task is and extremely daunting task, if not impossible.
We all know far too well how inefficient our government is. To mandate coverage to private industry makes no sense. The government has never run a profitable enterprise - EVER. Therefore it is crystal clear how this ambitious new plan will be payed for - tax increases. To even consider it ignores that reality.

But isn't mandating private coverage better than running the coverage program themselves? I agree that I don't know if it's the best time or not to be instituting any changes, but IMHO running the program through existing private insurers is far better than trying to copycat the Medicare program on a larger scale.

Think of it this way: if an illegal immigrant comes into an ER without insurance, and it is law that you must have a basic minimum of health coverage, then now that issue can be addressed in a legal fashion. No more people (of any immigration/citizen status) using the ER as a revolving door free clinic.

I don't think there is ever a 'good' time to institute change. Either there's a recession....or you're in 'recovery'...or the economy is strong and you wuoldn't want anything to upset that...There is always an argument to wait.

There are far too many people struggling with medical bills, or inadequate/no insurance. There are far too many people unable to get insurance because of existing medical conditions. It needs a solution. Though a recession may not be the best time to institute change, it's also the time it's likely to be most needed, as that's when people are losing jobs and employer based insurance. It's during a recession that the gaps show most keenly in people's lives.

That's how car insurance works.If the government ran something at a profit, it should either spin it off to private industry or decrease its budget. One of the reasons for a government to run something is if the profit motive is insufficient (e.g. pure science) or corrupting (e.g. the military).

If there were a way to set up private health insurance in such a way that the profit motive incentivized low premiums and paying claims, maybe that could work. Unfortunately, it's the other way round. Is there even a theoretical way for health insurance companies to be run at a profit without incentivizing the denial of claims?

All I can think of are from the other direction, placing more restrictions on the various reasons insurance companies give for denials, such as "preexisting conditions" or "experimental". But as long as the incentive is still for denial, they'd just make up new classifications.

But providing insurance for all removes the incentive, the reward, for being rich. ;)

There is always a good time to make a positive change. This change doesn't appear initially to be one though. It appears that we are going to get saddled with increasing costs and taxes, not decreasing. Yes,we will cover more people, but the rush to get another major plan done is disconcerting. This is huge and for the administration to come out and put a deadline on when this "has to be done" is foolish to me. If you think it should be done right then that should be the goal, not just getting something done by a certain date for what appears to be political reasons.
Thats BS.
Also, there are some very basic issues not being addressed - just off the cuff - Will medicare and/or medicaid be replaced, eliminated or modified?

Exactly how are we increasing the # of insured while decreasing costs SPECIFICALLY.
How are we going to provide services without rationing increase demand by as much as 25% while not increasing the supply of providers.

HM - With car insurance, which the Gov't DOES NOT PROVIDE, we are each assessed on our own risks/history. There are plenty of those who still drive without.

"If I am not paying for it what is the incentive for me to change my unhealthy behaviors?" If I am obese, diabetic or have clogged arteries because of my diet - Who is being penalized with the increased cost for my health care costs? Not me if I'm not paying for it.

It's been 15 years since the last time anyone talked about fixing health care in the US. If this doesn't get done now, while the Obama horse is still charging out of the gate, it simply isn't going to get done during his term. His administration, like all administrations, will get bogged down and run out of steam. Most likely, after Obama, the pendulum will swing back to the Republicans, who won't bring up health care reform. So it won't come up again until the Democrat after that. Perhaps in 16 years. Basically, it's a situation where we fix it now, or we wait another 16 years before bringing it up again. The question is, if you really believe there are huge problems with the US health care system, would you rather rush to fix them now, or let those problems exist for the next 16 years and be facing the same difficult prospect of fixing it then? That's the choice the country faces.

The Republicans can't do health care reform, like Clinton can't do welfare reform.

That was in response to the question of mandating coverage to private industry, which is part of the plan. Having a public option in addition to that is a different issue. Having single payer instead is another different issue.People who drive without are breaking the law, unless there's some exception I don't know about.

no, do it right or don't do it at all. The last time we rushed to get something done ...well we are still finding BILLIONS in waste from that one.

That's your opinion, and that's fine. But you are choosing to have illegal immigrants use the ER when they get a sore throat and we all foot the bill for that in increased medical costs. Why would you choose that?

Good point, but the republican haven't addressed health care reform, and show no signs of doing so on their own.

lol - I wouldn't - they would be outta here if it were up to me. They'd get one shot at that and be gone when they were done. The next major project comparable to the Hoover Dam, would be a wall on our southern border - think of the employment opportunity there... and the potential long term jobs it would create.

The less of them draining our system and denying our citizens of care , the better. Perhaps we'd have a few more employed citizens too. Just a thought.

Medicare prescription drug plan notwithstanding, I guess.

I would have to guess that this would be the lesser of two evils.

Sorry missed this post earlier - Yes, that would be a benefit if it actually got enforced, which I, unfortunately, don't think it will.

None of these have been addressed - still. I would think these would be at the top of the list when considering something of this magnitude. I wonder why that is.

Yet it happens every single day.

This is an interesting exchange with Kathleen Sebelius...

I'm not sure if you're asking us or the government to address these issues, but I can answer the second one for you: once someone is insured, even if it's against their will initially, they can now go to a normal family doctor for their sore throat instead of the ER. This will save huge amounts of money right off the bat, because a family clinic simply does not cost as much to run as a hospital. Hospital resources are wasted on non-emergency treatments, and that's a cost that the rest of us subsidize one way or another. What's more, when someone is insured, they are more likely to go in for preventive care and early checkups of symptoms, and thus may never need the emergency surgery they would have required if the disease sat until it could no longer be ignored. We all save the cost of that surgery, too.

... hypothetically speaking of course.

And I am asking for opinions here because many times we all look at things from different viewpoints and come up with interesting ideas.
I am also asking the Gov't and have written my "representatives" already.
I am still waiting for a reply.