Impeding changes to our Health Care system

Originally Posted by TheMercenary

Plenty of citation out there. I am just not going to discuss with you something you don't understand fully. Currently there is no detailed plan on the table.

Plenty of cites? I just asked for one that can provide any factual information that the Democrats will (or have) proposed a UK type national health service.

Next time you ask me for a cite, remember these words:

You obviously don't know (insert issue here) so I suggest you do some research. I am not about to do that for you.
~ The Merc.

[TheMercenary]

Originally Posted by Redux

Plenty of cites? I just asked for one that can provide any factual information that the Democrats will (or have) proposed a UK type national health service.

Next time you ask me for a cite, remember these words:

You obviously don't know (insert issue here) so I suggest you do some research. I am not about to do that for you.
~ The Merc.

You still can't show me the details of a plan that is being proposed by Congress and Obama can you?

[TheMercenary]

http://economix.blogs.nytimes.com/20...c-health-plan/

http://economix.blogs.nytimes.com/20...e-non-elderly/

http://economix.blogs.nytimes.com/20...-german-model/

http://www.pbs.org/wgbh/pages/frontl...roundtheworld/

LOL.

On a quick read, you have a guy who is comparing an expanded medicare type plan to European plans.

There is no expanded medicare type plan on the table.

Originally Posted by TheMercenary

You still can't show me the details of a plan that is being proposed by Congress and Obama can you?

I gave you the general principles of the plans as discussed by Obama and Congressional Democrats.

There is no plan, nor have there been discussion, of a UK or German or Japanese national health service type.

There is no plan, nor have their been discussions, of a plan funded primarily through general taxes instead of employer/employee premiums.

The framework has been more affordable and accessible through employer based plans, supplemented by government administered FEHB type.

[TheMercenary]

Originally Posted by Redux

LOL.

On a quick read, you have a guy who is comparing an expanded medicare type plan to European plans.

There is no expanded medicare type plan on the table.


I gave you the general principles of the plans as discussed by Obama and Congressional Democrats.

There is no plan, nor have there been discussion, of a UK or German or Japanese national health service type.

There is no plan, nor have their been discussions, of a plan funded primarily through general taxes instead of employer/employee premiums.

The framework has been more affordable and accessible through employer based plans, supplemented by government administered FEHB type.

Again you are uninformed. The plan generally proposed by Obama during the campaign are from an amalgamation of a number of plans from other countries around the world. You only need to educate yourself to understand the similarities. You say it is not going to be funded through a general tax, but yet you can't say where the money is going to come from? Obama has not proposed supplemental plans, he proposed an either employer based plan or government adminstered plans, not employer based. You have a lot of home work to do on this one.

Its all the same bullshit...again and again....issue after issue.

Obama and the Democrats are nationalizing the banks...nationalizing health care...intruding into every possible nook and cranny of our lives.....redistributing the wealth....Socialism is coming!

Will says it...Malkin says it...Limbaugh says it......it must be true!

Get over it, dude!

[TheMercenary]

Originally Posted by Redux

Its all the same bullshit...again and again....issue after issue.

Obama and the Democrats are nationalizing the banks...nationalizing health care...intruding into every possible nook and cranny of our lives.....redistributing the wealth....Socialism is coming!

Welcome to a world of US politics dominated one party rule. It just so happens this time it is the Demoncrats. Time will tell. I am willing to wait around to see. But you are right. Demoncrats have intruded into the freemarket to a level never seen before and it makes people nervous. Into the banks, into the auto industry, and now into health care, and it makes people very uncomfortable. You may be comfortable with "I am the government, I am here to help", I am not.

[TheMercenary]

Some more great discussions about the current plans. The first two actually took place before the election but it talks about the uncertainty in just how Obama would be able to pull this off without significant concessions by the insurance industry, doctors, and the whole health industry.

http://www.pbs.org/pov/pov2008/criti...interview.html

http://www.medpagetoday.com/Washingt...on-Watch/10652

http://healthcare.nationaljournal.co...ured-how-h.php

http://www.npr.org/templates/story/s...ryId=101706614

[TheMercenary]

One of the more detailed discussions of Obama's proposals during the run up to the election":

He would reinsure employer plans for a portion of their catastrophic costs. This would reduce employer costs but it would do so by simply shifting them onto the government. He runs the risk of shifting these costs away from a market that now has incentives to manage them to a big government program that likely will not have the same incentives to confront and manage them. I don’t see this as cost saving as much as just cost shifting.

Obama would make the insurance markets more competitive and efficient by creating the “National Health Insurance Exchange” to promote more efficient competition and he would set a minimum health cost ratio for insurers—not defined in detail. Reducing insurance company overhead is important but constitutes only a small percentage of costs and those overhead costs have been increasing at the rate of general inflation while health care costs have been increasing by two to four times the basic inflation rate in recent years. The biggest cost containment challenge is in the fundamental cost of health care itself.

Capping or even reducing costs means you have to cap or reduce costs. There are no magic bullets that reduce payments without doctors, hospitals, insurers, and lawyers getting less than they would have gotten. All of the health IT, prevention, wellness, and the like will not reduce costs by any big amount at least in the short term.

http://www.thehealthcareblog.com/the...iled-anal.html

Thanks for all the links.

Not one points to anything remotely like a UK, European or Japanese style national health care service. Only George Will's editorial..if that is an example your homework, you still havent supported your basic claim.

Several of the above point to encouraging competition, forcing concessions by the bloated insurance industry. Nothing wrong with that, IMO.

For the first time in years, the insurance industry has agreed to come to the table and be part of a broad solution and even offering concessions already (pre-existing conditions, portability) , as long as they are not frozen out of the market..and there is NO intention to freeze them out of the market.

[TheMercenary]

Like I said in a previous post. If you understand how the other programs work in the other countries you see the comparisons. Nothing Obama has proposed is detailed to this point. I suspect we will not know until the Dems ram it through Congress and it pops out the otherside as a mandate. But that is JMHO.

[TheMercenary]

It would require a major realignment of professional and economic power on the supply side.

Third, on the health insurance facet, the president would like to develop a well-functioning market for individually purchased health insurance, as an alternative to the employment-based system which covers most insured non-elderly Americans.

There now is such a market, but it covers only a small fraction of non-elderly Americans, primarily because it is highly fragmented and, moreover, in most states pegs the individual’s insurance premiums to that individual’s health status. To reform this market, the president would establish a National Insurance Exchange.

This can be thought of as the analogue to a farmers’ market on which competing insurers offer their products, subject to a set of regulations that make transactions in the market transparent and honorable, and the competition among insurers fair.

A major contentious issue here is whether the insurers competing in this market should include a newly established public insurance plan like Medicare, but for the non-elderly.

It would also disseminate information from what should be called “cost-effectiveness analysis,” but, as was discussed in earlier posts, has been constrained to be mere “comparative effectiveness analysis” (see this and this for more on this subject).

Finally, to make all of these pieces work harmoniously together — toward the social goals of improving the health status of Americans by providing all of them with access to timely care, and of protecting their budgets from undue inroads of medical bills — there would have to be a whole set of additional government regulations, mainly on the health insurance industry.

From one of my previous links:
http://economix.blogs.nytimes.com/20...c-health-plan/

Germany has one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. The health insurance reform 2007 requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment.

The options available to you for health insurance while living in Germany are the government-regulated public health insurance system, private health insurance from a German or international insurance company or a combination of the two.

http://www.howtogermany.com/pages/insurance.html

This is the normal health care cover that most Germans have. Essentially, you pay a fixed percentage of your salary to an insurance company and your employer does the same. Then, the insurance company provides you with health cover.

The percentage varies from one part of the country to another. For example, in Konstanz, which is a popular retirement destination, large numbers of old folk are subsidised by those in work and the percentage is high. Also, if your monthly earnings are above (currently) DeM6300, you only pay the percentage on that first DeM6300.

This is a much more extensive scheme than the UK and that sounds good until you consider a few things:

You are paying for it yourself. If you are contracting, then any employers contributions that you pay are coming out of your own money.

The scheme is actually rather more comprehensive that you might ever want or need and remember, you are paying for it!

There are some benefits for which you are unlikely to be eligible even though you are paying for them.

If you are earning a good income, you may well find that you are paying an awful lot of contributions.

In the Krankenkasse, highly paid single people are subsidising poorly paid people with large families.

The main alternative to the Krankenkasse is the Privatkasse. This is a private scheme where you pay an amount linked not to your income but to your health outlook. So, if you are old, have a poor medical history or a large family, you will pay more than a young single person.

If your income through a German employer is higher than a certain level, you are permitted to leave the Krankenkasse and join a Privatkasse. In the Krankenkasse scheme, you pay a fixed percentage of your income and so, young healthy single workers end up subsidising the old, the sick, the unemployed and those with large families.

This ability to opt out of the need to subsidise those other groups is the main appeal of the Privatkasse scheme. There is of course a drawback. Once you enter the Privatkasse, you are not allowed to go back into the Krankenkasse scheme. So, you have to be certain that you can fund your private cover for the rest of your life.

Rather than the pooled social fund structure of the Krankenkasse, the Privatekasse is an insurance scheme and so your premiums will increase as you age or as you aquire dependants etc.

When you are in employment, your employer must match your contribution to the Privatkasse scheme but, after retirement, you have to pay for the whole deal from your pension or other resources.

As with the Krankenkasse, you need to be an employee of a German company or a self employed person in order to join the Privatkasse scheme.

http://www.jpoc.net/countries/german...anschemes.html

Originally Posted by classicman

... and how cost effective are they?
What are the positive & negative attributes of each?

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.

How do they differ from the current independent plans available?

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.

Why cannot those people without insurance become covered under one of those plans?

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.

[Why do we need another Gov't run/administered program?

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?

[classicman]

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.

[classicman]

"No matter what you do, you end up with people who don’t receive a beneficial medical therapy because they can’t afford it."

Ever since invention of medicine, there has never been any country at any stage of history where this was not true. This is because people are meant to die, and therefore there is always an more demand for medical care and therapy than supply.

I wish that someone in the Administration would admit that the only way to reduce healthcare costs as a percentage of GDP is to ration care. That's it. Everything else is window dressing.

Let me explain the problems with employer-paid health insurance. It is not a privilege but a right for every employed person to get the best health care available. Why does it sound socialist? Because every person gets the same benefit and there is no choice.

Unlike some countries, in the USA the employer does not pay for our house rent/mortgage. Out of the take home pay, the employee determines how much she can afford to spend on housing accordingly buys or rents a home. The choice is hers, the consequences are hers and the office clerk and the CEO usually do not have identical homes.
When it comes to health insurance, the clerk and the CEO get exactly same health coverage. They usually do not care how much the doctor charges, how much the medicines cost or how much the hospital bill is. There is a place with unlimited funds called health insurance Company that will take care of everything. This attitude is formed because it is not the onus of the employee to buy insurance.

A few thoughts on the healthcare situation