News The US has the best health care in the world?

[Wax]

At the moment, electronic records doesn't save any money. It's more expensive to have someone monitor the system then to pull a document.

 

[WhoWee]

Corruption is a bipartisan phenomena.

The price you came up with is the cost of insurance pre health care reform. You haven't considered the whole picture. In order to be convinced, I would need to know how much profit insurance companies would make off of the plan, because after reform, profits will be forced down as competition sets in.

Secondly, reform goes deeper than just these regulations. For example, a lot of the spending goes into making health care more efficient. For example, electronic records, which will save a lot of money. When you add up and account for all the factors which will save money, adjust the profit margin to a realistic level, and throw in the money earned by those who currently don;t have insurance who will be forced to, there would be a difference.

If the plan works, insurance companies will pay less because care will be cheaper, and they will lower their rates accordingly. The competition of a public option will enforce this.

The cost of health insurance will increase due to Obama's mandates.

Obama has specified that policies will no longer have maximum lifetime limits. Currently, insurance purchasers can typically choose from $1 million, $3 million, $5 million, or $7 million per person on individual policies. The insurance companies consider their potential exposure and price accordingly. Now, assume you are the CEO of XYZ insurance, if the President mandates that you may not set a limit and tells you that you're no longer allowed to pre-approve procedures (which means doctors and patients are free to do whatever they want) and you realize your exposure could be $20 million, $50 million (who knows) - would you raise your rates?

Next, Obama has specified that people with pre-existing conditions will have to be accepted and can not be dropped. This means a person with a (bad heart, strokes, cancer, diabetes) has to be covered. You know their care will cost more. Would you charge them more than a health person?

 

[WhoWee]

It looks like the rational thing to do is to buy cheap insurance, pay the $3000 fine, and then if you get really sick, then opt-in.

That is one of the reasons why the President's estimate that only 5% of the people will be on the Government program is nonsense.

 

[Wax]

The cost of health insurance will increase due to Obama's mandates.

Obama has specified that policies will no longer have maximum lifetime limits. Currently, insurance purchasers can typically choose from $1 million, $3 million, $5 million, or $7 million per person on individual policies. The insurance companies consider their potential exposure and price accordingly. Now, assume you are the CEO of XYZ insurance, if the President mandates that you may not set a limit and tells you that you're no longer allowed to pre-approve procedures (which means doctors and patients are free to do whatever they want) and you realize your exposure could be $20 million, $50 million (who knows) - would you raise your rates?

Next, Obama has specified that people with pre-existing conditions will have to be accepted and can not be dropped. This means a person with a (bad heart, strokes, cancer, diabetes) has to be covered. You know their care will cost more. Would you charge them more than a health person?

That works fine for me. The doc can give me the best treatment possible without having to worry about what my insurance pays for.

There is no such thing as a pre-existing condition in any other industrialized country. Why must we have it? Every single developed country in the world has some type of nationalized health care system; everyone is covered which means there is no such thing as a pre-existing condition.

Costs will not rise with a public option. Insurance companies can't raise prices if they want to compete.

 

[WhoWee]

That works fine for me. The doc can give me the best treatment possible without having to worry about what my insurance pays for.

There is no such thing as a pre-existing condition in any other industrialized country. Why must we have it? Every single developed country in the world has some type of nationalized health care system; everyone is covered which means there is no such thing as a pre-existing condition.

Costs will not rise with a public option. Insurance companies can't raise prices if they want to compete.

If insurance premiums don't increase to cover the costs - then TAXES will increase or DEFICITS will increase.

 

[Wax]

If insurance premiums don't increase to cover the costs - then TAXES will increase or DEFICITS will increase.

Not of you restructure the payment plan. One of the main points of the bill is to reduce costs by restructuring the billing option. The concept of paying individually for an MRI, X-Ray, and checkups are being thrown out the door. The bill is being restructured so that you will be paying for your illness and not for the individual procedures. There will be no incentive to do extra procedures but there will be incentives to get it right the first time around.

 

[WhoWee]

Not of you restructure the payment plan. One of the main points of the bill is to reduce costs by restructuring the billing option. The concept of paying individually for an MRI, X-Ray, and checkups are being thrown out the door. The bill is being restructured so that you will be paying for your illness and not for the individual procedures. There will be no incentive to do extra procedures but there will be incentives to get it right the first time around.

Can you please reference the specific section of the Bill you are describing?

 

[Wax]

Can you please reference the specific section of the Bill you are describing?

Section 224
http://waysandmeans.house.gov/media/pdf/111/AAHCA09001xml.pdf

 

[mheslep]

In the Wed night speech I'm happy to see the US President vanquished the '47 million' uninsured figure he and other Democrats have used again and again, and again. Instead he nhttp://www.washingtontimes.com/news/2009/sep/09/text-barack-obamas-speech-joint-session//print/" :

There are now more than thirty million American citizens who cannot get coverage.

That's still overstated by ~twenty million, but at least he's now taking pains to subtract illegals from the former hyperbole.

 

[WhoWee]

Not of you restructure the payment plan. One of the main points of the bill is to reduce costs by restructuring the billing option. The concept of paying individually for an MRI, X-Ray, and checkups are being thrown out the door. The bill is being restructured so that you will be paying for your illness and not for the individual procedures. There will be no incentive to do extra procedures but there will be incentives to get it right the first time around.

This is the section you referenced.

"3 SEC. 224. MODERNIZED PAYMENT INITIATIVES AND DELIV4
ERY SYSTEM REFORM.
5 (a) IN GENERAL.—For plan years beginning with Y1,
6 the Secretary may utilize innovative payment mechanisms
7 and policies to determine payments for items and services
8 under the public health insurance option. The payment
9 mechanisms and policies under this section may include
10 patient-centered medical home and other care manage11
ment payments, accountable care organizations, value12
based purchasing, bundling of services, differential pay13
ment rates, performance or utilization based payments,
14 partial capitation, and direct contracting with providers.
15 (b) REQUIREMENTS FOR INNOVATIVE PAYMENTS.—
16 The Secretary shall design and implement the payment
17 mechanisms and policies under this section in a manner
18 that—
19 (1) seeks to—
20 (A) improve health outcomes;
21 (B) reduce health disparities (including ra22
cial, ethnic, and other disparities);
23 (C) provide efficent and affordable care;
24 (D) address geographic variation in the
25 provision of health services; or
VerDate Nov 24 2008 12:51 Jul 14, 2009 Jkt 000000 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 C:\TEMP\AAHCA0~1.XML HOLCPC
July 14, 2009 (12:51 p.m.)
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
f:\VHLC\071409\071409.140.xml (444390|2)
126
1 (E) prevent or manage chronic illness; and
2 (2) promotes care that is integrated, patient3
centered, quality, and efficient.
4 (c) ENCOURAGING THE USE OF HIGH VALUE SERV5
ICES.—To the extent allowed by the benefit standards ap6
plied to all Exchange-participating health benefits plans,
7 the public health insurance option may modify cost shar8
ing and payment rates to encourage the use of services
9 that promote health and value.
10 (d) NON-UNIFORMITY PERMITTED.—Nothing in this
11 subtitle shall prevent the Secretary from varying payments
12 based on different payment structure models (such as ac13
countable care organizations and medical homes) under
14 the public health insurance option for different geographic
15 areas."

I don't see the level of specifics you've outlined - very vague - and seems to be focused on the public option.

Even if your interpretation is correct, the cost of individual tests must be paid somewhere - not just thrown out the door as you stated.

 

[Al68]

No offense, but I am getting REALLY tired of people throwing the word "socialist" around like that.

I realize many people are offended by the word, but I'm using it generically, not as an insult or reference to infamous past socialists, or any official party.

Could you suggest an alternative to the word "socialist" that could be used, that would mean a belief in government control of economic matters?

I simply don't know an alternative that isn't either confusing because of multiple definitions (like "left", "liberal", "statist", etc.) or impractical because it takes too many words to explain.

 

[Vanadium 50]

The price you came up with is the cost of insurance pre health care reform. You haven't considered the whole picture. In order to be convinced, I would need to know how much profit insurance companies would make off of the plan, because after reform, profits will be forced down as competition sets in.

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.

 

[WhoWee]

I realize many people are offended by the word, but I'm using it generically, not as an insult or reference to infamous past socialists, or any official party.

Could you suggest an alternative to the word "socialist" that could be used, that would mean a belief in government control of economic matters?

I simply don't know an alternative that isn't either confusing because of multiple definitions (like "left", "liberal", "statist", etc.) or impractical because it takes too many words to explain.

Don't complicate things, just say "Tax and Spend Democrats" - nothing new here. Giving them control is like letting your kids do the shopping - lot's of junk, nothing you need, and very expensive.

 

[humanino]

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.

I'm not sure it's that simple at all. Yesterday I heard that the non-profit "rocky mountain health plans" is 30% cheaper than the average in the US. The documentary was in french and I did not find numbers in an english reference. One explanation was that with much better coverage, illnesses are detected at earlier stages making the costs eventually less.

Anyway, the US spends 16% of GDP and the US average citizen has worse coverage than Germany of France spending 10% for instance, I guess everybody agrees on those numbers., whichever theory explains the difference, the US can do better for sure. The comparison is even similar with Canada.

 

[WhoWee]

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.

Now you want to make profits illegal?

What kind of industry (other than state-controlled) is funded and operated with no potential profits?

Are hospitals going to be allowed to earn profits? How about pharmaceutical companies and testing labs? While we're eliminating profits, don't forget about those manufacturers that build all of the custom fixtures and equipment.

Also, to be "fair", maybe the utility companies should supply power at their cost, food should be sold in the cafeteria at cost, all Government workers involved in healthcare paid minimum wage and everyone must sign a waiver before obtaining services (to protect from lawsuits- new age tort reform).

Last, the doctors and nurses should be taxed at 90% - to redistribute their wealth.

Insurance companies have investors that took a risk (like the bond holders in GM) in expectation of a return on investment - that's how business works. If profits are forbidden, the insurance companies will refocus on to other lines - leaving only a Government run insurance program.

The bottom line is this, how much do YOU want to pay in taxes - 50%, 60%, 70%, 80%, or 90%? The Government has mismanaged the Social Security funds, admits to $900,000,000,000 waste and fraud in medicare and medicaid, is scheduled to lose $7,000,000,000 at the post office this year and next, and let's not forget about Amtrak. Do YOU honestly believe they will be able to lower costs (and not spend that money somewhere else and still tax you more)?

 

[Al68]

I realize many people are offended by the word, but I'm using it generically, not as an insult or reference to infamous past socialists, or any official party.

Could you suggest an alternative to the word "socialist" that could be used, that would mean a belief in government control of economic matters?

I simply don't know an alternative that isn't either confusing because of multiple definitions (like "left", "liberal", "statist", etc.) or impractical because it takes too many words to explain.

Don't complicate things, just say "Tax and Spend Democrats" - nothing new here. Giving them control is like letting your kids do the shopping - lot's of junk, nothing you need, and very expensive.

"Tax and Spend Democrats" doesn't convey the meaning I want to convey. I do notice that whenever I use the word "socialist", there is no confusion about what I mean. Some object to the word, yet know exactly what is meant by it with no confusion. Why object to the use of a word when its use accurately conveys the intended meaning? It's just a word.

 

[Al68]

One can get an idea by looking at what the insurance companies are making now. According to their 10-K's, United Health Care has earnings that are 3.6% of revenues and Wellpoint has earnings that are 4.7%.

So, even in a world where health care profit is illegal, we'd expect the cost to be of order 4% cheaper overall.

Are you assuming that the existence of profit actually makes things cost more in general? What do you think things would cost if they weren't profitable?

This is why basic economics should be taught better in school. A little knowledge would keep people from being so easily mislead.

 

[WhoWee]

I'm not sure it's that simple at all. Yesterday I heard that the non-profit "rocky mountain health plans" is 30% cheaper than the average in the US. The documentary was in french and I did not find numbers in an english reference. One explanation was that with much better coverage, illnesses are detected at earlier stages making the costs eventually less.

Anyway, the US spends 16% of GDP and the US average citizen has worse coverage than Germany of France spending 10% for instance, I guess everybody agrees on those numbers., whichever theory explains the difference, the US can do better for sure. The comparison is even similar with Canada.

Have you adjusted for elective procedures such as cosmetic surgery and doctor supervised diet programs? How about ALL of the "happy pills" that are prescribed? Plus, let's not forget our sports medicine programs. Also, let's not overlook the cost associated with regulations such as HIPPA and the cumulative legal and administrative. Last, consider the amount of money spent on marketing per year.

A system with no competition, no choices, no innovation, no re-investment incentives, and no profit/capped wages should cost less in the short term. But, have you ever chosen to stay in an old and run down hospital if you could have chosen to stay in a nice new and modern one? Do you choose your doctor based on the lowest price?

 

[turbo]

In the Wed night speech I'm happy to see the US President vanquished the '47 million' uninsured figure he and other Democrats have used again and again, and again. Instead he nhttp://www.washingtontimes.com/news/2009/sep/09/text-barack-obamas-speech-joint-session//print/" :
That's still overstated by ~twenty million, but at least he's now taking pains to subtract illegals from the former hyperbole.

The Congressional Budget Office has a different take on the number of uninsured.

Analysts warned that increases in the overall numbers of the uninsured were likely to be just the beginning. Based on current job losses, some researchers estimate the present-day number of uninsured is closer to 50 million. That's the number now cited by the Congressional Budget Office and it could continue to grow without meaningful reform.

http://news.yahoo.com/s/ap/20090911/ap_on_go_ot/us_census_uninsured;_ylt=AshwU8hhGyvHi5JZEcGhL11p24cA;_ylu=X3oDMTJxZGdhZW5lBGFzc2V0A2FwLzIwMDkwOTExL3VzX2NlbnN1c191bmluc3VyZWQEcG9zAzEwBHNlYwN5bl9wYWdpbmF0ZV9zdW1tYXJ5X2xpc3QEc2xrA2dyb3d0aG9mZ292dA--

 

[Vanadium 50]

Now you want to make profits illegal?

I'm not advocating anything. The argument was advanced that there would be cost savings with lower profits, and I am pointing out how much of an effect this is.

 

[mheslep]

The Congressional Budget Office has a different take on the number of uninsured.

http://news.yahoo.com/s/ap/20090911/ap_on_go_ot/us_census_uninsured;_ylt=AshwU8hhGyvHi5JZEcGhL11p24cA;_ylu=X3oDMTJxZGdhZW5lBGFzc2V0A2FwLzIwMDkwOTExL3VzX2NlbnN1c191bmluc3VyZWQEcG9zAzEwBHNlYwN5bl9wYWdpbmF0ZV9zdW1tYXJ5X2xpc3QEc2xrA2dyb3d0aG9mZ292dA--

Note your quote said simply said 50 million uninsured, it does not say citizens as did the President, because we know millions of them are not. When the 45-50 million figure is thrown around it is often done so to encourage the belief that passing a bill like HR3200 will simply cover all of them, and it certainly will not.

 

[mheslep]

I'm not advocating anything. The argument was advanced that there would be cost savings with lower profits, and I am pointing out how much of an effect this is.

Yes, but the logic of your argument is that anywhere we eliminate profits, that we somehow we lower the delivered cost by roughly the amount of the former profits, while obtaining the same product/value. That does not follow.

 

[turbo]

Note your quote said simply said 50 million uninsured, it does not say citizens as did the President, because we know millions of them are not. When the 45-50 million figure is thrown around it is often done so to encourage the belief that passing a bill like HR3200 will simply cover all of them, and it certainly will not.

From the same article (emphasis mine):

Overall, the number of Americans without health insurance rose modestly to 46.3 million last year, up from 45.7 million in 2007. The poverty rate hit 13.2 percent, an 11-year high.

 

[Alfi]

I will go back and have a read of the last few pages of posts, but before I do I first want to thank your President for a very good speech.
It was so much easier on my ears than the last president's speeches.

I think he addressed the lies and misinformation very well.

 

[mheslep]

From the same article (emphasis mine):

Then the AP is sloppy and wrong, and not for the first time. There are not 47-50 million uninsured Americans, implying citizens or at least legal residents, as has been documented numerous times in these health threads.

 

[Al68]

Then the AP is sloppy and wrong, and not for the first time.

Surely you jest. It's not like they have consistently portrayed what Democrats tell them as objective unbiased fact for years.

According to Wikipedia (http://en.wikipedia.org/wiki/Uninsured_in_the_United_States), which cites the U.S. Census Bureau (I'm too lazy right now to check their source):

The 46.3 million figure isn't the total number of uninsured at a given time, it's the number of people in the U.S., including non-U.S. citizens, that are without insurance at any time during the year. Obviously that inflates the figure.

10.2 million of those are not U.S. citizens.

18.1 million have more than $50,000 household income.

About one quarter are eligible for public coverage now, but decline.

There are many more stats available, but the bottom line is, as always, the AP uses whatever politically motivated numbers the Democrats use.

 

[Al68]

In the Wed night speech I'm happy to see the US President vanquished the '47 million' uninsured figure he and other Democrats have used again and again, and again. Instead he nhttp://www.washingtontimes.com/news/2009/sep/09/text-barack-obamas-speech-joint-session//print/" :

There are now more than thirty million American citizens who cannot get coverage.

Notice that he dishonestly says over 30 million "cannot get coverage", knowing that a quarter of those are currently eligible for public coverage, and over 18 million of the uninsured have over $50,000 a year household income.

Why would he purposely choose to say "cannot get coverage" instead of "don't have coverage", knowing that there's a huge difference? It's like he went out of his way to make sure he lied, when telling the truth would have been easy, and almost as good for his purpose.

Is it possible it was an honest mistake?

And then he says: "These are the facts. Nobody disputes them." Huh? Nobody? That's either an obvious blatant lie, or he is referring to many of us as "nobody".

 

[mheslep]

... and over 18 million of the uninsured have over $50,000 a year household income.

'Household' income is an ambiguous creature. If there are 4.5 people in that house then all the individuals are under the poverty level.

 

[humanino]

Do you choose your doctor based on the lowest price?

Interesting attempt at an argumentation. As a matter of fact, I have been in both systems, European and US. I dare say, the US health system is the single most important reason why I would consider not living in the US. Your argument essentially is "if it's cheap, it can not be good quality". I do not consider it deserves an answer.

Again, there is no argument, I do not care to argue, and I do not care to convince anybody. Your system is terribly bad. If you do not want to change it, that's your decision. I am just stating that it is silly and impossible to understand from an broader perspective.

 

[Al68]

'Household' income is an ambiguous creature.

Good point. But the source I used listed it that way, so I had to.

If there are 4.5 people in that house then all the individuals are under the poverty level.

Well, not according to the U.S. Census Bureau (http://www.census.gov/hhes/www/poverty/threshld/thresh08.html ), they would not be unless there were over ten people in the house. The relationship between required income and household size isn't linear.

My kids never lacked for anything (they needed) when I made much less with 4 of us.

 

[turbo]

Again, there is no argument, I do not care to argue, and I do not care to convince anybody. Your system is terribly bad. If you do not want to change it, that's your decision. I am just stating that it is silly and impossible to understand from an broader perspective.

I have Canadian friends who feel exactly the same way, including a nice lady that works as a medical lab technician.

The GOP pretends that they are "conservatives" and the sheeples follow along. Allowing the cost of health care to more than double every decade is not a conservative position - it is a radical neo-con position. The system needs to be fixed or it will drive the US into 3rd-world status. Currently, most of us are one catastrophic illness away from bankruptcy and financial ruin. Suffer one such illness and survive, and you'll never get health insurance ever again. My wife and I have savings adequate for our retirement and a house on a small piece of property. If either of us comes down with a catastrophic illness, her health insurance company (BC/BS) will drop us, and we will lose everything that we have saved through a life-time of fiscal conservatism. That's OK with the GOP, though.

 

[mheslep]

My kids never lacked for anything (they needed) when I made much less with 4 of us.

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

 

[turbo]

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

That's not a bad thing, but if health insurance coverage is mandatory with no public option, people will have to buy their coverage from the private insurers, who will then have no incentive to reduce costs.

I suggest that people should be allowed to opt into Medicare and pay for that coverage. That would bolster the pool of Medicare recipients (often elderly and disabled with high medical-service usages) with an influx of relatively healthier people, reducing the "experience rate" for the group as a whole. That would be a very simple fix, and one that I haven't seen suggested by any of our for-hire Congressional representatives.

 

[byronm]

There is a logical fallacy here.

The assumption that since mistakes and abuses occur in the present system, they will not occur in the proposed system.

This is a ludicrous claim.

In fact, from my experience with govt. I envision the number of mistakes getting greater, and the abuses getting far worse.

You're claim is even more ludicrous. Our government has been working for two centuries. Our democracy is strong. Affordable Health care only makes it stronger.

The only delusion there is, is the self prophesying delusion that government is a failure which is only true if your goal is to make it fail.

 

[WhoWee]

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

The insurance quote I pulled yesterday for a family of 4 - with the coverage Obama specified in his speech - would cost $22,224 per year.

If they chose to purchase lesser insurance coverage, they would be penalized $3,800.

 

[byronm]

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

At 50,000 dollar wages that tax incentive is meaningless and much less than what the monthly premium for insurance is.

What money would be used to "pool for the chronically ill" and who gets to decide who is covered by that pool and who isn't?

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

 

[WhoWee]

You're claim is even more ludicrous. Our government has been working for two centuries. Our democracy is strong. Affordable Health care only makes it stronger.

The only delusion there is, is the self prophesying delusion that government is a failure which is only true if your goal is to make it fail.

The Post Office is scheduled to lose $7,000,000,000 this year and next - that is a failure.

The President claims he can find $900,000,000,000 in fraud and waste in the Social Security, Medicare, and Medicaid programs - those are failures.

The Government is terrible at cost management.

 

[WhoWee]

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

Nobody is "chained to their employer" based plans now (unless you have a pre-existing condition). Employer based plans cost less for the individual, but you're free to spend more and buy your own.

 

[mheslep]

At 50,000 dollar wages that tax incentive is meaningless and much less than what the monthly premium for insurance is.

The tax incentive would be the same as one gets from the employer, so the self employed is exactly on the same footing as one covered by an employer. That is anything but meaningless. It frees one from getting coverage via an employer, as you advocate below.

What money would be used to "pool for the chronically ill" and who gets to decide who is covered by that pool and who isn't?

Guranteed Access Plans - defined by the state and federal governments, funded by federal money given to the states. The idea is make insurance for the truly unexpected, and let the GAPs cover the chronic ongoing illnesses, thus cutting insurance costs.

Direct Help for the Hard Cases

I wouldimprove the non-employer, individual insurance market by building on existing Health Insurance Portability and Accountability Act (HIPAA) protections for people with pre-existing conditions and by expanding support for guar*anteed access plan (GAP) coverage in the states that would insure them if they are denied private coverage or only offered coverage at very high premium costs.[40]

Under McCain's Guaranteed Access Plan (GAP), the federal government would work with governors and provide federal assistance to develop models for states to ensure that individuals who experience dif*ficulty obtaining coverage would have access to health insurance. One model envisioned under this approach would be a type of high-risk pool, in which a state or states would provide insurance with reasonable premiums to uninsurable individu*als. In the recent analysis by the Lewin Group, the GAP provisions would cost an estimated $235.4 bil*lion over 10 years.[41]

http://www.heritage.org/research/healthcare/bg2198.cfm

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

<shrug> I agree health care has to be cut loose from employers. But if we use a public option to do it then you're chained to a government program and the taxes to pay for it.

 

[mheslep]

Nobody is "chained to their employer" based plans now (unless you have a pre-existing condition). Employer based plans cost less for the individual, but you're free to spend more and buy your own.

That's misleading. There is an economic chain. Outside of an employer, one takes a tax hit buying coverage. HSAs help that some, but they're still not the tax equivalent of employer coverage. Also, without the size advantage of a large pool there's a negotiation disadvantage.

 

[WhoWee]

That's misleading. There is an economic chain. Outside of an employer, one takes a tax hit buying coverage. HSAs help that some, but they're still not the tax equivalent of employer coverage. Also, without the size advantage of a large pool there's a negotiation disadvantage.

I opted for an HSA with a high deductible. It lowered my premium and allows me to save the funds in an account - to be used for medical purposes or roll over until next year. Once I meet my deductible, the plan pays 100%.

I think the tax benefits are fair.

 

[mheslep]

I opted for an HSA with a high deductible. It lowered my premium and allows me to save the funds in an account - to be used for medical purposes or roll over until next year. Once I meet my deductible, the plan pays 100%.

I think the tax benefits are fair.

Yes I've looked into them too, a good way to if one is on their own. So? Employer based plans still have a tax and size advantage. I would prefer they didn't under current laws, but they do.

 

[Wax]

I don't see the level of specifics you've outlined - very vague - and seems to be focused on the public option.

Even if your interpretation is correct, the cost of individual tests must be paid somewhere - not just thrown out the door as you stated.

Nope, it doesn't. This isn't a case like an illegal alien going to an ER without health insurance. The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare. They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.

In summary, there is nothing for hospitals to write off because they accepted the payment plan. It's not a case in which an individual owes 20,000 dollars for a surgery and can not pay for it.

 

[mheslep]

...The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare.

What choice? They accept the government insured patients or they go out of business, except for the high end operations like Mayo.

They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.

That's exactly wrong. It's well known that Medicaid/Medicare costs are shifted onto private insurance.

 

[Wax]

What choice? They accept the government insured patients or they go out of business, except for the high end operations like Mayo.

That's exactly wrong. It's well known that Medicaid/Medicare costs are shifted onto private insurance.

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

 

[turbo]

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

The public plans don't shift costs onto private payers. The private payers shift costs onto others by refusing to cover people who actually get sick and need insurance to pay for treatment.

Regardless of what we hear from the right-wing, we ALL pay for uninsured and underinsured patients through higher charges by service providers. Health-care reform is absolutely necessary to protect our economy from further degradation, and to improve medical outcomes with early detection and preventative care. The "party of NO" wants to scare people into opposing health-care reform, and it seems to be working in large part. Fold in the "blue-dogs" and it might be impossible to get meaningful reform passed unless voters take up the issue with the elected representatives who answer to them.

 

[mheslep]

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

Yes, I am aware of that and cited one. But not every clinic/hospital can be a world class Mayo. Many of them can not turn away all the government plan patients and survive. Likewise in single payer systems, a provider does what they are told by the government or they go out of business.

 

[Al68]

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

I agree with you here. Obviously a family of 4 making $50K would never get a Cadillac policy, like the one HR3200 requires, unless it's part of their employment package. As someone pointed out before, their only practical option would be to simply keep the normal medical insurance they have temporarily.

Of course that would only be a temporary solution, since to continue being "grandfathered", their policy will have to refuse all new enrollments among other things, so they simply won't continue it for long. And HR3200 makes it illegal to buy any new policy that's not in the exchange. Then the family's only practical option is reduced to just paying the penalty and going uninsured.

 

[mheslep]

...I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

1. Obama at Aug. 14 2009 Montana Town Hall:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-in-town-hall-on-health-care-Belgrade-Montana/"

Q [...] I've learned that Medicare pays about 94 percent of hospital cost. And I've learned that Medicaid pays about 84 percent of hospital cost. And I've learned this from a reputable source, my brother who is a chief administrative officer at a large hospital group. He also explains to me, when I communicate with him, that private insurers -- his hospital collects about 135 percent of cost from private insurers, and that makes up the difference. So if public option is out there, will it pay for its way, or will be under-funded like Medicare and Medicaid? Thank you.

THE PRESIDENT: [...] But here's the short answer. I believe that Medicare should -- Medicare and Medicaid should not be obtaining savings just by squeezing providers.

Now, in some cases, we should change the delivery system, so that providers have a better incentive to provide smarter care. Right? So that they're treating the illness instead of just how many tests are done, or how many MRIs are done, or what have you -- let's pay for are you curing the patient. But that's different from simply saying, you know what, we need to save some money, so let's cut payments to doctors by 10 percent and see how that works out. Because that's where you do end up having the effect that you're talking about. If they're only collecting 80 cents on the dollar, they've got to make that up somewhere, and they end up getting it from people who have private insurance.

2. Medpac.gov
http://medpac.gov/chapters/Mar09_Ch02A.pdf"
Table 2A-4, pg 56: 2007. Medicare payment margin: -5.9% (verifies the claim of the questioner in Montana re Medicare)

3. Millman study (at the request of the insurance industry)
http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf"

[...]We estimate the total annual cost shift in the United States from Medicare to Medicaid to commercial payers is approximatey $88.8 billion. [...]

Note that this only addresses hospitals and physicians. Many nursing homes receive most of their income from government plans, http://findarticles.com/p/articles/mi_m0795/is_n1_v13/ai_11676874/", and are very sensitive to underpayments. Nursing homes also consequently have no choice but to accept government plans, especially Medicaid, or go out of business. Yes there are exceptions for homes that specialize in the like of Bill Gates parents.

 

[mheslep]

If if it is not clear who calls the shots in a single payer system:

Interview by an NPR/WaPo reporter with Naoki Ikegami, Japan's top health economist:

[Q] If I'm a doctor, why don't I say, "I'm not going to do them; it's not enough money"?

[A] You forgot that we have only one payment system. So if you want to do your MRIs, unless you can get private-pay patients, which is almost impossible in Japan, you go out of business. ...

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html