Health Care

Since the rowdies have taken over the other thread, I thought I would start another one so anyone who wishes to discuss the topic can do so.

I am sure the rowdies will take this one over as well because there is really no reason to discuss these issues and there is no way anyone could see this as blowing off steam.

I would just like to say that YES i think healthcare needs to be tweaked a little becasue i really don't think its that bad, NO i don't have a plane but i think our public servants should carefully disect it and not rush into anything, and MAYBE if i play the draft right I will be able to dominate in fantasy football this year.

I boil it down to this.

We have all, at some point, had to deal with a government agency for personal reasons, professional reasons, or both. Think of how those dealings went. (pause for thought time). Do you want those same people making decisions on your health care?

The defense rests.

I apologize if your feelings were hurt. I'm also sorry that your attempt at taking over the other threads failed. But I did notice the point you were trying to prove. Clever move, worthy advisary, clever move.

Straw I think I am in agreement with you. Our health care is still cheaper because it does not cost us half of our paycheck. So what is the problem? The problem is that Obama needs to check the detail in his "facts".

Did anyone watch/hear Obama's speech last night?

I am not attempting to take over the other threads. Just thought that thread topics had become pointless and all threads were basically one large chat room. Is this not the case?

definitely the case.

for realz.

I don't understand where you get this idea. He's not even suggesting that government make decisions for people about their coverage, let alone their health care. The whole point of this reform is put the decision-making back into the hands of doctors & patients - out of the hands of insurance companies, and not in the hands of government.

I didn't watch the speech last night, but looked up a transcript this morning. I don't have any issues with what he identified has been "roughly" agreed to. It seems to me the major conflict at the moment is figuring out how to cover 1/3 of the cost.

I just wonder about the scope of coverage - will people who choose alternative medicine be able to get insurance that will make these treatments more affordable?

The Congressional majority wants to pay for its $1 trillion to $1.6 trillion health bills with new taxes and a $500 billion cut to Medicare. This cut will come just as baby boomers turn 65 and increase Medicare enrollment by 30%. Less money and more patients will necessitate rationing. The Congressional Budget Office estimates that only 1% of Medicare cuts will come from eliminating fraud, waste and abuse.

Becka, that is the problem with most of BO's speeches. They sound good and relatively innocuous until you start looking at the implications of them, and the actions that will be required to fulfill the promises that he is and has been making.

Do you support the actions he has taken so far?

The problem I have with this bill is that I just haven't had time to read the 1000+ pages of it to even begin to understand it. I have read some things about it, that do raise some concerns such as: If you have your own plan you will be 'frozen' in that coverage plan.

How true is that? I don't know because I can't even find the bill online to try to verify it.

It seems like BO is trying to sell us something without giving us a chance to read the fine print. (Which could be important)

The point of the "reform" is to provide insurance for the uninsured. The problem is with the Government getting involved to the extent they want to, there will be an enormous waste of recources, and as Straw points out, it will definately lead to rationing, leaving the decision to treat or not to treat in someone elses hands.

Even now certain decisions are out of the doctors and or patients hands. Insurance companies make decisions as to certain procedures, drugs, etc. By no means is the current system perfect. My biggest concern is the speed that he is trying to push this through. Why the big rush to spend a trillion dollars? Everyone needs time to understand the program and where the funding will come from.

Sadly, you are woefully incorrect on this point. There will be a review panel that will determine what procedures are necessary, taking the decision from both the patient and the doctor, and placing it squarely in whatever government agency/panel that is created.

::cough cough::

is this where i can get some good health care?

Yes it is. You're number 245,678,890 Please have a seat and wait to be called.

who do i need to "pay off" to be next in line?

Me

most health related expenses occur in the last year of life, so us oldies will be the ones paying for all this...

by having the care rationed away from us - the ones not worth the effort .....

yes, please bend over and prepare for the government to give it to you good in order to pay for the healthcare...

Well that might be enough to make me change my position (just kidding)

I hope my kids don't think like you straw!

Is this what you're referring to:

"The Republican Congress passed a bill that created a panel of health care experts to make recommendations to Congress on how we could get better quality, lower cost. ... It's not going to reduce Medicare benefits. What it's going to do is to change how those benefits are delivered so that they're more efficient."

I don't understand how you conclude that care will need to be rationed, unless you are assuming that Medicare is the only option people have for coverage?

Maybe healthcare reform is really social security reform in disguise...

not at all (plus, Congress no longer Republican)...

All of this talk about cuts to Medicare makes me wonder - could this be why they are trying to push this through so quickly, before AARP gets their members organized and complaining - LOUDLY.

I think I'm going to expand my herb garden and buy some books on traditional medicine. Kitchen chemistry has got to be less painful than trying to figure this mess out.

I listened to the speech last night along with various rehashes afterwards. I agree with the newscaster who said 'I've got a Harvard degree and I still can't understand how this plan is supposed to work.'

Spreading the wealth that I've worked hard all my life to accumulate and then telling me I'm too old for an operation that may only give me another five years are both an insult to me. We won't even discuss how, at my expense, caring for people who are too lazy to care for themselves rubs me wrong. I come from a state that started Workfare. You can't sit on Welfare here forever. Maybe it's my Midwestern upbringing that says if you want something work for it. If you earned it, it's your's.

Yes, I think health care needs reform but this isn't it, imho. Start by overhauling the insurance industry and then come back and let me know what we need to tackle next.

**rant over**

I am concluding that Medicare (which is the primary insurer for elderly) will be rationed. Tremendous cost savings available there.

Make no mistake, if you want to lower medical costs, two things must happen. Defensive medicine practices need to be stopped and care needs to be rationed. Any statements otherwise are just false, as the non-partisan CBO report has made clear.

Did this thread get back on track?

Well, according to Sox, the whole point of reform is to insure the uninsured...

And pretty much every major issue raised concerns insurance...

So, it would appear that is exactly where we are starting!

True. But I need someone to explain how we will add people to the insurance rolls but reduce costs.

For example, look at Mass. They implemented a plan similar to the House plan and costs have skyrocketed.

These are questions neither the President nor Congressional Democrats have answered.

Can we say, Fat Tax, Sugar Tax, Carb Tax, Cable TV Tax, Anything that they want to TAX!

Air?

Not really. Rather than reform the existing, BO is proposing ANOTHER form of insurance run by the government that will cover people that can't get/keep their own insurance.

Then comes the problem that employers will likely drop their coverage forcing more people/everyone onto the government insurance.

In no way should this proposal be mistaken for insurance reform.

Here's a comparison for you. MDIA goes into effect next Thursday. Does it target the people truly responsible for causing the current mortgage crisis? He** no. It forces more reform on the already regulatory burdened banks without saying BOO! to the crooked mortgage brokers. That's the same way this health care reform will ignore the real problem. Throwing money that doesn't even exist at a problem doesn't fix it!

There is a lot of concern that employers may stop offering health insurance through private companies if there is a cheaper "public" option out there. More on the rolls, more cost.

Edited to add: TR just beat me to it.

And for what it is worth, how many of these "uninsured Americans" are illegally here? Lets drop that number right from eligibility-that should save billions.

"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it."

Like that ^^^^^ Miscuit!

Re Medicare - there most likely are some limits that should be done. I spent 10+ years as caregiver for my FIL. Before I got involved, he would run to the doctor for anything. Little toe hurts - off to the doctor, then complain when doc can't do anything about shoes that he bought that were 2 sizes too small. But would he stop wearing the shoes - not until we took them away.

There are a lot of seniors out there who run to the doctor for everything that comes down the pike. But there's no way to monitor that.

To add to that PB, my FIL has gone through 2 major heart surgeries and has diabetes, yet he still smokes, sits on his rear end all day and eats whatever he darn well pleases. I shudder to think of those costs (thank you everyone) and the fact he doesn't take care of himself.

I'm sure that's not a question I can answer. I'm trying to figure this all out, just like you; and it makes my head dizzy...

But, if we create more affordable options for health insurance, then more people can pay for coverage, and if more people are putting money into the system, wouldn't that help to reduce costs across the board?

I think the major hurdle is to allocate resources in a way that gives incentive for people to buy the service. There's an awful lot to this plan that puts the burden of cost directly on the insurance providers, which will save consumers a lot of expense - if they have coverage.

Maybe the reason we can't figure out the answer is that there isn't one

I was watching Star Trek: Next Generation (I know I am a geek) the other night and the episode was about an alien planet whose inhabitants committed suicide at age 65 so they didn't become a burder to their loved ones.

I know this is a purposely outrageous example, but any rationing smacks of this to me. However, Europeans and Canadians have been living with this for years. I think the difference is the greater individual indepenence endemic to American culture that creates such resistance to these ideas.

<<<---- already has an herb garden...

You're right, bad example. Logan's Run would have been a much better one

No, it won't. Not as long as they are still able to see a doctor. The only way the rest of us are spared the extra expense of their care is if a)they pay for the services out of pocket, or b)have insurance.

suicide at 65!?!?!?!?

I missed my appointment!

what a nightmare !

Official Motto of the State of Californeeya.

I'll try really hard not to go off on this topic. It's not aimed at you, Becka. I have personal experience with this and let me tell you, it stinks.

One of the reasons illegals come here is to get free medical care. The stories I could tell you about this would curl your hair. They're not paying for anything. They work in places that either don't offer insurance or require identification that they cannot provide. Trust me, the majority of this group will just continue to use up services that many of us believe should be reserved for Americans who pay for it or, at the very least, are entitled to it by birth/citizenship.

Sorry...as many of you know. I have a strong opinion on illegals.

But the plan as proposed does not call for more people to pay for coverage, it calls for increased taxes so that insurance can be given to those who don't have it. So not only will I be paying over $7,000 per year to insure my family (current rates, company paying another $22,000), I will have increased taxes to pay for someone elses...makes me grrrrrr

::pats future hubby on the head:: It's OK dear, I got a raise.

well, with the increase in minimum wage today, I would hope so...

I'm sorry, I just don't see where anyone has said that uninsured people are going to get it for free. What I keep hearing about is an effort to reallocate resources to create affordable coverage options so that more people can pay for their own insurance (or more employers provide it for their employees) - based on the assumption that health insurance is something people want and would be willing to pay for if they could (so it's not a mandate). The major tax issue I recall is the suggestion to help pay for the plan by limiting deductions for the wealthiest people - probably just one of several options being debated.

well, if everyone will be "buying" healthcare, why do we need a tax increase to fund it?

I'm sorry, I just don't see where anyone has said that uninsured people are going to get it for free. You do realize that the reason the vast majority of these uninsured people are uninsured is because they're unemployed or cannot afford insurance. Yes.

What I keep hearing about is an effort to reallocate resources reallocate what resources? If there are resources laying around to be reallocated, how about lowering my insurance premium? Seriously, if there are resources to reallocate, why the need for the huge tax increase? Reallocating subsidies to Medicare & Medicaid - money we're already paying, but not benefiting from. I have no idea what this "huge tax increase" is that you keep referring to - the suggestion to limit deductions for the wealthiest Americans certainly doesn't affect people like you and me. As far as needing the additional revenue, I can only imagine there would be some intention to expand existing services in order to improve quality. But really, who knows...

to create affordable coverage options so that more people can pay for their own insurance (or more employers provide it for their employees) - based on the assumption that health insurance is something people want and would be willing to pay for if they could (so it's not a mandate). We're back to the need for people to have JOBS before they can deal with health insurance. How about putting health care on the back burner and letting smarter heads than ours have time to come up with a realistic health plan that is affordable for us as taxpayers now and 10 years from now. Focus on fixing the economy and getting the unemployment numbers down before you forge ahead with higher taxes for something that large numbers of Americans have voiced disapproval of. Sorry, you lost me - you want them to put health care on the back burner and also come up with a plan?

The CBO stated the current proposal will costs an additional 1.5 TRILLION dollars to current spending. Do you think we can just keep borrowing or at some point do we need to actually pay for it.

That, coupled with the President saying the changes must be deficit neutral, and you can do the math. 1.5 trillion in additional spending must be accompanied by a tax increase, and a big one.

I still don't understand why it will cost more money if everyone will be paying for it...

So, $1.5 trillion is the 1/3 they're currently debating how to cover?

Perhaps we should just eliminate insurance altogether and we can just pay our doctors directly out of pocket for health care services? Of course, that would mean everyone currently working for the insurance industry would be unemployed...

as opposed to creating government healthcare that will put all the insurance companies out of business and ending with all the insurance employees unemployed??? end result is the same.

again I ask...why will we need to fund this with tax increases (or reductions in tax deductions) of $1.5 trillion if everyone will be paying? Something here is not adding up...

Or perhaps we stop the illusion that we can cover everyone for less money. Bottom line is covering everyone will cost more money, period. If as a society we agree to that, so be it, but to pretend that it will not cost more, and to convince people like yourself that we can do all these things without any negative consequences, is outrageous.

Because that many more people will be getting medical services. What has been seen in other countries, and in Mass., is when people have insurance, they use medical services that they may foregone if they had to pay for it themselves.

That is why it is critical insureds have some skin in the game. Small co-pays do not provide any insentive for the insured to shop for cheaper services or to forego services for minor ailments.

[quote=Becka Marr]
Reallocating subsidies to Medicare & Medicaid - money we're already paying, but not benefiting from. Who's the 'we' that isn't benefitting? My mom who just had knee replacement that Medicare paid for? My autistic niece who gets some government $$? The anchor baby children of my former sil who get all their medical needs met for free? YOU may not be benefitting but you're not suppossed to be. You're banking money into Medicare against the day when you'll need it. And just like a bank uses your savings account to fund loans, the government uses your Medicare money to pay my mother's surgery bills.

I have no idea what this "huge tax increase" is that you keep referring to - the suggestion to limit deductions for the wealthiest Americans certainly doesn't affect people like you and me. As far as needing the additional revenue, I can only imagine there would be some intention to expand existing services in order to improve quality. But really, who knows... I think everyone else has addressed this fact already. Logic dictates taxes will go up...and various members of Congress have agreed that it will as well.

We're back to the need for people to have JOBS before they can deal with health insurance. How about putting health care on the back burner and letting smarter heads than ours have time to come up with a realistic health plan that is affordable for us as taxpayers now and 10 years from now. Focus on fixing the economy and getting the unemployment numbers down before you forge ahead with higher taxes for something that large numbers of Americans have voiced disapproval of. Sorry, you lost me - you want them to put health care on the back burner and also come up with a plan? The 'back burner' concept means that people will keep working on cooking up a solution but it's not on the front burner where they have to watch it every moment and keep it at a full boil. Translated that means, yes, the Finance Committe should work with the Health Department and the INsurance industry to hammer out revisions to what already exists. This isn't anything that's going to happen in August, September or even this year. It's simply too complicated. However, a lot can be done to slow up and reverse job loss. THAT is what BO should be focusing on now. If people have jobs they have money and we can go back to your "assumption that health insurance is something people want and would be willing to pay for if they could"

You know, I used to believe this, until the company I have worked for for over a decade and had EXCELLENT insurance just decided to cancel our group policy and leave us to all get individual insurance, not seeming to care that someone with rheumetoid arthritis cannot purchase individual insurance in our fine nation....

my sister in law has rheumetoid arthritis and has no issues getting insurance on her own...try blue cross/blue shield

::places call to WHA-mbulance::

There are plenty of people pouring their money into health insurance (or work for employers who provide coverage) only to discover that it won't help them when they need it. My grandmother had insurance, but for one reason or another it didn't cover the in-home care she needed, so my aunt wound up paying out of pocket. I'm sure stuff like that happens all the time - people wind up in situations that either aren't covered at all, or only covered to a certain amount, so they're left to pay the bill or go bankrupt (which my grandmother certainly would've without my aunt's help).


My first year or two out of college I didn't have health insurance. I was working - I went through several different jobs, none of which either provided me with insurance benefits or paid me enough to afford my own. So, I didn't go to the doctor unless it was ABSOLUTELY NECESSARY (like needing oral surgery to remove an impacted wisdom tooth) because I knew I would have to pay out of pocket. I might also add that my dad is self-employed. He's been the sole proprietor of his own business since I was in high school - works very hard, and has done very well. But he still depends on my mother's employment for health benefits.

Bingo. It's amazing how when it is your own money (not you personally, you generally), you are more judicious in how it is spent. That is why the current plan increases costs 1.5 trillion dollars and why current health care costs increase on average 7% per year.

Becka, you do realize you're arguing my case, don't you? Medicare needs to be revamped. I do agree that people should have to pay as much as possible before Medicare steps in. The loopholes that some people crawl through while leaving your grandmother needing her daughter's help are what need to be closed.

Revamp Medicare and Medicaid. Get insurance companies to provide realistically priced policies for self-employed people like your dad.

Universal Health might make life easier for your dad but, as I understand it, all your aunt's money would not have been able to by your grandmother care becasue the managers would deny her due to age.

Personally, I was lucky to be young enough and my body healthy enough so that it wasn't a big deal to forego check-ups and preventive care. The older we get, the less true that becomes; and I know several others have touched on the very important point that many people simply do not take care of themselves (smoking, poor exercise and/or dietary habits, etc.) in order to prevent the need for frequent visits to the doctor. And having reasonably good habits is still no guarantee that you won't wind up in the ER with some horrible virus...

TR, you do realize Obama is attempting to accomplish these things, don't you?

Bwahahaaaaaaaaaaaaaaa........dang, almost spit my soda through my nose....

Wait. Where did I miss him saying that, Becka? I know I listened to the speech on Wednesday. And I've read tons on this too. Nowhere do I recall seeing anything about reform of insurance companies as part of Universal Health Care.

All I've heard and read says BO wants to set up an ALTERNATIVE to current insurance. That's the whole thing of being able to keep your current insurance or go to the government's.

Seriously, Becka. He's not interested in reforming. His plan will eventually do away with private insurance, just like Canada. You do realize that Canadians come here to get the health care they cannot get under their universal plan.

I did. I was denied outright.

Yes, ALTERNATIVE - not, REPLACEMENT! He talks quite a lot about eliminating waste, particularly in Medicare & Medicaid. He doesn't talk about eliminating the programs themselves, I believe he wants to make them a more efficent part of the system:

"We also want to create an independent group of doctors and medical experts who are empowered to eliminate waste and inefficiency in Medicare on an annual basis -- a proposal that could save even more money and ensure long-term financial health for Medicare. Overall, our proposals will improve the quality of care for our seniors and save them thousands of dollars on prescription drugs, which is why the AARP has endorsed our reform efforts. ...

It's not going to reduce Medicare benefits. What it's going to do is to change how those benefits are delivered so that they're more efficient.

Let me give you a very specific example. You've heard that as a consequence of our efforts at reform, the pharmaceutical industry has already said they're willing to put $80 billion on the table. Now, why is that? Well, the reason is, is because there's probably even more waste than $80 billion, in terms of how the drug plan in Medicare is administered. We might be able to get $100 billion out or more, but the pharmaceutical industry voluntarily said, here's $80 billion.

You know what that means? That means that senior citizens who right now have a so-called doughnut hole in their plan where after spending a certain amount on prescription drugs suddenly they drop off a cliff and they've got to pocket the entire cost, suddenly half of that is filled. That's a hard commitment that we already have.

So that's a change in how we are delivering Medicare. But you know what, it turns out that it means out-of-pocket savings for seniors. That's why AARP has endorsed this."

And then since you'll be in an ER they can't deny care for lack of payment or insurance anyway, your costs will be written off. Mine, being a patient in the same hospital, will go up. My insurance will have to pay more, I will have to pay more, my taxes will go up to pay more for you, and you pay nothing....

sigh...

(not you specifically, just you in the general sense)

For my grandmother: "If you have health insurance, the reform we're proposing will provide you with more security and more stability. ... It will prevent insurance companies from dropping your coverage if you get too sick. ... It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. ...

For my dad: "Now, if you don't have health insurance, or you're a small business looking to cover your employees, you'll be able to choose a quality, affordable health plan through a health insurance exchange -- a marketplace that promotes choice and competition."

For B_F: "Finally, no insurance company will be allowed to deny you coverage because of a preexisting medical condition."

That's IF he gets that passed, which is the only reason I'm supporting his efforts. Do I believe government control is the right way to go? NO NO NO NO NO. Do I believe we need more oversight in this industry to stop them from screwing Americans over? YES YES YES.

You quoted well, Becka. I concede the point.

I still don't believe that he can do what you quoted, especially if he insists on rushing it through. Haste makes waste and there's just too much to loose here.

True, but some of the millions of unisured make that calculation and say, you know what, I would rather roll the dice and not pay for insurance I am unlikely to use. The administration is saying no one can make that decision.

I was really highlighting what you said to point out why the current health care costs are skyrocketing and nothing in the reforms being proposed will stop that. Without the consumer having a stake in the cost, the costs will only continue to rise.

We will insure more people for lower costs. We will lower the world's temperture. We will increase spending. We will not raise taxes. There, I just made promises too. Anyone want to wager on whether they can be kept.

Come on Becka, need to look past the spin, and I mean that for all politicians, not just Obama. He is making promises he can't hope to keep and may not even want to keep.

“You come in and you’ve got a bad sore throat, or your child has a bad sore throat or has repeated sore throats,” President Obama explained at Wednesday’s press conference. “The doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out.’”

I think this speaks volumes of what Mr. Obama thinks of health care and the medical profession.

I'm sure he just calibrated his words incorrectly

Thank you. I respect your skepticism.

"Now, the truth is that unless you have a what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual, because there's always going to be somebody out there who thinks they're indestructible and doesn't want to get health care, doesn't bother getting health care, and then unfortunately when they get hit by a bus end up in the emergency room and the rest of us have to pay for it."



I'm not sure I understand what stakes you think are missing?

My boss and I were talking the other day about this specific issue, Straw. He basically considers Doctors "predatory", just like us big bad lenders. Predatory Doctors. I want an Early TIL and GFE from my doctor.

Under current House proposal this is false. All will be required to obtain coverage or pay a penalty greater than cost of coverage.



The economic stakes that the patient should have in treatment costs. None of us have that today and current proposal will not change that. Without patient having economic costs for treatment (not small deductible and nothing more), then health costs will continue to rise.

Think about what this is going to cost. I will quote this from another thread. Becca, do you think it is cheaper to just buy insurance or use the government one:

http://emac.blogs.foxbusiness.com/2009/06/23/health-care-myths/

OK here are average tax rates. Lets compare France (who has socialized medicine to the US: http://en.wikipedia.org/wiki/File:Income_Taxes_By_Country.svg

Please review the graph. Now both countries have certain services provided by the government. France obviously has more than the US does, but it is not so significantly different (other than health care) that we can't do a simple analysis.

The Average GDP for the US is listed here: http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)_per_capita

US = 46,859 we will round to 46
France = I used 36k. But the reason they are so much lower than we are is they are taxed so much (because of health care). Now, the difference in tax rates for an individual is the US = 28% vs France 52% for individuals (seems high but they are socialist).

So, what part of the income goes to tax? US = 12880, France 18720 for a difference of.... $5840. In a year I pay ~1200 in insurance payments. I spend ~40 on copays and have paid $500 once for an MRI and not needed major surgery. Of which case, if I did, there would be a deductible. The only way, that it would pay off to have France's health care program, is if I had major surgery annually?

So I ask. Which country has the higher cost health care program?

It sounds like you advocate a reduction of insurance services that would force people to pay more directly for the care they need. But how does that reduce the cost of care itself?

I advocate forcing people to pay more directly yes. Costs would come down because when people have to spend out of their own pocket, they will more carefully choose which doctors they see and for what purposes, like you did when you did not have insurance.


But rather than having some bureaucrat decide what care a person should get, the individual has control. If someone wants to spend more, they can choose to. If someone would rather spend that money somewhere else, that is there decision.

Just to throw this out there then (and I am not a supporter of Obamacare), but if we restructure to get people to pay more personally, that simply translate into paying for basic needed care... what encourages people to continue to seek out preventive care and checkups?

Without that, the costs could be far larger on the back end when they finally do go to the doctor because their pain is so great, and lo and behold they have late stage cancer of something or other... those costs could destroy peoples finances worse then, force hospitals into a further charity situation, and just overall be hurt the health of the nation and economy.

How do we as a socitey score on preventive care now? You can set up costs to be less for these for than for illness care, but unless we build in more individual responsibility into the equation, costs will continue to skyrocket. (Also need malpractice reform, which is never mentioned because of tort lobby donating heavily to democrats)

I'll support whatever healthcare the Presidnet and Congress come up with that has them on the same plan as me...until then, it is a joke

Except that not having insurance forced me to forego all of the basic preventive care that most everyone I think agrees is important for long-term health, and only seeking care in the event of an emergency. And when I did have a serious situation, I had to opt for the care & treatment I could afford, rather than the care & treatment that would best serve my conditon.

What I am saying is you would still have insurance, but you be responsible for a greater part of the cost than a $10 deductible. Now, if preventive care is something that concerns you, you could spend your money on that. If others would rather spend their money on lattes, they could choose to do that. Or would you rather tell the person that wants to spend their money on lattes that it is frivilous and they MUST forego that so they can contribute to a pool that allows others to get practically free preventive care, or whatever other procedure.

And when you have a serious situation, you could choose a doctor and facility with all the bells and whistles or you could choose a clinic, depending on how much would have to come out of your pocket for the differences. At least it would be your choice, rather than a bureaucrat.

straw, what you are describing sounds very much to me like the status quo. It seems to me that your argument against the reform proposal is based on the assumption that all of the people who are currently working and paying for their own insurance are going to be working and paying more for everyone else's insurance. That's not the intention of the plan as I understand it. The idea to make insurance more affordable is for all of the people currently NOT paying to start contributing to the pool, so that nobody is getting services for free. But I don't see anywhere that anyone loses freedom of choice in the matter.

Becka, lets just agree to disagree as I don't think you can see what the next logical step has to be.

Look at Europe, Canada, Mass. and Hawaii, all of whom have universal coverage. Europe and Canada have government reviewed care (care can only be obtained if deemed worth it, as determined by a formulary using patient's age, cost, expected outcome), Hawaii had to drop universal coverage due to sprialing costs and Mass. now has spiraling costs.

All come to the same point, rationing.

Explain how this will not happen under current plan.

This is going to sound nuts to some folks, but I think human medical insurance shouls work more like equine major medical/mortality insurance works. Just stay with me for a second here, OK? Now - when we *choose* to insure a high value animal we have options based on the desired insured amount and the "regular risk" the animal is exposed to (a mutli-000 performance critter vs a beloved backyard pleasure horse, for example). The insurance is only claimable for major procedures IF regular maintenance can be proven (those costs are out-of-pocket for the owner) and IF at least 2 vets agree the major procedure is required (if not an emergency situation). The owner pays a certain percentage of the cost out of pocket and the policy pays the rest. This mostly 'cash-and-carry' keeps vets competitive for basic procedures and routine care, and it keeps the major procedures located at conglomerate clinics with multiple in-house vets who can pool their resources for the cost of the big-time equipment. University clinics are still the go-to option for most owners in these situations.

Have I confused everybody yet? I think the point I'm trying to make is that scaling back WHAT insurance is used to cover and meeting those needs in cash would be a big first step in adding competitive restraint to medical costs. OK...I've rambled enough...sorry for the tangent. Just for the record, I think that what little I understand of the "Obamacare" proposal stinks. There's no way we (as a country) can afford it.

Another concern I have heard Becka is that if there is a "public option" some employers may drop coverage knowing there is another option for its employees to fall back on, adding more burden to the system.

<------ most likely not a "high value animal" under Becca's animal farm insurance company......

This is something my company is talking about. 220 employees cost us about 30% over their salaries for insurance.

If we only have to pay 8% payroll tax surcharge to not insure, cost wise the decision is a no brainer.

But the President's public statements haven't mentioned anything about that, so there is no way the surcharge would be set low enough to encourage employers to dump coverage and push more onto government plan.

Exactly. Or the employee portion of the premium will skyrocket. My employer already uses pricing to discourage the people with families from including them on their policy. If the spouse of an employee has health insurance coverage available to them (doesn't matter what the quality of coverage is), not only does the employee have to pay the higher family premium, but an additional amount as well.

Why don't employers just eliminate insurance benefits for employees now? It's not like the employee can't go purchase their own insurance from an existing company, right?

Fair enough.

fwiw, I don't disagree with the suggestion for people to share more of the cost out of pocket. In fact, my employer just announced that all employees will be paying a greater portion of our medical benefits before the end of the year. I'm not complaining: it sure beats getting laid off and losing them entirely.

companies doing this will be at a competitive disadvantage unless they increase the wages paid or offered by the cost of insurance offered by companies competing for employees....

company paid health insurance has been part of our compensation system since wage controls were placed by the federal govt. during WWII (I think I recall that correctly) and companies needed to incent workers to stay with them by providing health care.... later came retirement benefits at no cost to the employee from the largest employers....

This is my concern as well... my company would save oodles by dropping the ocverage we have and simply paying the tax, and perhaps me a little more to purchase my own. There is no way an individual like myself could buy the same quality of care that my employer can provide me, at their price.

You simply cannot compete with a program that will run at a loss. It would be simply a matter of time before most employer coverage is dropped, and the cost of a private plan is too high, thus the migration to the government plan begins, and the costs begint o spin out of control, as being the goverment, they can allow themselves to operate at a loss.

Employer paid insurance is like buying bulk at Costco. The more you buy, the cheaper it is. That's one of the bennies for working for a big company.

Conversely, if that same company can pay significantly less by just paying a tax surcharge and quit offering health insurance to their employees, especially in today's financial climate, you can bet they're going to drop it faster than the proverbial 'hot potato'. Then Obamacare ceases to be an alternative and becomes truly universal health care.

That is the scary part. Our country was built on choice. Making every one in this country conform to one insurance makes us more like France...or Canada. Seriously , is that what you want?

That's why somehow, in addition to eliminating the Obamacare option, we as individuals or as various defined groups (e.g. by professional association, by employer, by neighborhood, etc.) need to somehow be able to cross state lines and shop around for whatever coverage suits us.

And, since the tendency of any insurer is going to be to want to attract the lowest-cost insured (younger, healthier), the combination of HSAs plus [hate to say it, but don't see a way around it] mandatory catastrophic insurance with high co-pay (to cover expensive chronic as well as acute conditions) seems like the best way to go.

As for our tendency to view ourselves as invincible, thereby avoiding all preventive tests? Good publicity about the relative costs of the test vs. the treatment should help.

And, I can't justify offering free care to illegal immigrants....

:::Stands and claps! :::

Their plan should be the litmus test.

Probably common knowledge to most of us, but this caught my eye:

What's most likely to bankrupt you:
Harvard researchers say 62% of all personal bankruptcies in the US in 2007 were caused by health problems -- and 78% of those filers had insurance.

Full story

Will have to read the story later from home.

But the question that jumps instantly to mind is this: Let's just assume that all costs will be fixed. Every medicine and procedure and office visit will have a fixed price. Is Obamacare going to pay for everything for everybody medically speaking?

If not and people will still be responsible for co-pays, etc., do you really think the bankruptcy ratio will change? If so, how, pray tell.

I'll support whatever healthcare the President and Congress come up with that has them on the same plan as me...lead the way, boys, and we'll gladly follow...

http://www.defendyourhealthcare.us

Interesting site that may shed some light on the situation with the proposed health care bill.

White House Budget Director Peter Orszag, in a blog posting on the White House’s Web site regarding CBO's cost etimates states, “the point of the proposal . . . was never to generate savings over the next decade.”

I guess that answers my question on how costs will be reduced by the current proposal. The answer is they won't.

Obamacare is aimed at the 20% of the population that is not currently covered by some form of insurance/Medicare/Medicaid.

I listened to a very convincing argument this morning for first, expanding existing programs. In my state we have additional state programs that cover children and high risk patients.

Second, get a comprehensive audit department in place to monitor Medicare and all other government programs to cut down on all the fraud thus opening up funding for the expansions listed above.

btw, I believe it's a NYT survey that stated that it's now up to 40% of the country wants BO to focus on the jobs and the economy and worry about healthcare later.

end of life care will become an end of care issue....

just give 'em some pain pills until they die....

as opposed to how chronic illnesses are handled late in life now...

end of life decisions should be strictly between patients, families and doctor --

isn't this how it is now buccs?

how is it where you live?

I agree with you. But I'm saying that the vast majority of patient care for end-of-life patients who have chronic illnesses are centered around pain management.

I was remarking that if that's how it supposedly is going to be it will not be any different that how things are now.

When are end of life decisions made and by whom? That is what will change. For instance can a 100 year old woman get a pacemaker? Obama said she probably should have been given some pills instead of the procedure. Should be noted that woman is 105 today. This happened at one of the President's recent town halls.

And I don't disagree with that either. All I'm saying is that:

"the vast majority of patient care for end-of-life patients who have chronic illnesses are centered around pain management."

But this is the question being posed.

He doesn't wish to discuss the merits of health care reform plans currently being discussed.

Wow. Did this really happen?

Wow.

Will he manage healthcare the same way that he was able to make the decision to fire CEOs of private sector. Does he or some other bureaucrat get the say on pulling the plug?

This is your clever attempt to get me to say that Obama is personally going to go around, Logan's Run style, personally exterminating those who he sees as past their expiration date. While completely adsurd, you still expect me to answer.

I don't support someone else deciding that someone is past their prime enough to let them die. All I'm saying is that if people think that now patients who face the terminal stage of chronic illness are usually counciled by their physicians to do anything other than manage pain you're sorely mistaken.

No, but it's good to see you have a healthly level of paranoia.



What I am saying is that I don't think interjecting government bureaucracy into the Doctor - patient equation when it comes to level of care and/or end of life decisions where there is the possiblity of rationed care and set standards of life saving efforts that are limited due to some mandate is going to improve our healthcare system.

President Obama is on the record saying the 100 year old lady should not have gotten any extraordinary medical treatment... she did get the treatment and is now 105...

here it is.....

http://www.fireandreamitchell.com/2009/0...r-take-aa-pill/

I was being sarcastic. That's how conservatives are making it sound, so I thought I'd try it on.

@Pale: Good for her. In all honesty if I was 100 I wouldn't want extraordinaty treatment, but that's me. Obama obviously has an opinion also. This lady's was different.

The thing is that rationing is happening now. When I was diagnosed with sleep apnea, my doctor said before my sleep study that he knew I had apnea just by looking at my throat, but the insurance company wouldn't put the cost of the machine towards my deductable (I have a high-deductable insurance plan) unless I had money spent on a sleep study. $2600 later, the insurance company approved the machine. If I hadn't had insurance, I would have passed on the study and the machine altogether. But I'm sure that by the time I was in my late 40's or early 50's I would have had a catastrophic situation such as an enlarged heart that would probably have lead to my untimely demise, because I didn't have insurance and self-rationed care.

Have you ever skipped on a procedure because the insurance pre-approval didn't go through? I'd call that rationing.

So if I just replace "prudent business practice" for "rationing" then you'd be ok with it?

Here is the difference. You are not in a position to, nor do you believe you should, decide whether that woman should have gotten that procedure. Obama is in a position and one can speculate that he beleives he should decide whether that woman should have gotten that procedure.

And what you describe is not rationing, it is diagnosing. The insurance co. wanted verification of your apnea other than through your GP's opinion. Rationing would have happened if, after diagnoses, the insurance company decided you could not have the treatment because the costs outweighed the benefit.

But don't we pay doctors for their opinion?

Doctors, yes; politicians, no.

now your intentionally being difficult...

We pay doctors for their opinions.
Doctors base their opinions on visual observation and use tests to confirm their diagnosis.
Insurance companies don't have the luxury of seeing you so they rely on the confirmation of the test before they pay for the treatment.
Where does the government fit into any of this?

btw, congrats on getting the CPAP and using it. My husband and son both use one and it's made a huge difference in all of our lives. Not to mention avoiding that whole heart thing.

And it's HER body! Shouldn't her opninion be the only one that matters?

How some can yell that same message and fight over the rights of her body when speaking of the abortion debate and then turn and ignore that very fact (that it's HER body, thus HER decision) when it suits us - i.e., it will cost too much to let her live - is simply beyond me.

I guess the Pres. is so pro-death that it pervades his every decision.

And believe me - I understand what it's like ot fight for insurance for a life saving procedure.

I oh, too well, understand the fight for a liver transplant when your child has a 105 degree fever, is septic, has dropping platelets and is fighting for her life and someone on the other end of the phone wants you to drive your child to another hospital for a second opinion. I get the red tape.

What I can't get is why the government gets an opinion.

^^^^This is the best BOL example of someone who Obamacare is aimed at helping...and SHE DOESN'T WANT HIS HELP!!! What does that tell you about this plan?

Please, please, Mr. President, walk away from this. You're doing it to prove you can, not because it's the best thing for citizens. Go find a way to get people back to work. That stomach pain too many Americans have is from hunger not sickness.

Yes it should. From the beginning I said that I don't think that someone other than you or your doctor should be party to a medical decision.

I don't have the fear in my head that a government bureaucrat will review every medical decision that's being made. I guess that's just me though. When people talk about rationing in places like Canada (which isn't even an adequate example because what's being proposed in Congress isn't a single payer system) they're talking about non-medically necessary surgeries placed at the back of the line while life-threatening conditions that require treatment are moved towards the front.

But in all honesty, I think conservatives are going to "win" the debate on healthcare. I said a week ago or so that I thought there was only a 50-50 shot something would get passed. I think there's a 25% shot now. Congress is going to go home, get yelled at by both sides and there won't be enough support to pass anything but something watered down will pass that will run up the deficit and cover a handful more people. We'll still be in the same boat with healthcare in 5 years. I can almost guarantee it.

But what makes me sad about that is that I know that we are switching insurance companies AGAIN here this year because of cost. We have less than 25 employees and are paying nearly 100k annually for employee health coverage. We're also talking about dropping dental coverage to make up for rising health costs. My dad, a small business owner, has 8 employees. He pays for the entirety of all their healthcare- has since he's owned the business. He doesn't know how much longer he can do it because it costs so much. He told me it would be personally disgraceful if he couldn't pay premiums for everyone that works for him- he knows that it's not standard practice anymore but he likes to take care of the people he relies on.

I don't know what the answer is anymore. What's being proposed is so watered down I don't think it can change anything. On the flip side I don't think that free markets are a good approach to healthcare because in a free market there is rational choice, but the nature of the goods on offer and the actors in the market make it an irrational market. There isn't an adequate supply in my area to make a market truly competitive, and I imagine it's the same in a lot of other places.

That actually sounds like a fairly low-cost plan. We spend $22,000 per year per employee for employees with families on our plan, and $9,000 per employee per year for single. Employees with families pick up $7,000 per year, and single employees pay $2,500 per year. So $100,000 per year for 25 is not much. Dental is a seperate policy paid 100% by employees, no bank supplement.

As our costs have continued to escalate, we had to decide on whether to increase employee costs, or reduce costs elsewhere. We made the decision to lower our 401(k) match from 100% to 10%, with the option of increasing the match at year end if we have good years.

To all, Bucs is belying the exact thought process of the liberal elites who want to take over health care. For example



Like hip replacements. Average wait time in Canada is 18 months and those over a certain age (can't recall off the top of my head) are prohibited. In liberal minds, these are non-medically necessary procedures, but try telling that to someone who can no longer walk.



And despite several options other than governemnt care, this is the only option liberals can see. IF your father and other small businesses were allowed to pool together to improve negotiating position, costs would go down, but liberals will not allow this option.