Universal Healthcare

[Chuckinden]

I am going to post this here with trepidation. If this can be discussed objectively [eyeroll], it may open some eyes, but only if you have an open mind and don't bring partisan politics into it. I understand that too many can't do that and then it will go to the cesspool....er, political thread.

After lots of research and reading about the tribulations of our current health insurance system and those that are proposed, I am now in the camp for universal, one payer healthcare system. It wouldn't be a 100% cure all, but it would have to be better than what we have now.

Of course, it will probably never happen due to special interest lobbies that have bought off politicians, but IMO it would be the best for everyone in general when ALL things are considered.

Please state your opinions for and/or against. I am interested in knowing the pros and cons.

 

[Hank Camacho]

I tend to believe that Charlie Munger is right about almost everything, including a preference for a single payer healthcare system with the option for people to opt out if they so choose.

 

[Rex Kwon Do]

What's your plan to pay for it?

 

[backbeatcat_rivals376595]

What's your plan to pay for it?

This. The single payer will still have to pay the ridiculous charges billed by caregivers and those caregivers (especially specialist physicians groups) are VERY powerful lobbies. The single payer would be subject to paying high prices for drugs, hospital stays etc...just like the multiple payers. The largest driver of healthcare costs in my opinion are massive capital spends by hospitals and health systems that have raised the unit cost of care beyond what anyone can pay.

 

[qwesley]

I guess I just don't get anyone having confidence in our govt (both fed and state) to run the entire healthcare system. $550m and 4 years and still couldn't turn up a basic sign up portal. And the VA is still a cluster even with intense scrutiny.

 

[UKserialkiller]

What's your plan to pay for it?

Tax the **** out of middle and upper class while the poor and their unhealthy lifestyles thrive off it.

 

[Hank Camacho]

Tax the **** out of middle and upper class while the poor and their unhealthy lifestyles thrive off it.

We could probably cut out a megaton of waste just by ending free ER visits.

 

[UKserialkiller]

We could probably cut out a megaton of waste just by ending free ER visits.

Oh hell yeah Hank. 100% gold.

 

[gamecockcat]

In an ideal world, single payer would be great. However, we've seen how single payer systems in the US (Medicare, Medicaid) and abroad (most of Europe, UK, etc.) are run and it's not a pretty picture. Incredibly expensive, interminable waits on specialists, health outcomes are NOT better, etc. Single payer, just like socialism, does not work long-term. Medicare is projected to be spending >$1 trillion annually by 2026 and the trust fund to be exhausted in 2028. How is adding another 300 million consumers to that plan going to be anything other than a complete disaster?

I have yet to hear any politician address the 'supply' side of healthcare, i.e, the number of providers. Double or triple the number of providers, which, by the way, would greatly decrease the cost of medical school, and the price of services will decrease. That's Economics 101. If prices for services decrease, premiums for consumers, malpractice premiums, lawsuit judgments, etc. will also decrease. It's a win-win, in theory. Doesn't mean it will work exactly like that. But, I think it's a stone-cold fact that enlarging an already bloated system that is teetering on the verge of bankruptcy is foolhardy.

Which means we'll do it, of course.

 

[MountainDoc]

The government cannot do an adequate job with what they are currently running (medicare, medicaid, and VA). I do not want them running my insurance while I can avoid it. Rather than a single payer source I believe competition is the answer break down barriers and allow insurance providers to compete for patients. This will increase benefits and reduce premiums for the insured. In KY we see primarily Anthem (BCBS), Aetna, Humna, and a few odd ball (United Health etc). If there were MORE commercial insurance providers competition would allow patients to choose companies and truly shop for insurance companies and plans that fit their desires best. Insurance has basically become regional and monopolized from there.

Take medicaid and overhaul that system which is easily the greatest abused of all. Institute a bracketed system for medicaid to which only those truly impoverished have 100% funded health plans. As income increases so does a mandatory contribution by way of either co-pays (least likely to see compliance) or monthly premiums. If that's deemed impossible take a portion of those who receive tax refunds (and are on medicaid) to pay their contribution. If SOME of the medicaid recipients in this country shouldered even the slightest burden of their health insurance it would ease some weight being pulled by the middle class working (read tax paying) people. For example, if the middle and "upper" income brackets of those on government sponsored medicaid plans paid even a 5 dollar monthly premium it would put money back in the system from those who are benefiting from it.

While a single payer would simplify my job I believe it would complicate the system, decrease reimbursement, and likely reduce the quality of the care provided. The system as is though is extremely complicated and regulation changes nearly daily. There's a misconception that healthcare providers are all making tons of money off insurance in this country. This may be true for hospitals and larger chains. Us little people struggle with poor compliance, poor reimbursement rates, and constant denials for payment (with TONS of excuses from Ins providers).

 

[Hank Camacho]

I think, conceptually, that almost everyone agrees that a single payer system is the best method for pooling the risk across the broadest spectrum but no one trusts government to do an adequate job of running the system.

It is a ***** of a problem, to be honest, without an easy answer. This may make me a dirty hippie liberal, or whatever, but I was okay with Obamacare because at least it was a somewhat doable solution to the problem.

But, as indicated above, the biggest problem currently is the ballooning medical costs in America. I'm a knuckledragging capitalist who believes everyone should get every dollar they can, but medical costs are going to have be a bubble that is popped.

 

[wildcatadam6]

Single payer is great unless you need to use it.

This is a model that should grow in the coming years. Competition and free markets are wonderful things.

The Tom Woods Show: 481 How Capitalism Can Fix Health Care
https://overcast.fm/+BLhl2H8Fo

http://tomwoods.com/ep-481-how-capitalism-can-fix-health-care/

 

[TheEgyptianMagician]

Main problem is cost, bloated expenses and waste in American system. Fix that everything else takes care of itself. I don't care how it is accomplished, universal or no government involvement but a civilised society should be able to take care of its citizens' health... other developed and civilised countries manage it just fine contrary to what you may think.

I have direct experience under socialized healthcare and found it absolutely no different quality in care. Most noticeable difference was probably that I didn't see a bill for a few grand for a relatively minor outpatient procedure. KNow what else you don't see in Europe? Commercials for your local hospitals and the constant bombardment of advertisements telling you to ask your doctor about this or that to manage your irritable bowel syndrome or ulcerative colitis ... which hints at another obvious problem; stop eating like idiots you morons

 

[Bill Derington]

My wife is a Nurse Practitioner in a Cancer clinic, she was telling me a situation of a patient and Obamacare or lack thereof.

This gentleman worked part time, his employer didn't provide insurance, and the guy lived out of his minivan. I would think this guy would be just the type of person Obamacare would help, wrong. He earned too much at his part time job.

The Dr worked out a plan to where he would whatever he could, at that time he paid 5 dollars a visit, yet he still received treatment.

People don't go without treatment, thats a myth. Obamacare didn't lower ER visits, it didn't really do anything, but add fluff for politicians, and headaches for providers.
Universal won't either, it sounds great in a lecture, but reality is far different. Once you provide something likr that from the Govt it can't be taken back.

 

[cat_in_the_hat]

I don't think you can discuss a national health care system without bringing politics into the equation. Sorry. The question, in my mind, on most of these social programs is are they consistent with the Constitution, not whether they might improve upon what we have. In spite, of what the majority opinion was with the ACA law, I do not believe that a health care system run by the Federal Government is Constitutional. To more fundamentally answer your question, I don't favor it because it strips citizens of their rights because it removes the right choose something different and it would have to redistribute wealth in order to pay for itself. Both of those things are counter to our belief in individual liberty and are not moral actions for a government to take.

 

[WayneDougan_rivals170043]

I think, conceptually, that almost everyone agrees that a single payer system is the best method for pooling the risk across the broadest spectrum.

I do not agree with that at all.

 

[Moopyj]

we need gov't funded ***** houses. It would improve mental health.

 

[Hank Camacho]

I do not agree with that at all.

Ok.

Then what is your opinion?

 

[BernieSadori]

Universal coverage will do nothing more than ration healthcare.

I've already experienced a form of rationing with my Dr. I used to be able to get in within a week. Now...not so much. I called to see my Dr. a few weeks ago and was told the earliest appointment she had was in over a month. False. Now I have a new office I go to that was accepting new patients, but had to see a nurse practitioner.

The problem isn't with too many people being insured. I wish everyone had great coverage. The issue arises when there aren't enough Dr's to meet the new demand. This causes rationing of care. See Canada.

 

[Hank Camacho]

https://www.fool.com/investing/2017/05/07/warren-buffett-healthcare-is-the-real-problem-for.aspx

 

[Dig Dirkler]

Staunchly against it. I'm pretty much a social libertarian. I truly DGAF what someone does with their body or life nor do I GAF who they do it with -- and, in turn, I expect reciprocity from my fellow citizens. If a person wants to drink a gallon of whiskey and smoke a carton of cigs a day, then why should I care? Their life is their own to live as long...as I'm not having to pay for their habits and excesses.

However, what happens when it comes time to pay the piper for a lifetime of abuse? Who should be responsible for that bill? If my health insurance premiums are going to be based on everybody being in the same boat, then I definitely have a say in how someone lives their life. If I'm going to be forced by the federal government to have every schlub in my risk pool, and therefore my premiums are going to be higher because of someone's smoking habit (just one example), then I have a right to say whether they should smoke or not. Do we really want to go down that road? When it comes to paying for my brother's habits then I definitely do not want to be his keeper.

 

[LordEgg_rivals16573]

It's coming.

 

[BlueRaider22]

I'm in healthcare and I feel that a hybrid system is probably the best.

1. there should be a very low level care that all are eligible for. It's very crap care, but at least it's care. The single idea is to cover the people who can't achieve option 2 for whatever reasons.

2. This is mainly theoretical, but it's been done in other countries with good results. Think about the car insurance system. Your employer does not provide it for you. You are supposed shop around and find a custom policy that makes sense for you both physically and financially. Costs of premiums should take a nose-dive as holders shop around for policies. The consumers should also be able to shop care.....just as they would to look around for the best prices to fix their cars......thus healthcare costs should decrease.

At the end of the day the consumer is responsible.

 

[ukalumni00]

Anyone who thinks our government can run a well oiled healthcare system is beyond delusional. They cannot even develop a website without completely screwing it up and costing us billions in the process.

You give a politician or beaurocrat the power to control your healthcare and you get what you asked for.

Healthcare is so screwed up I highly doubt it gets figured out in my lifetime. Too much corruption involved. Comes down to what is the lesser evil and I think getting government as far away from it is the best option.

 

[Hank Camacho]

I think it is a complete red herring for people to ***** about other people's bad habits driving up healthcare.

Should Americans not be fat, diabetic, opiate addicted narcissists?

Yup.

Will they? Nope. Nor will any population with the resources to sustain abject gluttony.

It is very similar to the argument of a 20 year old healthy person asking why they have to pay into the healthcare system when they have no immediate needs... eventually you'll need it and there does not appear to be an efficient market driven way of allocating risk that will be politically viable.

 

[Hank Camacho]

I'm in healthcare and I feel that a hybrid system is probably the best.

1. there should be a very low level care that all are eligible for. It's very crap care, but at least it's care. The single idea is to cover the people who can't achieve option 2 for whatever reasons.

2. This is mainly theoretical, but it's been done in other countries with good results. Think about the car insurance system. Your employer does not provide it for you. You are supposed shop around and find a custom policy that makes sense for you both physically and financially. Costs of premiums should take a nose-dive as holders shop around for policies. The consumers should also be able to shop care.....just as they would to look around for the best prices to fix their cars......thus healthcare costs should decrease.

At the end of the day the consumer is responsible.

This.

 

[Moopyj]

Anyone who thinks our government can run a well oiled healthcare system is beyond delusional. They cannot even develop a website without completely screwing it up and costing us billions in the process.

You give a politician or beaurocrat the power to control your healthcare and you get what you asked for.

Healthcare is so screwed up I highly doubt it gets figured out in my lifetime. Too much corruption involved. Comes down to what is the lesser evil and I think getting government as far away from it is the best option.

right on, how many "glitches" or "bumps in the road" were there. What did Obama do? Oh I found out about it when you did. "Oh you can't see your doctor for 7 weeks now? I'm outraged and found out about it today.

 

[MacCard]

Staunchly against it. I'm pretty much a social libertarian. I truly DGAF what someone does with their body or life nor do I GAF who they do it with -- and, in turn, I expect reciprocity from my fellow citizens. If a person wants to drink a gallon of whiskey and smoke a carton of cigs a day, then why should I care? Their life is their own to live as long...as I'm not having to pay for their habits and excesses.

However, what happens when it comes time to pay the piper for a lifetime of abuse? Who should be responsible for that bill? If my health insurance premiums are going to be based on everybody being in the same boat, then I definitely have a say in how someone lives their life. If I'm going to be forced by the federal government to have every schlub in my risk pool, and therefore my premiums are going to be higher because of someone's smoking habit (just one example), then I have a right to say whether they should smoke or not. Do we really want to go down that road? When it comes to paying for my brother's habits then I definitely do not want to be his keeper.

I guess the argument to that stance would be that a good percentage of medical issues aren't caused by a "lifetime of abuse". Most just happen by freak occurrence, even to someone like yourself that otherwise lives a healthy life.

I agree that people that live a crappy lifestyle should be forced to pay more. But that's painting an awfully broad brush. Health care is something that every one needs at some point in their life, because we're all at least destined to whither away and die at some point - which is why everyone should have to chip in to some extent. I'm no Democrat, but I did kind of agree with the individual mandate for that reason.

 

[Dig Dirkler]

I think it is a complete red herring for people to ***** about other people's bad habits driving up healthcare. Should Americans not be fat, diabetic, opiate addicted narcissists? Yup. Will they? Nope. Nor will any population with the resources to sustain abject gluttony.

But the fact that we shouldn't be narcissistic addicts, or that most won't change their habits, is not a valid reason to force the rest of us who are following a healthy lifestyle to pay more for our insurance premiums.

 

[Dig Dirkler]

I guess the argument to that stance would be that a good percentage of medical issues aren't caused by a "lifetime of abuse". Most just happen by freak occurrence, even to someone like yourself that otherwise lives a healthy life.

But that's not true, at least not in America. I can't cite chapter and verse, and I don't have time to look it up right now, but most of our health-related problems and costs are directly related to our lifestyles. Hell, just two diseases alone, diabetes and heart disease, account for an inordinate amount of health care expenditure -- and these are both directly tied to life choices.

Still though, your post brings up the fundamental problem -- whether or not to consider health care a "right." I'm not trying to parse the Constitution, but why is it that health care should be a "right" mandated by the federal government?

 

[Hank Camacho]

But the fact that we shouldn't be narcissistic addicts, or that most won't change their habits, is not a valid reason to force the rest of us who are following a healthy lifestyle to pay more for our insurance premiums.

Then go figure out a way to create a market where people can pay according to individual responsibility level while still also doing the fundamental job of providing coverage against cataclysm like cancer, a special needs child, etc, hotshot.

I agree with you in theory but this is such a big problem and so scattered that I think that moralizing and being theoretical is not helpful.

 

[BernieSadori]

Then go figure out a way to create a market where people can pay according to individual responsibility level while still also doing the fundamental job of providing coverage against cataclysm like cancer, a special needs child, etc, hotshot.

I agree with you in theory but this is such a big problem and so scattered that I think that moralizing and being theoretical is not helpful.

How about yearly physicals w/ blood work? That should lump you into a certain group, no?

Year 1: Have butter blood from eating like **** = High premiums
Year 2: Worked out, lost weight, blood resembling blood = Medium risk
Year 3: Continued healthy lifestyle, all blood work is good = Low risk

Maybe money will motivate people to make better choices.

Also...the poor with free healthcare, is it really free? Does any money come out of their monthly allowance? If not, time to give up 3-5% to go in to the Universal fund for poors.

 

[UKserialkiller]

Then go figure out a way to create a market where people can pay according to individual responsibility level while still also doing the fundamental job of providing coverage against cataclysm like cancer, a special needs child, etc, hotshot.

I agree with you in theory but this is such a big problem and so scattered that I think that moralizing and being theoretical is not helpful.

I guess the only true way would be to tell if it's a genetic link or a lifestyle link. Either way, I'm not sure we really have the technology yet to determine that.

I mean in theory. People who have diabetes, heart disease, high blood pressure should maybe taxed more. cancer is one of those weird ones and I wouldn't even knwo where to begin on that one.

Maybe establish a healthy baseline. If you meet that criteria you get $10K back on tax returns or a $10K tax reduction.

 

[Dig Dirkler]

Then go figure out a way to create a market where people can pay according to individual responsibility level while still also doing the fundamental job of providing coverage against cataclysm like cancer, a special needs child, etc, hotshot.

I agree with you in theory but this is such a big problem and so scattered that I think that moralizing and being theoretical is not helpful.

Hotshot? I've been very careful to respectfully present my opinions without resorting to name-calling or petty bickering. Now personally, I couldn't possibly care less what you call me -- you're simply another face-less f--k on a message board. Still though, are we gonna start throwing out insults? I don't care one way or the other, I just need to know.

As far as your initial question, it would be nice if restrictions were lifted on insurance companies across the board -- e.g. allow them to sell policies across state lines, allow them to offer a wide range of policies, some bare-bones, some comprehensive in nature, allow them to GASP deny selling a policy for pre-existing conditions (are home insurers required to sell a fire policy after the house is already burned to the ground?), etc...

 

[Hank Camacho]

Maybe money will motivate people to make better choices.

I'm absolutely in favor of incentivizing good behavior and would love to see it done.

My issue is that the current system is so schizophrenic that no one actually knows what is going on. Costs are unsupportably high. There is no transparency nor real choice in insurance options (chiefly because it is tied to employment) so the consumer has almost no bargaining power. There is absolutely a ****-ton of waste caused in large part by the uninsured who abuse the system and that cost is foisted off on the responsible users of the system, as well as a ****-ton of waste caused by medical providers having perverted incentives that lead to more care rather than more health.

It is just a disaster and needs a legitimate fix, even if imperfect, that can be improved upon rather than having **** change all the time with political whims. That, frankly, is why I'm for Obamacare and hope the Senate kills this new healthcare bill.

Basically I'm arguing that we have a polished turd currently on the books, but I'd rather improve rather than destroy unless I see an actual workable solution.

 

[jtrue28]

Yep, until you start monetarily punishing people for showing up in the ER for a goddamn cold, this **** won't stop.

 

[Rebelfreedomeagle]

We could probably cut out a megaton of waste just by ending free ER visits.

Anyone arguing against this idea has never been to an ER. Toothaches, bruises and other primary care items are an all day normal because you can't get money out of someone who doesn't have money to get. Add in 2 out of 3 have "severe pain" and need a prescription really bad. An ER waiting room will make you hate the world. I can't say enough good about the people who work it every day.

 

[Hank Camacho]

Hotshot? I've been very careful to respectfully present my opinions without resorting to name-calling or petty bickering. Now personally, I couldn't possibly care less what you call me -- you're simply another face-less f--k on a message board. Still though, are we gonna start throwing out insults? I don't care one way or the other, I just need to know.

As far as your initial question, it would be nice if restrictions were lifted on insurance companies across the board -- e.g. allow them to sell policies across state lines, allow them to offer a wide range of policies, some bare-bones, some comprehensive in nature, allow them to GASP deny selling a policy for pre-existing conditions (are home insurers required to sell a fire policy after the house is already burned to the ground?), etc...

Blah. Learn Paddock.

Also (and this is entirely tangential to the above post and I am only doing this in order to avoid abject overposting) the cheapest thing America could do in the healthcare department is legitimately fund functional mental health services.

The fact that basic mental health issues like addiction, anxiety, depression, ADD, etc. are a ***** to get covered spirals into every aspect of life.

Fix that and you've already markably lowered the costs of everything without touching anything else.

 

[MacCard]

But that's not true, at least not in America. I can't cite chapter and verse, and I don't have time to look it up right now, but most of our health-related problems and costs are directly related to our lifestyles. Hell, just two diseases alone, diabetes and heart disease, account for an inordinate amount of health care expenditure -- and these are both directly tied to life choices.

Still though, your post brings up the fundamental problem -- whether or not to consider health care a "right." I'm not trying to parse the Constitution, but why is it that health care should be a "right" mandated by the federal government?

Diabetes and heart disease can be attributable to life choices, but not all the time. That's why it's such a complex subject and can't be painted with a broad brush.

I just think everyone needs skin in the game.

None of this also addresses the real issue - some of the ridiculous costs of health care.

 

[MacCard]

Blah. Learn Paddock.

Also (and this is entirely tangential to the above post and I am only doing this in order to avoid abject overposting) the cheapest thing America could do in the healthcare department is legitimately fund functional mental health services.

The fact that basic mental health issues like addiction, anxiety, depression, ADD, etc. are a ***** to get covered spirals into every aspect of life.

Fix that and you've already markably lowered the costs of everything without touching anything else.

For all the amazing advancements and knowledge we've gained in medicine over the years, we still are by and large stuck in the Middle Ages when it comes to mental health. Since there aren't any direct physical issues associated with mental health problems, most people just assume it isn't there or the person should just "suck it up". But having seen it first hand, it's just as real and devastating as a broken leg or other physical disease.

I think we'll look back in 50 years and marvel at how barbarically we treat mental health in general today.