Good thing no one cared about smoking when I wasn't a kid. I'll bet I reeked of smoke a lot as a kid from riding in the car with a parent that smoked.
Universal Healthcare
- Thread starter Chuckinden
- Start date
Second-hand smoke was not harmful back then.
This is the problem. Many ideas sound great in theory. They just cant be funded. Not without taking money from one person to subsidize another. A fundamental departure from everything this country is about, or supposed to be about.
This is the other problem, and a cause of the former. Theres no chance government can do anything competently and/or efficiently. Which increases the cost concern listed above.
Good idea in theory. Just cannot be executed without moving towards a socialist mindset.
They do a cotinine test which is found in the body when nicotine is used. I honestly don't know how much use it takes to trigger a positive test but in the 5 years they've been testing here I've never heard of anyone challenging the results of the test (occasional vs heavy use).
I'm not sure how you can characterize existing single payer systems like those in Canada, most of Europe, UK...basically the rest of the industrialized world as "incredibly expensive"? Expensive compared to what?
Those countries all spend 30-40% less than what we spend and all have better outcomes.
Your idea to double or triple the number of providers...it's still a free market out there. What is stopping providers from entering the market now? The medical school acceptance rate is about 70%...and there is money, programs and grants available for those who want to go and have the cognitive ability to do the work. It's actually tougher to get into most nursing programs. (Relative applicants vs spots available). I think you overestimate the number of people with the ability and desire to go to med school. Yes, the cost of medical school is high but it is not like we have seen the numbers of applicants drop from an earlier time when that cost was more reasonable. IT is one of the most lucrative professions around and we're having to import a very large percentage of our IT workers and outsource to overseas IT functions because Americans are not going into the field. Not a lot of "kids" are willing to commit to 10 years of study to become physicians.
IMHO, lowering admissions standards which would be necessary to increase the numbers of providers would RAISE not lower malpractice premiums and lawsuits as you would have more incompetent providers. To argue otherwise would require that you argue that those people being denied admittance to medical school are more competent than those currently being accepted and would make fewer mistakes.
I would also submit that there very little if any economic scalability for medical schools. You can't simply double the number of people in a class and expect the same outcome. Quality of instruction would suffer which would affect the quality of care down the road. Lab facilities would have to be increased, more professors hired, the number of physicians willing to take on residents would increase...
Nobody calling for Medicare for all believes that it wouldn't require that we not pay more in Medicare taxes. Of course we would have to do so. But we would pay less than what we currently pay in insurance premiums. We pay much less for care we receive through Medicare than that which is paid through private insurers plus we would lower the overall cost of care because everyone would have access. We would no longer have mothers showing up at the ER for deliveries who'd had zero prenatal care and deliver children who require intensive/EXPENSIVE neonatal care...or people who "put up with symptoms" for days, weeks, months and years for illnesses/injuries that could have been easily and inexpensively treated but now require costly care. The simple fact that access to care is the single biggest thing that can be done to lower the cost of care for all. That model has been proven time and time again.
I've become much more liberal on healthcare within the past year. I feel like the only way this country will ever get around to fixing the healthcare system is if it becomes a single player/socialized/universal (pick whatever term you want to use) system. It sure as **** beats what the GOP is trying to do by sending people to their deathbed by making insurance unaffordable for many people just so rich people can get a tax break.
I can only afford mediocre health insurance now as it is. I could get better health insurance through my employer, but since I'm only considered a 10-month employee, they say I have to pay the full cost of the premium in those other two months, which is over $1,000 a month (and I'm a single guy with no kids!), which is something I absolutely can not afford.
One time I went in to get a physical and ended up having to pay over a $900 bill. I will never get another physical until I can get better health insurance. Funny how preventative care costs so much when it should be covered much better, would help decrease healthcare costs long run.
Since then, I've done everything possible to avoid going to a doctor unless whatever plagues me lasts for more than a few days and seems to not be getting any better. Thankfully nothing serious has happened where I have put my life in jeopardy because I wasn't sure if I would be able to afford the bill.
I know some people that can't afford any healthcare at all. The only time they ever go to a doctor is if their condition is so bad that it requires a legitimate emergency room visit. I'm not sure how anyone can look at situations like this and say that we need to make access to healthcare even more difficult for millions of people. But I guess that's how selfish and heartless the GOP is these days.
I can only afford mediocre health insurance now as it is. I could get better health insurance through my employer, but since I'm only considered a 10-month employee, they say I have to pay the full cost of the premium in those other two months, which is over $1,000 a month (and I'm a single guy with no kids!), which is something I absolutely can not afford.
One time I went in to get a physical and ended up having to pay over a $900 bill. I will never get another physical until I can get better health insurance. Funny how preventative care costs so much when it should be covered much better, would help decrease healthcare costs long run.
Since then, I've done everything possible to avoid going to a doctor unless whatever plagues me lasts for more than a few days and seems to not be getting any better. Thankfully nothing serious has happened where I have put my life in jeopardy because I wasn't sure if I would be able to afford the bill.
I know some people that can't afford any healthcare at all. The only time they ever go to a doctor is if their condition is so bad that it requires a legitimate emergency room visit. I'm not sure how anyone can look at situations like this and say that we need to make access to healthcare even more difficult for millions of people. But I guess that's how selfish and heartless the GOP is these days.
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So your issue is with healthcare costs, not healthcare insurance or health insurance cost. Slapping the ACA band aid of insurance on the problem only exacerbates it, creating an unending upward pressure on costs. When we start thinking of health insurance as a subsidy instead of insurance (i.e. it helps offset the cost of all basic preventative health care instead of helping us afford catastrophic expenses), the system is inherently broken. Once it's used for every aspect of healthcare by everyone in the plan, it either skyrockets in price, or breaks the system.
Doubling down on the ACA or doubling down on what we had prior sure isn't the answer. I'm not sure what the right answer is, but we're nowhere near it as a country right now.
Wrong. My problem is with healthcare accessibility, which is every bit as much a political thing as it is a financial thing, as well as what it covers or doesn't cover (see it not covering jack **** for a physical for me). While Obamacare is far from a perfect solution, it sure as hell at least made some improvement and accessbility in what it covered (all insurance plans requiring essential coverage, thus doing away with junk insurance that covered basically nothing). What the GOP is trying to do - reduce coverage, reduce accessibility, jack up the prices for everyone but the healthy young people, sentencing millions to death due to lack of health insurance (rather that be due to finances or not insuring people due to preexisting conditions), etc. - is a crime against humanity.
To put into a mathematical formula...
healthcare insurance costs = (sum(all healthcare costs) - sum(out of pocket payments)) * 1.035
Insurance companies add about 3.5% of costs to healthcare...so $35 of a $1000 insurance premium goes to the insurance company.
Define a catastrophic expense?
No matter what threshold you apply, you are pricing people out of the market. To someone who earns $25K/yr a $500 bill can be catastrophic.
Preventive care is important and we know preventive care lowers the cost of healthcare. If people have to pay for preventive care out of their pocket, they will avoid those costs just like they don't perform regular maintenance on their vehicles. The result will be increased cost when issues arise.
The ACA allowed people who have pre-existing conditions to purchase insurance thus why insurance companies have lost money with ACA plans. The risks pools are heavy with people who were previously uninsurable or have known medical problems. Is your solution to throw these people out? Not even the GOP replacement does this although they do give states the option to throw those people into their own risks pools which virtually make insurance cost prohibitive to them.
That option is political suicide and ethically bankrupt.
This is my situation. Until I have health insurance that better covers preventative care, I will not be getting it. I can't afford a $900 doctor bill just for a damn physical. My recent visit to the ER didn't even cost me that damn much!
I believe single payer is really the only solution in the long run. A 5% tax on all income (no reduction for poverty) would pay for it. I would also add taxes to all tobacco products and all foods with high sugar content to help pay the cost of lung disease and diabetes. Basically self funded care for the folks who are making crappy decisions and extra deterrent to stop making those bad decisions.
Guess it's me, but I wanna keep the gubment out of as much of my life as possible. It's crazy to think the state will do anything but take your money and freedom.
I don't know the answer to this very complex question! Outstanding discussion by all, BTW.
However, the benefit of reviewing history would suggest the government is not capable of providing the solution. I would be willing to consider just about any alternative before I would consider allowing our gov't to provide us with a "solution." I say that with literally no political-affiliation whatsoever.
Gov't is great at creating problems. Gov't is great at convincing us there is a problem, and that they, alone, have the ability to solve the problem---they either created or created the narrative for the problem. JMO
However, the benefit of reviewing history would suggest the government is not capable of providing the solution. I would be willing to consider just about any alternative before I would consider allowing our gov't to provide us with a "solution." I say that with literally no political-affiliation whatsoever.
Gov't is great at creating problems. Gov't is great at convincing us there is a problem, and that they, alone, have the ability to solve the problem---they either created or created the narrative for the problem. JMO
Based on the average household income in the U.S., treatment and medications should cost about a quarter of what they currently do. You'll have to excuse us if we don't take advice from someone who thinks insurance companies have it tough because they only have a 3.5% margin of profit.
Dude, you can look up profit margins for most insurers as most all are publicly traded companies...and I never cried poverty for insurers, only stated the easily documented fact.
Insurance companies don't control the cost of treatment and medications. We do still have a private healthcare market and providers are free to set their own prices. The healthcare insurance market is a competitive one. Every employer that offers healthcare insurance as a benefit to their employees puts out for bid their benefits package. All insurers negotiate with companies to provide the best coverage at the best price. There are plenty of providers that will not be in your insurance company's network. Remember the stink over "you can keep your doctor"? Some doctor's chose to not accept the negotiated rates for the Obamacare plans.
Insurance companies cannot simply say "we will only pay you $X...take it or leave it". They negotiate rates with providers. If they want a provider in their network then they must come to an agreement. Don't know if you haven't noticed but there aren't many providers out there begging for work. Start calling around and see how many providers are accepting new patients.
Who should dictate what a drug company charges for its products?
Who raised the prices on Epipen 657%? Certainly not the insurance companies.
I have to be amused at those who are against the government in healthcare but want the insurance industry to control the costs of healthcare. How is that supposed to happen?
Do Humana, Assurant, Aetna, the Blue Cross and Blue Shield Companies, UnitedHealthOne, Kaiser Permanente, CIGNA, Unicare, and others all get together and collude to limit payouts? That's illegal to do. Who is fixing the prices?
...or they want to argue that insurance should only be "catastrophic" care and not cover preventive and non-catastrophic medical events. Yet they do not define the line catastrophic line nor do they account for those who regardless of where that line would be drawn would have the ability to pay. $1000 may be pocket change to one and $999 more than the life savings of another. What happens when they show up at the ER?
I'm not reading that, I'm just going to assume you're missing my point. You probably think I'm blaming insurance companies and then you proceeded to offer a few thousand words in their defense.
Just for fun, call a provider. Any provider. Ask them to quote you a price based on the rates with your insurance carrier for an MRI or visit or surgery or blood work or whatever.
Then ask the cash price. No insurance.
You'll be shocked at the difference. Especially you, fuzz.
Then ask the cash price. No insurance.
You'll be shocked at the difference. Especially you, fuzz.
Which penalizes the very high deductible, HSA self-insurance that is supposed to be promoted, if I understand your point correctly.
I'll give you a reasonable counter argument to this perception. Admittedly we can all come up with examples of government waste and inefficiency. However there are also some good examples of government successes. The government, under president Eisenhower created the interstate highway systems in the 50s and 60s. The government under president Kennedy put men on the moon and successfully returned them to earth. The government has been successfully education our citizens for over 200 years, and the government has built and maintained the most highly trained, efficient and effective military the world has ever seen. The governments of Canada, Japan, The UK, France, Australia etc. etc have established health care systems that the citizens largely approve of. OTOH we have beat our heads in for 70 years trying to come up with a system that addresses the needs of the citizens through an employer based/private insurance system that many folks are still not served by. What is it about all those other country's governments that makes them able to do something, that according to some, the US government cannot do?
I propose that citizens simply be given an additional option to buy into Medicare as an alternative to private insurance. That way the market place can decide which option is preferable. This is already being done for seniors. A senior has the option of choosing traditional Medicare which is government or Medicare Advantage which is a private insurance alternative. 69% of seniors have chosen traditional Medicare.
Your mathematical formula is not appropriate.
Insurance today is a subsidy, which insurance by its very nature is not intended to be. It is, in essence, a demand side subsidy (whether it's private with a profit margin or government funded is relevant only in that the profit margin itself is a further pressure point on the demand curve).
Adding a demand subsidy reduces the end cost to the consumer, which encourages them to use the product (in this case, healthcare) more. Basically, it encourages the supplier to increase cost. This is especially apparent where the price of the demand is largely inelastic.
That fact that the cost is largely born by the subsidizer (insurance) and not the consumer throws the idea of free market pricing out the window. major healthcare costs are almost entirely inelastic in demand- because you have insurance, you demand the service no matter how much it costs.
That's basic economics. That's the problem with a healthcare system in which insurance is NECESSARY for affording all facets of healthcare. it's no longer "insurance" against unexpected costs, but a "subsidy" towards all costs.
If car insurance worked the same way health insurance did, it, too, would be broken. You'd use it for oil changes. You'd use it for new tires. You'd use it for gas. You'd use it for car washes, etc. Instead, it works the way insurance is supposed to- when there is a very large expense outside the normal maintenance (i.e. an accident) that you don't want to or cannot afford without insurance. Insurance costs would go through the roof, as would maintenance, gas, etc. Driving would be far too expensive for a large swath of the population. The big difference is that it's much easier to forego driving than healthcare.
Indeed, the biggest difference between insurance as it's intended and insurance as our healthcare system operates is that consumers don't INTEND or PLAN to use insurance, but they have it in case they need it. That's why it works without driving the cost of insurance or the cost of auto care through the roof. With health insurance i today, we plan to use it from day 1 (actually we NEED to use it from day 1), which makes the entire healthcare insurance system antithetical to its purpose.
I don't have a solution. The free market approach of pre-ACA days, that the GOP seems to want to return to, does not work and is clearly not a solution. ACA didn't work because it tries to use insurance in a way that is economically infeasible (as even more of a subsidy than before). The European/Canadian single-payer systems work economically to some extent, but there are serious concerns about type and availability of care as well as it being largely antithetical to our own economic principles.
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Your example of the physical shows that your concern is cost. If a physical cost nothing, or, say, $20, there wouldn't be a whole lot of complaint no matter what amount insurance paid. NEEDING insurance to offset the cost of basic healthcare services shows there is an issue with the cost of basic healthcare services that is causing a lack of accessibility to healthcare. Insurance, what it covers, and what it costs are not the cause of that, and are not an appropriate solution because using it for all aspects of healthcare drives those costs further upwards.
Healthcare is readily available. There is no shortage of it. That our politicians have so blatantly confused the population on the difference between healthcare and health insurance for purely political purposes is criminal. The problem is the ability for a large portion of the population to afford healthcare. Making Insurance cover (nearly) everyone and every condition won't solve that- it will make our problems worse in the short term and the long run. Looking to insurance as the solution won't help.
Direct government subsidy possibly can, a single payer system possibly can, or some extreme downward pressure on prices. Competitive market forces might help in other ways. But all of those solutions have inherent drawbacks as well, and I don't know the ultimate solution.
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Deeee,
-The government didnt get into education over 200 years ago...c'mon man. In fact the fed dept of ed didn't exist until 1977 or 79. The quality of education has drastically dropped since.
-ill give you military...road construction is generally public/private by nature. There are mountains of waste in both.
-governments of much smaller largely homogeneous populations...can do a lot of stuff. Apples/oranges.
-The government didnt get into education over 200 years ago...c'mon man. In fact the fed dept of ed didn't exist until 1977 or 79. The quality of education has drastically dropped since.
-ill give you military...road construction is generally public/private by nature. There are mountains of waste in both.
-governments of much smaller largely homogeneous populations...can do a lot of stuff. Apples/oranges.
Rudd - referring to local governments/public school systems which have served as well.
There could be some merit to your size argument but how about the advantages of economies of scale? i.e. if government was the largest insurer they could put more price pressure on drug companies. I still like the idea of private insurers competing against a medicare type system - let the better system win in the market place.
-i am down with economies of scale. I am not down with thinking the the government will turn over a new leaf and leverage its buying power...they haven't done so to date
Adding layers of bureaucracy (state or corporate) *never* lowers cost.
-opening up medicare to the general population isnt a terrible idea...but it isn't a bastion of efficiency. Gotta deregulate...open up the market.
Adding layers of bureaucracy (state or corporate) *never* lowers cost.
-opening up medicare to the general population isnt a terrible idea...but it isn't a bastion of efficiency. Gotta deregulate...open up the market.
Well I won't debate this as it serves no point... Seems pretty easy to figure out.
If we're all going to be given the same car to drive, chances are we won't be happy with what we're given unless we don't have a car to begin with..
All the nice cars will be driven by government employees....
If we're all going to be given the same car to drive, chances are we won't be happy with what we're given unless we don't have a car to begin with..
All the nice cars will be driven by government employees....
Could and would are two different words. There's not as much incentive to save when you're spending someone else money.
I don't think the argument has ever been that government can't accomplish things. The arguments are that they cannot provide products and services as effectively and efficiently as private enterprise. The interstate highway system is an example of the type of things the Federal Government should be doing. It is part of their role as defined by the Constitution. That being said, there is no way to compare how the Federal Government performed in constructing those roads compared to what the private sector might have done. I'm not saying the private sector should build roads, I'm saying that because government accomplished something doesn't mean that they performed on the same level as private enterprise.
As far as the moon landing goes, how do you know that private enterprise couldn't have accomplished it more efficiently? You have nothing to compare it to.
Education is not something that is typically provided by the Federal Government, so I'm not sure how that applies. Public education is generally provided by local and state governments. That being said, it is hard to argue that public schools have provided that education as effectively and efficiently as the private sector does.
Private enterprise, because of profit motive and the infinite creativity of people trying to solve problems, will almost always outperform a government bureaucracy. If you look at history, there are many examples of government owned and run enterprises. None of them have been successful in the marketplace compared with private enterprise. Look at government owned Chinese companies, such as Hair. They have to acquire private enterprises in order to gain the competency to try and compete in a real competitive marketplace. There is just no reason to believe government can provide services or products with the efficiency or effectiveness of private enterprise. Besides that, government competing in the marketplace runs counter to every concept this country was founded on.
The key to containing healthcare costs is to try and create some competitive marketplace. Without that, we will have substandard care.
So to paraphrase 7 pages:
1. Cut ridiculous medical costs in the US, however possible.
2. Pool as much risk as possible for unforeseeable calamity (preferably without bureaucracy) and basic, barebones healthcare for every Tom, Dick, and Harry that is literally nothing other than aspirin in the case of a sprain but decent care in the event of cancer.
3. Create an actual market that allows people to pay according to individual responsibility and risk after paying (presumably a low) premium for number 2.
That it?
I'm in.
1. Cut ridiculous medical costs in the US, however possible.
2. Pool as much risk as possible for unforeseeable calamity (preferably without bureaucracy) and basic, barebones healthcare for every Tom, Dick, and Harry that is literally nothing other than aspirin in the case of a sprain but decent care in the event of cancer.
3. Create an actual market that allows people to pay according to individual responsibility and risk after paying (presumably a low) premium for number 2.
That it?
I'm in.
Who pays for insurance?
Insurance companies take money from consumers and gives it to providers...and keep a little for profit.
People seek healthcare when they NEED healthcare.
Yes, there are hypochondriacs out there that run to the doctor for every little sniffle...but the baseline is that people seek care when they need care. Actually, Americans generally wait too long to seek care resulting in higher costs. The need for healthcare is entirely inelastic in demand because when you break a bone, you need healthcare. When you have cancer, you need healthcare. When your kid falls and busts his head open with a cut that requires stiches, you need healthcare. When my wife was diagnosed with cancer in January she needed healthcare and you're damn straight that cost was the last item considered.
I suppose if your spouse or child was diagnosed with cancer...or just a broken bone, you're going to consider the cost before seeking treatment?
I'm sorry dude but this idea that there are millions of people seeking wasteful healthcare is frankly, idiotic. Most people try to avoid going to the doctor. If the insurance market went away tomorrow there would still be the same demand for healthcare. Would the same amount of healthcare be delivered? Probably not.
The cost of basic healthcare is what it is. Who do you want to accept less money to administer care?
Cost is a concern for everyone. The threshold of absorbing costs, especially unexpected costs varies greatly from person to person. While we know that in the long term, preventive care pays for itself by identifying medical issues earlier when they can often be treated (relatively) inexpensively, we also know that it is basic human behavior to avoid pain (out of pocket costs) when don't see an immediate need. People will forego annual physicals if they have to pay out of pocket. They just will. The price is paid on the other end when they show up with advanced illnesses, have heart attacks, strokes, etc. The $25/mo cholesterol medication could have prevented the $250,000 stroke. Yet if has a stroke and taken to the ER...it doesn't matter if they can pay. They are going to be treated and given care...or would you prefer that they show proof of ability to pay before receiving care?
I think Federal Express is a great company in fact I own a lot of stock in it, but so far they, nor UPS have figured out a way to deliver a letter for 48 cents. Back in the 80s TVA's rates were the 2nd lowest in the country. Only Washington State Utility District was lower because they got 80% of their power from free renewable source - hydro. (TVA about 10%). So I would reject that notion. I know people that work for NASA, NOAA, FAA, and the National Park Service and they are smart, competent people that do a high quality job. I don't think they deserve to be frown on simply because they work for the government. Police officers, teachers, FBI agents etc. some do challenging dangerous work for a lot less then they could make in the private sector.
OTOH not every private company operates with great effectiveness and efficiency. At our winter home in Florida we have to use Comcast. We have a BASIC cable service on 2 TVs and an internet connection. The DVR boxes have given us continue problems, requiring me to spend hours on the phone trying to get resolved. The reception has frequent "mosaicing" of the picture. The internet connection goes down at least once or twice a day and the semi-literate, verbally challenged morons they call "customer service people" are as worthless as tits on a bore hog. For this I pay a $180 ransom each month. I can't imagine even the most poorly managed government bureaucracy doing a worse job. So I don't think there is anything magical about private ownership that results in more efficiency and effectiveness.
The bottom line is I think for some on the right to label anything government as inefficient, poorly manged and wasteful is as equally short sighted as liberals who label all corporations as being greedy, corrupt, and socially irresponsible.
Actually most of the construction was done by private construction contracts as the federal government does not maintain that type of capacity. The federal and state governments worked out the planning, land acquisition and did the contracting. Federal contracting is done primarily through a competitive bidding process which normally results in lower prices than non-competitive or limited negations.
That was my point.
Sure if you want to compare an inner city school on a tight budget to a private school that's true. I think Charter Schools are fine but there are some really good ones and also some that are not so good, so I don't see them as being a total replacement for public schools. In fact school boards have said they aren't really feasible in rural areas. I'm all for allowing local school boards to consider Charter schools if they want along with public schools. I just think at the end of the day every kid should have a good, safe school to attend.
I agree the profit motive and competition drives innovation and entrepreneurship. That's how we have grown the greatest economy in the world. But some things don't lend themselves to the free market, and accordingly are performed by government services. To me health insurance is basically just a commodity. In it's simplest terms regardless if it's private or government insurance, it involves people putting money into the pot and then someone taking money out of the pot to pay claims. There is very little that innovation can add to that model IMO. It boils down to claim evaluation and processing.
Have to disagree. As has been pointed out by several members in this thread the real key is to lower the cost of health care products and services. I do agree that some level of competition is useful to keep downward pressure on insurance premiums. My idea was to allow competition between insurance companies and Medicare for that reason.
The amount of money that was involved in developing the technology to achieve the lunar landing would never have come from the private sector because of the size, scope and the most obvious reason - no return on investment. IMO the space program evolved exactly the way it should have. The government developed much of the research and technology to the point where space has now become commercialized. As such many private sector companies have entered the field in developing communication and military satellites and of course Space X which has the ambitious goal of a Mars mission.
Lastly we wouldn't be having this conversation right now if it was for that thing called the Internet which was developed by - you guessed it the government - DOD.
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[laughing]
The USPS delivers mail at $.48 alright, deeeeee.
Oh yeah, at a $6B per year loss.
The USPS delivers mail at $.48 alright, deeeeee.
Oh yeah, at a $6B per year loss.
They don't get any federal money but they did have to borrow $16B not $6B from the government to stay afloat recently. Politifact
Believe it or not Rex some corporations also take a loss some years too.
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- 2015 - $5.1 billion loss
- 2014 - $5.5 billion loss
- 2013 - $5 billion loss
- 2012 - $15.9 billion loss
- 2011 - $5.1 billion loss
- 2010 - $8.5 billion loss
- 2009 - $3.8 billion loss
- 2008 - $2.8 billion loss
- 2007 - $5.1 billion loss