Health Care Reform 2044
It appears that today might be the end of a very long road to health care reform. There's been a lot of debate on the subject really leading back before the election. The mainstream sounds like an echo chamber, so I'm hoping you guys have better insight. Will this bill do what the administration claims to do, or is it as bad for the future of America as Fox says?
This bill has nothing to do with health care. (Score:3, Interesting)
It is a desperate grab for tax revenue [market-ticker.org] to shore up a faltering budget.
Real health care reform would either include a single payer system or a rational free-market plan [market-ticker.org]. Nether party is willing to do this, however. I wonder why... [opensecrets.org]
Re:A false choice, of course... (Score:2, Interesting)
BTW, I've seen thousands of comment trolls, but I think this is the first story submission troll I've seen.
It's a good idea, maybe it'll help keep the bullshit left vs. right bickering out of the tech stories.
Neither (Score:4, Interesting)
Re:Health care: break the MD cartel (Score:4, Interesting)
Re:It is bad, wrong way to go about it (Score:5, Interesting)
Well, lets see (Score:5, Interesting)
How has private industry done so far with american healthcare? Cost more, gets less. Yup, that is a sign of success.
Oh and how has private industry been managing the economy?
It kinda amazes me that people with a healthcare system that is useless in the middle of a global recession all under the management of private industry, then dare to ask whether government can run things.
Imagine a discussion in North Korea: "Can private industry be expected to handle food production?"
Answer: "Who knows, but the question is silly when the current system is such an obvious mess".
Sometimes you got to take a chance. Do anything because when you are nose deep in shit, chances are anything is an improvement.
Can the government do a better job? It would be hard to imagine how they can screw it up even more.
Not perfect, but a start (Score:4, Interesting)
From our perspective (I'm a health policy person based in Europe), US health care is staggeringly expensive, very variable, and very unfair. It's the single biggest cause of personal bankruptcy in the States.
Your health is poor, overall, especially you have poor child health, and relatively poor maternal and infant health.
A large part of your population have no access to good quality health care, and this imposes large costs on your society.
Your major companies find high health care costs for staff a major burden, and this sharply reduces the competitiveness of good US employers.
You have the highest administrative costs for heath care that I know of, now running over 30%, and at current rates of increase, in thirty years you will be spending 100% of your GDP on health services.
At the top end, there is no better health care anywhere for acute illnesses, but very few people can access this.
The proposed changes are a start, and only a start. With no public option, there is a real risk that the insurance companies will continue to combine together to rip you off. However, the current proposals will save a lot of money over the next decade, which is why the insurance companies are spending millions buying ads, and influencing politicians to stop the change.
I hope it passes!
do you trust obama and the dems ? (Score:5, Interesting)
1) a whole bunch of programs to evaluate new ideas; basically grants to researchers of one sort or another
2) regulations to rein in the bad behaviour of insurance companies
3) provide insurance to 30 million people who now lack it
lets leave 1 aside and look at 2 and 3
Do you really think that this bill will stop the insurance companies ? For instance, there is a section (109 in HR3967) that bans lifetime benefit caps. and you can read it yourself, and it looks pretty straightforward. I don't know how the insurance companies will get around it, but htey have, literally, hundreds of millions of dollars to buy armies of lawyers and lobbyiest and politicians to overturn this over the next 5-10 years
So my conclusion is tthat at best, (2) will have some moderate effect over a few years
As to 3 - I think what will happen, based on the MA model(I live in MA) is that yes, there will be a lot of people who will get insurance, but we won't have the money to pay for it. So, to save money, we will make this new insurance cheap and not very good (eg, low payments to doctors and hospitals, so only really bad hospitals will take people on this plan), so what will wind up happening is that we will create a permanent underclasss of people who have "insurance' that doesn't really work - it is like poor people who get charged with a capital felony crime; we pretend to provide lawyers, but dont' do anything really effective
If you look at the down side, it is Huge.
Obama is instituting a new national policy - health care, a basic fundamental right ina civilized society, is providd by for profit companies, and the FED. Govt requires you to pay these for profit compnies its horrible
Another way to look at this is Obama's track record, say with the wall street bail out, where he made sure bankers got their million dollar bonuses - with tax dollars that came from your pocket.
how on earth could anyone trust this guy with a track record like that ??
so basically higher taxes (Score:3, Interesting)
higher insurance premiums and longer wait times in the emergency room
Re:I don't have health insurance. (Score:5, Interesting)
I have catastrophic insurance, so if I get cancer and my bills go over $20,000 then THEY will cover the cost.
That's what they want you to think. Of course, fighting a lawsuit when you're the one who has cancer and five-figure bills to pay, while the other side has a large legal department specialized on just that kind of case, is going to be fun.
Catastrophic health insurance is a scam.
Re:A false choice, of course... (Score:1, Interesting)
Exactly right.
If Fox news says its bad for America... It's probably good for Americans.
However this bill does not contain the public option or universal health care. It's basically a mandate that we all buy private insurance at existing rates. It does not appear to lower the current rates...
There's some good stuff in the bill such as getting rid of preexisting condition limitations etc.. but unfortunately without the public option, there will be no competition or healh care reform.
The democrats failed to do what they were elected to do, and now they're passing the dead remains of their failed efforts.
We wanted to get away from the private insurance companies, or at the very least force competition and have them lower their ridiculous rates which generate them massive amounts of profit every year.
Now... All this bill is at the heart of it... is a bill that delivers us right to those private insurance companies... who will profit even more than ever.
I'm still trying to understand IF this bill will lower existing rates. If not... then every American is going to be forced by law to pay $1,150 a month for healthcare.
Thats bizzare. I'm not sure how thats reform.
There are subsidies in the bill which will may help (time will tell)... but for those currently paying for private insurance... I'm not sure I see the reform when it comes to current rates.
Can anyone shed light on this?
Re:Health care: break the MD cartel (Score:3, Interesting)
And what part of your comment contradicts mine?
The number of physicians in the US is controlled, and kept artificially low. That was the point of my post. You said nothing to contradict that.
Question for the non-US based Slashdotters (Score:3, Interesting)
Obviously here in the states, this bill is a huge deal for us especially considering the price tag attached. I noticed several non-US based posters chiming in about how they don't care about this topic, etc. etc. Understandable since this is a widely read site across the globe. But instead of just posting a negative comment about our health care situation, how about helping us understand how health care works in your country. Pros...cons...whatever. Not being fully versed in what other countries offer and certainly not believing what the major news outlets spew, I figured this would be the best place to ask. Thanks.
Re:It is bad, wrong way to go about it (Score:3, Interesting)
If you really want to fix healthcare, do tort reform first. Then break up the AMA cartel. Then look at other things that may need to be changed.
Is there anything that the government runs that really functions correctly/efficiently?
Dude - you really need to stop reading World News Daily and watching Sean Hannity - they've made you innumerate.
The only people who talk about tort reform and aren't full of shit are the people who have never looked at any numbers. Malpractice claims amount to somewhere between 0.5% and 4% of total healthcare costs - i.e. if you eliminated all malpractice and other tort costs from healthcare bills, within a month you wouldn't even be able to notice the difference.
As for AMA - only about 25% of the nation's MDs are members.
The government used to do lots of things really well - until Ronald Reagan and his corporatists successors dismantled everything, sold it off to campaign contributors, and bought your votes with your own money.
The bill appears to suck but.... (Score:4, Interesting)
Still a lot of provisions I don't like. For example if you get cancer you are screwed with a 5 million per year benefits cap. But then again my insurance at work has a 5 million dollar lifetime cap, so I am even more screwed. People like my brother who didn't go to college and work at hourly jobs without benefits need this bill. He doesn't make enough money to afford health insurance, and the company does not provide it. So there's really nothing he can do. If he gets poison ivy, even real bad, he has to sit at home and suffer rather than visiting a doctor to get a prescription for a cortico steroid that could cure it. That's not right.....
Also an awful lot of personal bankruptcies are due to medical bills. There was a time when I graduated college and I was unemployed for almost a year before finding a job. If I got into a traffic accident or I broke my foot jogging, I would have been in deep trouble. Sometimes surgeries go into the hundred thousands or even millions.... I don't have that kind of money. Even now, if I got cancer and went over that 5 million lifetime cap on my company's insurance, I'd have to somehow borrow massive amounts of money that I would never pay back, or just die... Any system that doesn't value human life over all else is broken....
This bill pretty much sucks. The more provisions I see of it, the more I hate it. Also the parties are busy taking pot shots about things like abortion funding instead of fixing the bill. I don't really care about abortion funding. Most Americans don't give a damn either except for a few religious right nuts. I just want a bill that gives me some security that if I lose my job and get sick, I'm not going to have to declare bankruptcy or suffer with my illness until it gets better or I die......
Considering the Trillions we spend on wars, I think one trillion for health insurance is worth it. It is an investment in the american people... And unfortunately if this shitty bill doesn't pass, the same thing that happened in 1992-1993 will happen again, people will scream it is the other party's fault, and then it will go away..... But it's a shitty Bill for sure. It is overly complicated, probably on purpose so that no one can read/understand the whole thing before voting on it. I'm sure there are lots of special interest payments in here......
It also does nothing to address the over charging on medical supplies. Ie the $500 paperclip. Not only that but when you don't have insurance all the rates are way higher than the rates negotiated with insurance companies. So not only is it harder to pay, it is even more expensive without insurance. Because those companies have people to say $500 for a paperclip, you're full of shit, we'll give you $1 and the hospital will be like okay, we still make $.95. And the people doing the billing try to double/triple charge me all the time. The insurance company and hospital billing often fight for 6 or 7 months before they get the entire bill properly worked out........ The hospital will bill twice, the insurance company will see two bills and reject all the bills, etc... Then you have to act as mediator to teach the hospital how to code the bill....And the insurance company to be ready for a payment....it wastes a long time.... By yourself you don't have a chance.... The rates are crazy too. I was well over $1,0
Re:Single payer system (Score:2, Interesting)
You should do a little more research. One reason that other countries have such lower health-care costs is because they don't have the associated R&D costs associated with it. Essentially we spend so much on health care because we also shoulder the burden of new medicine and treatment research. When was the last time something revolutionary in medicine came out of anywhere but the U.S.?
The biggest problem in this country with medicine is the tying of health care to employment. Just like we have no impetus to develop alternate fuel standards. Gas in this country is heavily subsidized in this country. No one EVER pays the real cost of gas. With health care, you don't have any other option.
As an individual, you can't shop around. You can't buy health insurance across state lines. Look at BC/BS (blue cross/blue shield). Imagine if your company had to essentially operate 50 different companies, one for each state? The administrative costs ALONE would kill you.
Re:It is bad, wrong way to go about it (Score:5, Interesting)
Bad tax design (Score:3, Interesting)
One specific beef. One of the tax proposals is to extend the Medicare tax to unearned income for anyone who makes more than $200,000 ($250,000 if filing jointly). Specifically, it means that if you make $199,999 you're not taxed on any investment income or capital gains, but if you make another dollar then the tax applies retroactively to any capital gains you have whatsoever, possibly costing you hundreds of dollars.
That's bad tax design, and it will probably bite a bunch of middle-class/upper-middle-class types who have sudden large expenses and need to liquidate something to pay for them.
I Believe We Need Reform (Score:3, Interesting)
Re:A false choice, of course... (Score:5, Interesting)
First off, this isn't health care reform. It doesn't change all that much about the health care system. It's health insurance reform.
To that end, there are some small gains: insurance companies will be forbidden from doing some seriously awful things, like retroactively revoking the insurance of patients who get expensive illnesses, on the flimsiest of possible excuses (and in some cases based on faulty data that they refuse to investigate further).
In exchange, there are a lot of parts that are a big giveaway to insurance companies: because we've focused on giving everyone insurance instead of giving everyone health care, individuals are forced to buy insurance, but with inadequate oversight to ensure that insurance companies don't just gouge prices. Further, there isn't any choice for an insurance plan governed by democracy instead of stockholders, so we can probably expect that the small number of insurance companies will behave oligopolistically and raise prices, as usually happens when a small number of huge players control the market.
There will be some savings relative to the current system -- on the government's part -- but nothing like what could be achieved by a system that allows everyone to buy in to Medicare (and couples that with Medicare reforms like more careful monitoring of doctors who prescribe medically needless tests & procedures to make more money, and allowing Medicare to negotiate lower prices for its prescription drug benefit). The present bill is probably slightly better than not having it, but only very slightly.
Re:This bill has nothing to do with health care. (Score:3, Interesting)
What CBO analysis? They said they have not had time to review the new revised bill, so there is NO analysis.
And Kucinich is a politician, yes, but he also has to explain himself to the people who voted for him as a Socialist. He's already on record as saying he will never vote for a bill that does not include a Governement-run Option, and now he's flipped. That won't please the people back home.
Re:Well, lets see (Score:2, Interesting)
1. An overwhelming majority of Americans are satisfied with their health care plans.
2. Most economists say that a major factor in the cost of health care is the way that government taxes health care benefits.
3. Future Medicare ( a government run program) shortfalls are measured in the TRILLIONS and the program is to anyone with a grain of common sense unsustainable in its present form. Doctors and pharmacies sometimes refuse to take Medicare and Medicaid patients due to insufficient reimbursement rates.
4. Many of the successful systems in the world , e.g. Switzerland, are largely privately based albeit with governmental regulations.
5. Define "gets less". That's a rather complicated question when you talk about health care. In fact some viewpoints are that Americans get too much - to many unnecessary MRI's and test procedures. Are you talking about like expectancies which some assert are low for Americans due to non-medical factors like murder? Are you talking about outcomes, because then we need to a talk about specific diseases and the statistics for those, which in some cases favor the American system? Is it about availability of procedures, which in some countries are contrained by government rationing?
Bottom line - it's well more complicated than your facile response indicates.
Re:Health care: break the MD cartel (Score:1, Interesting)
Part of the efficiency problem is that due to your liability culture you throw too many tests and treatments at things.
I'm an Australian, medicare has been around longer than I can remember so I don't have any other experience to compare it to. My sister-in-law died of cancer a bit over a year ago. She had been going to the doctor about headaches for about 2 years, then suddenly had to go to hospital one day and a couple of months later was dead.
I don't have an axe to grind over health care systems, but a culture of "too many tests" would no doubt have saved her life. I know my brother-in-law would happily have paid for a 15% profit margin to have his wife alive.
Re:Correct Spelling (Score:3, Interesting)
Have to say "ditto", as an Australian who spends ~6 months a year in the US. Two main observations with US news:
- It's quite partisan. You tend to hear one side of the argument from one channel, and the other from another. Rarely do you hear a well-balanced story out of a single source. I think the lack of a well funded public broadcaster (ala BBC or Australian ABC) is most of the reason behind this.
- The emphasis placed on local, national, international is almost completely the opposite of what I'm used to in Australia. Generally in Australia, an international story or major domestic (but never local) story would be first in the bulletin. From my trips to the UK it appears to be similar there. Local stuff would be relegated to 2/3rds through the news, with sport and weather at the end. In the US it seems to be mostly local/domestic, then maybe if you're lucky one international story near the end (and only if its really major ... you never hear 'interesting but not that important' stories from overseas like you do elsewhere).
The other odd thing (to me at least), is that even if you compared a US local news with an Australian local news bulletin, the type of stories they run are quite different. In the US they have local stories like "the mall is getting extended" or "they are putting traffic lights in on this intersection". That'd never get reported at home ... the local stories are more along the lines of what the local/State govt. is doing, or any major crime incidents etc.
On the other hand, the US does one thing way better than anyone else - weather. Even little local stations in small towns have their own meteorologist and often their own Doppler radar, and they actually know what they are talking about! In Australia you just get some vacant blonde chick who knows NOTHING about weather, reading the script sent to her by the weather bureau. :)
Re:A false choice, of course... (Score:3, Interesting)
Re:A false choice, of course... (Score:3, Interesting)
You are talking a lot of sense - yes, I did say SENSE; it seems to me that most people hardly read as far as the end of sentences nowadays, and might have thought I was going to say something else.
As a non-American it is a deep mystery to me that America doesn't have a universal health-care service. I believe on average in Europe we only spend about half per patient p.a., and I can only speculate about why; but it seems obvious to me that the biggest factor is that in America big pharma is far better able to run rings around the system. Why else would it cost so much? I mean, as opposed to over here, it looks as if your insurance companies don't take care of several of the most expensive kinds of patients, like those with chronic illnesses - as far as I can see, it ought to work out as cheaper per actual patient.
What does the average American pay for health insurance per month? For comparison, I think I pay about £50 per month, for which I get free health care no matter what the circumstances; and I earn a pretty hefty salary, so I don't think it is bad.
Re:Random health care thoughts (Score:3, Interesting)
It amazes me that with the high percentage of negative public opinion on the health care bill that congress is still considering it. This is supposed to be government by the will of the people, right? To me, the will of the people is not being executed here.
Right wingers say that there's almost no support for it, and left wingers say that it's pretty popular. You want to bet what the real truth is? It's in the fact that it's on the knife edge right now.
Also, this is apparent in the back door manner in which they are trying to pass the bill by some trick of house/senate rules. This isn't some bill to appropriate a few million dollars for federal park support but a bill involving a trillion dollars of outlay. Given the current administration's massive spending and addition to the national debt with little to show for it, does anybody have any real confidence that this will work?
Given that no administration in the last thirty years has come close to a balanced budget (except Clinton, but his administration was awash in money due to the economy running up) I don't see "massive spending" as very damning. What did the last adminstration have to show for all the money they pissed away? Or the administration before that? I agree that this piece of the reform puzzle has some significant flaws but it's a start that allows actual progress in the next decade.
Some comments on health care industries making money hand over fist. Everybody seems to be in an outrage with doctors making hundreds of thousands of dollars per year, but nobody bats an eye when some sports star signs a multi-million dollar contract.
What a dumb example. If you're poor and can't afford tickets to the big game, will you die from it? People don't care as much because sports stars aren't a requirement for living, whereas doctors are.
If you were going to the hospital for open heart surgery, would you want the lowest paid doctor that has no incentive for good performance cutting you open? I'd want the super-star doctor that drives the Porche. If he's good enough to earn that much money, he's got to be worth his salt.
AHAHAHAHAHAHAHAHAHAAHA.....(gasp)....AHAHAHAHAHAHAHAHAHA. You must be new in town. Average salaries for primary care physicians (not the "superstars", but the rank and file) is $147,000, and that's the average for the lowest paid segment of doctors. The average salary for everyone else in the country is around $40,000, for comparison. If you think that astronomical salaries are any guarantee of competence, then you'd best hope that you don't ever need surgery.
If they were really serious about health care reform, why didn't they start with the biggest money issue in health care: tort reform.
Because tort reform is only a small part of a very ugly picture, no matter what Beck and Hannity have to say about it. Patent law reform would take a big bite out of health care costs too, but you never hear that mentioned on talk radio.
People are incensed about million dollar bonuses at financial firms, but nobody shines the light on lawyers that, for the amount of work put in, end up making thousands of dollars per hour in a settlement or ruling.
The very fact that this bill is wending its way through Congress is testament to the fact that plenty of people are quite incensed about the spending in health care.
Consider, also, that even though that doctor is making a quarter of a million dollars per year, he's paying 25 or 30 percent of that in malpractice insurance to protect himself from every Tom, Dick and Harry that decides to sue because they didn't follow instructions and ripped their stitches out.
Most people qould file the concept of earning "only" $175,000 in a year rather than $250,000 in the "cry me a river" slot. It's easy to point to tort reform with friv
So why don't we try something else... (Score:5, Interesting)
The whole insurance industry for healthcare is based on a flawed premise that normal care need insurance.
Here's the car analogy... if our cars were done like healthcare:
1. Gas would cost 10$/gal at the pump for cash/credit.
2. You would pay 25$ for every time you fueled up and your car insurance company would actually pay them 3.75$/gal for the gas
3. You would pay 150$/month for this "wonderfully cheaper gas"
4. Ohh... and if you need roadside assistance you have to pay for the first 5 fully before the insurance company starts picking up the tab.
So let's go back to why health insurance is flawed. Normal healthy individuals may make 3 (annual plus 2 cold/flu) trips to the doctor in a year. I pay 218$ per month for insurance through my employer (not counting the portion they pay). This means that I am effectively paying 872$ per trip to my doctor... ok... lets let that sink in... even if you count a nurse, doctor and receptionist out front splitting it and them only seeing 3 patients per hour (rough cases might take that long) we are still talking they would be making 1.74 MILLION DOLLARS PER YEAR EACH! Now if you have any friends that are medical professionals I bet you know that there are VERY few that are making that much per year... especially receptionists :)
Now the argument is that "well this money helps balance out all the catastrophic claims"... fine then why are we using insurance for non-catastrophic claims? I have home owners insurance in case a tornado takes my house out but I don't run my water-softener salt or home improvement projects through the insurance company.
Why when it comes to health insurance do we loose the common sense that the more people that touch the money the more we have to pay for the same service.
Leave insurance for catastrophic claims and lets get rid of the day-to-day shenanigans. This should quell a lot of the issues in the industry and make it so that people could pay for what they need instead of padding peoples pockets for day-to-day necessities.
The problem is high costs (Score:2, Interesting)
If I can figure all this out in my spare time, you know Congress has to know it too. Which means either A) I'm horribly wrong, or B) both parties define the problem differently than I do. Which raises the question, exactly what do they see as the problem?
Every other European democracy has this. (Score:3, Interesting)
1) Virtually every Western democracy has public health care (http://en.wikipedia.org/wiki/Universal_health_care).
2) By some miracle, they manage to pay for it.
3) By and large, if you read the blogs of people actually living in those countries, they appear reasonably happy with their imperfect but functioning health systems (http://www.thehealthcareblog.com/the_health_care_blog/international/).
So, the opponents are essentially claiming that America is too "special" (i.e. lame) to do what virtually every other country can do. That may not be what they say, but that's what they imply.
Any questions?
As I see it, its a mixed bag. (Score:1, Interesting)
Of course there is the requisite pork. (has any bill ever been past since anyone was reading this has been alive. that didn't include some pork?) But there are also provisions to expand Medicaid to more people(I think this is in there, but I am not absolutely sure). It also makes insurance companies allow parents to keep their children on their policy until they are 26. It prevents insurance companies from discriminating against people with pre-existing conditions (meaning no higher rates or refusing coverage). It will set up exchanges for those who are self employed or don't get insurance from their job. Insurance companies will not be able to cancel insurance because someone gets sick. It will cap total out of pocket expenses for consumers. There will be subsidies for those making up to 400% of poverty level to buy insurance. It will mandate that everyone, the exception of the most poor, get insurance or face a fine. It would require employers with more then 50 workers, who don't offer medical insurance, to pay $2000/employee, if any of the workers qualify for the federal health care subsidy. It would close the "doenut hole" in Medicare by 2020. Those are the highlights of what the bill will do.
If you are wondering if it will really address the rising cost of health care, I doubt it. The problem with health care in this country is that doctors are paid per procedure. So some, maybe even most, in contravention of the Hippocratic Oath, act in their own best interest preform procedures that aren't necessary. They have little to no motivation to work to make the patient healthier.
Its a first step. I am hoping they don't stop here. It will at the very least, get more people covered by health insurance.
Re: (Score:2, Interesting)
Re:ZOMG Socialism! (Score:2, Interesting)
The biggest push that Marxism or socialism in general has is the 'right to health care'. So when people are concerned about government run health care and socialism their fears are based in reality.
The military is not a business. I don't know how that is even an argument. Our constitution requires the government to have a military to protect our citizens.
Ignoring the George Bush comments, that's just name that's invoked to gain acceptance of other like minded liberals/socialists.
I agree with the change to metric, although the reason we don't switch over is the huge cost associated with such a large country.
Re:Well, lets see (Score:4, Interesting)
Look up the history of fire departments.
The only reason health insurance is rival and excludable is that the US has decided it should be. Look at pretty much every other western country, and you'll find that health insurance isn't rival nor excludable, because they see an advantage to cheap and readily accessible health care.
And I realise that part of this is because the US has somehow convinced itself that anything that even resembles social anything is somehow evil. But that doesn't mean it is the gospel truth. In fact, if you really want to be pedantic, you'll find that social medicine IS gospel truth - why else would Jesus talk about the Good Samaritan [wikipedia.org]? I'm pretty sure that parable wasn't about how the priest and Levite were right in leaving the beaten and half dead jew alone.
"Fore they knew, he did not hath Health Insurance, and thus they leveath him to die in a ditch. And God looked upon these actions and saw that they were good."
I'm not a religious man, but I'm pretty sure that part isn't in the Bible.
Re:Neither. (Score:3, Interesting)
The problem is that Harry Reid has no balls. He gave the Republicans everything they asked for, and then they complained the bill was too long.
You want a small bill? How about this: let any business or individual buy into Medicare at a price set actuarially to reduce the program contribution to combined state and federal deficit by some fixed figure; let's say a half trillion dollars over the course of a decade. That's roughly the net effect of the current bill. Subsequently premiums would be set so that the net change in government debt over the coming decade would be 0. Three would be no change in regulation of private insurance. Private insurers would be free to shed their sick patients on the Medicare. To discourage this, higher co-payments would be required for patients priced out of their private insurance by being sick, but with hardship exceptions. Even so, private insurance would be free to dump their unprofitable patients on the government, rather than on health care providers' charity. They'd have to moderate that practice only to the degree a rational person might question the value of an insurance product that does not insure.
This bill is pretty much the Republican counter-proposal to Clinton's health plan. Does it include every idea that Republicans have dreamed up in the last year? No. But based on their track record they ought to be able to get the Democrats to sign on to many of those, too.
True, but I still oppose the bill (Score:5, Interesting)
That's the problem, and it is a real problem. However this bill is not the answer. The answer is regulation at the state level.
The US health insurance industry is currently regulated by individual states. Different states have different rules. However, one element to the current system is that the state government (which is more responsive to the needs of citizens usually than the federal government) tends to have offices for dealing with these sorts of complaints. Additionally, the same offices take complaints from doctors about lack of authorization for procedures. While this means that some states have better health insurance requirements than others, it means there is a clear point of contact when a problem exists that needs to be resolved quickly.
The problem with this bill is it entirely supplants the state health insurance regulation structures and replaces them with a shiny new federal system. There is no way that the main protections that the states offer against insurance abuses will work right away in the federal system. By pre-empting a fairly mature system of state regulation, this bill will not save lives but rather cost them.
The secondary problem is that the bill has inadequate cost control provisions. In Massachussets, after they passed a similar bill, health insurance rates went up. We can expect the same here. Quite frankly, I have no idea how I will afford it when the rates go up. Right now, when insurance companies raise their rates, I can drop off until they lower them again. This bill makes me part of a captive market.
The real underlying problem left unresolved is that we have inadequate consumer protections in the areas of health care and health insurance. While this bill purports to improve these conditions, it fixes, IMO, the wrong problems and leaves major issues unresolved. Why is it that I have more consumer protections when getting my car repaired than in obtaining non-emergency medical care?
You need to get your facts straight (Score:3, Interesting)
Current support for the bill is running about even - around 45-45, with the remainder undecided. And if you ask people whether they're in favor of what's actually in the bill, they're overwhelmingly in favor. It's just that the Republicans (and their benefactors, the insurance companies) have done a good job of making the bill look bad in the public eye.
The republican house in 2005-06 used the same "back door manner" to pass almost a third of all the legislation they passed, and no one said a word. This argument is just dumb. The house is just going to vote on the original bill and the reconciliation fix at the same time. There's nothing "back-door" about it.
With respect to tort reform - this is nothing more than a thinly veiled attempt by the Republican party to get back at a group of people that traditionally gives more money to the other party (lawyers). Study after study has shown that tort reform would have a negligible effect on medical costs.
It's not what I hoped for... (Score:2, Interesting)
I'm a conservative. Sucks sometimes, but that's the way it is. Fox news is evil.
Needless to say, I was against health care reform from the start. But, I listened, and thought about it. At some point it occurred to me that it would be nice to separate my health insurance from my employer; changing jobs should not impact the coverage I provide for my family and myself. My current job is with a DoD contractor, which provides plenty of evidence that I wouldn't be happy with the government in charge of health care. If there were a free and open insurance market, one where price levels could be tied to services provided, and costs were not hidden, then buying medical insurance would be similar to buying auto or home insurance. Oh well, it didn't happen.
I think this bill will help, some. I also think more is needed. Getting rid of the pre-existing condition cop out is a big gain. But, we've just provided the insurance companies with millions of new customers, some of whom are young and healthy and won't use their insurance, and we haven't significantly changed the way they do business.
Re:This is not quite true. (Score:4, Interesting)
Re:A false choice, of course... (Score:3, Interesting)
When our government starts taking away our liberties (forcing people to buy health care
You're right about that -- it should simply pay for your health care, and when you get sick you're free to not go to the doctor, or go if you wish.
taking away private property to give to another private party
So you're against the US Constitution?
16th amendment: [cornell.edu]
So you think the US Constitution is bad for America? You should be a congresscritter, they all seem to hate the Constitution, too.
When it continues to spend us into either runaway iflation or economic ruin, I'd say that's bad for America.
Then work on getting those damned wars stopped. The stagflation in the 1970s was a direct result of paying fo rthe Vietnam war. NOTHING is as expensive as war, and the monetary expense is the smallest of those expenses. We spend far more on the military than anything else.
Additional budget trimming based on rasing the capital gains tax
Why should someone who "earns" his money by betting on the stock market pay less of a percentage of his income in taxes than a construction worker, who EARNS his money by working off the sweat of his brow in dangerous situations? I say the capital gains tax is far too low. While we're at it, raise the tax on incomes above $1m/yr. Let those who benefit most from government pay the most for government.
Re:A false choice, of course... (Score:3, Interesting)
Pelosi has said this is only the first bill and that we should expect many more. I would assume that means trying to push for public options, and perhaps eventually build on the populist anger towards private insurance to remove it from most of the market. I think the push for socialized medicine is exactly what a large part of the Democratic party is fighting for, though by no means enough to win the day right now.
However, aside from that (and I don't think a single payer system in this country would be a good idea for reasons of abuse of power I have seen from administrations of both parties, on both state and federal levels), there is some really bad stuff in this bill. For example:
The bill empowers the DHHS to waive most of the fines for things like long-term care facilities' employees abusing patients if the facility serves an under-served population, and this is defined as rural areas or ethnic minorities. This is just Jim Crow under a new name: it means that facilities serving ethnic minorities are held to a lower standard, and African-American patients of them are not entitled to the same protections of the laws that white patients are. That's just wrong.
How About Killing Subsidies for Fattening Foods? (Score:4, Interesting)
Similarly, the overall level of health might be improved if the feds stopped subsidizing meat, dairy, and corn (as in high fructose corn syrup). But not only is that not something being done outside of a healthcare reform bill, that's not even in this bill. You would think if the problem is how much it costs to make fat people not die, the first step would be to stop spending money that helps make them so fat in the first place.
Re:A false choice, of course... (Score:3, Interesting)
>>if this is going to affect roughly 1/6th of our economy, let's study and get it right.
But it's a step in the right direction (while not perfect or even ideal), and we have been trying to address this for decades with no progress.
The evidence, I think, points to special interests blocking progress in order to maintain profits from the status quo.
So it's actually better to pass this now and fix as best we can later (if we don't fix anything, it's still better than not passing it).
And by fix it, I personally mean remove more profit motive - remove profits - from the health care industry itself.
There is no room for consideration of profit over health care decisions: people die.
And when I think about it, I have to say the same for the entire rest of the economy: we are here to make things better for all of us, not to create an environment for a few of us to get super-rich.
Re:A false choice, of course... (Score:3, Interesting)
I weep every time I see an insurance company being thieved.
Me too. It's like watching one of the economic masterminds of the financial collapse get a parking ticket.
It feels good for a second, and then the realization hits me, all over again, that their decapitated heads still are not impaled on stakes as a warning to others.
And a single tear rolls down my cheek.
Re:A false choice, of course... (Score:4, Interesting)
So anyway, now it covers the routine stuff, but often not the catastrophic stuff. They'll deny you coverage! WTF!
The real fun is when you have a preexisting condition and hence can't get covered for routine stuff, either.
I had a congenital heart defect, meaning I needed open heart surgery the first day of my life. I had it. It solved the problem, but, as early open heart surgery can often do, it damaged my heart's natural pacemaker, so now I have an artificial one. (Aka, what everyone calls a 'pacemaker', they actually mean 'artificial pacemaker'. Everyone has a 'pacemaker'.)
Fair enough. It's about $15000 in expenses every eight years or so, and, frankly, I can cover that out of my pocket. I'm not a moron, I know the batteries die, I know roughly the costs, I can save up.
But now I can't get insurance for anything else. Forget heart conditions, they won't even bother to attempt to cover me for anything. I call them up, inform them I have a pacemaker, and they politely inform me they will not cover me.
Private insurance is stupid. They simply don't want to actually provide useful insurance. No, everyone needs to pay into a government catastrophic care fund, and whoever needs it can use it. And we should, of course, continue to help subside the care of the poor.
Likewise, we should probably subside a little preventative maintenance, also. A free checkup a year or something will reduce problems down the road.
I'm really having a hard time figure out why we shouldn't provide all care, free, like NHS over in England.
I can vaguely see the argument that costs will be reduced if some people pay for some of their care, but frankly, costs can be just as reduced if the government pays hospitals and doctors set amounts for specific procedures, obviously resulting in them reducing their costs to increase profit.
But the entire manner we're going about solving this problem is backwards, solving it with 'insurance'. Sadly, we're so fucked up that solving it backwards is also helping solve it, like a car stuck in the mud. If nothing else, it will cut into insurance company profits, thus making it harder for them to fuck with the next reform.
Re:How to have Healthcare that a Republican would (Score:3, Interesting)
Well, you have to foregive my brevity. It was written for ADD-enhanced Slashdotters. I avoid the detailed discussion.
While I won't run down the list exactly, but the general principal is that:
Personal choice that increases risk will have to be judged accordingly. If a behavior marginally increases cancer rates then it should be covered. If a behavior markedly increases rates then it should not be covered in the national coverage. What this is exactly, but 5% seems a good cut-off. Also to be balanced with this is by how many people are engaging in the behavior. If we all do it as Americans, then monetarily it makes sense to include it in the national policy.
Then your questions dive into gunshots crashes. These are not medical conditions. These are discrete unpredictable events requiring medial treatment. The insurance industry has already made the actuarial tables and decided what factors are statistically relevant to the premium. We can simply re-use these.
Yes, over time the plan will change. The government will try to reduce coverage, but it also will be balanced by keeping the costs low. If the government sheds responsibility, then we transition back closer to where we are today. But remember, the insurance companies don't want to pay out, so they will push coverage back on the government. I expect that we would be informed by people crusading for coverages to be added to the plan that "Coverage for XXX will save $YYYM by including it in the national plan". And I expect that the hallmark of the national plan is that it would provide the widest services at a lower premium than the insurance companies can provide today.
There will never be an end to the debate of what the national plan covers, and that is just how it is. It will allow it to change to meet the needs of Americans, as those needs change over time.
There is no "perfect" plan, and I don't for an instant think this is perfect. But it is a compromise that will be effective. If you read the current bill, and compare with what I describe here, which do you want to vote for?
But look at what this sets up - some framework for government coverage, which is competitive and expandable, while capturing the best of both sides.
Re:So why don't we try something else... (Score:3, Interesting)
(not counting the portion they pay).
That's a rather large thing to not count, especially since it likely amounts to more than double what you are paying. Your example should be more like $2616 per visit.
But your car analogy does touch on an important point, which is that your gas (healthcare) provider is gouging you with high rates then giving a discount to the insurance company, which reduces everyone's ability to survive without insurance.
If the Feds would simply pass a law which says that a health care provider cannot charge different rates to individuals and insurance companies most of the health care reform problem goes away. You would then see a large shift from high cost, high coverage policies to low cost catastrophic policies... which is really what insurance should be about.
Re:A false choice, of course... (Score:3, Interesting)
You could consider single-payer to be socialized insurance, but not socialized healthcare.
Well, yes, but by that logic food stamps are 'socialized food insurance'.
I mean, you're absolutely right in that it's not 'socialized medicine', no matter what anyone says.
I'm just saying, we don't really consider the government giving people money to pay for things to be socialized anything. 'Here's your socialized TV, paid for by your tax refund.'
Likewise, the term is wrong in another direction. Even something like the NHS, where the government owns the hospitals, isn't actually 'socialized medicine'. Socialism is where the government owns and operates the means of production.
Aka, it's socialism if the government produces goods and sells them.
Well, probably, it has to be a rather large segment of the market. The government producing postcards and selling them in the capital building is probably not socialism per se, or at least not worth talking about.
But a government providing services, OTOH, is something that governments have been doing for ages. That is the point of a government, to provide services. It does nothing else.
Every. Single. Thing. every government, in the entirety of history, has done, is 'pay people to provide services to citizens'. (Often stupid services, often not to all citizens, but whatever.) Socialism is a qualitative change, not a quantitative one. It is a different role of the government, not how much of an existing role the government plays.
The government producing goods, and selling them, is 'socialism'. That's it.
The government producing services, and giving them away for free, is 'the government'. It's not 'socialism'. it might be 'outside the bounds of what we want this government to do', it might even be outside the bounds of what the government is allowed to do, but it ain't socialism.
(Now, astute people will note I said 'goods' and 'selling', was one thing, and 'services' and 'free' was another, and didn't mention the other two combination. 'goods' and 'free' is communism, and 'services' and 'selling' is just a specific form of use tax.)
Re:A false choice, of course... (Score:3, Interesting)
FYI, the reconciliation package removes all these "sweetheart deals." Filibuster reform will help prevent more of such deals, but considering the fact that most red states (I'm looking at you, Mississippi) get more back from the Federal government than taxes they pay in thanks to such earmarks and deals, I'd say neither party can take the high ground on that issue (the so-called sausage making of legislation).
Re:Neither. (Score:1, Interesting)
> Become an independent, vote for people that match your standards and if they let you down kick them out of office.
Wise words. (And I'm fairly proud of my state in that respect - so many of us are independents instead of party registered that most statisticians refuse to even try to predict the party primaries here...)
> Don't even get caught up in the R or D Left or Right argument, it's a game.
But in practice, it's not so much an R vs D thing as a "wtf, the hit rate for Rs is about ZERO" D vs I game. Every time I look into an R who at least appears to be (or promises to be) sane, I find that they voted R 90% or more of the time, and their other 10% were always times where their party was in no danger of losing (in other words, a "safe" opportunity to go counter to the party to gain local credit, while not actually harming the party in any way). Because they're so horribly monolithic, I'm *forced* to judge the members by their party's overall performance.
The Ds may get mocked as "indecisive", but that's because they're not a big homogeneous lump. Which means I can actually evaluate them individually, because they actually have different platforms (and some subset of them actually stick to their guns). I may still dismiss 3/4 of them, but the remainder are gold.
> Any Republican or Democrat that wants to expand government and spend more money is destroying this country.
As always, it depends on the specific details of the specific issue. Some things need more regulation than they currently have and some things need less than they currently have. IMO, part of the reason the Libertarians don't gain momentum is that they're trying to strip away the parts that most people see as necessary and aren't trying to add any of the parts that most people see as sorely lacking.