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Let’s Have a Rational Talk about Healthcare

Posted 25 months ago|52 comments|798 views
Written by
Colorado
Westcliffe, CO
The rage healthcare creates keeps me out of the debate most of the time. I research what companies will make money from this bill because that is my job. However, I am a member of this nation and feel it is time to place my 2 cents into the firestorm.

My attention to healthcare was sparked by how much the United States spends on healthcare. The United States spends more as a percentage of GDP than any other nation in the world. In 2007, the United States spent 16% of our GDP on healthcare; compare that to 11% by France and 9% by the United Kingdom. However, spending is not the problem, the problem is the low quality of our healthcare system. The US came in at 16 of healthcare quality in the world, this indicates a systematic problem.

If the problem is a system issue, then identifying the main cause of troubles is imperative. Government involvement in healthcare is not new. The government officials that started the involvement process were trying to help yet the system got worse. There is nothing wrong with trying to create a better system but if the government solution was to throw money at healthcare in the name of helping the poor, then they planned poorly. The result of government involvement is a nightmare of perverse incentives that has turned the system away from the patient. How much money a hospital can get out of a patient is the most important aspect of most doctors. Add in the fear of lawsuits, defensive medicine, and no competition between hospitals you get an extremely expensive healthcare system.

Monetary expense is only one type of cost this nation pays. The number of people that die from hospital born disease and mistakes is staggering. 40,000 people died last year from staph infections they acquired in the hospital; that is unacceptable. In addition, government involvement in colleges has lead to an exploding cost of college and this includes medical schools. There are not enough doctors graduating from medical school to replace retiring professionals. There is a 100% chance of a shortage of doctors in this country which will drive up costs in ways I cannot imagine.

All of these issues convince me reform is/was needed. The argument that liberals are trying to take over our country and ruin the best healthcare system in the world is a ludicrous statement. The system was already terrible and socialist.

Healthcare reform did address some much needed issues but failed to fix any of the messed up incentives, tort-reform, medical college reform, or quality issues. The bill focused on most of the wrong problems that would have addressed cost and quality. Instead, politicians argued over uninsured and government insurance plans. This nation already had universal coverage, if you walk in you get treated.

I would have hoped Republicans would have tried to get cost control issues into the reform bill rather than saying no to reform. Without line-item veto Obama would have had to sign a bill that included universal coverage and cost/quality control laws. What did we end up with? A bill that did nothing but add more people into a crappy system.

Reform is needed, and both parties have to address the real issues.


Souces: The Economist, March 20th 2010
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COMMENTS
Out Of The Box
Out Of The Box
 Moderator
25 months ago: Here is the GOP site, and the plan put forth by the Republicans.

http://www.gop.gov/solutions/healthcare

Summary:

1. Lower health care premiums

2. Establish universal Access programs, to guarantee access to those with pre-existing conditions.

3. End junk lawsuits and curb defensive medicine.

4. Prevent insurers from unjustly canceling a policy.

5. Encourage small business health plans.

6.Encourage innovative State plans.

7. Allow interstate purchasing of insurance.

8. Promote healthier lifestyles.

9. Enhance HSA programs.

10. Allow young people to stay on parent's plan through age 25.

Looks pretty good, from where I sit.
Perfect Horizon
Perfect Horizon
Chicago, IL
25 months ago: A lot of these ideas are in the bill. 200+ Republican amendments...just because they didn't vote for it doesn't mean they aren't there. There is no public single payer option/system.
25 months ago: It's hard to take the GOP seriously on healthcare. For one, they truly support the structure as it is. For another, any gov't plan is a contradiction to the GOP idea of no gov't interference in the marketplace.

But, a couple of points...

3. One man's "junk" is another man's justice. Eye of the beholder.

6. Most states can't afford to expand healthcare, since they're already over budget. Seems to me this is too big for most states to handle. Better done at the federal level.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: Like you said, though, everyone is already covered by socialized medicine. Some just want to be covered, AND not have to be embarrassed by going to the free clinic or the ER.
25 months ago: Free clinics are limited in what they can treat. And ER can't treat chronic ailments. So where is the existing socialized services for those people?
Out Of The Box
Out Of The Box
 Moderator
25 months ago: Malpractice has both direct and indirect costs, including "defensive medicine." According to the American Medical Association, defensive medicine increases health systems costs by between $84 and $151 billion each year. Studies place the direct and indirect costs of malpractice between 5% and 10% of total U.S. medical costs, as described below:[21]

"About 10 percent of the cost of medical services is linked to malpractice lawsuits and more intensive diagnostic testing due to defensive medicine, according to a January 2006 report prepared by PricewaterhouseCoopers LLP for the insurers' group America's Health Insurance Plans. The figures were taken from a March 2003 study by the U.S. Department of Health and Human Services that estimated the direct cost of medical malpractice was 2 percent of the nation's health-care spending and said defensive medical practices accounted for 5 percent to 9 percent of the overall expense."
25 months ago: It would be the FIRST time there was any rational talk about health care.
25 months ago: Shut up Red. You stupid, uneducated podunk. Make yourself useful and go clean the spittoons. Only the enlightend ones are allowed to be rational. So just work your garden and stay away from hospitials unless you want to get sicker than when you first vistied. My plan is a government take over of the clorox company so they can get their cleaning supplies for free. Maybe then they could afford the labor to use them.
Altruist
Altruist
Eugene, OR
25 months ago: To bring down costs we need a nationwide data base that includes all of the available drugs, their generic equivalents, interactions with other drugs and supplements, side effects and what maladies the drugs treat and how effective they are. There is just way too much information out there for any doctor to stay abreast of.

The nationwide database should also be set up to help with diagnosis. If a patient has so and so symptoms it indicates this or that disease. Treat it with the following and it should take care of the problem. If that doesn't work it indicates this other complication, treat that with the following.

No doctor can recognize and know how to treat all of the diseases out there. They need help. I suspect many of those 40,000 deaths are because the docs just guess or trust the drug maker with no independent review.

If there is a national database and diagnostic tool and a doctor follows the suggested protocols, they should be protected from frivolous lawsuits.

This would reduce the number of unnecessary procedures that doctors use because they are just guessing or because they are just covering their butts.

I believe they are already getting a start on this in a very small way by going to digital records. Every pharmacist should receive a computer generated prescription instead of having to guess whatever that chicken scratch the doctor made really means.
25 months ago:
This nation already had universal coverage, if you walk in you get treated.

That's universal care (refering to the treatment), but not universal coverage (refering to payment).

Part of the current problem is that so many people are getting medical services they cannot pay for, which pushes the costs onto the rest of us.
25 months ago: At the heart of this debate is the nature of healthcare. Is it a utility or a luxury?

Imagine if electricity or the judicial system were priced the same as healthcare, which is currently based on the supply/demand model that our entertainment industries are based on -- charge as dearly as the market will bear.

It's interesting that we require the telephone company to provide basic services to everyone at an affordable price because we see the telephone as a necessary commodity, particularly in case you have an emergency. But we don't yet see the actual care you seek as an equally necessary commodity. So we make sure you can call the ambulance, but you're on your own when it comes to paying for it.

Part of the problem is that nowhere do you ever see a list of fees-for-services. This is the one industry where price is determined all after the fact. No one is even asked if they can pay (only if they have insurance). Not that I'm suggesting haggling or denial, but we shouldn't be surprised about so many medical bankruptcies when services are (1) priced as high as possible and (2) rendered with total disregard to ability to pay. It's like selling Ferraris on payment plans to anyone who asks. I wonder how many people would reconsider a non-emergency visit to the ER if they were first handed a pay schedule of fees...

So I think a rational talk about healthcare needs to reconsider our processes, and definitely make a decision about whether it is a necessity of life or just another commodity.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: Health care is a necessity and a commodity. Health insurance is a commodity.

You also get your electric bill after the fact, as well as your mechanic bill, and your repair bills around the house. If someone wanted to ask, they would be told how much it would cost to see a doctor and would be given a quote if requested.
25 months ago: Also, I think the current "Obamacare" law does a wonderful job addressing the horrible denial-of-service schemes of insurance companies. New denial schemes in the future will now be easier to thwart.

I'm not wild about the financial approach, however.
scotmanster
scotmanster
25 months ago: You don't get it Obama just gave a free pass for health insurance companies to increase their rates by insurance companies can not charge a young person less than the older person meaning the price of health insurance will albeit be the same whether young or old but the price point that will be set will be max to cover their derriere.
25 months ago: I really don't think ANYONE "gets it" on healthcare. Everyone has an angle based on their own perspective.

The price point will be, as it has always been, "set to the max to cover their derriere." This is how insurance has ALWAYS been.

Not charging old people more than young people is a good thing. Old people are the most vulnerable when it comes to healthcare. They have low, fixed incomes and cannot pay much.

But... most all of us have been paying for insurance most all our lives. So it's not like they're trying to get something for nothing. In the long view, this is trying to make sure lifelong payers finally get to collect on their lifelong investment.
scotmanster
scotmanster
25 months ago: It is not how health insurance worked I don't know were your getting your information from but you will pay higher premiums based on the the older you get that is why they purposed to the change were a young person in age will be charged the same as a person 65 years of age. They were "attempting" or so we were told to help senior citizens but what does it do in actuality? Increase health insurance premiums for the rest of us. Once the legislation takes effect it will be "balanced"?
scotmanster
scotmanster
25 months ago: On the average I would think your health start to diminish after age 65 now your rates will increase for your health insurance for the remainder of 15 more years you live. What about the 65 years of good health? Should you be charged the same as a person 65 years of age? No you should not, it is all in the wording and how Obama presents it all. Someone can present something very logical that means for 15 years of your life your health insurance premiums will not go higher. But what about the 65 years of good health you have, you are going to be charged the age 65+ premiums for the majority of your life.

My question is how many inconspicuous ties are their to Hillary, Emanuel, Obama and insurance companies?

Use your head think....
25 months ago: It's a much better system where we pay in for health insurance our whole life and then reap the benefits at the end. In your doomsday scenario, you pay in while you're young and healthy then get NOW UNLIMITED (since they can't cut you off) health coverage when you are old, sick, and unable to pay.

That's a pretty good deal. (Did anyone expect these added benefits to be free?)

Your preference is what has CREATED this healthcare problem. You don't want to pay anything until you need coverage--but I bet you don't want to pay in as much as you want to withdraw! You only want to pay in a low monthly payment while you are draining tens of thousands of dollars from the insurance company.

I don't think your argument holds up in the long view. Sounds like you want to "game the system" and effectively get something for nothing, or very little (which shifts the real costs off to the rest of us).

As for the Democrats, don't be naive. The insurance companies own BOTH parties equally. The GOP is just more obvious about it.
scotmanster
scotmanster
25 months ago: I never said the young do not pay the coverage they do now. What I am saying is insurance from a 65 year old greatly differs from a 20 year old seeking health insurance the rates will be extremely costly for the 65 year old. So what you are saying it is fine to charge that 20 year old the same rates as a 65 year old?

My preference did not create anything. If you buy the whole MSM ideals then certainly the United States has a huge Health Care crisis on their hands.........

As it stands you can get coverage for any condition you have simply walk into the hospital ER and they can not deny you their services with or without insurance.

It is a good deal if you take from one persons pocketbook and put it into another if you believe in socialism but this country was not founded on socialism.

You have a whole generation of brainwashed kids you know the kids that bought into Obama's Ideologies and won him his election? Yes that generation. They were fed this same notion that the Health Insurance rates need to be stabilized but little did they know they were the ones that would be flipping the bill by paying higher health insurance premiums that are pro-rated for a 65 year old person.
scotmanster
scotmanster
25 months ago:
It's a much better system where we pay in for health insurance our whole life and then reap the benefits at the end.

Kinda like Social Security was but somehow that money pot was dipped into one too many times and now it is on the verge of collapse?
scotmanster
scotmanster
25 months ago: "(1) priced as high as possible"

They are priced as high as possible becuase their is no option to buy across state insurance plans. This is called a monopoly on health insurance plans. If you open up online buying of health insurance plans this will undoubtedly lower costs.

When you purchase a Plan you only speak to a representative of the insurance company once in person the rest of the time is spent picking a doctor out of their directory listings or calling them on the phone. If insurance companies are allowed to expand their coverage across state lines will create the affordability we are looking for. But hey just mess it all up with a bunch a bureaucratic red tape and call it fixed! Makes sense to me.
25 months ago: I'm not against opening that up. But...I've bought other insurance in my state and out of my state and most of the time the rates are based on your region. (So it looks to me like your proposal won't really change anything much.) For example, if I buy car insurance locally or from a thousand miles away, I still get charged a higher price because of my region. (I know because I switched to an out of state insurer whose rates were lower initially then drove up even higher than local rates.) I'm in a high-risk region somehow (based on accidents mostly) even though my driving record is clean.

My experience doesn't convince me anything will improve much. But I'm not really against the idea.
scotmanster
scotmanster
25 months ago: Car insurance has to be based on a region becuase of weather conditions extremely vary through the winter months unlike health insurance. I see no comparison between the two types of insurance albeit the both have "insurance" in their name. I am talking Health insurance.
25 months ago: That sounds good, but weather has never been mentioned in the conversation, not around my neck of the woods. It's always about accidents, fires, theft and the like. That comes from local companies and a couple in California that I've dealt with.

I wouldn't doubt that health insurance keeps track of regions for similar reasons. For example, Appalachia has a high cancer rate (gone up by multiples in the last 40-50 years). Northeastern states have a rapid increase in childhood asthma and other breathing problems.

I really doubt that health insurers don't know about this and don't base rates on it too.

scotmanster
scotmanster
25 months ago: Rightly so. You just explained why car insurance companies and home insurance up the rates due to demographics but this is not the case with health insurance. My point is you are saying that a 20 year old pays the same premiums as a 65 year old are you not? This was another talking point from the left that they harped on they claimed that older people get raked over the coals for being older. But now your telling me it is not an issue and we didn't need the legislation to change it?

Lets face it their is still a problem a young person in age has considerably lower premiums than a 65 year old person the older person will still pay the high premiums meanwhile the younger person will pay that same premium pro-rated for a 65 year old.
scotmanster
scotmanster
25 months ago: "They have low, fixed incomes and cannot pay much."

Please show me the statistics that the majority of elderly are in the low income bracket.
25 months ago: You must live in a really posh location to even question that fact.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: As they say in wikiworld: (citation needed)
25 months ago: First off, I did NOT say the majority of elderly was in poverty. (According to the Census, 13% of elderly are under the poverty line. OF 33 million elderly, that's over 3 million people. And three million is three million too many.)

But... that's is just a look at their INCOME. Once you factor in how much an old person has to pay for medicine and deductibles--which often measures in thousands of dollars--that number should grow significantly above 13%.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: Let me put it this way. My recently deceased granny was drawing her SS. Her income was below the poverty level. However she owned hundreds of acres of prime real estate, for which she paid nearly nothing back in the 20's and 30's. She had more money than she could keep insured in one bank.

And the 10% you mention that are subsistant relying on the government plan are a glaring example of why government programs don't work.
scotmanster
scotmanster
25 months ago: Do you propose to provide them with care instead of trying to figure out why they are below the poverty line to begin with? What I propose is to bring our jobs back so they will not have to be dependent on the system in the first place.
scotmanster
scotmanster
25 months ago: I would also like to say one on the linch pins in Obamacare is "tax credits"..just think about how the tax shell game gets played and any con artist can rob you blind the whole while making it look like they are helping you. They know you want a deal becuase this country is based on consumerism.
25 months ago: You are right. Taxes are more about politics than finance.
scotmanster
scotmanster
Content Removed by scotmanster
scotmanster
scotmanster
25 months ago: I will tell you my Mom and Dad both had double coverage they have their regular insurance plus they have medicare. Little did they know they could opt of of medicare so in essence for 10 years of their life they were being charge 200$ a month for medicare and never even using it. I wonder how many elderly middle class Americans are doing the same? I would think 95% of them are. Were is the reimbursement for unused insurance?

That is how insurance works everyone puts in and it is supposed to cover everyone else no matter how much you put in or take out. If anyone is at fault it is the insurance companies from gouging into the benefit monies. But no one supposes to tackle this issue but to give them more money? Get real...

So please tell me about how society has all of a sudden started caring about our elderly? They care when it is convenient to care and the rest of the time nursing homes are a convenient resort for most people not wanting to take care of the parents that raised them. I can see nursing homes for the severe cases but just shutting them away becuase of the inconvenience is beyond me.
25 months ago: "If anyone is at fault" it is the DOCTORS and HOSPITALS. In truth, THEY jacked up the insurance system by price gouging the insurers just because they could get away with it. The insurance companies' response made it all worse, of course. I explained this once already.

Liberals have tried to help the elderly at least since FDR created Social Security, and later when LBJ created Medicare. If the 1930s and 1960s are "all of a sudden," then I guess you have a point.
scotmanster
scotmanster
25 months ago: Then why are those systems failing? Why are we having a problem becuase apparently those systems we supposed to work? But the fact of the matter is they don't work.
scotmanster
scotmanster
25 months ago: @ Colorado You have my respect you can always keep the debate civil and are open for other opinions.

I think the best way to fix our "problem" is to restore the lost jobs that were shipped overseas right now. This will make it so the average American can go back to work and not depend on Government social programs to make ends meet.

Cut the the head off the corruption in Unions with a two headed axe. Restore retirement benefits companies should be paying out. All my Fathers money went into his retirement plan as a Unionized Iron Worker but somehow those slick bastards are stealing the money out from under him by lowering his benefits each year....Maybe then we could afford Health Insurance?
25 months ago: I don't think you're interested in a rational conversation as much as hurling GOP talking points.

You talk a lot about socialism. To WHERE did our "free market" corporations take our American jobs...? Over to COMMUNIST China.

If you REALLY cared about economic systems, send your rants to CEOs. THEY are the ones who prefer SOCIALIST labor systems.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: Our jobs have been taken to many countries; India, Mexico, many South American countries. The CEO's could care less about the politics of the country they outsource to.

One of the prime reasons for this exodus of jobs is over-taxation and Unions demanding more than a company can bear in personnel costs. The result has been more companies closing up shop. Why should they continue operating and risking their capitol when they can get the same return on their money by simply investing it in stocks and bonds? When a company operates on a 15% profit margin, and you cut their profits down to 8% by taxes and personnel demands, the owner would be a fool to risk everything he owns by staying in business.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: You talk about having a rational conversation, and then make an irrational statement based strictly on emotion.

"To WHERE did our "free market" corporations take our American jobs...? Over to COMMUNIST China."

It seems that what you are saying is "Be rational, see things my way."
25 months ago: You talk as if that only happens at unionized companies.

My dad worked non-union and was promised IN WRITING a decent retirement with health coverage. Since non-union promises aren't binding contract (they can rewrite them at their whim and simply say they hadn't printed copies yet) he got ONE-FOURTH of what was promised.

If a union is corrupt, it is the fault of the union members for not getting new leadership. A union is like a democracy, it requires vigilance not complacency. Unions are a tool, not a solution in and of themselves.
scotmanster
scotmanster
25 months ago: "I don't think you're interested in a rational conversation as much as hurling GOP talking points."

Of course if I don't agree with what your saying then it is considered irrational.

But then again I did not mention or say it was not happening within non-unionized companies, you choose to think that becuase I did not state then it must not be?
25 months ago: Once again, this all goes back to personal experience. Clearly yours have been on the opposite side from mine.

There will be no agreement between us. Rightwing ideology has HARMED me at every turn. In your eyes, I have no doubt you believe that leftwing ideology has harmed you at every turn.

We are at an impass.
scotmanster
scotmanster
25 months ago: You chose to be at that impass I simply asked you to supply me a link showing most elderly are lower classed citizens?
25 months ago: Look above.
25 months ago: It would help the conversation if you would actually READ what I write rather than rewriting it in your mind to say something else.

I said the elderly were VULNERABLE to healthcare costs. I also said they were poor (many are), and on fixed incomes (both retirement and social security are fixed incomes).

At NO POINT did I say a majority was under the poverty line.

It's impossible to have a conversation with people who twist, distort, and rewrite what is actually said.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: Maybe you should go back and read what you wrote. Your exact quote was:

" Old people are the most vulnerable when it comes to healthcare. They have low, fixed incomes and cannot pay much."

That part about "cannot pay much" implied that they were in poverty.
25 months ago: Here are two more relevant stats.

The poverty rate among the elderly before Social Security was 47.6%
The poverty rate among the elderly after Social Security has dropped to 11.9%.
(http://www.cbpp.org/cms/index.cfm?fa=view&id=1863)


"The poverty rate among the elderly declined from 25 percent in 1970 to 13 percent in 1992." That's cutting the rate in half, while real income only went up 23% for men (one quarter) and 36% for women (one third).
(http://www.census.gov/population/www/pop-profile/elderpop.html)

So those tell me that it is pretty clear just how much good two major government programs have helped the elderly, Social Security and Medicare.

Say what you want, some people DO care and have done something about it.

Just because they're not perfect for every individual, overall, gov't programs CAN and often DO work.
Out Of The Box
Out Of The Box
 Moderator
25 months ago: But then look at the PERS programs that have so far been un-raped by government. I see Utah contributors retiring with $2.5 million cash in hand, with less than $100,000 invested. If the SS plan had been set up as an investment account, rather than a socialized system, it wouldn't be facing bankruptcy now.
scotmanster
scotmanster
25 months ago: Let me be blatant. Then why is social security in all it grandiose expected to go bust in my lifetime?
scotmanster
scotmanster
25 months ago:
The first time was in 1977 – well, almost. To head off the bust, Jimmy Carter got Congress to pass a major FICA tax increase – sorry, "contribution" increase – in order to save Social Security. The rate would be hiked in phases from 2% to 6.15% (times two: employee and employer). He promised: "Now this legislation will guarantee that from 1980 to the year 2030, the Social Security funds will be sound." (http://tinyurl.com/ybksxs4)

Carter's projection was off by a Georgia country mile. In 1983, the SSA program technically went bankrupt. Reagan signed a law that speeded up Carter's rate increases, added Congressional employees to Social Security, and delayed the age of eligibility. (http://tinyurl.com/ybksxs4)

Unless there is another Social Security tax increase in 2010, the system will go into red ink mode and stay there.

http://www.lewrockwell.com/north/north79...
scotmanster
scotmanster
25 months ago: So while you suppose to tax and tax I suppose we had enough a Governmental interventionism. We are supposed to be free men and women but here we are relying on the table scraps from our masters plate. Enough is enough. The father we go down the liberal social road the more indebted we become of and to the Federal Government. Time to stop being conned.

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