Health Care Reform in the US

[Hauptman]

To which other social problems shall we apply this odd logic?

There's no reason to have CAFE standards any more, because the rising cost of cars is resolving the problem.

Brilliant, no?

All "rising costs" are doing is reducing quantity demanded. It is not addressing the root problem of tax benefits being located with the wrong parties, eg employers. This is what skewed markets in the first place, but hey, why cure the disease when we can treat the symptoms incessantly instead?

In this case, I'll have to agree with Inq's argument, if not his snarky attitude.

I'd be happy to see employer based health insurance disappear altogether. It's a mess for the employers, it's a mess for our tax system, and it's a mess for the insured since people change employers so often these days, as opposed to the nearly lifetime employment we used to see 60 years ago.

[dcmdale]

This claim is advanced for many groups. I have heard it made for the state prisonworkers' union and the teachers' union at a minimum. I cannot find any figures to back any of them being strongest. Is there a list somewhere?

If there was a list, I would wonder what its bias was.

This statement was based on past discussions that I have had with members of the state legislature from both parties. This, of course, is opinion even from them because it would be fairly rare that the teacher's union would be strongly on one side of an issue and the doctors on the other duking it out the same way that the medical lobby routinely beats the trial lawyers lobby.

[Inquartata]

Mmm. There should however be some more reliable metric than expressed opinions. Amount of money given to campaigns, perhaps? Although that too would only capture lobbying power with politicians, not with bureaucrats and assorted other unelected power brokers ( like, say, spouses? )...

[dcmdale]

Mmm. There should however be some more reliable metric than expressed opinions. Amount of money given to campaigns, perhaps? Although that too would only capture lobbying power with politicians, not with bureaucrats and assorted other unelected power brokers ( like, say, spouses? )...

With enough thought one can usually come up with some metric that sounds reasonable. Don't forget to take into account the impact of counter-lobbying (especially offset instances where lobbies have some common interests and some antagonisms). Also public perception plays a role here: doctors may need less money to obtain the same influence than teachers because their brand is better. While teachers are generally have a good brand, their union is not necessarily looked upon as favorably. "Focus" would also need to be taken into account: the doctors tend to put their money on issues that impact the medical community or their patients whereas the teacher's union money is spent on a broad assortment of liberal causes.

I am not sure that it would change my argument much if the medical lobby turned out to be second or third most powerful, but perhaps an interesting academic exercise.

[lindajdunn]

http://www.govexec.com/story_page.cf...dcn=todaysnews

A proposal to put government employees on whatever public option health plan comes out of Congress (this would also impact the congresscritters).

I'm opposed. I advocate fliping this. Make the existing government health care package available as a public option for those who cannot obtain affordable health insurance through private companies.

[Inquartata]

But in reality neither has a snowball's chance of ever happening...

[Bayou Bum]

I know, I still haven't finished the "Health Care Plan for Bums", but I read about the amendment to the health care bill that the Senate Finance Committee approved that would allow employers to charge workers with unhealthy lifestyles more for their insurance coverage.

Proposed by Sen. John Ensign, R-Nev. and Sen. Tom Carper, D-Del.

Ensign: "Weight gain and unhealthy lifestyles that focus on smoking and lack of exercise have skyrocketed our healthcare costs."

Carper: "These costs could be lowered by focusing on what makes us healthy — through weight loss programs, smoking cessation and preventive care. Voluntary employee participation in these areas should naturally be reflected in lower healthcare costs."

This bothers me. On one hand, unhealthy lifestyles, such as weight, is a very serious problem in the US and the major cause of why life expectancy in the US is lower than other countries. On the other, I don't want the government dictating lifestyles, which I feel they already do excessively.

[lindajdunn]

My former employer offered us incentives for attending a health fair and eliminating making certain lifestyle changes as this reduced their overall cost of insurance. The difference here, is that it targeted the group versus the individual and it's been common for a long time. Companies that can show less than X percent of their employees smoke and less than Y percentage of their employees are obese, are married, are female, are over age Z, etc. get a significant reduction in health care costs and the smaller the company, the greater the savings.

In some cases, small businesses have simply FIRED (always for other reasons, of course) those whose health circumstances have driven up the cost of their policies. Now the person with the health condition has no insurance and is unemployed and cannot find employment.

Given the choice between how it works now and how they propose to make it work (charge the employee more), I prefer charging the employee more.

I also want to make one small change regarding targeting employees with health issues that are NOT caused by lifestyle changes. I want all of the upper management personnel at those insurance companies to go hunting with Dick Cheney and attend a small, informal, waterboarding party afterwards.

[PeterGustafsson]

Hi!

In some cases, small businesses have simply FIRED (always for other reasons, of course) those whose health circumstances have driven up the cost of their policies. Now the person with the health condition has no insurance and is unemployed and cannot find employment.

If USA - like any normal 1st-world country - would get employers/companies out of healthcare altogether, then dumb stuff like this would not happen in the first place.

Companies should produce stuff or provide services. If the rest of society should get anything from a company, it should be in the form of wages, payments, or taxes.

Companies are - hopefully - experts at producing their products. They should specialize in that, and not buy stuff for their employees that are not company necessities.

:facepalm:


Have a nice time!

Peter Gustafsson

[lindajdunn]

Hi!

If USA - like any normal 1st-world country - would get employers/companies out of healthcare altogether, then dumb stuff like this would not happen in the first place.

Peter Gustafsson

I'm coming to agree with you upon this point. Much as I love my employer-provided health insurance and much as I'd scream if deprived of it, I must concede that providing health insurance for employees is one of many factors that drags down companies and encourages them to outsource jobs to countries where they don't incure this expenditure. It also encourages them to subcontract since those non-employees also don't receive insurance.

[prototoast]

I'm coming to agree with you upon this point. Much as I love my employer-provided health insurance and much as I'd scream if deprived of it, I must concede that providing health insurance for employees is one of many factors that drags down companies and encourages them to outsource jobs to countries where they don't incure this expenditure. It also encourages them to subcontract since those non-employees also don't receive insurance.

The effects on employers aren't nearly as large as the effects on those individuals who don't have employer-provided coverage. They get royally screwed by the government.

[Phaeton]

Employer-based healthcare makes it very hard for consumers or the government to, respectively, make choices and effectively regulate. It's another level of complexity to go through. It's like trying to tie your shoes using chopsticks.

And this is one of the reasons health care reform WILL fail.

[PeterGustafsson]

Hi!

Employer-based healthcare makes it very had for consumers or the government to, respectively, make choices and effectively regulate. It's another level of complexity to go through. It's like trying to tie your shoes using chopsticks.

And this is one of the reasons health care reform WILL fail.

I once saw Mrs. Gustafsson - who is chinese - eat pancakes with chopsticks. The pancake had both whipping cream and berry jam on it, but she managed to pick it up without any of that running off the pancake. She then proceeded to eat said pancake, without anything falling on the plate or anywhere else.

I will ask her, and report back.


Have a nice time!

Peter Gustafsson

[I_luv_saber]

This bothers me. On one hand, unhealthy lifestyles, such as weight, is a very serious problem in the US and the major cause of why life expectancy in the US is lower than other countries. On the other, I don't want the government dictating lifestyles, which I feel they already do excessively.

Providing it stays 100% voluntary, I think that's great.

Insurance companies in, for example Hungary, will cover or partially cover things like exercise equipment, running shoes, etc. This is great, IMO, and if you're looking at the longterm is very likely a money saver.

... that is, unless your plan is to just deny people when they're going to have to go to the hospital for complications from diabetes anyway. Then it would make sense to not spend money on preventative care - which would explain why it isn't common practice here.

[Bayou Bum]

According to their own auditors, Medicare knowingly overpays for almost everything it buys. Examples include:

- $7,215 to rent an oxygen concentrator, when the purchase price is $600.

- $4,018 for a standard wheelchair, while the private sector pays $1,048.

- $1,825 for a hospital bed, compared to an Internet price of $1,071.

- $3,335 for a respiratory pump, versus an advertised price of $1,987.

- $82 for a diabetic supply kit, instead of a $47 price on the Web.

Not to mention the recent study that found Medicare denies coverage roughly 1.7 times that of all of the private carriers combined. It is very hard to understand how some people think government run health care is a good idea. Maybe everyone here is in the business of selling wheelchairs for medicare.

[jeff]

Despite that, Medicare total overhead is in the range of 3-5%, while private insurance companies total overhead is 18-20% That dwarfs the instances where Medicare overpays because it has a too-high scheduled price for some item. DonnaP described that problem months ago. Old news. All this despite handling the patient population guaranteed to have the greatest medical needs: elderly and disabled.

I provided the link for my figures weeks ago. If you have links to reputable sources you should post them. Besides, that's pretty weak: comparing actual prices to advertised "Internet prices".

[prototoast]

Despite that, Medicare total overhead is in the range of 3-5%, while private insurance companies total overhead is 18-20% That dwarfs the instances where Medicare overpays because it has a too-high scheduled price for some item. DonnaP described that problem months ago. Old news. All this despite handling the patient population guaranteed to have the greatest medical needs: elderly and disabled.

I provided the link for my figures weeks ago. If you have links to reputable sources you should post them. Besides, that's pretty weak: comparing actual prices to advertised "Internet prices".

It's misleading to use percentages, because old people require so much more medical care. If you consider someone young and healthy such as myself who rarely sees a doctor, the "overhead" will be nearly 100% of my costs. If I suddenly got in a horrible car accident, broke all my bones and came down with cancer, the "overhead" would probably fall to 1% or so.

[keith]

It's misleading to use percentages, because old people require so much more medical care. If you consider someone young and healthy such as myself who rarely sees a doctor, the "overhead" will be nearly 100% of my costs. If I suddenly got in a horrible car accident, broke all my bones and came down with cancer, the "overhead" would probably fall to 1% or so.

So how do explain the lower overhead of countries (with pretty much any) obligatory coverage system?

I'd agree that the use of stats in this area is dodgy at best but I don't think 'overhead' is used the way you describe.

[keith]

This bothers me. On one hand, unhealthy lifestyles, such as weight, is a very serious problem in the US and the major cause of why life expectancy in the US is lower than other countries. On the other, I don't want the government dictating lifestyles, which I feel they already do excessively.

So would you support the free market alternatives?

Pre-existing conditions are clearly an issue, but I didn't think most medical insurance companies where able to adjust risk the way life insurers (or car insurers are).

After all a detailed battery of genetic tests, an extensive family history and life history would give any actuary a pretty good estimate of cost-risk.

I don't see the republicans pushing that.

[jeff]

It's misleading to use percentages, because old people require so much more medical care. If you consider someone young and healthy such as myself who rarely sees a doctor, the "overhead" will be nearly 100% of my costs. If I suddenly got in a horrible car accident, broke all my bones and came down with cancer, the "overhead" would probably fall to 1% or so.

What Keith said - seriously.

Plus, "overhead" should be consistent with claims made. Why should there be disproportionate overhead for servicing your account when you're not filing any claims? Not wishing to spend an hour on the search function, I and others have provided multiple forms of cost accounting of our system (esp HMOs) against others, and we wind up spending much more in every instance. Figures have been produced showing how much of HMO budgets go towards paperwork and denying claims. They really are not efficient.