Health Care Debate

[_The Nehor]

I think the U.S. needs to make a decision. I don't have very strong opinions on which way to go but I think we need to choose one:

1. Socialize health care completely. Follow the European model and accept the slower research in exchange for security. Raise taxes, get rid of Insurance companies.

2. Capitalize health care entirely and get rid of insurance companies. I would recommend a social safety net to assist those who pay over a certain amount a year for health care. I would max out at around $10,000 for this. Prices should fall as insurance companies vanish and people will only seek health care when they need it due to the lack of free doctor's visits and the like.

I don't much care but the current system is untenable.

[_asbestosman]

2. Capitalize health care entirely and get rid of insurance companies. I would recommend a social safety net to assist those who pay over a certain amount a year for health care. I would max out at around $10,000 for this. Prices should fall as insurance companies vanish and people will only seek health care when they need it due to the lack of free doctor's visits and the like.

I would have to modify this a bit. First off I think that regular doctor's visits should be encouraged since preventative care is generally cheaper--to a point. I agree that health care shouldn't be used to cover everything and even covering doctor's visits will cause the price to rise. I think that the biggest issue is perscription drugs. I think people should have to pay for these out of pocket except in exceptional circumstances such as poverty. Getting rid of insurance companies is probably a necessary step unfortunately. It might also be necessary to cut down on tax breaks for health care although I could go either way on that (the tax break doesn't lobby like insurance does and does not look for excuses to not cover something).

Another change I think we ought to look in to is changing patent law and other intellectual property laws. While I agree with incentivizing innovation, I don't think we need as much protection as we have. Non profit organizations exist that research this stuff. That's not to say we shouldn't have patents, but we could limit them to fewer years and maybe require the availability of cheap generics for the poor. While such limitations might slow down innovation, it might at least keep the rest of us from going bankrupt and probably increase overall quality of life.

I also think we should consider incentives for healthy lifestyle choices: exercise, etc. Why should I pay more taxes for an alcoholic's liver transplant? Perhaps this could be done by taxing the foods most at fault such as sugary, or fatty foods.

[_Kevin Graham]

At a recent town hall meeting, a man stood up and told Representative Bob Inglis to “keep your government hands off my Medicare.” The congressman, a Republican from South Carolina, tried to explain that Medicare is already a government program — but the voter, Mr. Inglis said, “wasn’t having any of it.”

It’s a funny story — but it illustrates the extent to which health reform must climb a wall of misinformation. It’s not just that many Americans don’t understand what President Obama is proposing; many people don’t understand the way American health care works right now. They don’t understand, in particular, that getting the government involved in health care wouldn’t be a radical step: the government is already deeply involved, even in private insurance.

And that government involvement is the only reason our system works at all.

The key thing you need to know about health care is that it depends crucially on insurance. You don’t know when or whether you’ll need treatment — but if you do, treatment can be extremely expensive, well beyond what most people can pay out of pocket. Triple coronary bypasses, not routine doctor’s visits, are where the real money is, so insurance is essential.

Yet private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.

And in their efforts to avoid “medical losses,” the industry term for paying medical bills, insurers spend much of the money taken in through premiums not on medical treatment, but on “underwriting” — screening out people likely to make insurance claims. In the individual insurance market, where people buy insurance directly rather than getting it through their employers, so much money goes into underwriting and other expenses that only around 70 cents of each premium dollar actually goes to care.

Still, most Americans do have health insurance, and are reasonably satisfied with it. How is that possible, when insurance markets work so badly? The answer is government intervention.

Most obviously, the government directly provides insurance via Medicare and other programs. Before Medicare was established, more than 40 percent of elderly Americans lacked any kind of health insurance. Today, Medicare — which is, by the way, one of those “single payer” systems conservatives love to demonize — covers everyone 65 and older. And surveys show that Medicare recipients are much more satisfied with their coverage than Americans with private insurance.

Still, most Americans under 65 do have some form of private insurance. The vast majority, however, don’t buy it directly: they get it through their employers. There’s a big tax advantage to doing it that way, since employer contributions to health care aren’t considered taxable income. But to get that tax advantage employers have to follow a number of rules; roughly speaking, they can’t discriminate based on pre-existing medical conditions or restrict benefits to highly paid employees.

And it’s thanks to these rules that employment-based insurance more or less works, at least in the sense that horror stories are a lot less common than they are in the individual insurance market.

So here’s the bottom line: if you currently have decent health insurance, thank the government. It’s true that if you’re young and healthy, with nothing in your medical history that could possibly have raised red flags with corporate accountants, you might have been able to get insurance without government intervention. But time and chance happen to us all, and the only reason you have a reasonable prospect of still having insurance coverage when you need it is the large role the government already plays.

Which brings us to the current debate over reform.

Right-wing opponents of reform would have you believe that President Obama is a wild-eyed socialist, attacking the free market. But unregulated markets don’t work for health care — never have, never will. To the extent we have a working health care system at all right now it’s only because the government covers the elderly, while a combination of regulation and tax subsidies makes it possible for many, but not all, nonelderly Americans to get decent private coverage.

Now Mr. Obama basically proposes using additional regulation and subsidies to make decent insurance available to all of us. That’s not radical; it’s as American as, well, Medicare.

http://www.nytimes.com/2009/07/31/opini ... .html?_r=1

[_The Nehor]

I would have to modify this a bit. First off I think that regular doctor's visits should be encouraged since preventative care is generally cheaper--to a point. I agree that health care shouldn't be used to cover everything and even covering doctor's visits will cause the price to rise. I think that the biggest issue is perscription drugs. I think people should have to pay for these out of pocket except in exceptional circumstances such as poverty. Getting rid of insurance companies is probably a necessary step unfortunately. It might also be necessary to cut down on tax breaks for health care although I could go either way on that (the tax break doesn't lobby like insurance does and does not look for excuses to not cover something).

I think doctor's visits are a modest enough expense that we can cover them individually without hardship. I agree that preventative care is probably cheaper. I'd consider making health care expenses comparable to IRA contributions to create a small incentive to use a reasonable amount of medical care. While it is deductible now I think we need a bonus independent of whether you itemize. As part of this plan with the insurance companies gone I would open up the option of an HSA to everyone and maybe encourage employee matching of benefits to a degree mirroring 401k's. I agree that you should have to pay for prescription drugs. They're generally not bank-breaking.

Another change I think we ought to look in to is changing patent law and other intellectual property laws. While I agree with incentivizing innovation, I don't think we need as much protection as we have. Non profit organizations exist that research this stuff. That's not to say we shouldn't have patents, but we could limit them to fewer years and maybe require the availability of cheap generics for the poor. While such limitations might slow down innovation, it might at least keep the rest of us from going bankrupt and probably increase overall quality of life.

The idea I liked was to classify patents on new treatments and drugs by the scale of the disease. A treatment that would become popular would have a much shorter patent life. If the disease is rare the patent would extend longer to allow the developer to recoup costs (due to lower demand).

I also think we should consider incentives for healthy lifestyle choices: exercise, etc. Why should I pay more taxes for an alcoholic's liver transplant? Perhaps this could be done by taxing the foods most at fault such as sugary, or fatty foods.

I can't figure out how to do this. Sin tax on fast food? I'm at a healthy BMI and have it maybe every other week. Should I be taxed? On the other hand I might be willing to take that hit if it curbs general health care costs. Yesterday I went to get a burger and in front of me was an obese woman and her four children. The oldest probably 7-8. They were all obese. I wanted to call CPS.

One idea that might help a little is to make gym memberships tax deductible. I think making people more responsible for their medical care may encourage change as well.

[_asbestosman]

I can't figure out how to do this. Sin tax on fast food? I'm at a healthy BMI and have it maybe every other week. Should I be taxed? On the other hand I might be willing to take that hit if it curbs general health care costs. Yesterday I went to get a burger and in front of me was an obese woman and her four children. The oldest probably 7-8. They were all obese. I wanted to call CPS.

The idea of a sin tax on fast food is that it would effect people in direct proportion to the amount of junk food they buy. Someone like me who tries not to eat so much wouldn't be hit as hard as those who can't live without their comfort food. I don't think it's doable though since it turns out that poor people generally eat more of this stuff because it's cheap. Furthermore even though I have a healthy BMI, I have relatives who would feel resentment at having a sin tax on their comfort foods. Still, for them I say that if it's their choice and their buisness, then it should be their bill and that even though I love them as family.

One idea that might help a little is to make gym memberships tax deductible. I think making people more responsible for their medical care may encourage change as well.

I don't think gym memberships will work. The biggest problem I see with the people I know is motivation to actually use the gym. In my case it doesn't help that no matter how much I work out, I look about the same as my brothers who do not which takes away all the fun of weights. I'm fortunate in that I enjoy biking even if I don't look any better (I do feel better), but a gym won't help with that (I don't enjoy stationary bikes although watching a show makes it tolerable).

On the other hand, I agree that making people responsible for their medical care should help. Unfortunately I'm not completely sure how much. I know some people who suffer with various conditions due to their weight but still won't change their lifestyle. I know they don't enjoy being fat, but they aren't willing to replace old habbits that they enjoy with healthier alternatives which don't bring as much immediate satisfaction. Hit me in the pocketbook and I'll change, but not even that would motivate them. As long as they cover themselves, I'm perfectly happy to let them keep their old habbits. However, I still feel bad for them.

[_bcspace]

For example, why should I have to pay for someone else's lifestyle choices Overeating, smoking, drinking, std's, etc. I have 7 kids.

They do if your kids attend public school. Why are so many childless adults having to pay taxes to fund public schools so your seven children can get an education? I happen to think health is more important than education, but this is just one example of government services provided to only some, but paid by all.

Indeed. The public schools need to be abolished too. The perfect transition is to start allowing parents and kids to start choosing their curriculm and teachers. The market will then show what is and is not effective.

Why would anyone else want to pay for MY lifestyle choice? Yet we do and insurance costs spiral out of control thereby.

Insurance rates spiral out of control because they are trying to make a profit, and they can't unless they raise their rates to keep up with the ever growing costs of healthcare.

That's correct. But the market has been skewed by the government. We didn't have this problem so bad 40 and 50 years ago. Not understanding economics and the cause of the problem will always result in the wrong solutions such as that proposed by you, nehor, and Obama.

The solution here is to allow insurance companies to charge whatever they want for everything AND allow the consumer to buy exactly what and how much.

The solution here is to allow insurance companies to charge whatever they want for everything AND allow the consumer to buy exactly what and how much.

That doesn't make any sense.

It makes perfect sense and has worked before in the past.

You seem to think a competitive minded insurance company could just come along and charge less, without any concern for making a profit, thereby forcing others to be more competitive and drop their rates as well.

I don't think that at all. They will charge less (or more) depending on what the demand is. The supply will correct itself and so will price. And best of all, people will correct their behavior.

And even if they could, there is no real guarantee that your insurance company will cover all costs.

It is absolutely guarenteed! people who don't change their behaviors will pay more of course. Much more. And that is exactly what is wanted and needed.

Americans are continuously stressed out about getting sick.

BS. Some hypochondriacs paraded about by the democrats do though.

It is a huge factor in the number of bankruptcies. 22,000 people die every year because they cannot get health care.

That's because insurance companies are made to cover everything without allowing options for coverage. This incentivizes insurance companies to deny coverage.

That's like having a 9-11 tragedy every seven weeks, except the country doesn't notice it because they don't want to.

Obama's man.

The problem is that health care costs are so high, these companies have no choice but to keep high rates to stay in business.

That's right. The reasons why they are so high were outlined above. The insurance companies are simply play the field handed to them by the government. Eliminate the government and you return power to the people.

Any insurance worth having is going to cost someone around $13-20k a year for a family of four. That might not sound like much is you're making over 100k/year, but the average American makes less than half of that, and simply cannot afford it.

I am well aware of the costs of insurance right now. Our company teaches other companies how to significantly reduce this cost through cafeteria plans, a back door knife in the backs of Johnson/Carter/Clinton/Obama socialists, some of the most economically inept presidents we've ever had.

But that's still just playing the field the government has created and it will get worse as we go towards the single government HMO.

No, a single payer/buyer would make it worse.

That isn't what Obama is proposing. A government option is what he is proposing.

It is EXACTLY what he is proposing. No one else will be able to compete with the government option. Without competition, premiums (taxes) rise, supply becomes restricted, etc.

There is no real reason to believe a free market system will solve the problem.

It has solved every problem. No doubt there will be people on the margin. But it is the only way to minimize how many. Unlike you, I choose not to have everyone on the margin.

It works for businesses, but you can't plug in the free market model to cure everything. The NYT published an article last week discussing the problems with a free market health care system.

LOL! The NYT doesn't know what it's talking about that's for sure.

[_bcspace]

1. Socialize health care completely. Follow the European model and accept the slower research in exchange for security. Raise taxes, get rid of Insurance companies.

More untenable than now.

2. Capitalize health care entirely and get rid of insurance companies. I would recommend a social safety net to assist those who pay over a certain amount a year for health care. I would max out at around $10,000 for this. Prices should fall as insurance companies vanish and people will only seek health care when they need it due to the lack of free doctor's visits and the like.

Insurance companies will flourish in a purely captialist system. The very notion of insurance (not as we have it now) is pure capitalism. People will of their own accord band together to minimize risk and cost. Viola! An insurance company.

I don't much care but the current system is untenable.

It's already too socialist. That's why it doesn't work. We subsidize the world here as illustrated above. People have forgotten what insurance means (hint: it's not meant to cover everything). And as a result, prices rise.

[_bcspace]

The idea of a sin tax on fast food is that it would effect people in direct proportion to the amount of junk food they buy. Someone like me who tries not to eat so much wouldn't be hit as hard as those who can't live without their comfort food. I don't think it's doable though since it turns out that poor people generally eat more of this stuff because it's cheap. Furthermore even though I have a healthy BMI, I have relatives who would feel resentment at having a sin tax on their comfort foods. Still, for them I say that if it's their choice and their buisness, then it should be their bill and that even though I love them as family.

It's an attractive idea. However, a tax is a tax which means it also likely will benefit someone who, like the fast food eater, doesn't deserve it.

Let the insurance companies charge whatever they want to cover, for example, atherosclerosis. Let the consumer choose whether or not to have that specific item coverd. That price then will be driven by how many desrie such coverage and how much they are willing to pay. Let the consumer learn by experience the true cost of the disease, your pocket book and your perhaps your life. Then you have the proper moral way to induce people to change their behavior without punishing someone else.

As people modify their lifestyle, the cost will come down because there will be fewer claims. Perhaps the cost won't be so high because people will recognize their lifestyle and pay for coverage. Who knows? But it doesn't matter because in a pure market, everyone always pays the right price and the availability is always just right as well.

[_bcspace]

As it is now, we don't simply have bureaucracies, we have entire industries whose primary motive is to deny us health care in order to maximize their profits. HMOs, for-profit insurance companies, etc. who leech money from the system that would otherwise go toward providing actual health care.

So why are you acccepting a single large HMO from which you can't escape?

[_The Nehor]

1. Socialize health care completely. Follow the European model and accept the slower research in exchange for security. Raise taxes, get rid of Insurance companies.

More untenable than now.

I disagree.

2. Capitalize health care entirely and get rid of insurance companies. I would recommend a social safety net to assist those who pay over a certain amount a year for health care. I would max out at around $10,000 for this. Prices should fall as insurance companies vanish and people will only seek health care when they need it due to the lack of free doctor's visits and the like.

Insurance companies will flourish in a purely captialist system. The very notion of insurance (not as we have it now) is pure capitalism. People will of their own accord band together to minimize risk and cost. Viola! An insurance company.

I purely capitalistic system will not work. I have a friend who was born with a medical condition. He is capable of leading a largely normal life but treatment costs over a hundred thousand dollars a year (sometimes two or three times that). In a purely capitalist system no insurance company would touch him...ever. He is incapable of making enough money to keep himself alive. Under pure capitalism he would die. Under my semi-capitalistic system he would pay (a lot) each year but it would be manageable

The issue is that currently insurance companies can almost force you to have to buy in. Insurance companies negotiate large discounts with providers and unless you join them you pay far too much. Under a purely capitalistic model this would grow far worse. Insurance companies will not turn down a borderline monopoly.

I don't much care but the current system is untenable.

It's already too socialist. That's why it doesn't work. We subsidize the world here as illustrated above. People have forgotten what insurance means (hint: it's not meant to cover everything). And as a result, prices rise.

I think it's either too socialist or not socialist enough. We need to make a decision.