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Source: (consider it)
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Thread: Purgatory: Health Care
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by LutheranChik:
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
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I'm still struggling to understand what the downside of the public option is for the everyday consumer. I get why the big insurers are worried (I couldn't care less that they are, but I understand it). But why is the average consumer simultaneously worried that government run (again, a misnomer) health care will be "too expensive" while simultaneously sure it will "drive the private insurance companies out of business"? If it does drive the privates out of business (and again, I highly doubt that would be the case) doesn't that just PROVE it can be done cheaper? Isn't that a win-win for consumers? If you have a lot of stock in Cigna, yeah, that's a problem but for the pitchforked masses-- what exactly are you afraid of???
[ 17. August 2009, 00:45: Message edited by: cliffdweller ]
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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mousethief
Ship's Thieving Rodent
# 953
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Posted
They're afraid of the lies that have been told them about the NHS and the Canadian system, as well as the bogeyman word "socialist".
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
This may have been a tactic. Hillarycare failed. Lesson: Use a government plan as an initial bargaining position and compromise down to a universal private system. Not-for-profits that can't refuse customers would work. Given the huge political price that health reform carries, I think this was forseen by Obama's staff.
If I can think of it, they likely saw this long ago.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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mousethief
Ship's Thieving Rodent
# 953
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Posted
Could well be.
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This is the last sig I'll ever write for you...
Posts: 63536 | From: Washington | Registered: Jul 2001
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
Given the result that Massachusetts wound up with, I think this is even more likely.
From a policy perspective, the key goals of a plan are:
1) Universal coverage regardless of health.
2) Security of coverage (no terminations due to adverse claims, derived from 1).
3) Provision of a minimum agreed standard of care and benefits.
None of this implies a government-run plan, i.e billing the US Government directly for services or expanding Medicare to include everyone. A universal private system would work, though it would have higher administration and non-medical expenses. If that's the price of universal coverage, so be it.
It's really window dressing but if it helps the medicine go down (not intended as a pun, but....), great.
But winding up the Right with a guv'mint option and then compromising to your real position is just smart bargaining.
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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cliffdweller
Shipmate
# 13338
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Posted
agreed, sober PK. One of Pres. Obama's greatest strengths IMHO is that kind of savvy pragmatism. If it gets the job done, so be it.
[ 17. August 2009, 03:33: Message edited by: cliffdweller ]
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Macx
Shipmate
# 14532
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Posted
Sure, I am laughing while I say it but, yeah Obama is winning ![[Killing me]](graemlins/killingme.gif) He had in mind to blow 9/10ths of his political capital, entrench his opposition while swelling their ranks with moderates all while inspiring defections in his vanguard . . . this early in his first year. Should be a lame duck by Christmas, tactically wow!
"The messiah is a failure", get used to hearing that, it is gonna be coming around on the guitar a bunch more times.
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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New Yorker
Shipmate
# 9898
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Posted
I think it way too premature to say that "the messiah is a failure." Although I do want him to fail completely.
I don't think all this public option hype was a tactic since it has cost Obama political capital and the loony left will pull their admiration of him.
(The new bumper stickers may read:
"Obama: no longer a messiah; now just a politician!"
or
"From yes we can to well we tried!")
Anyway, my understanding of the Massachustes system is that it is bankrupting the State (or Commonwealth). Is this correct? This morning people are talking about co-ops. Yet, I hear that where this has been tried (in Washington State?) they have not really worked.
And at least some Canadians believe that their system is not working.
Posts: 3193 | From: New York City | Registered: Jul 2005
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Erin
Meaner than Godzilla
# 2
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Posted
I wish that the right/anarchists/whatever you call yourselves would freaking stop with the "messiah" strawman. It's insulting and a goddamned LIE.
That said, I'm not sure what to think about him pulling the public option. On the one hand, I have way too much first hand knowledge of the suckitude that is Medicare. On the other hand, I have way too much first hand knowledge of the suckitude that is private insurance.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by New Yorker:
Anyway, my understanding of the Massachustes system is that it is bankrupting the State (or Commonwealth). Is this correct?
No. MA is hurting from the recession, but less so than most states -- states just can't function in the black when so many of their tax-paying citizens are out of work. Their costs go up and their revenues go down, but the states are for the most part not allowed to run at a deficit, even during this sort of time.
MA just raised its sales tax from 5 to 6.25 percent to try to keep the books in balance. Nobody likes that option -- it's self-defeating to raise prices during a recession, but the states are hog-tied by their balanced budget requirements. MA will come out of this recession in good shape if it doesn't go on much longer, but it has been hard on everyone. The health insurance reform is not the major cause of that pain, though.
The health insurance reform has been a Godsend for many during this meltdown -- when people lose their jobs, the COBRA option has been a helpful stopgap, especially with the Federal government paying a substantial part of the cost during this emergency. But many folks have just plain run out of benefits -- they're no longer "unemployed" because they've been unemployed too long! Those folks are still able to get health insurance. This is a real safety net, as is the ability to get actual affordable insurance if you are self-employed or in a non-traditional job situation.
An awful lot of employers just plain don't offer insurance any more, but the people in MA are still able to get a reasonable plan. My daughter was one example, when she got back from working overseas and was working as a private contractor for the first year or so until she could land a job that she wanted with full benefits.
MA insurance does not refuse insurance to anyone, and the self-insured are not stuck in a pool of one for their rates and costs. The people can't be dropped for getting sick. The only folks who talk against the plan are ideologues who would be opposed to any plan. It isn't perfect, but it is better than any other state has to offer. My guess is that it will pretty much be what the federal plan ends up looking like if we get a federal plan at all. If not, I imagine that the rest of the country will try to move to MA.
--Tom Clune
[ 17. August 2009, 14:28: Message edited by: tclune ]
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Macx
Shipmate
# 14532
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Posted
Something that amuses me a bit about folks waving the MA banner as a success is an obvious factor MA doesn't have which many states do. That factor could very well be the chunk o' math that decides if such a program is viable or not in a state. I am of course, referring to illegals (and by extension non-taxpaying poly-generational wellfare families). MA isn't known for being a state with a huge population of illegals. To put it in number terms, where the per capita GDP is higher there tends to be a lower percentage of illegals and folks on the dole. So if you have enough people (MA) paying in or some people (NY) paying enough in, perhaps you can fly a MA style health care plan. Cut that GDP in half, by say running the same program in WV (where it is unemployment more than illegals) or AZ (where the reverse is true) and now you are talking about running a program that can't possibly be funded outside of straight up robbing people with jobs to pay for insurance for the illegals/ folks on the dole.
A problem with healthcare reform as the democrats/ leftists have advertised it, is that what could work in some states won't work in others. Where the demographics will sustain it and the people want it, I have no problem with the states passing MA style laws. Where the demographics won't sustain it and the people don't want it, nationalizing such policies seems not just draconian, not just to violate the 10th amendment, not just mindless of real economics, but foolish. Who's gonna pay the price in AZ, WV, MT, and LA (among others)? I haven't heard anyone on the left adress this.
This is why we have a 10th amendment. It wouldn't surprise me at all for Obama to go ahead and get some shaved down version passed in the hopes of regaining some face, just to have the whole shebang crapcanned via a 10th Amendment appeal to the Supreme Court and/or some other flavor of legal "states rights" revolt. Even if Obama "wins" at this point, he loses.
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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Jason™
Host emeritus
# 9037
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Posted
As happy as I am having Obama in office, I'd be just as happy if Obama's legacy was to push through some sort of universal health care system only to be ousted in 2012. I believe Canadians have voted Tommy Douglass as the most loved Canadian of all time, in part for his contributions to getting their health care system in place even though it was political suicide for him in many ways.
Socialized medicine could be very bad if done incorrectly. The answer, however, is not free market health care. The answer is better socialized medicine. All those who complain about socialism and big government and government interference and governement incompetence often have trouble articulating what they really want instead.
The reason for that difficulty is best explained by this clever rant "against" socialized medicine:
http://i4.photobucket.com/albums/y123/FistsOfCurry/5RkJK.png
A consistent argument in that direction involves a lot more desocialization than most realize.
Posts: 4123 | From: Land of Mary | Registered: Feb 2005
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by Macx:
Something that amuses me a bit about folks waving the MA banner as a success is an obvious factor MA doesn't have which many states do. That factor could very well be the chunk o' math that decides if such a program is viable or not in a state. I am of course, referring to illegals (and by extension non-taxpaying poly-generational wellfare families). MA isn't known for being a state with a huge population of illegals.
Macx, you don't know the half of it. Not only do we have few illegals, we have a lot of "legals" -- folks from New Hampshire who come down here to do our work and who pay MA taxes without being able to gain access to much of our social services.
I would urge every state to try to relocate next to NH. Their citizens are friendly and gullible -- the perfect neighbors...
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Macx:
Something that amuses me a bit about folks waving the MA banner as a success is an obvious factor MA doesn't have which many states do. That factor could very well be the chunk o' math that decides if such a program is viable or not in a state. I am of course, referring to illegals (and by extension non-taxpaying poly-generational wellfare families). MA isn't known for being a state with a huge population of illegals. To put it in number terms, where the per capita GDP is higher there tends to be a lower percentage of illegals and folks on the dole. So if you have enough people (MA) paying in or some people (NY) paying enough in, perhaps you can fly a MA style health care plan. Cut that GDP in half, by say running the same program in WV (where it is unemployment more than illegals) or AZ (where the reverse is true) and now you are talking about running a program that can't possibly be funded outside of straight up robbing people with jobs to pay for insurance for the illegals/ folks on the dole.
Well since in states like CA and AZ the state is already covering illegals, only in the most expensive way possible (ER care), it's really gonna work out pretty much the same as now.
But it does illustrate how all our economic woes are inextricably intertwined. And thus is a good argument for immigration reform and a good guest-worker program.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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moron
Shipmate
# 206
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Posted
quote:
Originally posted by Erin:
I wish that the right/anarchists/whatever you call yourselves would freaking stop with the "messiah" strawman. It's insulting and a goddamned LIE.
quote:
Because if we are willing to work for it, and fight for it, and believe in it, then I am absolutely certain that generations from now, we will be able to look back and tell our children that this was the moment when we began to provide care for the sick and good jobs to the jobless; this was the moment when the rise of the oceans began to slow and our planet began to heal; this was the moment when we ended a war and secured our nation and restored our image as the last, best hope on earth. This was the moment—this was the time—when we came together to remake this great nation so that it may always reflect our very best selves and our highest ideals. Thank you, God bless you, and may God bless the United States of America.
My bold.
![[Razz]](tongue.gif)
Posts: 4236 | From: Bentonville | Registered: May 2001
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RuthW
liberal "peace first" hankie squeezer
# 13
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Posted
quote:
Originally posted by tclune:
MA just raised its sales tax from 5 to 6.25 percent to try to keep the books in balance. Nobody likes that option -- it's self-defeating to raise prices during a recession, but the states are hog-tied by their balanced budget requirements. MA will come out of this recession in good shape if it doesn't go on much longer, but it has been hard on everyone. The health insurance reform is not the major cause of that pain, though.
You'll be in better shape than California, where on April 1 sales tax went from 7.25% to 8.25% -- local taxes bring it up to 9.75% where I live.
In today's NY Times Paul Krugman likens the MA program to the Swiss system. He thinks it would be cheaper simply to extend Medicare to everyone, but will settle for "using regulation and subsidies to ensure universal coverage" as an improvement over the current situation.
Posts: 24453 | From: La La Land | Registered: Apr 2001
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Taliesin
Shipmate
# 14017
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Posted
Just a short post to add my wholehearted appreciation of the NHS. I pay a very small percentage of my wage in NI contributions - nothing like the terrible amounts my American friends have to pay between jobs with adequate coverage. Every time a family member has a problem - from needing joint replacement or other non-urgent surgery, to treatment for an ongoing condition, to repairs after an accident -I expect to have to wait, or for specialists not to be available, or for there to be no NHS dentists, because I'm as susceptible as anyone else to what's said in newspapers, and 'statistics'...
And every time I've been amazed at the speed and professionalism of it all. I understand it may be better in some areas than others - maybe that's true in France as well?
I'm also stunned at how rude and ungrateful people are - people take it for granted and abuse the system; and yet it's STILL cheaper and more efficient. Good, huh?
Posts: 2138 | From: South, UK | Registered: Aug 2008
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Macx
Shipmate
# 14532
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by Macx:
Something that amuses me a bit <snip> Cut that GDP in half, by say running the same program in WV (where it is unemployment more than illegals) or AZ (where the reverse is true) and now you are talking about running a program that can't possibly be funded outside of straight up robbing people with jobs to pay for insurance for the illegals/ folks on the dole.
Well since in states like CA and AZ the state is already covering illegals, only in the most expensive way possible (ER care), it's really gonna work out pretty much the same as now.
But it does illustrate how all our economic woes are inextricably intertwined. And thus is a good argument for immigration reform and a good guest-worker program.
Hehe, yeah. CA's state budget is a model for the rest of the country ![[Roll Eyes]](rolleyes.gif) Problem is, the same people who are trying to cram an unpopular (in the United States, among United States citizens) Health Care plan down the throats of citizens are the same people who think amnesties are great for getting the legal family members of illegals to vote for your re-election, economy be damned.
The problem with talking about immigration reform is, it is a conversation we're going to need to wait at least 3 1/2 years to talk about in any kind of meaningful way. Maybe we could revisit tht topic of national healthcare after we accomplish immigration reform in some way that excludes sanctuary cities & includes felonies for aiding and abetting from the farmer that hires migrants to the district attorney that fails to deport illegals within his/her jurisdiction's jails. That, is a different topic though & likely to be discussed in Hell if it isn't floating around in Dead Horses.
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Macx:
[QUOTE] Hehe, yeah. CA's state budget is a model for the rest of the country
If you think that's what I was saying in my post then you just weren't paying attention.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Macx
Shipmate
# 14532
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Posted
Oh, not at all. We're on the same page.
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Macx:
Oh, not at all. We're on the same page.
Aack! Not even. Maybe just on the CA budget.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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Sober Preacher's Kid
Presbymethegationalist
# 12699
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by Macx:
Something that amuses me a bit about folks waving the MA banner as a success is an obvious factor MA doesn't have which many states do. That factor could very well be the chunk o' math that decides if such a program is viable or not in a state. I am of course, referring to illegals (and by extension non-taxpaying poly-generational wellfare families). MA isn't known for being a state with a huge population of illegals. To put it in number terms, where the per capita GDP is higher there tends to be a lower percentage of illegals and folks on the dole. So if you have enough people (MA) paying in or some people (NY) paying enough in, perhaps you can fly a MA style health care plan. Cut that GDP in half, by say running the same program in WV (where it is unemployment more than illegals) or AZ (where the reverse is true) and now you are talking about running a program that can't possibly be funded outside of straight up robbing people with jobs to pay for insurance for the illegals/ folks on the dole.
Well since in states like CA and AZ the state is already covering illegals, only in the most expensive way possible (ER care), it's really gonna work out pretty much the same as now.
But it does illustrate how all our economic woes are inextricably intertwined. And thus is a good argument for immigration reform and a good guest-worker program.
*Cough*
My favourite Republican, Mitt Romney said the problem of the poor and uncovered receiving expensive care motivated him to support health reform as Massachusetts governor.
I find this episode extremely illuminating as to which way the American health debate will unfold.
Oh, did I mention the Republicans have a mole in their midst? ![[Big Grin]](biggrin.gif)
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NDP Federal Convention Ottawa 2018: A random assortment of Prots and Trots.
Posts: 7646 | From: Peterborough, Upper Canada | Registered: Jun 2007
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Macx
Shipmate
# 14532
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by Macx:
Oh, not at all. We're on the same page.
Aack! Not even. Maybe just on the CA budget.
Little by little, you will be converted. It has already begun, there is no escape. . . . no turning back. ![[Biased]](wink.gif)
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Ghosts are always faster in the corners.
Your shipmate,
Macx
Posts: 457 | From: Whittier, Twin Cities, MN | Registered: Feb 2009
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Clint Boggis
Shipmate
# 633
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by LutheranChik:
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
.
I'm still struggling to understand what the downside of the public option is for the everyday consumer. I get why the big insurers are worried (I couldn't care less that they are, but I understand it). But why is the average consumer simultaneously worried that government run (again, a misnomer) health care will be "too expensive" while simultaneously sure it will "drive the private insurance companies out of business"? If it does drive the privates out of business (and again, I highly doubt that would be the case) doesn't that just PROVE it can be done cheaper? Isn't that a win-win for consumers? If you have a lot of stock in Cigna, yeah, that's a problem but for the pitchforked masses-- what exactly are you afraid of???
Yes it's completely ridiculous isn't it? It's sad that people so stupid argue against their own interests. With a very little willingness to listen, some of them might understand and then their simple little faces would light up with the joy of discovery!
Imagine if there had been no police. People with money would pay private security firms to patrol their properties or accompany them for personal protection. Some would get together in gated communities with a guard to control entry. Ordinary people would either fend off burglars and muggers using whatever means they have available or risk injury, losing everything they own and death.
Then a new president proposes a publicly funded police force to share to cost and share the risk among everyone. The majority breathe a huge sigh of relief at the prospect, while the rich and the stupid and those who mindlessly loathe anything to do with government or authority which 'usurps' their personal responsibility shout it down and tell lies to scare or persuade the gullible.
I can't imagine a civilised country without a police force to protect the public but then I'm not one of the pitchfork-wielding arsehole faction. Doesn't the same logic apply to police and health care?
.
Posts: 1505 | From: south coast | Registered: Jun 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by Clint Boggis:
quote:
Originally posted by cliffdweller:
quote:
Originally posted by LutheranChik:
Well, the latest is that the Obama administration is giving up on promoting a public option in its plan. This is very disappointing.
.
I'm still struggling to understand what the downside of the public option is for the everyday consumer. I get why the big insurers are worried (I couldn't care less that they are, but I understand it). But why is the average consumer simultaneously worried that government run (again, a misnomer) health care will be "too expensive" while simultaneously sure it will "drive the private insurance companies out of business"? If it does drive the privates out of business (and again, I highly doubt that would be the case) doesn't that just PROVE it can be done cheaper? Isn't that a win-win for consumers? If you have a lot of stock in Cigna, yeah, that's a problem but for the pitchforked masses-- what exactly are you afraid of???
Yes it's completely ridiculous isn't it? It's sad that people so stupid argue against their own interests. With a very little willingness to listen, some of them might understand and then their simple little faces would light up with the joy of discovery!
While I would personally favor a single-payer plan, I think it is incredibly counterproductive to assume that those with a different view are stupid (if you're liberal) or evil (if you're conservative.) It is perfectly possible to have a different view from me and be neither (which either proves that I'm MOR or that I am both stupid and evil).
The concerns about the public option are many. First, as Obama properly noted in his Colorado town meeting, is that the costs of a public option are not all borne in the open.
The example that Obama gave was the cost of capital and the related issue of how much money needs to be held in reserve to insure the viability of the insurance in the event of an unusual string of costly events. It is not waste or excessive profiteering that makes this a greater cost of a private company -- it is that the taxpayer is providing the insurance for the public option and not for the private option.
It is possible to structure a system where the cost of capital is essentially the same for public and private insurance entities. But being conceerned about this as a hidden cost of a public option and an overt cost of a private one is just a matter of honestly assessing relative costs and benefits.
Most of the benefits that one hopes to achieve with insurance reform can be achieved without a public option at all. Things like universal coverage, not dropping people when they get sick, etc. can be achieved through legislation that does not involve any public option.
Other benefits are not obviously achievable simply by adding public option. For example, the big non-medical cost of the health insurance industry is wrapped up in the multitude of rules and regulations that each plan has that they will pay for. While incorporating a standard list of common coverage will massively lower the paperwork in the typical case (again, not requiring a public option at all), there will still be many circumstances where it will be unclear whether a particular procedure is covered by a particular insurance, and negotiations prior to treatment will still be the norm AFAICS.
Finally, the big deal that can only be addressed AFAICS by a single-payer system is health care reform -- shifting the rewards from the extreme bias we currently have for specialization back to a less expensive and more medically-effective emphasis on primary care will require a system that can dictate the rewards to the medical establishment. That idea sticks in the craw of many, but the alternative seems to me to be a continuation of the high-priced treatment of conditions that could and should have been prevented in the first place if there had been high-quality primary care.
The medical community talks as though they were driven by altruism, but chooses their practice based on where the money is. There is nothing wrong with that, but it does mean that we as a society need to make sure that the money is in the kind of care that we want to receive. The private system that we have simply doesn't (and, AFAICS, can't) provide that guidance.
In all honesty, I can understand people opposing any public option and I can understand people opting for a single-payer system. What is considerably less obvious to me is what added value a new public option would add to our system.
--Tom Clune
[ 18. August 2009, 12:49: Message edited by: tclune ]
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by tclune:
The medical community talks as though they were driven by altruism, but chooses their practice based on where the money is. There is nothing wrong with that, but it does mean that we as a society need to make sure that the money is in the kind of care that we want to receive. The private system that we have simply doesn't (and, AFAICS, can't) provide that guidance.
The private system that we have doesn't provide that guidance. But David Goldhill (the author of that article in the Atlantic that I posted back a page or so) described a private system that probably could.
His opinion is that, as long as insurers are paying for virtually all healthcare, instead of patients, healthcare will respond to the needs of insurers and not of patients. So, for example, you get health care providers investing in IT for insurance billing, but not for patient records. It's almost impossible for patients to find out how much things cost. (Try it sometime, if you don't believe it.) And you've got high rates of hospital-acquired infections, which kill thousands and thousands of people, but which hospitals do almost nothing about. The patients aren't their greatest concern. In fact, if hospitals do their jobs too well, they make less money. It's a crazy system.
So Goldhill argues that we ought to buy our healthcare ourselves. Instead of paying an average of $12,000 per year to insurance companies on our behalf, if we were given that money, and required to stash it in a health savings account, and then use that to buy our routine health care, and used insurance only for truly catastrophic expenses, the system would become accountable to patients really, really fast.
Oh, and for the poor, he suggested that the government provide some or all of the HSA money, but leave it up to the poor to spend it themselves. It would cost the government less to do it that way, and it would have the effect of providing universal access to health insurance.
The article is worth reading. He may be describing what some folks have been saying they want: a uniquely American model with a minimal government role, universal access, and lower cost.
I wrote my senators and congresscritter, asking them to read the article, telling them that I consider it imperative to provide universal access to healthcare, and to decouple health insurance from employment. I know there are many ways to do that. I think the way described by Mr. Goldhill has merit (although I disagree with some of the details). It should at least be part of the conversation.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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Erin
Meaner than Godzilla
# 2
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Posted
quote:
Originally posted by tclune:
Other benefits are not obviously achievable simply by adding public option. For example, the big non-medical cost of the health insurance industry is wrapped up in the multitude of rules and regulations that each plan has that they will pay for. While incorporating a standard list of common coverage will massively lower the paperwork in the typical case (again, not requiring a public option at all), there will still be many circumstances where it will be unclear whether a particular procedure is covered by a particular insurance, and negotiations prior to treatment will still be the norm AFAICS.
A big chunk of the costs would be ameliorated if payers just complied with the HIPAA transaction and code set requirements. They refuse, of course, because otherwise they would have no excuse not to pay, but it's been how many freaking years and we still have to pick up the phone and call them?
quote:
Finally, the big deal that can only be addressed AFAICS by a single-payer system is health care reform -- shifting the rewards from the extreme bias we currently have for specialization back to a less expensive and more medically-effective emphasis on primary care will require a system that can dictate the rewards to the medical establishment. That idea sticks in the craw of many, but the alternative seems to me to be a continuation of the high-priced treatment of conditions that could and should have been prevented in the first place if there had been high-quality primary care.
The medical community talks as though they were driven by altruism, but chooses their practice based on where the money is. There is nothing wrong with that, but it does mean that we as a society need to make sure that the money is in the kind of care that we want to receive. The private system that we have simply doesn't (and, AFAICS, can't) provide that guidance.
I agree somewhat, but I honestly think the only way to get healthcare costs down is to have coordinated care amongst the physicians. Whether it be through the structure of the organization (Mayo Clinic) or the physicians just teaming up and getting it done (Grand Junction, CO), collaborative care is probably the single most effective way to manage healthcare costs.
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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Jason™
Host emeritus
# 9037
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Posted
Josephine,
Would this be similar to the Social Security accounts idea that failed for Bush a few years ago? Or is there a difference to it that I'm missing?
Posts: 4123 | From: Land of Mary | Registered: Feb 2005
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Josephine
Orthodox Belle
# 3899
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Posted
Given that the health savings accounts are intended primarily for short-term needs, I think they wouldn't be invested, but would be kept in some form of cash equivalent. You wouldn't have to worry about a stock market crash wiping out your health savings.
Also, these accounts would be topped off or funded entirely by the government for the poor. I don't recall anyone saying about the privatized social security option that, if you didn't have enough income to put enough into your retirement account, that the government would put money in it on your behalf.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by Erin:
A big chunk of the costs would be ameliorated if payers just complied with the HIPAA transaction and code set requirements. They refuse, of course, because otherwise they would have no excuse not to pay, but it's been how many freaking years and we still have to pick up the phone and call them?
I'm not really up to speed on the HIPAA initiatives. But I am thoroughly familiar with the DICOM attempts at standardizing structured reports and using SNO*MED nomenclature to standardize reporting and speed payments.
The basic difficulty seems to be that it just shifts the nature of the game. Dermatologists offer facials and code the "treatment" in the way that gets reimbursed, etc. This isn't just an insurance company problem -- greed exists on all sides of this equation and complicates rational delivery of care.
One thing that would be easier to include under a single-payer system is criminalizing many of the more egregious acts of some physicians. Theft is theft, even when it's done with an insurance claims form. Private insurance has absolutely no incentive to prosecute these frauds. That is kind of counter-intuitive to me, but empirically it is clearly the case.
The amount of medical fraud appears to be very substantial. We don't discuss that in these debates because the opposition would kill whoever questioned the integrity of any doctor. Can any politician survive an ad campaign that pits his integrity against that of the men and women in white lab coats? But that's an image problem, not a reality of medical practice.
We need to root out both incompetence and fraud in medicine to get control of the practice. Neither of these is addressed at all in our current system. We need a single point of entry to go after this sort of thing, but the politics is that raising the issue is a guaranteed loser for whoever does.
--Tom Clune
[ 18. August 2009, 13:53: Message edited by: tclune ]
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by Josephine:
So Goldhill argues that we ought to buy our healthcare ourselves. Instead of paying an average of $12,000 per year to insurance companies on our behalf, if we were given that money, and required to stash it in a health savings account, and then use that to buy our routine health care, and used insurance only for truly catastrophic expenses, the system would become accountable to patients really, really fast.
That seems to be nibbling around the edges rather than dealing with the main problem, which usually involves "truly catastrophic expenses" rather than routine health care. The financial incentive would still exist for the insurance company to dump the cancer patient or the patient with renal failure because they previously had acne.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by New Yorker:
A glimpse into the future?
How horrible! Those sorts of decisions should be made by insurance corporations like God intended.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by New Yorker:
A glimpse into the future?
No, that's a glimpse of the present. If you don't believe that care is routinely denied by private insurance companies now, you are so far out of touch with reality that there is no real basis for discussion until you get up to speed on how medicine is actually practiced.
--tom clune
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Erin
Meaner than Godzilla
# 2
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Posted
quote:
Originally posted by New Yorker:
A glimpse into the future?
No. In some ways it resembles the present, in that insurance companies today have people and groups that deny coverage for life-saving treatment every single day. Do you really not know this? Seriously: is it news to you that this happens every single day except maybe Sundays in this country?
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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Josephine
Orthodox Belle
# 3899
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Posted
quote:
Originally posted by Crœsos:
quote:
Originally posted by Josephine:
So Goldhill argues that we ought to buy our healthcare ourselves. Instead of paying an average of $12,000 per year to insurance companies on our behalf, if we were given that money, and required to stash it in a health savings account, and then use that to buy our routine health care, and used insurance only for truly catastrophic expenses, the system would become accountable to patients really, really fast.
That seems to be nibbling around the edges rather than dealing with the main problem, which usually involves "truly catastrophic expenses" rather than routine health care. The financial incentive would still exist for the insurance company to dump the cancer patient or the patient with renal failure because they previously had acne.
Did you read the article I linked to?
No, I didn't think so. Try reading it.
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I've written a book! Catherine's Pascha: A celebration of Easter in the Orthodox Church. It's a lovely book for children. Take a look!
Posts: 10273 | From: Pacific Northwest, USA | Registered: Jan 2003
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by Macx:
[QUOTE] Little by little, you will be converted. It has already begun, there is no escape. . . . no turning back.
Aack! My eyes! My eyes! The horror!
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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cliffdweller
Shipmate
# 13338
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Posted
quote:
Originally posted by tclune:
[QUOTE]While I would personally favor a single-payer plan, I think it is incredibly counterproductive to assume that those with a different view are stupid (if you're liberal) or evil (if you're conservative.) It is perfectly possible to have a different view from me and be neither (which either proves that I'm MOR or that I am both stupid and evil).
Absolute. But neither Clint nor I said that. We simply expressed our difficulty understanding both the logical inconsistencies of the conservative argument, and the motivation of some of the protesters.
quote:
Originally posted by tclune:
[QUOTE]
The concerns about the public option are many. First, as Obama properly noted in his Colorado town meeting, is that the costs of a public option are not all borne in the open.
The example that Obama gave was the cost of capital and the related issue of how much money needs to be held in reserve to insure the viability of the insurance in the event of an unusual string of costly events. It is not waste or excessive profiteering that makes this a greater cost of a private company -- it is that the taxpayer is providing the insurance for the public option and not for the private option.
How is this different than the current situation, when consumers pay for their own health care through private insurance, but also pay hidden costs through offsets for the care of the uninsured? We;re already paying these costs, but shifting the uninsured into the insured ranks we should at least be able to lower those costs by shifting the uninsured to less expensive preventative care, rather than strictly ER.
quote:
Originally posted by tclune:
[QUOTE]
Most of the benefits that one hopes to achieve with insurance reform can be achieved without a public option at all. Things like universal coverage, not dropping people when they get sick, etc. can be achieved through legislation that does not involve any public option.
Sure, which is why Obama is now willing to give it up. But that alone doesn't show that including a public option wouldn't provide some additional benefit or cost savings.
quote:
Originally posted by tclune:
[QUOTE]
Other benefits are not obviously achievable simply by adding public option. For example, the big non-medical cost of the health insurance industry is wrapped up in the multitude of rules and regulations that each plan has that they will pay for. While incorporating a standard list of common coverage will massively lower the paperwork in the typical case (again, not requiring a public option at all), there will still be many circumstances where it will be unclear whether a particular procedure is covered by a particular insurance, and negotiations prior to treatment will still be the norm AFAICS.
Finally, the big deal that can only be addressed AFAICS by a single-payer system is health care reform -- shifting the rewards from the extreme bias we currently have for specialization back to a less expensive and more medically-effective emphasis on primary care will require a system that can dictate the rewards to the medical establishment. That idea sticks in the craw of many, but the alternative seems to me to be a continuation of the high-priced treatment of conditions that could and should have been prevented in the first place if there had been high-quality primary care.
I don't see how either of these is as an argument against a public option. All you've done is show that a public option is not a magic bullet that solves everything. No one is suggesting it is. But NOT having a public option doesn't solve any of these problems either.
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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner
Posts: 11242 | From: a small canyon overlooking the city | Registered: Jan 2008
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New Yorker
Shipmate
# 9898
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Posted
quote:
Originally posted by Erin:
quote:
Originally posted by New Yorker:
A glimpse into the future?
No. In some ways it resembles the present, in that insurance companies today have people and groups that deny coverage for life-saving treatment every single day. Do you really not know this? Seriously: is it news to you that this happens every single day except maybe Sundays in this country?
Well, at least now if your insurance company denies care those who are able can self pay. If the death panels come into being then that option is removed.
Posts: 3193 | From: New York City | Registered: Jul 2005
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by cliffdweller:
quote:
Originally posted by tclune:
<snip>The example that Obama gave was the cost of capital and the related issue of how much money needs to be held in reserve to insure the viability of the insurance in the event of an unusual string of costly events. <snip>
How is this different than the current situation, when consumers pay for their own health care through private insurance, but also pay hidden costs through offsets for the care of the uninsured? We're already paying these costs, but shifting the uninsured into the insured ranks we should at least be able to lower those costs by shifting the uninsured to less expensive preventative care, rather than strictly ER.
I'm afraid I don't understand the equivalence you are trying to draw here. If we have universal coverage, of any flavor, there will be no shifting of payment from uninsured to insured. However, because insurance companies have to maintain a reserve of money in the event of a statistically unusual run on services, cost of capital will apply in either case. The cost of that reserve can be overt, as with a private company's costs, or hidden, as when Uncle Sam provides the deeep pockets to cover anomalous events. If the private company has to pay for the reserve and a public option can simply dip into the public treasury as needed, then there is an artificial advantage built into the public option. Obama's point seemed to be that the private insurers ought to have access to the same capital funding mechanisms that a public option might have, to provide a level playing field for evaluating which operations were actually achieving economies through efficient operation.
quote:
Originally posted by cliffdweller:
quote:
Originally posted by tclune:
Most of the benefits that one hopes to achieve with insurance reform can be achieved without a public option at all. Things like universal coverage, not dropping people when they get sick, etc. can be achieved through legislation that does not involve any public option.
Sure, which is why Obama is now willing to give it up. But that alone doesn't show that including a public option wouldn't provide some additional benefit or cost savings.
No, but the burden of proof is on those who are arguing for some large new government program. If it offers no known benefit, why would we do it? That's the point -- there is no gain that I can discern from the "public option" idea. I can see advantages to a single payer system, but I just don't see why a public option would add any advantage that we couldn't achieve without creating this new monster. So, what is it that creating this monster is going to do for us that we can't get without it? Saying that there might be such a thing isn't going to cut it. You need to identify what the advantage is (or at least is hoped to be).
quote:
Originally posted by cliffdweller:
quote:
Originally posted by tclune:
Other benefits are not obviously achievable simply by adding public option. For example, the big non-medical cost of the health insurance industry is wrapped up in the multitude of rules and regulations that each plan has that they will pay for. While incorporating a standard list of common coverage will massively lower the paperwork in the typical case (again, not requiring a public option at all), there will still be many circumstances where it will be unclear whether a particular procedure is covered by a particular insurance, and negotiations prior to treatment will still be the norm AFAICS.
Finally, the big deal that can only be addressed AFAICS by a single-payer system is health care reform -- shifting the rewards from the extreme bias we currently have for specialization back to a less expensive and more medically-effective emphasis on primary care will require a system that can dictate the rewards to the medical establishment. <snip>
I don't see how either of these is as an argument against a public option. All you've done is show that a public option is not a magic bullet that solves everything. No one is suggesting it is. But NOT having a public option doesn't solve any of these problems either.
You still haven't come to grips with the basic point: If you can achieve all the advantages that you are after without creating a new and huge governemental entity, it seems overwhelmingly obvious that you shouldn't create the huge governmental agency. If a public option doesn't provide a benefit that you seek, while a single payer system would, then again you have not got any reason to adopt a public option.
Unless you're just a fan of large bureaucracy, showing no benefit is the same as a reductio on the assertion that we should create one. If you want to argue that we need this option, you have to establish that there is something of value that we can't get without it. That's not a very difficult point.
Here's the short form: You need to show some problem to which a public option is the answer. Failing that, there is no reason to even consider creating such a thing.
--Tom Clune
[ 18. August 2009, 15:57: Message edited by: tclune ]
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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ToujoursDan
Ship's prole
# 10578
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Posted
quote:
Originally posted by New Yorker:
quote:
Originally posted by Erin:
quote:
Originally posted by New Yorker:
A glimpse into the future?
No. In some ways it resembles the present, in that insurance companies today have people and groups that deny coverage for life-saving treatment every single day. Do you really not know this? Seriously: is it news to you that this happens every single day except maybe Sundays in this country?
Well, at least now if your insurance company denies care those who are able can self pay. If the death panels come into being then that option is removed.
Says whom? There aren't these kind of "death panels" in any proposed bill and the public option doesn't mean that those who have the ability to pay out of pocket lose the ability to do this.
Furthermore, there isn't a single country with nationalized care, like the NHS or Medicare Canada or Australia that does anything like this.
It's nothing more than something people have made up. It doesn't exist. It isn't being proposed. It's fiction.
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"Many people say I embarrass them with my humility" - Archbishop Peter Akinola
Facebook link: http://www.facebook.com/toujoursdan
Posts: 3734 | From: NYC | Registered: Oct 2005
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Erin
Meaner than Godzilla
# 2
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Posted
quote:
Originally posted by New Yorker:
quote:
Originally posted by Erin:
quote:
Originally posted by New Yorker:
A glimpse into the future?
No. In some ways it resembles the present, in that insurance companies today have people and groups that deny coverage for life-saving treatment every single day. Do you really not know this? Seriously: is it news to you that this happens every single day except maybe Sundays in this country?
Well, at least now if your insurance company denies care those who are able can self pay. If the death panels come into being then that option is removed.
Really? I haven't read that, would you mind pointing me to your source?
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Commandment number one: shut the hell up.
Posts: 17140 | From: 330 miles north of paradise | Registered: Mar 2001
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ken
Ship's Roundhead
# 2460
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Posted
quote:
Originally posted by New Yorker:
If the death panels come into being then that option is removed.
You know perfectly well it was the Republicans, and the people pullign their strings, ones who thought that idea up. Is nothing to do with Obama or the Democrats and you should be ashamed for perpetuating the lie that it is.
May you dream of Stephen Hawking tonight.
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Ken
L’amor che move il sole e l’altre stelle.
Posts: 39579 | From: London | Registered: Mar 2002
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Crœsos
Shipmate
# 238
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Posted
quote:
Originally posted by tclune:
Here's the short form: You need to show some problem to which a public option is the answer. Failing that, there is no reason to even consider creating such a thing.
--Tom Clune
The public option is the counterbalance to mandated participation. Health care for catastrophic situations is something that a) you don't know if you'll ever really need and, unless you're incredibly wealthy, b) you couldn't save up for even if you knew in advance you'd need it. Given this, the obvious solution is some sort of risk pooling, with everyone paying in and those "lucky" souls who get cancer or banged up in a car accident being the ones to draw on the pooled resources of the group.
The problem with a program that isn't allowed to turn anyone away is that the incentive is for healthy folks to save their money by opting out and only joining at the last minute if they need the service. One solution to this problem (the current one in the U.S.) is simply to make it so that you can't just join up at the last minute. The problems inherent in this "die in the gutter" approach are more or less why there's a health care debate in the U.S. at the moment, so I won't go into them here. The other solution is to simply mandate that everyone participate in the system. The problem here is that requiring people to buy insurance (or have it bought for them by the state if they can't afford it themselves) is essentially a huge bonus for private insurers for whom the economic incentive is to charge as much as possible for their services. The semi-market-based solution to this is to have a competitor motivated by something other than pure profit to keep prices somewhat in line. In other words, the public option. It's not the only solution to this problem, but it's the one that't currently seen as "politically workable" in the U.S.
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Humani nil a me alienum puto
Posts: 10706 | From: Sardis, Lydia | Registered: May 2001
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RuthW
liberal "peace first" hankie squeezer
# 13
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Posted
Quit with the references to "death panels." No one has proposed such a thing.
Robert Creamer gives three reasons why we need a public option, one of which is practical and makes sense and two of which are entirely political:
1) If the government is going to require everyone to buy health insurance, it has to provide a public option, because otherwise they're requiring everyone to buy something from private entities that have no incentive to keep costs down because there is not enough competition among them. As he says, "Once government requires you to purchase a product, it has to provide some means to guarantee that the price is fair." The two ways to do this are for government to regulate prices -- fat chance getting that through Congress, given the insurance industry's pull -- or for government to provide a public option.
Something I'd add to what he says is that this could work the way California's low-cost car insurance works. The state requires all drivers to buy car insurance, and most people just buy insurance directly from private companies. But if you're poor enough, you can buy it through the state, which processes the applications and then randomly assigns people to private companies -- if you want to sell car insurance in California, you have to accept a share of low-income drivers. Premiums are set in each county to cover the costs of losses and admin.
2) The health care bill is going to get passed chiefly on the strength of votes by Democrats, and about 100 Democratic Representatives have said a public option is a must-have.
3) The public option is symbolic for the progressives, who are the only people who are going to get passionate enough to rise up in opposition to the loud voices on the right opposing health care reform.
Posts: 24453 | From: La La Land | Registered: Apr 2001
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by Crœsos:
quote:
Originally posted by tclune:
Here's the short form: You need to show some problem to which a public option is the answer. Failing that, there is no reason to even consider creating such a thing.
--Tom Clune
The public option is the counterbalance to mandated participation.
...
The problem here is that requiring people to buy insurance (or have it bought for them by the state if they can't afford it themselves) is essentially a huge bonus for private insurers for whom the economic incentive is to charge as much as possible for their services. The semi-market-based solution to this is to have a competitor motivated by something other than pure profit to keep prices somewhat in line. In other words, the public option. It's not the only solution to this problem, but it's the one that't currently seen as "politically workable" in the U.S.
I can see this as a problem if there were only one insurance company. But we have a wealth of insurance companies competing with each other, including many that are either non-profit (Blue Cross/Blue Shield) or are customer-owned (the various Mutual insurance companies). It still seems like a solution in search of a problem. I'd need a lot more reason to believe that the insurance companies are likely to engage in a conspiracy of price-fixing before I would find the public option at all compelling.
It is much easier for insurance companies to withold service from the expensive customers than to charge high prices -- you don't know that they'll stiff you on service unless you get sick and become an undesireable customer anyway, whereas everybody knows the cost of the insurance going in.
--Tom Clune
[ETA: The political reasons listed in Ruth's post seem much more honest than this turkey of an argument. I saw Rep. Waters discuss why she would be damned before she'd give in on the public option. She never mentioned any virtue to the option at all. Rather, she said that she had wanted the single-payer option, and gave in on that because of political pressure. So she wasn't going to give in on this, too. But a stupid position is not worth defending. If she had fought for the single-payer system, it would have been a fight with substance. This is just a fight to insist that if she isn't going to get what makes sense to her, then the other side isn't going to get what makes sense to them. It is idiocy.]
[ 18. August 2009, 17:57: Message edited by: tclune ]
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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ToujoursDan
Ship's prole
# 10578
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Posted
Using the car insurance example in California as a model, how does one deal with the fact that 25% of drivers in California [b]still[b] drive with no insurance even with that "low cost" option available?
New York Times: California's uninsured
In the case of car insurance you can give the person a ticket and take the car away.
Let's say the proposed healthcare bill forces everyone to buy insurance, or else. What is the "or else"? Most people don't buy insurance because they can't afford it. Are we going to start penalizing the poor or those in financial distress because they can't afford the costs of a mandatory private plan? What would that mean? Fines? Jail time? What happens to someone who shows up for treatment but whose mandatory insurance has lapsed or been cancelled for non-payment? Are we back to huge bills leading to bankruptcies again?
There has to be some kind of public fallback for those who do not, or can not afford to buy something on their own.
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"Many people say I embarrass them with my humility" - Archbishop Peter Akinola
Facebook link: http://www.facebook.com/toujoursdan
Posts: 3734 | From: NYC | Registered: Oct 2005
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tclune
Shipmate
# 7959
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Posted
quote:
Originally posted by ToujoursDan:
Using the car insurance example in California as a model, how does one deal with the fact that 25% of drivers in California [b]still[b] drive with no insurance even with that "low cost" option available?
New York Times: California's uninsured
In the case of car insurance you can give the person a ticket and take the car away.
Let's say the proposed healthcare bill forces everyone to buy insurance, or else. What is the "or else"? Most people don't buy insurance because they can't afford it. Are we going to start penalizing the poor or those in financial distress because they can't afford the costs of a mandatory private plan? What would that mean? Fines? Jail time? What happens to someone who shows up for treatment but whose mandatory insurance has lapsed or been cancelled for non-payment? Are we back to huge bills leading to bankruptcies again?
There has to be some kind of public fallback for those who do not, or can not afford to buy something on their own.
MA deals with this by requiring people to submit a form disclosing their insurance when they file their income tax. If they don't, they are fined a significant amount of money (although less than the cost of buying insurance.) If they can't afford insurance, there isn't a problem -- the state has a fund to provide coverage or a subsidy for those who needs-test as not having sufficient funds to buy it. We still do not have 100% insurance coverage, although it's pretty close (over 90%, but I forget the exact figure.)
There are people who are allowed to opt out. If you are a Christian Scientist, for example, you don't have to buy insurance. But, except in the case of people with a "note from their doctor," youare required to either get insurance or get fined. If you don't file income tax, you face other problems if you're caught...
--Tom Clune
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Posts: 8013 | From: Western MA | Registered: Jul 2004
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ToujoursDan
Ship's prole
# 10578
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Posted
I get it, but find this completely crazy.
Surely, it would be more efficient to just put everyone on a public plan than put together a bureaucracy to monitor and fine those who can't/don't buy a policy.
When I look back at my own life, my bouts with poverty came quickly and unexpectedly when I lost a job and had to make decisions on what I had to pay for first. Putting a roof over my head and keeping the lights on were much more important than something nebulous like insurance. The thought that the state would further penalize me for being in such a position seem pretty cruel.
You'll never get universal coverage if the onus is on the individual to dig into their own pocket and buy a plan. If you don't have universal coverage then all the problems in the current system, with the uninsured showing up at the emergency room and their costs being borne by the insured, return.
A tax funded option would make more sense.
[ 18. August 2009, 18:13: Message edited by: ToujoursDan ]
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"Many people say I embarrass them with my humility" - Archbishop Peter Akinola
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Posts: 3734 | From: NYC | Registered: Oct 2005
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