patrick.net

srla,

I believe you just made my point. Health insurance, if it is to exist, should only be for catastrophic needs like open heart surgery.

By the way, if you don't know Medicare Part D is driving up costs, you probably don't work in a pharmacy.

If my posts don't make sense you are free to ignore me thank you.

2ndClassCitizen - Um, less red tape, yes. That is the nature of a single payer system. They have no forms to fill out. But unless you are envisioning a healthcare system where doctors do little more than treat sinus infections and sprained ankles, the high cost of many procedures would neccesitate lots of forms, whether to insurance companies or creditors. And have you ever tried taking out an unsecured loan for 100,000?

Yes, Medicare's drug coverage is a disaster in that it intentionally stopped the government from negotiating the same group discounts that the V.A., Canada, and every other country get. But is this not an argument for government intervention with drug pricing? How else do you contend that part D drove up drug costs?

No, the nature of a single payer system is wealth redistribution on a national scale. Add to that single payer will force me and millions of Americans to fund yet another government program the majority of us do not want. Like I said in my first post, how about ya'll who want the program put your money together and run it. Just let the rest of us opt out.

Wow free will, what a concept.

Patrick,
I applaud your fierceness on your health reform forum. Let me just
say, I had to deal with the medical system and my HMO insurance
company in depth due to my illness, and they suck.

Of course, I never realized they s.... until I had problems. I, like
most working people, were basically healthy, and got satisfactory
services for the kind of minor illness I have.

But when I needed something slightly different, the medical group was
against me, Blue Shield at all levels was against me for no good
reason. They made me wait and wait and went though rejection after
rejection. Do not think it will not happen to you readers. It just may
happen if these health insurance companies have no competition to
make the system better.

We need to fight hard for a better system with reasonable and
"predictable" cost/premium. Right now, we are "slave" of he medical
and insurance systems here. We have to work just to have insurance.

I hope our President and Legislative Bodies learn from Taiwan, a small
country with s pretty successful mandatory national health insurance.

http://blog.lib.umn.edu/schwitz/healthnews/2008/01/humbled-by-taiw.html

Part D costs tax payers in the fact that it exists and is expensive, very expensive. Part D costs seniors in that insurers are constantly changing their formularys to maximize profits and seniors can't keep up with the changes. Part D forces seniors to subscribe even if they don't need any medications by forcing up premiums for every month they don't join the plan. Part D encourages beneficiaries to utilize their benefits because they are already paying for them (they might as well get something even if they know they don't really need it). Part D might suppress drug prices for some beneficiaries but the other consumers are paying for the difference in higher costs and co-pays. Pharmacies generally charge much higher rates for people who have no insurance because they have to just to make up for the losses they incur due to unreasonable reimbursements by insurance companies (especially part D). Part D drives up costs by refusing to give patients a 90 days supply of medication, and instead forcing them to visit the pharmacy each month. Should I go on......

srla,

It seems like you're the one that isn't thinking things through and you're arguments are just rehash from liberal websites.

2ndClassCitizen said:
"That is because these are routine and predictable expenses associated with owning a car. Why does insurance have to get involved in routine maintenance such as physical exams, blood pressure medication, etc.. Shouldn’t insurance be for catastrophic illnesses like cancer, and motor vehicle accidents?"

It may not be a bad idea to have everyone(regardless of if it's a government plan or a private plan) to have an insurance plan that covers any major procedures or if out of pocket expenses over $5000.

I took my less than $10K car for a routine maintenance checkup and it cost me $1300 (labor plus expense to replace a few worn out parts) and and extra $200 to fix the antenna(which had broken at the base).

For a routine follow up with with a primary care doctor, Medicare pays the doctor about $30. $100 if the problem is more complex. If you don't have Medicare and no insurance(or a high deductable plan) it would probably cost you $100 for a routine visit or $250 if the problem is very complex. Of course if you need an MRI, it will cost you $4,000.

This way, no one is bankrupt by poor health(if you can't afford $5000, then the government should subsidize it).

Insurance should insure you against major loss. It should not be used to go to the emergency room everytime you have a cold.

altos,

I deal with Blue Shield all the time and they have been reasonable. Can you give some examples of thing they denied? Was what you were seeking experimental? Was it supported by the medical literature? Was it based on evidence medicine? If so, did your physician try to submit an authorization so that you can get it?

Everyone needs to understand that with a single payer system, it's not going to be a license to get every single procedure or medicine you want. In fact, unnecessary, experimental, marginal, procedures are exactly the things that will be cut out. It needs to be. Otherwise, it will be just as expensive and wasteful as the current system. It may even be worse if they don't regulate these things.

"No, the nature of a single payer system is wealth redistribution on a national scale." Um... well, since we already fund 60-65% of healthcare, would it really be that much worse? Especially when you throw in the massive amount of money wasted on the employer tax credit we both dislike. Add that in, and we are already paying for upwards of 70-75% of healthcare costs.

There might be a free market alternative to our system, but I have never heard one proposed that has a chance of working. On the other hand, every other major nation has some form of national health care for all citizens, so we know they can be effective.

Look, we're paying trillions for wars many of us opposed on the grounds they would not benefit us. Sometimes we pay for things we don't like. As a currently single person, I pay far, far higher taxes than married people with kids, like it or not. In fact, I find it amusing when many older married people complain about their "tax burden", only to find out they pay a few thousand bucks a year on a six figure salary. I compared figures with somebody I know who is married with kids and made the same as I did one year. He paid $6,000 and I paid $32,000. I might not like paying being taxed five times as much, but that's the way our society works, so I grin and bear it.

We need to change the system, or we will all go broke. If you know of a free market plan that will actually work, I would love to hear the details. But if we as a society were to decide to opt for single payer like everyone else has, then I guess those who don't like it will have to live with it. And I'm sure in any case, I'll pay quite a bit more for it than many others will.

srla,

Are you trying to scare us with threats like "change the system, or we will all go broke?" I can't think of any society in history where everyone went broke because they couldn't pay for health care. This bubble will pop if we get government and its insurance industry pimps out of the picture.

DT: "It seems like you’re the one that isn’t thinking things through and you’re arguments are just rehash from liberal websites."

If you have any specific evidence to support that, I'm all ears. I happen to side with the single-payer people on this one issue. I hardly agree with liberal websites on many issues. But simply because liberal people make certain statements does not make them untrue.

You said, "It may not be a bad idea to have everyone(regardless of if it’s a government plan or a private plan) to have an insurance plan that covers any major procedures or if out of pocket expenses over $5000." There is some logic to this approach, to be sure. There is a high degree of waste in no-deductible plans, and people do make dumb decisions when they have no financial investment. But if the deductible is too high, many will make equally bad decisions and put off seeing a doctor, thus leading to even higher decisions down the line.

This problem could be rectified in any system by simply having some sort of co-payment, especially for ER visits, and potentially income-based so as to disincentivize everyone equally from abusing the system. Canada is dealing with this very issue too. But a balance needs to be struck.

2ndClassCitizen, that is not a scare tactic, but a fact, based on cost projections from the CBO and other sources. You can disagree about what needs to be done, sure. But it's impossible to deny that if costs keep going up at the current rate of 17% a year, we will indeed go broke. It seems you want something to be done, but you prefer a free market approach. Fair enough. But are do you really believe that if we keep the present system as is, costs will not be prohibitive?

Some guy,

Yes, people are rioting in the streets for health care. No wait, they are accused of rioting against it. My mistake.

If you don't want single payer, that's fine. Of course, nothing close to single payer is on the table. At this point, the most that could change is that a government plan could be added to cover maybe 10% of the population and use its size to drive bargains and force badly needed competition. Due to intensive lobbying, it seems doubtful this will end up happening in any meaningful form.

It does seem most of us agree we are suffering from healthcare industry manipulation of the legislative process. Unfortunately, that seems the least likely thing to change.

I will add that since single payer, at its most expensive in other countries, costs less that 2/3 what our healthcare system costs per patient, and since the government already pays almost 2/3 of our national healthcare costs, then the redistribution would not be very large (and trust me, as one who gets redistributed FROM, that does matter to me). In fact, the only major redistribution under a single payer (or German-style multiple payer) system would be from healthcare interests to the rest of the economy.

I can understand why people are scared of change, especially given all the lies being promoted out there. But if you object to single payer, it would be helpful if you stated the specific reasons and why you object and give data to support them, rather than just relying on generalizations. That way we could respond to specifics.

srla,

Yes, if the government continues to subsidize health care the government will go broke. If it quits we all may yet have a chance.

chrisborden says

Yea, it ain’t no good news for people like me who never go to the doctor because we keep ourselves healthy (I don’t have insurance now because I earn a whopping $400 a week, but if I’m forced to buy it, of course I will, unless the penalty is small enough). I don’t like the idea of being forced to pay a “tax” that will FORCE me to spend money I don’t have, for care I don’t and might not ever need. I’d be willing to bet that it’ll cost me at least $300 a month, and that’s money DOWN THE TOILET unless I get sick, and that makes me sick. A heavy tax just to “insure” my health, and of course, if I have to buy it, you can bet I’m going to make up every condition in the book to get my money’s worth, rather than have the money go to waste, and that is what it is, waste. If it’s under $200 a month, I might bite, but beyond that, it’ll suck about 12% of my yearly income, and for frickin’ what? To make corporate profiteers richer. So that’s where this American comes from.

That's exactly I was thinking too. In fact I was so confident of my good health that even when my friend said that he had fever and cough, I still agreed to take him in my car to a business meeting. It never occurred to me that I could catch it from him. And what happened next is just scary to say the least. In fact someone who always hated doctors and believed in good health ended up going to emergency room, because I could not sleep 2 nights because of sever cough and fever. I tried postponing going to hospital thinking it will recover. I did not have insurance at the time as I had quit my job for a long vacation last year. My thought process was very similar to yours. Why buy health insurance when I never go to the doctor anyways.

To cut the long story short I ended up paying (in fact some of it is still not paid) 1200 bucks for my misadventure and that was after a 75 % discount. The hospital (El Camino in MT view) wanted to make me feel indebted to them for that 75 % discount. Doctors took 1 hour and did some unnecessary tests and wrote few prescriptions. But I was in such a terrible state that had they asked me to pay 5K for my illness I would have paid....

When you are healthy and doing well...Its hard to imagine what it feels like having bronchitis or pneumonia or malaria or Tuberculosis or cancer or 100s of other such diseases....

I don't mind paying to a govt system 100 or 200 dollars per month as part of my taxes, if I can be sure I will have a hospital to go to if I fall sick...

People are so frigging brainwashed in this country by big corporations that they have lost their power to think independently.

Well we agree that the current state of government interventions is a disaster. We pay far too much, that we can agree on. A big reason I support single payer is that it has a proven track record in many other countries. No such track record exists for a modern healthcare system totally free of government intervention. It is hard to see how that would address all our problems.

I also don't agree that healthcare is in a "bubble" in the sense that real estate was or tech stocks were. Bubbles are driven by speculative frenzy. People buy in out of fear they will be priced out, and they buy in out of a desire to make a killing. The government helped inflate the housing bubble by making credit far too cheap for far too long. They could have aborted it by simply admitting there was a bubble, or by not manipulating markets in the first place.

With healthcare, no such frenzied buying occurs. The cost goes up for completely different reasons - most prominently because of massive waste, over-testing, drug patent monopolies, insurance company inefficiencies, and malpractice issues. Therefore, the fix is far more complicated that it would be with financial markets. If the government were to withdraw altogether from involvement in healthcare, insurance companies would drop the vast majority over a certain age and everyone with health conditions. It's hard to see how that wouldn't be a disaster. Back before medicare, only 40% of seniors had coverage. If you want to see actual riots, talk about ending Medicare.

commonman2003 - man, sad to say, but you got off cheap. My insurance agent broke his little toe, waited 5 hours, switched emergency rooms, waited another 5 hours, then was treated in what he described as a supply closet by a doctor that popped his toe back into position in about 3 minutes. For that, he was billed $3,500 by UCLA. And that was after the hospital "discounted" his fees - conveniently down to the exact amount of his copay.

2ndClassCitizen says

No, the nature of a single payer system is wealth redistribution on a national scale. Add to that single payer will force me and millions of Americans to fund yet another government program the majority of us do not want. Like I said in my first post, how about ya’ll who want the program put your money together and run it. Just let the rest of us opt out.
Wow free will, what a concept.

Wealth redistribution ? You are so frigging afraid of wealth redistribution ? You think you made your fucking money in some island without anyone's help ?..What about all the people in the food chain who indirectly helped you. You think gardeners and janitors and other poor people are basically a nuisance ? God forbid if your millions somehow make it to help other people....

This extreme self centeredness has fucked this country...Everybody wants to slave away their life for a big fucking corporations and send hourly status report to their boss...Look at the life in Silicon valley..people do not have time to even chat freely for few minutes...Everybody is busy accumulating wealth...and making sure their frigging wealth is secure in some heavy locker....:-)

Fundamentally speaking, how is it not at least a little bit perverse that the insurance companies and big pharma are able to turn such massive profits from the inevitable breakdown of our biodegradable designs, a built-in feature for which no individual can be held liable? Outside of smokers, alchys and skydivers.

If you are a citizen of a nation who in some way contributes to that nation's GDP, why is it not then in the nation's best interest to insure it's own productivity? This is probably at least partially the thinking behind mass inoculations; beyond eradicating deadly/debilitating diseases, it keeps the population strong and generating the taxable incomes needed to keep the Senators and Congressmen employed and insured, among other things.

Yes, if the government continues to subsidize health care the government will go broke. If it quits we all may yet have a chance.

Chance? At what? That ship has sailed. Again, WHERE was all this outrage and debate during the bailouts of the banking industry? There wasn't one tenth of one percent of this level of concern (or rage) over the national debt and future tax burdens to lower and middle-class families in the coming decades.

commonman2003 - hahah But like I said, the really weird part is, we're already paying roughly the same amount just for Medicare that we would pay in a true single payer system, give or take 5-10%. Hard to believe, but it's true. A lot of us do pay a pretty decent amount in taxes already, especially here in CA. The trouble is, if we don't cut out all the pork in the system and just force everyone to get insured privately, either private people will go broke from premiums or the government will from subsidizing those premiums.

We need some sort of overhaul to cut prices from their current trajectory.

Wealth redistribution ? You are so frigging afraid of wealth redistribution ? You think you made your fucking money in some island without anyone’s help ?..What about all the people in the food chain who indirectly helped you. You think gardeners and janitors and other poor people are basically a nuisance ? God forbid if your millions somehow make it to help other people….

Find me one millionaire who doesn't think he *earned* his fortune.

Austinhousingbubble - I think most people here were pretty outraged by the bank bailouts. And I'd add the war debt to that total too, since I thought it was a huge waste of money.

I don't see any alternative myself to eventual single payer in the long run. I can't help but have mixed feelings about that, given the immigration situation and the costs related to that. But I also can't see denying anyone access to healthcare. It's just not a remotely humane option in a country this well off.

commonman2003,

I wish it was so, most of us are just struggling to pay off our loans. Is it too much to ask that I get to choose where the fruits of my labor go? Or should I just send the fruits of my labor to you? Clearly you have better sense of where it should be spent than a 2ndClassCitizen like me. What is the address for my payments? You'll be the first to get paid after the bank is finished with me.

Come to think of it, I would have been better off doing what I guy I met a couple of months ago said he is doing. He was a school teacher in Chicago, but moved to Hawaii to live off welfare, he is "letting the system work for him." (his own words). I should have just not gone to college, not taken out any loans and let the system work for me. What was I thinking? Man am I dumb!

Yes, people are rioting in the streets for health care. No wait, they are accused of rioting against it. My mistake.

They might be if they weren't busy being laid-up in the ER or urgent care facility waiting four to five hours for a scrip.

The reason standard market rules don’t apply in healthcare is that people approach meidcal care far differently than they do buying a car or a house. They place complete trust in their doctors - in fact, they trust them with their lives. It is all but impossible to shop for prices for heart surgery or many similar treatments. The system is not set up for it, and people are simply not psychologically able to approach healthcare with the same attitude as they would shopping for a computer. And really, can you blame them? Paul Krugman made an excellent analogy when he said you wouldn’t want to comparison shop for firemen. People approach healthcare in much the same way as they do other public services. Sure, when forced to, they will comparison shop in India, but this is mainly out of desperation. It is not optimal.

if i want a open heart surgery, i want to go to the best doctor. when i do that it drives UP the income for the best doctor. it also drives down the income of bad doctor because i am not going to him. This kind of pricing pressure is needed for market to be functional. Hospitals will try to be better for the same price. A system without proper incentives generally breaks.history proves it. people if given a choice will shop for best doctor for the price they can afford. If i have $100, i'll shop for best doctor i can get for that $100. how is that not shopping for price ? A doctor will try to get a treatment to me for $100 because thats what i can afford. GET REAL GUYS, for most people health care is not affordable so they WILL shop for whats affordable, this will bring down costs.

Austinhousingbubble says

Yes, people are rioting in the streets for health care. No wait, they are accused of rioting against it. My mistake.

They might be if they weren’t busy being laid-up in the ER or urgent care facility waiting four to five hours for a scrip.

And I'm sure with single payer it will be 15 minutes or less or the next amputation is free.

Austinhousingbubble - I think most people here were pretty outraged by the bank bailouts. And I’d add the war debt to that total too, since I thought it was a huge waste of money.

There wasn't a thread two hundred posts deep, and rabble-rousers at Town Hall meets. The indifference was and is...dismaying.

I don’t see any alternative myself to eventual single payer in the long run. I can’t help but have mixed feelings about that, given the immigration situation and the costs related to that. But I also can’t see denying anyone access to healthcare. It’s just not a remotely humane option in a country this well off.

If the illegals are contributing to our GDP, then hey - better take care of them, too, right?

There's definitely a self-centered aspect to all of this; I just cannot think that anyone who is a vehement opponent of some type of reform is either a vest interested, or presently enjoys a stellar health plan (and has mistakenly assumed that they always will) I was joking around with a guy the other day after he got back from a trip to Beijing, asking him if he thought China was going to inherit the world; he laughed and said, 'hey, as long I get to keep my stuff, I don't care.'

"Wealth redistribution ? You are so frigging afraid of wealth redistribution ? You think you made your fucking money in some island without anyone’s help ?..What about all the people in the food chain who indirectly helped you. You think gardeners and janitors and other poor people are basically a nuisance ? God forbid if your millions somehow make it to help other people…."

I completely agree that people who make lot of money some how have an illusion that they deserve the money. They fail to understand that its not a perfect world.There are so many variables involved that its not even funny to think that a guy who became an investment banker in lehman brothers deserves 10000000 times more for his time that a farmer in somalia...but thats how the imperfect world is. most of the intellegent rich people ( like buffet) who are mature enough to know the big picture are very humble about the money they make and know that they have been just lucky to be either born with the right exposure ( famil,school..etc) or born in right country or have been lucky to be smart.

BUT i still don't like wealth distribution ...not because i think rich people deserve that money but because it removes the incentive for people to earn money. wealth distribution should be done minimally and very carefully to avoid loss of productivity but still improve collective happiness.

I wish it was so, most of us are just struggling to pay off our loans. Is it too much to ask that I get to choose where the fruits of my labor go?

Yes it is. It shouldn't be, but it is. And it has always been this way. Just wait until you hit your stride in your career and watch your standard of living remain static thanks to excessive taxes -- and I'm talking without any kind of health care option -- I'm referring to the deferred debt load to help pay off the excesses of a failed attempt at unregulated, free markets.

BUT i still don’t like wealth distribution …not because i think rich people deserve that money but because it removes the incentive for people to earn money. wealth distribution should be done minimally and very carefully to avoid loss of productivity but still improve collective happiness.

But wasn't Trickle Down a sort of wealth distribution model?

Austinhousingbubble says

I wish it was so, most of us are just struggling to pay off our loans. Is it too much to ask that I get to choose where the fruits of my labor go?

Yes it is. It shouldn’t be, but it is. And it has always been this way. Just wait until you hit your stride in your career and watch your standard of living remain static thanks to excessive taxes — and I’m talking without any kind of health care option — I’m referring to the deferred debt load to help pay off the excesses of a failed attempt at unregulated, free markets.

If you are right, then perhaps I was right too, I should just retire now and let the system work for me.

renter for ever_san jose - my point was that people in the midst of a healthcare emergency hardly are able to comparison shop. Healthcare, like the fire department, often operates under different rules. It is possible that a system where doctor fees were posted online could drive down some costs, but it is hard to see how that could scale to emergency scenarios or other crisis situations.

Actually, yeah, we've had a rather massive upward redistribution of wealth since 1990. After adjusting for inflation, the upper 1% makes about twice as much in relation to the "bottom" 80% as they did in 1990. And that was BEFORE the banking bailout.

If you are right, then perhaps I was right too, I should just retire now and let the system work for me.

I would like very much not to be right.

You don't have unique ownership of that particular sense of futility. What people usually do to compensate is get up to their chins in debt and tread water the rest of their lives, affording themselves whatever standard of living they feel entitted to, rightly or not.

Austinhousingbubble - "I’m referring to the deferred debt load to help pay off the excesses of a failed attempt at unregulated, free markets" As much as the banking bailout was utterly sickening, the national debt - currently at 80% GDP - should not be disabling to a huge degree. It was at like 140% GDP after WWII, and that period spawned the most robust economic growth in our history. So who knows, it might not suck as bad as we think... unless, of course, we don't tackle our trade deficit, especially with China.

As much as the banking bailout was utterly sickening, the national debt - currently at 80% GDP - should not be disabling to a huge degree. It was at like 140% GDP after WWII, and that period spawned the most robust economic growth in our history. So who knows, it might not suck as bad as we think… unless, of course, we don’t tackle our trade deficit, especially with China.

I really want to agree with you, but the period starting with the recession of '47 on through to the booming postwar years was a much more industrious time all round for this country. There is really no comparison to today. For one thing, we actually had a vibrant production industry to fall back on. Not only that, America was responsible for inventing products that were radical in their scope, using materials harvested mined and refined here, and finally manufactured here.

We were on top of the world after WWII when it came to R&D, from Western Electric to Raytheon to GE to DOW to IBM. America was the forerunner in everything from broadcasting/communication networks to the brand new science of magnetic tape recording (which we stole from the Germans) to television, to quantum advances in automobile engineering tp residential air conditioning to indoor cinemas, to say nothing of our strides in medicine, esp. with regard to vaccinations, or our weapons development and aerospace program. In short, we had a lot of irons in the fire.

Production, though, was the bread and butter. Quality Control was unparalleled in any of our manufactured goods when it came to other developed nations whether it be a Wurlitzer Juke Box or your basic undergarment. Some of the better tenets of Fordism were still being adhered to in those days, as well.

We sold all that up the river. It's long gone. You can blame anti-monopoly laws, bad economic policy, outsourcing, phony wars or our flagging public education system, or even a cumulative of all of the above. The fact is, it's gone.

If there's an industrial renaissance coming for America, I can honestly say that I am blind to whatever corner it is going to emerge from. I would love to live to see it.

Austinhousingbubble - all true, but it remains to be seen what would happen to our industrial base if, or rather when the dollar falls in relation to Asian currencies.

The country's greatest strength remains its university system, which is unparalleled, the minds it attracts, and the innovation it spawns. It's the one asset that is nearly impossible to replicate or ship overseas. World-class research universities take generations to build up, and we have probably 7-8 of the 10 best in the world. We're not returning to producing heavy industrial goods, but there would seem to be continuing opportunity in a wide range of emerging high tech industries. Again, actual domestic production jobs in these industries would depend on a more reasonable valuation of the dollar in relation to the Yuan, etc.

We certainly face a ton of challenges, and we need to retain more foreign nationals that graduate from our universities, along with rebuilding our science and math programs in our public schools. None of it will be easy, but I don't think the debt itself will be a major factor in suppressing growth. Healthcare could be far more damaging, if it continues to place unique stresses on domestic companies.

So I guess we are in uncharted waters, but I'm cautiously optimistic that we can pull through. We'll likely not revisit anything near post WWII levels of growth, but I feel we can be prosperous nonetheless.

Obama Health Plan's Dirty, Tyrannical, Hidden Secrets

http://www.rense.com/general87/dlead.htm