[mike777]

Krugman says we can have superior health care at a cost of one trillion...in worst case two trillion bucks......how can anyone be against that!

My guess and only a guess is conservatives are afraid the real total is 35 to 100 trillion......

[luke warm]

my guess, and it's only a guess, is that supporters don't care how much it costs

[PassedOut]

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

[kenberg]

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

And good luck with that. Sorry, I am just having a morning attack of cynicism.

[PassedOut]

Fortunately for me, it's always permissible to make that claim without proof!

[Rain]

I'm for universal health insurance, with a range of subsidies on premium for those unable to pay, income and assets based determination.

Choice of different plans (could be private insurance choices) all having to adhere to a minimal standard, and a few plans offered by government with different premiums and coverage type.

And is it not possible to ensure doctors can't benefit from excessive and expensive tests and procedures, and from pushing select drugs? (I'm currently getting tested twice a month for so many things, and I'm really not that sick.)

Finally, I want to see all except the highest premium plans have % copayments. Fixed copayments seem to encourage consuming the highest priced products. It can't be right.

Anecdote:

I broke my glasses and had to buy a new pair urgently. Went to 2 stores, both offer token discounts for AARP or AAA (I'm not a member of either). But both also have a buy 1 get 1 free thing. However, the catch is, each pair of glasses are extremely expensive. My conclusion is the stores here cater to those with vision insurance paying for 1 free pair of glasses every 2 years or whatever, so each pair is marked up significantly. If you had to pay a % of whatever you choose, won't it help deter from choosing the most expensive pair, and so the stores will be forced to lower their markup?

[helene_t]

Rain, your story sounds absurd to me. Is it really normal in the US that people get tested regularly for conditions which they have no symptoms of? As for copayment, I would expect it to be on a fixed compensation scheme, i.e. they pay up to so-much per year for new glasses and if you want something fancy you pay 100% of the extra costs yourself.

Sounds like there is plenty of scope for cost reductions. Why isn't there a market for a health insurance plan that offered sensible coverage for say 1/3 of the price other insurers ask?

[cherdanno]

helene_t, on Jul 1 2009, 10:25 AM, said:

Sounds like there is plenty of scope for cost reductions. Why isn't there a market for a health insurance plan that offered sensible coverage for say 1/3 of the price other insurers ask?

The health insurance market has very high barriers for entrance.
Every single health insurance company in the US needs to:
- Negotiate payment plans with every single health care provider they want their patients to have access to (ok, of course I am exaggerating, there are networks of insurance companies that negotiate with networks of providers - which means that becoming part of such a network is a barrier to entrance to the market)
- Find his way to avoid the adverse selection problem (i.e., only people who know they will have high medical bills signing up for his plan). In practice, this means signing contracts with employers who pay health insurance as part of their benefits.

The tax breaks for health benefits also make lowering costs less attractive. In theory, medical bills are tax deductible, too, but in practice for most people they aren't (because they are not filing itemized tax deductions).

[Rain]

About my regular blood tests - I am kinda sick, but the blood tests test for so many other things that really have nothing to do with the illness. For instance, HIV tests. That's unnecessary and just a waste of money for everyone.

Won't the framework for a universal health insurance plan already be in place in USA, with medicare and the thing for children? Many states also have high risk health insurance pool that's kinda like universal health insurance already.

I think in this country, states really operate very autonomously. Maybe this is part of the problem.

[Lobowolf]

Edit!

[jdonn]

luke warm, on Jul 1 2009, 05:24 AM, said:

my guess, and it's only a guess, is that supporters don't care how much it costs

My guess, and it's only a guess, is that detractors care only about how much it costs and not about the human impact or future savings.

[Lobowolf]

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

[luke warm]

Lobowolf, on Jul 1 2009, 12:18 PM, said:

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

probably not, but that isn't important - it's all about the human impact and/or future savings

[PassedOut]

Lobowolf, on Jul 1 2009, 12:18 PM, said:

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

If there is proper transparency, for sure. Pretty easy target to shoot at.

We will need to watch out for higher benefits for people living in the congressional districts of senior members. And given the fact that republican states generally rely more upon federal money than do democratic states, it will also be important to monitor distributions by state.

[jdonn]

luke warm, on Jul 1 2009, 01:55 PM, said:

Lobowolf, on Jul 1 2009, 12:18 PM, said:

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

probably not, but that isn't important - it's all about the human impact and/or future savings

Since I don't see anyone saying that earlier in the thread, I'm forced to conclude it is your actual belief. It seems a bit extreme, but I apologize for previously thinking your belief was extreme in the opposite direction.

[cherdanno]

Lobowolf, on Jul 1 2009, 12:18 PM, said:

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

Yes.

[luke warm]

cherdanno, on Jul 1 2009, 03:31 PM, said:

Lobowolf, on Jul 1 2009, 12:18 PM, said:

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

Yes.

based on what? the evidence presented by other gov't run systems?

[awm]

I've seen a lot of reasons put forward that government would do a better job of handling health insurance than private industry. Some of these include:

(1) Substantial bureaucratic costs would be reduced by having a "single-payer."
(2) It's easier for a large insurer (government being the largest possible!) to negotiate good deals.
(3) Because of the second point, there isn't enough competition in private insurance for market forces to work.
(4) Insurance companies are basically just hedging risk -- a capitalist market is good at encouraging "innovation" but it's not clear what an "innovative" insurance company does beyond find ways to kick people off the insurance as soon as they get sick.
(5) Because hospitals must provide emergency care to everyone, uninsured individuals are a huge burden on the system, and only government could require everyone to pay for insurance.

One thing I'm wondering about though, is that the private market for auto insurance seems to work pretty well. Even though government requires every driver to have auto insurance, and some of the same issues about insurance and "innovation" as well as uninsured individuals being a burden on the system seem to apply... auto insurance still seems okay in the private sector. There is lots of competition, many different insurers are advertising constantly to get business. New insurers seem to arise with reasonable regularity. And auto insurance is not rising in price at anything remotely resembling health insurance.

So why does the private sector work for one brand of insurance and not the other?

[Mbodell]

awm, on Jul 1 2009, 02:25 PM, said:

One thing I'm wondering about though, is that the private market for auto insurance seems to work pretty well. Even though government requires every driver to have auto insurance, and some of the same issues about insurance and "innovation" as well as uninsured individuals being a burden on the system seem to apply... auto insurance still seems okay in the private sector.

Your "even though" suggests that it is an opposite. But in face a mandate requiring everyone to have insurance makes insurance work because it solves the adverse selection problem. Also, I believe, in most states there are limits upon what the car insurance companies can use to set your rates. Things like age, gender, car value, zip code, and traffic tickets are fair game - preexisting medical condition is not. And drivers don't have the same long tail that you have in the medical world. A chronically ill person is going to cost money forever, where even a reckless drunk driver is likely to only have the odd accident before they lose their license. It isn't like they are likely to need ongoing expensive claims.

A mandate saying everyone needs to get insurance and saying insurance companies can not turn people away or use existing conditions to set premiums (or even worse to retroactively deny people coverage through recissions for preexisting conditions that they didn't even know they had!) would go a long way to help solve the problems. A public plan that then didn't try to build in a profit premium would be all you'd need to keep the costs competitive with the expenses. You'd get the bigger win if the public plan was the only plan (larger pool of risk and much less paperwork), but just the existence of the mandate and the restrictions on what insurance companies could do would be enough to get many of the wins.

[cherdanno]

luke warm, on Jul 1 2009, 05:19 PM, said:

cherdanno, on Jul 1 2009, 03:31 PM, said:

Lobowolf, on Jul 1 2009, 12:18 PM, said:

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

Yes.

based on what? the evidence presented by other gov't run systems?

For example. Gov't run health care insurance systems in other countries. Reducing profits in a non-competitive market.