I am in my 40's and have been a recipient of SSD, SSI, Medicare and Medicaid for 10 years now. I suffer from CFS/FMS and despite my efforts to regain enough health to return back to work, I am worse off now than ever and may never again work.

So what is my point? As a recipient of Government Entitlements I have a unique insider’s view of the pros and cons of Government Healthcare. Now don't get me wrong, I am honored to live in a country that provides a safety net for people like me. But like I said, all the care I receive is not without its problems.

Examples;

Sometimes when I get a cold, it quickly moves to a sinus infection then to bronchitis. When I call my understaffed and client laden HMO to make an appointment to see my doc, I am told that it will be 2 to 3 weeks before he can see me. So a week later I am so sick that I am forced to go to the Emergency Room at the cost of $600 (cost that you all pay, thank you very much) to receive a $15 prescription for a simple antibiotic that cures my condition within 2 weeks.

Now would it not have been much cheaper to be able to get in to see my doc, a doc, any doc at my HMO in a timely manner? Yes! Much cheaper! Need I even explain the bureaucracy that led to you all paying $600 for a $15 prescription (again thank you very much) when if I could have gotten into my HMO the cost would have been around 1/6th of the cost for the emergency room?

If you all had any idea of how many times I have had to go to the Emergency Room because I could not get into see my doc in a timely manner, and how that $600 per visit x 3 or 4 visits a year x the 10 years I have been disabled x millions of retired and or disabled people on SSI, SSD, Medicare and Medicaid... x ... well I think you are all smart enough to see a problem/pattern here.

How many Billions of dollars are wasted because of bureaucracy and inefficiency in our current Government Entitlement Programs? And the Libs want to spend more all the while complaining that Bush has squandered Clintons Surplus? OMG don't even get me started there!

I think Government Healthcare should be made available as an "option" for the lower middle class and the working poor. I believe it is imperative that all Americans are covered by Health Insurance. I think that SSI, SSD, Medicare and Medicaid are an important safety net for our disabled and or retired citizens, but the programs need to be streamlined in an effort to dramatically reduce waste.

I was going to give you all a few examples as to the rampant bureaucracy and infamous Government ineffency, but I think the above illustrates the problem well enough.

Now again with that said, I from the bottom of my heart thank God, all of you, and the best Country in the world for providing a safety net to catch the chronically ill and disabled, but I would not wish to inflict Government Health Insurance on the middle class and the working poor.

Point & Counterpoint:

1. How many of you were aware to the extent of Governmental waste? And do you still believe that throwing more money at the issue will fix the problem?

2. Do you believe that Health Care should be all private, all Government, or perhaps a mixture of both?

3. Should we fix the wasteful spending before throwing more money at the problem? Why or why not?

4. What other thoughts do you have on this issue?

You mistakenly suppose that the obvious inefficiencies in your medical care are due to these being government-financed. For example, it is an extremely common experience for anyone wishing to see physician, not only a beneficiary of government-financed care, to be told they have to wait two or three weeks. Often persons with accute symptoms are dealt with by a nurse, over the telephone.

Further, you incorrectly suppose that the bureaucracy and inefficiency that you see in your government-financed health programs are not present also in privately funded medical care. In fact, there is a vast insurance bureaucracy that administers claims and compels both physicians and patients to jump through high hoops before it will deliver financing for health services that are often patently necessary. And frequently, badly needed care is denied on shallow pretext, on the cynical basis that the patient does not have the resources to contest the matter in court, or if he does, will be dead long before payment is compelled by some final appeal. Indeed, such government-funded medical programs as exist in this country somewhat resemble private insurance in their quibbling administration. It is different in such places as England and France, where essentially everyone needing care is seen with relative promptness and with zero hassle over payment, which is supplied by taxpayers at large.

All of this administration, with its fussing over which services will be provided and which will not; which conditions were pre-existing and which were not; which were cause by accidents for which some other insurance company might have to pay, and which not; who is insurable, and who is not; which procedures are necessary and which are not; is a big part of the reason that health care expenses are so enormous in this country today. There would be a vast savings if the entire medical insurance industry were swept aside with a government-sponsored single-payer plan.

There is, to be sure, rationing of health care when this care is supplied at public expense. If you are 80 years old and need a hip replacement to be able to move about freely, for example, you might not be able to receive one at public expense for the reason that the public does not see much benefit in providing a $100,000 procedure to someone with such limited productivity and remaining life span. Equally a neonate born with grave deformities might not be able to receive extensive surgery at public expense, since neonates are easily replaced. You remain free, of course, to obtain a hip replacement at your own expense, or to pay yourself for heroic treatment for your deformed neonate. This last observation does indeed open the door to some degree of private insurance, for those wanting more services than a government-sponsored plan would supply.

But in countries where medical care is at public expense -- which is to say, all the Western industrial countries except the United States -- there is much less bureaucratic overhead, and much less uncertainty, in deciding what services should be provided to whom. There is also the very obvious fact that millions of people in these countries -- in sharp contrast to the United States -- do not have to go without needed medical care, or see their retirement savings evaporate when they, or a loved one, suffers from a grave medical condition.

Vladimir, there is much truth to what you say. For me personally I am against Universal Healthcare as I believe it goes against out free market foundation. I believe that the middle class and above make enough money to buy whatever health insurance they desire thus spurring competition in our free market for the most part.

As for providers there are good and bad. I have had excellent private insurance in the past, and was able to see a doc on the day I needed to be seen. I bet that there are good HMO’s out there too, just not mine.

All in all the system is screwed up in my view. I am against Universal Healthcare but still would like to see all Americans covered by Health Insurance. Many Republicans disagree with me here… until they or one of their family members slips between the cracks and needlessly suffers because lack of adequate health care options.

A friend of mine was doing great, house, great job, insurance… then he had a crash on the way to work and now lives in a nursing home on SSD, Medicare and Medicaid. His insurance took care of him for over a year and saved his life, but it ran out and he fell into the Federal Health Care safety net. He is frustrated with the system as I am, but he also is happy that the Government was there when he needed help.

There are many facets to this argument and I believe that many Republicans and Liberals have blinders on when viewing the pros and cons of Government Entitlement Programs.

Hi ISSGOD. Great topic. I don't think we've come across one another before on or elsewhere, so for context (and apologies for those that DO know me here) I'm a Brit living in England, where there is a tax-funded and government-run National Health Service that provides comprehensive health care for all, free at the point of delivery. Well, that's the principle, anyway...

1. How many of you were aware to the extent of Governmental waste? And do you still believe that throwing more money at the issue will fix the problem?

The NHS is not a perfect service, and healthcare outcomes are, across the board, average for the developed world. Historically, this was at very much lower healthcare spending, as a proportion of GDP, than almost anywhere else in the developed world, though in the last 10 years spending has been increased to around average levels for the EU. There is much debate here about how well that extra money has been spent - the consensus is "not very". For example, a big chunk went on increasing the salaries of staff (across the board, but mostly to nurses and General Practitioners) with no linked requirements to increase productivity. Also, billions have been spent on attempting to computerise the patient records system throughout the Health Service, with no tangible results except in the P&L accounts of the private sector IT contractors and the bonus packets of the management consultants who've been "working" on it.

That said, I think here that much of the cost of the bureaucracy that you speak of, which is more structurally inefficient than incompetent, is involved in the rationing of healthcare to the small sections of American society that qualify for it.

If everyone in the USA was entitled to, say, healthcare cost reimbursement (something like the French system - patients see private healthcare providers then claim the costs back from the state afterwards), the overall tax bill would necessarily higher, but there would be no need for a massive bureaucracy designed to discourage or prevent ineligible people from claiming.

2. Do you believe that Health Care should be all private, all Government, or perhaps a mixture of both?

Basic healthcare provision (by which I mean everything except "unnecessary" i.e. cosmetic treatments and procedures should be taxpayer funded. From where America is now, something like the French system would be a sensible goal - nationalising the whole health sector to create something akin to the British NHS would be ridiculously expensive.

3. Should we fix the wasteful spending before throwing more money at the problem? Why or why not?

Waste must always be watched, but if you hold back from spending money until all waste has been removed (in the public or private sector) then the system will winnow away to nothing before your eyes. Still, even if you're sick as a dog, you'll still have all that lovely money, right? And no private business ever wasted their customers' money.

Sometimes the waste only exists because money is tight. Counter-intuitive, I know, but as I say a big chunk of the bureaucracy comes from examining every claim to see if it is valid, and postponing treatment until such assessments are complete, by which time conditions worsen into emergencies which are more expensive to treat - as in your example.

4. What other thoughts do you have on this issue?

Americans spend the most on healthcare of all developed nations, both in terms of absolute figures and proportion of GDP. Most of that, of course, goes on private provision, but you still spend more than anyone else and yet have only slightly better healthcare outcomes than the French or Germans and have huge swathes of the population not covered by any kind of healthcare at all. In these groups, healthcare outcomes are more comparable to developing countries than other mature industrial economies.

In summary, you spend far more than anyone else to get worse results. Tinkering with the margins is not going to work - the US healthcare system needs to be redrawn from first principles. If tax-funding raises the usual American anti-government heckles, then a single payer insurance scheme, rather than the hotchpotch of local insurers, workplace funds, charities, etc. would be a step forward.

It's broken because of the way it is designed. Change the design.

I personally don’t believe government single payer system are worth considering. Waits like yours are common in Canada and the UK as I have posted. My question to you is WHY don’t you switch HMOs? Why put up with what is obviously bad service?

I would agree that if we must have some form of “government healthcare” we make it an “option”. Certainly no government run system could compete and win with “competition”. Never happen.

I won't spew the same talking points that everyone else has, and will. I just wanted to share a collection of reports, that illustrate what is wrong with Socialized Healthcare.

The Problems with Socialized Healthcare

I am sure some of our resident Liberals will take issue with the validity of this list of reports, so I look forward to their responses.

If switching HMOs were as simple as it sounded, I don't think America's healthcare system would be as corrupt as it is. Part of the problem is that there's very little transparency in the finances. And that lack of transparency is evident at all levels from the insurance companies to the hospitals themselves. With other Industries like retail or construction, all you have to do is either look at the price tag or ask an expert for an estimate before the job. With healthcare, you don't know how much you will owe for the service until an emergency actually happens, and then in that case you don't have the luxury of shopping around.

4. What other thoughts do you have on this issue?

I hate to skip right to the end of the story, but my thoughts on health care are simple, and answer all the other questions... even if an round-about way. The truth is that EVERY system rations health care... and any rationing of health care is bound to create social issues. In a private system rationing is done by wealth. As we've seen, this leads to a more advanced system, with better development of cutting edge technology and lifesaving techniques, but with less access to them for the population without a great deal of wealth. In a public system health care is rationed as well, but that rationing is done by supply; without unlimited wealth there are limits to the service offered.

Either approach leaves people upset; the primary difference is in efficiency. As can be demonstrated (not by anecdotes mind you), people in public systems live longer, have lower infant mortality rates and spend less of their economic output on health care.

Now, both systems are inefficient, but that's because health care is an inefficient process. It requires great deals of wealth and large organizations to administer that capital; and any private or public organization in that position is prone to corruption and waste... The proof is in the pudding though, public health care costs substantially less for comparable results. There can be little dispute as to which system is more efficient; the real debate is in how fair they are.

I'm also skipping past your skipping past the first three as well, as I'm busy today, but I have to address that infant mortality rate. We have infants in this country that never, ever would be delivered in some other countries. Countries like Switzerland don't "count" as a birth any infant less than 30cm, whereas we Americans try to save the baby and count it as a birth. The Eastern Bloc countries stretch that to any baby less than 35cm or 1 kg or 28 weeks. We have countries that essentially practice infanticide and abortion-as-birth control with low infant mortality rates. Please don't cite this statistic as an example of how health care is "better" someplace else, because you know darn well which country has the best chance of saving a baby at birth. You chided me for citing elsewhere the case of the Canadian triplets who were born in Wyoming, but you know that is just the tip of the iceberg.

I could quibble with the other stats as well, notably the murder rate effecting the average life span, etc., but again busy and have to leave work early...

Because, by complete coincidence, I am going for an MRI today due to a running injury. I booked the appointment late Wednesday, after seeing my doctor on 1 day notice. The exam will cost me a whopping $50 copay. Just sayin'

I'm sorry, to be honest those factors hadn't entered into my consideration. I will point out that according to my med school friend (not the most reliable source I admit, but I've found no disputing evidence) Canada and the United States have the same reporting method, and Canada's infant Mortality rate is about 35% lower.

Incidentally, our abortion rate is about 25% lower as well.

I am not surprised by this, but think your med school friend would agree that the reasons behind this don't have anything to with % of GDP or what medical system we have.

No, he agreed with me. The lack of access to health care among the poor is a major factor in contributing to alarmingly high infant mortality rates among the poor in the United States; and that is what leaves the U.S. with an comparatively poor infant mortality rate.

Of course there are other factors, including diet and cultural practices, but to me it's strange to say that the medical system has nothing to do with infant mortality.

"Health Care" is a pretty broad brush. In-utero substance abuse is a huge contributor to premature births and low birth weight, from smoking and drinking to drugs. I'm skeptical that free government health care would fix this all by itself. I back this up by noting that there is already free government health care for the poor here, but admittedly it could be a lot better. I posit that a reduction in illegitimate births would do more, but don't have time to research it. But thanks for asking!

The thing is that government health care reduces the quality for many of us, whether middle class Americans or well-to-do Canadians/Saudis/Mexicans who come here for care, in order to (hopefully) raise the quality for the poor. Based on my experience in the UK, it's just worse. Like getting health care at the DMV.

This is a good point. Rationing is inevitable no matter what type of system you choose. Juian cites the French system as an interesting way to keep health care providers private. Regardless, I'm wondering if we couldn't construct a hybrid system where the best parts of private and public systems could be emphasized. For example, there is no reason why someone couldn't purchase their own private insurance and "opt out" of the public system if they wished.

1. How many of you were aware to the extent of Governmental waste? And do you still believe that throwing more money at the issue will fix the problem?
All human organizations create bureaucracies, both in the public and private realms, and therefore all have waste and inefficiency to some extent. What is your point? I would argue due to issues specific to the "product" of healthcare, private healthcare insurance bureaucracies can be more inefficient and stress provoking for the average consumer. If you want to gauge satisfaction with a particular "system" by a popularity vote, I believe Businessweek reported a few months ago that only 40% of Americans liked the U.S. health care system, while 65% of the French said they were happy about theirs. Sounds like throwing money at the problem can indeed be a solution, provided the organization pitching it has a decent throwing arm and good aim.

2. Do you believe that Health Care should be all private, all Government, or perhaps a mixture of both?
Probably a mixture of both, but the bulk of healthcare being delivered by a public service. Non-critical cosmetic surgery probably should be put in a separate category from critical healthcare service when debating this however, as it is a poor example of the "success" of healthcare privatization since, although financially successful, it involves non-critical treatment that is cosmetic in nature, and therefore more amenable to ordinary consumer-driven market forces. Cosmetic care also needs to be differentiated from traditional critical care for the simple reason that it takes ordinarily healthy individuals and puts them at risk for permanent injury or even death from such "medical" procedures.

Granted, I believe 20+ years ago I recall the American Society of Reconstructive and Plastic Surgeons recommended the AMA and FDA include a new pathology, micromastia to the roster of diseases. Their official comment: "There is a substantial and enlarging body of medical information and opinion to the effect that these deformities [small breasts] are really a disease." So, perhaps cosmetic surgeons really do care about the welfare of people. As we can tell from their collective concern, they are just trying to help many women just become "normal". And we all know one can not be healthy if you are not normal.

3. Should we fix the wasteful spending before throwing more money at the problem? Why or why not?
A reasonable goal which may possibly necessitate the overhaul the existing public welfare system. Universal healthcare, anyone? I have been reading that typically, in countries that have universal care, public administrative costs per capita run only 1/3 of the percentage found burdening countries without universal care, and total per capita healthcare costs run about half of that found in the U.S. Sounds like privatized bureaucracies are the least efficient providers of healthcare. Moreover, those same countries with universal care frequently report higher per capita utilization of services while paying less.

4. What other thoughts do you have on this issue?
I was reading other comments regarding the comparison of infant mortality rates among countries. A useful related issue is child mortality within U.S. hospitals. Research already exists showing injured children within the same hospitals die twice as frequently if they are uninsured. There is additional research showing other comparisons of quality of care contingent on insurance. That is pretty direct evidence that one does not receive the same treatment without insurance, and debunks the notion that even if you don't have insurance hospitals still provide the same high level of care.

Also, while looking at other posts regarding costs of running public healthcare programs, comparisons of taxes among countries come up, and I was curious if anyone actually worked the numbers? I looked up the 2006 tax tables for the U.S. and Canada, did the tax rate calculations, and here are the results for California vs. various Canadian provinces. I arbitrarily selected four income levels, $40000, $70000, $100000, $200000 to calculate taxes for in the U.S. and Canada (adjusting also for the difference in the Canadian dollar). I also looked at province and state taxes and report the total tax as a single proportion of that income in percent. To get the total tax burden, just add province or state tax to the federal tax, (I also included sales tax info in case you want to add that as well):

Raw Canadian Federal Tax rates
----------------------------------------------------------------------
15.5% under..$37,178
22% above....$37,178
26% above....$74,357
29% above....$120,887

Proportion of Income
as Canadaian Federal Tax.......Ontario..........BC..........Alberta..........Nova Scotia
--------------------------------------------------------------------------------------------------
$40000...........16%...................6.4%............6.2%.......10%.............10.4%
$70000...........18.5%................7.6%............7.3.......... 10...............12.6
$100000.........20.6% ...............8.6%............8.9...........10...............13.9
$200000.........24.5%................9.9%...........11.8..........10...............15.7
--------------------------------------------------------------------------------------------------
Sales tax: .................................7%..............7%............0%.............14%

===========================================================
Raw US Federal Tax rates
-----------------------------------------------------------
10% under $7550
15% above $7550........23100
25% above $30,650.....43550
28% above $74,200.....80600
33% above $154,800...181750
35% above $336,550

Proportion of Income
as US Federal Tax
(adjusted to Canadian $).......California
------------------------------------------------------------
$37657..........15.9%.................3.9%
$65916..........19.8%.................6.1%
$94163..........22.0%.................7.0%
$188317........34.1%.................8.2%
------------------------------------------------------------
Sales tax:.............................7.7 to 8.75%

As you can see, over $40,000 in income, Canadian Federal taxes are lower than in the U.S. That is offset somewhat by slightly higher provincial taxes vs. lower state taxes in the U.S. In Canada, the tax rates are less progressive than in the U.S., so people earning over $200,000 /year pay less than their U.S. counterparts, people earning about $100,000 pay almost the same, and people earning less than that pay slightly more tax in Canada. I really don't see how Canadian Federal taxes are more burdensome than U.S. Federal taxes, as some people claim, because they aren't. Of course, that's it...the U.S. wastes billions of taxpayer dollars on unproductive wars that drag on for years. I knew something was left out of the calculation.

Canadians disagree.

"The public and media discussion of health care and taxes that followed often ended up with the same rationalization: "Taxes are higher in Canada than the States because our federal government pays for our public health care system." In other words, our higher tax levels are simply the price Canadians must pay for Medicare.

In many quarters, this has become public policy gospel. But is that the real reason for high taxes? A quick review of the evidence says no.

First of all, such arguments ignore the fact that public health funding in the United States, as well as in Canada, is pretty much the same.

Public sector funding in Canada represents about 70% of the all the health care dollars spent in our country, as opposed to south of the border where public sector funding is about 50% of the total. Private funding picks up the rest in both countries. But that’s not the whole story."


“No matter how you slice it, taxes in Canada are much higher than in the United States. One of the best measures of a country’s overall tax burden is to look at the percentage of tax revenue compared to a country’s economic output. For instance, the total tax burden in Canada represents 43.5% of our economic output. In the United States, the tax burden is only 31.6% of their economic output – an 11.9 point difference.”

http://www.taxpayer.com/main/news.php?news_id=615

I might dispute these particular figures, but I will concede that the level of taxation in most industrial countries, including Canada, is greater than in the U.S. What is obtained in return, of course, is health care, which in large part is funded here privately. Here in the United States, for example, heath care consumes 16% of economic output (and it's growing at three times the rate of inflation). Since most of that is private, that would seem to account, and more than account, for the 11.9 percent difference in output taken by taxation, eh?

Source:

http://www.washingtonpost.com/wp-dyn/conte...6010901932.html

Not really since if you just tax to cover everyone and don’t limit costs you sink the economy boat. And you limit growth – so a dollar taken to pay for “government” healthcare costs us more than a dollar in economic activity – esp. if the system is government run (and inefficient).

The bad news in from your article:
"Americans rejected the tougher restrictions of managed care in the late 1990s, and yet they want all the latest advances in medical technology," said Drew Altman, president of the nonpartisan Kaiser Family Foundation, which researches health issues. "Since government regulation of prices and services is not in the cards, the inevitable result is higher costs."
And if “Americans” are stupid enough to go for government controlled health care the rationing and restriction will be dramatic – as they are becoming in Canada and the UK.

Stay healthy.

You know there was something that this thread was missing that I couldn't put my finger on... turns out it was pointless anecdotal evidence and broad generalizations.

Is the tax burden in Canada higher? Yes... However, the article you cite is an 8 year old editorial which is a rather pathetic source for a detailed analysis. Taxes (whether they be income, corporate or sales taxes) have declined with every budget issued since that year.

Do Canadians pay more for healthcare? No. According to statistics posted here and a dozen other threads, Canada spends less of its economic output on health care than the United States.

Is government run health care "inefficient?" Well, you keep on pointing out that SOME Canadians dislike our health care, and that it SOMETIMES sucks; but whereas you accept these anecdotes as gospel you reject any similar positioning of U.S. health care outright.

I've said it before and I'll say it again, health care is rationed in the United States: health care is only for those who can afford it. You can argue which system is more fair, but your repeated flagellations of the "government health care is inefficient" horse are getting tiresome, and betray the shallowness of your intellectual approach.

The rationing of healthcare in the US is for those who have no insurance. And we need to change that in a way that is not a “single payer” disaster. Canada rations healthcare for everyone with long waits and denied treatment as I have demonstrated repeatedly. AND Canada refuses to give healthcare to illegal aliens as the US does (for up to 20 million people = about 60% of Canada).






Here are tax rates as of 2005 as % of GDP:

http://thinkorthwim.com/2007/04/29/tax-rates-by-country/

Not quite Ted. In fact, most of the rationing of healthcare in this country comes from insurance companies, not from someone not having insurance.

Insurance companies routinely deny care based on "pre-existing conditions". Or deny care because it may be related to a pre-existing condition. Limits are placed on the dollar amount to be spent either yearly or over a "lifetime".

And the rationing doesn't end there. HMOs and PPOs provide incentives and to physicians to not order certain tests or to not refer their patients to a specialist, even if it may be necessary. Insurance companies also routinely hire nurses or physician's assistants to oversee healthcare decisions. These nurses and PAs may refuse to cover treatment or a referral to a specialist (or at least delay it as long as possible)even if your physician has determined that it is medically necessary.

And of course, you are correct in that those with no insurance get only the healthcare they can afford out of pocket, unless it's a life and death situation, in which case they'll get whatever they need, and then spend the rest of their lives paying off the bills, or go bankrupt.

I guess the question becomes, who do you want rationing your healthcare? A single payer system can be forced through legislation to ration based on the best available medical evidence of what procedures can wait for a while, maybe, and what can't. On the other hand, are the insurance companies, who's decisions seem to be based solely on how much they can ration, in the name of pure profit, even at the expense of the patient.

Rationing is going to happen under either scenario. But which one is going to do the most good, for the largest percentage of the population?

Actually you are wrong about “pre-existing conditions” – It is illegal to use this to deny coverage in most if not all states.

And you are correct HMOs try to limit tests that will provide little info they do not already have. Still in this litigious society they probably do far more tests than necessary.

The lifetime limit does exist but remember people can change companies. Do you really believe that if the government ran and paid for all healthcare there would be unlimited funds available? Dream on. And look at Canada and UK. Then look at Japan where if you get serious cancer you re essentially dead.

Would you like to back this up with anything like evidence, Ted?

People are denied coverage all of the time, because of pre-existing conditions, or their policy limits treatment before x-amount of time, usually at least a year, if not longer has elapsed between treatments for the illness or condition. The policies I've gotten have all had these kinds of restrictions or exclusions in them. Every single one. If you can show me one that doesn't, I'll show you a policy that the average Joe probably can't afford. Because if there are such policies out there, they've got to be hellaciously expensive.


It would be nice if you didn't put words into my mouth, Ted. I never said anything about limiting tests that would provide little new info. I said they attempt to stop or limit tests, and/or referrals to a specialist, even if the doctor deems them necessary. Now, who would better know what tests or specialists a patient needs - the doctor that the patient is seeing, or some PA or nurse a thousand miles away, looking only at a chart (if that), and with the insurance companies (and their paychecks) interest at heart?


Not without those pesky exclusions and/or limitiations we talked about earlier, they can't.


There you go again, telling me I said something I didn't. Of course there will not be unlimited funds available under a government paid health plan. I never even hinted at such a thing. The whole premise of my post, was that no matter who funds healthcare, there is going to be rationing going on, to one extent or another. Then again, I've not advocated a single payer government-run healthcare model.

I have advocated before, a system like what the federal government has for it's employees, with some of Massachusettes' and California's program ideas thrown in. A select number of insurance companies, a tiered system of coverage, with standards for coverage and performance. A requirement for everyone to purchase their own insurance from one of these companies, but with subsidies or tax credits to help those who can't afford to pay for it out of pocket. A requirement that ends pre-existing conditions as a reason to restrict coverage, since you will be required to purchase it, and the ability to take it where ever you go in the country, since your insurance is no longer tied to your employer.

There's lots more, and I'll be happy to share it if you like, but suffice it to say, I am not talking about single-payer, government run health-care.

Would the government really be so wasteful compared to the patchwork of coverage Americans have now? I'm sure everyone has seen that nugget showing that private insurance spends a far greater percentage on overhead compared to Medicare, but I'm thinking about the whole picture: The hidden costs of private insurance that the government (and we citizens) end up paying.

First, the obvious - the cost of people already counting on Medicare and Medicaid because they have no insurance.
You have everyone in the Public Sector - the govt. is already paying for their insurance, too.
You also have the poor uninsured that head to the emergency room every time they need treatment. (Who picks up that tab, hospitals, I think? Anyway, the costs somehow get passed along to everyone in some form.)
There are still people out there who pay for care a la carte. (I wonder if Bill Gates bothers with insurance?)
People who get private insurance paid for by their employer - a lucky, shrinking group.
People who pay for private health insurance out of their own pockets. (And in my experience, most of these are people who have lower income jobs and can least afford the premiums.)
There is also the cost of the lost productivity due to illness (in the uninsured) that could have been prevented with health care. Call it the cost of a NOT having universal health care.
There is the cost of administration of all the above systems.
(I'm sure I have left something out, but that's what I can think of offhand.) And NO, I DON'T HAVE ANY NUMBERS TO DEMONSTRATE MY POINT.

Now consider the probable boost to business if employers are suddenly freed from the extra expense of health insurance. The big 3 car companies, for instance, have retiree health care obligations in the billions of dollars, plus that of their present work force. That's a hard load to carry, and it's always a big issue when their contract talks come up. And those types of giant companies are in a much better position to negotiate with insurers. Smaller companies pay more for the same plans.

So I'm not so sure that universal health care, if properly designed, would really cost America all that much in the end. Certainly it would be a fraction of what the Pentagon gets, but that's another debate.

I have an HMO and love it. They let me see a specialist when needed and fortunately that is not often. In MA insurance companies cannot exclude pre-existing conditions so your state needs to make that law.

Remember the problem with the “old system” was that every doctor had the incentive to over prescribe drugs and treatment since this increased their income. HMO took much of that incentive away. Most generic drugs are as good as some of the new ones but the HMO doctors now prescribe the generics when possible – this is why the drugs are now advertised heavily on TV – have you noticed.





I agree – this is exactly what I hope gets enacted eventually. It will be after the election but it has a good chance.

Just don’t let it be part of the Medicare disaster or be single payer!