Yes, I do. I don't deny that it exists, I don't think it is a real problem, at least for most people. Rather, it is just the free market in action. Companies offer health insurance, and we use that as a basis of choosing which company to work for. Does it create some disincentive to look elsewhere? Not so much. If you were to switch jobs, then health insurance would again be one of the market factors you would look at in determing whether, or if, to switch. If a company cuts back too much on what they offer vs other companies, then their employees will indeed leave. Would a truly portable system provide a freer market? Yes. But I have never felt locked into my job because of it, as every company I have considered moving too has a similar program, and with most company plans you get automatically accepted, so nothing is lost. Remember, this is the very same government that has already loaded each and everyone of us with a $455,000 mortgage just to pay current obligations through their current mismanagement. Now, I'm supposed to suddenly believe they can give me health insurance for less money? Fool me once, shame on you. Fool me 455,000 times, plus one more, shame on me. I refuse to be that gullible.



Why would any less of it be caught up were universal insurance in place? The cost would be the same, all that would change would be the manner in which it is paid for.



I would not. My health care costs closer to probably $500/month, and I doubt seriously I would get similar coverage at the same price with our bungling government in charge.

Also, again, what do you think is going to happen when the unfunded obligations the government currently has start to come due? As I stated previously, they're going go have to massively slash programs. Health care is surely going to be one of them. Simultaneously, they're going to have to raise taxes and print money, throwing the economy into turmoil. Where will that leave everyone? No jobs, higher taxes, and less health coverage, with less money available to make up the difference. There is simply no way they can provide decent health care to us then -- they just won't have the money. What is so good about the scenario that I should want to sign up for it? These are the same sleazy salesman that sold us that $455,000 plot of swamp land. I'll be danged if I'm going to buy more property from them, or let anyone else buy it for me. They're going to have to find a way to purchase it on their own, without including me.

Hobbes, I was hoping you would address the questions I asked of you, I am interested to see what alternative ideas people have to reforming health care in this country. I am most interested in seeing how this can be accomplished without the need for more government intervention. I think this debate focuses too often on the idealogical reasons or justifications people have for not supporting a universal coverage system and so we never see any alternatives offered.



If you read my previous posts you will see that I always focus on and list price controls as one of the major components of reform. Also private health insurance companies and industries also help set and determine prices and have their own set of factors and practices that also cause prices and costs to rise. You can not contain our three classed system's faults to just one sector of the system, that is a very limited view.


Again this is not exclusive to Medicare, many private plans are also considered too burdensome for the providers and they will just flat out refuse to take that particular private insurance. What if that is the only insurance your employer provides for you? Or what if it is the only insurance you can afford to purchase? I think the private system could be more competitive and I think consumers could have more options and more importantly affordable options. I think in cases where you are not happy with the plan your employer offers or the level of compensation they provide you should have the choice or ability to find a competitive plan.


Again this is not exclusive. There are secondary insurance programs for those who have private insurance too, so if private insurance is so great then why the need for a secondary insurance? Also I am not really getting why you find the above a failure of the public system. I have already acknowledged that medicare does not cover every person in the system 100%. It offers programs where some of the costs are carried by the patients through as you mentioned deductibles and or subsidization. I don't have a problem with this, I think in many cases people just need the costs lowered or made affordable, not made for free. All the above you explained sounds a lot like my own personal and privately funded care, I pay a monthly premium, far higher than $100, I pay deductibles and often my insurance refuses to completely cover the costs for care I received, outside of premiums I also pay thousands of dollars out of my own pocket for health care for my family. So why am I paying so much more? If they each use many of the same techniques of keeping costs down, and private insurance is even given the advantage with the practice of risk selection..why is the gov's costs still lower?



And as I already pointed out all health care costs account for 16% of our nation's total GDP, they are said to climb to 20% in less than 10 yrs. Not to mention the US cost of health care is the highest % of GDP of any other industrialized nation, and we are the only one who does not have a universal system is place.

As the personal costs for private also continue to increase at a far faster pace than inflation (and the public programs) through premiums etc. then again we will see more and more people enter the system from the other side of it that many here seem to pretend does not exist...not the financing side of it but the actual institutions and places of health care. If you do not have health insurance or medicare or you are priced out of it, or you have decided the costs are to much to be bothered with anymore you still have health needs and your costs will not be negated just because you are not accessing the financing side of our system.

This thrid way consists of public and voluntary hospitals, community health centers, public health clinics, emergency rooms, free clinics, and services donated by private physicians etc. It is this final "safety-net" that allows people like you and all the others here to argue that health care access isn't all that urgent or significant enough of an issue to get serious about or allocate funding and resources to.

But the fact remains, we still pay for it, it is still a piece of the system and our taxes fund this form of access too. Do those who could afford to carry some kind of cost reimbursement and pay some portion of their health care costs need to be required to do so? Obviously I believe they do, and in order to successfully do so we would first need to require universal coverage.



Then how do you explain the high rise in costs in the private sector? Or perhaps is the private sector of health insurance lacking in competition too?

Companies using their health plans to attract employees may seem like free enterprise to you, but to me it seems like a two-tiered system where anyone without an "Inc." at the end of their names is powerless to negotiate with insurance providers. So big corporations get better deals, and individuals make up the difference. There is no "free market solution." When it comes to health care, it's a myth. It's just another advantage big corporations have over smaller companies and individuals.

And what happens when you decide to retire? You are no longer an employee, and you have zero bargaining power with your old company, so they start chipping away at your promised benefits every chance they get. It's happening to my father right now - a lifetime employee of a big corporation, promised a pension and health insurance for the rest of his life, and the company is paring down the insurance every year. I'll put my chips with the government. Even when I'm old, I still have a vote.

Job lock is a bigger problem than you think. Depending on the type of work you do, you may never be affected, but there are a lot of workers out there that are - and the percentage of Americans covered by employer-provided health insurance is shrinking.

It's a huge factor in what people are doing now. Like I said before, we are tethered to my wife's insurance. She has opportunities to leave her position at a research institute to work at smaller operations, but the health benefits are always lacking. I have no groups to effectively negotiate my insurance rates. COSE (Council of Smaller Enterprises) has lousy rates, and so do the bar associations that offer insurance.

Hobbes- do you realize that we pay more now than we would with a universal provider?

Do you also realize that part of the squandering of health care costs involves routine denial of care?

Do you understand that, maybe, possibly the profit motive, in regards to the health insurance biz, is actually worse than a goverment run program?

The why of it is this- thier only way to make money is to deny care. If they pay out each time someone is actually owed- they will go broke, and fast.

The mission of providing health care insurance is completely at odds with actually providing care.

Do you agree that one of the main costs of health care in the US is super high administratiive costs?

Aetna, for instance- spends 26% of it's revenue on administrative costs, mostly in utilization review- i.e.- finding ways to deny care.

When we went away from the insurance companies completely, with the exception of a stop-loss policy, we dropped those administrative costs to less than 10%, and, with that savings, were able to provide far more benefits.

I have heard you say you only spend 500 bucks total on your health insurance a month?

I have not heard of a plan that is that low for a family of four, not without massive, crushing deductables.

CruisingRam, do you realize that our government simply can't afford to provide health insurance? That they're already $54 Trillion behind on current liabilities, and will simply have no money in the cover to pay for everyone's health care, and that they'll then have to slash benefits? How much denial of care of care do you think you'll see then?

Let me put this differently...if you were choosing a health insurer, would you pick the one that already had $54 Trillion in liabilities it couldn't pay for? No, of course you wouldn't. That company could promise all sorts of coverage, but you wouldn't care, because you'd know that they couldn't possibly deliver on them. In fact, that would be the absolute last place you'd want your health care from. Yet that's exactly what you're advocating here...go with the company that can't even pay its current obligations. Doing so makes no sense, no matter what might be promised.

Right CR and you can DIE waiting for the “100% coverage” to get to you. What I want is a way to stay the hell out of it. And if you love that “government” care so much – GREAT – you can have it fo you and your family – but don’t whine later when you wait years for care.

“Government-run health care in Canada inevitably devolves into a dehumanizing system of triage, where the weak and the elderly are hastened to their fates by actuarial calculation. Having fought the Canadian health-care bureaucracy on behalf of my ailing mother just two years ago -- she was too old, and too sick, to merit the highest-quality care in the government's eyes -- I can honestly say that Moore's preferred health-care system is something I wouldn't wish on him.

In 1999, my uncle was diagnosed with non-Hodgkin's lymphoma. If he'd lived in America, the miracle drug Rituxan might have saved him. But Rituxan wasn't approved for use in Canada, and he lost his battle with cancer.

But don't take my word for it: Even the Toronto Star agrees that Moore's endorsement of Canadian health care is overwrought and factually challenged. And the Star is considered a left-wing newspaper, even by Canadian standards.”
http://wizbangblog.com/content/2007/07/30/...ystem-moore.php

http://www.csmonitor.com/2002/0828/p01s04-wogi.html

Is America in default? No, we are OK. In debt, but not close to defaulting. Besides, if we elect a president that puts health care on the agenda, they will probably have the good sense to end the war quickly.

Also, what is the difference between spending money on health care and spending money on a stimulus package? What if, instead of handing over $150 billion to us in hopes that we spend it on American-made products, the government spent $150 billion on universal health care?

Okay hobbes- how is the more money we are spending now better than spending less money with a universal health coverage plan?

I will have to ignore Ted's post, it has been pointed out to him about a thousand times that our system sucks compared to any other developed country- I don't think he is all that much interested in evidence anymore. Ted- I have actually been to Canada, and had to access thier system as well- it is much better than ours. In alaska, there are a great deal many Canadians working as part of the NAFTA trade agreement. They don't want to immigrate because they don't want to lose their health insurance.

If you really think that Canada has a worse system, bully for you- but it is still wrong, and I would trade my employer health care, which is excellent by american standards, for the Canadian system in a new york minute.

But anyway, I digress Hobbes,

right now, the payment is bigger. Other countries payment is smaller than ours, and they get more for thier money.

It is not that I want to spend more money here Hobbes, I want to spend LESS.

And, quite frankly, there is a 1.6 trillion dollar expense we can fund pretty much every social program a communist would even dream of right this very second- we aren't talking a 54 trillion dollar 30 year away debt- we have a 1.6 trillion dollar expense RIGHT NOW. Now, if we cut that one 1.6 trillion dollar expense- hell, we don't have to have a single welfare program at all- let's see, if I didn't miss a zero here or there (1.6 trillion is alot of zeros my friend )- that equals out to what, about 53 million dollars per person, for every man, woman and child, and even illegal immigrant, in the nation.

So what is so expensive about health care again?

heck, I am with you- take the 1.6 trillion and just divvy it up, and we have plenty of money to buy our own damn health care. Heck, I think I will purchase a few Canadian doctors myself.

Do you see my point hobbes? Right now, we pay for more, we get less. I want more for my money. We are not saving money with the system we currently have by NOT going to the other system. There are some alternatives I would like to see- but they are not politicaly realistic, don't you agree?

So, therefore, I am willing to go with the most politically realistic, fiscally responsible option, even though it is not my favorite option.

With math skills like these, good luck with Engineering courses...

Even if what you said were true (it's not), $1.6 trillion is $5,300 per person, not 53 million.

1,600,000,000,000/300,000,000 = 5,300

And that's the alleged cost of the war over the last four and a half years (I think that's what you're talking about). So we're talking $1200 a year. A lot of money, but not enough to fund health care or to buy your own personal doctor.

It is a good idea in general to look at one's numbers and see if they make sense. $53 million for every American does not make sense considering that the GDP of the US is around $45,000 a year. The GDP is a measure of the economic activity of the entire country and the GDP per capita is that number divided by the number of people. That number is 10000x lower (four orders of magnitude for those engineering types out there) than the number you postulated. These kind of mistakes undermine whatever your argument was, which was pure rhetoric to begin with.

One big problem with government run healthcare is how we decide what is covered and what is not. Should we perform every life saving measure until all measures run out? Should we cover basic preventative care only? Should we cover mental health? Cosmetic care? Abortions? Should everyone in the country be able to opt for coverage at the premier hospitals such as Johns Hopkins or the Cleveland Clinic or do they have to use their local health care providers? Should we put people on permanent life support or if not, when do we pull the plug? Is there an actuarial decision at some point that someone is not worth saving? How much are we willing to spend on public health?

In 1992, President Bush attempted to push guidelines down to the states that cut off Medicaid treatment for those with a less than 10% chance of living for 5 years after the treatment. Is this inhumane? He later dropped the requirement because it was an election year.

Most states would list Medicaid as one of their biggest budget nightmares. They need more federal revenue to offset increasing costs and their obligations are taxing state budgets. It is the second largest burden on state government and most states are looking for ways to "reform" (i.e. cut) Medicaid. Medicaid covers about 46 million people at a cost of about $300 billion a year. Most Medicaid recipients are on managed care--private health insurance paid for by the government.

So we can probably estimate that the cost of covering the 47 million uninsured will be in the ballpark of $300 billion a year. It will likely have coverage similar to Medicaid, which isn't exactly great.


My intention was to point out that Medicare sets its prices and is backed by the force of law. In many instances, it reimburses at below the market rate and can set future prices by the force of law. A command economy which we know does not work.



Again, I am simply pointing out the weakneses of Medicare.




The government also practices risk selection. It doesn't cover everything. It cuts off coverage at a certain point. I've already addressed why Medicare's costs are lower: they are dictated by the government and the extra is passed onto private insurance users. Medicare recipients also pay thousands out of their own pockets. My entire point is that there is nothing magical about Medicare except the force of law on prices: its command economy model.

In this case, government will set the price of services at some level (most likely below market costs) and providers will simply dry up. Why are there fewer doctors per capita in Canada? Why are doctors' salaries lower up there? Why is there a shortage of nurses and specialists? Answer: they aren't paid enough and they are forced to work too hard (55 hours a week).

The same will happen here if we arbitrarily decide on how much is enough to pay for services.

Here is an overview of the healthcare “crisis” and why we would never, ever want the government to run it for us – this from an insider – with over 45 years in the industry, and familiar with the numbers. He hits the nail on the head here.


From a local town paper Forum.
Our healthcare crisis?
by Kerry Kissinger
"I believe nearly everyone would agree that our healthcare system is in crisis. We are constantly told that:
A. There are 30+ million uninsured in this country;
B. the newly-minted Massachusetts Health Plan is $200 million in the red and failing;
C. the drug manufacturers and the insurance companies are running roughshod over us;
D. the Canadians have it all figured out.
Does anyone dare to dispute this? It ís no wonder that healthcare is near the top of the issues in this Presidential election cycle. We’re in crisis!
I have been implementing accounting systems in hospitals and doctors’ offices since before Medicare was enacted in 1965, and my perspective on the topic is somewhat different. My views have been shaped by how I have seen the healthcare system respond to federal government programs. The federal government, via Medicare, has been the largest single purchaser of healthcare over the past 40 years. It has been a classic case of “unintended consequences.”
In its first 20 years, Medicare paid hospitals whatever it cost them to deliver services. Buoyed with this new source of funding, hospitals went on a buying frenzy of technology and brick and mortar the likes of which had never, ever been seen before. The cost of healthcare in the U.S. rose from <5% of GNP before Medicare to >12% of a much larger GNP by 1985. Then the Fed decided it needed to put on the brakes, and Medicare started paying fixed costs for each procedure. Suddenly, hospitals were losing money on Medicare patients, so they did the logical thing; they raised the prices they charged to Blue Cross and commercial insurance companies to make up for the losses. Thus insurance premiums have been escalating at double digit rates.
As to items A; B; C; & D above:
A. The Robert Woods Johnson Foundation studied the make-up of the 30 million uninsured and found that when you took out those who had just changed jobs and technically had a gap in coverage; took out those who could afford it but risked not buying it; removed illegals from the rolls; and adjusted for other factors, there may have been around 6-8 million people without insurance. It is also important to note that no one in this country is refused treatment if they cannot afford to pay for it. They may have to seek it in the ER of a hospital, but they are never turned away.
B. It is also important to note that an individual could purchase “premium level” healthcare insurance in Massachusetts for about $350 a month. Yes, the start-up costs of the new plan have placed it in the red, but that is to be expected during the phase of enrolling new members prior to the positive cash flow of premium revenues.
C. It is quite easy and convenient to blame drug companies and insurance companies for the high cost of healthcare, yet the facts tell a different story. Doctors and hospitals account for 52% of total healthcare costs, prescription drugs for 10%, yet they have contributed enormously to our quality of life and longevity. Insurance company administration, marketing, and profits make up only 12% of their premium costs. The long and short of it is that, since 1970, hospital costs have risen by >$600 billion; doctors fees have increased by >$400 billion; prescription drug costs have risen by $200 billion; and private insurance costs have risen by $150 billion.
D. I am a “snowbird” in Florida in the winter, and my Canadian friends that I see daily say they are disenchanted with waiting three months to see a doctor, six months for an MRI, a year for a hip replacement, and a ten-month waiting list for the maternity ward. As one person told me, “I can always go to the ER if I need care urgently.” Wow. And to think that they get all this for a tax burden of 37% of GDP vs. 27% in the U.S., and they pay a pittance for defense. It is very enlightening that, whereas America’s founders wrote of “life, liberty, and the pursuit of happiness,” the equivalent phrase at Canada’s founding was “peace, order and good government.”
The conventional wisdom may hold that our health-care system is in crisis, and the only solution is for the government to save us from ourselves. I believe that facts speak to just the opposite. There is a saying in healthcare that there should be three components to it: (low) cost, (high) quality, and (easy) access. You can pick any two, but you can’t have all three. Our current system offers easy access and high quality, but at a relatively high cost. A government-run system will certainly assure higher cost and more control over access, and it is anybody’s guess at what will happen to quality."

We keep going over this topic.

Let's set a few groundrules for all future attempts at this topic:

1) Insurance is a red herring. We do not have enough medical equipment and personnel (MEDSYS) to service anywhere close to 300 million (approx US pop) insured people, all of whom having essentially the same coverage. We will have to ration, and since rationing by ability to pay will be all but gone, we will have to have some govt committee to decide who gets care.

The elderly, who even if cured are likely never to be 100% after treatment, will be the likely ones left to die first and to have care withheld.

In my state right now, the number of internists and GPs coming into the market is not even keeping up with retirements. No one wants this duty now--lots of work, less money, meddlesome govt rules, PITA.

2) Accessibility will go down dramatically. Even if you qualify under the inevitable rationing imposed, the wait times for access for the entire US population to the MEDSYS will be huge except for major emergency care.

3) We likely will have to have govt created clinics staffed by nurse prac and similar para-pros to provide most of the care we will need. We will be going from regulated air travel of the 1960s to the cattle calls of today. I cannot see any other way to handle the volumes.

Until you address these issues, the rest is just silliness. We can afford some kind of national health insur--but, do we want the kind of care such insur would be able to buy?

1.)Can private providers realistically provide health insurance at a reasonable cost to families? Why or why not and provide numbers.


Private providers will always be more efficient and therefore cheaper. Obviously if the hospitals and doctors costs make the “price” unaffordable for a family earning 30K the state or government has to help if the family is to be insured. The “public” plan would be similar except more costly and less efficient.