More insurance will not solve our health-care woes

[marmar]

from the Providence Journal:



Deborah Burger: More insurance will not solve our health-care woes

01:00 AM EDT on Wednesday, May 28, 2008

DEBORAH BURGER

SACRAMENTO

YOU CAN TELL how far off track the discussion on health-care reform has gone when the idea of forcing everyone to buy corporate health insurance is sold as “universal health care.”

That has been the crux of the debate between Senators Hillary Clinton and Barack Obama over what is called individual mandates. She’s for it, he’s against it.

Compelling people to pay private insurance premiums is not “universal health care.” Especially when you let those insurers continue to charge as much as they want and do nothing to stop the all too routine practice of denying medical treatment or blocking access to specialists or diagnostic tests because the company doesn’t want to spend the money.

Senator Obama has a point that many without insurance can’t afford it, especially as the economy continues to collapse and premiums now average over $12,000 per family, not including skyrocketing deductibles, co-pays and other costs that have made medical bills the leading cause of personal bankruptcy.

To hear just one example of how the costs have become crushing for so many Americans, listen to the voice of Karen Hlynsky, of Providence.

“Because of my low income I get a discount on insurance. But the discounted costs are still more than my mortgage payments. Because I must pay for labs out of pocket, I’m reluctant to see a doctor until I’m very worried about an ailment. I’m still paying for tests done 10 months ago.

“Three years ago I had a terrific job with terrific benefits, including great health care. Who knew that on leaving that job I’d be in this awful situation? ......(more)

The complete piece is at: http://www.projo.com/opinion/contributors/content/CT_berger28_05-28-08_91938RS_v9.39d7fc6.html

[patriotvoice]

1. Insurance = Cartel

When doctors do not know how much a service costs, there is a problem. When a doctor says something must be done, but the company to whom you pay for service refuses to pay, there is a problem. When you cannot save your own money, and earn interest on your own money, there is a problem. When the prices are fixed by a conglomerate middle man between consumer and provider, there is a problem.

Wake up people! Insurance is *not* the answer.

My dentist and doctor give discounts for (a) paying in cash, and (b) paying in full. I save them from going through the health care "system" and put the money in their account immediately, and they reward me with fair, low prices. If I need to, I can enter into a payment plan. That's simple, beautiful capitalism. Now, back that arrangement up with tax-deferred a Health Savings Account, and my family is effectively covered.

The only part I would like to see is government guaranteed support via a very low interest loan for accidents, should my HSA balance be insufficient. I would be willing to pay more taxes to have that support system built-into my HSA.

[dflprincess]

9. That works for routine care

I can't quite imagine paying for a transplant with a health savings account - and how do you negotiate "fair, low" prices for drugs?

[patriotvoice]

13. Transplant: HSA backed by government secured loan; Drugs: by in bulk

Let's begin with the assumption that the Cartel is not price-fixing.

To pay for the transplant, the Government covers part of the cost (say 30%) and loans you the rest at a very low interest rate. Assuming you live, you pay it off. Assuming you die, the Government underwrites the entire debt (potentially negotiating to a settlement price).

To negotiate fair, low prices, the Government buys in bulk. You then buy from the Government. Bonus: the government can better regulate.

The final component is mandated personal health programs for both children (via schools) and adults (via employers).

[dflprincess]

15. "Low cost" loans?

I don't see that working any better than the system we have. You still have people going into debt for care a citizen of nearly every other country could get without having the added stress of worrying about how to pay for it. And, given the cost of drugs, even if they could be bought from the government the out of pocket cost would still be prohibitive for some people.

[patriotvoice]

20. Someone has to go into debt:

It's either the person with the problem, everyone paying communally, or some combination thereof. My solution says it's primarily the responsibility of the person with the problem (or their family), then secondarily the responsibility of the community (federally, per-state, or both). There is no worry of payment, because it's going to be paid, regardless of how much you have in your HSA -- but that doesn't absolve you of your personal responsibility to pay for your own health care.

Regardless, and the point of this thread, the most urgent issue is the price, as fixed by the insurance companies. Until we resolve that, everyone is paying too much.

[dflprincess]

22. So you would consider health care an item that only those who can

afford to pay should have? What's your take on public education?

[patriotvoice]

23. I believe that everyone should be responsible for their own debts.

If you are rendered a medical service, you are obligated to pay for some of it. No one -- neither the rich, nor the poor -- get complimentary medical service. From my HSA, I pay; the government covers the rest. From my pay cheque hence forth, funds are withdrawn to pay down the debt.

My position on public education is stated here:
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=102&topic_id=3326069&mesg_id=3326198

Education is a slightly different discussion, however, and so shall I clarify: I believe taxes should pay for services that benefit everyone. Education is a service that benefits everyone. Paying all the medical costs of everyone doesn't benefit everyone: it only benefits those who were helped. Taxes to pay for *some* of the medical costs of everyone and taxes to pay for *all* the health incentive programs (more parks, more playgrounds, exercise programs, etc) for everyone are acceptable, to me.

[dflprincess]

29. And what happens to a person whose paycheck barely covers housing and food?

Too bad for them?

It isn't always an issue of risk sometimes things just go wrong. An expectant mother who has done everything by the book during her pregnancy can have expensive complications at delivery. An infant can be born with problems even though its mother did everything right. You can get bitten by a mosquito and get Lyme's Disease. You shouldn't have to go bankrupt to cover medical bills.

A healthier population does benefit everyone as does living in a "we" as opposed to a "me" society.

I find your attitude curious given the comment you have on your profile "A citizen has the courage to make humanity's well-being his personal responsibility." Isn't healthcare part of humanity's well-being?

[patriotvoice]

33. What happens to him: the government pays for his health care,

which is exactly the opinion most here express. But every month, that person contributes something -- even if it's only 1% of his income -- to pay down his own medical debt. This in no way forces someone into bankruptcy: the government doesn't boil your HSA and your bank accounts down to $0, then garnish 100% of your pay cheque; instead, a portion is removed commensurate with your ability.

The point is: *no one* gets complementary service, and *everyone* pays some into the community pool (via taxes) and some against their own debt (via garnishment).

I agree 100% that a healthier population benefits everyone, which is why I am strongly for compulsory preventative measures: more parks for people to exercise in and relieve stress; mandatory exercise programs for children (via school) and adults (via employers); and so on.

I believe my attitude is exactly in line with my profile comment. I believe everyone has to stand up and contribute to humanity's well-being, and that is a two-fold proposition:
1. Everyone must contribute to the whole to help the individuals in need.
2. Everyone must take personal responsibility and lessen their individual impact on the whole.

On this particular matter, that means we all:
1. Pay some taxes to cover the preventative and reactive medical costs of the whole
2. Pay some to reduce our own personal medical debt

[depakid]

32. Like many Americans, you have A LOT to learn about economics

and public health.

Indeed, some would posit that dysfunctional attitudes like the ones expressed here are part and parcel to why America is in the sorry shape its in relative to pretty much ALL OTHER wester nations- and even some 3rd world countries.

And why it's destined to decline further still.

[patriotvoice]

34. Then provide alternatives, Professor.

Sway me with your own position. Disassemble my position with yours, so that I may see an alternate viewpoint. But don't insult me personally because you disagree with my position.

Your post is nothing but arrogance, and is equivalent to calling a child stupid because he thinks the world would be if everything cost a penny. If I have such a fatally flawed view, and our system is already in such a sorry shape, you have a responsibility to contribute to the education of me, and everyone else.

So speak up.

[depakid]

37. No worries- but first one needs to grasp the basic economic assumptions underlying the issue(s)

Without a common and rational framework to start from, one ends up arguing over odds and ends that cannot be reconciled logically. It's like trying to work with fractions without a common denominator.

In economic terms, public health is what's known as a " http://en.wikipedia.org/wiki/Public_good">public good," not unlike air we breath or literacy we enjoy as a society. Public goods by their very nature cannot be allocated by "traditional" means, though one can see that public policy, relative wealth and natural laws do have an effect on the quality or the quantity of public goods.

In the US, the clean air act for example increases the quality and quantity of fresh air and public education and the K-12 public education system increases the literacy rate.

By extension, a single payer basic benefits health care system provides a means to increase quality and quantity of the public health, through vaccination and treatment that keeps us free from diseases (that strike the homes of rich and poor alike) and treatment and prevention of ailments that collectively drag down productivity, create widespread cost shifting, burdensome externalities and cause deleterious, multiplier effects- all of which in turn, decrease EVERYONE'S quality of life and adversely affect a nation or state's macroeconomy.

Other Western nations (and some 3rd world nations) understand this- and have crafted solutions to address these fundamental problems.

Once one accepts that markets "fail" to efficiently or equitable allocate "basic health," (remember- it's not a private good like a loaf of bread) the question then becomes what policy solutions best fit a particular nations' needs, which methods pool the available resource efficaciously and how best to implement the policy with the least amount of disruption and the most public benefit.

Policies such as the 3 leading Dems proposed do NOT address the fundamental problems associated with America's fragmented health care system- and by themselves are doomed to fail, because they rely on unsound premises and keep gross inefficiencies (and parasites) built into the system.

Likewise, HSA's (while perhaps a wise individual decision) fail even more profoundly as collective policy- for a number of reasons which are concisely set out here:

For Bush, Nothing Succeeds Like Failure

http://www.commondreams.org/views06/0216-25.htm
------------

As an aside, transportation can also be viewed as a public good- and those regions with the foresight and political fortitude to adopt responsible land use planning and mass transit are faring far better in the post cheap oil era than are places like the Research Triangle in North Carolina, where notions of "individual property rights," "automobile entitlement (dependence?)" and hostility towards collective solutions have led to mindless sprawl, destruction of productive farmland, and a situation where one can't even get a bus from Raleigh airport!

Contrast that with Portland, Oregon or Newcastle, New South Wales, where one can either walk, bike or get on public transit and go damn near anywhere one needs to go locally- and even (for the time being) to most major cities all over the globe.

[eridani]

26. Fine. Let's do the fire department the same way

People who don't have fires don't pay property taxes to support the fire department, whose costs are split yearly among only people who have fires.

How fecking stupid is it possible to be? Ever heard of the concept of shared risk? Since in very age demographic, 15% of the people account for 85% of the costs, getting expensively sick is like having a house fire. It probably won't happen to you, but it could. Therefore everybody shares the risk, and no money gets siphoned off for insurance company profit.

[patriotvoice]

28. Yes, lets do that.

If my house burns down, I have the responsibility to pay the fire company for coming out and hosing it down. I am willing to pay some taxes to a) keep the fire department operating at minimum expense, and b) defer some of my costs should my house burn down, BUT I am strongly against complementary (read "totally paid for") service. When my house burns down, it is my responsibility: there is no free ride.

It is patently unfair for those who do not smoke inside to share the risk with those who do. I am 100% for someone smoking in their house, but when they do that, they -- not me -- assume that risk. Likewise, when someone eats fast food for 2 meals a day, makes no attempt at moderate exercise, and works a high stress job, they -- not me -- assume the health risk.

It is impossible to argue "shared risk" while also arguing "equality," because there are disparate risk classes into which each of us fall. I am not willing to become a classist, but I am willing to pay a small portion for the benefit of all (point a, above) and to guard expense the unexpected for me (point b, above).

[eridani]

30. Smokers and non-smokers pay the same property tax rates

--and that is exactly how it should be. A lot of the disparate risk in health care is genetic, and only a moral imbecile would advocate not sharing that risk.

Our society now decrees that that kid with the abscessed tooth had no right to the $80 for treatment that his mother didn't have, but he did have the right to go to the emergency room when the infection spread, and to have $250,000 spent on him in a futile attempt to save his life.

For you and others who like to wallow in your snotty sense of superiority (little brat probably didn't even brush his teeth!), that smugness now has a specific price tag--$249,920 to be exact. Is it really worth it to you?

[patriotvoice]

35. To argue equality amongst chosen risk classes is to not argue equality.

Let me stipulate that genetic risk is shared. I cannot see how you find it equitable for one family who mitigates risk, and another family who chooses to bathe in risk, to pay the same.

As I have earlier stated in this thread, preventative care is 100% covered -- because prevention costs and benefits everyone equally -- and is paid out of the tax taken out specifically for preventative care. The people who ignore prevention -- and thus put themselves at risk -- then personally accept the majority of the cost associated with that risk.

Our society's degree that $80 prevention is too much, but $250,000 in reaction is enough, is abhorrent. My position in no way accords with that philosophy. My position is founded upon the twin-principles of:
1. Everyone must pay something toward the community preventive care pool and something toward the community risk pool (both via taxes)
2. Everyone must pay something toward reducing their own individually-incurred medical debt (via wage garnishment)

From that arrangement, everyone gets:
1. Upon birth, automatic enrollment in a personal, tax-deferred HSA that is funded with each pay cheque (whether yours, or your parents)
2. Complimentary preventative maintenance: bi-yearly dentistry, yearly physicals, more parks, more playgrounds, more bike/running lanes/trails, etc.
3. Automatic government backing on all debits from HSA: medical costs, dental costs, funeral costs
4. Automatic payments back into depleted HSA from each pay cheque
5. Upon death, the government assumes your balance and settles your debt with lenders -- none (or perhaps a small percentage) carries forward with your estate.

I fail to see how this is morally bankrupt or derived from a sense of superiority. If you make nothing, the government carries you completely. If you make anything, you contribute some to the general welfare and some to your own specific debt. If you are chronically sick, you may rest assured of the backing, but you will contribute some toward your medical costs your entire life. If you are chronically healthy, you will always pay for the general welfare, but you will not have to pay additionally for your own medical costs.

[OhioChick]

2. K&R

:kick:

[magellan]

3. We had to cancel our insurance this month

We simply can't afford the premium even on a $10K deductible policy.

I feel better already.

Will somebody please tell me what Obama's health care proposal is at the moment, or where I can read about it?

[marmar]

5. 10K deductible? Yikes!

That's a disgrace! :argh:

[Vinca]

6. We gave ours up about 3 years ago when it hit $12,000

with a $5,000 deductible. Obama's plan is nearly the same as Clinton's only he doesn't send the insurance police out after you if you don't purchase it. Both candidates' schemes suck. We need universal, single payer, not a bonanza of 47 million new suckers for the insurance cartel.

[magellan]

11. Yoiks! Was that a quarter?

Thanks for the info on Obama vs Clinton's healthcare plans. Sucks is the right word: straight out of our pockets into the insurance companies'. This is new and somehow better?

We need to get rid of the middlemen and the interlopers. How I wish Kucinich was our candidate!

[Rose Siding]

25. Here it is-

http://www.barackobama.com/issues/healthcare/

scroll down just a bit for "Barack Obama's Plan"

[lonestarnot]

4. Insurance is a scam!

[harun]

10. Probably the worst scam out there (n/t)

[lonestarnot]

12. Why do you think the scammers held their fund raiser in Phoenix at and insurance man's mcmansion?

[area51]

7. k&r

Newt Gingrich's idea of people being forced by law to buy rightwing shitty insurance is insane. Insurance is the problem! We need single-payer now.

[Kitty Herder]

8. A great big K & R!!

[lumberjack_jeff]

14. This is grossly dishonest.

Universal and optional are not compatible.

One of Hillary's healthcare options is to allow people to choose a public medicaid-like program. No insurance company can charge whatever it wants when the competition is a public plan.

Also, Obama's plan is predicated on making it cheap so that everyone will buy insurance. One major problem, our current system is expensive largely because it's optional. You won't get cheap until you get universal.

The entire universe of options ranges from Hillary's plan to McCain's do-nothing plan, with Obama's closer to McCains.

Obama's healthcare plan has as its main selling point the fact that it's pretty much like what we currently have, but with insurance lobby provided pom poms.

[marmar]

16. Hillary's health care plan is crap; So is Obama's.....

..... You could empty out Sephora and still not find enough lipstick for those health care plan pigs.

[dflprincess]

17. Any plan that contiunes to funnel money into the pockets of the crooks that are currently

cheating us on healthcare is crap.

[lumberjack_jeff]

18. The perfect is the enemy of the good.

You can't have perfect, and you're unwilling to accept good.

Problem is that there is no agreed definition of perfect. So we muddle along content to allow the situation to deteriorate further and further.

Public health care was first proposed by Teddy Roosevelt. We've been fighting over how to do it ever since. 100 years.

This generation, Hillary's plan is the only workable and salable plan available. I hope my great grandchildren don't have to continue to debate it.

[dflprincess]

21. There is no perfect system -

but including the companies that are causing most of the problems now will hardly make for a good system. And, if they are included, your great grandchildren will be debating it 100 years from now.

[lumberjack_jeff]

24. It's moot now. Let's talk again in 8 years. n/t

[Lugnut]

19. Insurance companies are the problem.

Any solution to the problem must exclude them.

[jtrockville]

27. Health insurance prevents us from getting adequate health care.

[OneBlueSky]

31. does anyone know what percentage of our healthcare dollar goes to . . .

corporate advertising and profits? . . . I have a hunch it's not an insignificant amount . . . remove those costs, and all of a sudden we have hundreds of millions of additional healthcare dollars available for -- well -- healthcare! . . .

[marmar]

36. At least a quarter, probably more, goes to non-medical costs......

If I'm remembering Thom Hartmann's quoting of stats the other day.