The 663 Million Dollar Question - page 3

Yet another argument for universal access and/or a single payer plan. Gov. Tim Pawlenty asked an interesting question recently: "How much would it cost to provide health insurance to every... Read More

  1. by   wjf00
    Quote from ZASHAGALKA
    This is why French immigrants riot due to lack of jobs and British immigrants plan to blow up airplanes.

    ~faith,
    Timothy.
    Thank you for clarifying this for me, no American would blow up a building in Oklahoma City or anything.
  2. by   ZASHAGALKA
    Quote from wjf00
    Job growth at Walmart and Mc Donalds hardly address the need for healthcare when GMC, Ford And Boeing are laying off benfited workers.
    But isn't what you propose CORPORATE WELFARE?

    Aren't you, in fact, letting Wal-mart and Mickey D's OFF THE HOOK by advocating that we citizens take up the slack?

    If I proposed a 663 MILLION DOLLAR CORPORATE WELFARE PROGRAM, wouldn't the same people that advocate this under a different name scream foul?

    So, why not create collective healthcare bargaining units, and require both employers and employees to 'buy into' them. With unemployment at 4.6%, THAT alone would cover a large portion of the population and the other percentage could then BE reasonably covered by state 'medi-caid' type programs. In fact, the Mass program is reasonably doing just such a thing. And, both the Republican Gov Mitt Romney AND Teddy Kennedy are on board.

    So let me ask this question another way: WHY WOULD YOU PROPOSE A CORPORATE WELFARE PROGRAM THAT WOULD COST UPWARDS OF 6 BILLION DOLLARS IN ONE STATE ALONE?

    Especially when the result is to drive out mom and pops and just further entrench the wal-marts of the world. You can't have it both ways: you can't decry the wal-martization of our economy and yet propose corporate welfare schemes that CREATE the wal-martization of our economy.

    And you have to wonder WHY the big benefit companies are being forced into layoffs BEFORE you propose the same dynamics to effect the entire state by moving those liabilities to the State's coffers.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Aug 20, '06
  3. by   Spidey's mom
    Another option that comes to mind is having the choice to only buy insurance that covers major medical expenses - like a CABG - and we pay for all the "little" stuff. Like the doctor office visits and the prescriptions and maybe even the xrays and mammograms.

    The idea that I pay $400 a month for 12 months and only spend a fraction of that on medical costs is crazy. That money would be better off in a measly savings account.

    I even opted out of coverage for eye exams and glasses because I figured out it costs me more to pay the insurance than it does to pay for the eye exam and new glasses.

    One of the reasons medical costs rose so high 20 or so years ago was the fact that insurance companies would pay the costs. Now it is not so easy.

    steph
  4. by   ZASHAGALKA
    Quote from HM2Viking
    Please explain to me how you arrived at a figure of 6 BN dollars from 663 million. I fully recognize that there is no free lunch but I also think that the real difference between our viewpoints is that it is far too expensive for our society to continue doing nothing to address uninsured patients. The reality of most of the state government sponsored insurance plans (Minnesota Care, Badger Care etc.) is that enrollees do pay premiums on a sliding scale which hardly is an entitlement program. (entitlement almost by definition involves something for nothing.) One of the goals of a Universal Access program is to break the cycle of the "benefits" handcuffs.
    That's a conservative figure. It's likely to be closer to 7 Billion. This is EXACTLY the cost of Medicare compared to its original estimates: a ten-fold increase.

    And medicare is the unfunded liability program on point. You can talk about reducing costs and standardizing care all you like. The technology of healthcare is creating phenomenal benefits - but the price is that the cost of healthcare is growing at mulitiples of the rate of inflation.

    Any gov't takeover must take that into account. It's silly to say that the state can 'cut costs'. Such cost cutting would soon be over-run by the aggravated pace of health care costs. And, the only real way to contain those costs is to contain the advances that create them.

    So, the choice is runaway spending, or curtailed care. Neither are practical choices or solutions to our healthcare problems.

    And entitlements are not simply 'something for nothing'. It is anything you are automatically entitled to that costs more than you pay for it and the balance is paid by taxpayers. Social Security and Medicare are both 'entitlement' programs, regardless the fact that people pay into them. On the averages, they simply do not pay into them what the programs costs. And the balance is an unfunded government liability.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Aug 20, '06
  5. by   ZASHAGALKA
    Quote from wjf00
    Thank you for clarifying this for me, no American would blow up a building in Oklahoma City or anything.
    Different rationales altogether. OKC isn't on point. We aren't talking about terrorism, per se, but about macro-economics and the price of unfunded liabilities.

    Both the French riots and the current plot in Britain are DIRECTLY linked to immigration, or, more to the point, the difficulties of assimilating rapid immigration.

    And the need for that immigration is to prop up unfunded liabilities. This can be seen in our own SS program. When first initiated, the ratio of workers to beneficiaries were a highly manageable 18:1. Now, they are 3:1 moving towards 2:1. So, how do you prop up the current SS system? Many are saying by the purposeful and willful ignoring of 11 million illegal immigrants from our southern border. As they assimilate, their kids and even them will add to the population growth necessary to support the system.

    This IS on point. Unfunded liabilities must eventually be funded. There must be bodies and workers to 'fund' them. Especially since, once created, both the costs and the numbers on their roles will exponentially grow.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Aug 20, '06
  6. by   HM2VikingRN
    Direct subsidization of new public-private plan. A number of states are exploring a public-private partnership model in which a new health plan is developed for small businesses. Either a state-designated board or a private insurer administers the plan, and the state subsidizes the premium for low-income workers.
    State-negotiated health plan. A way for states to help make coverage more affordable to small businesses without actually subsidizing the coverage is to bargain on behalf of employers. States have much greater clout than individual small businesses when negotiating prices with pharmaceutical firms or premiums with health care plans. A variation on this model is to allow small businesses and uninsured workers to actually buy into the state-employee health plan.

    The Commonwealth fund has several really interesting ideas on how to close the gap.
  7. by   HM2VikingRN
    Quote from azhiker96
    Oops, sorry for getting off topic and off thread. I'll get back on topic then. Um, apparently the people in MN who know their system and have studied this say it's $663M. I don't have any special insight into their healthcare system so I guess the answer is $663M. There you have it! :spin:
    No problem....I just thought it was important to focus on the original post.
  8. by   ZASHAGALKA
    Quote from HM2Viking
    Direct subsidization of new public-private plan. A number of states are exploring a public-private partnership model in which a new health plan is developed for small businesses. Either a state-designated board or a private insurer administers the plan, and the state subsidizes the premium for low-income workers.
    State-negotiated health plan. A way for states to help make coverage more affordable to small businesses without actually subsidizing the coverage is to bargain on behalf of employers. States have much greater clout than individual small businesses when negotiating prices with pharmaceutical firms or premiums with health care plans. A variation on this model is to allow small businesses and uninsured workers to actually buy into the state-employee health plan.

    The Commonwealth fund has several really interesting ideas on how to close the gap.
    I like these ideas better. The Commonwealth of Mass idea DOES interest me. It's a more workable idea to use and expand upon current systems and to put some responsibility on the those that are being provided with a service - especially the uninsured that are uninsured BY CHOICE because they choose not to participate in their employers' health plans.

    I'm not an 'evil big business republican'. In fact, I have previously argued that such programs would serve the interests of big business, to the detriment of small business. I, in fact, do not own any business.

    And I'm not heartless to the concept of providing access to care.

    But, platitudes and realities are sometimes two very different creatures.

    Creating unfunded liabilities might solve such problems, for a time. But the nature of such programs is to simply shunt such problems to the future. And that is more of a disservice to eventually more of our citizens then the current problem we are trying to solve.

    If we are to solve such problems, the solutions must be within our means. And the costs must be accurately figured. I disagree with the 663 million BECAUSE it takes the circumstances AS THEY EXIST TODAY and projects those costs into a system that will be DIFFERENT AS A RESULT OF THE VERY CHANGE BEING MADE. As a result, the numbers lie. They cannot tell the truth because they aren't being calculated based upon the expected changes being made to the system. I doubt it's even possible to accurately calculate the costs based on expected changes. THAT is why Medicare is so out of sight to its original estimates.

    And that's why I consider the proposal disingenuous.

    And, I disagree with the idea that 'administrative' costs will save so much money. They might very well, for a while. But the pace of healthcare spending is such that ANY such solution is also only temporary.

    We can't keep spending our childrens' money and resources to meet OUR needs. Eventually, that is a pyramid scheme, and WE are the first ones in. It's our children that will be holding the empty bag.

    I wish I could say that's a Republican concept. But the current crop spends like drunken Democrats (Sorry if I offended, Teddy). It has to stop. It WILL stop, but again, at what price and who bears that price? And, ultimately, how much worse is this potential solution then the problem we are trying to fix?

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Aug 21, '06
  9. by   ZASHAGALKA
    http://www.boston.com/news/local/mas...ing_insurance/

    "The Romney administration estimates that about 460,000 people, or 7 percent of the state's population, are uninsured. Of those people, the administration calculates that 106,000 are eligible for Medicaid but not enrolled. The governor says roughly 200,000 earn more than 300 percent of the federal poverty level, or $48,270 for a family of three, and will be able to afford the low-cost policies insurance companies will provide under his plan. The remaining 150,000, who make too much for Medicaid but not enough to afford the discounted plans, would get state subsidies to help them pay for private insurance."

    ~faith,
    Timothy.
  10. by   HM2VikingRN
    the one thing that strikes me about this whole debate is that nearly everyone agrees that there is a problem. when smaller businesses are required to pay 18% more for premiums that is a significant disadvantage for local businesses. increasing the size of the group is definitely one way to reduce costs simply through economy of scale and bargaining power. the big picture of all entitlement spending is beyond the scope of this discussion.

    i ran a few numbers on paper just to get a sense of what the real challenge is to meet the needs of the uninsured (in minnesota).

    663 million (number to reach all uninsureds).
    less 250 million (money already being spent for unins. health care)
    less 112 million (realized by reducing admin costs from 31% to 17%)
    yield 301 million in new money to achieve universal access/coverage for uninsured minnesotans.

    a couple general observations:

    1. states must balance their budgets each budget cycle.
    2. savings for other subscribers yielded through reduction of administrative and other costs will in essence make our health care dollars go farther without a net cost increase.

  11. by   ZASHAGALKA
    Quote from hm2viking
    the one thing that strikes me about this whole debate is that nearly everyone agrees that there is a problem. when smaller businesses are required to pay 18% more for premiums that is a significant disadvantage for local businesses. increasing the size of the group is definitely one way to reduce costs simply through economy of scale and bargaining power. the big picture of all entitlement spending is beyond the scope of this discussion.

    i ran a few numbers on paper just to get a sense of what the real challenge is to meet the needs of the uninsured (in minnesota).

    663 million (number to reach all uninsureds).
    less 250 million (money already being spent for unins. health care)
    less 112 million (realized by reducing admin costs from 31% to 17%)
    yield 301 million in new money to achieve universal access/coverage for uninsured minnesotans.

    a couple general observations:

    1. states must balance their budgets each budget cycle.
    2. savings for other subscribers yielded through reduction of administrative and other costs will in essence make our health care dollars go farther without a net cost increase.
    while i might agree that the 'big picture' of entitlement spending is beyond the scope of a single thread, valid comparisons to similar entitlement spending is on point. if you want to examine a position, comparing it with similar models already in existence is exactly on point. and adding to an already growing and out of control entitlement nightmare with yet more unfunded liability spending is also on point.

    if you can't examine a position from all sides, and with all the implications of any such positions intact, then no position is worth discussing.

    and call me cynical but i just don't see turning such services over to the gov't will reduce administrative costs. the gov't is infamous for its over- administration, otherwise known as beauracracy, or simply, red-tape.

    and your observations take into account that users of a universal system will completely eliminate uninsured expenses. in fact, many of the same inappropriate users of the healthcare system (usings ers for primary care) will continue to do so, merely transferring the costs to the new system (not eliminating them).

    so the reductions you tag to the 663 million dollar pricetag will not be totally or even mostly realized. and the true costs of the proposal have been purposely disguised by making assumptions on current trends and applying them to a model that would be changed by the proposal itself.

    and even if the costs savings are realized, they will be systematically eaten away by the rising costs of healthcare, creating an unfunded liability, even a decade from now, far away and above the current projections.

    in light of the trends known to occur in programs already implemented, and no effort to account for these trends - indeed, it seems an effort to hide the true costs of these trends -, you are talking about a program that will greatly overrun these 'too modest to believe' estimates.

    you are talking about a multi-billion dollar proposal. and, as the politicians say, a billion here, a billion there, and fairly soon, we're talking about real money. but, it's not money we'll have to pay; that's what children are for.

    (yes, states must balance their budgets, but the cost will merely be transferred to higher tax obligations and decreasing job creation pressures that will occur as a result of tying up billions in gov't programs instead of allowing it to remain in the private, economic arena. the problems will grow as a result of huge unfunded liabilities and so, affect the future prosperity of our children. they will have to pay for ever increasing programs with ever shrinking resources.)

    ~faith,
    timothy.
    Last edit by ZASHAGALKA on Aug 21, '06
  12. by   pickledpepperRN
    Isn't it a matter of priorities?
    How important is healthcare?

    http://www.budget.state.mn.us/budget...ry/index.shtml
  13. by   azhiker96
    I doubt there will be any net savings from a reduction in administrative costs. A lot of the administrative costs must be filing and billing for services rendered, checking for coverage, requests and approval for procedures, etc. If these are reduced or eliminated, any savings will likely be eaten up by increased fraud. The amount of personel needed for this work is largely dependent on the number of insured, not the number of insurance programs. I agree it will be more efficient if healthcare providers deal with fewer insurers, fewer types of forms. That savings would be pretty small though, especially with electronic billing. A large part of HIPPA was standardizing DRGs and electronic billing.

    Perhaps what we need is to think totally outside of the box. Setup a system where the state covers all of it's citizens, paid by employment taxes with additional subsidy by employers. Include direct payments to people who make healthwise choices such as no tobacco use, appropriate BMI, yearly checkups, etc. Also setup rebates to employers who take an active part in promoting health among their employees. The cost of the program is easy to contain, just eliminate procedures to stay withing budget. If a 50 yr old wants a new hip or CABG, they can pay for it. The age cutoff for procedures can be adjusted as needed.

    I think it would need to be done at the federal level though to avoid two problems. First, what would MN do when an uninsured Floridian shows up at the ED? Secondly, we'd see lawsuits if one state paid for certain procedures that were not paid in another state.

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