The 663 Million Dollar Question - page 4

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   HM2VikingRN
    the original article made the point that in mn we treat the uninsured at our ed's. state of residence does not come into play. az what you are really suggesting is a type of single payer or universal access similar to what is offered in canada. the numbers offered in my breakdown for admin cost savings were based on the assumption that we would reduce our administrative costs (on avg) from the current 31% to the canadian average of 17%.

    for an example of how increasing the group size reduces costs to beneficiaries i found the following reference:

    4) social security is extremely efficient, private accounts are wasteful
    [font=times]on average, less than 0.6 cents of every dollar paid out in social security benefits goes to pay administrative costs. by comparison, systems with individual accounts, like the ones in england or chile, waste 15 cents of every dollar paid out in benefits on administrative fees. president bush's social security commission estimated that under their system of individual accounts 5 cents of every dollar would go to pay administrative costs.
    [font=times]
    [font=times]while this is a retirement issue the analogy holds for health care. the larger systems be it tricare, federal employees health, minnesota advantage, the va etc. are all more successful in cost containment than under the current system where small firms are buying policies for small groups, paying more for less coverage and have fewer resources to cover large claims. insurance by definition is spreading risk over a larger pool of people which is in effect socializing the risk. my honest opinion is that while single payer has its limitations the current system in the us does not work and is in effect destroying the industrial base of the us economy. (gm starts out with a 1500 dollar price disadvantage for its products due to health care issues.) because of a lack of leadership from washington the states are tackling this issue in a patchwork fashion. ultimately i think that the states will all go towards a system where small employers will be able to purchase insurance either through the public employees pool or through programs such as mn care that serve the uninsured.
  2. by   azhiker96
    Viking, yes, the original article does say the uninsured are treated. I think that was the main problem and that they were trying to get everyone covered by insurance. Maybe I read that incorrectly. My point was that if you want to fix the problem of uninsured in the ED it needs to be a national solution. Otherwise you will end up treating the uninsured from other states. Border towns will be harder hit than others of course.
  3. by   wjf00
    Quote from ZASHAGALKA

    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.


    ~faith,
    Timothy.
    There is no evidence to back up this assertion. Many social scientists would argue that vigilante groups such as the Minutemen and the like could easily be labled as terrorists themselves. The tired old refrain of blaming all your troubles on immigration just doesn't work.
    The same profiling could be used to blame any hospital deaths of unknown cause from New Orleans post Katrina on 'failed ethics training in nursing programs' A ridiculous assertion by any reckoning.
  4. by   HM2VikingRN
    Quote from azhiker96
    Viking, yes, the original article does say the uninsured are treated. I think that was the main problem and that they were trying to get everyone covered by insurance. Maybe I read that incorrectly. My point was that if you want to fix the problem of uninsured in the ED it needs to be a national solution. Otherwise you will end up treating the uninsured from other states. Border towns will be harder hit than others of course.
    I absolutely agree that it should be a national solution. I think state by state incrementalism is more expensive in the long term. I think I misread your post about out of state residents so I apologize for that.
  5. by   HM2VikingRN
    From Minnesota Public Radio:

    "Would we cover more people? Yeah, and I'd be happy to have more people carrying HealthPartners' ID card and I think that's fine," she says. "But I also think for an organization like us, we see what happens when people show up in our emergency room because they haven't gotten care or treatment elsewhere. And there's simply every bit of evidence that you have longer life, lower health care costs in the long haul and better health if you have health coverage."

    The cost is only one hurdle. Another major hurdle is making sure that everyone is covered. Brainerd says universal coverage won't work unless it's mandatory. She acknowledges that requiring coverage won't be popular, especially among Minnesotans who have enough money to buy health insurance, but choose not to.

    "I think the most challenging part of it is the mandate, in that most people don't like mandated anything. But you could very clearly tie it to the process of paying taxes and make sure that we, at the time when you submit taxes, you also submit proof of coverage," she says.
    ...you could very clearly tie (mandatory coverage) to the process of paying taxes and make sure that, at the time when you submit taxes, you also submit proof of coverage.
    - Mary Brainerd, President and CEO of HealthPartners


    Brainerd's idea relies on private health plans like HealthPartners to provide coverage. Blue Cross Blue Shield of Minnesota, the state's largest health plan, also supports that approach. Blue Cross has been studying the Massachusetts plan and will release a white paper next month showing ways Minnesota could get to universal coverage.

    President and COO Colleen Reitan says the goal is to find a sustainable approach.

    "Because you could reform the insurance market and you could get universal coverage, but the question is, is it sustainable? Because ultimately you have to have affordable access to health care over a longer period of time and that's what's going to be sustainable," she says.
  6. by   subee
    Quote from HM2Viking
    Before we could have universal health care we'd need to devise a rational health care system. That would require RATIONING. The Regan administration shot down Oregon's plan which stuck me as outstandingly thought through and realistic. But in a country in which children are rarely allowed to die and frail, elderly patients get pacemakes and total hips, it occurs to me that putting the rational in rationing will never happen. Is it rational to replace the hips and knees of five hundred pounders? If the taxpayer has to pay for all the joints our tubby society will need in the next 20 years there will be very little take home pay. I do not want to pay for this. Universal health care would surely dictate a modicrum of care for everybody (with which I have no problem) but the wealthy would be able to buy more, as is the two-tiered system in England. And if the wealthy guy wants to pay for the MRI for his headache that's alright too, but I don't want to pay for it. I don't see Americans as ready to deal with the tough questions so don't see any way in my lifetime that the situation will improve since everyone wants everything at any cost.
  7. by   pickledpepperRN
    A neighbor is alive and well years after having a brain tomor removed. It was diagnosed by MRI. They thought it was migraine headaches but the physician ordered the MRI "just in case."
  8. by   HM2VikingRN
    Quote from spacenurse
    a neighbor is alive and well years after having a brain tomor removed. it was diagnosed by mri. they thought it was migraine headaches but the physician ordered the mri "just in case."
    i think that this example illustrates exactly why we need to design a basic universal access system for all patients. in many ways i think of universal access as pay a little now to prevent huge expenditures later. i read an email from a minnesota health economist that clearly argues for single payer as the optimal outcome but recognizes that universal access may be what is politically feasible.

    access to affordable health care is a basic human right.
  9. by   HM2VikingRN
    Quote from subee
    Before we could have universal health care we'd need to devise a rational health care system. That would require RATIONING.
    Rationing of health care already occurs in our society. Every time that we as a local community have to hold a bake sale, church benefit supper or raffle to help pay for someone's transplant, cancer treatments, or ? that is rationing in action. The uninsured do not receive the needed basic care that may very well prevent serious illness. When they do get sick and are treated by the ER at much higher cost this ends up being passed on to the insureds which weakens the system.

    I have yet to be convinced by anyone who opposes universal access that our current system is either financially or socially more efficient than single payer. (The French have a universal access system that costs roughly $2700/year per capita with everyone insured while the US spends $5000/year per capita with 46 million people uninsured at some time in any given year.)

    A prevention oriented health care plan should be relatively easy to develop that insures access to basic services. The goal of society should be to over time to reduce the number of patient's (currently 7%) but who consume 30% of the health care dollars according to the Commonwealth fund.

    The other thing that struck me as I read your post was "Do we as a society really want to reduce the quality of life for our patients by denying them access to joint replacements unless they can pay the total cost out of pocket?" Would you want someone to tell you to pay for your joint replacement surgery out of pocket. Oh you can't pay well go see the Social Security office down the street and they will help you file for disability. You may also want to call your attorney because over half of personal bankruptcies are related to medical bills. So you will probably end up losing your home and everything that you have worked for over the past 20 years. Its much easier to make comments about not paying for a needed suregery when it does not affect you or a loved one.

    For example, If a 40 something year old worker is disabled from work by a bad knee and ends up on disability it would not take very long before the disability payments and other income supports would exceed the cost of the knee replacement. Either alternative has a significant cost to society but paying for the knee replacement restores a worker to the workforce as a productive member of society. The basic assumption may become that younger workers with children have first priority while others will be waitlisted. Haven't we already designed a priority system for organ transplantation? Undoubtedly, the insurance industry will develop supplemental plans to allow patients to access these types of medical services more rapidly and at probably a higher out of pocket cost but the important thing is that we have designed and implemented a more efficient health care system. There are no easy answers but to do nothing is far more costly.
  10. by   subee
    Quote from spacenurse
    A neighbor is alive and well years after having a brain tomor removed. It was diagnosed by MRI. They thought it was migraine headaches but the physician ordered the MRI "just in case."


    Whoa! Usual over-reacting to the idea of rationing? I NEVER even implied that there isn't a place for MRI in w/o for headache or that a 40 year old person shouldn't have a knee replacement! Where did you see that? However, if we do have universal health care, there will be fewer total joint replacements in 300 lbs. and over patients because everyone can not have everything and some patients won't have access to the goodies. If you have good insurance now, you can get everything - whether you need it or not. For the little guy he will get more than he has now under a universal system but not everything. These are the tough ethical and practical decisions that have to be made. Preferably before the system changes than after. What we have now is about 30% of our insurance dollars going out to subsidize costs occured in moving the money around. I'm not opposed to the concept of universal health care but have no faith in our ability to change the paradigm and do what we'll have to do to have a rational, sane alternative


    edited: sorry, spacenurse, this was meant for viking.
    Last edit by subee on Aug 23, '06
  11. by   subee
    [QUOTE=HM2Viking]Rationing of health care already occurs in our society. Every time that we as a local community have to hold a bake sale, church benefit supper or raffle to help pay for someone's transplant, cancer treatments, or ? that is rationing in action. The uninsured do not receive the needed basic care that may very well prevent serious illness. When they do get sick and are treated by the ER at much higher cost this ends up being passed on to the insureds which weakens the system.

    I have yet to be convinced by anyone who opposes universal access that our current system is either financially or socially more efficient than single payer. (The French have a universal access system that costs roughly $2700/year per capita with everyone insured while the US spends $5000/year per capita with 46 million people uninsured at some time in any given year.)

    A prevention oriented health care plan should be relatively easy to develop that insures access to basic services. The goal of society should be to over time to reduce the number of patient's (currently 7%) but who consume 30% of the health care dollars according to the Commonwealth fund.

    The other thing that struck me as I read your post was "Do we as a society really want to reduce the quality of life for our patients by denying them access to joint replacements unless they can pay the total cost out of pocket?" Would you want someone to tell you to pay for your joint replacement surgery out of pocket. Oh you can't pay well go see the Social Security office down the street and they will help you file for disability. You may also want to call your attorney because over half of personal bankruptcies are related to medical bills. So you will probably end up losing your home and everything that you have worked for over the past 20 years. Its much easier to make comments about not paying for a needed suregery when it does not affect you or a loved one.

    For example, If a 40 something year old worker is disabled from work by a bad knee and ends up on disability it would not take very long before the disability payments and other income supports would exceed the cost of the knee replacement. Either alternative has a significant cost to society but paying for the knee replacement restores a worker to the workforce as a productive member of society. The basic assumption may become that younger workers with children have first priority while others will be waitlisted. Haven't we already designed a priority system for organ transplantation? Undoubtedly, the insurance industry will develop supplemental plans to allow patients to access these types of medical services more rapidly and at probably a higher out of pocket cost but the important thing is that we have designed and implemented a more efficient health care system. There are no easy answers but to do nothing is far more costly.

    Obesity is rare in Europe. Their diet is better. Can't compare health costs for these two societies.
  12. by   HM2VikingRN
    [quote=subee]
    Quote from HM2Viking
    Rationing of health care already occurs in our society. Every time that we as a local community have to hold a bake sale, church benefit supper or raffle to help pay for someone's transplant, cancer treatments, or ? that is rationing in action. The uninsured do not receive the needed basic care that may very well prevent serious illness. When they do get sick and are treated by the ER at much higher cost this ends up being passed on to the insureds which weakens the system.

    I have yet to be convinced by anyone who opposes universal access that our current system is either financially or socially more efficient than single payer. (The French have a universal access system that costs roughly $2700/year per capita with everyone insured while the US spends $5000/year per capita with 46 million people uninsured at some time in any given year.)

    A prevention oriented health care plan should be relatively easy to develop that insures access to basic services. The goal of society should be to over time to reduce the number of patient's (currently 7%) but who consume 30% of the health care dollars according to the Commonwealth fund.

    The other thing that struck me as I read your post was "Do we as a society really want to reduce the quality of life for our patients by denying them access to joint replacements unless they can pay the total cost out of pocket?" Would you want someone to tell you to pay for your joint replacement surgery out of pocket. Oh you can't pay well go see the Social Security office down the street and they will help you file for disability. You may also want to call your attorney because over half of personal bankruptcies are related to medical bills. So you will probably end up losing your home and everything that you have worked for over the past 20 years. Its much easier to make comments about not paying for a needed suregery when it does not affect you or a loved one.

    For example, If a 40 something year old worker is disabled from work by a bad knee and ends up on disability it would not take very long before the disability payments and other income supports would exceed the cost of the knee replacement. Either alternative has a significant cost to society but paying for the knee replacement restores a worker to the workforce as a productive member of society. The basic assumption may become that younger workers with children have first priority while others will be waitlisted. Haven't we already designed a priority system for organ transplantation? Undoubtedly, the insurance industry will develop supplemental plans to allow patients to access these types of medical services more rapidly and at probably a higher out of pocket cost but the important thing is that we have designed and implemented a more efficient health care system. There are no easy answers but to do nothing is far more costly.

    Obesity is rare in Europe. Their diet is better. Can't compare health costs for these two societies.
    My point was not meant to compare the two societies it was rather meant more as a comment that we already have a defacto rationing scheme in place which results in significant social costs. I wasn't trying to come down like a ton of bricks on you so much as to point out that as a society we may think that we are saving money by not having universal care but the reality is that subsequent social costs from not providing good preventive care should be factored into the equation. I was glad that you pointed out the 30% administrative cost in our current system as a problem.
  13. by   HM2VikingRN
    An interesting quote from John Kenneth Galbraith which I think draws a bright shining line about the progressive vs. conservative attitude towards access to affordable health care:

    The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness.
    John Kenneth Galbraith

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