Are you willing to pay more taxes to ensure health coverage for all?

Nurses Activism

Published

cbs/new york times poll, february 2 007

if you had to choose, which do you think is more important for the

country to do right now, maintain the tax cuts enacted in recent

years or make sure all americans have access to health care?

cutting taxes 18%

access to health insurance 76%

would you be willing or not willing to pay higher taxes so that all

americans have health insurance they can't lose, no matter what?

willing 60%

not willing 34%

(if "willing") would you be willing or not willing to pay $500 a

year more in taxes so that all americans have health insurance

they can't lose, no matter what?

willing 82%

not willing 6%

Specializes in Maternal - Child Health.
But this is proven not to be true.

In over a dozen countries. In fact, the US has the highest cost per capita of ANY country in healthcare.

Therefore your argument is unfounded.

Using your argument, I would say that considering the worldwide statistics, the current US healthcare system is the most expensive, wasteful system there is...

Perhaps I should have stated that as long as the consumer views the "government" or the "insurance company" as the payor, costs and unnecessary utilization will only increase.

But otherwise, you just proved my point for me. If indeed the US has the highest healthcare cost per capita of any nation, it is because virtually NO individual here pays DIRECTLY for his/her own services. We have already tried this experiment. It was called HMO coverage, and it was a dismal failure because people flocked to their doctor's offices and other providers for unnecessary services that they perceived to be free.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

We have already tried this experiment. It was called HMO coverage, and it was a dismal failure because people flocked to their doctor's offices and other providers for unnecessary services that they perceived to be free.

I'd like to see the statistics or documentation on that. HMOs were notorious for denying claims. They also gave bonuses to providers who kept costs down by not doing costly procedures, etc.

Specializes in Maternal - Child Health.
Or they squandered their allowance by being too liberal with it (eg seeing a doctor for every little cold). So you still have the question of determining who receives what, if any, extra support in addition to their allowance. Perhaps some kind of allowance for kids', however, that the child can then put towards education if there's any extra at the age of 18.

I'm not suggesting that the "allowence" should be the only source of healthcare funding for anyone. With or without healthcare coverage, are we not all responsible for saving towards our own expenses, just as we do with our household, costs, automobile expenses, vacations, etc.? I would intend it to be a tax credit or subsidy that would enable an individual or family to CHOOSE to purchase healthcare coverage, or save and invest it to pay for expenses directly, along with their own savings. But, just as Social Security does not pay for 100% of a retiree's living expenses, we can not expect any health plan to pay 100% for healthcare. We seem to have lost our sense of personal responsibility in funding our own needs. If someone squanders their "government" funding, should we have to bail them out? I think not.

Perhaps I should have stated that as long as the consumer views the "government" or the "insurance company" as the payor, costs and unnecessary utilization will only increase.

But otherwise, you just proved my point for me. If indeed the US has the highest healthcare cost per capita of any nation, it is because virtually NO individual here pays DIRECTLY for his/her own services. We have already tried this experiment. It was called HMO coverage, and it was a dismal failure because people flocked to their doctor's offices and other providers for unnecessary services that they perceived to be free.

Huh? You lost me.

Anyways. I don't have a crystal ball. I wish I did because then I could just go buy own private little island somewhere and pay the doctors to come to ME!

At any rate, seeing as I do not have the gift of foresight, I can only go by what has been done and what is being done by other countries and assume that similar results would happen in the US if a similar system was adopted.

But bottom line is that I am actually quite done with this subject. I only came on here to dispute the blatant myths that were being spread about Canada and their healthcare in general.

I hope the US gets it together and finds a solution. I don't know what it is. But I hope it will be a fair one...

I also want to mention that the US that I know and love is one of compassion and interest in the fellow man. I have found that the US has become more and more 'all about me' and less 'all about us'. We, none of us, live in a bubble. I have seen the hardening of America and it grows harder and harder every year and it saddens me. America has grown great because it was a nation that invested in its people. All of them. Now it only seems to invest in the rich.

When I go back home to California, I find the people are changing. More suspicious. Less, well, human. When I say hi to the person behind the 7-11 counter, they are suprised I even spoke to them, or they are suspicious. And after I mention I am from Canada, the smiles and the America I know so well comes out. I find that Canada is a kinder nation with everyone fairly willing to give the next person the benefit of the doubt. Perhaps it is the feeling of caring for the fellow man. Perhaps it is something else.

What is happening to to the American heart?

I will end my participation in this thread with two quotes from my most favorite person - the great, late Winston Churchill.

One is for Darren - "A fanatic is one who can't change his mind, and won't change the subject."

And one for the world at large...

"We make a living by what we get, we make a life by what we give"

And no, I am not talking about all you wonderful people who volunteer as many of us do. I am saying that this philosophy as a nation is being lost. And that is sad.

Specializes in Maternal - Child Health.
I'd like to see the statistics or documentation on that. HMOs were notorious for denying claims. They also gave bonuses to providers who kept costs down by not doing costly procedures, etc.

I'm not at the library, so I don't have access to the search engines that would enable me to find statistics to back up my claim. But by Googling "physician office visits and HMO coverage" I found information on a number of current HMO plans that limit their members to anywhere from 3-20 visits per year to their primary physician, apparently an attempt to prevent over-use of the office by some HMO members.

When HMO's became common, one of the biggest complaints of participating primary physicians was an explosion in the number of unnecessary office visits requested by patients for minor complaints such as colds, viral illnesses, etc. These were patients who had never before come in for such complaints, but started doing so once they perceived the office visits to be "free". That was just one of many problems with the HMO model of care.

You are absolutely correct that primary physicians also benefitted by keeping referrals to specialists and other providers to a minimum, and some went way overboard in doing so. When I was pregnant, my primary physician had to "sign off" on anything my OB wanted to do. I was having symptoms of pre-term labor in my second trimester, and my OB ordered a urine C+S, part of a standard workup for PTL. My primary doc refused to OK it. He insisted that I come into HIS office to be evaluated, since he was unwilling to accept the diagnosis made by my OB, who was a high-risk specialist that HE had referred me to! After days of being bounced between the OB and family doc's office, I ended up hospitalized and treated for...you guessed it...a UTI! Obviously, there were no cost savings by denying me a simple, inexpensive test, and there was lots of dissatisfaction on my part, and the part of my OB.

There were many flaws with the HMO model, as there are with ANY system of healthcare delivery and payment. It helps when we learn from our past mistakes when crafting a new system, though, in an effort to avoid making those mistakes again.

we have tried the privatization scheme with medicare. it is more expensive!

in theory, private plans, particularly managed care, would reduce the program's escalating costs. government payments, it was argued, would allow these plans to offer both standard and extra benefits and encourage efficient, low-cost care. however, after 2003 the government began shoveling huge sums of money into the medicare advantage plans to entice seniors to leave the traditional program--in effect subsidizing privatization even more and bringing right-wing think tanks like the heritage foundation closer to their objective of ending medicare as social insurance. the ultimate goal, of course, is to make seniors bear future costs, sparing their benefactors the need to pay more taxes to keep medicare afloat. this year the government will pay insurers on average 12 percent more than it costs to provide the same benefits to people who stay in the traditional program, according to the medicare payment advisory commission (medpac), an independent group that advises congress. hmos will get 10 percent more, but private fee-for-service plans will get a whopping 19 percent more, a subsidy that lets them offer rock-bottom premiums and lots of extras--at least for now.

http://www.thenation.com/doc/20070716/lieberman

vs the french model:

the government provides basic insurance for all citizens, albeit with relatively robust co-pays, and then encourages the population to also purchase supplementary insurance -- which 86 percent do, most of them through employers, with the poor being subsidized by the state. this allows for as high a level of care as an individual is willing to pay for, and may help explain why waiting lines are nearly unknown in france.

france's system is further prized for its high level of choice and responsiveness -- attributes that led the world health organization to rank it the finest in the world (america's system came in at no. 37, between costa rica and slovenia). the french can see any doctor or specialist they want, at any time they want, as many times as they want, no referrals or permissions needed. the french hospital system is similarly open. about 65 percent of the nation's hospital beds are public, but individuals can seek care at any hospital they want, public or private, and receive the same reimbursement rate no matter its status. given all this, the french utilize more care than americans do, averaging six physician visits a year to our 2.8, and they spend more time in the hospital as well. yet they still manage to spend half per capita than we do, largely due to lower prices and a focus on preventive care.

that focus is abetted by the french system's innovative response to one of the trickier problems bedeviling health-policy experts: an economic concept called "moral hazard."

...

problem is, studies show that individuals are pretty bad at distinguishing necessary care from unnecessary care, and so they tend to cut down on mundane-but-important things like hypertension medicine, which leads to far costlier complications.

...

in order to prevent cost sharing from penalizing people with serious medical problems -- the way health savings accounts threaten to do -- the [french] government
limits
every individual's
out-of-pocket expenses
. in addition, the government has identified
thirty chronic conditions, such as diabetes and hypertension, for which there is usually no cost sharing, in order to make sure people don't skimp on preventive care that might head off future complications.

http://prospect.org/cs/articles?article=the_health_of_nations

better results, true provider choice for patients and lower cost!

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
I'm not at the library, so I don't have access to the search engines that would enable me to find statistics to back up my claim. But by Googling "physician office visits and HMO coverage" I found information on a number of current HMO plans that limit their members to anywhere from 3-20 visits per year to their primary physician, apparently an attempt to prevent over-use of the office by some HMO members.

When HMO's became common, one of the biggest complaints of participating primary physicians was an explosion in the number of unnecessary office visits requested by patients for minor complaints such as colds, viral illnesses, etc. These were patients who had never before come in for such complaints, but started doing so once they perceived the office visits to be "free". That was just one of many problems with the HMO model of care.

http://content.healthaffairs.org/cgi/reprint/10/4/78.pdf

The way I see it is that many HMOs failed because so many people were dissatisfied with their lack of choices and lack of coverage, that employers stopped using them in their benefits packages (which is what my employer did). Doctors stopped accepting them as well, because they lost their autonomy in the quality care they felt was needed for their patients. Add to that, all the horror stories of people dying because they weren't approved for life-saving treatments, dying because they went to the wrong, non-group hospital, etc. and you had a doomed enterprise. HMOs worked on numbers. They failed because people were so fed up with them, that they left the pool.

As for your point that now those who have HMOs (vs PPOs, for instance) make more doctor visits: They may have chosen to pay more and get the HMO, because they already have more medical needs. If I had a chronic illness, I would be shelling out for more coverage than I am, and would have opted for the HMO as well. The HMO offered by my employer is very expensive. No one is going to opt for it unless they have more medical needs than the average healthy person with an average healthy family. Believe me, at what it costs to have the HMO, no one that I know of would perceive the care they get as free.

http://content.healthaffairs.org/cgi/reprint/10/4/78.pdf

The way I see it is that many HMOs failed because so many people were dissatisfied with their lack of choices and lack of coverage, that employers stopped using them in their benefits packages (which is what my employer did).

If I had a chronic illness, I would be shelling out for more coverage than I am, and would have opted for the HMO as well. The HMO offered by my employer is very expensive. No one is going to opt for it unless they have more medical needs than the average healthy person with an average healthy family. Believe me, at what it costs to have the HMO, no one that I know of would perceive the care they get as free.

Where I am, the HMO option is less than PPO and the co-pays are higher for the PPOs ($30-$50 as opposed to $10-$20 for HMOs). For those with on-going health problems who can afford it generally prefer the PPOs because they can go directly to specialists for self referrals and on-going treatment without having to have those visits and treatments approved by a primary care gatekeeper. As people got frustrated with HMOs, PPOs became the preferred choice of many. Still, those who are otherwise well and don't want to spend any extra money on a health plan preferred the cheaper HMO option. Also, the PPOs have more paperwork to deal with and the patient must keep on top of bills and reimbursement policies to make sure they receive the benefits specified in their contract.

Of course, HMOs have morphed over the years from all-inclusive organizations like Kaiser to groups that maintain complex contracts and reimbursement policies with a wide assortment of private providers. I think these latter organizations are what need to be pared down before we look at how else health care might be organized and delivered. This type of contracting of private services has led to ridiculous layers of beauracracy and confusion at the patient and provider level about what is and isn't covered by the different HMOs that they have contracts with. It's crazy-making.

Plus, there have many instances of sudden changes in contract either because the HMO/PPO had a major change (merger, downsizing, etc) or the provider organization (put together for bargaining power and administration of all those different HMO/PPO contracts) went out of business without warning (perhaps due to the loss of certain contracts). I've met several people who have had their medical group disappear overnight. It happened to me as well. I called one day and was told to call back the next week as the dr was out. The next week, that particular medical group had completely dissolved and my doc had relocated with a different group a few miles away.

In regard to the assertion that doctors' visits increased by those enrolled in HMOs... it could very well be. There's a positive side to that in that people who otherwise might have ignored problems or put off going to see a doctor due to the out of pocket expense might have had their problems taked care of sooner. Keep in mind, that when HMO's started, employers generally paid the bulk of the membership fees and employees only had to cover a small co-pay (eg $5-10 versus paying outright for a doctor's visit, maybe $50-60 at the time).

On the negative side, there were probably folks who didn't really need a doctor but went anyway "just in case" since it cost so little. But is that SO bad? Where is goes wrong is when dr's are so pushed for time and worried about client retention that they find it easier to just prescribe a useless antibiotic than to educate the patients.

If we had more affordable, accessible, walk-in clinics, then the bulk of the worried well who are likely to overuse their health benefits could be taken care of there.

Whew! There are so many different angles and things to consider in health care delivery!!! :monkeydance:

Specializes in Cardiac Surg, IR, Peds ICU, Emergency.

I will end my participation in this thread with two quotes from my most favorite person - the great, late Winston Churchill.

One is for Darren - "A fanatic is one who can't change his mind, and won't change the subject."

And one for the world at large...

"We make a living by what we get, we make a life by what we give"

And no, I am not talking about all you wonderful people who volunteer as many of us do. I am saying that this philosophy as a nation is being lost. And that is sad.

1. I took a break from this topic while others, including you, continued to post away. Additionally, I have already dropped this subject; your comment is insulting.

BTW, engaging in a seque on the discussion is what ticked people off, so your comment about 'changing the subject' makes no sense.

2. Are you suggesting that I am a fanatic because I won't change my mind? Will you change yours? What does that make you?

analysis by jonathan gruber of m.i.t. — a leading health economist who has conducted a good part of the work on schip crowd-out on which the cbo analysis rests. and whose work on crowd-out the heritage foundation repeatedly cites — has found that despite crowd-out, “public insurance expansions like schip remain the most cost-effective means of expanding health insurance coverage” (emphasis added). gruber’s work shows that expanding schip is far more cost-effective than proposals such as health tax credits and deductions.

http://www.cbpp.org/6-21-07health.htm

Clarifying terminology is often useful.

A "right" can be defined different ways (language is a living thing and change despite dictionary definitions). One major way the term is used relates to the correction of and prevention of categorical, systematic discrimination. This would include things like citizens having the right the vote, to work, to move freely in public, etc.

However, as systematic discrimination has been dismantled over the years, people still found many barriers to practicing those rights. If a disadvantaged community doesn't have any polling stations while a more wealty community has several convenient polling stations, one has to ask if that means their rights have been infringed upon in some way. One could argue that no one's RIGHTS had been infringed upon but it clearly in that scenario, there's a definite PROBLEM however one technically defines it. I think that's the case with health care as well. When people say "health care should be a right" they are really saying "health care should be more affordable" (eg highly regulated like most utilities upon which we're dependent) or "health care should be publicly-funded" (like k-12 education).

So, back to the issue at hand, do citizens have a right to some degree of publicly-funded health care in a similar manner than children in the US have a right to publicly-funded education through grade 12? This kind of social right differs from the one above in that it provides a service. Despite current problems with public education, I do think public education is important and has a history throughout many societies of being good for society and individuals. I think some kind of publicly funded health care is a good thing. We already have the public health service as well as health care benefits associated with other social welfare programs. Perhaps some greater degree of publicly funded health care could be advantageous. But there's A LOT of ground and possibilities between what we have now and completely government-run health services.

Personally, I think services like health care and utilities need some greater degree of regulation than other consumer goods and services since we are so dependent upon them and can't always wait for good ol' capitalistic competition principles to keep prices and accessibility in line with needs and demands.

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