Clinton unveils new health care plan

Jolie, BSN · Sep 18, 2007

Except that in the case of catastrophic illness/injury as a society we still end up paying for their care. This kind of individual choice is horribly destructive to the common good. As a society we place limitations on behavior all the time because it damages the public interest. (Speed limits, drunken driving laws etc.)

You have just made my point for me. We don't prohibit people from drinking. We simply hold them responsible for their actions.

The same should apply to health insurance. If someone chooses not to carry it, s/he should be held responsible for the consequences of that choice. If they remain healthy, they keep the cash to use as they wish. If they utilize expensive healthcare services for which they are not insured, let them pay for it, for the rest of their lives, if need be. We need to loose the mentality that we as a society are responsible for "righting" people's personal choices, or worse yet, that we do them favors by preventing them from making choices in the first place.

What is destructive to the common good is eliminating competition by implementing a single payor, especially a single government payor.

Music in My Heart · Sep 18, 2007

What is destructive to the common good is eliminating competition by implementing a single payor, especially a single government payor.

Yes, because we see how well competition has kept pharmaceutical prices in the US so much lower than in those countries with capped rates.

And competition has helped to drive down health care costs and yield better service and coverage.

Yay, free market!!

Jolie, BSN · Sep 18, 2007

Yes, because we see how well competition has kept pharmaceutical prices in the US so much lower than in those countries with capped rates.
And competition has helped to drive down health care costs and yield better service and coverage.
Yay, free market!!

You are right, competition is simply one piece of the puzzle, but it is an important piece. Without competition, there is no incentive to reign in costs, and no incentive to insure quality, and no incentive for the consumer to "shop" for higher quality and less expensive services. Just go into any small town that has only one grocery store, or visit a rural area with only one hospital for miles around.

Another important factor in limiting costs is personal responsibility for paying the bill. Something most Americans want no part of. We have come to expect pre-paid healthcare, not insurance to cover catastrophic costs. Virtually no one thinks they have any personal responsibility for paying for basic, routine services anymore, let alone co-pays, co-insurance, deductibles, etc. Consumers expect everything for "free" because they have insurance, often utilizing unnecessary services that simply drive costs up even further. Do you personally know of anyone who actually budgets for their anticipated healthcare expenses? I know very few people who do. But you can bet that those who don't budget for healthcare expenses DO budget for entertainment, new cars, new clothes, etc. It is a priority that has been lost on most Americans, because they expect someone else to pay their healthcare bills. What few people seem to understand is that healthcare is not free, having insurance does not make it free, and, when insurance pays for something, that money is coming out of ALL of our pockets.

Any successful healthcare/payment system MUST include compteition and must include personal responsibility for paying the bill.

pickledpepperRN · Sep 18, 2007

Mandatory health care won't curb costs

Presidential hopeful Hillary Clinton laid out her plan for health care yesterday, which includes mandatory health insurance. But commentator Jamie Court says demanding more cost-effective coverage would be a better solution..../

...The reason health insurance is so unaffordable today is that no one is watching the costs. With standardization, insurance would be cheaper and people would want to buy it -- not have to because the government is threatening them with a tax penalty.

Oh wait, I can hear the plaintive cry of the free market. You can't tell a doctor, insurer, hospital or drug company what's reasonable to charge. That's socialism.

Well, how reasonable then is it to tell every American you have to buy a product whose cost is obscene if you want to be a U.S. citizen? Isn't that corporate socialism?

Mandatory health insurance is a government bailout of a free market that's failed its customers. ...

...There's a business plan of course. Mitt, Arnold and Hillary each received six or seven-figure campaign contributions from the insurance industry. The plan is insurers send the bill and we have to pay it....

http://marketplace.publicradio.org/display/web/2007/09/18/forced_health_care_wont_curb_insurer_costs

ZASHAGALKA, RN · Sep 18, 2007

You are right, competition is simply one piece of the puzzle, but it is an important piece. Without competition, there is no incentive to reign in costs, and no incentive to insure quality, and no incentive for the consumer to "shop" for higher quality and less expensive services. Just go into any small town that has only one grocery store, or visit a rural area with only one hospital for miles around.
Another important factor in limiting costs is personal responsibility for paying the bill. Something most Americans want no part of. We have come to expect pre-paid healthcare, not insurance to cover catastrophic costs. Virtually no one thinks they have any personal responsibility for paying for basic, routine services anymore, let alone co-pays, co-insurance, deductibles, etc. Consumers expect everything for "free" because they have insurance, often utilizing unnecessary services that simply drive costs up even further. Do you personally know of anyone who actually budgets for their anticipated healthcare expenses? I know very few people who do. But you can bet that those who don't budget for healthcare expenses DO budget for entertainment, new cars, new clothes, etc. It is a priority that has been lost on most Americans, because they expect someone else to pay their healthcare bills. What few people seem to understand is that healthcare is not free, having insurance does not make it free, and, when insurance pays for something, that money is coming out of ALL of our pockets.
Any successful healthcare/payment system MUST include compteition and must include personal responsibility for paying the bill.

Absolutely.

1. I hear the typical - blame the drug companies, etc. argument, all the time. First, drug companies AREN'T free enterprise so much as gov't asst neomercantilists. The very things about insurance and pharmaceuticals that make them unpalatable is that the gov't assts them in being anti-competitive. SOOOOOO, BECAUSE the gov't is in bed with them BEING anti-competitive, to the detriment of the entire system, the answer is for the gov't to remove ever more competition from the system. It is simply a false choice to say that the CURRENT system is a choice between gov't takeover or free markets. In reality, the choice being given is between alot of gov't meddling in healthcare, or even more than alot. There is a rational and effective third choice: LESS gov't meddling in the system. It's not like the pervasive meddling to THIS point has done anybody any favors.

2. I love the argument that healthcare should be SOOOO fundamental, that we have an obligation to remove innovation and effective pricing from the system. It is SOOOO fundamental, that only bloated bureaucracy and ineffective utilization should be allowed to control the system. That makes no sense, whatsover. HOWEVER, when you argue that profit motive (free enterprise) should be removed from the system, that is EXACTLY what you argue in favor of: large decreases in efficiency and quality.

In fact, the free market is the BEST avenue for healthcare because it produces, and always has, the best combination of quality and pricing. It always has. Considering that advances in healthcare occur so often and so fast that healthcare as a result will exceed inflationary growth, cost containment is a big factor. Considering it is YOUR health, quality is a big factor. The free market has been proven to be the BEST innovator of quality vs pricing in the history of the world. To suggest that the best method of quality/pricing shouldn't be a part of healthcare is to completely misunderstand the engine of economy.

3. In fact, the thing that torpedoed HillaryCare before is that it didn't pay for what it wanted to do. It offered that competition would bring prices down, even as it eliminated competition. At the back end, once anti-competition failed to control pricing, HillaryCare aimed to do so by a backup system that would limit the amount that could be charged for care. THAT is what killed HillaryCare - the concept that it wasn't going to be paid for by any means except rationing.

See, Hillary is at least smart enough not to point out THIS time that she would ration care. It tanked her before. She doesn't mention HOW she will contain costs in an anti-competitive system except to say she will limit what private companies will be able to charge. The result: private companies will not be able to keep up with the gov't subsidizing its own plans, at a loss, and so, insurance will shift to the gov't, ala single payor. That is the dirty secret of the her plans: it declares itself to be a combination of gov't and private care while devising a system that will let the gov't, over time, systematically weed out all competition, from itself.

Behold, the behemoth monopoly that cares about you SO much that it will, of its own accord, and without motivation, always strive to bring you the best combination of price and quality. You believe in that version of your Uncle Daddy gov't? Personally, I stopped believing in Santa, a long time ago.

Reality is reality and you cannot devise a system that removes motivation to excel and expect excellence. This is the chief failure of socialism: it doesn't take into account human motivation. It is why it is ALWAYS a failure; you just can't design a system that expects certain human behaviors WITHOUT the motivation to encourage such behaviors. Fortunately, we HAVE designed a system that DOES provide ample motivation to encourage excellence, and it is the free market.

In fact, it is only because of the outstanding success OF the free market that we stand here, with the financial means and ability to contemplate repudiating the same. You are only free to knock the free market BECAUSE the free market has made you rich by any world standard. If you live in America, you ARE rich. THANK GOD our framers believed in a free market. THANK GOD. In fact, I do, daily.

Gov't is a tyrant best left locked in the dungeon.

~faith,

Timothy.

pickledpepperRN · Sep 18, 2007

Hillary Learned the Wrong Lesson from 1994 Health Care Fiasco

The pundits might have it right on this one. Hillary Clinton did learn a lesson from her 1994 fiasco on healthcare reform. Unfortunately for most of us who don't have an Inc. after our name or a private jet to cart us around, it was the wrong lesson.

In the days leading up to the announcement of her latest, much anticipated health plan, Sen. Clinton threw around the word "consensus" a lot. In this case, the consensus she was seeking was with the same industry that so savaged her prior experience with healthcare.

This time, she apparently wants to soften them up in advance with a proposal that will generate hundreds of millions of dollars in additional profits for the insurance giants. It's probably not a coincidence that she is also the top recipient of healthcare sector contributions to her presidential campaign….

http://www.huffingtonpost.com/rose-ann-demoro/hillary-learned-the-wrong_b_64905.html

rigmedic · Sep 19, 2007

Two thoughts on this subject, if I may.

First, I think we will ultimately end up with some form of universal single payer healthcare, just like the rest of the developed world. This will be, however, an 8 to 10 year process. The proposal Hillary outlined is an achievable first step in that process.

Second, the basic question in the debate about healthcare reform is whether or not your personal health is just another consumer buying decision, like a car, or whether it is fundamentally different. We don't leave fire protection, police protection, or national security up to the "free market". We recognize those functions as distinctly different and something that it is not appropriate for corporations to control.

As a nation, average citizens are being asked to take on greater and greater levels of risk while their wages are kept relatively flat. Twenty years ago, it was quite common to be able to retire from a longterm employer and receive a "defined benefit" pension. The companies decided that was costing them too much and now everyone has a 401k. If the stock market tanks, no more retirement. Great plan!

In my personal opinion, both healthcare and retirement should be run by the government with the employers making contributions to both. Look back over history and you will see thousands of companies having come and gone. The government has always been there. If we did that sort of system, it wouldn't matter who you worked for or where you lived, your healthcare and retirement would be secure.

We will eventually get there, but it will just take a lot of years and a lot of dust being thrown up by the corporate interests that will fight the change.

Jolie, BSN · Sep 19, 2007

We will eventually get there, but it will just take a lot of years and a lot of dust being thrown up by the corporate interests that will fight the change.

I appreciate your articulate response, and will have to agree to disagree as to whether we would be better off with a private or a governmental system of healthcare and payment.

But I will be throwing up a lot of dust along with the corporate interests in fighting the change to government controlled healthcare, as I believe it will have a huge negative impact on my interests as well.

Take a look at Social Security. I have paid into the sytem since I earned my first paycheck 27 years ago. The likelihood of collecting a benefit when I retire is slim. If I had that money, and had been able to invest it myself, I would have a substantial nest egg. (In fact, I do have a substantial nest egg, because my husband and I have always invested on our own.) But my point is that I have been a far better investor than the government has been. Given the government's abysmal track record in safekeeping (let alone growing) my money for my future, I have no reason to believe that they will do any better with my money for my healthcare. There is a fundamental difference between the government providing police and fire protection versus providing investment and healthcare services. Most individuals are incapable of providing police and fire protection for themselves, but are fully capable of managing their own money and healthcare, and in a manner far superior to the government.

rigmedic · Sep 19, 2007

Jolie,

Two points to your last post. First, if the rich people had to pay Social Security taxes on ALL of their earnings (wages, as well as investment income) there would be zero problem with SS funding. As it is now, they only pay taxes on the first $87,900. I pay Social Security taxes on 100% of my earnings. That is fundamentally unfair. If you'll notice, their "solution" to the problem is to turn all retirees over to the tender mercies of Wall St.

The thoughts that "government is incompetent" and "I can do better in the market than Social Security" sound very good in an environment of historic stock market highs, and near-record low interest rates. Let those things invert and a LOT of people will be singing a quite different song!

Jolie, BSN · Sep 19, 2007

jolie,
two points to your last post. first, if the rich people had to pay social security taxes on all of their earnings (wages, as well as investment income) there would be zero problem with ss funding. as it is now, they only pay taxes on the first $87,900. i pay social security taxes on 100% of my earnings. that is fundamentally unfair. if you'll notice, their "solution" to the problem is to turn all retirees over to the tender mercies of wall st.
again, i will agree to disagree. the federal government having access to more money would simply result in the waste of more money. taxing 100% of an individual's income for social security will do nothing to insure that the resulting funds would be invested wisely, or distributed to beneficiaries. note the lack of funds in the social security "lockbox". congress has repeatedly raided these funds for non-ss spending. they no longer exist, and there is no reason to believe that replacing them with increased social security taxes would remedy this.
the thoughts that "government is incompetent" and "i can do better in the market than social security" sound very good in an environment of historic stock market highs, and near-record low interest rates. let those things invert and a lot of people will be singing a quite different song!

the truth is that one can invest his/her own money in an fdic insured savings account (an investment with the lowest return, due to the federal guarantee of funds) and still fare better than the return on social security. there is no need to purchase "risky" investment to outdo the government's track record. by investing a portion of one's money in federally-insured products, and a small amount in various higher-risk non-insured products, anyone can far out-pace the government's return, regardless of market conditions. the key is self-discipline and personal responsibility, something the government does not encourage. politicians would rather convince you that you need to rely on them than support your efforts to provide for yourself.

teeituptom, BSN, RN · Sep 19, 2007

I read her plan, or rather, the transcript of her speech describing it.
Some observations:
1. It is EXACTLY like the failed 1993 plan she devised with the exception that she at least has learned not to call her pooled plans a regional healthcare alliance (bureaucracy). She goes out of her way to point out that isn't the case. In fact, it is.
2. Just like in 1993, she has not devised a way to pay for her plan except for non-specific things like kill drug research and increase the debt by repealing the tax cuts that grew the treasury. In fact, what she says she will do is hand out tax credits to everybody like crazy to pay for the program. How to pay for the tax credits? Who knows? She doesn't. She does vaguely hint that she'll tax business to the breaking point. It hails back reminders to '93, when a small businessman complained about the cost of her plan, and Hillary responded, "It's not my responsibility to ensure the survival of every underfunded small business." Here's your cake.
3. Insurance is required but not mandatory. So, when a percentage of the population refuses? She either has to pay for them outright, punish them, or wail to the public that she needs far more changes to make coverage universal. My guess is that she'll bait and switch at THIS point, and say the current system (her newly implemented plan) isn't working and we need a more universal model. In fact, this is JUST what she has said she learned from the '93 plan: to attack the problem one bite at a time. THIS plan is only the first bite.
4. At the same time she says we need a consensus to change healthcare (duh!), she snipes at Republicans, at every turn. Consensus is NOT, "The idiots will come to see things my way when I wear the pants."
Hillarycare redux. It was defeated 15 yrs ago. It will be defeated 2 yrs from now. No matter how much the left might think so, there is NOT a consensus of Americans that will truly trust the gov't with their healthcare. HEALTHY distrust of the gov't is as American as apple pie.
~faith,
Timothy.

Timmy

The people of this country have no one to trust but the Government. When you look at medicaid, medicaire. Even Private Insurances like BC/BSfollow the reimbursement guidelines established by medicaire. And you look at all the other federal and state Heath and Welfare entities. I mean really now, who else is there to trust. Yes its normal to distrust The Gov't. But who else is there big enough to handle it. Private Corporations, never. There really isnt anyone other than the Government.

That comment about small businesses, the very great majority of small busineesses are doomed to failure anyway.Why should she guarantee there survival. What is it 98% are doomed to fail within 2 yrs.

What you call any health care plan. Any and all of them are all appropiately termed Beureaucratic. Its the nature of the beast, bureaucacy at its best

I think Hillary looks better in pants

teeituptom, BSN, RN · Sep 19, 2007

Mandatory health care won't curb costs
Presidential hopeful Hillary Clinton laid out her plan for health care yesterday, which includes mandatory health insurance. But commentator Jamie Court says demanding more cost-effective coverage would be a better solution..../
...The reason health insurance is so unaffordable today is that no one is watching the costs. With standardization, insurance would be cheaper and people would want to buy it -- not have to because the government is threatening them with a tax penalty.
Oh wait, I can hear the plaintive cry of the free market. You can't tell a doctor, insurer, hospital or drug company what's reasonable to charge. That's socialism.
Well, how reasonable then is it to tell every American you have to buy a product whose cost is obscene if you want to be a U.S. citizen? Isn't that corporate socialism?
Mandatory health insurance is a government bailout of a free market that's failed its customers. ...
...There's a business plan of course. Mitt, Arnold and Hillary each received six or seven-figure campaign contributions from the insurance industry. The plan is insurers send the bill and we have to pay it....
http://marketplace.publicradio.org/display/web/2007/09/18/forced_health_care_wont_curb_insurer_costs

Companies like Medicaire, BC/BS and all of them, tell the doctor he can charge what he wants but they only pay for what they feel is appropiate anyway. So in essence, yes the Doctor, the Hospital, everyone and everything already knows in advance how much they will be paid.

"Mandatory health insurance is a Government bailout of a free market that has failed its customers. One you are assuming there is a free market, there hasnt been a free market for decades now.

Oh yes the terms socialism, amd corporate socialism. Tired out old terms with no significance in todays world. So oft misused anyway. 40 yrs ago we would have and did call it communism. Also misused.

Government bailout, I dont think Lee Iacocca would agree here. :lol2: :balloons: