I keep hearing all this talk about how the emphasis in medicine needs to be on prevention of disease, and not disease management or cures. As a nurse with over 20 years experience in a variety of clinical and business settings, most recently in mental health, I would like to suggest the new paradigm of prevention first is a bit mis-guided and unrealistic.
First, what is prevention? How do you realistically "prevent" obesity, high blood pressure, diabetes, heart disease? There are only 2 ways to affect these chronic diseases: education or dictate. The health community has focused on education for 40 years. Constant repetition on message has slowly changed the numbers of unintended pregnancy, smoking, STDs, and AIDS related illness. There are other examples too, but changing behavior is a slow process. Education alone does not prevent chronic medical problems, at least not quickly.
So the new health reform thinks they can prevent first, limit the expensive care to a few choices at the end of life, and suddenly every one in this country will have excellent universal care that is cost effective, paid for, and even reduce the deficit. Only one problem: you can't dictate behavior.
This is the only way large scale changes could lead to the kind of Utopia one side of the spectrum is envisioning for this county. If you punish behavior that causes chronic disease, it is the only way to effect change rapidly. So, your freedom to choose is taken away, "for your own good" because people left to their own devices will not make smart choices. Outlaw transfats, outlaw tobacco (so why is it still legal if you really want people to quit smoking?) Outlaw sugar, outlaw meat (global warming), remove all snacks except fruit and vegetables from the school vending machines, tax complex carbs to reduce useage, mandate 1 hour of exercise daily for all citizens, fines for BMI over 30, fine smokers. I know - maybe you could just remove food and use compressed supplements with all the recommended nutrition. And those weak humans to do develop diabetes, or high blood pressure, or have too much fat? What do we do with them, after all our "help" controlling their weakness?
Maybe it is time to re-read Brave New World, Farenheit 451, Animal Farm, and Soylent Green. As for me, I prefer the education route, and continue to fund research in to cures. This may be a bit tongue-in-cheek, but this pie in the sky talk about prevention, not cure or treatment of disease seems to ignore the human factor and the gift of free will. I don't want government to take that away from me. Positive reinforcement has always worked better to change behavior than punishment, and yet in this new world of reform, the only way to prevent disease is to punish the behavior that causes it.
Why not tell insurance companies they can't use pre-existing conditions as a reason to not cover someone and they can't drop someone because they are sick. A very simple solution. Why does it have to be more than that?
Because all that that, by itself, will accomplish is to cause all the insurance companies to dramatically increase their rates. If they are required to take on people they currently turn away, people who are "losing propositions" financially for the insurance companies, that will cost them more money and where do you think that money is going to come from?? Certainly not out of their profits ...
The only way to avoid that would be for the government to also dictate what they can charge for premiums, and there goes your beloved free market and capitalism -- we're back to the dreaded government control of healthcare ...
Because all that that, by itself, will accomplish is to cause all the insurance companies to dramatically increase their rates. If they are required to take on people they currently turn away, people who are "losing propositions" financially for the insurance companies, that will cost them more money and where do you think that money is going to come from?? Certainly not out of their profits ...
The only way to avoid that would be for the government to also dictate what they can charge for premiums, and there goes your beloved free market and capitalism -- we're back to the dreaded government control of healthcare ...
So we have to carry those who are losing propositions. Those who aren't gonna work etc? If the insurance companies can't make it under the laws then they fold. At least it would be a start and see what the free market can do.
People were required to carry car insurance and there was alot of crying about that but in the end people did it.
When the insurance companies can't afford it any more they can get bailed out like everyone else has.
So we have to carry those who are losing propositions. Those who aren't gonna work etc? If the insurance companies can't make it under the laws then they fold. At least it would be a start and see what the free market can do.
People were required to carry car insurance and there was alot of crying about that but in the end people did it.
When the insurance companies can't afford it any more they can get bailed out like everyone else has.
I was not referring at all to whether people work or not (although that seems to be an obsession of yours); I was referring to people who would pay premiums to the insurance company, but for whom the insurance company would have to pay out a lot of $$$ in healthcare costs -- the people they currently turn away because covering them is bad for the bottom line. If forced to cover those people, the insurance companies would raise everyone's rates even higher than they are now to cover those costs while maintaining their profits. So what would that accomplish?
And -- we've seen what the "free market" can do in healthcare; that's how we got to the sorry state we're in now.
I was not referring at all to whether people work or not (although that seems to be an obsession of yours); I was referring to people who would pay premiums to the insurance company, but for whom the insurance company would have to pay out a lot of $$$ in healthcare costs -- the people they currently turn away because covering them is bad for the bottom line. If forced to cover those people, the insurance companies would raise everyone's rates even higher than they are now to cover those costs while maintaining their profits. So what would that accomplish?
Sorry Kidney, but Elk is right on this one. It's the reason why the bill is pairing "no rejection for preexisting conditions" with "Everyone has to buy insurance" to balance it out. You cant just mandate that they accept everyone and expect the costs to remain the same without closing the insurance industry completely.
And -- we've seen what the "free market" can do in healthcare; that's how we got to the sorry state we're in now.
Is that how we got here? Because Health care isn't run by the free market at all. The free market is just a popular target for people who are upset with the corporations. Take a walk to your nearest lets say...shoe store. Notice all the different brands from different manufacturers? That's the free market system in play. Now how many options do you think you have for healthcare? Considerably less, I would wager.
Government is already corrupt, and lobbyists have as strong a voice, if not stronger, then the voting public. Although this time, it's on the state level. Each state regulates who gets to have the privelidge of selling insurance in that state. And they lock out anyone else. In a truly free market, you wouldn't have to worry about a monopoly of a select group of insurance providers, and they'd be forced to compete with companies across the country, driving down costs, improving efficiency, and what not.
Of course, this wouldn't do much to change the situation as far as rejecting the higher risk members, but it would serve to lower premiums across the board. As for those with preexisting conditions/higher risk factors/requiring regular treatment/etc, I would rather see them evaluated on a case by case basis. I'm guessing there are already government mandates in place that limit what the insurance companies set as their premiums, or require them to charge the same to each member. That just seems foolish to me. Look, the high risk cases should have access to health care the same as the rest of us, but if they're going to be using it considerably more, why shouldn't they pay more for it? Let the insurance companies decide whats a fair premium for each case, depending on what they pay out, and see where it goes from there. I'm sure there are plenty who get rejected flat out that would be more then happy to pay double if it meant that they would continue to have access to all of the treatments and care that they require. Instead, as it is...the insurance companies obviously don't have that freedom, and they're forced to flat out say no.
I was not referring at all to whether people work or not (although that seems to be an obsession of yours); I was referring to people who would pay premiums to the insurance company, but for whom the insurance company would have to pay out a lot of $$$ in healthcare costs -- the people they currently turn away because covering them is bad for the bottom line. If forced to cover those people, the insurance companies would raise everyone's rates even higher than they are now to cover those costs while maintaining their profits. So what would that accomplish?
And -- we've seen what the "free market" can do in healthcare; that's how we got to the sorry state we're in now.
First off I believe this is the first time I've mentioned work or not. And I'm not obessessed. Passionate maybe.
So let me get this straight the insurance companies would have to raise rates but the government wouldn't have to raise rates. Oh I know all about the for profit stuff. It's not as much as many would like us to believe. And remember when the insurance companies are gone, in some instances, half of some people retirement investments will go right down the drain also.
We haven't seen what the free market will do because they haven't been challenged. Many insurance companies have stepped up to the plate with better coverage. I have no pay mammos, no pay colonoscopy and a no pay physical once a year. That is new this year. I get no pay for Weight Watchers. I've never had that.
Again I will say AGAIN, that it's not the insurance companies it's the providers of care. It's the COST and to get the COST down every one is gonna have to pay from their pay checks TWICE. Once in lowered pay and once in taxes.
BTW I pay $46.00 biweekly. I don't believe that's too much for what I get.
Sorry Kidney, but Elk is right on this one. It's the reason why the bill is pairing "no rejection for preexisting conditions" with "Everyone has to buy insurance" to balance it out. You cant just mandate that they accept everyone and expect the costs to remain the same without closing the insurance industry completely.
What happened to risk pool. The 47 million we are gonna add to the risk pool. Look, as I see it, most of the advocates of healthcare want to close the insurance companies anyway. And I'd hate to be labeled as a downer for them.
Everyone in Mass has to buy insurance. Some insurance. Yes there are a few who STILL get it from the state. But many had to pony up. I watch the Boston station all the time now. They advertise all the time for Harvard Pilgrim, BCBS, MVP etc. None of them have gone out of business. Actually, several companies have come into the state.
Is that how we got here? Because Health care isn't run by the free market at all. The free market is just a popular target for people who are upset with the corporations. Take a walk to your nearest lets say...shoe store. Notice all the different brands from different manufacturers? That's the free market system in play. Now how many options do you think you have for healthcare? Considerably less, I would wager.
This is so true and it's our government who's limiting our choices ALREADY. AAMOF many in Mass are against the new healthcare reform because they have already got a system. We will still be 50 states and DC in this.
Government is already corrupt, and lobbyists have as strong a voice, if not stronger, then the voting public. Although this time, it's on the state level. Each state regulates who gets to have the privelidge of selling insurance in that state. And they lock out anyone else. In a truly free market, you wouldn't have to worry about a monopoly of a select group of insurance providers, and they'd be forced to compete with companies across the country, driving down costs, improving efficiency, and what not.
Of course, this wouldn't do much to change the situation as far as rejecting the higher risk members, but it would serve to lower premiums across the board. As for those with preexisting conditions/higher risk factors/requiring regular treatment/etc, I would rather see them evaluated on a case by case basis. I'm guessing there are already government mandates in place that limit what the insurance companies set as their premiums, or require them to charge the same to each member. That just seems foolish to me. Look, the high risk cases should have access to health care the same as the rest of us, but if they're going to be using it considerably more, why shouldn't they pay more for it? Let the insurance companies decide whats a fair premium for each case, depending on what they pay out, and see where it goes from there. I'm sure there are plenty who get rejected flat out that would be more then happy to pay double if it meant that they would continue to have access to all of the treatments and care that they require. Instead, as it is...the insurance companies obviously don't have that freedom, and they're forced to flat out say no.
This is what I have be saying now for months. All anyone has to do is try to buy private insurance and they'll see that each state has different numbers of insurance companies allowed to sell insurance in that state.
BTW I pay $46.00 biweekly. I don't believe that's too much for what I get.
Are you talking about employer-provided coverage? In most cases, the amount employees see deducted from their paychecks on their stubs is just a small fraction of the actual cost of the insurance. I would be extremely surprised if $92.00 a month is the full cost of your insurance, and I encourage you to contact your HR department to find out what the real figure is.
If you are getting real, comprehensive health insurance for $92.00/month, you're getting the best deal in the entire US and I can certainly see why you feel the system doesn't need improvement ...
Look, the high risk cases should have access to health care the same as the rest of us, but if they're going to be using it considerably more, why shouldn't they pay more for it? Let the insurance companies decide whats a fair premium for each case, depending on what they pay out, and see where it goes from there. I'm sure there are plenty who get rejected flat out that would be more then happy to pay double if it meant that they would continue to have access to all of the treatments and care that they require. Instead, as it is...the insurance companies obviously don't have that freedom, and they're forced to flat out say no.
The insurance companies charge the same for everyone when it's a group policy (employer- or union- provided coverage, for example), but they are free to charge premiums as high as they like for individuals (individuals are really screwed when it comes to shopping for insurance).
As for the high risk people, that comes down to a basic philosophical difference -- again, does one see healthcare coverage as a commodity, like a car or washing machine, where each one of us can buy however fancy a car as we can afford and we don't really care what kind of car other people drive (or if they can afford a car at all), or does one see it as a vital, necessary public service, like police or fire service -- everyone pays taxes so the service is there, and everyone gets whatever service they need when necessary. Obviously, there are plenty of posters on this site on either side of that divide.
I'd love to see some data on some of the ridiculously unfounded views spouted in this thread. It's really very sad to see that health "professionals" have such views.
I'd love to see some data on some of the ridiculously unfounded views spouted in this thread. It's really very sad to see that health "professionals" have such views.
Are you talking about employer-provided coverage? In most cases, the amount employees see deducted from their paychecks on their stubs is just a small fraction of the actual cost of the insurance. I would be extremely surprised if $92.00 a month is the full cost of your insurance, and I encourage you to contact your HR department to find out what the real figure is.
If you are getting real, comprehensive health insurance for $92.00/month, you're getting the best deal in the entire US and I can certainly see why you feel the system doesn't need improvement ...
BCBS from Mass. I never said it was the full cost of the insurance I said that's what I pay. We pay half the company pays half . We are self-insured. I never said the system doesn't need improvement. I SAID I DON'T BELIEVE THE GOVERNMENT SHOULD RUN HEALTHCARE. Please refrain from putting words in my mouth.
I'd love to see some data on some of the ridiculously unfounded views spouted in this thread. It's really very sad to see that health "professionals" have such views.
I agree with you. Some would like to see the next generation bankrupt.
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elkpark
14,633 Posts
Because all that that, by itself, will accomplish is to cause all the insurance companies to dramatically increase their rates. If they are required to take on people they currently turn away, people who are "losing propositions" financially for the insurance companies, that will cost them more money and where do you think that money is going to come from?? Certainly not out of their profits ...
The only way to avoid that would be for the government to also dictate what they can charge for premiums, and there goes your beloved free market and capitalism -- we're back to the dreaded government control of healthcare ...