After posting the piece about Nurses traveling to Germany and reading the feedback. I would like to open up a debate on this BB about "Universal Health Care" or "Single Payor Systems"
In doing this I hope to learn more about each side of the issue. I do not want to turn this into a heated horrific debate that ends in belittling one another as some other charged topics have ended, but a genuine debate about the Pros and Cons of proposed "Universal Health Care or Single Payor systems" I believe we can all agree to debate and we can all learn things we might not otherwise have the time to research.
I am going to begin by placing an article that discusses the cons of Universal Health Care with some statistics, and if anyone is willing please come in and try to debate some of the key points this brings up. With stats not hyped up words or hot air. I am truly interested in seeing the different sides of this issue. This effects us all, and in order to make an informed decision we need to see "all" sides of the issue. Thanks in advance for participating.
Michele
I am going to have to post the article in several pieces because the bulletin board only will allow 3000 characters.So see the next posts.
Get rid of third party payor systems and have the average citizen directly pay for his/her basic healthcare. THAT will return some financial frugality to the system.
1. Catastrophic insurance that everybody must pay into, on a means tested basis, like the proposed Massachusetts plan signed by Gov. Romney.
2. Tax exempt Healthcare savings accounts for basic health needs. Our 'insurance' system is not really an insurance system because it doesn't just provide for 'insured' needs, like catastrophic care. In reality, it's a 'pre-pay' system in that you are pre-paying for all your health needs.
Can you file with your electric bill on your homeowners insurance? Can you put your gas bill on your car insurance? But, you can file routine bills on your healthcare plan. What's the difference? One's an insurance program, and one's a default pre-pay plan.
Instead of 'pre-paying' some insurance company, health savings plan would allow you to 'pre-pay' yourself. As the consumer, if YOU are paying for the bills, you have much more control on the services you get. Right now, as many have pointed out, if an insurance company pays your bills, it's THEIR choice. If we move to the gov't paying your bills, it would be THEIR choice.
The greatest mix of choice and cost control would come from consumers paying the bill and minding the costs.
That's not nearly as expensive as it sounds. First, if you are already paying 3-4 grand a year for insurance, paying only 1 grand for a purely insurance model catastrophic plan plus shielding 2-3 grand into a HSA would not cost more money. Second, with individual consumers minding the price, do you think any company could really charge a grand for a CT scan?
How many drug companies could charge 150 dollar for a prescription if consumers were much more interested in the 15 dollar generic of the same class of drug?
What we normally say NOW is that you are paying for yourself and the 3 people that didn't pay. But then, the market would be forced to directly match demand. Costs would spiral downward.
If you want to fix the system, introduce more direct capitalism into it, not less. Less will just get you more of the same. Much more.
"Unfortunately, U.S. healthcare policies still tend to limit competition, restrict consumer's freedom to choose, and discourage consumers from shopping for value. Thus, there are too few choices and there has been little attention paid to price and quality of service. The answer is clearly not more government intervention, but instead letting competition and the power of the marketplace drive down prices and increase quality and access to care.
Health Savings Accounts are the Solution
There is increasing recognition that third-party health insurance payers are actually a major cause of escalating medical costs and the decline in the quality of service. The increasing adoption of HSA plans has already begun to cause greater transparency and competition in the medical marketplace. There are now physicians available by phone, medical kiosks setting up in malls, doctors that accept only cash (and charge significantly less), and others competing directly for the consumer's healthcare dollar."
~faith,
Timothy.
O.K. I like the idea of castastrophic insurance. The rest seems to simplistic. I can wipe out the 2-3 grand on a couple of visits to the doctors office. What happens if I need emergency surgery, or if my plateletts drop to zero-gammaglobulin cost $1500 a pop. Why is it that hospitals and doctors will settle with an insurance company to pay for a percentage of
the bill , while they will charge a private pay person top dollar? There is corruption at all levels of the system and it all needs overhauled.
An HSA sounds great based on the assumption that you are young and healthy and are not going to need it for quite a while. What about pregnancy and deliveries, that could wipe you out in a heartbeat. the way I see one person could maybe save up enough to cover 1 stay in the hospital. And what kind of return are you going to get on this HSA account 5%...why not just take it and play the stock market your return would be better. These suggestions would work better
with our current system and continue with health care premiums. Then when insurances don't pay you could use your HSA, isn't that the same as a Flex-spending account? And why do you loose all the money at the end of the year in a Flex account if you don't use it,,why not just add it to your income and tax it then?
Why is it that health care keeps rising year after year? Why has cost doubled since 2000? I think, unlike so many of my colleagues, the answer is because of the odd way we pay for health care in America."
~faith,
Timothy.
Dr. Gratzer actually made some excellent points in this article,first being that he advocats reform of the free market system, without this the capitalistic model of heathcare(consumer driven healthcare) will never work. Second point is in order for Capitalism to work , we need to stop the practice of "Crony Capitalism".Dr. Gratzer advocates moving away from employer based health insurance, good idea.He also advocates a tax incentive , once again this will help the rich much more than the poor,and he advocates unions and religous organizations to provide healthcare , what about non union workers or atheists;) . Hmmmm..... good food for thought, its worth reading the article even though its long.
And why do you loose all the money at the end of the year in a Flex account if you don't use it,,why not just add it to your income and tax it then?
One of the proposals is that HSAs would 'roll over' year after year. That way, while you are young, and theoretically healthy, you would be rolling money towards the day when health problems begin to appear.
Since YOU are managing those accounts, they would not only be portable, like retirement accounts, but you would have a vested interest in growing them, and therefore, a real dollar incentive to find the best healthcare bang for your buck.
If the HSAs were made portable, then coverage would not depend on current employment at any point in the system, but on aggregate employment. How many people are afraid to change jobs because of healthcare? Used to be the same way with retirement. 401(k)s and the like unhinged the concept of employer for retirement. Why not do the same for healthcare.
Employer sponsored healthcare IS a throwback to wage controls of WWII. An employer was prohibited by law to use higher wages to attract employees, so, they used 'fringe benefits' not regulated by those wage controls. Employer sponsored healthcare is a throwback to an outdated concept, just like the typewriter key positioning on this machine I'm working on, an 'agrarian' based school schedule, etc., etc.
Combined with catastrophic insurance for hospital coverage, HSAs have the potential to reintroduce real, consumer driven cost controls.
It's not a perfect idea and would have to address how to take care of the chronically ill, or those who are not healthy and young, but there are other ways to take care of that.
For example: means test SS and Medicare. IF you have more than 500k/yr assets, you don't qualify for either. Essentially these programs were designed as safety nets, "insurance programs" but have the same built in inefficiencies as 'pre pay' health insurance. Use the money saved by THAT to both shore up those systems AND to extend coverage to those more chronically ill.
I'm actually surprised that more people that believe the system is basically rigged rich vs. poor aren't advocating for means testing of SS/Medicare for the same reasons they advocate taxing the rich more.
There ARE innovative market reforms that can happen to healthcare.
Ultimately, I believe that both universal healthcare and our current system suffers from the same problem: by taking price out of the equation, there is no rational basis for controlling demand.
You can build incentive based access into the system that would benefit most people without throwing the, for lack of a better word, 'outliers' under such proposals to the curb.
I don’t have the detailed solution. I am VERY glad the conversation is happening.
Here are some statistics from the 2006 election cycle. I tend to doubt the sincerity of those who got so much money from health insurance, pharmaceuticals, and other lobbyist dollar$ -
As to your analogy, we have less new cars today as we do old clunkers in need of repair. Old or new we still have maintainence costs, and unlike health insurance, auto insurance does not cover those cost. I would much rather pay the $50 for oil change,lube job and tires rotated and fluid levels checked for my car than the $480 that it cost on my last doctor visit just in lab work not counting the stress test and PFT's. Not a practicle analogy.
The point is that most "health insurance" is NOT insurance. It's more like a warranty. For one set fee, all other costs are covered or reduced. However, no one wants to sell warranties for cars that aren't new, right? Just like health care plans don't want to cover people who aren't young and healthy. So again, the point there is simply that "health insurance" is a misnomer for most health care plans we have.
A different issue is the cost of health care. Part of the high costs is probably due to the problems with the system. Because health plans reimburse so little, providers jack up the prices. Many providers are complaining that they can't cover all of their costs with the low reimbursements they get from health care plans. Some people believe that if we get rid of third party payors, health care costs would go down. Such that a physical would cost less than $480. However, health care does cost more than we'd probably like whether we're paying out of pocket, whether a health plan is paying (via premiums and co-pays) or whether our taxes are paying.
Let's look at the physical and tests you're talking about. Lab personnel get paid, the lab supplies cost money, the PFT machine costs money to run and maintain, the doctor's office personnel paid.... What's the lowest reasonable amount all those services would cost? How much in taxes would we need to pay in order to fund those services for everyone as well as all other health care costs? Maybe that amount is reasonable. Maybe I'm willing to pay that in order to have universal care.
Again, I don't have answers. I'm just exploring various angles.
Let's look at the physical and tests you're talking about. Lab personnel get paid, the lab supplies cost money, the PFT machine costs money to run and maintain, the doctor's office personnel paid.... What's the lowest reasonable amount all those services would cost? How much in taxes would we need to pay in order to fund those services for everyone as well as all other health care costs? Maybe that amount is reasonable. Maybe I'm willing to pay that in order to have universal care.
Again, I don't have answers. I'm just exploring various angles.
But there is a certain bias in cost vs price.
A bag of NS cost about a buck. Hospitals normally charge far more than that. When I was in the hospital in 1993, I was charged 120 bucks for an IV and a bag of NS w/ 20meq KCL. Working at the VA at the time, I was able to look at the raw cost of those supplies: 12 bucks. Even presuming that the VA negotiated a better price and the time of staff involved, 25 bucks would have been a reasonable price. But, I didn't pay for it, my insurance did. So why should I complain or shop around?
CT scan costs pennies after the equipment is bought. The equipment is a sure expense, right? Even presuming the staff to conduct, read, and dictate a report: worth 1000/pop?
CBCs can be run for a few bucks on the machine. Last I heard, they are normally charged somewhere near 200 bucks.
Ultrasounds cost a pretty penny because of the equipment, right? Then WHY are there companies selling ultrasounds out of several malls right now for the pretty pictures, absent a medical need?
Look at Lasik eye surgery. Not normally covered by insurance. But, a way has been found to present it to the masses. Best money I ever spent, btw.
Bottom line, because there is no incentive base for cost vs. price, there is no relationship whatsoever between cost and price.
Most employees have 1 choice for health insurance through their employers. Certainly, on a micro level, just about as anti-competitive as universal healthcare would be. The gov't, in negotiating health plans for millions of workers, offers each worker dozens of choices. Those companies work their tails off to be competitive in a tight market.
Look at futile care. How much money is spent on care we all know is needless and ultimately dignity denying because there is no association between need and cost?
Look at emergency rooms. I pay 125 dollar co-pay for use. I don't go there for any and every reason. The rampant abuse of the system is NOT because the poor or those on medicaid lack morals; it's because they lack any incentive NOT to use those services.
With the right reforms, I have no doubt that the cost for care could be reduced by half without seriously compromising the quality of care.
I just see universal healthcare as more of the same. It is a move even further way from cost containment.
Personally, I don't see HSAs and 401K's as a good thing. Some of these "manage your own account" ideas seem more like a parental attempt to "teach" people how to be "be responsible" with their money than to actually make health care and retirement more accessible to more people.
To me the point of employer-sponsored health plans and retirement plans is provide an actual plan, not just dump the money they would've spent on a plan into a tax-sheltered account. The company shells out for the benefits as a way to keep good employees instead of having to keep training new ones. Companies are motivated to create attractive plans and employees are motivated to stay with a company long term. Such employees may be sacrificing the potential for higher wages somewhere else, but they get the benefit of the company's attractive plans.
If I'm financially savvy enough to "do better" with the allocated funds than the employer-sponsored plan, then I'm probably going to do just fine financially with or without such plans. The employer-sponsored plan is a benefit and if you choose to not participate that's your right. That doesn't mean you have a right to the money they would've paid into the plan for you.
On the other hand, if everyone opts out and takes the cash equivalent in a tax-sheltered account, what happens if they don't manage it well? What happens to the people whose costs exceed the amount in their HSAs? Don't we end up back at square one? It seems the people who would benefit the most from HSAs and 401Ks are the very people who least need assistance.
I apologize that I can't seem to be brief! I always end up writing more than I thought I would :imbar
Personally, I don't see HSAs and 401K's as a good thing. Some of these "manage your own account" ideas seem more like a parental attempt to "teach" people how to be "be responsible" with their money than to actually make health care and retirement more accessible to more people.
To me the point of employer-sponsored health plans and retirement plans is provide an actual plan, not just dump the money they would've spent on a plan into a tax-sheltered account. The company shells out for the benefits as a way to keep good employees instead of having to keep training new ones. Companies are motivated to create attractive plans and employees are motivated to stay with a company long term. Such employees may be sacrificing the potential for higher wages somewhere else, but they get the benefit of the company's attractive plans.
If I'm financially savvy enough to "do better" with the allocated funds than the employer-sponsored plan, then I'm probably going to do just fine financially with or without such plans. The employer-sponsored plan is a benefit and if you choose to not participate that's your right. That doesn't mean you have a right to the money they would've paid into the plan for you.
On the other hand, if everyone opts out and takes the cash equivalent in a tax-sheltered account, what happens if they don't manage it well? What happens to the people whose costs exceed the amount in their HSAs? Don't we end up back at square one? It seems the people who would benefit the most from HSAs and 401Ks are the very people who least need assistance.
I apologize that I can't seem to be brief! I always end up writing more than I thought I would :imbar
With real portable HSAs that still provide the tax incentive for companies to contribute, just like 401(k)s, there would be incentives for companies to 'match'.
At least with a 'match', you could directly evaluate what a company is providing as a "fringe" benefit. Unfortunately, too many people have no idea how shoddy their employer healthcare is until they are part of the system.
A bag of NS cost about a buck. Hospitals normally charge far more than that. When I was in the hospital in 1993, I was charged 120 bucks for an IV and a bag of NS w/ 20meq KCL.... But, I didn't pay for it, my insurance did. So why should I complain or shop around?...I just see universal healthcare as more of the same
The argument with universal healthcare is that due to government oversight hospitals couldn't mark up prices like that. We know that health plans don't pay close to the full billed amount. People didn't question the $120 IV solution their insurance paid for but they are questioning the increasing premiums and co-pays health plans are now demanding. I think that is one reason why this is such a hot topic these days.
It seems that there was a spiral effect over the years. Health care plans would negotiate a discount rate - say 20% - and the provider would benefit by getting more business. But some providers realized if they raised the prices, they'd get more money because 20% of 100 is more than 20% of 80. Health plans caught on and decided they'd cap the amount spent on any particular type of care to discourage price inflations. Perhaps because the reimbursements weren't enough, providers were tempted to up-code diagnoses in order to clear more reimbursements from health plans. They also increased fees for private pay to help make up the difference. Health plans also began to dominate the market so that providers had no choice but to accept ever smaller reimbursements that the plans pressured them accept.
Contributions from PACs and individuals giving $200 or more during the 2005-2006 election cycle that were released by the Federal Election Commission on Monday, December 11, 2006.
burn out
809 Posts
O.K. I like the idea of castastrophic insurance. The rest seems to simplistic. I can wipe out the 2-3 grand on a couple of visits to the doctors office. What happens if I need emergency surgery, or if my plateletts drop to zero-gammaglobulin cost $1500 a pop. Why is it that hospitals and doctors will settle with an insurance company to pay for a percentage of
the bill , while they will charge a private pay person top dollar? There is corruption at all levels of the system and it all needs overhauled.
An HSA sounds great based on the assumption that you are young and healthy and are not going to need it for quite a while. What about pregnancy and deliveries, that could wipe you out in a heartbeat. the way I see one person could maybe save up enough to cover 1 stay in the hospital. And what kind of return are you going to get on this HSA account 5%...why not just take it and play the stock market your return would be better. These suggestions would work better
with our current system and continue with health care premiums. Then when insurances don't pay you could use your HSA, isn't that the same as a Flex-spending account? And why do you loose all the money at the end of the year in a Flex account if you don't use it,,why not just add it to your income and tax it then?