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.
the government pays medicare advantage plans roughly $1,000 more per beneficiary per year than it would cost to cover the same person through traditional medicare. even though private plans were brought into medicare to lower costs, the medicare payment advisory commission (“medpac,” congress’ expert advisory body on medicare payment policy) and the congressional budget office (cbo) have found that they are paid 12 percent more, on average, than it would cost traditional medicare to cover the same beneficiaries. these overpayments currently average about $1,000 per beneficiary, according to the commonwealth fund. moreover, cbo says the average overpayment will likely rise in the future because medicare advantage enrollment is growing fastest in the areas with the highest overpayments.
these overpayments significantly weaken medicare’s finances. the overpayments will total $54 billion over the next five years and $149 billion over ten years, according to cbo. that puts an added strain on medicare, moving up by two years (from 2021 to 2019) the date when its trust fund will become insolvent, according to the chief actuary at the centers for medicare and medicaid services (cms). it also means restoring solvency will require much larger benefit cuts and/or tax increases than would otherwise be needed; as medpac chairman glenn hackbarth warned congress, medicare faces “a very clear and imminent risk from this overpayment that will put this country in an untenable position.” similarly, cbo director peter orszag has testified that if current trends in medicare advantage continue, “the result would be a fundamental change in the nature of the medicare system that may then be hard to reverse.”
the overpayments also force beneficiaries in traditional medicare to pay higher premiums. according to both medpac and cms’s chief actuary, the overpayments raised the premiums for part b of traditional medicare (which includes physician visits and other types of outpatient care) by $2 per month per person, or $48 a year for a couple, in 2007. this means that the 35 million seniors and people with disabilities enrolled in traditional medicare are charged higher premiums every month in order to help subsidize overpayments for private plans that serve approximately 8 million beneficiaries. (for about 7 million of these 35 million beneficiaries — low-income people whose premiums are paid by medicaid — the added costs are borne by the federal government and the states, which jointly fund medicaid.)
medicare advantage plans do not have to provide all the benefits available through traditional medicare — and many do not. while the plans use part of their overpayments to offer services that medicare otherwise does not cover or to reduce premiums and cost-sharing (the rest goes to administrative costs, marketing, and profits), some of the private plans have scaled back benefits available through traditional medicare that are used primarily by sicker individuals, evidently to deter sicker people from enrolling. as a result, some beneficiaries in poorer health can wind up significantly worse off if they enroll in medicare advantage.
your claims about a voucher plan or free market improving educational performance are not supported by the evidence. if anything your claims about private schools being superior speak to the very real adverse effects of poverty on health and student educational performance.
milwaukee provides a case example on both the relative performance and the relative cost of public vs. private schools. in 1991, the catholic archdiocese of milwaukee released the test scores of children in its schools. the results showed that when the performance of children from similar social and economic backgrounds were compared, the catholic schools in the milwaukee archdiocese did no better and perhaps a bit worse at educating minority children than the milwaukee public schools.61
in a review of the research on school choice in three countries (the u.s., great britain, and new zealand), geoff whitty found little evidence to support the contention that the creation of educational "markets"increases student achievement. he did, however, find that educational "markets" make existing inequalities in the provision of education worse.36 martin carnoy drew a similar conclusion based on an analysis of the effects of school privatization in chile and other countries.37
fact: there's no link between vouchers and gains in student achievement. there's no conclusive evidence that vouchers improve the achievement of students who use them to attend private school.
fact: vouchers undermine accountability for public funds. private schools have almost complete autonomy with regard to how they operate: who they teach, what they teach, how they teach, how — if at all — they measure student achievement, how they manage their finances, and what they are required to disclose to parents and the public. the absence of public accountability for voucher funds has contributed to rampant fraud, waste and abuse in current voucher programs.
fact: vouchers do not reduce public education costs. actually, they increase costs, by requiring taxpayers to fund two school systems, one public and one private.
fact: vouchers do not give parents real educational choice. participating private schools may limit enrollment, and in many cases may maintain exclusive admissions policies and charge tuition and fees far above the amount provided by the voucher. unlike public schools, private and religious schools can — and do — discriminate in admissions on the basis of prior academic achievement, standardized test scores, interviews with applicants and parents, gender, religion, income, special needs, and behavioral history.
arguably these results have been replicated in health outcome studies of our system.
fwiw i don't think that any single payer advocate in the us is in favor of a socialized system along the lines of the uks nhs. although if you study their health outcomes they achieve better results than the us. if anything i think that the most likely reform is along the lines of the french model.
There's never been a law yet that didn't have a ridiculous consequence in some unusual situation; there's probably never been a government program that didn't accidentally benefit someone it wasn't intended to. Most people who work in government understand that what you do about it is fix the problem -- you don't just attack the whole government. Molly Ivins
Wow, 6 trillion dollars ($6,000,000,000,000) spent on the great society since the 60's, and we still have all of this poverty around us.
Your claims about a voucher plan or free market improving educational performance are not supported by the evidence. If anything your claims about private schools being superior speak to the very real adverse effects of poverty on health and student educational performance.
Private schools provide superior education, at a fraction of the cost. Plus, they allow parents real input into the flavor of that education.
I'm all for a complete voucher system for schools. Not to mention, eliminating the Federal Dept of Education. How your children are educated should be none of Washington's business.
If the mediocre school system is your example of what the government will do with health care, then I'm very afraid. Will the gov't just declare my health as passing some minimum standard, whether it is, or not?
We're already funding them (and then some) by paying the exorbitant costs of public school systems. In my area, the cost per pupil in a parochial school is roughly 1/2 the cost per pupil in a public school. By simply allowing the child and parents to "opt" for private school education, we would educate that child for 1/2 what we are already spending. As a side note, the public high schools in my area have an average 30% drop out rate. The parochial high schools have a drop out rate of nearly 0.
I'm not saying to dismantle the public school system. Those who want to, should still be able to attend. Those who don't should be able to take their "cut" and go elsewhere, which would be less expensive and produce better results.
Wow, 6 trillion dollars ($6,000,000,000,000) spent on the great society since the 60's, and we still have all of this poverty around us.
L. B. J. declared his "War on Poverty" 44 years ago. Contrary to cynical legend, there actually was a large reduction in poverty over the next few years, especially among children, who saw their poverty rate fall from 23 percent in 1963 to 14 percent in 1969.
But progress stalled thereafter: American politics shifted to the right, attention shifted from the suffering of the poor to the alleged abuses of welfare queens driving Cadillacs, and the fight against poverty was largely abandoned.
In 2006, 17.4 percent of children in America lived below the poverty line, substantially more than in 1969. And even this measure probably understates the true depth of many children's misery.
"lbj declared his "war on poverty" 44 years ago..children..saw their poverty rate fall from 23% in 1963 to 14% in 1969.":spam:
nice manipulation of statistics by a self-defined liberal, [paul krugman, who writes opinion pieces for the new york times] but it leaves out a huge chunk of data. poverty was declining long before the great society kicked in. in fact, poverty has been declining since the 1940's, when it was 39.7%.
in 1959--22.4%
in 1963--19.5%
in 1965--17.5%
in 1969--12.1% [all per us census bureau]
so..poverty rates did decline during the war on poverty--at about the rate as it declined before the war on poverty!
poverty rates stopped decling in 1969--just when welfare programs [as opossed to education and job training programs]really took off. [welfare benefits-cash and in kind, went from $25 billion in 1950, $425 billion in 2000, in adjusted dollars. how much more is univeral coverage going to cost..and please don't expect anyone to believe it will be "offset" by lowered or absent premiums.]:gtch:
btw, prior to the late 1940's, there was no such thing as third party health insurance. it was intended as an extra benefit for returning gi's in the competative job market. when people stopped paying with their own real money, the spiral upward of medical care costs began..because "someone else" was paying.
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.
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a wiser approach is to seek to separate cost-effective care from unproven treatments, and align the financial incentives to encourage the former and discourage the latter. the french have addressed this by creating what amounts to a tiered system for treatment reimbursement. as jonathan cohn explains in his new book, sick:
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.
the french do the same for pharmaceuticals, which are grouped into one of three classes and reimbursed at 35 percent, 65 percent, or 100 percent of cost, depending on whether data show their use to be cost effective. it's a wise straddle of a tricky problem, and one that other nations would do well to emulate.
HM2VikingRN, RN
4,700 Posts
some very simple fixes for medicare:
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[*]source: http://www.cbpp.org/12-5-07health.htm
market based solutions have driven up costs with arguably poorer results.