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.
Isn't the reason that Medicare costs are rising is because health care costs overall are rising? There are ever more and more wonderful, yet expensive and on-going treatments and diagnostic techniques out there. And people are living longer with chronic disease and thus racking up health care costs. And fewer businesses are offering health insurance benefits to retirees.
UHC could theoretically reduce some costs by simplifying the reimbursement system. But of course, it would likely increase costs because more people would access it, some because they could now afford to and some because of the sense that "I paid for it, so I should use it whether I really need it or not." In regard to the latter, such behavior isn't a problem exclusive to government assistance programs. Private insurance companies also have to deal with this mentality as well. Either way, measures must put in place to minimize abuse.
So back to the point, it's true that UHC wouldn't have an infinite budget and would quickly run up against financial constraints. Private health insurers are also running up against this problem as well. So premiums keep going up, especially for those unlucky enough to have extensive health care needs.
Thus, I don't see UHC primarily as way to keep costs low. I see it as a way to spread the costs for expensive health care across all groups. I see it as way to insure everyone from the fear that if they get ill, they may end up having to spend down all of their assets. And then they end up completely dependent upon public assistance. So how is it more cost-effective to NOT protect against this?
Yes, individuals could attempt to insure against catastrophic health care costs. But to fully protect oneself from the kind of astronomical, on-going costs that certain illness can accrue, the cost for such insurance would be prohibitive to the average person, at least as things currently stand.
Personally, I'm not all gung-ho about UHC. But I don't think it's evil either. I'd like to see health insurance be *insurance* and not some kind of all access membership fee. I'm all for the consumer paying for services directly. However, how could we go about dismantling the current system? And it would seem we'd still want some kind of regulation in case there are some vital services that aren't profitable enough to offer at prices affordable to the average person. I know currently if I had to pay out of pocket to take care of a UTI, it would cost well over $200. It would be a lot more affordable to self-diagnose and get some meds from Mexico. So would we then need to reconsider our current system which would usually require an office visit and a lab test in order to treat a UTI?
"Free market" and "choice" and "personal responsibility" are great ideals, just like "affordable health care for all" and "social insurance" and "public services." It's not all or nothing.
I don't see how HSAs and tax breaks help those with low incomes manage health care costs better. When you're not making much, your medical expenses could easily outstrip the taxes that you owe. HSAs mean having to estimate your health care costs ahead of time. The money comes out of your paycheck, buffered by the tax benefits. So instead of getting a paycheck for $800 every two weeks, you get a paycheck for, say, $750 with $80 going to your HSA. Now you have to pay your health care bills out of pocket... let's say $150... and send the receipt in for reimbursement from you HSA. For a low-income worker, it's an awful lot of work for not much savings. For any substancial expense, there's no way they could put enough aside into an HSA to make a difference. Tax breaks have the advantage of not having to guess how much one's future health care expenses will be. Still, they don't help you if you're faced with an $1,800 bill now. You have to wait til next April to deduct the expenses. And again, for those in a low income category, expenses can quickly run over whatever taxes are owed, meaning a rather low limit on the assistance such breaks offer to low income people.
thus, i don't see uhc primarily as way to keep costs low. i see it as a way to spread the costs for expensive health care across all groups. this concept of risk shifting or spreading the costs, is what is causing so much disagreement here on these uhc threads, some simply will never accept this concept, despite the fact that it makes a lot of sense.
"free market" and "choice" and "personal responsibility" are great ideals, just like "affordable health care for all" and "social insurance" and "public services." it's not all or nothing.
despite all the uncertainty regarding health care reform, it will have to happen, we cant sustain our current system for much longer.
How about letting people choose to buy into Medicare at any age?
It already covers those over 65 years old and the disabled.
Why not let people choose what plan they want including Medicare?
At the same cost seniors pay for it?
We could choose Part "A", Part "B", or any combination.
Medicare would have to compete with the commercial insurance plans.
Tricare, the military insurance for military members, is also a good option. They are now letting reservist buy into Tricare for medical insurance for themselves, and their families. There is also Tricare Dental Insurance that reservists can also buy into.
Tricare also has Pharmacy benefits, that we can use. I pay a $9 co pay for name brand prescriptions at a neighborhood pharmacy, and $3 for a generic. These are programs that are already in place and can be extended to the American public. If they can make the command decision to cover reservists they can make the command decision to cover the American public.
I don't see how HSAs and tax breaks help those with low incomes manage health care costs better. When you're not making much, your medical expenses could easily outstrip the taxes that you owe. HSAs mean having to estimate your health care costs ahead of time. The money comes out of your paycheck, buffered by the tax benefits. So instead of getting a paycheck for $800 every two weeks, you get a paycheck for, say, $750 with $80 going to your HSA. Now you have to pay your health care bills out of pocket... let's say $150... and send the receipt in for reimbursement from you HSA. For a low-income worker, it's an awful lot of work for not much savings. For any substancial expense, there's no way they could put enough aside into an HSA to make a difference. Tax breaks have the advantage of not having to guess how much one's future health care expenses will be. Still, they don't help you if you're faced with an $1,800 bill now. You have to wait til next April to deduct the expenses. And again, for those in a low income category, expenses can quickly run over whatever taxes are owed, meaning a rather low limit on the assistance such breaks offer to low income people.
jjjoy,
I respectfully disagree with your assessment of medical savings accounts. I currently have a high-deductible plan with a medical spending account. The plan covers recommended preventive care at 100% regardless of deductible. Other care is paid out-of-pocket (via our medical spending account funded by payroll deduction and employer contribution). Because of the type of insurance I have, I know down to the penny exactly what my maximum financial responsibility is for healthcare expenses for the entire year, including dental, vision and Rx drugs. (When I say "my", I actually mean for my entire family.)
Now granted, based on our income, I can afford a higher deductible than most people. I budget for the full amount that I might potentially have to pay for the year. That money is set aside in a medical savings account and can't be used for anything other than healthcare expenses. If we are healthy and utilize fewer services than expected, the money rolls over, either into next year's healthcare spending fund, or long-term savings. If we reach our maximim out-of-pocket expenditures (and drain our yearly medical spending account), our coverage kicks in 100%. So it is very easy to predict our expenses in terms of the maximum amount we will have to pay in a year for healthcare services.
As for funding the spending accounts, tax breaks, payroll deductions (which would be small in the case of low-income participants) and government contributions would be used to create medical spending accounts (eligible to be used for healthcare expenses only) that participants would use to pay their healthcare expenses up until the point they meet their deductible. Deductibles would be based on income levels. Very low income recipients would have small deductibles. Higher earning participants would have to meet a higher deductible before having their coverage "kick in". This set-up accomplishes 2 important tasks: It requires financial participation in relation to a participant's ability to pay. I firmly believe that in any social program, participants take "ownership" and utilize resources more appropriately when they have at least a small financial stake. It would also enable and encourage participants to make cost-effective decisions regarding their spending. If they opt to go to the ER rather than a clinic for a non-urgent issue (such as a cold), they will have to pay for that out of their spending account. That will create incentives to utilize resources wisely, something I think we can all agree that Medicaid does not do.
tricare, the military insurance for military members, is also a good option. if they can make the command decision to cover reservists they can make the command decision to cover the american public.
sorry, but as a vet, daughter of a vet, and mother of two active soldiers, i disagree.
:usarm:
tricare covers military men and women in service to our country and their families, who tend overall to take good care of themselves and are obligated [at least for themselves] to take all measures indicated to follow up on ordered care.
if individuals without insurance want tricare, they can raise their right hand and take the oath, too. then, they'll have job, and insurance, and can travel the world for all sort of adventures just like our hard working troops are now.
Deductibles would be based on income levels. Very low income recipients would have small deductibles. Higher earning participants would have to meet a higher deductible before having their coverage "kick in". This set-up accomplishes 2 important tasks: It requires financial participation in relation to a participant's ability to pay.
Can we get private health insurance to buy into this idea of having different deductibles based on payer income? Sounds like a good idea. I can see how that would work with tax breaks and HSAs but I don't see a *necessary* linking of the two ideas (tax breaks/HSAs and variable deductibles). As it is, we currently do have tax breaks/FSAs without income-related deductibles. So we could theoretically have income-related deductibles with or without tax breaks/HSAs.
I'm not sure how HSAs are intended to help, though. Is the main point to incentivize the personal saving of money for health care costs? Kind of like IRAs? Because it seems like an an extra layer of paperwork otherwise and you still end up having to have the money on hand to pay for bills up front - or put it on credit, not something we really want to encourage for those living on the edge financially. Those who are financially savvy enough to maximize their tax savings through HSAs would seem to be the very people who already are good savers and don't need an incentive.
Is the thought that with the tax break on HSA money, those who currently haven't saved enough to cover health care costs now will be more motivated to put money aside? Because again, it seems that such an incentive would be much more motivating for those in higher income brackets than lower income brackets since the savings for lower income families wouldn't be that great versus having to pay a little more taxes and have their money immediately.
can we get private health insurance to buy into this idea of having different deductibles based on payer income? sounds like a good idea. i can see how that would work with tax breaks and hsas but i don't see a *necessary* linking of the two ideas (tax breaks/hsas and variable deductibles). as it is, we currently do have tax breaks/fsas without income-related deductibles. so we could theoretically have income-related deductibles with or without tax breaks/hsas.
this type of plan already exists in the world of private insurance. my family's plan is thru bc/bs. the idea of variable deductibles is that individuals can choose the plan that best meets their budgets. would you rather pay higher premiums for a lower deductible plan, or save on premiums and pay a higher deductible? we have relatively low healthcare expenses, and prefer to save on premiums, so we expose ourselves to a higher deductible. the medical savings account allows us to budget for the out-of-pocket expenses associated with that higher deductible, thus avoiding unplanned healthcare expenses. my proposal would involve enrolling lower income recipients in plans with lower deductibles that they could budget for and meet with their medical savings accounts. their premiums would be subsidized.
i'm not sure how hsas are intended to help, though. is the main point to incentivize the personal saving of money for health care costs?
yes.
kind of like iras? because it seems like an an extra layer of paperwork otherwise and you still end up having to have the money on hand to pay for bills up front - or put it on credit, not something we really want to encourage for those living on the edge financially. those who are financially savvy enough to maximize their tax savings through hsas would seem to be the very people who already are good savers and don't need an incentive.
medical savings accounts are an important part of the plan because each individual recipient needs to have a financial incentive to utilize healthcare resources wisely and frugally. if a recipient can now go to the er and never be held responsible for paying a bill, why would they inconvenience themselves by scheduling a clinic appointment instead? if recipients are required to contribute to their own healthcare costs (as we insured now do), they will become more responsible about how they spend healthcare dollars.
is the thought that with the tax break on hsa money, those who currently haven't saved enough to cover health care costs now will be more motivated to put money aside? because again, it seems that such an incentive would be much more motivating for those in higher income brackets than lower income brackets since the savings for lower income families wouldn't be that great versus having to pay a little more taxes and have their money immediately.
just thoughts and questions!
tax braks, tax credits, any means of encouraging participants to plan, budget and save for their healthcare expenses is a positive, and a necessary component of any healthcare reform.
Ouch. Aren't the poor being irresponsible just by being poor?
Yes. That should be obvious.
For abled-bodied people, poverty is a choice. We do people no favors by excusing and subsidizing such choices.
From a hierarchy of needs, we limit people by taking away their needs. We might provide the lowest base of that pyramid of need, but we do so at the expense of the self-actualization of the higher Maslov needs. THIS is a fundamental reason why the poor have no hope and no self-confidence. Why should they, when the message we send, in countless ways, is that you're too much of a loser to even bother to try.
I don't subscribe to the notion that poverty is a state of being beyond the control of those that experience it.
In fact, there are two simple actions that serve to avoid that state of being: full time employment, and dual parenthood. Failing to do those things, in able-bodied people, IS a choice.
Oh to be sure, baby-daddies can be complete jerks. They can lie, cheat, beat, or just disappear. However, CHOOSING your baby daddy IS STILL a choice. There seems to be little introspection into such choices anymore, and WHY should their be: the gov't will bail out your bad choices. Not to mention, the gov't being a child's Uncle Daddy does little more than subsidize those behaviors: lying, cheating, beating, scramming. Why should a dad be a step-up kind of guy, when Uncle Daddy is awaiting in the wings to take their place?
Subsidizing poverty is not compassionate.
Oh I know, I know - 'He Who Must Not Be Named' will change all of this with his politics of 'hope'. That and a buck will buy you a cheap cup of coffee. Hope absent empowerment is empty. Subsidizing poverty isn't empowerment. You can't deny access to a person's higher Maslov needs and then credibly claim the goal of aiding in the fulfillment of such needs. That message itself, in action, is fundamentally dis-empowering, not to mention, contradictory.
In this, I am the one being an advocate for the poor. I am the one saying there is something more profound in their potential than is currently being tapped. I am the one being compassionate. I am the one sending a more powerful and more self-actualized message than 'don't even bother'.
Or, let me turn it around. IF poverty ISN'T a choice, then credibly explain to me why those that are poor SHOULD bother to even try to change their fate? The very idea that poverty isn't a choice strictly implies that nothing can be done to change it. If it can be changed, then how, if NOT through the employment of better choices?
Health care isn't a right; it's a personal RESPONSIBILITY.
medical savings accounts are an important part of the plan because each individual recipient needs to have a financial incentive to utilize healthcare resources wisely and frugally. if a recipient can now go to the er and never be held responsible for paying a bill, why would they inconvenience themselves by scheduling a clinic appointment instead? if recipients are required to contribute to their own healthcare costs (as we insured now do), they will become more responsible about how they spend healthcare dollars.
msas are an incentive to budget ahead of time for anticipated health care costs - not necessarily an incentive to utilize health care resources wisely and frugally. if a main concern is over people who already haven't been able to budget well enough to cover initial basic health care costs, i don't see that msas would be that much of an incentive to change their behavior. and what if they don't contribute to their msa? or would that be mandatory? what happens when they tap out their hsa? what's the point of saving a few hundred dollars here and there if all it takes is one little health hiccup and it's all gone?
if the problem is the inability to get patients to pay at any level for their er visit, then i don't see that msas or subsidized health insurance coverage helps. it would still be cheaper to just get the *free* service. now why can't hospitals recoup any of their costs from these patients who shirk their bills? why can't they garner wages or sue or do whatever else other bill collectors do? i'm sure there are reasons, but that seems like an issue that goes well beyond how health care is provided in this country.
why aren't there 24/7 low-cost clinics right next door to ers? then at least if a patient shirks their bill at the clinic, it's only a $400 bill and not a $14,000 bill. and is there any way to keep a simple office visit with a routine diagnostic and maybe a one-time prescription from costing up to $400?
i certainly don't have the answers! but for me it's helpful to be able to discuss these things and look at the different angles.
jjjoy, LPN
2,801 Posts
Isn't the reason that Medicare costs are rising is because health care costs overall are rising? There are ever more and more wonderful, yet expensive and on-going treatments and diagnostic techniques out there. And people are living longer with chronic disease and thus racking up health care costs. And fewer businesses are offering health insurance benefits to retirees.
UHC could theoretically reduce some costs by simplifying the reimbursement system. But of course, it would likely increase costs because more people would access it, some because they could now afford to and some because of the sense that "I paid for it, so I should use it whether I really need it or not." In regard to the latter, such behavior isn't a problem exclusive to government assistance programs. Private insurance companies also have to deal with this mentality as well. Either way, measures must put in place to minimize abuse.
So back to the point, it's true that UHC wouldn't have an infinite budget and would quickly run up against financial constraints. Private health insurers are also running up against this problem as well. So premiums keep going up, especially for those unlucky enough to have extensive health care needs.
Thus, I don't see UHC primarily as way to keep costs low. I see it as a way to spread the costs for expensive health care across all groups. I see it as way to insure everyone from the fear that if they get ill, they may end up having to spend down all of their assets. And then they end up completely dependent upon public assistance. So how is it more cost-effective to NOT protect against this?
Yes, individuals could attempt to insure against catastrophic health care costs. But to fully protect oneself from the kind of astronomical, on-going costs that certain illness can accrue, the cost for such insurance would be prohibitive to the average person, at least as things currently stand.
Personally, I'm not all gung-ho about UHC. But I don't think it's evil either. I'd like to see health insurance be *insurance* and not some kind of all access membership fee. I'm all for the consumer paying for services directly. However, how could we go about dismantling the current system? And it would seem we'd still want some kind of regulation in case there are some vital services that aren't profitable enough to offer at prices affordable to the average person. I know currently if I had to pay out of pocket to take care of a UTI, it would cost well over $200. It would be a lot more affordable to self-diagnose and get some meds from Mexico. So would we then need to reconsider our current system which would usually require an office visit and a lab test in order to treat a UTI?
"Free market" and "choice" and "personal responsibility" are great ideals, just like "affordable health care for all" and "social insurance" and "public services." It's not all or nothing.