The Healthcare Debate, 1961

[grEnAlEins]

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[Army]

Well........there you go :)

[drg]

This was about medicare. So he was wrong.

[BigEvil]

The Gipper is spinning in his grave these days. Boy, we could sure use him here now.

[grEnAlEins]

This was about medicare. So he was wrong.
Not if you listen carefully. Foot in the door, and all that. I see it as quite accurate, given what is happening today.

[drg]

Not if you listen carefully. Foot in the door, and all that. I see it as quite accurate, given what is happening today.

This was 50 years ago. The time is long past for this to have possibly been proven correct. Bottom line is the fearmongering was unfounded. Medicare works just fine, and nobody is even considering getting rid of it because everyone knows it works just fine.

[busby]

http://www.fff.org/blog/jghblog2008-06-12.asp

[Lohman446]

This was 50 years ago. The time is long past for this to have possibly been proven correct. Bottom line is the fearmongering was unfounded. Medicare works just fine, and nobody is even considering getting rid of it because everyone knows it works just fine.

While I would question the accuracy of some of the assumptions I would also highly question that medicare is working just fine as well.

[Shirow]

I don't think anyone can argue that any healthcare system in this country is working 'just fine' right now - I think medicare is generally working about as well as anything else though.

[grEnAlEins]

This was 50 years ago. The time is long past for this to have possibly been proven correct. Bottom line is the fearmongering was unfounded. Medicare works just fine, and nobody is even considering getting rid of it because everyone knows it works just fine.
But there has not been a gap between these two points philosophically. There have been attempts at universal health care since then almost annually in the form of one bill or another. Most were never taken seriously or made it out of committee, but they were still attempts at expanding control. This has been a continued an consistent effort, not sporadic or a set of two isolated incidents. What this video was intended to demonstrate was that expansion of government power and control with respect to this issue was always on the to-do list of a certain segment of society.

Do you really believe it works just fine? I hope not. Try depending on it and tell me what you think (I sincerely hope this is not a part of your retirement or disability plan, for your sake). What's more, try financing it and tell me it works as promised (not that you probably do not already, assuming you pay your taxes). It has certainly not been a salient fund, this evidenced by the fact that we constantly have to increase the burden on the working people to pay for it. It costs way more than was anticipated, and serves far less good (fewer benefits for those depending on it when compared a similarly priced private program, which is why some many old people are buying supplemental plans and even replacement plans in some cases). That is not quite what I would tend to call "working fine" but I suppose this is subjective. If it is working so well, why all the buzz about medicare reform for the last several years? If it was working fine, wouldn't this be wholly unnecessary? Why was Part D needed if it was working just fine? We all know the answers the these questions are as follows: It was not; yes; Republicans were trying to capture some of the old people vote.

Examining the root of the debate is hardly fear mongering. In fact, some would argue that gathering historical and contextual information on a topic is a good thing to do when formulating an opinion regarding said topic. This is the purpose served by the above video.

[bornl33t]

Well the world is in good order if you're telling us this isn't true. It's true, just like it's true that liberals can't see the truth. Just like it's true that a good lib goes around stirring up "crap" every where he goes. This thread has been dead for over a week and you come in here and barf all over it. :tard:

Stop coming in here telling people they are wrong....because, YOUR WORNG!

[Psi]

Reagan's simple belief that the founders of this country got it right did more to make this country prosperous than any President in my life time. (10 Presidents so far). Like any man, and especially a politician, he was not perfect, but by a large margin, Reagan was right.

The cost of health care will plague us for as long as man inhabits this world because, to live one more day, most of us will pay all that we have. There will never be a simple answer and we will spend a long, long time finding the complex one. I get the feeling though that the solution will come from those who practice medicine. It will most certainly not come from the corporations that currently control the health care industry. As inept as the government is, I have a hard time imagining them wasting as much money as the drug companies, hospitals, and insurance companies currently profit. But when it come to wasting money, well, the government has no equal.

[Frizzle Fry]

Reagan's simple belief that the founders of this country got it right did more to make this country prosperous than any President in my life time. (10 Presidents so far). Like any man, and especially a politician, he was not perfect, but by a large margin, Reagan was right.

I spent my childhood with a house to live in rather than a one-room apartment purely because Regan took Carters 17% inflation rate and 18% interest rate and brought them back into the single digits. Do I support everything Regan ever said or did? No. Do I think he was right about quite a bit? Absolutely.

You'd be hardpressed to find another leader of this country in the last half century whos economic policies inspired such a turn-around... I often hear rich Boston area granola-munchers say that "Reganomics" consisted of BS and scare tactics, but regardless of whether that's true (devils advocate?) it doesn't really matter considering the effectiveness of his policies. It's fairly easy for Massachusetts uber-leftists to hate Regan... He helped people who needed it and didn't top off their trust funds.

[drg]

Do you really believe it works just fine? I hope not.

I don't just believe it works fine, I know it works fine.


Try depending on it and tell me what you think (I sincerely hope this is not a part of your retirement or disability plan, for your sake).

I depend on it and it works fine, for what it is.

I do agree that funding needs to be increased however, and would like to see a progressivizing of the Medicare tax rate.


Reagan's simple belief that the founders of this country got it right did more to make this country prosperous than any President in my life time. (10 Presidents so far). Like any man, and especially a politician, he was not perfect, but by a large margin, Reagan was right.

He did more to make the illusion of prosperity than any President in your lifetime. People on the right raise high hell about deficits and debt today, but the modern unsurmountable deficit has its roots in Reagan policy. Reagan created the insane and ultimately disastrous policy of making less and spending much, much more. Sure in the short term things might feel good, but in the long term ... you're screwed. We're seeing the fallout of that terrible philosophy today, and while we are at least staying afloat, the Reaganomic chickens have yet to fully come home to roost.

If they do ... god help us. The best we can do is hope we can slow down the disaster so they come home one at a time.

[Lohman446]

The disastor is expecting to get more than your labor is worth.

Be it from the liberal "give me" stand point or the "rich" stock market scams. Face it... if we want to provide for those on the lowest rung we have to quit sending jobs to China so that we can have 50" tvs for $500. And... no job is worth being paid 100 million a year with no entrepenurial investment.

Pay what you are getting is worth, get paid what you are doing is worth. Quit looking for something for nothing and things work. And I mean that to both sides - again $500 plasma tvs might exist but you are taking jobs away from Americans. They don't exist if made by those living at the bare standard we call acceptable. If you are going to take those jobs away you are going to have to support those who did them one way or another.

I'd think everything was working just fine too if I didn't pay for it. For instance that $250 10 minute consultation with a doctor would be working just fine if I could just kick the bill off and not worry about it. Things are not working fine.

[grEnAlEins]

I don't just believe it works fine, I know it works fine.
O RLY? Would you care to examine the financial standings of the programs? Would you like to compare it to a suitable policy? Would you like to compare it to a similarly priced policy?


I depend on it and it works fine, for what it is.
And now I see why you need it to work, and need to believe it is working. I am sorry to have to be the one to tell you, but you got "effed" over by your government. They money that you put in is not there for you, and all of the promises were and are completely hollow.


I do agree that funding needs to be increased however, and would like to see a progressivizing of the Medicare tax rate.
Who are you agreeing with exactly? Do you have any interest on progressive returns or direct reapportionment? We both know you're not. It seems you just want the fruits of someone else's labor. You should only get what you put in, nothing more and nothing less. There is no free lunch.

[grEnAlEins]

He did more to make the illusion of prosperity than any President in your lifetime. People on the right raise high hell about deficits and debt today, but the modern unsurmountable deficit has its roots in Reagan policy. Reagan created the insane and ultimately disastrous policy of making less and spending much, much more. Sure in the short term things might feel good, but in the long term ... you're screwed. We're seeing the fallout of that terrible philosophy today, and while we are at least staying afloat, the Reaganomic chickens have yet to fully come home to roost.

HAHAHAHAHA! I think you need to re-read your history book. Deficit spending occurred WAY before Reagan's time. Actual deficit spending is a product of the FDR administration. The problem is rooted somewhat further back than that. Adjusted for inflation, the FDR and Reagan numbers are not all that far off. When you also break it down by population and adjust for inflation, the FDR numbers are WAY WAY worse. Of course you will not likely be fond of an apples to apples comparison... :rolleyes:

[Ando]

You guys need to look at Germany’s healthcare system. They're taxed what 35-40% when I was there in the late 90’s and it almost hit 50% just a few years ago which most of it goes towards their broken healthcare system. This isn't coming from me; this is coming from German friends, their parents and a majority of their grandparents. And to top it all off, are forced by the government to use the system if they make less then 45k a year if I remember correctly.

You honestly think you'll have the "option" to not use this public “option” healthcare system (aka...Obama care), you’re out of your skull.

There's nothing good about Germany’s healthcare but here we are, buying into the same system.

Get ready for your taxes to shoot through the roof guys.

BOHICA!!!

[Shirow]

The other side of the coin being - regardless of your job, employer, physical status or illness, you will be treated without having to worry about coverage being revoked or refused. You will never have to worry about someone you know dying because of insurance issues.

The base fact in all this is healthcare is very expensive and a lot of changes need to be made to fix that problem. I don't think a lot of what is being proposed will fix it in this country but the status quo is not sustainable. There's a lot of money wasted in the system right now and you can argue a large portion of that is insurance company profit and doctors being paid by service. Some of the most efficient and well respected clinics in this country (Mayo, for example) have already made changes that would probably fix a lot of the issues if they were widespread, but it is easier to try to make some of these major changes than to try and restructure every hospital in the country.

My personal opinion is that health insurance companies are a worthless entity. That being said - if they disappeared tomorrow and were replaced by the government, I don't think anything would really change. A lot of the issues are tied to things like medical malpractice, fee for service and a multitude of other things that may or may not end up being addressed. Hopefully I will be proven wrong.

[Lohman446]

My personal opinion is healthcare costs got out of hand when the power was taken from the consumers. We pay the health care companies to take care of our bills. If the costs go up they simply up our costs. When we were paying directly for the services received we had ultimate control over costs, and costs were not out of hand. Hospitals didn't have multi-million dollar artsy staircases and entranceways either. Administrators were not paid the same as doctors. Things got out of hand from a "I can get something for nothing" attitude. Personally I think all health care companies should be forced to use a 10-20K deductible, placing routine care back into the hands of the consumers and forcing companies to justify the cost of healthcare.

Personally I no longer donate to charities. I figure the government takes enough of my money and uses it for unconstitutional handouts. I hate the thought of my taxes going up to support some welfare case who smokes and eats ding-dongs all day destroying his body and then expecting the rest of us to pick up the bill. I understand some people have bad luck and need help, and I have no problem with the idea of helping them. But I have watched government determine who should have help, and they are not diligent about weeding out corruption and laziness.

[bornl33t]

I don't just believe it works fine, I know it works fine.



I depend on it and it works fine, for what it is.

I do agree that funding needs to be increased however, and would like to see a progressivizing of the Medicare tax rate.



He did more to make the illusion of prosperity than any President in your lifetime. People on the right raise high hell about deficits and debt today, but the modern unsurmountable deficit has its roots in Reagan policy. Reagan created the insane and ultimately disastrous policy of making less and spending much, much more. Sure in the short term things might feel good, but in the long term ... you're screwed. We're seeing the fallout of that terrible philosophy today, and while we are at least staying afloat, the Reaganomic chickens have yet to fully come home to roost.

If they do ... god help us. The best we can do is hope we can slow down the disaster so they come home one at a time.

Your wrong

[Lohman446]

He did more to make the illusion of prosperity than any President in your lifetime. People on the right raise high hell about deficits and debt today, but the modern unsurmountable deficit has its roots in Reagan policy. Reagan created the insane and ultimately disastrous policy of making less and spending much, much more. Sure in the short term things might feel good, but in the long term ... you're screwed. We're seeing the fallout of that terrible philosophy today, and while we are at least staying afloat, the Reaganomic chickens have yet to fully come home to roost.

If they do ... god help us. The best we can do is hope we can slow down the disaster so they come home one at a time.

Elaborate off the talking point. Its already been shown that deficit spending was not new to Reagan and in fact traces it routes to long before. In fact, for someone complaining about deficit spending you surely don't seem to have a problem with the current deficit spending that is going to far outrun anything done in decades before, if not ever before.

[bornl33t]

Elaborate off the talking point. Its already been shown that deficit spending was not new to Reagan and in fact traces it routes to long before. In fact, for someone complaining about deficit spending you surely don't seem to have a problem with the current deficit spending that is going to far outrun anything done in decades before, if not ever before.

He's a lib, it's only bad if a conservative does it...

[Ando]

He's a lib, it's only bad if a conservative does it...
ROFL...

[Psi]

My personal opinion is that health insurance companies are a worthless entity.

I couldn't agree more. I heard an insurance industry exceutive say they only made 5 cents of profit on every dollar the other day. I had to laugh. Exxon only get 4 cents and their drilling projects cost billions. What up front cost do insurance companies have? And if the purpose of insurance is to avoid financial catastrophe, the number one reason given for personal bankruptcy filings would indicate that private health insurance is a failed model.

When it comes to a government "option" what many people fail to realize it that the Old Age, Survivors, and Disability Insurance program is the government model on which the government insurance "option" will be based. Suffice it to say I don't think a government "option" in the health care system will fare any better than the OASDI program has. Like the OASDI, it will suck more and more people (who have no need of it services) into it as it will be the cheapest option, and in their old age, when they do need its benefits, they will discover it is woefully lacking in providing for their needs. But that will be after the government has mandated the "option" for everyone and mandated payroll taxes to pay for it.

While many people can not articulate that, it IS what they fear, and why so many are vehemently opposed to a government health care option. For those not familiar with the OASDI program, that is the official name of Social Security. As bad as the thought of another Social Security system would be , the current private insurance system might be even worse. Incompetence vs Greed is not much of an option. But so far they are the only options being offered.

[drg]

Elaborate off the talking point. Its already been shown that deficit spending was not new to Reagan and in fact traces it routes to long before. In fact, for someone complaining about deficit spending you surely don't seem to have a problem with the current deficit spending that is going to far outrun anything done in decades before, if not ever before.

It's not so much that deficit spending per se is bad, and indeed Reagan may have had a reason to deficit spend early. However the problems with Reagan's deficits were, among other things, that they were unprecedented in size for peacetime and when the economic cycle went the other way, he did not cut spending and raise taxes again. Unfortunately he did not pay a political price for this and left us with the disastrous legacy of failing economic policies and the terrible lesson that there is no political price to pay for creating those irresponsible policies. He basically told people there is such thing as a free lunch, when as we now know, there is not now nor was there ever such a thing.


I couldn't agree more. I heard an insurance industry exceutive say they only made 5 cents of profit on every dollar the other day. I had to laugh. Exxon only get 4 cents and their drilling projects cost billions. What up front cost do insurance companies have? And if the purpose of insurance is to avoid financial catastrophe, the number one reason given for personal bankruptcy filings would indicate that private health insurance is a failed model.

When it comes to a government "option" what many people fail to realize it that the Old Age, Survivors, and Disability Insurance program is the government model on which the government insurance "option" will be based. Suffice it to say I don't think a government "option" in the health care system will fare any better than the OASDI program has. Like the OASDI, it will suck more and more people (who have no need of it services) into it as it will be the cheapest option, and in their old age, when they do need its benefits, they will discover it is woefully lacking in providing for their needs. But that will be after the government has mandated the "option" for everyone and mandated payroll taxes to pay for it.

Is your dour analysis of OASDI/social security based on anything other than the projected solvency of the program? As a guaranteed benefits program backed by the most powerful entity in the land, it works fine. It is an important guarantor of the freedom of the so-called free market to explore both success and failure without risking incurring social disaster.

Funding is an issue insomuch as it is a political football; this could and should be solved by legislation that requires proper funding levels. In any event, several commonsense changes such as the elimination of the wage cap and proper levies against unearned and/or corporate income would easily meet funding goals render the program solvent indefinitely. Only political machinations keep this very desirable result from happening.


While many people can not articulate that, it IS what they fear, and why so many are vehemently opposed to a government health care option. For those not familiar with the OASDI program, that is the official name of Social Security. As bad as the thought of another Social Security system would be , the current private insurance system might be even worse. Incompetence vs Greed is not much of an option. But so far they are the only options being offered.

While it is true that corporate programs are always subject to the influence of greed (as it is the very definition of for-profit), it is a curious misconception that the government is always incompetent. The government operates in the same environment and draws from the same populace as the private sector; in America, ostensibly the government IS the people. There is clearly a lot that the government does competently, or the nation would not be able to function at the level it does.

At any rate, the dichotomy of incompetence vs greed is a false one in this case. Let's accept for arguments' sake that the labels do in fact apply -- the status quo then is greed, but the public option is not incompetence, it is the choice between incompetence or greed. It is not putting healthcare in the government's hands or corporate hands as it is now, it is putting healthcare in YOUR hands. That is the ultimate dishonesty of opposition to the public option.

[Lohman446]

I think its too easy to call a for-profit greed, just as it is to call a government program incompetent. I have very specific instructions that if the services I provide cannot provide a needed service at a fair price that I am to sit down and rethink how things are going. Not every corporation is driven primarily by greed.

Deficit spending on occassion is likely not a problem. It becomes a problem when it becomes a way of life rather than the exception.

[bornl33t]

It's not so much that deficit spending per se is bad, and indeed Reagan may have had a reason to deficit spend early. However the problems with Reagan's deficits were, among other things, that they were unprecedented in size for peacetime and when the economic cycle went the other way, he did not cut spending and raise taxes again. Unfortunately he did not pay a political price for this and left us with the disastrous legacy of failing economic policies and the terrible lesson that there is no political price to pay for creating those irresponsible policies. He basically told people there is such thing as a free lunch, when as we now know, there is not now nor was there ever such a thing.
But there is free health care/inshurance?




Is your dour analysis of OASDI/social security based on anything other than the projected solvency of the program? As a guaranteed benefits program backed by the most powerful entity in the land, it works fine. It is an important guarantor of the freedom of the so-called free market to explore both success and failure without risking incurring social disaster.

Funding is an issue insomuch as it is a political football; this could and should be solved by legislation that requires proper funding levels. In any event, several commonsense changes such as the elimination of the wage cap and proper levies against unearned and/or corporate income would easily meet funding goals render the program solvent indefinitely. Only political machinations keep this very desirable result from happening.



While it is true that corporate programs are always subject to the influence of greed (as it is the very definition of for-profit), it is a curious misconception that the government is always incompetent. The government operates in the same environment and draws from the same populace as the private sector; in America, ostensibly the government IS the people. There is clearly a lot that the government does competently, or the nation would not be able to function at the level it does.
Hardly. Name one thing the government does better then the private sector. Over legislation of any government run business results in too many people doing not enough..in which case the government always hires more. It's no secret that the best benefits comes from a government job. So now we have way too many people being employed by the people getting payed way more then they are worth.....


At any rate, the dichotomy of incompetence vs greed is a false one in this case. Let's accept for arguments' sake that the labels do in fact apply -- the status quo then is greed, but the public option is not incompetence, it is the choice between incompetence or greed. It is not putting healthcare in the government's hands or corporate hands as it is now, it is putting healthcare in YOUR hands. That is the ultimate dishonesty of opposition to the public option.

Foot in the door policies....get something/anything going and we can just keep throwing new ideas/people into the mix until it works.
How about just allowing capitalistic competition (health insurance across state lines) instead of government intervention? Are we afraid that a few thousand people that don't want a job will stay uninsured? Some people like to live in tents, you can through all the money in the world at them and they will stay a bum. Your obviously a brain cause you thought this through so well with such big words that you confused or lost most of your audience and the ones that stayed with you found no reasoning or contradicting arguments ( not unlike our current president ). Not always does higher education eliminate stupidity. As I see it sometimes fortifies it...

oh yeah...and... YOUR WRONG

[Psi]

Is your dour analysis of OASDI/social security based on anything other than the projected solvency of the program?

Yes. My dour analysis is based on 1) knowing how much I have put in 2) knowing what rate of return I could generate on the same money 3) reading the updates I receive from them and their projections for what I will be paid 4) and knowing that it will be wholly inadequate for providing even my basic needs.

The only reason the OASDI is because I can not be trusted to provide for my own old age, unemployment , or disability. Therefore the government mandates that I participate in the program so others can provide for my shortcomings. That in concept is a wonderful and noble concept. In reality though, it is a recipe for fraud, abuse, and fostering a mindset where my future is not my responsibility. It has been my observation that anytime you collect a big pile of money for the collective welfare of the public that some will abuse the privilege of drawing from it, some will steal from it, and the vast majority of the people that contribute to it will get screwed.

[Lohman446]

Because I am curious. Does Wal-mart profit at all on the $10 prescriptions they offer? If they were all about greed would they not cut this program for a more profitable one?

[grEnAlEins]

Yes. My dour analysis is based on 1) knowing how much I have put in 2) knowing what rate of return I could generate on the same money 3) reading the updates I receive from them and their projections for what I will be paid 4) and knowing that it will be wholly inadequate for providing even my basic needs.

The only reason the OASDI is because I can not be trusted to provide for my own old age, unemployment , or disability. Therefore the government mandates that I participate in the program so others can provide for my shortcomings. That in concept is a wonderful and noble concept. In reality though, it is a recipe for fraud, abuse, and fostering a mindset where my future is not my responsibility. It has been my observation that anytime you collect a big pile of money for the collective welfare of the public that some will abuse the privilege of drawing from it, some will steal from it, and the vast majority of the people that contribute to it will get screwed.
A quick point on #1: Don't forget to add in "your company's" contribution via payroll tax. They were forced to take money they could have payed you and pay it in taxation instead. They then do not show you how much it is. It was effectively a way to greatly increase your tax rate without your knowledge. Yay transparent and trustworthy government (read overlords).

Let's not forget another point. Social Security started out as a strictly voluntary program. At its inception, it was promised to never be a mandate. When not enough people were stupid/trusting enough to use it, it was mandated under the guise of "public good" and "collective/societal rights" (:tard: ). Why should/How could we be expected to believe that Uncle Sugar Insurance would be anything different? It is just another foot in the door, voluntary now, mandatory later, expansion after that. The problem is, I already have too many socialist feet in my door. Even if Obama swears up and down, right hand on the manifesto and all, I still do not trust him when he says I can keep my plan if I like it. I guess technically he did not specify the time-frame that the government would graciously allow me the freedom of choice regarding my personal affairs though, so it would not be a total lie... :rolleyes:

[Shirow]

Are we afraid that a few thousand people that don't want a job will stay uninsured? Some people like to live in tents, you can through all the money in the world at them and they will stay a bum.


I think this is a poor argument. The issue is not about a few thousand people living in tents or bums.

I think it's unfair to state that the reason people are pushing for healthcare reform is because lazy people don't want to get a job. The healthcare issues are affecting a lot more people than welfare leeches.

[Lohman446]

I think this is a poor argument. The issue is not about a few thousand people living in tents or bums.

I think it's unfair to state that the reason people are pushing for healthcare reform is because lazy people don't want to get a job. The healthcare issues are affecting a lot more people than welfare leeches.

True, but we have failed to identify the problem

The problem is not in lack of insurance, at least not in the base. Its absurdly rising costs of care (partially to blame excess pay / tort law / etc.) and thus rising costs of coverage. Since the health care companies and the health insurance companies can simply pass the expenses on to the consumer - or their employer thus making even the consumer more uncaring - they get away with some absurd charges. Hospital operating room approx. cost $3000 per hour not including surgeon or anestechiolgist (sp)

[Shirow]

True, but we have failed to identify the problem

The problem is not in lack of insurance, at least not in the base. Its absurdly rising costs of care (partially to blame excess pay / tort law / etc.) and thus rising costs of coverage. Since the health care companies and the health insurance companies can simply pass the expenses on to the consumer - or their employer thus making even the consumer more uncaring - they get away with some absurd charges. Hospital operating room approx. cost $3000 per hour not including surgeon or anestechiolgist (sp)

Sure, there are a lot of issues with the cost of healthcare, but I think some of them are just the way it is. Other countries are able to control their healthcare costs a lot more than we are. Some of the big issues in my mind are:

Ridiculous medical malpractice insurance requirements
Doctors being paid by service (so it's in their best interest to see as many people as possible and prescribe as much care as possible, even if it's not worthwhile)
Insurance companies in general

Honestly, I can't see any real point in health insurance companies. They don't do anything to control costs at a care level other than deny care to people who need it. They don't serve any real purpose in a financial exchange capacity - we give them our money, they keep some of it and give some to doctors. They exist to make profit but don't actually provide a meaningful service to consumers in my opinion.

I think the main issue is the direction healthcare has been steered in this country. As a previous citizen of the United Kingdom, I can tell you how things are over there - hospitals are not a particularly enjoyable place to stay (uncomfortable beds, shared rooms) and sometimes there are long waits for doctors. However, having experienced both systems, if I was to have my choice of which to use, I'd pick the UK system. Yes, they also have cost issues and yes, there is some exploitation of the system. However, my personal viewpoint is that healthcare is not a service that should be available to those who can afford it - it is an inalienable right. This is the heart of the debate, really. If a kid is sick, his fate shouldn't be decided by whether or not his parents health insurance provides 100% surgery coverage and they can afford to cover the costs. If you happen to be born with some genetic defect that increases your chance of developing some disease, I don't think that you should have to pick between selling your house or dying.

So, based on those beliefs, from my perspective, it makes sense to enforce coverage for everyone and the simplest way I can see to do that is to do it through the government (e.g. Medicare)

I realize that this is an unpopular view in this country (or, at least, on this forum :)) but I have actually lived both systems and the above is my personal opinion based on my life experiences and beliefs.

I will say - as of right now, I love my healthcare coverage - it's covered mostly by my employer, I have $0 deductible/copay on surgery and I spend very little on healthcare. The quality of care I've received in hospitals has been wonderful and when my family came over for the birth of my child they commented on how nice the hospitals are and how much it felt like a hotel vs government run hospitals in the UK.

That being said - that is all part of the problem also :) I also worry that, if I was to ever lose this job, I may not be able to get or afford the same kind of high quality coverage I have right now and that is a big concern to me, as I'm the sole provider for a household of 4.

[grEnAlEins]

Honestly, I can't see any real point in health insurance companies. They don't do anything to control costs at a care level other than deny care to people who need it. They don't serve any real purpose in a financial exchange capacity - we give them our money, they keep some of it and give some to doctors. They exist to make profit but don't actually provide a meaningful service to consumers in my opinion.
Really? Can you afford to pay a hospital $20k out of pocket this afternoon? My insurance company did it for me not long ago. I do not have debt because I chose a policy that was right for me both by way of cost and coverage level. That is their real purpose in a financial exchange capacity. They pay a set amount that I choose, and I pay a monthly fee and occasional deductible which I also choose. I pay for this service that they offer. Much of the problem is people cannot cope with idea of choice, or more aptly, that choices have consequences. If you cannot afford a reasonable insurance plan for $150 a month, but you can afford $100 a month for an unlimited wireless plan, Cheerios instead of Toasty O's, cable tv, and $20 Old Navy jeans (or an even more expensive "cooler" brand) instead of $8 Wal-Mart jeans, then you are not a victim of anything but bad judgment and lack of self discipline. Also, insurance is a choice. You can choose to go without it. Nobody is forcing you to have insurance, yet anyways (unless you live in Massachusetts, where their required insurance program in bankrupting the state :) ).

This is not true of all insurance companies. Have you ever heard of Blue Cross Blue Shield? They are a not for profit entity. I find their services to be most meaningful.

[Shirow]

Really? Can you afford to pay a hospital $20k out of pocket this afternoon? My insurance company did it for me not long ago. I do not have debt because I chose a policy that was right for me both by way of cost and coverage level. That is their real purpose in a financial exchange capacity. They pay a set amount that I choose, and I pay a monthly fee and occasional deductible which I also choose. I pay for this service that they offer. Much of the problem is people cannot cope with idea of choice, or more aptly, that choices have consequences. If you cannot afford a reasonable insurance plan for $150 a month, but you can afford $100 a month for an unlimited wireless plan, Cheerios instead of Toasty O's, cable tv, and $20 Old Navy jeans (or an even more expensive "cooler" brand) instead of $8 Wal-Mart jeans, then you are not a victim of anything but bad judgment and lack of self discipline. Also, insurance is a choice. You can choose to go without it. Nobody is forcing you to have insurance, yet anyways (unless you live in Massachusetts, where their required insurance program in bankrupting the state :) ).

This is not true of all insurance companies. Have you ever heard of Blue Cross Blue Shield? They are a not for profit entity. I find their services to be most meaningful.

That wasn't what I meant. What I mean is - clearly, no individual can afford the cost of health coverage. If a procedure costs, 20k, 50k, 100k - there are very few people that can afford to pay that out of pocket.

So you have two choices - have an insurance company handle it or the government. In this particular scenario, I would personally prefer the government handled it. To me, the insurance company adds nothing but a layer of profiteering.

The problem with the current system is that, you don't always have a choice. If you have a gap in your coverage, or you move off your parents coverage, a 'pre-existing condition' - you can be stuck with no coverage. That's something I have a big issue with. If you force insurance companies to take everyone, pre-existing condition or not, then you really have to enforce universal coverage, or everyone would just wait until they had cancer to buy health insurance.

From my perspective, enforcing coverage makes sense, based on that. For me personally, I'd be OK with the government doing that. I think, as I said early, saying things like this are not really a fair statement:


If you cannot afford a reasonable insurance plan for $150 a month, but you can afford $100 a month for an unlimited wireless plan, Cheerios instead of Toasty O's, cable tv, and $20 Old Navy jeans (or an even more expensive "cooler" brand) instead of $8 Wal-Mart jeans, then you are not a victim of anything but bad judgment and lack of self discipline.

I don't think this is indicative of the major causes of health coverage issues. I don't think all the people that have declared bankruptcy because of health costs did so because they bought Cheerios instead of Toasty O's.

[Lohman446]

However, if prices were reasonable, individuals could afford it.

Think of it this way. What if we simply only allowed catastrophic insurance - from either private or government. Nothing under 10K is covered.

The $300 office visit would have to be justified. The $3000 an hour operating room, would have to be justified. Consumer choice and consumer control of spending generally works to keep prices in check. Take it out of consumer hands, put it in insurance companies hands and government handouts and costs become unchecked.

[Shirow]

However, if prices were reasonable, individuals could afford it.

Think of it this way. What if we simply only allowed catastrophic insurance - from either private or government. Nothing under 10K is covered.

The $300 office visit would have to be justified. The $3000 an hour operating room, would have to be justified. Consumer choice and consumer control of spending generally works to keep prices in check. Take it out of consumer hands, put it in insurance companies hands and government handouts and costs become unchecked.

I think this makes sense - in a perfect world where all humans are the same. However, what if your kid has some illness that requires many, many hospital visits, all under 10K, while my kid is born perfectly healthy?

I don't think anyone should ever have to forgo treatment because they can't afford it.

Also, this system just pushes people into waiting until they are seriously ill to seek treatment, which is another cause of all the issues in this country. If more people had good, preventative medicine, it will probably drop a lot of the emergency room visits and major surgeries needed because of conditions that weren't caught early.

[grEnAlEins]

From my perspective, enforcing coverage makes sense, based on that. For me personally, I'd be OK with the government doing that. I think, as I said early, saying things like this are not really a fair statement:



I don't think this is indicative of the major causes of health coverage issues. I don't think all the people that have declared bankruptcy because of health costs did so because they bought Cheerios instead of Toasty O's.
Enforcing coverage is not going well here in Massachusetts,not by any stretch of the imagination.

The Cheerios and Toasty O's example was metaphorical of bad choices and judgment. It is a factor in most cases, I would think. Dropping out of highschool making it impossible to find a job with benefits or pay high enough that you can afford insurance would be another example. There is always judgment and choice as a part of the equation, though luck can be a part of the equation as well.

The point is that we as a society should not punish those who have good judgment, luck, or both solely because of there good luck, judgment or both.

Also, if you continually punish those who work hard to make a comfortable life, at what point do you think they will stop bearing the burden of those around them? At what point is there no more incentive to work hard?

[Shirow]

The point is that we as a society should not punish those who have good judgment, luck, or both solely because of there good luck, judgment or both.

I also believe the opposite - we shouldn't unduly punish people who have bad judgement, bad luck or both either. I almost dropped out of high school because of a variety of factors in my childhood - I ended up completing and have gone on to be fairly successful in life but a lot of it has been luck as much as anything else. Some people are born into situations beyond their control and have to fight - hard - to get out of those situations. Others are more lucky. In the grand scheme of things, I feel very lucky to be born into the life I was born into but there are many others who have been undoubtedly more lucky than me.

I don't envy them or feel they need to be punished, neither do I feel that those that have been unluckier than me need to suck it up and deal with it.

I also wouldn't feel 'punished' if the government paid a doctor to give me healthcare, no more than I feel 'blessed' that United Healthcare pays my doctor right now. I don't care who pays my doctor as long as I can go and see him when I need to.

Massachusetts has problems, but universal health coverage is not something that is unique to that state. Other places have made it work - granted, the world is groaning under the weight of health care costs right now but they are affecting the USA as much as any country providing universal coverage.

[Lohman446]

I think this makes sense - in a perfect world where all humans are the same. However, what if your kid has some illness that requires many, many hospital visits, all under 10K, while my kid is born perfectly healthy?

I don't think anyone should ever have to forgo treatment because they can't afford it.

Also, this system just pushes people into waiting until they are seriously ill to seek treatment, which is another cause of all the issues in this country. If more people had good, preventative medicine, it will probably drop a lot of the emergency room visits and major surgeries needed because of conditions that weren't caught early.

So make it cumulative over the course of a year or something. Apply it the same as you do food stamps to allow the poorest to receive care regardless.

We all know preventative care is better. However, we can look at the eating and exercise habits in America and realize all the doctor visits in the world are not going to undo what people do on a weekly basis.

[Shirow]

So make it cumulative over the course of a year or something. Apply it the same as you do food stamps to allow the poorest to receive care regardless.

We all know preventative care is better. However, we can look at the eating and exercise habits in America and realize all the doctor visits in the world are not going to undo what people do on a weekly basis.

That's true of some people, sure. There are people out there who get sick with the healthiest lifestyle though.

And let's be honest - most of us posting in this thread probably do one or more of the following: eat too much, smoke too much, drink too much, don't get 5-8 servings of fruits and vegetables a day, don't exercise enough, eat too much red meat, eat too much fat... etc

Not many people attain nutritional and lifestyle perfection. I don't think they should have to die for it. Making people pay a large amount per visit would just dissuade most people from going until they are sick. To me, it's not much different than mandating coverage.. people pay $300 each time they go to the doctor or they pay $200 a month for coverage.. if you're going to force people to pay for services, then I think it's better to implement it so they can get the care they need, when they need it - not when they can afford it. The big difference is, if it is mandated, you are more likely to go for regular checkups etc, since you are paying for it either way. If you pay a large amount per visit, I think most people would put it off until they need a triple heart bypass.

[Lohman446]

The problem I see here is no accountability.

Since my employer pays my health insurance you don't care what it costs. This is fictitious since your benefit package could be pay, but few people catch on here so let it be.

Since the health insurance company balances any increase in cost by raising rates they don't care what it costs.

Since noone cares the hospital can justify $3000 an hour to rent a room by saying "geez, its important to your health, its worht any price".

Put the consumer paying out of pocket a bit more and things will come in check. There are plenty of people who are sick because of hte choices they make. While I have no problem within reason, and helping those who are unlucky, I am really sick of paying for the people who refuse to work because they are sitting around eating twinkies all day.

[Shirow]

I am really sick of paying for the people who refuse to work because they are sitting around eating twinkies all day.

Do you know a lot of these people?

I know they exist, but I'm not totally sure it's quite as widespread as people make it out to be. Even if there are a lot of them, I wouldn't necessarily be fundamentally opposed to my taxes letting them see a doctor - I mean, they're already raising rates by going to the emergency room and declaring bankruptcy on large bills which raises our insurance anyway. If everyone was forced to pay for health coverage nationwide, rates would probably go down really.. more money in the pot, evens out the risk.

Either way, I'll tell ya - with two kids and a stay at home wife, I sure as hell am glad I'm not paying for my health coverage out of pocket. I'd hate to have to choose between treating my sick kid and paying some other bill. I think it would be a giant disaster to switch to a 'pay as you go' model.

[Lohman446]

I know enough of these people to be annoyed - one being my ex wife for instance. There are likely not as many out there as I would allude to, or as few as you think. Its best we both agree that they are out there.

I would point out that the money your employer is paying for health coverage is money that could be going directly to you. I beleive that you are responsible enough with your money to put it where it needs to be. I trust you to do what is right and needed. I trust you to make the right choices for you and your family. See the recurring theme here. Similarly I trust me to decide where I want to give my money should I want to help out others. I do not trust the government to do either of these things efficiently for me or you.

More to the point I think once you are in control health care will become competetive. Think about it this way. Millions of people would opt for filet mignon over chopped sirloin if they did not have to pay directly for it. The price of eating would go up astronomically. Yet there is no difference in feeding you. Keep on track here, because I know I am going to hear "but who wants the chopped steak of health care". The fact of the matter is most of us are not getting the filet mignon of health care - our insurance companies do not approve the most cutting edge. We are using the tried and true, proven and taught of the health system. Yet they are billing us for standard procedures (gall bladder removal - millions? done per year - 2 hours in the hopsital $8000 if no complications) as if they were research procedures done by the best of hte best. So you are getting chopped steak and paying for top sirloin. The filet mignon is still reserved for those actually paying directly for it.

[vf-xx]

I'm curious:

For all this debate, what are ya'll DOING about it?

[Lohman446]

I'm curious:

For all this debate, what are ya'll DOING about it?

Converting my dollars to Euros :) (not really, not yet). Personally, I do demand reasonable prices from my doctors, and only carry a catastrophic policy.

[Shirow]

I'm curious:

For all this debate, what are ya'll DOING about it?

Me? Nothing. I'm not a citizen so I can't vote. I'm also perfectly fine with healthcare personally - I have a great policy, I don't pay much for it and the standard of care my family gets is great. While I believe that everyone is entitled to good care, I'm not politically motivated enough to get terribly involved in enacting change.


I would point out that the money your employer is paying for health coverage is money that could be going directly to you. I beleive that you are responsible enough with your money to put it where it needs to be. I trust you to do what is right and needed. I trust you to make the right choices for you and your family. See the recurring theme here. Similarly I trust me to decide where I want to give my money should I want to help out others. I do not trust the government to do either of these things efficiently for me or you.

I'd never take the money my employer pays over the health coverage I get. Imagine if my wife gets breast cancer and I have to pay out of pocket for all her treatment. Right now, she would probably die or I'd be completely financially ruined (or both!). Even if I had coverage for everything 10K+, I'm not sure I could pay to cover all the <10k treatments.

If everyone paid as they went, there would be a lot less preventative medicine going on than there is today and I think healthcare costs would probably go up, not down since all the procedures would be major ones and there wouldn't be enough small visit/procedure income to cover the doctors needed.

But on that point, I think all we can do is agree to disagree, since it's largely speculative - I can't think of a developed country with a pay as you go system to reference.

[Shirow]

And let me end with a funny picture:

http://images.huffingtonpost.com/gadgets/slideshows/2780/slide_2780_38631_large.jpg

[drg]

However, if prices were reasonable, individuals could afford it.

Think of it this way. What if we simply only allowed catastrophic insurance - from either private or government. Nothing under 10K is covered.

The $300 office visit would have to be justified. The $3000 an hour operating room, would have to be justified. Consumer choice and consumer control of spending generally works to keep prices in check. Take it out of consumer hands, put it in insurance companies hands and government handouts and costs become unchecked.

I really hate to bump this thread up after so long, but I saw this study today and remembered that you had been a proponent of this seemingly counterintuitive strategy.


A new study in the New England Journal of Medicine has a provocative finding: Bigger co-payments for primary-care and specialty doctor visits were tied to more in-patient hospital time for elderly patients. The implication is that people avoided the doctor’s office to save money, then ended up in the hospital when their problems weren’t detected or treated in their early stages. The apparent effect seemed stronger among people living in low-income areas, and for those with high blood pressure, diabetes or a history of heart attack, among other groups. The bottom line was that raising co-pays “may be a self-defeating cost-containment strategy and may have adverse health consequences,” says Amal Trivedi, the study’s lead author and a professor at Brown’s Alpert Medical School. The result is generally consistent with a number of other studies, many focused on patients’ out-of-pocket costs for drugs. They’ve linked higher co-pays to reduced use of medications, and vice versa. Here’s one of those and here’s another. Advocates of so-called value-based benefits design point to them as evidence for why insurers and employers should try to align patients’ financial incentives with the care they most need, particularly preventive treatment for chronic conditions.

The implication is that people avoided the doctor’s office to save money, then ended up in the hospital when their problems weren’t detected or treated in their early stages. The apparent effect seemed stronger among people living in low-income areas, and for those with high blood pressure, diabetes or a history of heart attack, among other groups.

The bottom line was that raising co-pays “may be a self-defeating cost-containment strategy and may have adverse health consequences,” says Amal Trivedi, the study’s lead author and a professor at Brown’s Alpert Medical School.

The result is generally consistent with a number of other studies, many focused on patients’ out-of-pocket costs for drugs. They’ve linked higher co-pays to reduced use of medications, and vice versa. Here’s one of those and here’s another. Advocates of so-called value-based benefits design point to them as evidence for why insurers and employers should try to align patients’ financial incentives with the care they most need, particularly preventive treatment for chronic conditions.
http://blogs.wsj.com/health/2010/01/27/study-higher-co-pays-mean-more-trips-to-the-hospital/

Turns out, what sounds like a bad idea is, in fact, a bad idea. Raise copays and preventive care drops, costing more in the long run. Your proposal would have a devastating effect on health and healthcarecare in this country.

[grEnAlEins]

And with sampling and selection biases like that NEJoM study sited in that article, who could argue :tard:

You cannot site a study that primarily examined medicare participants and pretend that it has implications system wide. This was also a very short term study of people who are not used to having to be semi self sufficient, so of course they will be apprehensive and attempt to evade new financial responsibilities by avoiding the cause due to this "responsibility shock". Additionally, the full "conservative strategy" was not implemented here. It was implemented in a controlled market. If we still had a truly free market, doctors would lower costs to increase the volume of visits, and that is the desired outcome. For this to work the change would need to go system wide. It is really a moot point, as this will never happen in the US.

How about you post a study that does not only sample medicare patients, and does not eliminate most of those via the selection process.

[Lohman446]

"if you can buy health insurance for $150 a month" is a straw argument. Show me where you can get comprehensive coverage that covers preexisting conditions for that? Even the 8K the government is claiming is over $650 a month - interestingly enough it works at to $666 a month.

DRG - my issue again is that we have let the system get out of hand. $300 office visits are ridiculous. You would not except the lack of service (and lack of quality) while paying those prices in anything but healthcare. Why do we in health care? How do we check these abuses (look up the cost to have child (no complications) in 1950 vs today) that basically are the system now? Since I don't like government interference (I beleive that freedom also carries responsibilities) I am more accepting of consumer control. Yes we have to provide for the poorest (as we already do, I think this point is missed), but we also have to consider that health care costs are unreasonably high - also check our costs per capita vs any other country, we far exceed and yet do not have better care.

[Ando]

Just look at the countries that already have this type of system installed. Is it working....No!

Germany's health care system is FUBAR'ed.

[Coralis]

Just look at the countries that already have this type of system installed. Is it working....No!

Germany's health care system is FUBAR'ed.


Ours isnt much better one situation that requires a hospital stay is a huge expense unless you happen to have VERY GOOD insurance policy (that more then likely costs you and/or your employer a ton of money.

[Lohman446]

This is the issue I have:

This office visit was $300 please pay it:

The person paying directly asks why, expects quality, and if does not receive it seeks treatment elsewhere. Because of this competition creates better prices and better quality.

The person who can says "oh, well let someone else pay it for me" and doesn't care if it takes 10 more to have satisfaction.

The problem we don't seem to see is that we can't all just let someone else pay for it. That eventually comes back to all of us.

Take a common surgery (pick one). Check the complexity of open surgery, the risks involved, the time involved, and the recovery time (in hospital) and the cost in 1950 (1960, 1970) Take the same surgery today. Chances are technology will have made the surgery far less complex, with far less risks, far less time to do and far less recovery time. You will also find it far more expensive to the order of magnitudes. Then, for kicks, compare the costs to income of the itme

"But technology costs money". Yeh, to some degree. A color tube television then (I think 32" was considered huge) was also like $800. You can get flat screen LCD for the same price. Needless to say $800 in 1950 had a whole lot more buying power than $800 today. Generally increases in technology make things less expensive over time. And recall I did say common surgery, those that are performed all the time, those which are not using the cutting edge technology - frankly those that are using technology and procedures developed decade(s) ago.