The Healthcare Debate, 1961

[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" ( ). 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...

[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.