[JerryLove]

To not-Noli:

In all the hub-bub and bru-ha-ha... and more to the point all the posturing and reframing of arguments going on in the public discourse: I want to try to come back to some basics of what should be discussed.

There are two premises which must first be looked at and decided.

• Is universal healthcare good?
• Is a public insurer good?

I think universal health-care is clearly good on more levels than I could possibly want to type out tonight. Ignoring the moral argument, the economic one is compelling.

People without health care are less likely to get vaccines, less likely to treat disease (indeed, to even get it identified), less likely to maintain conditions to avoid those getting worse.

Sick people are a drain on the economy.
Sick people get others sick.

And what of the person with chronic high-blood pressure that just had a heart attack because they are not on their meds (they can't afford them)? Are they just too poor to live? And when (having not gotten cheap medication) they get expensive intensive care: I'm suddenly paying for it.

So those without healthcare actually just have bad healthcare I foot the bill for. That's better than universal coverage? I think not.

And what about the non-poor? I'd like to be able to afford healthcare: but that doesn't work when the young tend to not participate. Of course then one of them needs a million dollars in intervention for that cancer they got, but the others aren't paying into the pool so who does pay for it? Me again.

So universal healthcare means less sick people, longer lives, and lower costs, not higher.

What about a public insurer?

Why not?

I can tell you that, without one, only severe regulation will prevent price-fixing.

If it's badly run, then no one will choose it. If it's well run, then why is it bad?
If private insurance is simply inferior then why do I want private insurance to continue. So I can be "capitalist"? I'm not sure human suffering is the best place to look for profit.

Past the generalities, I wish they would stop with the lies.

I work in medical. Every day I see fights with insurers who are between doctors and their patients. That's not new.

There are several public options now. That's not new either.

Many companies are making a great deal of money serving public options. Saying that public options drive out private ones is not true. Compete or die.

It will not cost $100B new dollars a year (usually told as a trillion in 10 years). That's a lie. The estimate is total cost, not new cost.

It's not socialism. Not even a little. As pointed out, it's also not new. The US already has public health insurance. It has for many decades; Medicade, Medicare, Veteran's, STAR, etc.

The horrible shame is that the time we could spend fixing the *real* problems with the proposals, with discussing the real issues, are wasted on stupid, dishonest, sound-bytes.

[Thrash]

I am ignorant on the subject except on what I hear through the grapevine and on the radio, but what about all the other little things tagged onto the bill? The things that have little or nothing to do with the base of the program or idea of Universal Healthcare?

[JerryLove]

Originally Posted by Thrash

I am ignorant on the subject except on what I hear through the grapevine and on the radio, but what about all the other little things tagged onto the bill? The things that have little or nothing to do with the base of the program or idea of Universal Healthcare?

I suspect that there are a large number of problems with the proposed bills. If we could get past people screaming "the government can't do anything, they are going to put old people out to pasture" etc then it could be discussed.

Before I more to a discussion of specifics, do you agree that the two pre-questions are answered positively?

[Thrash]

Your proposal, in my quick read through, seems sound.

[Ax]

Originally Posted by JerryLove

To not-Noli:

In all the hub-bub and bru-ha-ha... and more to the point all the posturing and reframing of arguments going on in the public discourse: I want to try to come back to some basics of what should be discussed.

There are two premises which must first be looked at and decided.

• Is universal healthcare good?
• Is a public insurer good?

I think universal health-care is clearly good on more levels than I could possibly want to type out tonight. Ignoring the moral argument, the economic one is compelling.

People without health care are less likely to get vaccines, less likely to treat disease (indeed, to even get it identified), less likely to maintain conditions to avoid those getting worse.

Sick people are a drain on the economy.
Sick people get others sick.

And what of the person with chronic high-blood pressure that just had a heart attack because they are not on their meds (they can't afford them)? Are they just too poor to live? And when (having not gotten cheap medication) they get expensive intensive care: I'm suddenly paying for it.

So those without healthcare actually just have bad healthcare I foot the bill for. That's better than universal coverage? I think not.

And what about the non-poor? I'd like to be able to afford healthcare: but that doesn't work when the young tend to not participate. Of course then one of them needs a million dollars in intervention for that cancer they got, but the others aren't paying into the pool so who does pay for it? Me again.

So universal healthcare means less sick people, longer lives, and lower costs, not higher.

What about a public insurer?

Why not?

I can tell you that, without one, only severe regulation will prevent price-fixing.

If it's badly run, then no one will choose it. If it's well run, then why is it bad?
If private insurance is simply inferior then why do I want private insurance to continue. So I can be "capitalist"? I'm not sure human suffering is the best place to look for profit.

Past the generalities, I wish they would stop with the lies.

I work in medical. Every day I see fights with insurers who are between doctors and their patients. That's not new.

There are several public options now. That's not new either.

Many companies are making a great deal of money serving public options. Saying that public options drive out private ones is not true. Compete or die.

It will not cost $100B new dollars a year (usually told as a trillion in 10 years). That's a lie. The estimate is total cost, not new cost.

It's not socialism. Not even a little. As pointed out, it's also not new. The US already has public health insurance. It has for many decades; Medicade, Medicare, Veteran's, STAR, etc.

The horrible shame is that the time we could spend fixing the *real* problems with the proposals, with discussing the real issues, are wasted on stupid, dishonest, sound-bytes.

The problems I have with it are this:

Timing: The timing of this is rather ludicrous, we have so much on our plates right now and our debt is already so high, I really don't think adding to the nat'l debt is a good idea. It's actually rather bad. And if the gov keeps spending this way inflation is going to reach levels never before seen in the U.S., along with soaring interest rates and loss of jobs.

Cost: mostly see above.

Efficiency: Look at what the government did with the trailers for Katrina victims. Thousands upon thousands of brand new trailers were shipped there but because of the bureaucratic process involved and government efficiency, the leases expired on them before a single one was even unwrapped. I've seen these with my own eyes. Also, the gov is losing billions of dollars on the U.S. Mail, several reports have been done that show that if a private company ran it, but the government is so inefficient at doing anything they lose money.

Elimination of competition: I know many companies will, as a cost saving measure, cut their insurance, not only that but eventually Obama wants to have single payer insurance, he's stated that publicly several times.

Constitutionality: pretty obvious. It's out of the fed's realm. They have no business there and have no right to do this.

I do see a need in this country for reform, but rather than providing universal healthcare I think these would be good starts for fixing the problems.

Increase competition: allow people to choose insurers from out of state. Currently you cannot. Also: eliminate exclusive contracts between employers and insurers. This alone will drive down cost because insurers will have to price their services competitively.

Regulate the cost of medications: several things here... huge markups over cost, and then offering the same drug overseas for less than half the cost. I'm usually anti-regulation but sometimes, it's necessary.

Healthcare for duration of unemployment: Only for those who are eligible to draw, also, tighten restrictions for how much/how long people can draw. There needs to be tougher rules on who/how long/how much people can draw anyways.... This already exists in some cases from the former employer but not always.


Another thing is that soon people will have little incentive to get a job. Free healthcare programs, free food, free housing projects... there are programs for all of these... some people just mooch off the government already... do you really wanna enable them to do so even more and easier?

[AlphaSigma]

Originally Posted by JerryLove

To not-Noli:

In all the hub-bub and bru-ha-ha... and more to the point all the posturing and reframing of arguments going on in the public discourse: I want to try to come back to some basics of what should be discussed.

There are two premises which must first be looked at and decided.

• Is universal healthcare good?
• Is a public insurer good?

I think universal health-care is clearly good on more levels than I could possibly want to type out tonight. Ignoring the moral argument, the economic one is compelling.

People without health care are less likely to get vaccines, less likely to treat disease (indeed, to even get it identified), less likely to maintain conditions to avoid those getting worse.

Sick people are a drain on the economy.
Sick people get others sick.

And what of the person with chronic high-blood pressure that just had a heart attack because they are not on their meds (they can't afford them)? Are they just too poor to live? And when (having not gotten cheap medication) they get expensive intensive care: I'm suddenly paying for it.

So those without healthcare actually just have bad healthcare I foot the bill for. That's better than universal coverage? I think not.

And what about the non-poor? I'd like to be able to afford healthcare: but that doesn't work when the young tend to not participate. Of course then one of them needs a million dollars in intervention for that cancer they got, but the others aren't paying into the pool so who does pay for it? Me again.

So universal healthcare means less sick people, longer lives, and lower costs, not higher.

What about a public insurer?

Why not?

I can tell you that, without one, only severe regulation will prevent price-fixing.

If it's badly run, then no one will choose it. If it's well run, then why is it bad?
If private insurance is simply inferior then why do I want private insurance to continue. So I can be "capitalist"? I'm not sure human suffering is the best place to look for profit.

Past the generalities, I wish they would stop with the lies.

I work in medical. Every day I see fights with insurers who are between doctors and their patients. That's not new.

There are several public options now. That's not new either.

Many companies are making a great deal of money serving public options. Saying that public options drive out private ones is not true. Compete or die.

It will not cost $100B new dollars a year (usually told as a trillion in 10 years). That's a lie. The estimate is total cost, not new cost.

It's not socialism. Not even a little. As pointed out, it's also not new. The US already has public health insurance. It has for many decades; Medicade, Medicare, Veteran's, STAR, etc.

The horrible shame is that the time we could spend fixing the *real* problems with the proposals, with discussing the real issues, are wasted on stupid, dishonest, sound-bytes.

Your propositions seem well-grounded to me.
I've been a proponent of Single-Payer health care for a while now, but I also realize how tricky it can be in terms of selecting a doctor and having to wait extended periods of time for surgeries.

Would you propose universal health care for all, or offer a choice to those who would rather keep their private insurer?

[tlj009]

People without health care are less likely to get vaccines, less likely to treat disease (indeed, to even get it identified), less likely to maintain conditions to avoid those getting worse.

Sick people are a drain on the economy.
Sick people get others sick.

And what of the person with chronic high-blood pressure that just had a heart attack because they are not on their meds (they can't afford them)? Are they just too poor to live? And when (having not gotten cheap medication) they get expensive intensive care: I'm suddenly paying for it.

So those without healthcare actually just have bad healthcare I foot the bill for. That's better than universal coverage? I think not.

And what about the non-poor? I'd like to be able to afford healthcare: but that doesn't work when the young tend to not participate. Of course then one of them needs a million dollars in intervention for that cancer they got, but the others aren't paying into the pool so who does pay for it? Me again.

Now it is hard to argue that the poor doesn't deserve healthcare. But I am going to argue that if you can afford healthcare and choose not to get it, why do you not have to live with the consequences? Shouldn't there be consequences for bad choices or simply gambling with your life? I am not arguing that these people shouldn't get help but is it unreasonable to maybe give them a low interest loan to cover healthcare. So that they pay something back even if it isn't the whole thing. Perhaps they would reconsider things if they had to pay back a certain amount every month.

So universal healthcare means less sick people, longer lives, and lower costs, not higher.

Actually all of those benefits depend entirely on how it is achieved.

What about a public insurer?

Why not?

I can tell you that, without one, only severe regulation will prevent price-fixing.

Why a public insurer? Why not expand charity hospitals? Why not the existing public insurers to cover those that other insurance companies don't want to cover and that drive up costs for the rest of the population? Also, isn't price-fixing already illegal. The industry may be practically untouchable because of political connections but simply enforcing the existing laws may be a good thing.

If it's badly run, then no one will choose it. If it's well run, then why is it bad?
If private insurance is simply inferior then why do I want private insurance to continue. So I can be "capitalist"? I'm not sure human suffering is the best place to look for profit.

Again, it is all about how it is implemented. If the public option is inferior but cheaper for businesses, assuming businesses still pay a large portion of the employee's premium, then I can see it being chosen and putting other companies out of business. After all, they wouldn't have to make a profit to stay in business but private insurers would. Also, you would have to consider whether or not the public option would stay afloat from the money they bring in or if they will constantly receive government money. Working it as a non-profit may be more beneficial. But the details are extremely important and really I don't know if I trust anyone currently involved to come up with the right solution.

Past the generalities, I wish they would stop with the lies.

I work in medical. Every day I see fights with insurers who are between doctors and their patients. That's not new.

There are several public options now. That's not new either.

Many companies are making a great deal of money serving public options. Saying that public options drive out private ones is not true. Compete or die.

There is a little difference in public options serving a group that no one else wants to serve and a public option that serves the entire market. But again, good or bad would depend on the details.

It will not cost $100B new dollars a year (usually told as a trillion in 10 years). That's a lie. The estimate is total cost, not new cost.

It is a cost that I have heard no one defending. Obama says he won't sign it unless they come up with some way to pay for it so that it won't increase the deficit but even in the discussions that I heard, they cut some existing programs to pay for this. If you want to blame people for using the numbers provided to them, then you should also blame the ones supplying the numbers and the ones supporting the program but not correcting these "lies".

It's not socialism. Not even a little. As pointed out, it's also not new. The US already has public health insurance. It has for many decades; Medicade, Medicare, Veteran's, STAR, etc.

Not even a little? And it is new in that it covers the whole market instead of just covering a piece of the market. Are private insurers competitive in serving verterans? What those programs do is reduce the competitive market for private insurers. That may be good or bad but when it amounts to the entire market, the public option will have to be regulated pretty tightly to keep from running companies out of business. In other words, there is a risk. And where there is a risk, it should be brought up so that it can be avoided. But if we start down this road, then I suspect that sooner or later there will be "minor" changes that bring all of the risks to light.

The horrible shame is that the time we could spend fixing the *real* problems with the proposals, with discussing the real issues, are wasted on stupid, dishonest, sound-bytes.

It is not likely to be determined by us. It will be determined by the politicians. And I have a very low opinion of our politicians in general.

[Bryan]

it's fine with me, provided we amend the constitution to give the federal government the power to create a universal health care system.

[Bryan]

I agree with your first two points above.

Originally Posted by JerryLove

It will not cost $100B new dollars a year (usually told as a trillion in 10 years). That's a lie. The estimate is total cost, not new cost.

I don't see how it is not new cost. It may not be $100mill, but Medicaid, Medicare, VA, STAR(what's that) probably don't cost $100mm all together. I'd like to see what it would cost.

I'd say we completely replace the health insurance companies with a public insurer. Instead of doctors sending the bill to United Health Care, it gets sent to the Department of Health & Human Services.

But by regulating prices that doctors can charge (which is what private health care does now) by the DHHS or some other government department, it is socialism. (Though I'm not entirely opposed to that).

[bravesfan007]

Originally Posted by Ax

Constitutionality: pretty obvious. It's out of the fed's realm. They have no business there and have no right to do this.

This is one of my main arguments against this, but it applies to many things the federal government does.

Personally, I don't see a universal health care system being a good thing. Allowing a public buy-in option to an already established plan, yes. Free for everyone, no.

[JerryLove]

It sounds like the two general questions, and their answers, aren't particularly controversial (good). The devil, I will certainly agree, is in the details.

Originally Posted by Ax

Timing: The timing of this is rather ludicrous, we have so much on our plates right now and our debt is already so high, I really don't think adding to the nat'l debt is a good idea. It's actually rather bad. And if the gov keeps spending this way inflation is going to reach levels never before seen in the U.S., along with soaring interest rates and loss of jobs.

So you believe it's a good idea, but not a good idea for the US right now because we are otherwise occupied?

That seems fair. We, as a country, would need to ask ourselves a few more questions then.

1) Is this a net increase or decrease in costs over the medium term? (I think, and have support for why I believe so), that we can lower costs in the medium and long term.

2) Where should this fall on our national priorities? That's certainly a complex question.

3) What are the various options available (certainly there's more than one way to do this)? Are some more cost-conscious than others? (can we do some of the things now and save others for later?).

Efficiency: [...] Also, the gov is losing billions of dollars on the U.S. Mail, several reports have been done that show that if a private company ran it, but the government is so inefficient at doing anything they lose money.

Firstly: this statement appears wrong (USPS - Postal Facts) The USPS is operating solely off the income it makes, not off tax dollars.

Private companies don't do what the USPS does because they can't figure out how to make money doing it.

I remember some of the same types of claims over the IRS (IRS agents are 5-times more effective per-dollar-spent (per agent) at collecting revenue than private companies employed by the IRS for the same job), over prisons (most private prisons went into huge cost overruns and were eventually re-taken-over because they couldn't do the job), and numerous others.

There is a lot of governmental waste. There is a lot of private industry waste. I think that the conventional knowledge here is wrong.

I also think that there are some areas where companies rising and falling in a market is fine and good (restaurants), and others (like universal health insurance), where constantly changing players and bankruptcies are not a viable option.

Elimination of competition: I know many companies will, as a cost saving measure, cut their insurance, not only that but eventually Obama wants to have single payer insurance, he's stated that publicly several times.

Your USPS example is interesting here as, despite several advantages (mailboxes) and having been there first, we still have UPS, FedEx, DHL, Airborne, etc.

Let me also point out that for 70 years or so we have had public options (Medicare, Medicade, etc) and that there are private companies operating in those fields as well (in fact, the government will pay for them); and that's just helathcare: there are also public options (for example) in homeowner's insurance.

Constitutionality: pretty obvious. It's out of the fed's realm. They have no business there and have no right to do this.

I agree, but with the caveat that the fed is already operating far outside their constitutional grounds (in other words, let's make sure we don't cherry-pick that some are ignored and some are policy-making).

It seems that the constitution should be amended to move forward.

Increase competition: allow people to choose insurers from out of state. Currently you cannot. Also: eliminate exclusive contracts between employers and insurers. This alone will drive down cost because insurers will have to price their services competitively.

The same thing was said over credit cards. Prices shot up. The same was said over deregulation of power in California. Costs increased almost an order-of-magnitude. The same was said of home-owners insurance: costs shot up.

It is simply not true, and it will not solve either of my initial points. People who should be paying in but don't think they'll get sick still wont, and then they (or their children) will get gravely ill, and someone will have to pay for what they literally won't have the money for; meanwhile, people like me will not be able to afford healthcare because the risk of serious illness makes the best investment to simply not cover us.

Here's something to remember about private health-care companies. Their best interest is to take as much of your money as possible while providing as little service as possible.

Regulate the cost of medications: several things here... huge markups over cost, and then offering the same drug overseas for less than half the cost. I'm usually anti-regulation but sometimes, it's necessary.

Healthcare in general is far less expensive overseas.

Another thing is that soon people will have little incentive to get a job. Free healthcare programs, free food, free housing projects... there are programs for all of these... some people just mooch off the government already... do you really wanna enable them to do so even more and easier?

Do hospitalized people interview well?

If they are healthy, paying for their medical bills isn't incentive: and if they are so sick they need care (and aren't getting it) they are mostly unhireable. I'm sure that there's some other aspect of welfare that would be a better target for this criticism.

[JerryLove]

Originally Posted by tlj009

Now it is hard to argue that the poor doesn't deserve healthcare. But I am going to argue that if you can afford healthcare and choose not to get it, why do you not have to live with the consequences? Shouldn't there be consequences for bad choices or simply gambling with your life? I am not arguing that these people shouldn't get help but is it unreasonable to maybe give them a low interest loan to cover healthcare. So that they pay something back even if it isn't the whole thing. Perhaps they would reconsider things if they had to pay back a certain amount every month.

A stream of counter-examples come flooding up so fast filtering is a problem.

Of course, I've already mentioned that an ounce of prevention is worth a pound of cure. What about those who die at the end of expensive intervention, or who hare old and don't pay it back, or who go into bankruptcy? What about their children when they get sick? And who will front all these loans?

Actually all of those benefits depend entirely on how it is achieved.

I don't think as much as is implied. Stray too far and it's no longer universal healthcare.

Why a public insurer? Why not expand charity hospitals?

Shriners is shutting down hospitals right now due to lack of funding.

How would you expand charity hospitals? Collect taxes and pay them from government funds? How is that not the worst of both worlds?

Why not the existing public insurers to cover those that other insurance companies don't want to cover and that drive up costs for the rest of the population?

So the insurance companies will make huge profits by insuring the not-sick, and the government will pick up the tab for everyone who actually needs care? Who does that benefit?

Also, isn't price-fixing already illegal.

Sometimes. Sort-of. Happens all the time.

The industry may be practically untouchable because of political connections but simply enforcing the existing laws may be a good thing.

It would likely be a good thing.

Again, it is all about how it is implemented. If the public option is inferior but cheaper for businesses, assuming businesses still pay a large portion of the employee's premium, then I can see it being chosen and putting other companies out of business.

There are certainly wrong way to run a public option: but I see no precedent for such a worry. It doesn't happen now with current public options.

Me personally: I'd set regulation to prohibit cost-discrimination on most grounds (can't charge me more because I had cancer), then set a public option with a per-member budget, then offer that amount as a voucher if you want to go to a private insurer (much like Medicare now).

Alternately: I'd offer a minimum healthcare public option, and let private companies fill in all the bells and whistles.

After all, they wouldn't have to make a profit to stay in business but private insurers would.

Heaven forbid that sickness and suffering stop being a profit opportunity.

Also, you would have to consider whether or not the public option would stay afloat from the money they bring in or if they will constantly receive government money. Working it as a non-profit may be more beneficial. But the details are extremely important and really I don't know if I trust anyone currently involved to come up with the right solution.

The problem is that I certainly don't trust the solution we have now.

It is a cost that I have heard no one defending. Obama says he won't sign it unless they come up with some way to pay for it so that it won't increase the deficit but even in the discussions that I heard, they cut some existing programs to pay for this. If you want to blame people for using the numbers provided to them, then you should also blame the ones supplying the numbers and the ones supporting the program but not correcting these "lies".

The number provided is (as far as we know) accurate. Universal healthcare will cost $100B per year as proposed.

Here's where it gets funny. It seems the government is already spending tens-of-billions per year on healthcare for people that will be covered under the universal programs.

So we will spend $100B on UH, but we will stop spending (let's say) $60B on existing programs rendered obsolete by UH. Mentioning one without the other is dishonest.

Not even a little?

No. Socialism is government ownership of the means of production and distribution. Health insurance is not manufactured.

Owning GM. THAT is socialist.

And it is new in that it covers the whole market instead of just covering a piece of the market. Are private insurers competitive in serving verterans?

United Healthcare just won the contract for veterans previously held by Humana. It seems that Humana had been using a clause that allowed them to charge far more for covering people living outside of common areas (read: far away from any bases or concentrations of personnel) and declaring everyone (even those living actually on bases) in it, so that they could charge far more than they bid.

What those programs do is reduce the competitive market for private insurers. That may be good or bad but when it amounts to the entire market, the public option will have to be regulated pretty tightly to keep from running companies out of business.

Like the Post Office does?

It is not likely to be determined by us. It will be determined by the politicians. And I have a very low opinion of our politicians in general.

They are owned by the corporations.

[Epaphras]

As far as I'm concerned, the "uninsured" are made up of a few different groups of people, and the health care solution will be different for each group. A one-size-fits-all plan will not work.

Groups within "uninsured":
- The "uninsure-able". People with pre-existing conditions and chronic illnesses that are a "bad bet" for private insurers and thus denied coverage on their employers' plans or in the private insurance market. If they earn too much to qualify for Medicaid then they are screwed.
- Undocumented residents. Cannot apply for Medicaid because they do not have documentation. Hospitals must stabilize everyone who comes through the door flat-lined, including those without documentation (whether that means an illegal immigrant or someone who simply does not have their ID or insurance info on them and is unconscious). Non-emergency care for non-Medicaid, uninsured patients either comes out of hospitals' charity care budget or else a special pool should be created to cover this population.
- The 20-something "invincibles". On one extreme end of the spectrum of this population, is students and/or young adults who turn 21 or 23 and are dropped from their parents insurance, and don't realize it until they go to the emergency room and find out they don't have coverage. On the other extreme are 20-somethings who rationalize that they are young and healthy, exercise often and eat well, and thus the odds are in their favor and so they don't need insurance.
- The poor who qualify for Medicaid but do not sign up. Speaks for itself.
- The "working poor" who do not receive coverage from an employer, but do not have enough disposable income to afford private family insurance that is comprehensive enough for their needs. Even if they purchase a high-deductible plan, they may forego routine doctor visits because they have to pay 100% out of pocket for the visit and any lab work, and prescriptions.


Like I said, the solution will look different for each group, and should be separate pieces of legislation:
- The "uninsure-able". Solved either through amending current Medicaid programs, or through legislation aimed at insurance companies prohibiting them from denying coverage.
- Undocumented residents. Crack down on businesses who hire illegals by forcing them (employers) to withhold and pay income taxes, Social Security, and FICA. That way illegals are at least paying into the system. This issue is really just a symptom of the illegal immigration issue, and thus a solution will come from comprehensive immigration reform, not health care reform.
- 20-somethings. They need to be educated that they will be dropped from their parents' insurance at a certain age, and will have to purchase private short-term insurance, find a job that pays benefits, or (if their income is low enough) get on Medicaid. The "invincibles" (of any age) I really don't know how to address. In an emergency they would get "something for nothing", either from Medicaid if their incomes are low enough, or from the hospitals' charity care budget. But honestly, this segment is so small their effects on the system or negligible.
- The poor who qualify for Medicaid programs but do not enroll. Educate, educate, educate! On one level it really is up to individual responsibility, but at the same time the services need to be made very accessible. Meaning facilities located on public transit lines, multiple languages, etc. etc. etc.
- The working-poor. Tort reform would help, to make private insurance more affordable for everyone, including employers. The working poor may not need to buy private insurance after tort reform because their employers can now afford to offer it to part-time employees too. The other option is expanding Medicaid to reach up and cover that "gap" population, those who make too much to qualify for Medicaid but not enough for private insurance. Or, create a CHIPs (State Childrens Health Insurance Programs, designed to reach the children in that gap population) style program, only for everyone, with an emphasis on preventative care.

Bottom line is, I don't see why we need to change the entire system that serves hundreds of millions of people well (those with employer coverage either private employer or government employees), to benefit the 20 or 30 million who are stuck in the limbo created by the current system. It just needs some tweaking, not a massive overhaul.

[tlj009]

A stream of counter-examples come flooding up so fast filtering is a problem.

Of course, I've already mentioned that an ounce of prevention is worth a pound of cure. What about those who die at the end of expensive intervention, or who hare old and don't pay it back, or who go into bankruptcy? What about their children when they get sick? And who will front all these loans?

The government can front the loans if they want. But I am not worried about them getting paid back. What I was more concerned with was letting people make their own choices and facing the consequences without being too heartless toward them. It is a tough balance. There are those in need and those that make poor choices. The needy, I agree we should help (maybe not the government but we should help). The foolish need to realize at least some consequence to their actions.

I don't think as much as is implied. Stray too far and it's no longer universal healthcare.

I do think that it is as much as is implied. There are hundreds of ways to come up with universal healthcare and I would guess only a handful that would actually work. Massachusetts is the latest failed attempt in the US, but I understand that several other states had failed attempts too. Shouldn't we get it to work on a State level before the entire nation goes to it?

Shriners is shutting down hospitals right now due to lack of funding.

How would you expand charity hospitals? Collect taxes and pay them from government funds? How is that not the worst of both worlds?

You mention Shriners. It is a great hospital that has operated for many years without government funding. Doesn't that indicate that it is a good working model? So how is it the worst of both worlds to eliminate the cost of insurance altogether and simply pay for the healthcare directly?

So the insurance companies will make huge profits by insuring the not-sick, and the government will pick up the tab for everyone who actually needs care? Who does that benefit?

Well that depends. If the prices come down like they should, the insurance companies can make a reasonable profit while the government picks up the tab for everyone else. So the drain on the economy consisting of those without preventative care because they lack health insurance would be eliminated. And the private insurance companies would still be competitive in their market.

Sometimes. Sort-of. Happens all the time.

I don't doubt it.

It would likely be a good thing.

A good thing in a good many other areas too.

There are certainly wrong way to run a public option: but I see no precedent for such a worry. It doesn't happen now with current public options.

I see precedent to worry about any additional power that the government takes upon their self.

Me personally: I'd set regulation to prohibit cost-discrimination on most grounds (can't charge me more because I had cancer), then set a public option with a per-member budget, then offer that amount as a voucher if you want to go to a private insurer (much like Medicare now).

Vouchers could be a good thing. But maybe you can explain a little more how it would work. Medicare works because more people pay in than draws on the system. Would the public insurer set their operating budget and then send "extra" money back to the people as vouchers? That would likely be a very small voucher.

The way that I see it, the public option would need to make most of its operating money through premiums that are based on income, while at the same time everyone pays in through taxes to cover healthcare for the poor whose premiums are too low to cover the cost and for when you become elderly. Working it that way, the public insurer could be cheaper up to a certain income, say $30,000, and from there the private insurer would be cheaper.

Alternately: I'd offer a minimum healthcare public option, and let private companies fill in all the bells and whistles.

Can be done. That is what FedEx does in conjunction with the US postal service. But it would drastically reduce the size of the insurance companies. Maybe not run them out of business but definitely make them much smaller. It would basically take jobs from the private sector and turn them into government jobs.

Heaven forbid that sickness and suffering stop being a profit opportunity.

Yeah, I mean people shouldn't make a profit. It should all be charity. A profit shouldn't be made by munition companies selling to the military. It shouldn't be made by contractors drilling water wells for a community water system. Doctors don't deserve to make a profit. Hospitals don't. What do you do Jerry? Because you may not deserve to make a profit either.

The problem is that I certainly don't trust the solution we have now.

Well of course not. There needs to be some reform. But your biggest problem is that you have cancer. It is treatable but it costs a fortune. So you are pushing to receive charity called universal healthcare. Now if I need something, I go hat in hand and ask for it. But that isn't the push that I see here. What I see is people insisting that they are entitled to healthcare and for me to pay for it. That always rubs me the wrong way from the start even when at the same time I do see the need. There are people in need everywhere.

Edit: I was watching PBS the other night and there was a discussion on this. She pointed out that the split isn't necessarily along party line but between people who have or have not had a serious illness. I agree with that. Welfare is billed as what it is welfare. It is to help the less fortunate. In my opinion, it would be more honest and cause it to be received a little better if universal healthcare was billed the same way instead of as an entitlement.

The number provided is (as far as we know) accurate. Universal healthcare will cost $100B per year as proposed.

Here's where it gets funny. It seems the government is already spending tens-of-billions per year on healthcare for people that will be covered under the universal programs.

So we will spend $100B on UH, but we will stop spending (let's say) $60B on existing programs rendered obsolete by UH. Mentioning one without the other is dishonest.

I can't say yes or no without seeing how they came up with the numbers.

No. Socialism is government ownership of the means of production and distribution. Health insurance is not manufactured.

Owning GM. THAT is socialist.

So as long as it is a service and not a tangible product, then it is not socialism?

United Healthcare just won the contract for veterans previously held by Humana. It seems that Humana had been using a clause that allowed them to charge far more for covering people living outside of common areas (read: far away from any bases or concentrations of personnel) and declaring everyone (even those living actually on bases) in it, so that they could charge far more than they bid.

Maybe I need to study up on this some more. Is the VA paying the insurance company directly or are the veterans paying premiums. Why doesn't the VA simply pay their own doctors and hospitals?

Like the Post Office does?

Yes. I would guess that FedEx would be much bigger if the USPS didn't provide the service that they provide.

They are owned by the corporations.

Yeah.

[Bryan]

Originally Posted by tlj009

Yeah, I mean people shouldn't make a profit. It should all be charity. A profit shouldn't be made by munition companies selling to the military. It shouldn't be made by contractors drilling water wells for a community water system. Doctors don't deserve to make a profit. Hospitals don't. What do you do Jerry? Because you may not deserve to make a profit either.

ok, stop attacking a strawman. Jerry didn't say profit was evil or wrong or anything like that. But what profit does do is make people greedy. When the chief end of the health care industry is to make a profit, then I think that's a problem.

What should matter most is the number of lives saved, the quality of care given, the number of diseases treated/cured. But when profit is involved, this often becomes the chief focus and saving lives becomes a means to an end instead of an end itself.