Universal Healthcare

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WRONG AGAIN. The Senate bill never mandated end of life counseling, either. They did not mandate it; they did not regulate it; in fact, they did not even mention it. No language of any kind pertaining to end of life services has ever been included in the senate's proposed legislation.

It should be fairly obvious at this point that I am both willing and able to look this stuff up by now, so it would behoove you to cease being so cavalier with the facts in the future.

 

I have no idea what that has to do with anything, unless you meant the "free handouts" we've been giving the insurance companies.

It changes the value of the apple.

 

Here is why its quite possible that it will kill private competition.

Another factor in the bill is a cost that will be levied against companies that do not offer a certain level of health care benefits. Unless that cost is at least equal or more than what a company is spending to insure its employees, it will lead to companies dumping plans and just outright paying the cost of not providing it.

Why?

Because unlike a health care ins plan, you will know the costs up front. X 1000s of $ per person or whatever the proposed amount is. Depending on the size and demographics of a companies employees, this will definitely happen if it can show a savings.

Further supporting this would be companies that self-insure. This means that instead of buying an insurance plan that estimates the costs of healthcare for its workforce, the company instead actually pays the bills. They still use one of the major carriers to administer the plan, but in the end, its the company and not the plan paying the bill. Those companies will definately consider dumping health care plans if it would cost them less.

What is truely sad and ironic is that many hospitals have switched to self-insured plans. Its quite possible they would dump healthcare plans and pay the penalty instead, because historically, healthcare employees utilize services more than most other demographics.

So that is why there is a strong belief that a government run public option will destroy the private insurance industry.

What I have not seen discussed at all by the Democrats is the way the Swiss run their health insurance. Politifact evaluated it here.

http://www.politifact.com/truth-o-m...t-says-netherlands-switzerland-achieve-unive/

 

Currently, we don't have "private competition."

Which bill are you citing here?

We know that some companies are already dumping insurance plans, and not because the cost is less, but because they cost more.

As a result, companies are alrerady backing out of the current system in several ways:

1. They are not giving raises because instead, they are using that portion of expense to cover the cost in health care increases.

2. They are shifting the burden onto the employee (the solution my own company is using), for instance rather than paying 75 percent of the policy, they are only paying 65 percent, with me and other empolyees making up the other 10 percent.

3. Companies are laying people off as a way of keeping insurance for their workers. This is even worse solution, because it really impacts the entire economy.

We can only hope....

 

Well thats mostly due to federal regulation that is cited here

http://healthcare.ncpa.org/commenta...n-the-individual-health-insurance-marketplace

So what do you think is the easier and cheaper option? Creating an entirely new entity or allowing for competition across state lines by changing a set of regulations that were enacted in 1945?

Here is the bill. It might have changed since this is 2 months + old, but the debate is still out there because of it.

http://blogs.suntimes.com/sweet/2009/06/house_democratic_draft_health.html

You are correct in all 3 of your statements. I am on the executive board of my union at work. This means I actively am part of our contract negotiations. Through creative means, we were able to keep an 85/15 split on our plan, but that is becoming more and more difficult to do because of the overall rising costs of health care. There is not as much that can be done about the yearly increase in the premium price though, which has been rising at approx 6-8% for the past 5-10 years at least.

This is the untenable position that needs to be corrected. Public option does not address this issue. Instead it merely creates a fictional "employer" that offers a health care plan to people on a national level.

What really needs to be done is reforms in regulation at many levels and in many parts of the health care system. From how medical devices, pharmaceuticals and supplies are introduced and sold, to various over-regulation of administration, to outright fraud and abuse in Medicare and Medicaid. All of these things can be done in part without committing close to 1 trillion to the national debt.

There does need to be a way to insure those who aren't currently covered, I just don't think that until rising costs are addressed that a public option does anything except add more cost to a system running out of control.

 

The house bill more than likely will not be the final bill. It appears that Obama is embracing the Senate bill instead, but with some qualifying features. The odds are against a public option being in the final bill, but more than likely there will be a phony pretense by the use of a "trigger." But that threat will probably never be used.

John Goodman is an Obama critic and a poltical hack. That said, it does not discount his argument. I promise I will take a closer look at the specific regulation of cite, but I am not that familar with it enough to comment either way. Nevertheless, MR Goodman has little credibility with me. Give me some time to look at it.

 

You know, for the life of me, I can't find the link I posted to the actual bills (it was months old, but I'm sure it was in this thread or the other Health Care thread). It was well into the bill, page 500 something, but it was mandated. Honestly, I think it's a good idea, mandated and all, but apparently others don't. If you can find it, feel free to link.

 

As you either have already figured out, or soon will, I usually am centrist or right leaning in many things, but I have zero support for the right on this particular little debate.

The entire reason for the section unless I have no command of the English language at all, is to ensure that *EVERYONE* knows what their various options and benifits are when it comes to the end of your life.

This meaning, wills, power of attorny, funeral costs, how much if any heroic measures should be taken in order to keep you alive in case of your health failing, A great deal of people learn all of this at the last minute when they or a loved one is facing death. This is a way to teach people about those things before they get in the situation.

I am sure I am missing other things and may not be completely correct in my descriptions, but I remember when I 1st heard about this so-called death panel and looked at the bill myself. That is what I got out of it and my response to the death panel claim was "HUH?".

Maybe I am wrong and we are soon to be following in the footsteps of Logan's Run and Soylent Green, but I really doubt it.

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FYI, I only chose that particular link because it seemed to contain what I was talking about. If I could have found the section in the bill itself online, I would have quoted that, but it was far easier to google and grab X random page that quoted it factually (I hope it did as that is what I was looking for).

 

I see one problem here at once:

I am more of a liberal who likes state's rights, rather than the federal handed mandates, in MOST instances. I think government should be closest to the people who have to live under it. While that is not always practical in a country with 50 states, and the Founders really struggled with this issue, states should be free to make many of the decisions that impact them.

In this instance, the complaint is that each state has its own set of rules that insurance companies have to do business with, and what you are suggesting is that the insurance companies get passage around individual state regulations through the federal government. In principle, that is a bad idea. But I'm certain that not only the insurance companies, but many other large corporations would love that suggestion. Besides, you see where anti-trust deregulation got us with the financial business...

I think this is what you are suggesting. Correct me if I am wrong. Federal mandating can be important to achieve specific results that better serve the National Consititution and the general welfare of the nation, but I'm not certain it would help in this instance. Still, I have to look at it more closely, since Republicans keep bringing it up.

 

No. The senate bill never talked about end-of-life care. When it made its way into the house bill, the senate had not yet discussed it, and they now have no intention of including it after all the controversy caused by irresponsible misrepresentation of the house bill. This is an established fact that even Republican Senator Grassley acknowledged in townhall meetings and in a statement he made to the public on August 13th. Here's the statement in its entirety.

I don't agree with his gross misrepresentation of the house bill or his blatant fear mongering, but he is correct in asserting that end of life care was brought up and summarily dismissed by the senate finance committee without being entered into their draft of the bill. This is a verifiable fact -- the senate bill has no such provision and never did.

 

It will probably be cheaper if the private companies don't get their acts together and start charging "administrative costs" similar to those in, you know, the rest of the world. Considering that the aged and the poor (as well as the veterans, Amerindians, and who knows who else I do not know of) already have something like a public option, and it hasn't killed off private enterprise, I doubt universal coverage will. It may shake things up a little, but I doubt this would be such a bad thing as things are. Heck, if a public competitor would scare the private companies into getting off their collective behinds, it will be worth it for that alone; as the events after Clinton's attempt to change things showed, the mere possibility of one did not change things that much.

@ Daremo, regarding your initial post - I doubt it, actually. Are companies in any way forced to offer healthcare plans now either? As far as I know there is no noncompliance fee or anything else, as the US does not have universal healthcare. If companies offer healthcare now, when not doing it costs them nothing (directly, at least), it makes no sense that they would stop doing it if they had to pay more as a result.

Regarding the second one - If the problem as far as the companies are concerned are the high (and rapidly rising) costs of the plans they are offered, and the public option is priced lower than most private ones and prices do not rise as rapidly, it does address the problem. I thought this was the point of having the reforms in the first place, and also why people are worried that the private companies can get out of business (which, I as I said above, is extremely unlikely).

 

Shaman, I think you misunderstand where the costs come from. In any plan, there is usually a split, 80/20 or whatever. The company pays 80% of the total bill, you pay 20%. That cost is derived from the number of participants in the group, the co-pays that are part of the plan, the services offered and also by the previous years usage. So demographics play a huge part in this.

If you looked at a company that had a huge amount of younger workers (mid 20s) say a game software company, they are not going to have alot of usage because in your 20s, people normally don't get sick. That means overall, their coverage costs less. Switch to a different industry, say your standard auto manufacturer. Much bigger age range of its insured members and consequentially more usage = more cost.

There other factors that can influence cost as well. Labor negotiations, cost of drug prescription plans. Some companies have had great success with preventative measures like encouraging exercise at work, quitting smoking, and even eating healthy. This increases the overall health of the members in the plan which lessens the amount of usage of health care services and makes the plan cheaper to buy from the insurance company.

The number of people in the plan also make a big difference. A small company costs more to insure its members because there are less people to spread cost of using services among. A big company like Microsoft has a huge amount of employees so they can negotiate a better price.

So you create a public plan. You can negotiate a better price because you will have a huge pool of people (15-20 million probably), but it will still have to deal with rising costs unless those are addressed. Furthermore, if the public plan exists and there isn't a penalty for companies to drop their coverage, then it makes great business sense to drop coverage all together and push people to the public plan. So that will eventually cascade to all companies and presto everyone is on the government plan.

That is why there needs to be at the very least a cost to companies for not offering a plan or they ditch them.

Why aren't all companies doing that now? Because it hurts recruiting for one. Hard to hire people if your competition offers a health care plan and you don't. Labor unions with negotiated contracts is another reason.

There are solutions to the problem of un-insured people out there that don't require the creation of a public option, but even creating that still does not fix the underlying problem of rising costs. Just because there is a public does not mean costs of things are not increasing. You still have to pay hospitals and doctors for the care they provide. Their costs will still increase every year because of inflation and increased usage because of the baby boomer generation getting older = more sick people = more usage. You can't just arbitrarily say the public plan will only pay X$ for things or you will end up destroying the entire health care industry. Those companies and doctors still need to make a living just like the rest of us. So I don't see how a public option magically reduces costs.

Incidentally, Obama mentioned saving some huge number in fraud and waste from Medicare and using that to pay for a public option. Umm HELLO, what its ok for it to continue right now, but if we are going to have a public option THEN we should prevent fraud and waste? That's just insane thinking and irresponsible as well.

 

@ Duremo : the thing is, the same reasons to not drop health insurance that exist now will exist under a universal system - whether with a public option or not. In fact, there will probably be a new reason whatsoever - the noncompliance fine, however large it is; it simply does not exist now afaik. Thus, companies in a universal healthcare imo will have every reason to make sure their workers have some healthcare plan (theirs or the government's) as they have now. Any noncompliance fee will be an extra reason so, if anything, to should motivate companies that now offer no healthcare plan to do so. From the viewpoint of the companies, nothing really changes. Maybe they don't have the moral imperative of having to support their employees as there is now a survivable alternative to having an employer-provided coverage; unfortunately, as a lot of people already said, this moral imperative is already quite shaky.

Currently companies can decide they can't be bothered and not offer healthcare, leaving people to buy it from private companies. If this all changes as you say, people will just have the option to buy a (supposedly more affordable and better-priced) public plan as well. That is not worse as the old options are still there; there is simply a new one which, most likely, will be a better one. From the viewpoint of the people, this is, by and large, a positive development.

Sure, there may be some company push to have people switch to the government plan as private persons; I do think the final draft should have provisions that in such a case the employer has a reason not to abdicate in such a way. The thing is, they can do so right now - at most, the plan will not improve matters. Given as this is all just guesswork and there is no final draft, I do not know how prevalent this will be. This could be a problem for the workers only if three conditions are met:

- if it happens on a large enough scale and they can not try to "punish" their employers by moving to a competitor who does offer a company-sponsored healthcare plan.
- if a public plan, offered to the people as private individuals, is more expensive than what they pay under an employer-sponsored coverage or can not handle all the customers (depends on what the final bill will be; I think so far the suggestion is that it will at least be competitive so it is a good option for people who are not employed)
- and, finally, if the private companies do not provide better options than those they currently offer.

I think neither of the three is all that likely. The third condition is actually quite important, public plan or no. In the situation you describe, private insurers lose a whole lot of customers, and I think they will not let this happen without a fight. They will offer alternative solutions; not doing so would be cutting their own throat. A public plan will help by offering a reliable competition that the private companies have to beat. In general, I think that the situation will be no worse, and probably better, than what there is now. At the end of the day as long as the final "consumer" - the individual - has an affordable and reliable healthcare plan, whom and how s/he gets it from is secondary.

Also, one other thing: a public option will have to deal with rising costs, but it can have features that limit them significantly. Some increase in cost is unavoidable due to inflation, which - if nothing else - affects hospitals and pharmaceutical companies, and thus will drive the final costs up. The advantage of a public, or at least a non-profit system, is that it does not have to add its own share to the increasing costs - it does not need to turn a profit for its shareholders or to care about the value of its stocks, so it has less motivation to rise prices higher than what it pays for. Also, if it has enough customers - it probably will, especially if Medicare/Medicaid/VA somehow are tied to it - it can enter corporatist negotiations with hospitals and pharma companies to get better prices and conditions than most private companies can. After all, if it can deliver a large enough number of customers to them, cutting some of their own per person profit margin would be worth it.

 

That would be, if that was the case, which it isn't. First, Obama wants to end payments that are paid to insurance companies by the government for Medicare Advantage; essentially which is corporate welfare. Second, since Obama has been in office, he has started his program of cracking down on fraud. For instance, last month the DJ rounded up a bunch here in Houston for Medicare fraud as well as in other areas of the country.

 

This weekend, I heard a very interesting argument from Congressman Anthony Weiner, D-NY.

He argues that the main reason health care reform is so necessary is because the price health insurance companies charge is disproportionate to the service they provide. He argues that the only service health insurance companies provide is take money from one group of people, keep a percentage of the money as profit, and pay out the remaining money to other people. He concedes that this is what all insurance companies do - auto insurance and home owners insurance companies basically do the same thing. However, the profit margins for the health care insurance industry are far greater than any other insurance industry.

One of the reasons this is so is because the health insurance industry is also far less regulated than the auto insurance and home owners insurance industries. And this also makes sense, when you consider that you are required to carry auto insurance if you own a car, and you are required to carry home owners insurance if you own a home. Government regulation is almost inevitable when you are making most people pay for something.

He acknowledges that you can avoid paying for auto and home owners insurance by not owning a car or a house, but that is neither desirable nor practical for a great many people. He further concedes that unlike health insurance, car and home owners insurance are risk-tested (lousy drivers pay more for auto insurance, and owners of more expensive homes pay more for home owners insurance, but everyone on a company medical plan pays the same amount for health insurance). Pretty much everyone pays auto insurance (currently there are more cars registered in the US than there are licensed drivers). The vast majority of people pay homeowners insurance (nearly 3/4 of all people live in homes that are paid off or are currently carrying a mortgage - the other 1/4 rents). In the case of both car and home owners insurance, tighter government regulation and the more people who carry them have actually caused the price per person to go down*, which is why he advocates for tighter government regulation and a personal mandate for everyone to carry at least a basic health care insurance plan.

* Prices have gone down relative to inflation when you look at both home owners and auto insurance for the past 30 years. Or to put it another way, the price increase in the auto insurance and home owners insurance have been lower than inflation, which effectively means it costs you less to insure a car or a home today than it has in the past.

 

Not top split hairs, but you are only required to insure your car if you intend to drive it -- and you are only required to have home owners insurance when there's a lien on your property. That said, the thrust of your argument is dead on, as usual, since most people mortgage their homes and intend to drive their cars.

 

Excellent, article Aldeth!

I've ben lurking for a while, and thought I'd throw my hat in.

I have a STRONG dislike for insurance companies. When you most need them is when you either:

1. Find out you haven't got the coverage you need. They misrepresent what they will cover or don't tell you at all, or hide it in fine print and legalese gobbelygook.

2. Your premiums go through the roof, and they become unaffordable.

3. They drop you entirely.

I've got real life examples for all of these in case anyone's interested.

 

Drew, by extension, does that mean you only need health insurance if you intend to live (or would that be life insurance)?

 

It did before then they removed the death panel provision from the house bill.

 

Weiner did not mention life insurance in his example - probably because it would weaken his argument, as life insurance is (AFAIK) not mandatory for anyone to purchase (just highly advisable if you have dependents).

I was unaware that you were only required to carry home owners insurance if you have a mortgage (probably because I have never been in a situation where I did not have a mortgage on my home). Then again, if your home was paid off and you don't insure it, that would be incredibly stupid, as you can insure the home for a small fraction of the home's value.

And I did know that you only had to carry auto insurance if you intend to drive said car. For example, if you own some classic car from the 1950s for display purposes only, you wouldn't need to carry insurance on it. But like you said, most people actually want to drive their cars.