Health Care reform

[OUstudent4life]

Seeing how the country can barely afford to provide health care for most people right now, and adding the increasing costs of caring for baby boomers...what do you all think should be done?

I just read a decent article:

http://www.slate.com/id/2160834/pagenum/all/

...which outlines a plan I'd like to look into more. I personally don't think the government can just wait for the market to work itself out, because, well, I don't think it will. I'd like to hear opinions, though. It's pretty much established that over the next 20 years, a BUNCH of people (read: elderly) are going to become VERY sick (the leading risk for cancer = age) and be VERY expensive to treat...

[MamaMia]

During the gubernatorial race, there was mention of a state insurance plan that was in place here in Oklahoma. Has anyone here taken advantage of that program, or know much about it? I think its called Insure Oklahoma.

[royalfan5]

There is one surefire plan to fix health care in America. We all need to become Christian Scientists.

[mdklatt]

http://www.slate.com/id/2160834/pagenum/all/



Here are some points in that article for all those who think we can't afford government-funded health care:


Employer-based coverage is a drag on the economy, tethering workers to jobs they would otherwise leave and harming the competitiveness of American manufacturing by adding to the cost of goods.




The Lewin Group, an independent consulting firm, has estimated that Wyden's plan would reduce overall national spending on health care by $1.5 trillion over the next 10 years and that it would save the government money through great administrative efficiency and competition.

[Tulsa_Fireman]

During the gubernatorial race, there was mention of a state insurance plan that was in place here in Oklahoma. Has anyone here taken advantage of that program, or know much about it? I think its called Insure Oklahoma.

Is this what you're talkin' about, Mama?

Insure Oklahoma (http://www.oepic.ok.gov/agent/faq.aspx?x=1#1)

[MamaMia]

Is this what you're talkin' about, Mama?

Insure Oklahoma (http://www.oepic.ok.gov/agent/faq.aspx?x=1#1)
That must be it. Thanks. :)

[BajaOklahoma]

Before you start talking about nation health care, start talking to some of the folks in Canada who "benefit" from the wonderful system. And don't think it will be better here.
There is a reason that they come down here for health care.

[mdklatt]

Before you start talking about nation health care, start talking to some of the folks in Canada who "benefit" from the wonderful system.

Before you start talking about Canada, make sure the plan in question is anything like the Canadian system. This is not nationalized health care, this is transferring the burden away from employers and onto the individual. As far as I can tell, the only government involvment is providing subsidies (funded by revenue generated from elimnating the healthcare expense deduction for employers).

[sooner_born_1960]

Before you start talking about Canada, make sure the plan in question is anything like the Canadian system. This is not nationalized health care, this is transferring the burden away from employers and onto the individual. As far as I can tell, the only government involvment is providing subsidies (funded by revenue generated from elimnating the healthcare expense deduction for employers).
Employers could do that now if they wanted to.
The transferring the burden part.

[LilSooner]

I don't know much about the above, but I do know that in the next year or so that your hospitals are going to be paid in a MUCH different way. Hospitals nation wide are switching to a Paid for Performance scale. Which means if your nurse is a tard and doesn't wash her hands before treating you thus giving you some rare strand of an unknown virus and you are stuck in the hospital for three more months instead of being there three day. That hospital doesn't get paid jack for the care that give.

It's going to do one of two thing either health care professionals are going to get their freaking act together (Northwestern Oklahoma Hospitals I'm looking at you) or were going to get even more ****ious care than normal.

[mdklatt]

Employers could do that now if they wanted to.


And good luck hiring anybody.

[sooner_born_1960]

And good luck hiring anybody.
Are they going to outlaw employer sponsored health care? What's to keep companies from offering it?

[BajaOklahoma]

Sorry mdklatt, I read your comment without reading the article.

[OUstudent4life]

To tell the truth, true "national" health care (single-payer) I don't think would work (for us, at least...it might work well for other people). This plan seems like a reasonable step between two extremes. The problems with the extremes is that you either have:

A) a bunch of people uninsured, some people insured, and some people able to afford whatever they want, and therefore easier access to "high-end" care (tertiary?), i.e. MRI's and the such (and a BUNCH of specialists), or

B) EVERYBODY insured, with (hopefully) a TON of primary-care people, but considerably less access to high-end care.

The way the current US system is (A) doesn't translate overnight into B, nor should it, really, since neither system works perfectly.

[Jerk]

I really don't want to say anything except that if they ever make it to where I can't chose my own Doctor, I will go into Jihad mode, and probably millions of others, too.

I'm sure Hillary will have a brilliant plan for all of us in 2009, which will usher in a new era when socialism actually works, unlike the past, because she is so much smarter than all of us combined.

[mdklatt]

Are they going to outlaw employer sponsored health care? What's to keep companies from offering it?

Why would they even want to? Simply giving somebody an extra $400/month is a whole lot easier than administering a health plan.

[Scott D]

I really don't want to say anything except that if they ever make it to where I can't chose my own Doctor, I will go into Jihad mode, and probably millions of others, too.

I'm sure Hillary will have a brilliant plan for all of us in 2009, which will usher in a new era when socialism actually works, unlike the past, because she is so much smarter than all of us combined.

Jerk, I suggest you read the article.


Under Wyden's plan, employers would no longer provide health coverage, as they have since World War II. Instead, they'd convert the current cost of coverage into additional salary for employees. Individuals would use this money to buy insurance, which they would be required to have. Private insurance plans would compete on features and price but would have to offer benefits at least equivalent to the Blue Cross "standard" option. Signing up for insurance would be as easy as ticking off a box on your tax return. In most cases, insurance premiums would be withheld from paychecks, as they are now.

Nothing about being forced to see an 'assigned' doctor. And in essence by cutting out the middle man process both businesses and the working individual have less of a financial burden on them which leads to less of a financial burden on the country.

[jacru]

Why would they even want to? Simply giving somebody an extra $400/month is a whole lot easier than administering a health plan.
Bingo! and don't tax it.

[Stoop Dawg]

I skimmed the article and I like it, but I'm not so sure you really even have to go that far. I think that simply eliminating group insurance plans might be enough. Leave the rest alone, but disallow group plans and allow individuals to select their own plan - any plan they choose.

But the plan outlined in the article seems pretty solid to me too, as long as individuals get to pick their own plan.

[Vaevictis]

Before you start talking about nation health care, start talking to some of the folks in Canada who "benefit" from the wonderful system.

The problem with the Canadian system isn't that it's nationalized, it's that there is also mandatory equality. It's not everyone having health care that causes the problem, it's the fact that you're not allowed to go outside the system.

In Britain, you have nationalized health care and private health care side by side, and if the nationalized health care does what, when and where you want it to do something, you use that. If it doesn't, you have the option of forking out cash or buying additional insurance to go outside of the system to private doctors.

In short, you can have federally provided health care without having a system like Canada's.

[Stoop Dawg]

In short, you can have federally provided health care without having a system like Canada's.

You can, but why? I think that our current free market system, with just a touch of regulation (I know, it hurts to type that) forbidding group plans, would be fine.

[Vaevictis]

Well, part of the advantage of having a universal system is that such systems tend to place an emphasis on preventing or treating conditions early because it's much cheaper than treating it once the condition becomes acute.

Better to make sure the diabetes is diagnosed and treated before it gets to the point where the guy needs weekly dialysis, a kidney transplant and an amputation, right? (for example)

In theory, it saves money for everyone in the long haul.

(I also know that you might expect insurance companies to go this route, but it seems as if the SOP is often to try to deny coverage and cut people loose whenever they can...)

Ultimately, the way I lean now is that I'd rather see private insurance, a universal singer payer, and tax credits (not deductions!) to buy insurance coverage.

[Stoop Dawg]

(I also know that you might expect insurance companies to go this route, but it seems as if the SOP is often to try to deny coverage and cut people loose whenever they can...)

I have some thoughts on that, but I'll mull it over for a bit first.


Ultimately, the way I lean now is that I'd rather see private insurance, a universal singer payer, and tax credits (not deductions!) to buy insurance coverage.

I'm not sure exactly what that means. Can you explain it further (and perhaps dumb it down a bit) for me?

kthxbye.

[Vaevictis]

Ultimately, the way I lean now is that I'd rather see private insurance,

This one is pretty self-explanatory. Have a more or less free market on insurance coverage.


a universal singer payer

One of the big problems I have right now with the system is how much goddamn money is spent on overhead. I'm pulling figures from my memory now, but I read an article awhile back wherein private industry spends something like 10-20% of their money on administrative tasks like processing claims. Medicare pays something like <3%. There's a lot of cost savings to be had on that. (Note that this has nothing to do with actual *coverage*, but rather who handles the administrative task of determining what's covered and shuffling the money around... Also, I suspect that there are health insurance providers that turn a profit on this inefficiency by stringing out claims. I would like to see that ended.)

Also, if we had a universal single payer gateway, we could define a single automated protocol where doctors could run an automated check to see if their patients are covered, how much coverage, file a claim, get payment electronically, etc, and they wouldn't have to spend so much time or effort sorting out payment. Hopefully, they'd pass some of the savings on to their customers.


and tax credits (not deductions!) to buy insurance coverage.

A deduction's value scales as your income increases. A credit's value is (generally) constant, irrespective of income level. Lower income people will need more additional money to pay for health insurance than higher income people, so I'd like to make sure that the tax instrument used to help deliver coverage isn't one that is weighted towards the higher end of the scale.

[Stoop Dawg]

Also, if we had a universal single payer gateway, we could define a single automated protocol where doctors could run an automated check to see if their patients are covered, how much coverage, file a claim, get payment electronically, etc, and they wouldn't have to spend so much time or effort sorting out payment. Hopefully, they'd pass some of the savings on to their customers.

Hmmm. Good point.

I wonder if we could still have a central claims processing system without a universal single payer. All insurance companies are required to participate in the system. The insurance companies fund the system. All doctors would process all claims through this system. Eventually, it would be silly for an insurance company to refuse to be in the system because no doctors would accept patients on that insurance (too hard to file claims).

[Vaevictis]

I use the two terms interchangeably because from the health care provider's (doctor/hospital) point of view, a central payment clearance house would look like a single payer.

Also, I don't see why the insurance companies funding the system would be necessary or desired. One, it would create a conflict of interest (you tend to side with who foots your bills), and two, I don't see why you couldn't run it like a credit card clearing house that takes a small percentage off the top.

[jeremy885]

One of the big problems I have right now with the system is how much goddamn money is spent on overhead. I'm pulling figures from my memory now, but I read an article awhile back wherein private industry spends something like 10-20% of their money on administrative tasks like processing claims. Medicare pays something like <3%. There's a lot of cost savings to be had on that. (Note that this has nothing to do with actual *coverage*, but rather who handles the administrative task of determining what's covered and shuffling the money around... Also, I suspect that there are health insurance providers that turn a profit on this inefficiency by stringing out claims. I would like to see that ended.)



Are you sure you didn't get that from the movie "Bulworth"? ;)

[Rogue]

I don't know much about the above, but I do know that in the next year or so that your hospitals are going to be paid in a MUCH different way. Hospitals nation wide are switching to a Paid for Performance scale. Which means if your nurse is a tard and doesn't wash her hands before treating you thus giving you some rare strand of an unknown virus and you are stuck in the hospital for three more months instead of being there three day. That hospital doesn't get paid jack for the care that give.

It's going to do one of two thing either health care professionals are going to get their freaking act together (Northwestern Oklahoma Hospitals I'm looking at you) or were going to get even more ****ious care than normal.

T'would be nice in a way, but it won't happen unless a truly independent body does the oversight. As it is groups like "The Joint Commission" and CARF are beholden to hospital groups that fund them. If groups elect to blow off an accrediting body the body loses $$, if one body is more lenient than another guess which one the hospital will hire? Having lived through several accreditation visits, they are very subjective and, in the end, the results are quite negotiable.

Veterans' eligibility for VA healthcare is a sore spot with me. Current OIF and OEF vets are only eligible for 2 years at the VA unless they have a "bona fide" disability. Every day WWII vets and others are turned away and not allowed to enroll for VA healthcare (actually put on a waiting list that never moves due to current legislation) because they made too much money last year or don't have a "bona fide" disability. If I hadn't enrolled when I did, before the rules changed, I wouldn't be able to be seen at the VA now. Veteran's healthcare should be an entitlement. :mad:
One advantage of a system like the VA is that there is a tremendous incentive to provide preventive healthcare - because you will be a VA patient for life. They also do decently at providing mental health care and long term care.

Too many related and, sometimes competing, rich and powerful lobbies will keep the system mostly as it is but with more confusion.

Very few states offer decent non-institutional long term care options because of the powerful nursing home lobby. Very few groups get good deals on drugs because of the powerful pharmaceutical lobby. Note that neither are run by MDs. If doctors ran hospitals, we would probably be better off. MDs are generally caught up in this and the AMA was long ago bought and paid for by the drug co.s.

I really am more of an optimist than this.

[John Kochtoston]

Would Wyden's plan require health insurance companies to provide coverage to employees, or others? One of the big problems right now is that many patients with pre-existing conditions cannot get health insurance at all, or only at exorbitant rates.

Edited to add "many" before "patients"

[sooneron]

I really don't want to say anything except that if they ever make it to where I can't chose my own Doctor, I will go into Jihad mode, and probably millions of others, too.

I'm sure Hillary will have a brilliant plan for all of us in 2009, which will usher in a new era when socialism actually works, unlike the past, because she is so much smarter than all of us combined.
You can chose whatever doctor you want now? We have a good plan and we are still forced with a list of doctors.

[OUstudent4life]

Part of the problem we're fighting is actually pointed out by the movie Sicko (though he's not my favorite person in the world...)

We can complain all we want about how bad health care is (HMO's, Big Pharma) but if those companies weren't doing their absolute best to earn a profit for their shareholders in whatever way they can within the law, they'd be breaking the law.

That problem will have to change if we ever want to save money. I'm not sure how, though.

[SCOUT]

Would Wyden's plan require health insurance companies to provide coverage to employees, or others? One of the big problems right now is that many patients with pre-existing conditions cannot get health insurance at all, or only at exorbitant rates.

Edited to add "many" before "patients"
Actually, under HIPAA you have continuity of coverage unless you pretty much make a concious effort not to.

The government has not done anything efficient ouside of the military in its entire existince. The less involved it is in health care, the better off we will all be.

The single portal comment earlier is similar to so many in the past. Take our tax code for example. The idea was that people would pay a certain percentage, based on their level of income, in federal taxes. Man, that is a simple plan. Any guesses as to what our tax code comes to in number of pages?

About 44,000 pages....

The government is not good at efficiency. Please keep that in mind when you are deciding whether or not they should be responsible for your health.

[Scott D]

personally I think we should do away with healthcare, and just let everyone die when they get sick. It would be far more efficient.

[SCOUT]

personally I think we should do away with healthcare, and just let everyone die when they get sick. It would be far more efficient.

That sounds very similar to a modest proposal I heard once before :)

[olevetonahill]

Seeing how the country can barely afford to provide health care for most people right now, and adding the increasing costs of caring for baby boomers...what do you all think should be done?

I just read a decent article:

http://www.slate.com/id/2160834/pagenum/all/

...which outlines a plan I'd like to look into more. I personally don't think the government can just wait for the market to work itself out, because, well, I don't think it will. I'd like to hear opinions, though. It's pretty much established that over the next 20 years, a BUNCH of people (read: elderly) are going to become VERY sick (the leading risk for cancer = age) and be VERY expensive to treat...
How in Hell does anyone think its The "countrys " place to provide any Health Ins, for anyone ?:eek: :mad:

[Blue]

We'll take care of you until you're about 85. After that, you're on your own. Quit living so long, damnit.

[Vaevictis]

Part of the problem we're fighting is actually pointed out by the movie Sicko (though he's not my favorite person in the world...)

We can complain all we want about how bad health care is (HMO's, Big Pharma) but if those companies weren't doing their absolute best to earn a profit for their shareholders in whatever way they can within the law, they'd be breaking the law.

That problem will have to change if we ever want to save money. I'm not sure how, though.

I don't think that that is quite right. AFAIK, there isn't any law requiring corporations to maximize profits using any legal means; the law, however, does require the board and officers to execute in a way that is faithful to the corporate charter and other lawful directives from shareholders. Shareholders could, if they desired, require the directors and officers to execute in a way that maximizes profits in so far as the activities they pursue are socially responsible.

The notion that for-profit businesses must exist only to turn a profit is garbage, a myth perpetuated by the greedy in order to justify the increasingly sleazy means by which they seek to turn a profit. Businesses exist for whatever reason the shareholders desire. Usually this includes turning a profit, but it is not necessary that it be limited to that.

It's not that the law is requiring businesses to maximize profits at all costs, it's that the shareholders are.

[OUstudent4life]

Fair enough. And olvet, I agree with you. I don't think the government should provide health care for everyone...they would stink at it. Case in point = the VA.

The government should do their best to assure everyone has easy access to health care, but it should still be through private business. That's why its so freakin' complicated, in my mind.

Another problem (outlined somewhere else) = there are a billion interest groups out there that want to "fix" health care, and they're all pretty powerfull. However, they all have a very specific agenda, and if they don't get their specific plan passed, they're happy with the status quo. Which is too bad, because the status quo doesn't seem to be working.

[Harry Beanbag]

personally I think we should do away with healthcare, and just let everyone die when they get sick. It would be far more efficient.


I would keep healthcare, but stop treating people who don't have insurance. That would probably be a pretty effective way to deal with illegal immigration as well as some other problems we have. ;)

[OUstudent4life]

I would keep healthcare, but stop treating people who don't have insurance. That would probably be a pretty effective way to deal with illegal immigration as well as some other problems we have. ;)

...like a bunch of (~17%, or ~150,000) of those pesky kids in Oklahoma.

;)

In all honesty, though, that's better than it used to be

[Suerreal]

Single payor/provider plans do not work without some kind of escape valve.

Britain's NHS has private insurance and private paying patients to get care that the NHS cannot provide in a timely manner.

Canada didn't like the two-tier system Britain has, and outlawed private pay. So patients who can afford it come to the US rather than wait over a year for their hip replacement.

The US military health system used to be socialized(single payor/provider) medicine. Inpatients waited a week for CAT scans and MRIs in the 1980s at Walter Reed. Eventually, they decided it was cheaper in the long run to use civilian doctors and facilities through CHAMPUS and TRICARE than to provide care themselves in many situations.

Someone mentioned Pay For Performance (P4P) as a good thing. In theory, yes, it is good to reward docs and facilities that do well. But it assumes that outcomes are due solely to the attention and effort of the doctor/hospital.

Example:
Heart patients and people with diabetes should keep their LDL (bad) cholesterol at or below 100 (some should keep it below 70). The doctor can measure the LDL, counsel the patient about needing to keep it low, refer them to a nutritionist and prescribe meds to get it down, and advises the patient to return in 3-6 months to recheck it. If the patient doesn't change their eating habits, see the nutritionist, fill the prescription, or return for the recheck, should the doctor really be paid less when the LDL doesn't meet the target? If a patient started with an LDL cholesterol of 367 and can only tolerate low doses of meds and works very hard at diet and gets it down to 154, the doc still stands to get paid less.

The law of unintended consequences means that patients who are difficult to treat or don't follow treatment recommendations will have a very hard time finding a doctor willing to treat them if doctors are paid based on results. The very patients most in need of health care will have a difficult time getting it.

[Rogue]

Good points Surreal. Especially about the difficulty of pay-for-performance.

Measuring things like that lead inevitably to great looking health (if not entirely accurate) records and 15 minute appointments with only 3 minutes of eye contact between doctor and patient. VA is trying this now and seeing the mixed bag of results.

I don't think that Champus and Tricare were improvements in any way. In the 1980s, funding for DoD and VA healthcare were gutted. Basically DoD healthcare is run by a skeleton crew now. When I try to find providers to refer active duty troops and families to I always find several that are on the approved provider lists but conveniently aren't taking new patients. :mad:

Compare almost any healthcare system to the VA right now in terms of costs, performance, and yes even efficiency and VA is leading in most of those categories. I'm not saying the model would work universally, but it is waaay better than any state system out there and better in most ways, excepting profit and making Big Pharm rich, than 75% of the private systems. All while training more students, residents, and researchers than the others. Something about it works. I'm an eligible vet with BC/BS insurance. I choose to go to the VA over any of our "Appalachian Emergency Room" or docinabox places in this area and when I lived in TX too. Now, for big surgeries and such, maybe I'll join wifey and choose someplace like Cleveland Clinic.

I'm convinced that even if a baseline level of healthcare were available to everyone, the amount of "elective" medicine, procedures, and alternatives available would still keep the profit mill turning.

[Stoop Dawg]

We can complain all we want about how bad health care is (HMO's, Big Pharma) but if those companies weren't doing their absolute best to earn a profit for their shareholders in whatever way they can within the law, they'd be breaking the law.

That problem will have to change if we ever want to save money. I'm not sure how, though.

IMO, the problem is that there are too few health insurance companies. I think that group plans are mostly responsible for this.

If health insurance companies are soooo profitable, why isn't everyone scrambling to start a new health insurance company? Barriers to entry. The big boys have large employers locked in. With so many people on their plan, they dictate pricing to the health care providers. So they get treatment on the cheap from providers and a captive audience by wooing large employers.

Say I wanted to start my own health insurance company. I don't have any customers, so I can't dictate lower rates for treatment. I can't get lower rates for treatments so I can't offer lower premiums. Not only that, but there's no way I touch a GM employee (for example) who is getting their insurance paid by their employeer - as long as they use the employer's insurance company. It's a catch-22.

I think that health care providers should have to offer the same rate to everyone. They can charge whatever they want, but it has to be the same for everyone (regardless of insurance company, or even lack of insurance). I also think that we should eliminate group plans and make it a truely competative market place. Insurance companies should have to compete for every single customer.

[OUstudent4life]

Another chime in, another problem...

We do need a truly competitive marketplace, and we need everyone to be covered with a basic plan, because that's the only way preventative medicine will ever be offered on a wide scale. Right now it makes little to no sense for large group plans to offer preventative medicine services, because the average length of a contract with a health care provider (insurance) is around 3 years (if I remember correctly from my wife's rants following her MPH classes). Companies don't want to offer preventative medicine, 'cause they don't want to help out the NEXT guy who's getting the contract.

And the main problem with the VA is the variability. The VA in Oklahoma pretty much stinks, from my perspective. When it takes 3 days to get a vet some Ensure, really to the point that a resident was about gave my wife some cash to go to Walgreens to buy it herself...there's something wrong there. The VA in some states is WAY better than in others. Same with the Indian Health Service (don't get me started :mad:). The VA has the potential to be great, but can come up pretty short.