Thoughts on Health Care and the Obama Presidency

[Time for change]

Any meaningful discussion of health care (or any other policy issue) should begin with a discussion of goals. If people have different goals in mind for a program, then there is no chance that they will agree on the details of how the program should be designed. But if they can come to a consensus (or near consensus) on goals, then there is a good chance that they can agree on the rest.

With respect to the goals of a national health care plan for the United States, I believe that there is a wide consensus among DUers (and most other Americans as well): The main goal should be to ensure that every American has the opportunity for good quality affordable health care. There are other important goals, of course – such as reasonable cost. And one could argue about the meaning of “affordable” and “good quality”. But in broad outline, I think that most of us agree on the goal that I stated here.

One could also rightly say that a more important goal is that all Americans have good health, rather than health care. There is an important difference between the two, since good health depends on a lot of things other than health care. However, that’s a tremendously more complex subject, and beyond the scope of this post.


The major problem with our current health care system

If we agree on the goal, then the major problem with our current health care system is that there are many millions of Americans who do not have the opportunity for (or access to) good health care. We have about 47 million Americans without health insurance. And a great many of the rest of us have inadequate health care insurance.

The problem with private for-profit medical insurance
There are many reasons for woefully inadequate health insurance coverage of the American people, but one stands out above all others: Many of us lack the financial means to purchase adequate (or any) health insurance. Health insurance is inordinately expensive, and the private corporations that sell health insurance to us mean to keep it that way because they profit from doing so. The health care plan that the Obama-Biden team offered during their presidential campaign made this point very well:

It is not right that Americans families are paying skyrocketing premiums while drug and insurance industries are enjoying record profits…. The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. In recent years, for-profit companies have bought up not-for-profit insurers… Premiums have skyrocketed… Insurance administrative overhead has been the fastest-growing component of health spending… And while health care costs continue to rise for families, CEOs of these insurance companies have received multi-million dollar bonuses.

That pretty well sums it up. Compared with government provided health insurance, private health insurance is inherently wasteful and unfair. It is wasteful because an excessive amount of money spent on private health insurance goes into profit and excessive administrative costs. The administrative costs are excessively high because so much of them are used to ensure a high profit, through such means as lobbying Congress and pre-screening patients for illness or risk factors so that the insurance company can avoid offering health insurance at a reasonable price to those who most need it.

Private health insurance is often unfair because of the great imbalance in knowledge and power between the insurance companies and the American public. Those imbalances enable the insurance companies to deny insurance claims almost at whim, regardless of the terms of the insurance contract, in the hope that the insured person will not notice when s/he is getting screwed.

My personal experiences with the medical insurance industry
I’ve had several unpleasant encounters with medical insurance companies, as have so many other Americans. I’ll just mention two here, in which I took my children to medical providers who were not pre-approved by my insurance company, for emergency medical conditions. The terms of my insurance contract said that the insurance company must pay for medical visits that are not pre-approved only in cases of medical emergency.

On one of those occasions I took my son to the emergency room for a severe headache, which was diagnosed as a migraine headache. A migraine headache is an emergency medical condition because it is one of the most painful experiences known to medical science. On the other occasion I took my daughter to the emergency room because of symptoms of appendicitis. Appendicitis is an emergency medical condition because if an inflamed appendix bursts it can lead to a fatal infection, and the probability of a fatal outcome increases with the length of delay between the burst appendix and the onset of surgical and medical treatment. It turned out that my daughter did not have appendicitis on that occasion. But her symptoms were identical to those of appendicitis (which sometimes happens with children), and there was no way to know if she had appendicitis without getting laboratory tests.

On both of these occasions my insurance company denied my medical claims because the medical provider was not pre-approved by them, and because the insurance company claimed that the conditions for which I took my children to the emergency room were not medical emergencies.

But as a physician I knew for a fact that they were medical emergencies. So on both occasions I wrote my insurance company a nasty letter that explained why the condition for which I took my son and daughter to the emergency room was a medical emergency, told them that they were committing fraud by denying that obvious fact, and threatened to sue them. They quickly paid the claims. But most people would not have known the difference, and would have accepted the claim denial. This kind of stuff happens all the time in the United States, in the quest to increase profits. In fact, many insurance companies act this way routinely, as a matter of policy.


How the Obama-Biden health care plan proposed to address the problem

The health care plan that Barack Obama campaigned on during both the Democratic primaries and the general election promised to address these and many other important issues. There are many good aspects to that plan. The one that most gets to the heart of the problem, to achieve the goal stated at the beginning of this post is this:

The Obama-Biden plan will create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, ANY American will have the opportunity to enroll in the new PUBLIC plan or an approved private plan, and income-based sliding scale tax credits will be provided for people and families who need it.

The bottom line is that, through this plan, ALL Americans would have the option of obtaining public health insurance that would ensure affordable medical care.


Criticisms of the Obama-Biden health care plan from the left

There have been some criticisms of the Obama-Biden health care plan from the left (There are also vehement criticisms from the right, but they’re hardly worth mentioning. I’ll touch on them later in this post). I will discuss them here because I think that their importance is over-emphasized. I agree that addressing those criticisms would make the plan better. But even without doing so, the plan should go quite far towards accomplishing the goal of providing affordable health insurance for all Americans:

Criticism: The plan doesn’t completely remove private health insurance
Some people vehemently criticize the plan because it doesn’t completely remove private health insurance companies from the picture. Rather, it gives us the option of choosing the public plan or a private insurance company plan.

In my view, the most important point is that we all have the option. For reasons discussed above, the public plan will undoubtedly be far better for the American people than any private insurance plan. The government doesn’t have to waste our money on providing for corporate profits, lobbying, or screening to remove high risk people from eligibility. The money that would be saved would go into providing higher quality and full health care coverage. In short, there is no way for private insurance companies to successfully compete with Medicare-like publicly provided health insurance.

So, why would anyone choose private health insurance over public insurance? Undoubtedly, there will be some people who make that choice. People might choose private insurance because they’re ideologically hostile to government programs, or simply because they like the coverage that they currently have. No big deal. That will be money out of the pockets of those who make that choice, and they’ll either learn from their bad experiences or they won’t, or they’ll get lucky and not have to suffer any consequences.

Criticism: It will set up a two tiered health care system
Some people are against the Obama-Biden health care plan for the same reason that they are against school vouchers and other plans that take money out of the public school system.

But what we are talking about is health insurance, not health care. As noted above, there is no reason for the public plan to be inferior to private insurance, and every reason to believe that it will be superior. The principle is the same as the principle that Medicare runs on. People don’t receive inferior health care just because Medicare pays their medical bills.

Criticism: The plan is voluntary (for adults) rather than mandatory, and therefore will leave some people uncovered
That is a legitimate criticism. In the absence of mandatory coverage there will always be some people who will choose not to purchase health insurance even though they can afford it. Under the community rating rule they could then purchase health insurance if they get sick, thus driving up the cost of health care and making it more expensive for everyone else. Or, they would receive health care in emergency rooms at taxpayer expense, which would also drive up health care costs for everyone else. Thus, the rationale for mandatory coverage is based on an economic argument. Without it, some people will game the system, thus increasing costs for everyone. Mandatory health insurance coverage is analogous to the principle of mandatory taxes.

In other words, the lack of mandatory coverage in the Obama-Biden plan increases the overall cost of the plan – but at least it provides coverage for all children, as well as for all adults who choose it. And that comes pretty close to the goal that I discussed at the beginning of this post.

During the primaries, Paul Krugman singled out this lack of mandatory coverage as the primary problem with the Obama plan, compared to the Edwards plan:

Although Mr. Obama says he has a plan for universal health care, he actually doesn’t, a point Mr. Edwards made in last night’s debate. The Obama plan doesn’t mandate insurance for adults. So some people would take their chances and then end up receiving treatment at other people’s expense when they ended up in emergency rooms. On the whole, the Obama plan is better than I feared but not as comprehensive as I would have liked. It doesn’t quell my worries that Mr. Obama’s dislike of bitter and partisan politics makes him too cautious. But at least he’s come out with a plan.

What is the status of the Obama-Biden national health care plan now?

For the reasons I discussed above, I would be satisfied if President Obama comes forward with a health care plan that is substantially similar or identical to the one that he campaigned on (though it is somewhat inferior to the plans put forward by Kucinich, Edwards, and Clinton). However, some of his recent actions have caused some people to worry that he may be about to backtrack on his health care-related campaign promises:

Right wing Republican Senators complain to President Obama about his health care plan
On March 4th, President Obama met with a group of right wing Republicans (There are few other kinds of Republicans these days), including Mitch McConnell, Orin Hatch, Charles Grassley, Mike Enzi, and Judd Greg, to go over a letter written by Mitch McConnell on the subject. The Republicans were very much against Obama’s health care plan. McConnell’s letter stated:

Forcing free market plans to compete with these government-run programs would create an un-level playing field and inevitably doom true competition. Ultimately, we would be left with a single government-run program controlling all of the market. This would take health care decisions out of doctors and patients and place them in the hands of another Washington bureaucracy.

Well, they’re right about the first part of that statement. This is the same issue I discussed earlier in this OP. Of course it would create an un-level playing field. How can private for-profit health insurance plans hope to compete with a government insurance plan that is used, not to make profits, but to make health care accessible to the American people? They can’t. So, the Republicans are correct – Ultimately we would be left with a single government-run health plan. That’s the whole point.

But the idea that it would take health care decisions out of doctors’ and patients’ hands is pure bunk. In fact, it is so disingenuous that it can best be characterized as a lie. Again, we are talking about health insurance, not health care. All American citizens would be perfectly free to retain the same physician that they originally had. And they would have more choices, not less, because their health care insurance coverage would be greater.

Obama’s response to the right wing Republicans
Here was the President’s response to the Republican Senators:

Okay. Well, let me just – I'm not going to respond definitively. The thinking on the public option has been that it gives consumers more choices, and it helps give – keep the private sector honest, because there's some competition out there. That's been the thinking.

I recognize, though, the fear that if a public option is run through Washington, and there are incentives to try to tamp down costs and – or at least what shows up on the books, and you've got the ability in Washington, apparently, to print money – that private insurance plans might end up feeling overwhelmed. So I recognize that there's that concern. I think it's a serious one and a real one. And we'll make sure that it gets addressed, partly because I assume it will be very – be very hard to come out of committee unless we're thinking about it a little bit. And so we want to make sure that that's something that we pay attention to.

What on earth did he mean by that? In the first paragraph he defended his original plan. And then in the second paragraph, in the interest of “bipartisanship”, in one of the most incoherent statements I’ve ever heard him make, he tells the Republican senators that he understands their point of view.

The “serious and real concern” that he says “we’ll make sure that it gets addressed” is that his plan will destroy private insurance companies. It is disturbing to me and many others who care deeply about universal health coverage that Obama would be concerned about and determined to “address” the possibility that private for-profit health insurance companies may have to bite the dust because of their inferior product. Why should they be allowed to continue to make a profit off of the illnesses and dying of the American people, when a better solution is at hand? Why should he care more about them than us? And it doesn’t help any that Mitch McConnell approved of the “bipartisan” health care talks. `


Conclusion

I do not know how President Obama plans to handle this, or even if he has decided yet. How “seriously” does he intend to take the worry of the Republican senators that his plan will ultimately destroy private for-profit health insurance in our country if he carries through with his campaign pledge to offer the American people a better deal?

As I see it, he has two choices. He can carry through with his campaign promises to offer the American people a national health care plan that will make quality health care affordable for tens of millions more Americans. Or he can accede to the desires of the private for-profit insurance industry and the political hacks who support them, who have been screwing the American people for so long.

If he chooses the latter course it will rip the heart out of the health care plan on which he ran his presidential campaign. Making health care available to the American people by providing no options other than private insurance companies is analogous to trying to dig us out of a severe recession by pouring hundreds of billions of dollars into failing and mismanaged banks rather than providing it directly to those people who most need it.

We should let the Obama administration know what we think of that idea.

[lsewpershad]

1. SINGLE PAYER

Insurance companies and Pharma care only about their bottom line even if it means no health care for millions.

[ayeshahaqqiqa]

2. Well put, Doctor

I work in an MD's office and handle--guess what--insurance. I get sick of insurance companies practicing medicine. One company denied payment for a TSH test (that's for thyroid) because one had already been run that year and was "within normal range". Well, the patient in question was still exhibiting all the signs of classic hypothyroidism (including lack of reflex response in the ankle area), and my boss had treated her for it--and wanted to make sure the treatment was enough and not too much. And I could tell you numerous horror stories where insurance plans won't pay for prescription drugs because they have decided a different drug would be better--even though their drug would interact negatively with another drug being taken by the patient.

I don't have health insurance, and will only get it if I can be assured it will be easy to file claims and that said insurance agency will NOT practice medicine without a license.

[HysteryDiagnosis]

3. I understand thyroid tests that indicate everything is ok can be

totally not ok.

[paulsby]

18. while i am definitely not happy with the current system overall

i have to give props where props are due and say that my
insurance company is very very good.

in almost every way, i am very satisfied.

[Emit]

25. "Best practices"

We need to take the 'best practices' from the current system and apply them. Finding out why something is working well is often as important as discussing what is not working well.

I can guarantee you that Obama's people are being made to discuss 'best practices' as much as they are being asked what the main problems are. The reason I know is that I have participate in one of his staff's (Ntl Field) groups and this was the norm. He also did that recently -- I can't recall on what topic/forum - maybe the governors' meetings? (Rush has a field day slamming him for having breakout groups)

Anyway, good on your ins company.

[paulsby]

26. they certainly charge enough for it

but my employer pays 100% of my health insurance.

so, from MY angle they rock!

:)

[ayeshahaqqiqa]

46. Do you know what Obama means by "Preventive Medicine"?

I ask because from the local forum we had, it seemed from the questionnaire that he means just getting yearly checkups and stuff like mammograms. These are monitoring procedures. Preventive medicine means finding out the diet that is right for you, the exercise program that is right for you, and the supplementation program that is right for you. By "diet" I don't mean a weight loss program you go on for a little while and then revert to your former way of eating. By "diet" I mean the eating program you should stay on the rest of your life. Please note, too, the stress is upon individualization. Each person has different factors that determine what they need to eat and what they need to avoid. For example, I have hypothyroidism, a history of diabetes/hypoglycemia in my family, and have O- blood. All those factors helped my doctor come up with a diet that I can live on the rest of my life--and this diet will help me stay healthy.

[unapatriciated]

36. most are satisfied with their insurance company....

until you are hit with a catastrophic illness. I had top coverage when my son became ill in 1990 with a rare autoimmune disorder. I was constantly fighting with them over what was and what wasn't covered. They were always second guessing the doctors at Children's Hospital and delaying treatment. I like the poster knew how to answer the denial letters (I worked for an Insurance Broker and knew how to read a policy) but they still managed to delay payments that were covered under my policy, ruining my credit and costing me my home.

[Time for change]

43. That must be very frustrating, to witness those horror stories so frequently

That's one big reason why we need universal health insurance.

[lumberjack_jeff]

4. THE goal is access to good care provided as cost-efficiently as possible.

This goal can be met piecemeal, via several milestones, but the next step must include, at a minimum, the ability for the public to opt into a public insurance pool, administered aggressively to maximize benefit while minimizing costs. The profitability of the private insurance which competes with it should not be a consideration.

[Orwellian_Ghost]

5. One way to assess Obama's plan

is to look at how the "health" care industry insiders view it. They are in fact quite pleased with this plan and that should send up a red flag to anyone who supports health care that serves people rather than Big Pharma et al.

[Time for change]

6. Which plan are you talking about?

The health insurance industry is very upset about the plan that Obama campaigned on. That's what the meeting I described between Obama and the Republican Senators in this OP was all about. They believe that it would destroy private health insurance.

[Orwellian_Ghost]

8. The one we're getting n/t

[Time for change]

10. How do you know which one we're getting?

Obama apparently hasn't decided yet.

Anyhow, if you supplied a link or two to support your point it would be a lot easier to discuss.

[Emit]

7. People might choose private health insurance over public insurance if

public insurance did not offer all the coverage they wanted, for example, if the public insurance offered only the basics.

Aside from that, I'm still reading - just thought I'd respond to your question.

[Time for change]

9. Yes, that's true, but since public health insurance is so much more efficient than

private health insurance (for the reasons I mentioned in the OP), and since they don't have to worry about making a profit, it seems highly unlikely that private health insurance would offer benefits that public health insurance wouldn't.

[Emit]

11. Well, for example

If with public health insurance, which might cover just basic health and routine services, does not allow for certain costly expenses, like elective surgeries, cancer treatments, or organ transplants but private insurance, that may cost more, does. Those who are able to afford it might opt for the costlier health insurance and decline public health insurance.

Depends on what services are covered and allowed for under the public health insurance system - my guess is that they would have to deny/leave out some of the services due to cost and/or whether those services/treatments are experimental, for example.

BTW, I am in deep discussions with someone in my area who is heavily involved in proposing a plan to Obama admin. He would argue that private is always more efficient than public and it is through private, for profit that truly good service can be provided, as there is incentive that is lost with public services. He uses me as his guinea pig, since I have a very different view about the whole matter. But I do see his point, having worked in both private and public service sectors in the mental health field.

[Time for change]

13. Has he commented on why Medicare has been so popular?

[Emit]

14. Popular in what sense? That a lot of retired and/or disabled people have it and use it because

it's available to them because they paid into the system?

I'm not sure I follow.

What he and I have discussed is how many docs are refusing to take Medicare patients now because of the hoops they have to jump through to get certain procedures paid (i.e., if you mis-code the diagnosis, Medicare refuses to pay, etc.) and the low reimbursement rates that docs get.

On more than one occasion, it took my mother and I numerous phone calls to find specific types of docs in her area who would take Medicare. On the other hand, the ER is quick to take her with no questions asked, so there is benefit to that. Edited to add, however, the extent of her care is always dictated by what Medicare will pay for, and in some cases (with my elderly mom, dad and grandma), their care was cut short because Medicare wouldn't pay, which in my Dad's case, nearly cost him his life.

[Time for change]

16. Have you had better experiences with private health insurance companies?

[Emit]

20. No, quite the contrary - my insurance has not covered many of my family's med expenses

over the last few years. In two years, we have had to pay out of pocket costs that exceed 10K. For two years in a row, we met the tax criteria for being able to claim medical expenses. Our premiums have increased over the years, I have had many problems similar to the ones you expressed in your OP in trying to get things covered, being told something wasn't covered for a variety of reasons, and not getting important medications covered because they are not in our ins's formulary (another common problem with Medicare, btw).

It's not an argument of which is better. There are problems inherent in both. The whole systems is messed up, imho.

edit typo

[ayeshahaqqiqa]

47. Another reason doctors don't accept Medicare

is that Medicare does not cover certain types of therapy. If a doctor takes on a Medicare patient, it opens up ALL his records to Medicare review and if they find him using a therapy they do not accept,they can prosecute him for using it, even if it is for a non-Medicare patient. (I'm thinking chelation therapy here; apparently only Medicare considers this a non-therapy, and has prosecuted doctors for malpractice who have used it.) Anyway, the thought that Medicare can come and investigate EVERY patient and check EVERY chart and demanding EVERYTHING be done according to THEIR rules has a chilling effect for some MDs.

[Emit]

42. I'm not sure that the 'reasons you mentioned in the OP' prove that public health insurance is so

much more efficient.

I went back to re-read through your posts, and your comparisons mostly relate to why private is so costly, but never really detail what makes Medicare more efficient.

In that regard, your link references mostly administrative fees:

"Public health insurance programs have administrative costs nearly 10 percent below those of most private insurance policies, according to the Department of Health and Human Services."

But, what is missing in this discussion is what problems we face with Medicare.

For example, if I am reading the following correctly, what this is saying is, in the worst case scenario, by 2050, Medicaid and Medicare combined will consume all of the Federal taxes that government collects:

Projections of Medicare and Medicaid Costs

Long-term projections of Medicare and Medicaid spending are subject to considerable uncertainty from a variety of sources. However, the dominant source of uncertainty is the future rate of growth of Medicare and Medicaid spending per enrollee relative to the growth of per capita GDP. For this report, CBO presents projections under three scenarios:

* Spending per enrollee grows 2.5 percent faster than per capita GDP;

* Spending per enrollee grows 1 percent faster than per capita GDP; and

* Spending per enrollee grows at the same rate as per capita GDP.(2)

The three scenarios represent vastly different assumptions about the future path of Medicare and Medicaid spending.

~snip~

The high-cost scenario, in which the assumed rate of excess cost growth of 2.5 percent is slightly lower than the long-term historical average, results in future costs that are seemingly unsustainable. Federal costs for Medicare and Medicaid as a percentage of GDP would double to 7.8 percent in 2020, hit 15.1 percent in 2038, and reach 21.3 percent in 2050. To put those estimates in perspective, the entire federal budget currently consumes 20 percent of GDP.

http://www.cbo.gov/doc.cfm?index=4916&type=0&sequence=4

[Time for change]

45. The costs that private health insurance companies face that a government health insurance doesn't

include the required profits (including huge CEO salaries and bonuses), lobbying Congress, advertising, and screening patients to idnentify their risks so that those who are high risk can be either excluded entirely or be charged much higher amounts.

You mention the rising costs of health care. But that is something that applies equally to public and private health insurance companies, so I don't understand what your point in mentioning that is.

Anyhow, we don't know what future medical costs will be, and government can do certain things to control those costs. One prominent one is offering preventive care, which can reduce future costs substantially. Private health insurance companies rarely do that because there is no profit in it, since the costs saved through improving the health of their clientele are likely to be switched to other insurance companies, since people don't generally stay with the same insurance company long enough to make preventive care profitable for them.

[steelmania75]

12. Well this could've been easier, but thanks to Evan Byah, and other so-called moderates it's going to

be a long haul

[Laelth]

15. I don't need health insurance. I need health care.

Obama campaigned on mandatory insurance (iirc), and I don't want that. It failed in Massachusetts, and there's little reason to believe it will work on a larger scale. If Obama has to take baby steps to get to single-payer, so be it, but I continue to believe that's where he's heading, and that's certainly where I want to go.

:dem:

-Laelth

[Time for change]

17. Single payer health care doesn't necessarily mean that the government provides care directly

rather than doing it through paying others to provide the care. For example, Medicare is considered single payer health care for the elderly, though it is actually an insurance plan.

I too would prefer a plan where the government provided care directly to people. But that kind of plan has never been on the table. Even Kucinich never proposed that:
http://www.bestsyndication.com/?q=120407_universal_health_care_insurance_single_payer_differences_what_are_comparison.htm

[ayeshahaqqiqa]

48. Oh yeah!

I couldn't agree with you more--I don't want to be forced to pay for insurance that won't cover my health care. And health care should include health education. Obama's concept of "preventive medicine" appears to be annual checkups and the like. That isn't preventive medicine. Preventive medicine is going to an MD and determining what foods you should and shouldn't eat for the rest of your life. Preventive medicine is determining what exercise program is going to be most effective for you to maintain health over the years. Preventive medicine is finding out what supplements may help you maintain your health so that you are less likely to have to use prescription medicine.

[dflprincess]

19. Yesterday Obama indicated he would support a public option

only for those who couldn't get private insurance (see this thread:
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x5344343 )

He appears to be setting up the public option to fail. If only those who can't get private coverate (mainly those with preexisting contions) are covered by the public plan, it will cost too much. To succeed a single payer system needs a broad cross section of the public (especially a lot of healthy people in their late teens and twenties).

If he sets it up so only chronically ill people are on the public plan he and his buddies in the insurance companies will be able to point to it and claim it doesn't work.

Face it, Obama doesn't care anymore about our having access to health care than the average insurance company executive does.

[bvar22]

21. Thats the way I read it too.

Set up to fail.

[ayeshahaqqiqa]

49. That's what I fear

No wonder the insurance companies applaud his actions! He will take away the "drags" on their profits. Why will laws have to be enacted forcing insurance companies to take on folks with "pre-existing conditions"? They can just go on the government insurance. And the insurance companies can gleefully deny coverage to anyone they want. They will continue to practice medicine without a license, denying clients' prescriptions not to lower costs but because they have a sweetheart deal with one Big Pharma company and not another. Doesn't matter to them that their drug choice will interact negatively with other scrips the patient is taking--its their way or the patient pays in full for the meds. Usually what happens is that the patient doesn't take any medicine at all, to the detriment of their health!

[Time for change]

51. That would be very disappointing

And it would be inconsistent with what he promised during the presidential campaign.

[many a good man]

22. How can private insurers possibly lower costs enough to compete with Medicare?

There is one way: take the profit out of it. You can allow them to exist but make them cover all people. The key is to put ALL the people into one big insurance pool.

Private insurers can then divide up that pool among themselves. The government mandates a basic plan with a standard formulary that all must adhere to. People with preexisting conditions cannot be denied. The government will negotiate costs with providers and tell the private insurers how much they are allowed to charge in premiums. The insurers are guaranteed a small profit, much like we used to do with public utilities.

Insurers can boost profits some by encouraging preventative care and healthy lifestyles. They can also offer gap policies that go above and beyond the standard formulary.

I, too, think single payer is the best approach, but this plan or a variant thereof would have a better chance of being realized.

[Emit]

23. The folks I've been discussing health care with agree with you, and some have suggested similar plan

like a tiered system, that offers, for a fee, folks to up their policy for more coverage.

It's been interesting talking to people about health care vs insurance, and whether taking the profit out of it is the answer. Even in your example, you offer profit by allowing the insurers to boost profit through incentives and gap policies - most of the folks I'm talking to have very similar ideas, but realize that a compromise needs to be met, and that large segments of the insurance and medical field may experience lay-offs, or loss of profits. It's not going to be a win-win-win situation. Someone's going to lose along the way, but from my perspective the vast majority of folks who have no medical coverage are the ones losing right now and have been for far too long.

Also, some of the concerns from folks I've talked to relate to, for example, if we take the profit out of the system, will we continue to have good docs and good medicine? - Medicine has made significant gains due to the fact that it is profit driven. Without incentive to 'win' ($$), will there be such competition to fund research for the next hopeful drug, for example?

[many a good man]

24. Layoffs in the medical field?

How is that? In all probability it will increase the number of health care workers because you can expect 50 million more patients. Expect more GPs and specialist costs start to be contained.

Insurance workers will be reduced, but not too badly I would imagine. Fewer claims adjusters and salesman, but they'll still exist.

[Emit]

40. Depends on what system is implemented and I imagine, whatever is implemented will be driven by

attempting to keep costs affordable. If, for example, streamlining the record keeping system is implemented, many workers in the medical field who file, record, transcribe, etc. may suffer layoffs. Likewise, if eligibility intake Social Workers in private sector hospitals or clinics, for example, are no longer required because we've streamlined the eligibility process efficiently, they will be displaced. While adding patients might increase the numbers of some health care professionals (and I was actually referring to workers in the health/medical care to include clerical, administrative, etc. rolls as opposed to a lot of the professional roles), many positions might be carved out in whatever system evolves or is set up. Also, if costs are capped, then wages may be reduced, thereby creating a shortage of certain medical professionals, like nurses, technicians and even doctors, potentially.

[Time for change]

30. I think that the important thing is to take the profit out of insurance -- not medical care

The government can offer health insurance much more efficiently than private insurance companies, for the reasons I discussed in the OP. It doesn't take any great specialized sskill to do that, and anyhow our government is already in the business.

I don't think it's necessary to take the profit out of those who provide health care, however. I can see where that would cause a lot of problems and upset an awful lot of people.

[Time for change]

28. What's to prevent private plans from denying legitimate claims -- as they routinely do now?

It would take a very large and very well run regulatory framework to prevent that from happening. Wouldn't it cost a lot less if the government simply administered the plan themselves?

And why do you think that they would boost their profits by encouraging preventive care? The reason that most of them don't do that now is that it would cut into their profits. Paying for preventive care is profitable for an insurance company only if there is a very good chance that the patient will stay with the plan over the long run. That does not happen frequently enough in this country that it is worth it for them to do that.

And even if there was some way to take the profit out of private insurance companies, as you suggest, they wouldn't stand for that any more than they accept the idea of going into competition against a public plan.

[many a good man]

32. Must comply to participate

All insurers would have to abide by the basic plan if they want to participate.

The only way to squeeze a little more profit then would be to become more efficient and/or offer customers something the other plans don't.

I believe the plan I described is almost exactly how they run health insurance in ... France. (gasp!)

[Time for change]

29. Dupe

[Gwendolyn]

27. It's probably a question of attitude, and the vastness of the country.

Universal Healthcare won't be seen in the US for quite some time because of these reasons, I think.

Canada implemented it because, although vast, the country is sparsely populated and so for that very fact, a cooperative mindset took over. Half the country is uninhabitable, the rest is scattered, and so to be a country, people invoked some sort of neighborly ideal across many communities. Euro countries lived through two devastating wars, and after being so beaten down and seeing first hand how terrible living that way was, they all moved toward a more equitable existence, within and without their tiny countries. They all speak several languages as well. Plus, in most towns and cities, they still have monuments practically on every street corner that speaks of those who died, and no one wants their child to relive it. That inspires cooperation. The US is a motley crew of states, many different from the others, but most are inspired by this cowboy tude, never having seen true war, or really a history of any kind beyond the last few hundred years. There is very little cooperative spirit, some of which is fine, some not. But what always makes me shake my head is all the people who seem to think that implementing universal health care is a sudden panacea for all the world's ills, as though, get it and everyone who is not documented can come in and be saved. That's not how it works at all.

[Time for change]

31. But the American people want universal health care by more than a 2:1 margin:

Should government guarantee health insurance for all?

Yes 64%
No 27%

http://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml

[Gwendolyn]

33. Yes, but Americans want it like they want healthy margarine or a paid vacation...

It's the idea of it people like, not the actual implementation. Very few people understand what it means, and mostly no one wants a "card" thingy you swipe when you go to the doctor's office whereby the entire government knows who you are. I hope it works, but it will take a lot of getting used to, and won't happen in my lifetime I don't think. Pessimism discounted, I would say 15 years at the least.

[Time for change]

35. If it doesn't pass, I think it will more likely be due to our politicians being beholding to

the insurance and pharmaceutical companies than resistance from the American people.

There was little or no resistance from the American people to Medicare. The resistance was from the health care industry and insurance companies. And since it passed I don't think that there has been much clamor from the American people to abolish.

[Gwendolyn]

37. Medicare was passed in what, 1969 or around there. Ask today.

You're forgetting about the fact that 30% of our population is religious, to the nth degree, and so add that to the pile of industry and insurance companies. All countries that have healthcare for all, do not have the religious industry we have. Religious cooperation requires that people are beholden to their churches, mosques, temples, and so they too are against a more secular, even-handed approach. As soon as the welfare of citizens moves from churches to the state, obviously citizens become educated, and this doesn't bode well for churches. In the US that would be like a huge blowing of infrastructure of gaskets all around.

[Time for change]

38. You think that religious people are against universal health care?

I never heard that before.

[Gwendolyn]

41. You play.

:)

That's fine, but doesn't change what I said.

[Jackpine Radical]

39. America has a long history of civic cooperation.

This "rugged individual" shit is some John Wayne invention that got foisted off on us. Think of the co-op movement, universal education, barn-raisings and cooperative harvest operations in rural areas. Universal health care may not be a panacea, but it comes damn close in many ways.

[OHdem10]

34. Since the 80s the GOP have been promoting "Access" and "Voluntary

Anyone who knows a thimble full about Republican Philosophy, knows
and understands they simply do not believe the Government should
be in the business of Health Care. There it is their objective
or goal to intervene and stop it as much as possible. Will you
get a Republican Politician to state this on TV. Of course not,
they are politicians. When they know the majority of Americans
want it--they are not stupid. They use--every person should have
access. Translated--you can have any insurance you wish if you can
pay for it.

Therefore, having watched the GOP over the years I get "sketchy"
when speaking in general terms.

Voluntary is their pet. This means there is no real enforcement.
How much farther ahead are we????

I hope Senator Obama really pushes for Health Care. I saw a program
tonight in which the Unemplyment is not going to begin to go any
where near normal until at least 2013. Health Insurance for half
the country who are employed is no big accomplishment. We have to
make a serious decision. What kind of Country do we want. Another Mexico with small number of Uberrich a few rich and
then the masses.

[Faryn Balyncd]

44. K&R--Does it worry you that we've hired a White House advisor who wants to privatize Medicare?

(...and create a plan that has only private options?)

...Is this what Obama is hinting at in his ambiguous statements about addressing the Republican concerns (about the ability of insurance companies to compete)?

http://journals.democraticunderground.com/madfloridian/3684





Thanks for such a thoughtful and comprehensive analysis, Time for Change.

[Time for change]

50. Thank you -- It most certainly does worry me

Obama's health plan was a central part of his campaign. Kucinich and Edwards offered their plans first. Though Obama's plan wasn't quite as good, at least it had an option for public health insurance, along with government subsidies to pay for that. If he would not have offered that, I seriously doubt that he could have ever won the Democratic nomination.

I will be very upset if he takes that away now. I don't think that there is any legitimate reason for doing so. The only reason is to accede to the demands of the private insurance companies -- but in the process it will destroy most of the value of the plan.