HealtchCare Round II, Anybody Interested?

[Beavah]

If insurance companies can't refuse coverage because of pre-existing conditions - one of the requirements in the current bill - what moron is going to actually buy insurance in advance?

 

Yah, that's why the mandate for coverage, eh? Only way to make a health care system (or any insurance) affordable is if the low-risk folks buy in. Purpose of insurance is to spread risk.

 

I'm a low-risk driver, both demographically and practically, eh? I still have auto insurance. State makes me, but I would anyways. I'm a low-risk homeowner and my mortgage is paid up, but I still have homeowner's coverage. As Lisabob says, I can afford it, and it's worth it to be protected against a catastrophe. Problem is, for many scout families around these parts it's a choice between health coverage and keepin' the kids in clothes and food, eh? Yeh can't afford insurance for a catastrophe if payin' the premiums would be a financial catastrophe for your family.

 

Puttin' it another way, if an insurer can cancel or deny coverage to anybody with a pre-existing condition, it's a bit like an auto insurer suddenly canceling or denying coverage because yeh own a Toyota (just discovered a pre-existing acceleration risk). If yeh want auto insurance you'll have to buy a lower-risk car.

 

Just that yeh can't buy a lower-risk body.

 

Such exclusions deprive insurance of its only legitimate purpose - to share risk. If an insurer through demographic skimming really isn't spreading risk it's serving no ethical purpose. Like exotic derivatives in da financial markets, it's just a way of stealin' from the less informed.

 

Lots and lots of good people, lots and lots of scouts and scout families, lots and lots of American businesses have and are being hurt badly by the current system, eh? If yeh have a sick child and lose your job because a bunch of unethical bankers chose to gamble with other people's money, now yeh have to make a choice between watchin' your kid suffer without treatment and losing your family's home. If you're a small American manufacturer with an older workforce, yeh face health insurance costs that are so large that yeh can't compete with international competitors who aren't burdened by such high overhead.

 

Just so insurers like AIG can offer bigger bonuses to execs, eh?

 

This stuff is hard, no question. Figurin' out what's fair and just, and what makes economic sense, isn't easy. Let's not forget, though, that right now our system hurts a lot of good folks, and is less economically efficient than most of the rest of the world. Seems like we Americans should be doin' better.

 

Da current bill got all muddled up because of ignoramuses and special interests in da Congress. IMO President Obama should put the thing out of its misery and come back with a more coherent and cost-effective moderate plan with no accounting hocus-pocus. Problem is there are no statesmen or moderates left in da Congress, and the wingnuts on both sides are more interested in "winning" than they are in serving.

 

I confess that I'm most embarrassed for my generation, eh? Never seen a greedier, more self-centered bunch of fools than we are. Yellin' about "socialized medicine" as we fight every cost-effective change to Medicare tooth and nail, and lay our burden on our grandchildren twice over. I stand ashamed.

 

Beavah

 

[JoeBob]

Beavah, I can't quibble with much of what you said.

Lisabob, you sorta make my point:

If medical care was not given to those who didn't pay (read no insurance) the costs would drop significantly, and 1- more people could afford insurance; and 2- there would be a strong motivation to buy insurance.

We're in a 'death-spiral' now. What is it, 70% are paying for 100% of the costs, while 30% freeload? How expensive is it going to be when only 50% pay? How long can the system support 80% riding on 20% paying? BCBS of California had to raise premiums 39% because of rising costs. What part of the population in California is paying for insurance?

 

Please don't try to villify the insurance industry for having large profits. They only run a 3% profit margin; grocery stores typically run a 6% profit. 3% of 1/16th of the US economy is a large number that can be pedagogged. Thank goodness it's a 3% profit! What if the insurance industry ran a 3% loss? They'd be gone in a year.

[Lisabob]

"If medical care was not given to those who didn't pay (read no insurance) the costs would drop significantly, and 1- more people could afford insurance; and 2- there would be a strong motivation to buy insurance."

 

 

I don't buy this either. For one thing, we would have significant public health issues. When really sick people do not get treatment, disease spreads more efficiently (if they have something contagious). For another, I think it is an outrage to suggest that the inherent value of someone's life is somehow less because they cannot afford health insurance. That, in one of the wealthiest countries in the world, people should be denied emergency care when they are in dire straits, is inexcusable to me. It is offensive. We might as well go back to the time of Charles Dickens in England (Are there no work houses?)

 

And besides, I am not convinced that prices would actually go down. The incentive might well be for insurance companies to keep their prices high and retain their profits.

 

Your argument really only works if you can produce evidence that lots of folks who could afford insurance are actively choosing not to buy it, so that they can freeload off the public system. And that lots of people who currently have no insurance and are reduced to using mandated public emergency services, are happy with the status quo regarding their health care. Without good, solid, evidence of these, the point you make would be poor public health policy, not to mention being heartless.

 

 

 

[OldGreyEagle]

being in Healthcare I agree that if only people who could afford healthcare would receive healthcare then the prices would come down.

 

Of course, then we also have to be able to step over the bodies of the dead and dying when we go to the hospital and learn to bypass remnants of unattended deliveries in the home

 

As a society we have to choose how we value human life and whenever cultural diffrences are talked about between US and THEM, one of the points brought up is "They don't value human life the same way we do". If we adopt only those who can pay get healthcare, there goes that difference. Perhaps we are on the road to a compromise as we speak.... about who gets healthcare

 

The issue is, there are some who know that if healthcare is a right, then they don't have to pay for it and the local Emergency dept becomes the Clinic when its not serving as the Knife and Gun Club meeting place.

 

I wish I had answers, I know the way it is now, it needs changing. I also know that the changes I have read will do nothing to improve the quality of Medicine

[scoutingagain]

"JoeBob, are you seriously suggesting that many people intentionally opt not to buy insurance (when they could otherwise afford to buy it), just because they can get emergency care in public hospitals even without insurance? "

 

Actually I do know folks in this category, or I did until MA required that they buy insurance. Most were single, self-employed or employed with an employer that did not provide health insurance. In this category, purchasing an individual policy was prohibitively expensive. Particularly when the option of free or near free care was available at several municipal hospitals. Many took the chance they would not need care except for catastrophic injuries or illnesses. Now nearly all purchase a more affordable plan that is mandated under the MA Health Care program.

 

SA

 

[JoeBob]

To further the point OGE made; if health care is a right, then every non-payer has a right to a part of my life, ie- my money earned through my labor can be confiscated to pay for their doctoring.

 

I'm sure that most indigents will still get healthcare at charity clinics, where funding is obtained from voluntary donations. That's how Catholics got into the hospital business in the first place.

 

 

An un-intended consequence of not underwriting free healthcare might be a reduction in violence. Where's the deterent in a wounded hero resting up on clean sheets in an air-conditioned room with cute nurses and cable TV?

Watching his fellow gang-banger slowly die of gunshot induced septicemia might be just the motivation a young fellow would need to forego shooting up the streets himself.

 

[OldGreyEagle]

Just so there is no confusion, I am not on JoeBob's side in this

[Lisabob]

Scoutingagain writes: "In this category, purchasing an individual policy was prohibitively expensive."

 

That's the key, though. People feel forced to spin the roulette wheel because the costs of purchasing insurance on their own are so out of reach. I doubt many people think "well affording health insurance really isn't a problem for me, but I think I'll keep my money and spend it on a vacation to the Bahamas (or where ever) instead. After all, I can get free care at the local emergency room."

 

More likely, it goes: "Well I would prefer to buy health insurance and not lose sleep at night, worrying about whether I'll get sick or my kid will have an accident on the school playground and break his arm. But the price is so high that I really don't have much choice so I'm going to pay the rent, make sure I can afford to feed my kid every day, and hope and pray that nothing bad happens in the meantime until I can find another job that offers benefits."

 

Personally, I know that there were periods in my early adult life while I was still trying to establish my career, where that was exactly the calculation I had to make. Thankfully, those periods have been brief. But if I lose my job over the summer, which is possible, I do not know what my family will do for insurance.

 

JoeBob, all I can say is "Wow."

[Lisabob]

Scoutingagain writes: "In this category, purchasing an individual policy was prohibitively expensive."

 

That's the key, though. People feel forced to spin the roulette wheel because the costs of purchasing insurance on their own are so out of reach. I doubt many people think "well affording health insurance really isn't a problem for me, but I think I'll keep my money and spend it on a vacation to the Bahamas (or where ever) instead. After all, I can get free care at the local emergency room."

 

More likely, it goes: "Well I would prefer to buy health insurance and not lose sleep at night, worrying about whether I'll get sick or my kid will have an accident on the school playground and break his arm. But the price is so high that I really don't have much choice so I'm going to pay the rent, make sure I can afford to feed my kid every day, and hope and pray that nothing bad happens in the meantime until I can find another job that offers benefits."

 

Personally, I know that there were periods in my early adult life while I was still trying to establish my career, where that was exactly the calculation I had to make. Thankfully, those periods have been brief. But if I lose my job over the summer, which is possible, I do not know what my family will do for insurance.

 

JoeBob, all I can say is "Wow."

[Kahuna]

Beavah writes:

"There's not much of a Constitutional argument here, IMO"

 

I think there really is. I guess we have to agree to disagree. But then, that's what lawyers are for, eh?

[skeptic]

Until last year, when I became Medicare eligible, my only affordable care was through the absolute minimum level of VA coverage. While it was/is better than some have available, it certainly was not particularly convenient, especially for basic stuff. Why was that? I got down sized and was very soon "priced out" of coverage, as has been discussed over and over here and in the media.

 

I can see a lot of reasons why there are concerns about the insurance companies, as well as areas of the medical providers too. We read about the salaries of the people on the top of these companies, and they are often as obscene as those of the top banking heads. We read about "a few" doctors who are multi-millionaires doing specialties that often are seen as unnecessary, while apparently opting to ignore basic care to those who cannot pay. But, these same doctors will appear as "wonderful saviors" when they suddenly find the ability to bring someone from another country and do miraculous things. While few would want that child or special case to suffer, it still makes you wonder where these people find the resources when we have basic suffering that goes untreated here in our own communities.

 

I suspect that "most" doctors do not make obscene profits and live up to their oaths as best they can. A few literally struggle almost as much as those to whom they reach out. Considering the training and dedication it takes, we should not begrudge care givers "comfortable" life styles. But, we who are on the lower part of the societal pot also likely often wonder "why" some seem to never have "enough comfort".

 

While hard work should be rewarded, and innovation as well, it is hard to fault the majority in our society who question why those "very few" seem never to "have enough". Pardon my naivete, but why is a million dollars a year not enough to live on, especially if it is supplemented with other perks, such as access to places to stay and ways to get there without paying. Every time I look at my own life, I see that there was a short period, when I was still fully employed, and so was she, that we pretty much had no concerns. And we were no where nearly as well "compensated" as CEO's and the top echelons directly below them.

 

So, a few questions. Should hospitals really be "for profit"? Should there be a "ceiling" on how much is enough, for heads of large companies? Wouldn't society, and shareholders, possibly be better served if the extreme compensation was paid to those who "actually are responsible, the workers in the business". There are really no easy answers to these problems. But until that "huge gap" between most of us and a few starts to close, we will continue to have more and more upset and rebellious people.

 

But, "most of us" still need to recognize that "needs" and "wants" are two different things. If we cannot pay, then, if not a necessity, we need to accept that we do not need it at the moment. We need to, as a society, get back to taking responsibility for our own choices and actions. That includes "some type of Tort reform", not only for medical suits, but civil and accident cases as well.

 

Okay, I guess I need to take off the "rose glasses" again.

[Beavah]

I wish I had answers, I know the way it is now, it needs changing. I also know that the changes I have read will do nothing to improve the quality of Medicine.

 

Yah, dat's about the same place I'm at, OGE.

 

Kahuna, to expand my point a bit, even if yeh think there's a constitutional argument to be made, my point is that actually making that argument is bad strategy for conservatives. Not that any of the right are very good at strategy at the moment. At it's heart, the argument you're proposing is an argument for single-payer government-run health care. We can't make people buy insurance through legislation, so the only way to address this is by taxing everyone and providin' the service directly.

 

Same as we do for government-run education, eh? Tax everyone, then provide the service only to those who opt in.

 

Is that da argument you really want to make?

 

Beavah

 

[Kahuna]

Beavah writes:

 

"At it's heart, the argument you're proposing is an argument for single-payer government-run health care."

 

I suppose that's the liberal way to look at it, but that would not necessarily be the result if the Supreme Court eventually kicks it out. It would mean the Democrats would have to be in power at the time to pass it into law. Meanwhile, that provision of the bill would just be out. Right?

 

Heh, heh, is that the argument I want to make? Certainly not, but one thing I've learned about liberals is that they never, ever stop trying. So, my assumption is that we'll end up with a single payer system at some point in time.

[JoeBob]

OGE: Sometimes I'm not on my side either. I never claimed to be a nice person, but I sometimes pretend to be one online.

 

At the bottom of it all, isn't the health care debate really just a different version of wealth envy?

 

Nancy Pelosi today:

But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy."

 

Transparency, anyone?

 

PING!

[Beavah]

At the bottom of it all, isn't the health care debate really just a different version of wealth envy?

 

Huh?

 

I don't get yeh here, JoeBob. From where I set, it seems like the health care debate is about as far from that as I can imagine.

 

It's sometimes about values - about how compassionate we are to our fellow citizens in need.

 

It's sometimes about economics - what makes the most sense as a policy to promote and sustain a healthy workforce for the nation in a competitive world while keepin' costs under control?

 

It's occasionally about public health, as Lisabob mentions, eh? When that poor fellow gets sick and isn't cared for, disease spreads to da rich fellow too, eh? Microbes don't care much for bank accounts.

 

Nothing in any proposal is goin' to prevent the wealthy from getting top-notch health care. The question is what do we do for the hardworkin' family man who gave the last 20 years workin' for GM/Saturn and is now out of a job. Do we sentence his wife who has cancer to death, because he now has no insurance, and da exclusions for prior conditions prevent him from getting any?

 

Beavah