Universal Health Care

[Conan71]

Since this will be a large issue in the 2008 election, it's pretty topical.

http://www.forbes.com/business/healthcare/2007/03/28/unitedhealth-walmart-medicaid-ent-hr-cx_mf_0328outlookuniversal.html

It's promised as being a win-win for employees and companies.  Both Democrats and Republicans are jumping on the band-wagon.  Mitt Romney was behind the push for it in Massachusetts along with a Democrat-controlled Congress.  The Mass. plan calls for compulsory coverage, just like auto liability insurance.  It requires individuals to buy it or pay a penalty.  It also requires employers with more than ten employees (which still fall under the definition of small businesses) to provide it or pay an annual assessment for not providing it.

http://www.mass.gov/?pageID=hichomepage&L=1&L0=Home&sid=Qhic

http://www.washingtonpost.com/wp-dyn/content/article/2006/04/04/AR2006040401937.html

For companies, it is promised to lower their cost of providing health care for employees.  For employees it is touted as being low-cost to no cost, and every American will now have parity in health care.

Wisconsin, which launched a model program for welfare reform is now poised to provide what they believe is a model program of UHC, based on the Canadian "single pay" program.

http://www.wisconsinhealthcareforall.org/

http://www.prospect.org/web/page.ww?section=root&name=ViewWeb&articleId=12608

There is presently access to the medical system via Medicare and Medicaid.  Heck, you don't even have to be a U.S. citizen to access our healthcare.  Proponents of these UHC programs claim it will mean more people will take advantage of preventative medical care.  I do agree to an extent this might happen, but there is still a percentage of people out there who won't ever go to a doctor until they are dying, regardless of medical coverage, then who do you blame?

Some of the Democrat-proposed plans actually work out to be a boon for large companies to limit their employee benefit costs by passing those costs to a payroll tax or an income tax on the back of the employee.  While at the same time placing a large burden on small business.

Personally, I pay about $48 per month for my portion of my health insurance premiums with no dependents.  After my five year anniversary with the company, they will pick up the entire tab.  I work for a company which falls in the 15 to 20 employee range.

My wife has somewhat of a vested interest in the outcome of the issue since she is a health-care professional and has worked in the hospice industry for four years.  I honestly don't know what would happen to hospice coverage should UHC come to pass.

Personally, I'm not a big government person and I think there could be other solutions which don't amount to corporate welfare and which don't leave anyone out in the cold.  I've taken a harder stance on it because of the hyperbole which has been passed around about all these people dying because they don't have health care.  

All one has to do to see how inefficient the U.S. government is with health care is to look at problems within the V.A. system and the large beaurocracy in Medicare and Medicaid.  If it is to be government-mandated, it seems to be much more manageable on a state-by-state basis.

Should this be a national program or a state-by-state issue?  Is a promise of UHC by Presidential candidates just more hot air to get elected?

Opinions, educated guesses, inside knowledge?

[swake]

My goal would be basically that the current health benefits that employees of large companies have be expanded to all people
•   Employers should have to pay for insurance for contract employees just like other employees
•   The restrictions on "pre-existing" conditions should be removed, insurance should be portable if needed
•   The self employed should have access to the same pricing from insurance companies that employers do
•   The unemployed, the disabled and the retired should all be covered private insurers. Medicare should morph into a program that pays for the insurance for covered persons and providers should compete for individuals business
•   All employers have to provide healthcare to all workers. Part time employees get partial coverage based on the percentage of full time hours they work, these partial payments would be in the form of vouchers that could be combined or granted to Medicare for the purchase of insurance coverage
•   The impact on small employers should be mitigated by the regulation of Insurance providers, providers can still compete, but small employers should have access to the same prices for plans that large employers too, we should remove the advantage of scale
•   There should be small, reasonable co pays for all people for visits and treatments, the prices should be regulated by the government and can be waived for the very poor. Treatment cannot be denied for not paying co-pays, but the money IS owed.
•   Drugs should be free for all people as needed, prices charged to insurance plans should be regulated and most drug research should be taken over by government and universities and funded by government. Pharmaceuticals should be in the business of manufacturing drugs, not creating more and more variances of drugs to maintain patents and the sales of those drugs.
•   Advertisements should be banned for prescriptions drugs
•   More drugs should be available on a non-prescription basis
•   Patient privacy should be better protected by law, and once that is accomplished, most medical records should be automated and warehoused by a national database for efficiency, probably administered by Medicare.
•   Malpractice insurance for doctors should be regulated and costs capped right along with malpractice claims, but at the same time licensing boards and regulations on doctor practices should be taken out of the hands of doctors and should be much more public and transparent serving the patient more than the doctor.

[Conan71]

Swake-

My goal would be basically that the current health benefits that employees of large companies have be expanded to all people

•   Employers should have to pay for insurance for contract employees just like other employees

Let's say in the case of home construction, where a contractor uses subs, does that mean he would be responsible for paying for the framing crew's insurance for a two week job?  What about if I hire a contract code welder to do a project for me for a month at a customer's location?

•   The restrictions on "pre-existing" conditions should be removed, insurance should be portable if needed

Somewhat agreed

•   The self employed should have access to the same pricing from insurance companies that employers do

Speaking from experience, they can get it for the same price, just less coverage, but I get your point.  I could see it as being an incentive to encourage new small-business.  Employer-sponsored benefits is one of the reasons I've consistently heard over the years as to why someone is reluctant to follow a dream to have their own business.

•   The unemployed, the disabled and the retired should all be covered private insurers. Medicare should morph into a program that pays for the insurance for covered persons and providers should compete for individuals business

This is the one that gets me.  All that seems to do is to be a fund shift of the government paying for insurance coverage instead of paying the medical costs.  The insurance company has to operate at a profit.  In order to do so, the rates would have to be very, very high, higher than the actual medical costs for that group, which means it would cost the government more.  The retired and disabled are generally going to be the most expensive group to care for.  As will the chronically unemployed because many in that group usually have a substance abuse problem.  I don't see that working at all, though it might be a solution for the temporarily un-employed.

The gov't already has very good bargaining power with health care providers via Medicare and Medicaid, setting the rates for which they are willing to pay for a particular service.  The providers pretty much have to take what the gov't is willing to pay.  One good recent local example is the EMSA reimbursements.  I can tell you first-hand that Medicare dictates what they will pay for daily hospice care, and what that care has to entail.  


•   All employers have to provide healthcare to all workers. Part time employees get partial coverage based on the percentage of full time hours they work, these partial payments would be in the form of vouchers that could be combined or granted to Medicare for the purchase of insurance coverage

I'm a little confused as to how partial coverage would work, and that also skews the idea of parity in coverage for everyone.  I don't get the idea of "partial" when it comes to medical coverage.  Do you mean no meds, or no dental?  What exactly?

•   The impact on small employers should be mitigated by the regulation of Insurance providers, providers can still compete, but small employers should have access to the same prices for plans that large employers too, we should remove the advantage of scale

I believe the idea is to spread the risk group over every citizen so that the costs would be flat.  Several plans call for cutting out a lot of the competition amongst insurers by limiting the number of insurers allowed in or by just cutting it to one clearinghouse.  That would eliminate a lot of good paying jobs in the insurance industry and create mediocre-paying government clerk positions.

•          There should be small, reasonable co pays for all people for visits and treatments, the prices should be regulated by the government and can be waived for the very poor. Treatment cannot be denied for not paying co-pays, but the money IS owed.

In reality, other than inconsistent co-pays from one insurer to the next, this is how it works now in most areas of the country.  It's just that the government picks up the tab or people who can pay for healthcare pick up the tab in higher rates paid to medical providers.

•   Drugs should be free for all people as needed, prices charged to insurance plans should be regulated and most drug research should be taken over by government and universities and funded by government. Pharmaceuticals should be in the business of manufacturing drugs, not creating more and more variances of drugs to maintain patents and the sales of those drugs.

I dunno, that's an area where free-enterprise and free-thinking has allowed for innovation in a lot of life-saving and life-enhancing medications.  Again, private enterprise has a tendency to offer better paying jobs than gov't.

•   Advertisements should be banned for prescriptions drugs

Agreed.  Marketing budgets are funded on the backs of prescription users.  There is a need to create awareness of drugs and educate doctors on when it's appropriate to prescribe.  

But I've long felt there is a weird incestuous relationship between drug reps and doctors.  I asked my own PCP once how she chooses which drug to prescribe when several from competing companies do the same thing.  I quizzed whether it was whomever had bought her lunch lately or took her golfing.  She didn't bat an eyelash and said: "Yep."

•   More drugs should be available on a non-prescription basis

Certain classes, yes.  There are plenty though that need to stay behind the counter.

•   Patient privacy should be better protected by law, and once that is accomplished, most medical records should be automated and warehoused by a national database for efficiency, probably administered by Medicare.

Already done with Hipaa.  Streamlining record-keeping is how proponents claim a lot of the programs would be funded as they claim that archaic record-keeping is an inefficient waste of taxpayer money in with the current gov't programs.

•   Malpractice insurance for doctors should be regulated and costs capped right along with malpractice claims, but at the same time licensing boards and regulations on doctor practices should be taken out of the hands of doctors and should be much more public and transparent serving the patient more than the doctor.

I'd like to see John Edwards jump on the band-wagon for malpractice caps. [B)]  He talks about reforming health care whilst he made his fortunes bilking it on spurrious CP lawsuits against ob-gyn's.  On the one hand, I can see your point of making medical boards more transparent, but is it smart to have people who don't understand medicine regulating the industry?

[Conan71]

Obama's plan finally revealed, summarized in news story form, it looks a bit shakey to me, and it doesn't seem to have much thought put into it.  Admittedly, I have not had time to go to his web site to read the actual text.

I think by releasing his prior to Hillary releasing her plan, it leaves him fair game for attack and I'm sure her people are going to be using the flaws in his plan to craft their own.

http://www.cnn.com/2007/POLITICS/05/29/obama.health.ap/index.html?section=cnn_latest