Public Insurance Off The Table?

[Red Arrow]

Given how competition in the private sector has thus far failed to produce reasonable prices, what do you think will bring costs back to something affordable for most people other than public competition?

Maybe for starters, the punitive portion of lawsuits could go to a public charity of the winners choice.  I am all for a damaged party to receive compensation for damages.  They should not get money for punitive damages any more than I should receive a reward for calling in an incapacitated driver to the police.  That might help reduce the cost of malpractice insurance.

This next thought is difficult.  All insurance is socialistic. Everyone pays into a pot and the needy get to withdraw.  It is a price we pay to cover catastrophic events that may occur.  I buy car insurance (in addition to the fact that it is required) to pay for judgements that I could not otherwise afford to pay.  I do not buy insurance for normal maintenance, tires, engine belts, etc.  Health insurance has become "maintenance insurance" as much as catastrophic event coverage.  Part of the blame goes to the greed of the Pharmaceutical companies and I believe partly because if any drug cause damage to anyone, the big rich Pharm companies get their pants sued off so they price their products to cover those events in addition to the so-called development costs.  There is no free health coverage.  Some one or entity (government/taxpayer) will pay.  

In summary, I believe some sort of Tort reform would be a first step to more realistic health coverage costs.  Reform brought the small aircraft industry from unavailable at any cost to merely outrageous prices.  It could do the medical industry some good.

[nathanm]

Maybe for starters, the punitive portion of lawsuits could go to a public charity of the winners choice.  I am all for a damaged party to receive compensation for damages.  They should not get money for punitive damages any more than I should receive a reward for calling in an incapacitated driver to the police.  That might help reduce the cost of malpractice insurance.

I hate to be the bearer of bad news, but the tort reform drum is a straw man created by the insurance industry and big pharma. I forget the exact number, but less than 1 cent of each health care dollar goes to paying for damage awards. Far, far less even go to punitive damages. (The enormous punitive awards big insurance and big pharma like to tout are almost always drastically reduced before all is said and done)

That particular straw man is easy to fall for however, given the shocking regularity with which the outright lie is repeated in the media.

Now, the argument can be made that fear of malpractice suits causes doctors to order more expensive tests, but I think the evidence points to some doctors doing that for the benefit of their bottom line rather than the benefit of the patient or to ward off malpractice suits.

I'm of the opinion the largest part of the problem is simply the insurers themselves. Between their inordinate overhead, their refusal to work together to simplify the claims submission process, and their premium increases far in excess of actuarial necessity, I'd say they are the largest part of the issue. They get away with it because there is no transparency whatsoever in their operations. Since most of us only pay a small fraction of the premium and nobody but doctors have to deal with the process of submitting claims to hundreds of different insurance companies the problems go largely unnoticed.

Health care is broken not only for the 35 million uninsured, but for everyone in our so-called system.

The only way to rein in private health insurers is to make them entirely optional. I think the best way to do that is a single payer government-run system that essentially expands Medicare to everyone. If someone desires supplemental coverage, they are free to purchase it.

In the alternative, having a viable public insurance plan is about the only other way to force them to solve their problems. I don't think onerous regulation will do the trick. I think competition is the only way, and there is no real competition among health insurers at present. If their choices are streamline or die, they will finally stop being part of the problem and become part of the solution.

I await guido's irrelevant red-baiting Obama references with bated breath. 

[waterboy]

Try again Waterboy.  President Reagan, Cap Weinberger and George Schultz were the masters of detente`.

The rough patch our region went through in the 1980's had little to zilch to do with Reagan's economics or tax cuts.  There was a never-ending orgy of higher and higher interest rates from the Carter years which finally broke the back of the average homeowner and businessman, a borrowing binge based on oil approaching $40 a barrel, and some seriously greedy and dishonest bankers willing to roll the dice and bankroll speculative life-styles.

Reagan inherited a very full plate.   Can you honestly say with a straight face that America was worse off when Reagan left office than when he took it?  Where's your credibility when you spit on President Reagan, a man whom history has objectively shown was a very, very effective President?  Who won the Cold War, if it wasn't Reagan?

You had to be there. My responses would merely veer back off topic. Suffice it to say, objectively historians rate Reagan as an average president who receives more credit in this area than in others. Besides, you guys are firing the heavy guns, I'm just an interested observer.

[Conan71]

You had to be there. My responses would merely veer back off topic. Suffice it to say, objectively historians rate Reagan as an average president who receives more credit in this area than in others. Besides, you guys are firing the heavy guns, I'm just an interested observer.

I was there.  So was my family. 

[Conan71]

I'm of the opinion the largest part of the problem is simply the insurers themselves. Between their inordinate overhead, their refusal to work together to simplify the claims submission process, and their premium increases far in excess of actuarial necessity, I'd say they are the largest part of the issue. They get away with it because there is no transparency whatsoever in their operations. Since most of us only pay a small fraction of the premium and nobody but doctors have to deal with the process of submitting claims to hundreds of different insurance companies the problems go largely unnoticed.

Health care is broken not only for the 35 million uninsured, but for everyone in our so-called system.

The only way to rein in private health insurers is to make them entirely optional. I think the best way to do that is a single payer government-run system that essentially expands Medicare to everyone. If someone desires supplemental coverage, they are free to purchase it.

In the alternative, having a viable public insurance plan is about the only other way to force them to solve their problems. I don't think onerous regulation will do the trick. I think competition is the only way, and there is no real competition among health insurers at present. If their choices are streamline or die, they will finally stop being part of the problem and become part of the solution.

Next time you have a regular doctor visit or procedure, review your statement from your insurance carrier.  You will find a deduction for a pre-negotiated lower rate for services.  One other thing you will find is that most providers will accept a 10 to 20% discount if you offer to pay a significant deductible in cash, right away.

IOW, insurance companies do help negotiate lower rates on behalf of their insured.  Now whether or not that's causing providers to jack up their rates for services to wind up with a procedure payment they want is beyond me.  I'm quite well aware of anecdotal evidence from friends who have no coverage who have negotiated as much as 25% off the stated price of a procedure for offering to pay cash at time of service.

We can have it one way or the other: continue to pay higher premiums to private insurers, or subsidize health services via a government program which will either have to raise revenue (taxes) or increase borrowing (deficit) to stay solvent and provide a competitive arena to keep insurance companies "honest".  Neither is an attractive option to me. 

The more I see and read of the reform that's proposed.  It's got very little to do with capping costs and providing health care to a segment of the population which is supposedly dying without it.  It's about cradle-to-grave dependence on the Federal Government.  There are very good programs out there already which help those without other means for health insurance.  I name-drop this on about a monthly basis:  In our state, we have Sooner Care.  Do some Googling on it, it's a Medicaid-based program (I do believe) and is a hand-up type system.  There's no vacuum of health care for those who really want it or need it.

Here's two stories of interest from the Tulsa World this morning which relate to government health care programs.  One states there will be no COLA this coming year for SS recipients, but their Medicare benefit cost will increase.  Whoops! 

"Millions of people with Medicare Part B coverage for doctors' visits also have their premiums deducted from Social Security payments. Part B premiums are expected to rise, as well. But under the law, the increase cannot be larger than the increase in Social Security benefits for most recipients."

http://www.tulsaworld.com/news/article.aspx?subjectid=16&articleid=20090824_13_A8_WSIGOm561175&archive=yes

The other is about the possiblity of Fairfax and Bristow losing their hospitals.  Lower Medicare reimbursement (government-provided health care) is cited as one reasons why solvency seems to be a problem for smaller hospitals.

http://www.tulsaworld.com/news/article.aspx?subjectid=17&articleid=20090824_17_A1_JimClo213658&archive=yes

A critique of the WH's handling of the reform package:

http://www.tulsaworld.com/news/article.aspx?subjectid=17&articleid=20090824_17_0_WASHIN124635

[nathanm]

We can have it one way or the other: continue to pay higher premiums to private insurers, or subsidize health services via a government program which will either have to raise revenue (taxes) or increase borrowing (deficit) to stay solvent and provide a competitive arena to keep insurance companies "honest".  Neither is an attractive option to me. 

So if a health insurance company charges you money it's called a 'premium,' but if a government-run insurance company charges you money it's called a 'tax.' Can't argue with that.

Regarding SoonerCare, that's great if you are a child, blind, disabled, over 65, or pregnant. For males and non-pregnant females, it does not apply. You can thank the 90s Republican Congress and Bill Clinton for that, BTW.

Smaller hospitals close because of lack of use, not because the big, bad government forces them to. It's capitalism at work, actually. They can't afford to buy advanced diagnostic machines which causes people who might otherwise use those hospitals to choose other facilities in larger cities, thus reducing revenue below a sustainable level. It sucks, but that's the way the cookie crumbles.

[we vs us]

If we're talking about Reagan, the single most destructive thing he did (IMO) was to shape the modern conservative movement around the "government involvement in anything = bad" meme.  It's destructive because 1) his acolytes rage and rage against even necessary and or possibly beneficial intrusions and 2) it sets up his own party for failure (cf. how do you govern effectively when, at core, you don't believe in the mechanism for governing?  GWB, ironically, found himself in that exact bind over and over again.) 

But the problem in general is:  if government involvement is off the table, then how do we have a policy discussion?  The conservatives in this country are doing everything they can to keep any government response completely out of the discussion.  There's no real debate about how to construct a new system or change the old.  The debate is entirely based around LALALALALAIDONTHEARYOUGOVERNMENTISSOCIALISM.  Failing that it's LALALALPERSONALRESONSIBILITY11!1

Blend that with the fear of any new taxes anywhere ever and you we can't even start a discussion.  Because anything that will address the healthcare crisis will absolutely require:  higher (possibly a lot, possibly a little ) taxes; more government; and an admission that individuals are, by and large, NOT in control of their healthcare. 

BTW, I think there are Dems (mostly blue dogs) who are uncomfortable with the scope of what's being proposed, but there's at least as much uncomfortability with the public reaction than with the bills in committee.  And as we know, a lot of the public reaction has been ginned up or is coming from an exceptionally vocal minority.

If the Dems weren't completely incapable of message discipline, you'd see a lot less waffling and more resolve.  Alas, the D's have never been particularly good at speaking with one voice, and the current debate shows that up in spades.   

PS Conan, thanks in advance for not threatening to kick me in balls. 

[waterboy]

I was there.  So was my family. 

So was Chauncey Gardener.

[Conan71]

So was Chauncey Gardener.

+1 for the "Being There" reference. 

[Conan71]

But the problem in general is:  if government involvement is off the table, then how do we have a policy discussion?  The conservatives in this country are doing everything they can to keep any government response completely out of the discussion.  There's no real debate about how to construct a new system or change the old.  The debate is entirely based around LALALALALAIDONTHEARYOUGOVERNMENTISSOCIALISM.  Failing that it's LALALALPERSONALRESONSIBILITY11!1

PS Conan, thanks in advance for not threatening to kick me in balls. 

I know your wife and have seen your beautiful baby.  I hope you make more (though I hope they wind up with a more conservative tilt  ) I wouldn't think of kicking you there.

Only thing I'm going to bust YOU on is the meme that conservatives have not come up with anything substantive to counter or add to health care reform other than complaints and hate.  It's been documented that they have solutions they would like vetted, yet the liberal majority have done everything possible to keep conservatives from the discussion and kept anything out of conservatives from coming out of committee.  I ask how can you have an intelligent conversation on health care when neither side will allow the other to speak?

[nathanm]

Only thing I'm going to bust YOU on is the meme that conservatives have not come up with anything substantive to counter or add to health care reform other than complaints and hate.  It's been documented that they have solutions they would like vetted, yet the liberal majority have done everything possible to keep conservatives from the discussion and kept anything out of conservatives from coming out of committee.  I ask how can you have an intelligent conversation on health care when neither side will allow the other to speak?

Perhaps I'm dense, but all I've heard from the right on this issue are "OMG SOOSHULISSSMMM!!" and attempts to keep the status quo, which already includes health savings accounts and high deductible catastrophic medical insurance.

If I've missed something amongst the Hitler and socialism references, please speak up.

I'm totally serious about the Hitler thing, BTW. I was in Florida last week and saw on the local news several Obama = Hitler signs carried outside the town hall meeting a couple of Congresspersons had down there. "Hitler gave good speeches, too" is the one that stuck most in my mind. Alongside "Gov't doesn't get to decide when Grandma goes". Out of the 30 or 40 signs I saw, the vast majority were of the batshitinsane variety.

It's hard to hear reasonable discussion over that sort of noise.

And how can you say that there's no input from conservatives on this? Obama is placing far too much emphasis on bipartisanship on this issue for my taste, but again, my frustration may just be a result of the public face of the opposition.

[Conan71]

Perhaps I'm dense, but all I've heard from the right on this issue are "OMG SOOSHULISSSMMM!!" and attempts to keep the status quo, which already includes health savings accounts and high deductible catastrophic medical insurance.

If I've missed something amongst the Hitler and socialism references, please speak up.

I'm totally serious about the Hitler thing, BTW. I was in Florida last week and saw on the local news several Obama = Hitler signs carried outside the town hall meeting a couple of Congresspersons had down there. "Hitler gave good speeches, too" is the one that stuck most in my mind. Alongside "Gov't doesn't get to decide when Grandma goes". Out of the 30 or 40 signs I saw, the vast majority were of the batshitinsane variety.

It's hard to hear reasonable discussion over that sort of noise.

And how can you say that there's no input from conservatives on this? Obama is placing far too much emphasis on bipartisanship on this issue for my taste, but again, my frustration may just be a result of the public face of the opposition.

Please don't confuse the ignorant rantings of a few thousand (if that) cro magnons with the idealogy of every person who identifies themself as a conservative or Republican.

Start here:

http://www.cbsnews.com/blogs/2009/06/17/politics/politicalhotsheet/entry5093897.shtml

http://www.reuters.com/article/healthNews/idUSTRE55F7HR20090616

http://www.ncpa.org/sub/dpd/index.php?Article_ID=18329

[FOTD]

Please don't confuse the ignorant rantings of a few thousand (if that) cro magnons with the idealogy of every person who identifies themself as a conservative or Republican.

The only thing confusing is why no Republicans are condemning these thousands of cro magnons.

Forget affordable health care. Here's the latest on the Senate Finance bill to screw us... posted on the DailyKos today: In otherwords the insurance industry won a big victory and we are going to pay for it.

http://www.dailykos.com/story/2009/8/24/771571/-The-Senate-Finance-Bill-Forces-You-To-Pay-35-of-The-Bill!

[Conan71]

The only thing confusing is why no Republicans are condemning these thousands of cro magnons.

Forget affordable health care. Here's the latest on the Senate Finance bill to screw us... posted on the DailyKos today: In otherwords the insurance industry won a big victory and we are going to pay for it.

http://www.dailykos.com/story/2009/8/24/771571/-The-Senate-Finance-Bill-Forces-You-To-Pay-35-of-The-Bill!

If you don't want to hear the condemnation, chances are, you won't hear it.

[FOTD]

If you don't want to hear the condemnation, chances are, you won't hear it.

The devil wants to hear it badly, Conan!

Please, tell me how to hear it. Is there a special code or listening device?

Their silence is pathetic....the lack of intent to stop their intimidating strategy is pitiful.

Here's your deaf Senaturd! You must wonder how he got through med school. And don't you just love the credibility hole this reporter blows through the crap head.