An Attempt at a CIVIL Health Care Discussion

Okay, the health care bill has passed. Nobody really knows how all the lawsuits will pan out or whether it will really cover the uninsured. Previous threads discussing the merits of the legislation, or lack thereof, have degenerated into shouting matches. So I'd like to take a step back and try to look at what ails the current system from a more general standpoint.

The population can be divided into several groups:

1) Those with serious but treatable chronic diseases (coronary artery disease, diabetes, some forms of cancer, lupus, etc.). These people need coverage that allows them to get the treatment they need without bankrupting their families.

2) Those who are basically healthy, don't use much in the way of health care resources, but are of an age where shit starts to happen with increasing frequency (i.e. over 40. I wouldn't object to saying over 50). These people need to be covered because sooner or later something will happen. Everyone who has ever lived (including Jesus Christ his ownself) has died of something.

3) Those who are young and healthy. An argument can be made that these people don't need coverage. The problem is that there are a slew of nasty diseases that tend to manifest in this age group (lupus, Crohn's disease, a variety of neurologic problems, leukemias, etc.). And any adult can get appendicitis, gallstones, kidney stones, or other acute problems that can kill you if they're not treated.

4) Children. They should be covered. Any questions?

5) Those with end stage, terminal illnesses. This group uses the largest proportion of health care resources by far. People with heart failure, cirrhosis, and kidney failure who have to be hospitalized for a week if they eat a piece of salami (too much sodium, you know). People with severe Alzheimer's who have forgotten how to eat. People with widespread cancer who have failed three different chemotherapy regimens. Care for this group is extremely expensive for the life expectancy gained, especially when quality of life is considered. These people need coverage, but how many heart transplants is one person entitled to?

6) The Worried Well. These are people who don't really have anything serious wrong with them, but they use lots of health care resources because they're afraid they do. Every symptom has to be evaluated by a specialist, because everyone knows someone who had exactly the same symptoms and turned out to have cancer. They might fall into either Group 2 or 3 above except for their disproportionate use of resources. These folks are usually already covered.

In case you can't tell from the above, yes, I'm a health care provider. The problem with the U.S. health care system is that most of the money comes from Group 2, while most of the money is spent on Group 5. There is some waste in the system for all the groups, but it is greatest for Group 6. To get more money to spend on the other groups, you can get more people paying into the system (those in Groups 2 & 3 who aren't already paying premiums), eliminate some of the waste, or spend less on Group 5.

To increase the risk pool, you can establish a universal health care system where everyone is covered and everyone is taxed out the wazoo, or you can try to force people to buy private insurance.

To eliminate waste, you must have meaningful tort reform. Here's a dirty little secret about the health care industry: most of the waste in the system is from defensive medicine. It doesn't get measured as such in studies because it's so widespread that it has become the standard of care. If, for a given symptom, one person in 10,000 will truly have a serious problem that could be found by a moderately expensive test (say, a CT scan), a doctor will order the scan every single time. This is because while 9,999 times it's a wasted test, the 10,000th person can and will sue for missing the diagnosis. Even if the suit is thrown out, it's a huge hassle and may take years of dealing with lawyers to resolve. Until it is permissible to miss a long-shot problem, there will be a lot of waste in the system. See Group 6 above.

To reduce spending on aggressive treatment of terminal conditions you may think I'm going to say someone has to have the authority to stop treatments regardless of patients' wishes. Not so. This area is actually the greatest failure of the medical community. All that really needs to happen is that doctors tell their patients the truth about what is going on. There comes a point where the burden of treatment is greater than its benefit. It's amazing how often people choose to be kept comfortable rather than take that fourth type of chemotherapy if they are given a realistic assessment of its likely benefit. It's also amazing how many people don't realize that they have the right to refuse care that is offered (no, just because you've been on dialysis for five years doesn't mean you can't stop it when you find out you also have a brain tumor). The problem here is that it takes a lot of time, is emotionally draining to do, and it goes against everything modern medical education preaches. "Heal the sick, comfort the dying" has evolved into "Heal the sick, never admit anyone is dying."

So IMHO, the root of our health care crisis isn't something that politicians, insurance reform, or mandating coverage can fix. Republicans and Democrats can tear each other to shreds over this issue, but none of them can fix the underlying problem.

This is a long post on a controversial subject, so I expect some heat. But I'm hoping people can state their views in reasonable fashion. Now let the flames begin.

STOP GIVING AID TO OTHER CONTRIES FOR WEAPONS AND WE CAN PAY OUR BILLS. HEALTH CARE BILL A MUST BAD BILL OR GOOD GET IT DONE THEN YOU HAVE 4 YEARS TO ADD OR REPLACE. LOOK AT ALL THE PEOPLE WHO LOST THEIR JOBS ALONG WITH THEIR HEALTH CARE PLAN. THINK IF YOU PAID 200 A MONTH FOR 5 OR 10 YEARS THE GOT FIRED ALL THAT MONEY DOWN THE DRAIN. COMMON SENCE

"Defense-related expenditures outside of the Department of Defense constitute between $216 billion and $361 billion in additional spending, bringing the total for defense spending to between $880 billion and $1.03 trillion in fiscal year 2010."

"By the end of 2008, the U.S. had spent approximately $900 billion in direct costs on the Iraq and Afghanistan Wars. Indirect costs such as interest on the additional debt and incremental costs of caring for the more than 33,000 wounded borne by the VA are additional. Some experts estimate these indirect costs will eventually exceed the direct costs."

Keep these figures in mind when you bring up the TEN YEAR cost of the health insurance reform law. The U.S. spends more on defense in ONE YEAR and ...not a peep from conservatives. Republicans were 100% in charge when they blew through the same amount in half the time...looking for WMDs in Iraq. lol Also, keep in mind that those wounded soldiers (as do all soldiers) use a single-payer healthcare system. If you really think single-payer is socialism...feel free to try and take it away from them.

"Defense-related expenditures outside of the Department of Defense constitute between $216 billion and $361 billion in additional spending, bringing the total for defense spending to between $880 billion and $1.03 trillion in fiscal year 2010."

"By the end of 2008, the U.S. had spent approximately $900 billion in direct costs on the Iraq and Afghanistan Wars. Indirect costs such as interest on the additional debt and incremental costs of caring for the more than 33,000 wounded borne by the VA are additional. Some experts estimate these indirect costs will eventually exceed the direct costs."

Keep these figures in mind when you bring up the TEN YEAR cost of the health insurance reform law. The U.S. spends more on defense in ONE YEAR and ...not a peep from conservatives. Republicans were 100% in charge when they blew through the same amount in half the time...looking for WMDs in Iraq. lol Also, keep in mind that those wounded soldiers (as do all soldiers) use a single-payer healthcare system. If you really think single-payer is socialism...feel free to try and take it away from them. Originally Posted by Longermonger

"PEEP!!"

Yep - and I'm all in favor of keeping the Defense department budget up. It's one of the two federal government programs that are run well (the other is the National Park Service). We fight the wars overseas so that we don't have to fight the wars here on our own soil.

I have/had family members in the VA system, and, yes, it is single-payer. It is also one of the worst run medical systems I have ever seen. The doctors working in the VA hospitals are usually brand new or are from medical schools overseas and have no doctor-patient rapport that you would find with a personal physician. Waiting times for procedures are long and, for example, my FIL, who needed quadruple-bypass surgery, had to be moved from his home hospital in Sioux City to Houston in order to have this surgery, after waiting 4 months in the hospital before getting approved. Single payer/socialized medicine systems are really wonderful. I would love to take this away from them if the free-market would allow veterans to get quality health care rather than the bureaucracy they have to put up with in the current system.

The lawsuits that have been submitted on behalf of the 17 states are based on two points:

1) Violation of Amendment X - in which the mandate of the states to fund the increases to their Medicare rolls to cover the increased number of individuals that would be enrolled in their Medicare programs is an unfunded mandate that violates the states' rights clause of the Constitution. Unfortunately, this point has a slim chance of success because there have been other unfunded federal mandates that were litigated and dismissed.

2) Violation of Amendment XIV - in which the federal government mandates that individuals purchase a product for their own use and fine those that do not make that purchase. This point may have a chance of succeeding, as it would be difficult for the federal government to show that the purchase of a product for the individual's own use rather than for the use of the government would be considered a tax, and be covered by a US Supreme Court decision in 1937 in which Social Security contributions by employers and employees are not specifically earmarked for the Social Security program and are considered taxes.

I'll be running a betting pool to see when this thread implodes.

I was part of the military's single payer system. I have lots of bad stories...lots of them. Its that simple. It was a poor standard of care, often by doctors who could not achieve a license issued by one of the states.

The insurance for dependents was so confusing, they had a newsletter, where people could write in and ask 'is this covered'. The answer was always the same: 'Have the procedure, file a claim, and see if it gets approved'????

Here is the federal budget for last year:

http://en.wikipedia.org/wiki/United_...federal_budget

Defense was big (23%)...but we are in the midst of an existential fight...so its hard to do without.

Entitlement programs are of course the biggest.

Scroll down and look at the graph which shows how explosive the entitlements become after 2030.

We're broke. The whole country is 4 months past due on the rent, and we just bough a new flat screen tv. I'm sure alot of people feel 'good' about the new bill...but the money has to come from somewhere.

Recent news about a shakey bond sale:

http://socioecohistory.wordpress.com...-bond-auction/

I ask as many young people as I can: "How much money does the Federal Government Have?"

Most don't know...they come up with some number in the billions (recently its changed to trillions ).

Answer - nothing, nada, not a thin dime. Even the gold reserves really just back the currency. Every time the government gives...it also has to take.

Now, human nature being what it is...what stops me from cancelling my health insurance, paying a small fine every year, and if I get sick just sign back up? As far as I can tell, nothing. Why wouldn't everybody eventually use this strategy. Then, the only people left in the pool of paying insurance premiums would be sick people...completely defeating the purpose of spreading costs and risks through insurance.

This is not a difficult problem to fix if one actually wants health care reform instead of advancing a particular political ideology.

Solutions to large problems require teamwork and full contribution from team members. Improving healthcare will require the government, private market, and individuals to each contribute their particular skills.

The government’s strength is market regulation. The government can create rules, incentives and disincentives that shape the market. For example, making mortgage interest deductible resulted in large increases in home ownership. Prudent market regulation helps the market provide desired goods and services that might not otherwise be provided for a variety of reasons. However, there is a huge difference between the government regulating the market and the government participating in the market.

The private market is best at efficiently and effectively providing the vast majority of goods and services within our economy. The market allows for efficiency, quick responses and innovation not normally found in the political or bureaucratic process.

For any solution to be successful over the long term, it must preserve individual dignity and responsibility. When the individual is reduced to merely a passive recipient of government assistance or has no power of choice in the market, the individual becomes disengaged and loses incentive to provide for themselves.

So, how do we use the skills of these team members to improve access to and the quality of healthcare in this country?

By treating healthcare like we do food.

Food stamps are vouchers that the government issues for food purchases. The individual takes the food stamps to the grocer of their choice to purchase the food of their choice. The need for food is met through the private market (grocery stores) with the government paying for those unable to afford it. The government regulates what can and cannot be purchased with food stamps. The government uses the market (grocery stores) rather than providing the food directly. The individual retains the power of choice and market participation.

Treat health insurance the same way. Vouchers could be issued to purchase insurance. The individual would take the voucher to the insurance company of their choice and purchase the health insurance of their choice. Insurance companies could compete for this new pool of customers. The individual must select the coverage just as they select the food from private grocery stores with food stamps. Individual choice and dignity are preserved.

A sliding scale could be used to issue vouchers in varying amounts. For the very poor, vouchers could cover 100% of the cost of the insurance. The amount could be reduced and phased out as income moves up. Those with the means to provide it themselves should provide it themselves. If they choose not to be covered, that choice should be honored but they should be ineligible for certain other government assistance should they find themselves in need due to their failure to act responsibly. Help should be provided for the needy, but effective assistance requires people to experience the natural consequences of their own actions and decisions, both good and bad.

With more people being covered, the government could regulate pre-existing conditions, coverage requirements, co-pays and deductibles just like it regulates certain purchases with food stamps. The cost would undoubtedly be lower than anything currently being proposed. The private market would do what it's best at (providing goods and services in a competitive environment) and the government would do what it's best at (regulating without participating in the market). The individual still retains choice and autonomy but is given necessary assistance to be covered by health insurance.

You have to use the government, market and individual equally to solve these problems by allowing each to do what they do best.

I have always thought that health care could be handled by tort reform and by opening up medicare to those under a specified graduated income level. Meaning These people pay premiums based on there ability to pay and at a certain level their care becomes free. I never saw the need for a complete overhaul of the system except if there is an another agenda. Personally I think this is the first step in a complete government takeover. I mean I just can't get the Presidents words out of my head when he said in an interview in the Dem primarys that he could see 15 or 20 years down the road where there will be a single payer system. If the true goal was really insuring those uninsured then there were simpler and more ecomnomic ways of doing things. I know many in this society think that the government should run everything but I am not one of them. I do find it really interesting that they stuck a federal take over of student aid in the health care bill.

I'll be running a betting pool to see when this thread implodes. Originally Posted by BigMikeinKC

IMO it won't be long. It's naive to think this group can discuss politics and/or religion in a civil manner. I think a good share of the thread starters know that and start them just to cause trouble. Hmmm? Sounds like trolling to me.

This is not a difficult problem to fix if one actually wants health care reform instead of advancing a particular political ideology.

Solutions to large problems require teamwork and full contribution from team members. Improving healthcare will require the government, private market, and individuals to each contribute their particular skills.

The government’s strength is market regulation. The government can create rules, incentives and disincentives that shape the market. For example, making mortgage interest deductible resulted in large increases in home ownership. Prudent market regulation helps the market provide desired goods and services that might not otherwise be provided for a variety of reasons. However, there is a huge difference between the government regulating the market and the government participating in the market.

The private market is best at efficiently and effectively providing the vast majority of goods and services within our economy. The market allows for efficiency, quick responses and innovation not normally found in the political or bureaucratic process.

For any solution to be successful over the long term, it must preserve individual dignity and responsibility. When the individual is reduced to merely a passive recipient of government assistance or has no power of choice in the market, the individual becomes disengaged and loses incentive to provide for themselves.

So, how do we use the skills of these team members to improve access to and the quality of healthcare in this country?

By treating healthcare like we do food.

Food stamps are vouchers that the government issues for food purchases. The individual takes the food stamps to the grocer of their choice to purchase the food of their choice. The need for food is met through the private market (grocery stores) with the government paying for those unable to afford it. The government regulates what can and cannot be purchased with food stamps. The government uses the market (grocery stores) rather than providing the food directly. The individual retains the power of choice and market participation.

Treat health insurance the same way. Vouchers could be issued to purchase insurance. The individual would take the voucher to the insurance company of their choice and purchase the health insurance of their choice. Insurance companies could compete for this new pool of customers. The individual must select the coverage just as they select the food from private grocery stores with food stamps. Individual choice and dignity are preserved.

A sliding scale could be used to issue vouchers in varying amounts. For the very poor, vouchers could cover 100% of the cost of the insurance. The amount could be reduced and phased out as income moves up. Those with the means to provide it themselves should provide it themselves. If they choose not to be covered, that choice should be honored but they should be ineligible for certain other government assistance should they find themselves in need due to their failure to act responsibly. Help should be provided for the needy, but effective assistance requires people to experience the natural consequences of their own actions and decisions, both good and bad.

With more people being covered, the government could regulate pre-existing conditions, coverage requirements, co-pays and deductibles just like it regulates certain purchases with food stamps. The cost would undoubtedly be lower than anything currently being proposed. The private market would do what it's best at (providing goods and services in a competitive environment) and the government would do what it's best at (regulating without participating in the market). The individual still retains choice and autonomy but is given necessary assistance to be covered by health insurance.

You have to use the government, market and individual equally to solve these problems by allowing each to do what they do best. Originally Posted by Racerunner

RR - you make some excellent points and a methodology of distribution that I had neither thought of nor heard espoused by anyone in this debate. I would take your idea one step further, in allowing the purchase of insurance across state lines. In this way, the lowest price insurance would be available regardless of the location of the insurer. I would disagree, however, in allowing the government any power to regulate pre-existing conditions, coverage requirements, co-pays and deductibles - that should be up to the individual insurer in how it markets its product. Competing firms will make the most attractive product available based on the firm's morbidity experience and the pool of insureds under its plan. I would also like to see small businesses who would be otherwise be ineligible to purchase group insurance to pool their businesses together and purchase group insurance from a common carrier - that would provide coverage for most individuals otherwise not covered in the present system.

I have always thought that health care could be handled by tort reform and by opening up medicare to those under a specified graduated income level. Meaning These people pay premiums based on there ability to pay and at a certain level their care becomes free. I never saw the need for a complete overhaul of the system except if there is an another agenda. Personally I think this is the first step in a complete government takeover. I mean I just can't get the Presidents words out of my head when he said in an interview in the Dem primarys that he could see 15 or 20 years down the road where there will be a single payer system. If the true goal was really insuring those uninsured then there were simpler and more ecomnomic ways of doing things. I know many in this society think that the government should run everything but I am not one of them. I do find it really interesting that they stuck a federal take over of student aid in the health care bill. Originally Posted by dirty dog

DD - the provision regarding the take over of student aid was stricken from the "fix-it" bill, which requires the House to re-vote on it - but I believe it's been removed. And, I agree with you that the whole purpose of this exercise is the complete takeover of the free-market system by the federal government. John Dingell, the most senior House Democrat stated on a Detroit-area radio station on Tuesday morning that the purpose of Obama-care is to "Control the people".

http://www.breitbart.tv/shocking-aud...rol-the-people

The Bamster has stated time-and-time again that he wants a single payer system and that his goal is to have it in place 10 years after he enacted his first plan. This is why there is so much anger and vitriol expressed in the general public - they see their freedoms evaporating in front of them by a government run by 60's radicals that believe they can construct a socialist utopia and have willing accomplices in the media support their cause.

"I think a good share of the thread starters know that and start them just to cause trouble. Hmmm? Sounds like trolling to me."

Hmmmm so does this comment

IMO it won't be long. It's naive to think this group can discuss politics and/or religion in a civil manner. I think a good share of the thread starters know that and start them just to cause trouble. Hmmm? Sounds like trolling to me. Originally Posted by Omahan

Nope. Not trolling, just hoping that moving the focus away from the specific bill that passed to what the system really needs might reduce the level of vitriol. And I didn't think putting that long a screed in someone else's thread would be appropriate. Part of what makes the whole issue so tough to deal with is the fact that everyone is emotionally invested in some way.

Help should be provided for the needy, but effective assistance requires people to experience the natural consequences of their own actions and decisions, both good and bad. Originally Posted by Racerunner

In theory, I agree. Actions have consequences. But executing a policy decision like that requires being able to say to a 55 year old father of three, "You chose to smoke two packs of cigarettes a day for the last 30 years and you chose not to buy health insurance. Now you have lung cancer. Because of your previous poor choices, you aren't going to be treated. Now go home and die quietly." Who gets to have that conversation?

Sooner or later everyone is going to develop a serious health problem. When they do, they want and expect to be treated regardless of their ability to pay.

As to a civil discussion about health care, only too happy to oblige.

I feel there is no need for medical insurance companies. They make coverage expensive with their costs, and offer nothing to improve service. They get between me and my doctor when they dictate to him what they will pay for. They are a "no value add". These things may sound like opinion, but it's not opinion, it's fact.

The only thing that the insurance companies do that is valuable is employ people. That is a VERY important fact. Something would have to be done to help them. Except for perhaps their higher management they are human and have families as well as I do.

But tell me, has anyone got the math on what would happen if we did make them go out of business? How many jobs would be lost? How much would be saved if we just said to Cigna, Kaiser, Blue Cross, Coventry and all the rest, "Go away and take your denials of coverage with you? I would like to know that information.

What if every CITIZEN were covered? Covered for everything...whatever medical treatment their Dr.'s say they need to be healthy. Rx too. How much would that cost? No fair copping out and giving a blanket "Too much, that's what it would cost!" Really what are the numbers? How much would the economy benefit from a healthier work force? How many families would not be forced into bankruptcy by medical bills they can't pay? What kind of dollar figure would that be?

Politically I understand many of you are loathe to give the government more money. Frankly some of you are loathe to give it ANY money. That is understandable, since our wages have been mostly stagnant (when adjusted against inflation) over the last 40 years. If the government gets more money then it gets a larger percentage of what we make both actual and cost adjusted for inflation.

The other side of that is Medicare. What if everyone got Medicare? What would the math be to make up what Medicare needs to cover every CITIZEN, and what we could gain by cutting out the "no value add" insurance companies and giving a portion of what we used to pay in premiums to Medicare? Medicaid and SCHIP would go away. You'd see the Doctor you want, and could even get a supplemental policy like seniors do now to handle the deductibles. The increase in those policies numbers would lessen the number of people that would have to be let go from those insurance companies. Rx would be covered, as there will be a gradual closing of the Part D "donut hole". Who wouldn't want that? I know Kansas and Missouri cops will be pissed about any donut hole going away, but hey who cares?

There is the ideological problem of giving the government that kind of power. But they have that power over us eventually anyway, as soon as we turn 65 and go on social security and Medicare. DD wants his Medicare, I want mine, and I assume everyone wants theirs too. How much extra would this cost us? Would it be worth it to you?