I just heard on NPR

[AVG-JOE]

The base problem is that young workers dump tons of money in to the "Health Care System" via insurance premiums paid to a private, for profit bureaucracy, and then, when they turn 65 and start seeing doctors more regularly, the private bureaucracy that collected all those health-care dollars in the past tells those workers to fuck off and send their medical bills to the taxpayers via Medicare.

Whatever 'system' we come up with needs to be one that collects from us while we're young and pays for us when we're old.

The current system of collecting from young workers and then dumping them on the taxpayers when they start needing services and using the resulting 'profits' for a new Jag and a marketing meeting in Aruba isn't working.

 

[thewanderer]

I'd really love to see just that kind of reset. But it's hard to imagine finding much agreement on a 'clear understanding of the mistakes' we made. That's really the crux off the political dysfunction. We can't even agree on what problem should be solved.

Exactly. Which is why I have been saying for a long time now the first thing that needs to happen before we decide anything else is that we have to come to some sort of consensus about what level of making sure everyone has access to health care (and how much and under what circumstances) we can agree on as a nation. Then we can figure out how to deliver it, whatever "it" is.

I personally estimate that the vast majority of Americans would agree that everyone in this country should have access to some level of health care services regardless of ability to pay.

What I see working best to deliver that goal is a combination of both public and private health care services, just like we have in our educational system. Public clinics and even hospitals for people who can't afford to pay out of pocket or who are simply satisfied with public services and private clinics, hospitals, and insurance for people who want shorter wait times, better quality services, etc. and are willing and able to pay for it.

I don't see any other way to effectively deal with that goal. If we're not willing to let a significant number of people simply go without (and I'm convinced that collectively we're not), then I don't see any other way to do it.

 

[thewanderer]

The base problem is that young workers dump tons of money in to the "Health Care System" via insurance premiums paid to a private, for profit bureaucracy, and then, when they turn 65 and start seeing doctors more regularly, the private bureaucracy that collected all those health-care dollars in the past tells those workers to fuck off and send their medical bills to the taxpayers via Medicare.

Whatever 'system' we come up with needs to be one that collects from us while we're young and pays for us when we're old.

The current system of collecting from young workers and then dumping them on the taxpayers when they start needing services and using the resulting 'profits' for a new Jag and a marketing meeting in Aruba isn't working.

Excellent point.

 

[dblack]

I'd really love to see just that kind of reset. But it's hard to imagine finding much agreement on a 'clear understanding of the mistakes' we made. That's really the crux off the political dysfunction. We can't even agree on what problem should be solved.

Exactly. Which is why I have been saying for a long time now the first thing that needs to happen before we decide anything else is that we have to come to some sort of consensus about what level of making sure everyone has access to health care (and how much and under what circumstances) we can agree on as a nation. Then we can figure out how to deliver it, whatever "it" is.

...

Well, maybe. In my view, the first thing we need to do is restore balance to the health care market.

The problem that you're wanting to tackle first, what to do about people who can't afford health care, is completely dependent on the cost of health care. If the market dysfunctions causing health care inflation aren't corrected, no one will be able to afford it and your problem will be impossible to solve. Likewise, if market sanity is restored, and prices come back to some kind of reasonable equilibrium, dealing with people who can't afford health care becomes a much more manageable problem.

 

[dblack]

The base problem is that young workers dump tons of money in to the "Health Care System" via insurance premiums paid to a private, for profit bureaucracy, and then, when they turn 65 and start seeing doctors more regularly, the private bureaucracy that collected all those health-care dollars in the past tells those workers to fuck off and send their medical bills to the taxpayers via Medicare.

Whatever 'system' we come up with needs to be one that collects from us while we're young and pays for us when we're old.

The current system of collecting from young workers and then dumping them on the taxpayers when they start needing services and using the resulting 'profits' for a new Jag and a marketing meeting in Aruba isn't working.

I'm glad you quoted the word 'system'. It's obviously a very loaded term in this context and includes a number of assumptions and implications depending on how it is used.

When you say, "Whatever 'system' we come up with ...", for example, are you suggesting that a 'system' be designed and imposed by centralized authority? Or are you referring to the organic result of people making their own decisions?

That's a fundamental question we seldom ask ourselves and skipping over it results in all kinds of problems.

 

[AVG-JOE]

All I'm saying is that whatever 'system' is employed to track payments out and premiums in should collect from us while we are young and healthy and pay for us when we're old, on a fixed income and seeing lots of doctors.

Whether its fair and free competition across state lines for private health insurance companies or a single payer option I don't really care. Collecting premiums from young healthy workers for 40+ years and then dumping them off on the tax payers via Medicare is not fair to the tax payers and not the way 'insurance' is supposed to work.

Editorial: Health care CEO salaries outpace even health care costs : Stltoday

 

[Foxfyre]

50 years ago, healthcare was affordable for most Americans. If you went to the doctor you paid out of pocket the $5 to $10 fee plus whatever x-ray or shot or other treatment that you received just as we paid out of pocket for home repairs, auto repairs, getting the television or lawn mower fixed. Insurance didn't kick in until you had exhausted a fairly high deductible. A semi-private hospital room was affordable for most and hospitals worked out a monthly pay plan for those who didn't have insurance or the money for their deductibles.

And then the government got involved.

Almost from Day One costs were no longer market driven and began escalating at an unprecedented rate that has accelerated as the years pass. And now we have unaffordable healthcare costs for most Americans and just as high a percentage of uninsured people as we had before. Except now the uninsured people aren't supposed to work out payment plans with healthcare providers. They look to the rest of us to pay their bills.

It is so simple people. Get government out of the healthcare business altogether except for what regulation is necessary to prevent monopolies and unfair trade practices and let the market work. Insurance companies, healthcare providers, pharmaceutical companies cannot stay in business without customers. Take away their biggest customer, the U.S government with its deep pockets, and they all will be forced to find ways to make their products affordable so the rest of us can buy them. Voila!!! Affordable healthcare again.

 

[dblack]

Whether its fair and free competition across state lines for private health insurance companies or a single payer option I don't really care.

And if it's something else entirely?

 

[Pop23]

50 years ago, healthcare was affordable for most Americans. If you went to the doctor you paid out of pocket the $5 to $10 fee plus whatever x-ray or shot or other treatment that you received just as we paid out of pocket for home repairs, auto repairs, getting the television or lawn mower fixed. Insurance didn't kick in until you had exhausted a fairly high deductible. A semi-private hospital room was affordable for most and hospitals worked out a monthly pay plan for those who didn't have insurance or the money for their deductibles.

And then the government got involved.

Almost from Day One costs were no longer market driven and began escalating at an unprecedented rate that has accelerated as the years pass. And now we have unaffordable healthcare costs for most Americans and just as high a percentage of uninsured people as we had before. Except now the uninsured people aren't supposed to work out payment plans with healthcare providers. They look to the rest of us to pay their bills.

It is so simple people. Get government out of the healthcare business altogether except for what regulation is necessary to prevent monopolies and unfair trade practices and let the market work. Insurance companies, healthcare providers, pharmaceutical companies cannot stay in business without customers. Take away their biggest customer, the U.S government with its deep pockets, and they all will be forced to find ways to make their products affordable so the rest of us can buy them. Voila!!! Affordable healthcare again.

This is absolutely correct

Nothing is perfect, but reality is not perfect. The reality is that when you look to government to solve a problem they simply make the bad worse. That is by design. The health care "system" became a giant jobs program. The more Uncle Sam could screw it up, the more jobs the politicians could claim they provided.

 

[Foxfyre]

All I'm saying is that whatever 'system' is employed to track payments out and premiums in should collect from us while we are young and healthy and pay for us when we're old, on a fixed income and seeing lots of doctors.

Whether its fair and free competition across state lines for private health insurance companies or a single payer option I don't really care. Collecting premiums from young healthy workers for 40+ years and then dumping them off on the tax payers via Medicare is not fair to the tax payers and not the way 'insurance' is supposed to work.

Editorial: Health care CEO salaries outpace even health care costs : Stltoday

But you see a private single payer option is a monopoly which will never be as effective or affordable as a competitive enterprise - or - it must be managed by government which never, in the history of civilization, has done things as efficiently, effectively, or with as much innovation as the private sector can do things.

The choices are that we a) let the government take our money, choose how to spend it, and direct how we will be required to live our lives - or - b) we manage our own money and choose how to spend it and how we will live our lives.

If the government takes our money, it will require a huge percentage of it just to feed and serve the government. If we spend it, and do so wisely, we get full value for what we spend.

The government has no business collecting money from us now on the pretext that it will use it for our benefit later. Let us save and grow our own money for what we will need to buy later. If the government MUST be involved, set up a voluntary catastrophic medical plan that people can buy in case their own modestly priced everyday health insurance won't cover a catastrophic illness. So few people would need the catastropic coverage that it could be very affordable just like federal flood or earthquake insurance.

And let us have medical savings accounts that are tax free up to XXX dollars each year and whatever we don't need for medical expenses, we can roll over and use for whatever tax free. What great incentive to live a healthy lifestyle and avoid medical expenses.

There are so many private sector solutions that government will never be able to do. We need to get away from this notion that government can solve our problems and we don't need to.

 

[thewanderer]

The problem that you're wanting to tackle first, what to do about people who can't afford health care, is completely dependent on the cost of health care.

Not exactly. If the answer to the question I want us to really answer is, "No, people who can afford health care have no obligation to those who can't to make sure they have some sort of access to it," if that's the answer we collectively come up with, then the cost is irrelevant.

 

[dblack]

The problem that you're wanting to tackle first, what to do about people who can't afford health care, is completely dependent on the cost of health care.

Not exactly. If the answer to the question I want us to really answer is, "No, people who can afford health care have no obligation to those who can't to make sure they have some sort of access to it," if that's the answer we collectively come up with, then the cost is irrelevant.

The problem of people not being able to afford health care is directly dependent on the cost of health care - regardless of whether (or how much) we decide it's a communal responsibility. My point is that doing something about the artificially inflated costs is the first problem we should address, definitely not something to consider as an afterthought.

 

[Foxfyre]

The base problem is that young workers dump tons of money in to the "Health Care System" via insurance premiums paid to a private, for profit bureaucracy, and then, when they turn 65 and start seeing doctors more regularly, the private bureaucracy that collected all those health-care dollars in the past tells those workers to fuck off and send their medical bills to the taxpayers via Medicare.

Whatever 'system' we come up with needs to be one that collects from us while we're young and pays for us when we're old.

The current system of collecting from young workers and then dumping them on the taxpayers when they start needing services and using the resulting 'profits' for a new Jag and a marketing meeting in Aruba isn't working.

But that is not what insurance is or was ever intended to do.

While some insurance policies are set up for dual roles; i.e. life insurance that both provides a designated payment of cash in the event of the person's death AND, if the person doesn't die, accumulates a cash value to be claimed later on in lieu of life insurance. . . .

All other insurance policies, including private health insurance, are covering us now/today for specified perils that might occur today. It is true that premiums are established via a mathematical probability that most people who buy the insurance will pay more in premiums than the insurance company will pay out in claims and expenses. But that isn't a matter of 'saving up' our premiums to use at a later time.

The more the risks can be spread over a wide area, the cheaper the premiums can be. The more people are willing to assume some of the risk themselves via higher deductibles, the less risk there is to the insurance company and the cheaper the premiums can be. Safe drivers who drive fewer miles will enjoy lower auto insurance rates than will people who have multiple accidents and drive long miles. People who are not engaged in high risk activities or lifestyles and keep themselves healthy will enjoy lower rates for life insurance and health insurance than will those who do not do that. Also private insurance companies don't always have to collect as much as they pay out for long term policies because they can invest and grow the surplus cash they have on hand and that too helps them keep premiums lower. The government cannot do that. Or it doesn't It just sees cash on hand as money that should be immediately spent.

Monopolies at the government or private level are usually not good because there is no incentive to be better than the other guy when there is no other guy.

With enough regulation in place to prevent unethical and usurious or unfair trade practices with impunity, nothing is as effective as the free market to keep costs lower and a superior product available to the people.

 

[thewanderer]

The problem of people not being able to afford health care is directly dependent on the cost of health care - regardless of whether (or how much) we decide it's a communal responsibility. My point is that doing something about the artificially inflated costs is the first problem we should address, definitely not something to consider as an afterthought.

I get your reasoning; I'm not sure you get mine.

The simple fact that you feel that we collectively should solve a problem about the cost of health care presupposes that you have a position regarding the question I feel we need to answer, which is exactly why I feel we need to ask it. Again and again, as many times as it takes, until we actually resolve it. You're serving as a great example of why i think we need to do this, in fact. Everyone's running around assuming that we're trying to reach the same goal and talking about the same problem and I don't think we are.

If we decide that we are unconcerned with providing access for all, then the solution to your question is extremely simple. In that case there is no problem to solve...we simply go to a cash system and allow a completely free market to sort it out. The proponents of cash claim that such a system would lower costs, and it would, at least regarding health care.

There will be a lot more care that, from a clinical standpoint, should be delivered that doesn't actually get delivered, and it would result in smaller problems going untreated and therefore growing into bigger problems and workplace absenteeism, presenteeism, disability and worker's compensation would go through the roof, but we've decided we don't care about that...the most important thing is lowest cost for each individual health care expense, so there you go.

If, on the other hand, we decide that we want to get costs as low as possible while still providing access to everyone, that's a lot harder problem to solve. Both government and 3rd party pay artificially inflate costs.

We've got to know exactly what problem we seek to solve before we can effectively solve it.

 

[dblack]

I get your reasoning; I'm not sure you get mine.

I didn't, but thank you for clarifying. I've sliced up your post for clarity, I'll try not to take anything out of context.

The simple fact that you feel that we collectively should solve a problem about the cost of health care presupposes that you have a position regarding the question I feel we need to answer, which is exactly why I feel we need to ask it. Again and again, as many times as it takes, until we actually resolve it. You're serving as a great example of why i think we need to do this, in fact. Everyone's running around assuming that we're trying to reach the same goal and talking about the same problem and I don't think we are.

This brings a smile to my face, because it's a key point in the health care debate, and something I've been going on about for years to anyone who would listen. We're trying to solve two different, but related, problems and we need remain aware that the solution to one will likely have profound effects on the other. It feels odd getting chastised on this issue (usually I'm the one pointing this out), but I think you're misconstruing my point here.

If we decide that we are unconcerned with providing access for all, then the solution to your question is extremely simple. In that case there is no problem to solve...we simply go to a cash system and allow a completely free market to sort it out. The proponents of cash claim that such a system would lower costs, and it would, at least regarding health care.

There will be a lot more care that, from a clinical standpoint, should be delivered that doesn't actually get delivered, and it would result in smaller problems going untreated and therefore growing into bigger problems and workplace absenteeism, presenteeism, disability and worker's compensation would go through the roof, but we've decided we don't care about that...the most important thing is lowest cost for each individual health care expense, so there you go.

If, on the other hand, we decide that we want to get costs as low as possible while still providing access to everyone, that's a lot harder problem to solve. Both government and 3rd party pay artificially inflate costs.

We've got to know exactly what problem we seek to solve before we can effectively solve it.

Indeed.

For the point I'm trying to make here, I don't have any specific solutions in mind, I'm merely trying to identify an obvious priority. I get what you're saying regarding the "access" problem. If we go with either of the extremes you suggested (laissez faire or government guaranteed health care) the solutions to the inflation problem melt away: in a free market costs would find sane equilbrium, if the state is financing health care they can pretty much name their own prices.

But there's no clear consensus on either of those extremes. We're not going to get real free market in health care, and we're not going to get single-payer-for-all, taxpayer funded health insurance. Regardless of the promises of our leaders, we're going to get something that works out to an expanded safety net. We'll pay for as much health care for the poor that we can afford. And here's my point - how much we can afford will depend directly on what it costs.

If we don't do something about inflating health care prices, it won't matter how badly we want to provide health care for all - we won't be able to. If we do succeed at bringing prices down, "access" becomes much easier - both for people paying for it themselves, and for the government when it pays for those who can't.

 

[Pop23]

Insurance is always misrepresented in this debate, as foxfyre correctly pointed out.

If you want a system that works, the word insurance should not be a part of the discussion.

 

[Harry Dresden]

Competition in the market place - the Rs hate that but its causing insurance premiums to go down and insurance companies to compete for business. That's partly why people are getting refund checks from their insurance companies.

The days are gone of insurance companies deciding who gets treatment and who does not.

Only problem is that, as we've seen, the GObP will fight to keep Americans from getting the same coverage we pay for them to have. If its so bad, why doesn't congress give up their own?

The GOP's Worst Very Likely Nightmare: Obamacare Succeeding - Occupy Democrats

If its so bad, why doesn't congress give up their own? ???

strange question......

Congress wont give up theirs because theirs is much better.....and we probably pay for theirs.....

 

[Foxfyre]

Of course we pay for theirs.

 

[Foxfyre]

Insurance is always misrepresented in this debate, as foxfyre correctly pointed out.

If you want a system that works, the word insurance should not be a part of the discussion.

I don't have a problem with insurance being a part of this discussion as long as it is a regulated free market system. Regulated ONLY to the extent of keeping us from doing economic, environmental, or physical harm to each other with impunity.

But the question has to begin with who is responsible for my healthcare. Me? Or you? Or Avg-Joe? Or everybody else?

If that isn't the first question on the list to be answered before all others, we won't get anywhere in any discussion.

 

[AVG-JOE]

50 years ago, healthcare was affordable for most Americans. If you went to the doctor you paid out of pocket the $5 to $10 fee plus whatever x-ray or shot or other treatment that you received just as we paid out of pocket for home repairs, auto repairs, getting the television or lawn mower fixed. Insurance didn't kick in until you had exhausted a fairly high deductible. A semi-private hospital room was affordable for most and hospitals worked out a monthly pay plan for those who didn't have insurance or the money for their deductibles.

And then the government got involved.

Almost from Day One costs were no longer market driven and began escalating at an unprecedented rate that has accelerated as the years pass. And now we have unaffordable healthcare costs for most Americans and just as high a percentage of uninsured people as we had before. Except now the uninsured people aren't supposed to work out payment plans with healthcare providers. They look to the rest of us to pay their bills.

It is so simple people. Get government out of the healthcare business altogether except for what regulation is necessary to prevent monopolies and unfair trade practices and let the market work. Insurance companies, healthcare providers, pharmaceutical companies cannot stay in business without customers. Take away their biggest customer, the U.S government with its deep pockets, and they all will be forced to find ways to make their products affordable so the rest of us can buy them. Voila!!! Affordable healthcare again.

50 years ago insurance companies wanted nothing to do with the elderly because of all those pesky claims they file, so Medicare was invented.

Sending our 'health-care dollars' to private bureaucracies when we're young and working and then sending our medical bills to the tax payers when we're old seems stupid to me.