Health Care: The Policy Choices--And Where To Look For Help

KT: Thanks for providing the links. I hope you are going to continue to spotlight the healhcare crisis in some of your threads If your stories result in even one person getting the care they need to survive, you're doing an outstanding service.

[...] Swampland - TIME.com created an interesting post today on Health Care: The Policy Choices–And Where to Look For HelpHere’s a short outlineRon Brownstein lays out five big ones here. Also, I am belated in linking to a terrific story that our Austin stringer Hilary Hylton did on some folks who are doing heroic work for cancer patients and their families–the American Cancer Society’s National Cancer Information Center. As I noted in my cover story this week, the center’s Health Insurance Assistance Service has gotten calls from more than 20,000 people since it began in 2005. It now serves 36 states and the District of Colum [...]

KT,

Great cover story and btw, you looked great on Washington Week last night.

I have to say that I thought your article was excellent. Being a Brit living in Germany, I didn't realise how random the insurance system in the US was. Whatever other people say about the social healthcare here in Europe, I can honestly report that I have always taken it completely for granted.

Very nice and clearly laid out. Thanks for posting it. My only objection is his use of the generic "The Left" not to be confused with "many on the Left." While he doesn't seem to be attributing fictitious positions to that group (as many who use that construction do) he does end with:
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The common theme across them is that Obama cannot achieve universal coverage without demanding flexibility and concessions from all interests, including his closest allies.
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If Obama is disagreeing sharply with "The Left", why is it still OK to refer to them as "closest allies."

Thanks for some more information. What I find depressing is that the debate is all about how to satisfy some constituency. If basic health care is a necessity why can't it be part of our budget process? Why dowe need health care profit centre? I can understand if you want a private room, special treatment, instant access: then you pay the premium. But all Brownstein tells me is that from the moment health care became a business we got drawn into the profit web.

The whole legacy costs issue is a bad outcome of unions who pushed the envelope when they were powerful, resulting in some one retiring at age 55 and getting health care after that. Legacy costs are not an issue in Canada and Europe.

What is wrong with a guaranteed level of basic care, with payment for plus, plus?

Shorter insurance industry:
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We'll finally start taking care of sick people as long as you send us a big pool of well people to pay for it!
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Makes perfect sense actually......

The Industry Lobbyists are firmly controlling the debate about health care reform. They keep us focused on providing "health insurance for all" instead of redesigning the broken system so we get the most health and the least suffering for our precious health care dollars, 60% of which is tax payer money. Controlling cost is paramount and that isn't going to happen until we have a system in which the explicit goal is health. "Health, Money and Fear" is a 48 minute video that explains why health care costs so much, what it says about us, and what we can do about it. It is available for viewing, in chapters, at http://www.ourailinghealthcare.com

Check it out. You will be startled by the quality and content of the production.

We need to shift the debate from providing health insurance to providing cost effective health care. Until then the non-system will continue to maximize profits instead health. What we have now is a very bad joke.

But other insurers might quietly welcome a government plan as leverage to force price cuts from doctors and hospitals.
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I truly enjoy how "the Left" love to stipulate how big government and big spending will "cure" the ails of the masses. When in fact, what ails everyone is poor preventive medicine in America.
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Socialized medicine has been a failure in all countries who have implemented, and demanded such, yes even Canada.
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Here is a great link I found that spells out the truth;

http://www.echeat.com/essay.php?t=31715
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In particular, I like this touching story.
"In the countryside there are at most two doctors for an entire area. These doctors must see everyone and are usually on call 24 hours a day. This was not a problem for most rural doctors because due to the increase in work they had a direct increase in pay. In fact, until the salary caps, most rural doctors were averaging 10% higher incomes than city doctors were. After the salary caps these rural doctors still had the same amount of work but could no longer make higher incomes. In the city physicians now made just as much money and with much less work. This created doctor shortages in rural areas and has had some very negative effects such as this story taken out of a local newspaper:

The hospital rebuilt just two years ago, cost $15 million. Virtually on its doorstep, Joey and his father waited for an air ambulance. The boy was flown from Valleyview to Grand Prairie and then to Edmonton, delaying his medical care for nearly an hour. The next morning, doctors at the University of Alberta Hospital declared the lad dead of head injuries”(C.S. 11).".
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It seems that "waiting" is synonymous with socialized health-care. Waiting too long, and you are dead. Is that the new democrat strategy? Provide socialized health care, and "wait" until we kill the masses, and hopefully those that vote democrat will survive?
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I am truly sorry for your brother's condition Karen. But, had he lived in Canada his condition would be considered chronic, and he would have waited for treatment, despite the free coverage. How long do you think he would survive with a "wait and see" medical condition?
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I think you are totally off-base on both of your blog's and your time article. I suppose in America you can loose your money due to the high cost of health care. But, if you have money in Canada and England stashed away in the bank, but you cannot get the medical treatment you need and eventually die, what good is money in the bank?

How to fix the current logjam...
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1) set up a "medicare for all" system on the federal level
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2) require everyone to purchase health insurance, but provide a generous subsidy based on income. (For instance, people making minimum wage should not be required to pay at all...)
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3) require health insurers to have ONE PRICE for everyone -- no "pre-existing conditions" or "age based" variability.
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4) require health insurers to offer at least one plan that provides the same level of coverage as the federal "medicare for all" option -- and require that no plan provide less coverage than "medicare for all"
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5) Limit the tax deductability of health insurance plans to what "medicare for all" costs
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6) Impose a "sales tax" on all insurance plans that cost 10% more than "medicare for all"
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7) impose a "health care tax" on employers who don't pay for at least 75% of "medicare for all" toward their employee's health care cost -- regardless of the size of the company.

Congressional Democrats estimate that a universal coverage plan would cost double or triple the $634 billion Obama has proposed to set aside.
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but it would also relieve state & local governments, and employers (and hospitals) of the cost of providing medical care/insurance -- and there would probably be a net savings...

rustyreturns: I can give you ten examples in Canada to prove your point. I can give you hundreds of examples in the US to prove that even here people die because they don't get health in time. The issue is that for a vast majority of people getting health care in Canada is easier and less costly (out of taxes) than it is here. We think we are so superior!

Obviously, this is a complicated issue. However, Obama's summit is at least putting all parties on record. There will be none of the stealth campaign against health care that took place in the nineties. By making sure all parties are at the table and giving them an opportunity to come up with alternatives, insures that all the parties involved have to make concessions. And the transparency so far is making all parties subject to market backlashes if they are seen as sabotaging the initiative.
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The one thing I wish was pointed out a little more is that while the insurance companies seem to be saying that they will take on the sick if they get more guaranteed access to the healthy. But as someone who is sick now, why do they need to take on more healthy people to justify maintaining my coverage? Doesn't my in surance premiums paid over the last thirty years when I was healthy cove any expenses I am causing now?
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I'm just saying, this is just another example of twisted capitalism. Privatize the profits and leave the losses to somebody else. The market is supposedly about profiting from risk but where is the risk in this kind of approach. Isn't this the problem with AIG, they sold insurance on securities but didn't put any money aside for paying claims and now tax payers have to do it.

it would also relieve state & local governments, and employers (and hospitals) of the cost of providing medical care/insurance -- and there would probably be a net savings...
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If this could be realistically estimated one way or another...

And the transparency so far is making all parties subject to market backlashes if they are seen as sabotaging the initiative.
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HAHAHAHAHA!!!!
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In case you did not know that socialized medicine has not been tried in America, John Stossel, reporter for ABC News has a great article he did in 2007 for Real Clear Politics.
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http://www.realclearpolitics.com/articles/2007/08/let_wisconsin_experiment_with.html

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See Karen, even real journalist debunk your lame ideas for the rest of us in America! Go back to licking the boots of Obama, you are much better at that than real reporting.

Okay, admittedly the AIG analogy is a bit overly simplistic, but the premise is certainly accurate. We cling to a perception of cowboy capitalism that doesn't exist and for all I know may never have existed. What I see is the ultimate PR campaign that has convinced Americans that any collective solution is bad and only individual focused solution is American. What crap, if the American people are so opposed to so-called socialized solutions, if a government run health plan will be so poorly run that people will literally die in lines waiting to be seen, then why are they so afraid of any option that expands Medicare.
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The GOP says expanding medicare would make getting health care like going to the DMV or IRS. So if medicare is so bad why do seniors love the program? In fact, after thirty years of indoctrination that all government run programs are bad where is the out cry to get rid of the program? Even more curious is the anecdotal evidence that during the last few presidential campaign that many seniors deny that medicare is even a government program?

rusty please! Stossel is clearly among those following Conservative dogma.

Pluk, you laugh is that because you don't believe the public mindset has sufficiently changed to where they would want to exact a price for blocking health care reform?

It's not rocket science to realize that CEO salaries, golden parachutes, bonuses, and stock dividends take money away from patient care.
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It's also not rocket science to realize that doctors having to hire two administrators to handle coding from the myriad of different billing regimes from each of the HMOs adds a ton of non care related costs to bills.
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Now if HMOs would all like to share universal coding, cap executive salaries, etc, they may be able to compete with a government plan.

Oh my Dee please! Stossel is one of the few journalists, who still does investigative journalism.
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And, to to answer your question above about "where is the out cry to get rid of medicare"?
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Answer: You actually think you will have a government program like medicare when they socialize medicine? If you do, I would like to introduce you to a book called "Alice in Wonderland". Perhaps you will like it, as you seem very gullible and naive.
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But seriously, why Medicare works is that you have 70 to 80% of the population who support the cost of medicare that our senior citizens enjoy. Take and spread it out over the basis of "everyone" now has a program like medicare (including the democrats new voter base, illegal immigrants), and you are left with millions of people who will wait for medical treatment.
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"Save the young guy Doctor, and let that old woman die. She is about ready to croak anyways".

And for trifecta;

ICD-10 is the coding book utilized by all insurance companies and Physicians. ICD-10 along with DSMR-IV are used to code illnesses and disease. This is universal coding. With ICD and DSMR, payment for illnesses and diseases are completed by insurance companies along with a new "criteria" called "Interqual" developed by McKesson Corporation out of, hold your hat on now, SAN FRANCISCO, CALIFORNIA!!!
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Interqual criteria helps the insurance companies base payment on the evidence submitted by Doctors and other health care providers to obtain reimbursement for treatment.
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Here is a link if you would like to learn more.
http://www.mckesson.com/en_us/McKesson.com/For%2BHealthcare%2BProviders/Hospitals/InterQual%2BMilestones/InterQual%2BMilestones.html
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Believe me after working with HMOs for years now, if there was a way to keep from reimbursing one nickle, they would. The problem is not universal coding, salary caps or Obama's electronic medical record. The problem is we have more people than the current medical system can treat adequately. Under a universal health care / socialized system, more people WILL die. More people will go without treatment, and less research will be conducted because we will not have the government dollars to support it. All of the government money will be spent on little Joey going to the Doctor for antibiotics that he shouldn't get in the first place, rather than letting the virus run its course and allow a simple fever eradicate the virus.

Oh Rusty, just because Stossel presents as a more rational figure than Glen Beck, doesn't make him any less right wing. Whether or not he investigates is irrelevant because the prism through which he analyzes what he sees is hard core conservatism. Republicans have gone so far to the right like it's doubtful that Reagan could win in a Republican primary.
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And I'm confused, on the one hand conservatives call medicare socialized medicine and now you say if we socialize medicine we won't have a program like medicare? Okay new rule: To debate you must offer a sensible argument. Preferably one that is fact based or at the very least represents a perception in keeping with the general laws of physics.

rusty, you are an idiot. We pay tens of thousands for colds that turn into pneumonia from people using the ER as primary care. Why does everybody else do it cheaper?

In Health Care, we have extremely elastic demand in the context of limited resources. We can't afford proton beam radiation treatments for old men with prostate cancer while the needs of those with hypertension and diabetes go wanting. Rationing health care is inevitable. We have to decide if we are going to do it rationally in the spirit of social equity or irrationally to maintain profits. The taxpayer already foots 60% of the total bill, so essentially we are all paying for everybody anyway. Why not design a system that reflects this reality? Pool our health care dollars to offer a basic benefit package for everybody. It won't cover everything. If you want it and it's not cost effective for ALL of us to get it, you will have to pay for it yourself.
You can call it what you will: "single payer", "publicly financed, privately delivered health care"... The analogy is public schools which guarantee 12th grade education to everybody. So if you want to call it "socialism", we've got socialism in public education. No big deal.