Democrats versus Republicans

[Eric!]

Originally Posted by sck5

We ARENT the only country in the world that has good ideas. And when our health care is literally on the same level as COSTA RICA for Gods sake, then that ought to be a signal that we can do better.

Actually I like the care and cost better here in Costa Rica than in the US. Also we've had excellent care in Mexico, Nicaragua, Ecuador and Panama and not just minor things, things like cancer and kidney stone surgery.

[sailaway21]

sck5....heck yeah, we can improve our system...haven't you been reading the health care threads? A good start would be to allow market forces to go to work on it. The only government involvement I really see necessary is to get government less involved than it is at present. I'll leave the details for the health care thread and just posit the idea that what we really have right now is a political crisis that has very little to do with the non-crisis of health care. The Republicans have plenty of ideas on how to improve the system but it doesn't really matter what they have for ideas since the Democratic- controlled Congress has told them not to bother broaching any of them as they are strictly DOA. The administration doesn't want a debate on the matter, it just wants to get the nationalization horse saddled up as soon as possible. If you have not noticed, the Republicans cannot block ANY change, as you posit, and they cannot even ensure that their ideas will get a hearing. It's your Congress, Sport! Anything they and the Obamateur do, you're going to have to wear as your own. Yup, it's as if there weren't any Republicans at all.....which should remind one to be careful for what he wishes for.

You work under the conditions you choose to work. it is up to you to either negotiate more vacation or request unpaid time off. Most companies are quite reasonable about unpaid time off or a leave of absence. Most workers, on the other hand, elect to work as much as they can; it's a rather uniquely American phenomena. Take some time off and go sail, or leave a rich widow. But do not pretend that it isn't your choice. Or is it the case that you expect your employer and the government to be in charge of your happiness as well as your health care?

[PBzeer]

Health Savings Accounts. My prescription for health reform.

Fleshing out the details. What would an Health Savings Account look like?

First of all, the mechanism is already in place from the Bush Administration. So we aren't creating another government agency. There are though, qualifications that need to be changed. (In this respect, I feel the government does have a role, if not consistent with the Constitutional role, at least with current government practices.)

Like SS, everyone will have an HSA. (again, while I deplore the addition of yet another government mandate, it's the only practical solution, so I'll live with it.) Contribution limits (max and min) will be based on family size, and minors will be able to contribute to their HSA while still covered under their parents. Monies may be disbursed for any immediate family member (great grandparents through great grandchildren) above a certain minimum level of coverage for the one sharing. In other words, if you have, for example, 5k in your account, any amount above that can be used to assist immediate family member expenses.

Also, any amount above minimum can be invested in government debt vehicles. In other words, we buy our debt, rather than sell it to foreign countries. Once these investments reach a defined minimum, per person under the HSA, they can be used for specific purposes (purchasing a home, education or applied to one's catastrophic insurance premiums). Any and all monies are applicable to medical expenses at any time.

Catastrophic insurance will be the responsibility of the insured, with premiums to be from gross income as an incentive (tax free in other words). Employers may contribute to premiums, but aren't required to, and doing so would come with no tax advantage for them. (So, instead of being tied to a job by insurance, it would be simply an incentive to work for a particular business like wages are.) Employers would be able to make tax free contributions, ala 401k's, to an HSA.

Catastrophic insurance will be available nationwide and portable, regardless of employer or employment status. The only two regulatory provisions will be a basic coverage level and no restriction for pre-existing conditions. The insurance companies though, will be free to offer higher coverage, exclusionary plans, though they will be based solely on the consumers choice to pay for them, IF, they offer a basic non-exclusionary plan. In other words, they can't cherry pick their pool of participants to lower their costs, vis-a-vis those only offering the basic plan. (Of course, I don't hear a lot of outcry about auto insurance picking their pools, or charging higher premiums for even non-driving related reasons, ie: credit status, as well as on driving record.)

So, we have actual incentives that can actually control costs by making medical expenses the direct concern of the consumer rather than a third party. We have also introduced true market competition for those consumer dollars that can't be equaled by government "competition". But, beyond that, we have government creating equal opportunity, which is it's province, rather than trying to provide some unattainable equality of outcome, which is not it's mandate.

As an added benefit, if they just address the issues I've outlined, we're talking a 10 page bill as opposed to the 1,000+'s one's now being debated.

[Freesail99]

John,

As someone who lives with the health insurance night mare, and who was self employed. Isn't a Health Savings Accounts just another name for a premiumen ? Which would be based on family size, est ....

[PBzeer]

No, it wouldn't replace insurance. It would be the source of paying for common routine health expenses. You would still carry catastrophic insurance for coverage beyond the routine.

You would be paying cash for things like doctor visits, eye exams, minor injuries, etc. from your HSA. Because you would then be sensitive to the price of those services directly, cost would be a factor in your choices. Under insurance, you don't actually worry about the cost, but about whether you're covered or not ...... regardless of the price. Medical care is a service, just like a plumber or electrician, and is sensitive to consumer demand, which is what sets prices. (Any provider of a service will charge as much as they can, but not more than people will pay. That's how markets work.)

What happens is that as price pressures come to bear on the services, there is a direct incentive to the provider of them to not only contain costs, but to lower them if possible, so as to gain more of the market share. This, in turn, works to bring down the overall cost of healthcare, while the broader pool of insured helps to bring down the cost of insurance, along with the price sensitivity of a competitive market.

Somebody like windy or sway can probably detail the economic incentives better than I, but for example, look at the cost of phone service now, and prior to deregulation.

[ssneade]

amen, john.
it's like i was saying earlier; "health insurance today is not health insurance, it's a maintenance plan." you should be able to pay out of pocket for minor things, like checkups, new tires, having tour teeth cleaned, putting a new roof on your house. normal pregnancies in my opinion should not be covered by insurance, as well as drug and alcohol rehab, smoking induced illnesses and or any other self induced medical problems that may incur in your life. ya gotta man up and pay the toll for those. i wonder how much cheaper catastrophic health insurance would be if not for those?

[ssneade]

oh yeah, and don't even cry to me about not being able to afford insurance for your children. if you couldn't afford them, why did you have them? downloading heirs to your fortune means you have a moral obligation to care for them. if you have to work two jobs to do so, do it.

yeah, i'm a cold hearted bastard, but my kids are taken care of.

get a life, lardasses. don't expect me to pay for yours too. i didn't sign on for that

[Freesail99]

Medical care is a service, just like a plumber or electrician, and is sensitive to consumer demand, which is what sets prices. (Any provider of a service will charge as much as they can, but not more than people will pay. That's how markets work.)

That statement just isn't true in the real world. There are two prices, the full price for those who don't have insurance, and the discounted price ( read the price the HMO will pay the medical provider ). This is a sad fact of life. Did you know you can also negotiate the price of a procedure at a hospital? I do it all the time.

[PBzeer]

Most doctors and hospitals will negotiate price for cash payments.

The whole point is, you have to do something to make prices responsive to the consumer. And nothing in the current plans does that. The non-partisan Lewin Group, in fact, says they will raise prices. The CBO says much te same thing. We just aren't going to get from here to there with any of the current proposals.

[camaraderie]

In 1965 Medicare was passed and the government estimated it would cost 9 billion dollars in 1990. The actual cost was 60 billion.
During the Bush admin...it was projected that the prescription drug benefit would cost 350 million. THREE years later the cost was double that.

What multiple should we assign as the REAL cost of Obama-care??