… how much, I don't know.
Conservatives now really really hate the individual mandate, in spite of the fact that it was invented in a conservative think-tank, it was pushed by conservatives for years, and introduced into our health care legislation by that Rock Of Conservative Purity (OK, maybe not) Mitt Romney.
Liberals hate it because it's a big fat giveaway to the insurance companies. And, you know, insurance companies are incurably evil, no matter how much we regulate them or outlaw bad practices or whatever.
Well OK. And I don't like mandates very much either. All things being equal … hey, just leave me alone and I'll decide if I want insurance, all right? Step off, Big G.
Thing is, if you don't have insurance and get hurt … someone else picks up that tab. Who? Well, maybe you, if you're stuck with the bill and can actually sort of pay it — which may well land you in the poorhouse. And if you can't, and you default or go bankrupt? Other ratepayers pay for it, or it gets carved out of the hospitals and doctors income, which they likely make up in charging higher rates to everyone else. There Is No Free Surgery.
So, going without insurance is emphatically not merely a personal choice, like what kind of cell phone to have or what color underwear to buy. Because one way or the other, everyone else has to pay for you.
And if you don't like having to pay an insurance company, and think it should all come out of taxes … well, then, you're a single-payer purist. That's a position with intellectual merit! It's right! I even agree! And it's completely politically impractical right now. There aren't the votes for it; the country's not there. I wish it were, but changing that has already been, and will continue to be, a generational process. And in the meantime more people will go bankrupt and die young because they lack insurance, and the rest of us will pay more and higher premiums.
So, there was some back-and-forth about how necessary the mandate was back in the 2008 Dem primary … and maybe it's not the be-all and end-all. It's certainly not synonymous with “the health care bill” in toto. Still, it's easy to imagine how those who have health problems (or expect to use health care services) will buy insurance, and make claims on it; meanwhile the “healthy” decide to drop it. This means ever-higher rates for the users, leading to more incentive for people to drop, etc. etc.
So, you know, I don't like it either. But I understand it. And policy is about making choices between real options, not between individual mandates on one hand, and ponies and bunnies on the other. Liberals cheering the challenges to the individual mandate should think twice.
…but I submit that you are often too much of a realist, and not enough of an idealist. You’re constantly yielding to what can work now or what will get 60 votes in the Senate, whereas I’d prefer to fight a little harder to eviscerate the 60-vote rule or show leadership to get to where our preferences become workable. When Jamie Eldridge ran for Congress he often said, “I’m not running to follow political reality; I’m running to create political reality.”
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p>As for the mandate, I think it’s constitutional, but stinks on the merits, especially without the public option component. There should be a way to allow for me to purchase with a long-standing condition like my mild cerebral palsy, but not for a week-old cancer diagnosis. On another thread someone suggested this will force us toward single payer.
We will end up with government-sponsored single payer.
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p>We have an opportunity to get there in a managed way. If, through such idiocy as blocking the individual mandate, we force the current system to collapse, then we will get there in an un-managed way.
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p>It occurs to me that the government can mandate that insurance companies and/or providers must provide needed care — squeezing the already destitute is not an option.
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p>The right wing must be forced to confront the reality that the current health care legislation is their best option. All the other alternatives will be far worse for their corporate owners.
and also realize they perform an important service of in many cases stopping unneeded expensive procedures.
… when they actually stop being villains.
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p>I think you mean ‘preventing unneeded’ proceedures. Stopping one already in progress would, I daresay, not contribute to lowering expenses =-).
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p>The problem, and the villainy, is that they don’t specifically target unneeded and expensive procedures but that they target ANY expensive procedure. In some cases the bar for ‘expensive’ is low enough such that they are effectively targeting any procedure.
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p>This does lower the cost… TO THEM. Unfortunately, it raises the cost to the rest of us as deferred care festers into urgent (and orders of magnitude more expensive) care…
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p>Any citation or substantiation for that absurdly broad claim. Reality and all….
why should I do your homework for you ?
How Crafty Health Insurers Are Denying Care
I know that in the mid-nineties, the reason why health insurers wanted the most significant database and analysis technology possible was in order to deny claims. I know because I was the expensive “Managing Architect” contracted to design, plan, and execute the information systems they used to accomplish this.
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p>The clients I worked for (I worked for a major company whose name you know for health insurers whose names you know) hired claim investigators with training in the health-care services in order to use their expertise to pick apart claims.
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p>The workflow processing engines (and the workflow processes they supported) were intentionally designed to provide numerous opportunities to delay, obstruct, and redirect otherwise-valid claims. Entire departments were measured by, and their capital equipment budgets pegged to, the total dollar volume of claims rejected. Nobody in those departments cared about patient outcomes; the laser focus was on reducing claim payouts.
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p>These were multi-million dollar contracts, usually well north of ten million dollars. I leave the question of deriving the dollar volume of claim reductions that justified those huge expenditures as an exercise for the reader.
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p>At no time did any of my clients express concern about potentially negative consequences for health care or patient outcomes. Not once.
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p>This is not “villainizing” health insurers, this is my first-hand report of the behavior I witnessed.
Lots of things have changed since the mid nineties.
You think this behavior is different now? I think the onus is on you to show even a little bit of evidence to support that extraordinary claim.
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p>This is what they’re doing. It is what they have always done. It is how they show a profit, and they are showing comfortable profits. The challenge you face (and I understand your desire to duck it) is to explain how it’s good for anybody except those who temporarily profit from the short-term economic advantage such rapacious behavior yields.
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p>As in so many other things, follow the money.
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p>Such treatment forces people to get more expensive ER care. More expensive ER care means higher profits for insurers and providers (both peg their rates to the dollar volume they transact).
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p>The buck stops with the individual consumer, who must fight (I alternate gender pronouns in the interest of neutrality):
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p>I think we consumers need some help countering this relentless pressure, because we cannot do it alone.
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p>Every American is entitled to receive affordable high-quality health care.
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It’s different all right – it’s worse now!
I won’t argue that the insurance companies are tight in their goals of making more money (and keeping premiums low). My point was they do question treatment/test… which should be questioned. If it were up to Doctors they would test you for a hundred things and see if anything turns out. I believe insurance companies often limit the tests in a logical sequential manner. I’ve seen this first hand and I’m sure everyone else has to.
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p>The Insurance companies are not perfect and I’m not trying to say they are. They are trying to keep costs down so they can make a good profit and keep our premiums down. The real culprit is the actual costs.
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p>Let me ask you this, have you ever gone to the Doctor and taken a test (say some blood work)… and then you schedule a visit in 1 or 2 weeks to go over the results of the test when it could all be done over the phone. Why? I asked a Doctor (my Mother’s) why they did this and he said they have to see the patient to bill them, phone calls can’t be billed. I know this is a small thing but these kind of changes should happen.
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p>If you believe this then keep pushing as you are.
… incentives haven’t.
You might be tempted to think that liberals “hate” insurance companies because, well, you think we hate all companies bigger than a local organic, wild-flower florist.
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p>In fact, though, our busy-bee wonks have been gathering lots of data to substantiate a rather negative view of how insurance companies operate.
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p>Like some on the wonky side of the continuum, I’m disinclined to attribute this behavior to moral attributes (greed or kleptomania). I am inclined to think of it as a result of the current market and regulatory environment.
Can you imagine how happy people would be if the corporatist health care nightmare was over? If the process had resulted in single payer, the Democrats would have gained seats in Congress and the conversation would be much different today.
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p>We’ve had 18 years of “pony/bunny avoidance” and it’s not worked out well. In fact, it’s a bloody catastrophe. Maybe we should go back to ponies and bunnies.
The individual mandate is the tax that pays for universal coverage.
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p>There are two groups of uncovered in the country, those who choose no coverage and those who can’t afford it. To make insurance affordable for those who can’t afford it, the risk pool has to be larger. Those unlikely to need insurance need to pay in. Without the mandate, the system doesn’t have enough money to cover those who can’t afford insurance.
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p>No mandate, the whole thing falls apart. It’s why there’s a mandate in Massachusetts and in Obamacare. The issue of the not likely to need insurance needing insurance and not being able to pay for it is a relatively minor issue.
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p>That said, the mandate is the only way to have universal coverage with private insurers. As Ezra Klein notes, killing the mandate just makes single-payer more likely.
it will be found unconstitutional to limit one’s choices for coverage. What you will get is an inequitable system where those in the public plan will get poor coverage as doctors and hospitals cater to those with private insurance. This is already happening in Quebec as a result of the Supreme Court of Canada saying that it is against the Charter of Rights and Freedoms to prohibit people from buying private insurance, or paying a doctor themselves.
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p>Let the true free market work. Get rid of HMOs move to a catastrophic based insurance system and bring down the cost of health care for all.
The approach you propose will result in health care costs skyrocketing, as the “free market” drives more and more people to avoid preventive care (because of cost) and instead rely on acute care.
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p>The cost of letting readily avoidable conditions turn into catastrophic illnesses is astronomical.
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p>Unless, of course, you suggest that we instead force the poor and destitute to simply die from lack of health care.
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p>Our market is as free as we can get without moving towards cost control via assisted suicide…
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p>As has been pointed out previously the whole and entire affect of overturning the individual mandate will be to turn some bright lamps upon the reason for the mandate: politicians unwilling to tell the insurance companies directly that they should stop with the crazy amounts of administrative overhead directed at care denial. This monstrously cruel and cruelly inefficient cycle of rejection and care deferral is the reason for costs. The individual mandate is a compromise between the need to insure everyone and the unwillingness to face down insurers. If the individual mandate is unconstitional then single payer is inevitable.
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p>Free market principles have led us to this point.
… models and insurance don’t mix. At least they don’t provide the efficiency optimizing results the free market is supposedly promising. It’s much closer to a lottery because although what you think you’re buying is a product that could be described as ‘coverage’, what your really buying is a right to participate in a risk pool (with some profit skimmed off the top). To the extent that you think everyone should have a basic minimum set of rights to medical treatment, and to the extent that you want that treatment to be affordable, then the state has an interest in the make-up and quality of the financial/medical risk pools that make up our insurance system. If you want a private market, then a mandate becomes a necessary thing since your giving up the states ability to manage the pools (where it has an interest) itself. This is why virtually everywhere else where there is a private market for health insurance, there is either an individual mandate or a tax system mandate. The only reason the state uses a mandate is because it’s the simplest most efficient way to keep private pools that are inclusive and dollar efficient. The simplest and most efficient would be a single pool funded with taxes.
In the MA law, there is an alternative similar to the auto insurance ‘deposit’ option. If you choose not to purchase health insurance, then the state will intercept your MA tax refund up to a ceiling of $10,000 (the bond amount you have to deposit with the Treasurer to not buy auto insurance). If you are not using the state as a Christmas Club, your financial penalty will be negligible. Point is – the state isn’t FORCING you to engage in commerce, and the free care pool is reimbursed for caring for you when you fall downstairs and break your leg.
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p>And that is leaving aside the issue of the Feds usurping the purview of the states – isn’t the LAW giving authority to states in matters of insurance still on the books? It’s cited as the reason why we can’t buy across state lines!
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p>The original Romney plan was good, in that it allowed catastrophic coverage in conjunction with MSA’s. DeLeo stripped that, with his ‘nanny state’ mentality and forced HMO coverage. And speaking as someone who used to design self-insured plans, an HMO is like having a lawyer on retainer if all you plan to do is write a will. Every dollar paid in premium is a dollar lost forever – you are far better off, barring chronic illness, with a catastrophic plan and savings to meet a deductible of several thousand dollars. That’s what self-insurance IS.
is pretty much the same. Prior to the HMO craze of the 80s and 90s many large corporation “self insured” that is took the entire cost of their employees upon themselves. Of course since we outsource most of our manufacturing to the Chi-Coms now we don’t have many very large corporations left.
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p>My parents as employees of BASF in Bedford had a company self insured plan in the 1970s and early 1980s.
… there is nothing stopping anyone from doing exactly this right now. Of course, unless your pool of employees is large enough, this is likely to be wildly inefficient. About the only example I can come up with of a system like you describe is the US military.
Here’s how it worked – A company with 20 people bought a policy (usually Gerber or Mutual of Omaha) with a deductible of, say, $5,000 per person. The premium on this ran about $10 pp, or $200/mo. They would place on deposit with us $100,000. We’d contact the doctors and ask them to bill us, and ask test compaines, etc. to do so as well and we paid them. At the end of the month, we sent them a bill to ‘top off the tank’ of benefits actually used, plus a 5% administration fee. The only money expended was for benefit received, plus the $200 catastrophe fee.
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p>The employer could structure their own co-payment schedule, from zero to 50/50 to $25, etc. However they wanted to handle it.
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p>I remember during the height of the Baystate Ins. crisis, we had companies where if every man, woman child and dog covered by the policy maxed out in a single year they would STILL pay less than their HMO premium.
… not quite “self insurance”. That is, the pricing on your premiums and deductibles were based on your membership in a larger risk pool (Gerber’s or Mutual of Omaha’s).
There was no membership pool.
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p>The castrophe was a stop-gap coverage. It was more like a hole-in-one policy for a golf torunament. Gerber/MOA had no expectation of every having to pay off. In fact, when you went higher than a $5 or $10 thousand ceiling, the rates went into cents instead of dollars.
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p>Even self-insurers like the state have a stop-gap coverage beyond a certain dollar amount.
… that under certain circumstances you dipped into an insurer’s money, then you’ve paid them to handle a financial risk – and I doubt you were the only one. Thus you were in a pool, however the particulars were worked out.
Without the public option or a single-payer system, decent health coverage will continue to be prohibitively expensive for far too many people. Right now, if you are self-employed, the premiums needed to purchase health insurance are personal budget busters. It’s like making a second mortgage payment every month. Mandating the purchase of such insurance is simply imposing yet another burden on a growing number of people who don’t have employer-sponsored health coverage.
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p>In abandoning the public option, President Obama tossed out the potential for true health care reform in order to get something passed and be able to say he was the first president to pass health care reform. Now this supposed accomplishment of his first year in office is starting to crumble around him. But without the public option, it was never much of an accomplishment.
catastrophic insurance plans from Massachusetts.
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p>The only way, and I think this is what conservative think tanks were thinking, to reduce costs is to get away from HMOs and single payer type plans and to real health insurance. That is a catastrophic plan. Where you pay for all of your healthcare to a certain amount and then your insurance kicks in. That would drive down costs by making doctors compete, it would allow doctors to get by with less administrators and would restore the doctor patient relationship.
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p>That is real healthcare reform. HMOs were a poison pill invented by Ted Kennedy to march us closer to socialized medicine where the government gets to decide who live and dies by whom they give medical procedures too. Any true civil libertarian should be scared out of their mind about that prospect.
Given the choice between a government bureaucrat who we, the people, can influence and an insurance company bureaucrat who we, the people, cannot influence, I would rather have the government bureaucrat make such a decision.
… interesting flaws. When you hit your ceiling, what are your incentives as a health care consumer to avoid hitting your ceiling X 2, or X 10? How about incentives for your doctor to avoid this problem?
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p>I don’t think you’ve thought this through.
… the question. What incentives for an HMO to do what exactly?… pay out everything above a subscriber’s ceiling? They have all the incentive in the world to keep from paying out. What am I missing?
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p>Since you state that you are against Eabos plan, you must, therefore, be completely and totally in the tank for HMO’s. AS such a brutal and aggressive proponent of HMO’s, by virtue of having said nothing whatsoever about them… it’s up to you, now, to defend them even more staunchly with, you know, words and actual, like… effort. It’s simple, doncha see!?!?
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p>Group health insurance is inherently, inseparably and (for you) inconsolably socialized medicine. If you are against socialism of any kind, you must (should you prize consistency) be against the very concept of group insurance. That’s fine, if that’s what you want. But you can’t have it both ways: either you adopt it or reject, but you can’t try to craft it whilst simultaneously rejecting it.
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p>No a “Conservative” is someone who believes that privately he or she has the obligation to help those in need, but the government has no right to force others to do so.
… do-gooders, by the very voluntary nature of their work, hamstring themselves in pure market competition utopia of conservatism. After all, making sure that do-gooders and non-do-gooders alike take on the burdens of society’s needs is no way to run a society, I guess.
is never a way to run a society. Isn’t that why we threw the yoke of British rule off of us 235 or so years ago?
The Articles of Confederation proved that voluntary taxation failed miserably. Government coercion is how we stop a multitude of crimes. It is how we ensure that we have a literate electorate.
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p>Are you an anarchist as well as a right-winger?
… with any public obligation to one’s fellow man or society. All obligations are voluntary and for the individual to decide. So much for funding the US army.
is part of the constitution. The nanny state isn’t.
“Promote the general welfare” immediately follows “provide for the common defense” as a reason for ordaining and establishing the Constitution, and thus by extension the nation and its government.
… federal program not linked to the constitution directly (as Christopher notes, “the general welfare” seems an awfully flexible phrase to just dismiss), is coercion to fund. Hmmm… no national mall, no national parks, no hoover dam, no NASA, no FBI, no US highway system, no SEC, no EPA, no USPS (even when there wasn’t a private alternative), no Federal research grants (unless defense related), no Congressional staffing, no non-defense federal construction. That’s off the top of my head.
…when ELECTED representatives are making the decisions. THAT is the big difference compared to our relationship with Parliament. Exactly which freedom does this violate again? It does none of the following:
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p>Cancel free, fair, and regular elections
Deny equal protection of the law
Constitute and ex post facto law or bill of attainder
Deny your right to speak, write, assemble, petition
Force you to practice religion against your will
Abridge your right to bear arms
Force you to quarter troops
Overrride requirements for a search warrant
Allow you to be tried twice for the same crime
Force you to testify against yourself
Deprive you of counsel or a jury trial
Inflict cruel and unusual punishment
Inflict upon you slavery or involuntary servitude
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p>Those are our freedoms; I think I got them all.
..is that many conservatives claim that we were founded as a Christian nation and thus advocate for our laws to be Biblically based. Petr is suggesting they are not putting their money where their mouth is and advocating helping the needy which the Bible suggests is a societal obligation as well.
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p>If you believe in Christianity and if you believe in representative democracy there is nothing in opposition: the represented, being Christians, should vote for those who best express their Christian values and most particular amongst those values, from Moses to David to Isaiah, Amos, Micah and to Mary, all the way to the Man himself, is how you act towards the poor and the hungry. A smoothly running Republic predominantly comprised of Christians ought to express fully that particular “obligation to help those in need“, and no Christian should feel oppressed by it in the slightest.
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p>That might be true, it might not be. It might have been especially not true if the Democrats just came out and supported it in Congress — a simple, elegant, how about this? proposal. But they didn’t. They never even tried it. I agree, it wouldn’t have gotten the votes, even with that month of work. But so what? Spend the month. Move the ball in that direction. Hell, force a compromise with the GOP where you simplify and expand existing single payer… simplify by merging VA, Medicare, Medicaid, and other overhead programs, and then expand by offering single payer Medicare to federal government employees currently on private insurance, as an option. Had the Dems done those sorts of things, I think progressives would have been OK with an additional outcome of mandate.
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p>But starting with mandate, ostensibly as a cost control measure, never really made sense. Fix the insurance companies first so folks don’t hate their product, or offer a tolerable product directly from the government. The solution to crappy health care isn’t forcing folks to have more crappy health care.
It’s even a bill. There are sponsors. But not enough.
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p>Look, to get to single-payer, we need to change our culture first. I don’t like that conclusion, but I think it’s unavoidable.
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p>And by the way, I supported Jamie Eldridge in 2007 for the precise reason that his health care thinking was more clear-eyed, progressive and ambitious than the others.
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p>Am I too much of a realist? My goodness, compared to what my gut instincts tell me about every issue, that’s an amazing comment — gratifying, I suppose.
Being a bill is pretty much the literal meaning of the phrase “on the table.” That the President isn’t particularly inclined to talk about it is a symptom of the fact that it doesn’t really have that much support in Congress, not a cause.
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p>In order to make single payer be politically viable it’s not enough to merely propose the idea. The bully pulpit is not magic. You have to actually work to get politicians to like single payer. By old fashioned lobbying, by electing politicians who support single payer, and so on. If the President said nice things about single payer that would help somewhat, but he has said nice things from time to time. The problem lies elsewhere.
“Fix the insurance companies first so folks don’t hate their product”
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p>Like ending exclusions on pre-existing conditions? Done.
Like requiring community rating to make sure that risk gets spread around? Done.
Like requiring insurers to spend 80-85% of premiums on care? Done.
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p>And on and on.
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p>Looking at the individual mandate without the context of the industry reforms is blinkered. I’m not saying that I know for sure that “crappy health care” is a thing of the past; but a lot of the abuses have indeed been curbed in the new law.
but it doesn’t get around the reality that the more insurance companies deny care, the more money they make. It’s a fundamental. So we played whack-a-mole. The mole will pop up elsewhere.
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p>Furthermore, they could have put a bunch of those regulations (like community rating and 80-85%, as well as gender-neutral rates) without the mandate and the pre-existing condition game. They could have made insurance better first, and then rolled out the mandate. They could have also expanded those who are eligible for direct gov’t care in the ways I wrote about above. They could have done both of those things before the mandate.
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p>I’ve never liked the mandate. I wrote about (against?) it when Kennedy and Romney were sitting around a table signing the thing in MA. I know it makes folks uncomfortable to use the word, but government requiring folks to enter into contracts with private businesses (for profit or not) is fascism. Governments are always “free” to make people pay for government services — that’s called taxes and fees.
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p>Ending exclusions on pre-existing conditions is ending one particular mode of care denial.
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p>Requiring insurers to to spend 80-85% of premiums on care is the progressive version of ‘starve the beast’… Administrative overhead directed at care denial currently eats up way more than 15-20% of premiums
While were at it let me explain how government drives up the cost of care.
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p>1. AMA and congress limit the number of seats available each year fro medical school. Increase the supply of doctors and you will reduce the cost of paying these same doctors.
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p>2. Delivery of care: CVS Minute Clinic is a innovative care delivery system that will redcue cost and increase access for patients. But, Massachusetts did not allow CVS to offer “chronic care” medicine at Minute Clinics in Mass. CT, VT, NH, ME all have “chronic care” offerrings but not here in Mass, thanks Partners Healthcare!
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p>Two simple examples of why government is the problem not HMOs or patients. The free market is choked to death by government and not allowed to lower cost, incrase access and improve healthcare in Mass and the USA
You’re right on (1) and probably on (2). Your conclusion is nonsense. Your free market is right out of Upton Sinclair’s literature.
What seats are you refering to and how are they limited? You make it sound like there is some sort of quota on the number of people who can become doctors each year. I can’t possibly be interpreting this correctly.
I’ve read the wikipedia and a couple of other articles about it, so I have an idea how it works, but I still am not clear on a few points.
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p>If a national single payer system was implemented, would it forbid private insurance from providing the same service?
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p>If private insurance is still allowed, would people who choose to partake of it be responsible for paying fees into the single payer system? (i.e. my kids go to private school but my taxes still go to public schools)
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p>Does single payer directly pay doctors and hospitals, or are insurance companies still being used in an ancillary manner?
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p>And from Charley: As a consistent and clear voice of support for single payer, what are the pitfalls or negative aspects of a single payer system relative to what we currently have?
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p>In theory it’d be fine, as long as the revenue for the public risk pool was collected. In this way, you’d be covered by both a public and private option. The point here isn’t that you shouldn’t be allowed to ‘opt in’ to alternatives, but that you shouldn’t be allowed to ‘opt out’ of the main pool. The easiest way to ensure this kind of a thing politically is for the public single payer system to be paid for by non-specific revenue sources. That is, make id a general expenditure, like defense.
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p>Yes, see above. Contributing to the welfare of the national risk pool (and thus ensuring it’s efficiency) would be an unskirtable obligation, like paying for national defense even if you’re a pacifist or public police even if you have private security.
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p>It could work either way. The latter method would be one where the ‘single payer insurance company’ (i.e. the gov’t) would contract out the processing to private insurance companies. The private insurance companies would actually be insurance companies in the sense of owning a risk pool for themselves, but would be hired to administer a segment of the large risk pool. Their profits would just be from deducting their costs, but unlike regular insurance, their costs wouldn’t have to do with the quality of their risk pool. It’d really just be a volume processing business.
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p>The risk is that the administration of the large pool becomes a bloated bureaucracy. In the case of the US, this is hardly a risk because the inherent bloat from factors such as profit, administration of adverse selection, and advertising, as well as other structurally related problems that result in higher costs for us, are so so so much higher than any kind of “administrative waste” we’d likely see.
…but this should answer your questions. Scroll down to the “Elements” section for key components. Yes, it would prohibit private insureres from offering duplicative services. It’s essentially Medicare for all, though you are probably seeing a lot of TV ads this month for supplemental plans because open enrollment ends the last day of the year.
The insistence that this was NOT a tax when the bill was being debated is what makes them look foolish now saying that it really is. If it’s a tax, Congress has the power to levy. If it’s NOT, it dosn’t have the power to compel economic activity. Allow, regulate, subsidize – yes. Compel, no. It’s this white lie that’s going to sink them.
“How much money should we spend to continue a life?”
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p>I read a story in the Globe this weekend about an elderly Indian man (91 years old) who was in the hospital for the last 2-1/2 years for a variety of ailments. While the story is centered on his unpaid balance, a startling take-away message I got was they spent over $3,000,000 on this one man. How much money are we suppose to spend on keeping people alive?
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p>I can understand the visceral response to that question is “Whatever it takes!” but some sobering analysis might determine that we cannot afford to spend these outrageous sums of money on people, especially when they get to be very old.
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p>I’m sure this issue deserves its own diary but I think the third rail reality of what I am bringing up is that while it is swimmingly easy to point our fingers at the evil Insurance companies in their pursuit of record profits as the cause of the spiraling costs of healthcare, I think we have to look into the real causes of the huge costs… caring for the elderly.
JohnD is volunteering to head a death panel.
AS I said, of course the answer we would all give is that we need to do whatever it takes to save someone’s life. But while I’m no expert in medical costs, I believe I’ve read that 80% of the money spent on a person’s medical costs will be spent during the last year of their life.
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p>How do you answer the question David? If your answer is “unlimited” then I would love to hear from Social Service providers to find out how many lives would be “saved” by spending $3,000,000 in other ways? Matter of fact, maybe there are all sorts of people who would tell you countless lives could be saved in many ways such as preventive care, education, interventions, homeless care… with $3,000,000 vs it being spent on one elderly person.
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p>Conversations like this may be the 800 pound gorilla very soon in our country.
This is what Sarah Palin and Michelle Bachmann labelled death panels. And socialist. And unamerican.
but David said I “volunteering to head the death panel”. I have no idea what the solution is but I thought it was worth talking about. When I start asking to “kill Grandma” so we can use her hospital bed, then you can call me the Grim Reaper…
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p>You’re using data points from a badly derived, monstrously inefficient system to justify changes to our ENTIRE outlook on medicine… rather than TO THE SYSTEM!!
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p>This is a radical notion.
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p>If you shopped at a supermarket that sold you spoilt meat three times outta five, I doubt very much you’d be all ‘I can’t afford to shop anywhere else… so I might as well just accept the consequences of eating spoilt meat.’
why does it cost $3,000,000 dollars to take care of a person for 2.5 years. Someone is making a profit there, a very big profit, probably an obscene profit.
Like I said, these exorbitant costs are the issue, not the Insurance companies!
A significant portion of that $3,000,000 covers the cost of the many uninsured patients who every facility treats.
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p>Yes, the profits are obscene. I’ll feel much better about health care costs when the average doctor drives a ten year old vehicle with over 100K miles like I do.
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p>Nevertheless, those last 2-3 years of care for the very elderly are generally in hospitals whose facilities are used to treat indigent patients with no money and no insurance.
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p>Those who have can pay for their treatment pay (more) for those who cannot.
if the health insurance they’re forced to buy is affordable and high quality, like a single payer system. I assume we would have been thrilled with a German-style system, too.
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p>The problem with the mandate as its been enacted is it will fail both of those measures, when it’s rolled out. Let’s not forget about the soft underbelly of the Massachusetts Health Care Reform Act of 2006 that no one likes to talk about — it may have gotten us to 96 or 97% insured, but large portion of the state regularly chooses not to get medical treatment because they don’t think they can afford it. When people have deductibles that are upwards of $3,000 or $100+ copays, they’re going to hold out going to the doctors unless it’s absolutely dire.
We’re at 98.1% insured, btw. Hawaii is #2, way behind @ 91%. Virtually all kids in Massachusetts have health insurance.
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p>Much more here:
http://www.mass.gov/Eeohhs2/do…
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p>MA maximum deductible is $2000/individual, $4000 for a family. Out of pocket expenses are capped @ $5000/individual, $10k/family.
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p>http://www.mass.gov/Ador/docs/…
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p>
what good is insurance if people can’t afford to use it? They’re paying $$ for nothing. That’s not the problem with every mandate, but it is a problem with our mandate, and a worse problem for the federal mandate — which is going to force worse insurance on people throughout the country than Ma’s.
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p>Simply put, with crappy insurance, people will put off going to the doctors as long as possible if it’s going to have to come out of their own pockets, or even if the copay is unreasonably high. We need to realize that, just maybe, this is for a reason.
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p>Yeah, Blue Crap Blue Care’s subsidized plans may help them in a dire emergency — better to owe $2000 or $4000 than $200000 or $400000 — but people don’t think in those terms whenever they feel sick and first suspect they need care, and in most of those emergencies, those people can’t be denied care anyway.
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p>We shouldn’t force that kind of crappy insurance on people. At a personal level, if someone has a choice between no insurance or the FUBAR variety, they’re better of going no — even if at the societal level, we’re better off throwing the albatross around their neck and hoping they don’t drown from the crap they can’t afford. You’re thinking about the system, I’m thinking about the people drowning in it.
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p>Again, I’m not arguing against the mandate. I’m arguing against the current Ma policy and the national policy which won’t even be as good — it ain’t what it’s cracked up to be. Until we’re less interested in the % of people who are insured, and more interested in the % of people who are getting the care they need, I’m really not interested in any mandate worship at the alter of missing-the-forest-for-the-trees librul paint-by-number politics. The % of people who are insured in Massachusetts is a smokescreen — masking the problem that people still aren’t getting the care they need, even if they’re paying an arm and a leg for the ‘privilege’ of insurance that doesn’t do anything for them.
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p>Throw in a public option, or medicare-for-all plan, and maybe we’ll be having a different conversation. Until then, though, it’s highly unlikely we’ll be able to regulate insurance companies enough to make sure enough of their dollars goes to bedside care to make sure the insurance they’re forced to buy is affordable and accessible.