The US has the best health care in the world?

[mheslep]

The Congressional Budget Office has a different take on the number of uninsured.

http://news.yahoo.com/s/ap/20090911/ap_on_go_ot/us_census_uninsured;_ylt=AshwU8hhGyvHi5JZEcGhL11p24cA;_ylu=X3oDMTJxZGdhZW5lBGFzc2V0A2FwLzIwMDkwOTExL3VzX2NlbnN1c191bmluc3VyZWQEcG9zAzEwBHNlYwN5bl9wYWdpbmF0ZV9zdW1tYXJ5X2xpc3QEc2xrA2dyb3d0aG9mZ292dA--

Note your quote said simply said 50 million uninsured, it does not say citizens as did the President, because we know millions of them are not. When the 45-50 million figure is thrown around it is often done so to encourage the belief that passing a bill like HR3200 will simply cover all of them, and it certainly will not.

 

[mheslep]

I'm not advocating anything. The argument was advanced that there would be cost savings with lower profits, and I am pointing out how much of an effect this is.

Yes, but the logic of your argument is that anywhere we eliminate profits, that we somehow we lower the delivered cost by roughly the amount of the former profits, while obtaining the same product/value. That does not follow.

 

[turbo]

Note your quote said simply said 50 million uninsured, it does not say citizens as did the President, because we know millions of them are not. When the 45-50 million figure is thrown around it is often done so to encourage the belief that passing a bill like HR3200 will simply cover all of them, and it certainly will not.

From the same article (emphasis mine):

Overall, the number of Americans without health insurance rose modestly to 46.3 million last year, up from 45.7 million in 2007. The poverty rate hit 13.2 percent, an 11-year high.

 

[Alfi]

I will go back and have a read of the last few pages of posts, but before I do I first want to thank your President for a very good speech.
It was so much easier on my ears than the last president's speeches.

I think he addressed the lies and misinformation very well.

 

[mheslep]

From the same article (emphasis mine):

Then the AP is sloppy and wrong, and not for the first time. There are not 47-50 million uninsured Americans, implying citizens or at least legal residents, as has been documented numerous times in these health threads.

 

[Al68]

Then the AP is sloppy and wrong, and not for the first time.

Surely you jest. It's not like they have consistently portrayed what Democrats tell them as objective unbiased fact for years.

According to Wikipedia (http://en.wikipedia.org/wiki/Uninsured_in_the_United_States), which cites the U.S. Census Bureau (I'm too lazy right now to check their source):

The 46.3 million figure isn't the total number of uninsured at a given time, it's the number of people in the U.S., including non-U.S. citizens, that are without insurance at any time during the year. Obviously that inflates the figure.

10.2 million of those are not U.S. citizens.

18.1 million have more than $50,000 household income.

About one quarter are eligible for public coverage now, but decline.

There are many more stats available, but the bottom line is, as always, the AP uses whatever politically motivated numbers the Democrats use.

 

[Al68]

In the Wed night speech I'm happy to see the US President vanquished the '47 million' uninsured figure he and other Democrats have used again and again, and again. Instead he nhttp://www.washingtontimes.com/news/2009/sep/09/text-barack-obamas-speech-joint-session//print/" :

There are now more than thirty million American citizens who cannot get coverage.

Notice that he dishonestly says over 30 million "cannot get coverage", knowing that a quarter of those are currently eligible for public coverage, and over 18 million of the uninsured have over $50,000 a year household income.

Why would he purposely choose to say "cannot get coverage" instead of "don't have coverage", knowing that there's a huge difference? It's like he went out of his way to make sure he lied, when telling the truth would have been easy, and almost as good for his purpose.

Is it possible it was an honest mistake?

And then he says: "These are the facts. Nobody disputes them." Huh? Nobody? That's either an obvious blatant lie, or he is referring to many of us as "nobody".

 

[mheslep]

... and over 18 million of the uninsured have over $50,000 a year household income.

'Household' income is an ambiguous creature. If there are 4.5 people in that house then all the individuals are under the poverty level.

 

[humanino]

Do you choose your doctor based on the lowest price?

Interesting attempt at an argumentation. As a matter of fact, I have been in both systems, European and US. I dare say, the US health system is the single most important reason why I would consider not living in the US. Your argument essentially is "if it's cheap, it can not be good quality". I do not consider it deserves an answer.

Again, there is no argument, I do not care to argue, and I do not care to convince anybody. Your system is terribly bad. If you do not want to change it, that's your decision. I am just stating that it is silly and impossible to understand from an broader perspective.

 

[Al68]

'Household' income is an ambiguous creature.

Good point. But the source I used listed it that way, so I had to.

If there are 4.5 people in that house then all the individuals are under the poverty level.

Well, not according to the U.S. Census Bureau (http://www.census.gov/hhes/www/poverty/threshld/thresh08.html ), they would not be unless there were over ten people in the house. The relationship between required income and household size isn't linear.

My kids never lacked for anything (they needed) when I made much less with 4 of us.

 

[turbo]

Again, there is no argument, I do not care to argue, and I do not care to convince anybody. Your system is terribly bad. If you do not want to change it, that's your decision. I am just stating that it is silly and impossible to understand from an broader perspective.

I have Canadian friends who feel exactly the same way, including a nice lady that works as a medical lab technician.

The GOP pretends that they are "conservatives" and the sheeples follow along. Allowing the cost of health care to more than double every decade is not a conservative position - it is a radical neo-con position. The system needs to be fixed or it will drive the US into 3rd-world status. Currently, most of us are one catastrophic illness away from bankruptcy and financial ruin. Suffer one such illness and survive, and you'll never get health insurance ever again. My wife and I have savings adequate for our retirement and a house on a small piece of property. If either of us comes down with a catastrophic illness, her health insurance company (BC/BS) will drop us, and we will lose everything that we have saved through a life-time of fiscal conservatism. That's OK with the GOP, though.

 

[mheslep]

My kids never lacked for anything (they needed) when I made much less with 4 of us.

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

 

[turbo]

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

That's not a bad thing, but if health insurance coverage is mandatory with no public option, people will have to buy their coverage from the private insurers, who will then have no incentive to reduce costs.

I suggest that people should be allowed to opt into Medicare and pay for that coverage. That would bolster the pool of Medicare recipients (often elderly and disabled with high medical-service usages) with an influx of relatively healthier people, reducing the "experience rate" for the group as a whole. That would be a very simple fix, and one that I haven't seen suggested by any of our for-hire Congressional representatives.

 

[byronm]

There is a logical fallacy here.

The assumption that since mistakes and abuses occur in the present system, they will not occur in the proposed system.

This is a ludicrous claim.

In fact, from my experience with govt. I envision the number of mistakes getting greater, and the abuses getting far worse.

You're claim is even more ludicrous. Our government has been working for two centuries. Our democracy is strong. Affordable Health care only makes it stronger.

The only delusion there is, is the self prophesying delusion that government is a failure which is only true if your goal is to make it fail.

 

[WhoWee]

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

The insurance quote I pulled yesterday for a family of 4 - with the coverage Obama specified in his speech - would cost $22,224 per year.

If they chose to purchase lesser insurance coverage, they would be penalized $3,800.

 

[byronm]

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

Of course we don't need anything like HR3200 to address that. McCain and other's had plans that would shift the employer tax break to individuals, and would set up guaranteed pools for the chronically ill.

At 50,000 dollar wages that tax incentive is meaningless and much less than what the monthly premium for insurance is.

What money would be used to "pool for the chronically ill" and who gets to decide who is covered by that pool and who isn't?

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

 

[WhoWee]

You're claim is even more ludicrous. Our government has been working for two centuries. Our democracy is strong. Affordable Health care only makes it stronger.

The only delusion there is, is the self prophesying delusion that government is a failure which is only true if your goal is to make it fail.

The Post Office is scheduled to lose $7,000,000,000 this year and next - that is a failure.

The President claims he can find $900,000,000,000 in fraud and waste in the Social Security, Medicare, and Medicaid programs - those are failures.

The Government is terrible at cost management.

 

[WhoWee]

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

Nobody is "chained to their employer" based plans now (unless you have a pre-existing condition). Employer based plans cost less for the individual, but you're free to spend more and buy your own.

 

[mheslep]

At 50,000 dollar wages that tax incentive is meaningless and much less than what the monthly premium for insurance is.

The tax incentive would be the same as one gets from the employer, so the self employed is exactly on the same footing as one covered by an employer. That is anything but meaningless. It frees one from getting coverage via an employer, as you advocate below.

What money would be used to "pool for the chronically ill" and who gets to decide who is covered by that pool and who isn't?

Guranteed Access Plans - defined by the state and federal governments, funded by federal money given to the states. The idea is make insurance for the truly unexpected, and let the GAPs cover the chronic ongoing illnesses, thus cutting insurance costs.

Direct Help for the Hard Cases

I wouldimprove the non-employer, individual insurance market by building on existing Health Insurance Portability and Accountability Act (HIPAA) protections for people with pre-existing conditions and by expanding support for guar*anteed access plan (GAP) coverage in the states that would insure them if they are denied private coverage or only offered coverage at very high premium costs.[40]

Under McCain's Guaranteed Access Plan (GAP), the federal government would work with governors and provide federal assistance to develop models for states to ensure that individuals who experience dif*ficulty obtaining coverage would have access to health insurance. One model envisioned under this approach would be a type of high-risk pool, in which a state or states would provide insurance with reasonable premiums to uninsurable individu*als. In the recent analysis by the Lewin Group, the GAP provisions would cost an estimated $235.4 bil*lion over 10 years.[41]

http://www.heritage.org/research/healthcare/bg2198.cfm

The best thing about the public option is that it doesn't chain me to my employer. I could go independent and still have benefits as i would working for someone else. Thats the ultimate democratization of health care if you ask me!

<shrug> I agree health care has to be cut loose from employers. But if we use a public option to do it then you're chained to a government program and the taxes to pay for it.

 

[mheslep]

Nobody is "chained to their employer" based plans now (unless you have a pre-existing condition). Employer based plans cost less for the individual, but you're free to spend more and buy your own.

That's misleading. There is an economic chain. Outside of an employer, one takes a tax hit buying coverage. HSAs help that some, but they're still not the tax equivalent of employer coverage. Also, without the size advantage of a large pool there's a negotiation disadvantage.

 

[WhoWee]

That's misleading. There is an economic chain. Outside of an employer, one takes a tax hit buying coverage. HSAs help that some, but they're still not the tax equivalent of employer coverage. Also, without the size advantage of a large pool there's a negotiation disadvantage.

I opted for an HSA with a high deductible. It lowered my premium and allows me to save the funds in an account - to be used for medical purposes or roll over until next year. Once I meet my deductible, the plan pays 100%.

I think the tax benefits are fair.

 

[mheslep]

I opted for an HSA with a high deductible. It lowered my premium and allows me to save the funds in an account - to be used for medical purposes or roll over until next year. Once I meet my deductible, the plan pays 100%.

I think the tax benefits are fair.

Yes I've looked into them too, a good way to if one is on their own. So? Employer based plans still have a tax and size advantage. I would prefer they didn't under current laws, but they do.

 

[Wax]

I don't see the level of specifics you've outlined - very vague - and seems to be focused on the public option.

Even if your interpretation is correct, the cost of individual tests must be paid somewhere - not just thrown out the door as you stated.

Nope, it doesn't. This isn't a case like an illegal alien going to an ER without health insurance. The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare. They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.

In summary, there is nothing for hospitals to write off because they accepted the payment plan. It's not a case in which an individual owes 20,000 dollars for a surgery and can not pay for it.

 

[mheslep]

...The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare.

What choice? They accept the government insured patients or they go out of business, except for the high end operations like Mayo.

They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.

That's exactly wrong. It's well known that Medicaid/Medicare costs are shifted onto private insurance.

 

[Wax]

What choice? They accept the government insured patients or they go out of business, except for the high end operations like Mayo.

That's exactly wrong. It's well known that Medicaid/Medicare costs are shifted onto private insurance.

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

 

[turbo]

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

The public plans don't shift costs onto private payers. The private payers shift costs onto others by refusing to cover people who actually get sick and need insurance to pay for treatment.

Regardless of what we hear from the right-wing, we ALL pay for uninsured and underinsured patients through higher charges by service providers. Health-care reform is absolutely necessary to protect our economy from further degradation, and to improve medical outcomes with early detection and preventative care. The "party of NO" wants to scare people into opposing health-care reform, and it seems to be working in large part. Fold in the "blue-dogs" and it might be impossible to get meaningful reform passed unless voters take up the issue with the elected representatives who answer to them.

 

[mheslep]

No, it's a choice. There are clinics inside of the U.S. today that only accept private insurance.

Yes, I am aware of that and cited one. But not every clinic/hospital can be a world class Mayo. Many of them can not turn away all the government plan patients and survive. Likewise in single payer systems, a provider does what they are told by the government or they go out of business.

 

[Al68]

$50k is a livable wage for a family. But let's look at whether or not the earner has coverage through an employer there. If the earner's employer doesn't offer anything, then he/she might have to get an individual plan. Now that's still workable for most people, but if one of the kids has chronic problems - say asthma - then the premiums might take a serious bite out of that $50k.

I agree with you here. Obviously a family of 4 making $50K would never get a Cadillac policy, like the one HR3200 requires, unless it's part of their employment package. As someone pointed out before, their only practical option would be to simply keep the normal medical insurance they have temporarily.

Of course that would only be a temporary solution, since to continue being "grandfathered", their policy will have to refuse all new enrollments among other things, so they simply won't continue it for long. And HR3200 makes it illegal to buy any new policy that's not in the exchange. Then the family's only practical option is reduced to just paying the penalty and going uninsured.

 

[mheslep]

...I haven't seen any article that says Medicaid and Medicare shifts costs onto private insurances.

1. Obama at Aug. 14 2009 Montana Town Hall:
http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-in-town-hall-on-health-care-Belgrade-Montana/"

Q [...] I've learned that Medicare pays about 94 percent of hospital cost. And I've learned that Medicaid pays about 84 percent of hospital cost. And I've learned this from a reputable source, my brother who is a chief administrative officer at a large hospital group. He also explains to me, when I communicate with him, that private insurers -- his hospital collects about 135 percent of cost from private insurers, and that makes up the difference. So if public option is out there, will it pay for its way, or will be under-funded like Medicare and Medicaid? Thank you.

THE PRESIDENT: [...] But here's the short answer. I believe that Medicare should -- Medicare and Medicaid should not be obtaining savings just by squeezing providers.

Now, in some cases, we should change the delivery system, so that providers have a better incentive to provide smarter care. Right? So that they're treating the illness instead of just how many tests are done, or how many MRIs are done, or what have you -- let's pay for are you curing the patient. But that's different from simply saying, you know what, we need to save some money, so let's cut payments to doctors by 10 percent and see how that works out. Because that's where you do end up having the effect that you're talking about. If they're only collecting 80 cents on the dollar, they've got to make that up somewhere, and they end up getting it from people who have private insurance.

2. Medpac.gov
http://medpac.gov/chapters/Mar09_Ch02A.pdf"
Table 2A-4, pg 56: 2007. Medicare payment margin: -5.9% (verifies the claim of the questioner in Montana re Medicare)

3. Millman study (at the request of the insurance industry)
http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/hospital-physician-cost-shift-RR12-01-08.pdf"

[...]We estimate the total annual cost shift in the United States from Medicare to Medicaid to commercial payers is approximatey $88.8 billion. [...]

Note that this only addresses hospitals and physicians. Many nursing homes receive most of their income from government plans, http://findarticles.com/p/articles/mi_m0795/is_n1_v13/ai_11676874/", and are very sensitive to underpayments. Nursing homes also consequently have no choice but to accept government plans, especially Medicaid, or go out of business. Yes there are exceptions for homes that specialize in the like of Bill Gates parents.

 

[mheslep]

If if it is not clear who calls the shots in a single payer system:

Interview by an NPR/WaPo reporter with Naoki Ikegami, Japan's top health economist:

[Q] If I'm a doctor, why don't I say, "I'm not going to do them; it's not enough money"?

[A] You forgot that we have only one payment system. So if you want to do your MRIs, unless you can get private-pay patients, which is almost impossible in Japan, you go out of business. ...

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html

 

[WhoWee]

Nope, it doesn't. This isn't a case like an illegal alien going to an ER without health insurance. The government option is a choice, hospitals and clinics choose to accept the insurance. They are not in any way forced to take the payment plan. Government insurance exist today and it's called Medicaid and Medicare. They both pay 80% of what a private insurance company pays and the costs does not translate into higher private insurance because the hospitals and clinics chooses to accept those terms and conditions.

I think you need to double check all of your information.

 

[Phrak]

"If either of us comes down with a catastrophic illness,..."

Are you expecting to live forever? I don't thing there is a health care plan that will fulfill this expectation. Not in the US. Maybe you can live forever in Sweden.

 

[turbo]

Got an update from a friend in Canada today. His daughter ended up with a sports injury resulting from years of running and Scottish Highland dancing, and had to have surgery on a hip. Once the surgeon got in there and took a look around, he decided that he could do a more extensive procedure and repair part of the "envelope" that he had planned on cutting away. The surgery took 3 hours instead of the anticipated 2 hours, and will result in a much shorter recovery time. The surgeon is the same guy who operated on Mario Lemieux's hip for a similar injury. Total cost to my friend - $0.00.

 

[turbo]

"If either of us comes down with a catastrophic illness,..."

Are you expecting to live forever? I don't thing there is a health care plan that will fulfill this expectation. Not in the US. Maybe you can live forever in Sweden.

I'm not expecting to live forever, of course. I'd rather drop dead of a heart attack, though, than to come down with a tough-to-treat cancer, kidney failure, etc. Then you're at the mercy of the insurance company's "death panel" which decides whether or not to drop you for the sake of their bottom line.

 

[mheslep]

... Total cost to my friend - $0.00.

Only at the hospital door. Otherwise no it was not free.