<p>I don’t have a problem with that except that I see problems getting every state to create a system. What would you do to make sure all states implement a plan which covers all of their citizens without bumping into the states right argument? </p>
<p>For instance, right now there are states which are refusing to set up their own insurance exchanges and/or expand medicaid per ACA. </p>
<p>How would you make it so it would be constitutional to require every state to create their own health insurance plan? What clause or amendment would you use?</p>
<p>“States rights” died with the Confederacy, and thankfully so.</p>
<p>States do not have “rights” - people have rights. We are one sovereign nation with a supreme federal government.</p>
<p>But the supreme federal government does not have a Constitutional power to force state governments to install health care systems. So lerkin, what part of the Constitution are you reading that would allow for such a requirement?</p>
<p>What would prevent a state from having absolutely no health care program for its citizens?</p>
<p>states’ rights also States’ rights (stts)
pl.n.
All rights not delegated to the federal government by the Constitution nor denied by it to the states.
The political position advocating strict interpretation of the Constitution with regard to the limitation of federal powers and the extension of the autonomy of the individual state to the greatest possible degree.</p>
<p>Now, it someone would like to tell me which clause or amendment to the Constitution the Federal Government would use to require each state to create and implement a health insurance plan I am all ears.</p>
<p>Okay EmilyBee…you have received lots of good input and food for thought, and ideas to deserving respectfully consideration…but obviously not the answers you wanted to hear and so it just results in silly belligerence. Not playing that game.</p>
<p>It isn’t a question of whether it is acceptable or not. It is a reality that certain jobs cannot support the cost of health insurance. Take a minimum wage job and add $8K to $10K for health insurance and the work performed by the employee may likely cost more than the value to the employer. Thus, the employer will eliminate the job. It’s ECON 101 that if you increase the price of a service the quantity demanded decreases as the price of the service increases. Raise the cost of an employee to an employer who cannot raise prices (most employers) and the employer will have to get cut costs elsewhere or get rid of the employee. </p>
<p>If you want to talk about what is acceptable, 8 percent unemployment is not acceptable. Apparently the govt wants to reduce unemployment by making many more people part time employees. Employers move full time employees to part time and hire more part time workers. It’s a stupid way to reduce unemployment but it will likely work.</p>
<p>Again, razorsharp, are you then arguing that the majority of the health care costs for those workers should continue to be borne by taxpayers through Medicaid and the insured through inflated billing to offset charity-care writeoffs? Because that’s the way it works now. Those companies are effectively being subsidized by everyone else because their failure to offer employer-provided insurance results in increased costs imposed on the rest of society.</p>
<p>Health care costs are going to get paid somehow - because we as a society have decided that it is morally unacceptable to allow the poor and working poor to die in the streets because they lack the ability to pay for emergency medical treatment. Those costs don’t magically disappear - they get built in to the costs that you and I and everyone else has to pay. Are you saying the status quo is OK and we should just keep going with it?</p>
<p>This is the entire reason why the Republican arguments against Obamacare completely failed at the ballot box - just about everyone recognizes that the system as it stands today is broken and we need to try something different. Obamacare is imperfect, flawed and certainly not my preferred option. Heck, it’s really a Republican plan to begin with - the Heritage Foundation developed it and Romney implemented it first!</p>
<p>But the GOP just stamped their feet and screamed SOCIALISM rather than develop a coherent alternative policy proposal of their own. So Obamacare it is.</p>
<p>If we put everyone in the country on Medicare, we’d be able to redirect tens of billions of health care dollars that are now pocketed by insurance executives and shareholders.</p>
<p>So yes, let’s look at that highly-effective system. Great idea.</p>
<p>“Okay EmilyBee…you have received lots of good input and food for thought, and ideas to deserving respectfully consideration…but obviously not the answers you wanted to hear and so it just results in silly belligerence. Not playing that game.”</p>
<p>I fail to see how pointing out that your plan is very likely unconstitutional is “silly belligerence”.</p>
<p>Medicare for all would likely be an improvement, but would not completely solve the cost problem (or some other problems). Remember that the US government spends about 7% of GDP on health care for the segment of population covered by Medicare, Medicaid, and government employee coverage (civilian and military) – about a quarter of the US population. Other rich countries spend about 7% of GDP to cover their entire populations. (Private spending on health care is much higher in the US than in other rich countries.)</p>
<p>Medicare’s low reimbursement rates but lack of resistance to questionable (or outright fraudulent) billing is likely a problem with incentives driving up the cost, where providers are given incentive to favor more care, rather than better care.</p>
<p>Agreed. Every time Medicare looks at ways to control costs, we wind up with the political demagoguery of “death panels” and everyone just says to throw more money at it. Definitely a problem that needs to be addressed - and it’s broader than just Medicare, it’s a cultural issue. We often spend vast sums of money on medical care near the end of a person’s life and the net benefit for the patient is often questionable. But even offering end-of-life counseling and planning was written out of the ACA.</p>
<p>My elderly parents, both in their late 80s and poor health, have probably had a million dollars’ worth of medical care in the last 5 years – each. I love them, but even I will say that the value of doing this has been questionable. Part of the culture you mention, polarscribe, is the Heroic Doctor. American docs are really, really good at focusing on the specific problem in front of them and fixing it. It’s their instinct, and it’s what they’re trained to do. But it makes them not so good at stepping back, looking at the whole patient, and putting the proposed treatment into a context. </p>
<p>Other countries do a much better job of managing end-of-life care. They’re far more likely to provide palliative medicine, whereas we will expend massive resources to patch up a very old, very sick person, and then send them home until the next crisis develops in a month or two. That’s how it’s been for my parents, and I don’t think it’s doing them any favors.</p>
<p>It is not just at the end of life. Remember the uproar when the USPSTF said that mammograms for women age 40-49 are given the C recommendation (“Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.”) and that PSA screening for prostate cancer is given the D recommendation (“Discourage the use of this service.”)? Seems that a lot of providers do not like the idea of missing some revenue from testing of questionable value (or more invasive testing or treatment that results, not always to the improvement of the patient’s condition due to complication risks when a false positive is treated), and a lot of patients have bought into the idea that more care is always better care.</p>
<p>Same goes for drugs - the pharmaceutical companies spend billions and billions of dollars on direct advertising telling Americans that they can self-diagnose all sorts of illnesses and syndromes and problems that can be solved by just going to their doctor and asking for the newest, hottest, patented and most expensive drug on the market.</p>
<p>Male? Feeling down? Your sex not hot enough? You must have Low-T, and you need a bunch of drugs to fix you right up! Never mind that for zillions of years men have dealt with lowering testosterone levels as a natural part of aging - we can fix it with modern medicine and lots of money that your insurance company will cheerfully fork over!</p>
<p>Health care is nothing but a huge money making profitable entity, it should not be.</p>
<p>I was in an eye doctors office today, my line of work deals with disease tracking/treatment/managed care etc.</p>
<p>The doctor showed me a letter he received at the end of December from an insurance company. The way medicaid is dealt with within NY, all plans must take on medicaid patients, perhaps a certain percentage, I am not sure. Since this has happened, this doctor said he is treating more medicaid patients, however still small minority of his practice.</p>
<p>The letter informed him medicaid patients would be coming in for exams, with a voucher, he was to sign it, the patient would then submit and receive a $15 WALMART gift card. He said because they are medicaid patients, they did not have a copay, nor coinsurance. He showed me what he is paid for the eye exam. He receives TWELVE DOLLARS to do the exam, yet the patient walks out with $15. THIS is where the all our premiums are going. He had a family of 4 come in demanding he see and sign their vouchers to obtain their gift cards. </p>
<p>Money is fungible, whether the insurance plan is getting it from high paying premium customers, or state funded plans, the money is being spent from one old big pot of money. </p>
<p>The company I work for is paid $500 per chart by insurance companies. In a given hour I can complete 4-6. </p>
<p>^^This is exactly why a national plan will not work–reimbursements are too low, dr’s will stop practicing and you end up with substandard care. </p>
<p>LasMa–the outcomes in the US are NOT worse than the rest of the world. The US leads the world in medical innovation, which will cease under a national health plan–how many medical advancements have come out of England or Canada in the past 50 years??? Ask your Canadian friends how much they pay in income taxes, state sales taxes and various other taxes to cover their “free” medical care. If you are talking infant mortality rates–the US bases their figures on infants living to 1 year, other countries base their rates on living a month or two. Compare apples to apples.</p>
<p>Again, look as far as Medicare to see exactly what will happen if the US goes to a national plan because that is exactly what it is. Ask your parents which medications they don’t take because they can’t afford them or which treatment they skipped because they can’t afford them or who they see for a dr now because their dr of 40 years has stopped seeing Medicare patients…</p>
<p>polar- I would have liked to see a proposal of Medicare for all citizens with the ability for the purchase of gap policies for those who were so inclined.</p>
<p>SteveMa- what do you think the response would be if we called for an end to Medicare since the private system works so well? Medicare covers the highest cost patients in the country. Cover everyone and the average cost per patient will be driven down. There are plenty of succesfull meical companies operating in countries with national health care. Innovation is not going away.</p>
<p>tom1944–what innovations have come out of these “successful” medical companies in the past 40 years??? You do realize that many people with “free” medical care in these so called wonderful plans purchase private plans to fill in the gaps, right? The wait times, etc. for procedures is more than double what you find here. The ACA requires everyone to get insurance, it does away with any pre-existing condition clauses as of 2014. Every person in this country (legally) will not have insurance. People are already complaining about the rising costs, it’s only going to get worse. If you take out the market competition to keep costs lower, plan on 50% of your income going to taxes…how much goes in for just Medicare right now (covering roughly 18% of the US population only). You do realize that most people on Medicare also have a private policy to supplemental coverage, right?</p>
<p>The private system works a lot better today than people think. The problem is, people think that it’s the insurance company that decides what is and isn’t covered and that just isn’t the case. Your employer picks your plans. Your costs for those plans are directly related to how everyone on that plan uses the plan. If your coworkers are running to the ER for ear infections, your costs are going to be high. Also, how much you pay in premiums and your perception of “expensive” is all relative. Some premiums I’ve seen people complain about in other threads are very low–they just don’t think they are. Also, people tend to pick plans based on the premium cost alone, without figuring out the true cost of the plan.</p>
<p>One example, talking to a woman who had the choice of 3 different plans through her employer. She picked the most expensive plan because she liked paying 10% of her bill—well, ok, but the MOST she would have paid, premiums and out of pocket costs, for the lower cost plan was $1000 LESS than the plan she was on. Tell me this is the fault of the insurance company that she is paying $9000/premiums.</p>
<p>But Steve, people NOW are having to fill in the gaps (or sell their houses/go into bankruptcy) over uncovered medical costs. The private insurance companies are not trying to help patients–they are trying to extract as much profit out of every transaction as they can. What is the point of insurance if it doesn’t cover everything? How is it fair that preexisting conditions can prevent someone from being insurable? How is it right that a healthy person who has a lapse of coverage due to a job loss has to jump through hoops to get on a decent policy again (and usually pay through the nose for the privilege)? </p>
<p>Half of my family is in the UK, and they have NEVER complained about their care. It just isn’t something that keeps them awake at night the way concerns about healthcare do here. They look at us here and think it is ridiculous that we have the system we do.</p>