<p>I think we need to go to single-payor, but I don’t think that we are going to do that. </p>
<p>There are just too many people and institutions profiting by the system we have now.</p>
<p>How many industries are raising rates 59% these days?</p>
<p>The most profitable point is exactly that point at which you squeal and squirm but pay the premium anyway, and then squeal and squirm and decide not to get the care you really think you need.</p>
<p>Then, after your needs get built up, in three or four years, it’s usually a good idea for them to find a way to drop you, if they can. It’s one of those industries where retention of the same customers may be less profitable than recruiting new ones, or at least can be.</p>
<p>It’s frankly disgusting, if you ask me (and I know you didn’t. ;))</p>
<p>I’m not arguing. I just don’t think single-payor is going to happen.</p>
<p>I think the health care system is terrible in this country.</p>
<p>A friend of mine’s insurance went from $20,000 to $30,000 in a year. Maybe two years.</p>
<p>It’s a family plan.</p>
<p>He is going to get another plan.</p>
<p>And that’s just the idea. If the deductibles are high enough, or the lab fees, or wahtever, he’s delayed enough care so the first company may not want him (for now - they may get him back in 3-4 years, and at an even higher cost.)</p>
<p>Hey, he’s lucky that he could buy it at all. I couldn’t.</p>
<p>My company insurance plan went from $12,000 to $15,000 for the whole family. So it’s about 25%.</p>
<p>Yep, For us, Kaiser went from$1238/month to $1430/month this year. That insures 3 people, my spouse, my college age son and my high school daughter. I can’t get HI because of a pre–existing medical condition. We don’t know what to do, except to keep paying until we…can’t.</p>
<p>
</a></p>
<ol>
<li>Health care is not a right. Something which costs money can never be a right. It’s a good which is bought & paid for. If we go to single payor, there will be rationing. There will be triage. There will be people who are too sick and will effectively be given a death sentence (which happens now, of course).</li>
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<p>I don’t understand how people think health care is a right. It never was a right. It’s no more a right than owning a car.</p>
<p>“I don’t understand how people think health care is a right. It never was a right. It’s no more a right than owning a car.”</p>
<p>Health care. Owning a car. Health care. Owning a car. Health care. Owning a car.</p>
<p>Hmmm. Maybe if I write the above enough, I’ll start believing that these two things are equivalent.</p>
<p>Let’s see. What would I rather have my daughter have? Health care? Her own car?</p>
<p>ANYTHING can be a right. A “right” is simply something that people, acting in concert, guarantee to each other. It’s as simple as that. Yes, even owning a car could be a right, at a time and place in which a community guarantees the “right” to ownership to its members. (I note that you created a logical problem for yourself - the “right to own a car” is different from the guarantee of a car to you.)</p>
<p>Rights change over time. Once, kings were said to have a “divine right”. Once voting was guaranteed only to those who owned certain amounts of property (something which, by the way, could indeed be purchased with money.) Once there was a “right” to avoid military service in exchange for a certain amount of money. Once, the right to freedom from slavery was guaranteed only to those who had a certain skin color, but one could purchase that right with money regardless of skin color.</p>
<p>Rights and money often go hand in hand. Usually, the conflation is rights, money, and power.</p>
<p>
At least mini gave an intelligent response.</p>
<p>Sorry…</p>
<p>
Exactly. Now in a time of declining wealth I’m not sure that health care is more of a right than before, when we had rising wealth!</p>
<p>Your point is no doubt true though. Rights are a human construct dictated by those in power (in a democracy that is essentially the people, as you’ve said). I’m not against single payor as much as most, I just think the dialogue & analysis is pretty weak, so far.</p>
<p>1) How will it provide savings while maintaining the additional care of all those currently uninsured?
2) Will the savings then be eaten by other things (ie: with no money spent on advertising does that mean we will need to provide unemployment to now unemployed marketers)?
3) How do we prevent people from coming to the US solely for medical care (ie: 20 million illegals)?
4) How do we decide rationing (this will be done, undoubtedly)?</p>
<p>Healthcare is an issue for our country. </p>
<p>However, in this economy it ranks very low on the need to fix list…even in a surplus it will rank low until the financially affected outnumber the non-affected. People vote with their wallet. We all might want to believe that we are altruistic, but that is simply not true. We support candidates, bills and regulations depending on how it affects us …what benefits me is not the same as what benefits my neighbor. Military members have medical coverage that costs minimal amounts, the health care issue doesn’t rank as high to them than being deployed or a defense cut. Union members would rather see money go to bailouts for car makers than health insurance…no bail out…no job. Teachers would rather money be poured into the educational system than the health care…many teachers in poor areas are tired of spending their own money on supplies, they have health care, but are now paying for new crayons, chalk, dry erase markers, etc. Low income working for min wages have no healthcare, but Medicaid, however, I bet they would vote for higher min wages over health care. My mother is retired and still has Blue Cross Blue Shield along with Medicare. Health insurance for her is not a factor, what she cares about is SS and property taxes. In all of these scenarios, health care loses priority. WHen times are good health care will still lose because there will always be another issue that will take precedence…i.e. Social Security going bankrupt wil most likely be given more attention than health care.</p>
<p>I guess this is why the stimulus plan ticks me off…spending 335 Million for STDs is insane, 600 million for new cars for the fed, 2.5 B for parks, etc etc etc. Add that up and you could probably give a nice tax credit for healthcare. By giving that credit people will have more money to spend and probably a better plan. More people being able to purchase healthcare would spur on hiring in that industry, hiring would spur on more people with more disposable income, so on and so forth. Instead of being in a downtrend cycle it would begin to be a positive cycle.</p>
<p>We were military and had great med coverage at a very little cost. Bullets current employer has a great Aetna plan, and I have no place to b*tch (family of 5, med. dental, orthodontics, eye and prescription for 300 a month). However, I now have a better understanding of why healthcare is a major issue for many people.</p>
<ol>
<li>The overhead - administration (both inflow and outflow), underwriting, bureaucracy, “managing to care less”, advertising, and profit amount to 31% of current health care costs. On the very first day of single-payor, every single American who is currently uninsured could be provided health care without even one penny more being spent on the health care system. Over time, while technological innovation, etc. may increase costs, at the same time, the pent-up need for health services would decline - it might actually get cheaper over time.</li>
</ol>
<p>Within my state, I actually have “single-payor” health care. The state and I pay a single premium to a non-profit health care board. There is no “insurance” (the plan is self-insured). There is no advertising. There are no health care intermediaries. Health care providers can sign up directly to become part of the network. A board of consumers and practitioners handle any appeals - there is no underwriting section trying to prevent me from receiving needed care. The result is that, for exactly the same package of benefits (written into law), my health care premiums are approximately 30% lower than those of both the non-profits and for-profits my plan competes with.</p>
<p>The problems with single-payor elsewhere, when they exist, almost always have to do with funding for it, not with the systems per se. There is no evidence of overutilization in single-payor systems. Since we currently spend up to double per capita what other countries spend on health care, that is currently not at issue - which is not to say it couldn’t become one. But it is different from the systems issues.</p>
<ol>
<li><p>Yes, there will be winners and losers. Obama’s plan is a giant (several trillion dollar) giveaway to his friends in the private health care insurance business. In fact, it would actually be cheaper to give them two trillion in “bonuses” over the next two decades and go to single-payor than to do what he suggest.</p></li>
<li><p>There may be people who go to Canada or the UK or to France or to Germany, etc., now for health care. I honestly don’t know. We have an increasing number of Americans now going abroad for health care they can afford. It would seem to me that immigration enforcement is an issue somewhat different than health care - undocumented immigrants currently get care in emergency rooms, and it would be a heck of a lot cheaper if they got primary care elsewhere. </p></li>
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<p>In a time of declining wealth, access to health care may become more of a right, as people demand it. Or it may not. It could easily turn out that the election of Obama is a significant step backward.</p>
<p>
I doubt that highly. We will see. I suspect that our private insurance subsidies the public side right now. Once the private side is eliminated I suspect a lot of costs will be transferred over and make savings <em>much</em> less than what we see now. The core driver in cost increases is new technology, it’s as simple as that. Cost control requires using cheaper stuff.</p>
<p>For all its problems (which, again, have to do with funding), Medicare (a "right) now has overhead of slightly under 3%.</p>
<p>You can doubt it, but I am LIVING it. I have single-payor NOW. Every year, I am presented with a choice of health coverage products, where the package of covered benefits is exactly the same. I can choose the single-payor option, with higher customer satisfaction, higher quality, and 30% lower costs, or the non-profit/for-profit insurance products. Without any advertising whatsoever, the single-payor now has more than 50% of its market.</p>
<p>If you want to read about the cost studies, both internal, and international, among the best sources is the journal Health Affairs (out of Stanford, I think), much of which is available on-line.</p>
<p>"Single-Payer National Health Insurance</p>
<p>Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. </p>
<p>Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 47 million completely uninsured and millions more inadequately covered.</p>
<p>The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.</p>
<p>Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.</p>
<p>Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.</p>
<p>Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.</p>
<p>A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.</p>
<p>One of the problems with health care is the pre-conditions. Many of us are stuck with the insurance companies we already have. We can’t shop around, because other insurance companies don’t want us. </p>
<p>I don’t think we are going to save 31% with single-payor but even a tiny fraction of that in savings would make single-payor a huge improvement.</p>
<p>I remember when my dad was diagnosed with Adult Myelomic Leukemia, he had health insurance, but before UPENN took him, they called the bank to check on how much the house was worth and how much he owed. Hospitals admit that they charge more because the insured are picking up the cost for the uninsured. I have always wondered, if UPenn didn’t get the right answered would they have admitted him (they did and he still died within 1 yr). </p>
<p>Some of the insurance problems/issues can be placed firmly on the medical field shoulders. Dad had a psychiatrist show up for about the first 3 days, to talk to him, he never asked for it, UPENN just sent him. Dad turned to the doc and said how much are you charging me for this? Doc had no answer, he contacted his insurance company and found out that it was 500 for ea visit. EVen starting his chemo, he contacted UPenn and told them keep this guy out and I refuse to pay. A large problem is hospitals are charging people for crap that has no effect on their illness. I still have my bill from DS2, for 3 tylenol + codeine tablets I paid $270 in 1994. If hospitals are allowed to do this, of course our insurance carriers will pass it along. Highway robbery starts at the hospital.</p>
<p>Healt care is a “right” in all the other developed nations. When POTUS sits at the table with the other members of G8, he is the only one whose fellow citizens are not covered by some version of national health care or a national health service. </p>
<p>When India has established itself as the low cost provider of health care services, I wonder if the private health insurance companies in the US will force customers to use Indian hospitals? A $40,000 quadruple bypass with 6 weeks in a resort to recover sounds pretty sweet compared to $300,000 for domestic service and getting kicked out of the hospital before the sutures stop bleeding.</p>
<p>Of course the Indian Doctors don’t have to support US malpractice attorneys.</p>