52293-Health Care Reform

[vorpal blade]

Well, it seems you've caught my reference to Jonathan Swift's satirical essay, "A Modest Proposal." However, I wasn't being satirical in this case. I sincerely believe my proposals would make health care more affordable, and therefore help more people in this country have better health care, with longer and more productive lives.

[Whistler]

if you were serious, it seems that your titling your essay "a modest proposal" is misleading, as it indicates a parody or homage to the original satire.

[vorpal blade]

if you were serious, it seems that your titling your essay "a modest proposal" is misleading, as it indicates a parody or homage to the original satire.

Knowing me, did anyone think I wasn't being serious? The joke was to be serious but give a reference to Jonathan Swift's satirical style. Just my sense of humor, I guess, but I really didn't care if anyone got the joke or not.

[vorpal blade]

I think in order to set the stage for my health care reform ideas I should have first outlined the need and the solution framework. So, here goes (seriously):

The Current Situation

Making sure every American has access to high quality health care is one of the most important challenges of our time. The number of uninsured Americans is growing, premiums are skyrocketing, and more people are being denied coverage every day. A moral imperative by any measure, a better system is also essential to rebuilding our economy – we want to make our health care system work for people, not just the medical profession and insurance and drug companies.

The Solution

Reform the health care system:

We need to take steps to reform our system by expanding coverage, improving quality, lowering costs, honoring patient choice and holding individuals and private companies accountable.

Promote scientific and technological advancements:

We need to commit to putting moral values ahead of irresponsible science and technological innovation when it comes to medical research. We believe in the enormous capacity of American ingenuity to find cures for diseases that continue to extinguish too many lives and cause too much suffering every year.

Improve preventative care:

In order to keep our people healthy and provide more efficient treatment we need to promote smart preventative care, like cancer screening and better nutrition, and encourage critical investments in electronic health records, technology that can reduce errors while ensuring privacy and saving lives.

[TheBlackSheep]

Vorpal, I must be getting to know you a little better, because I knew you were serious, as destined as the pair of us are to forever disagree on this issue.

I do, however, sincerely like how you've thought completely out of the box on this one, even if I couldn't disagree with you more.

[vorpal blade]

Vorpal, I must be getting to know you a little better, because I knew you were serious, as destined as the pair of us are to forever disagree on this issue.

I do, however, sincerely like how you've thought completely out of the box on this one, even if I couldn't disagree with you more.

You make me smile, TheBlackSheep. Well, thinking completely out of the box makes it more exciting, don't you think? If I can get you to think outside of the box, who knows, you might enjoy it. Being a conservative is so liberating. No more remorse for failing to change people against their will.

Now that I've let my health care reform proposal out of the bag, I'm anxious to see it passed into legislation. I have my critics, but they are working from a familiar Washington script that we've seen many times before that favors politics over policy. I'm tired of politicians trying to slow my health care changes in the hopes it fails. My critics favor government over consumers. A delay in my reforms fails to put the interests of Americans first.

I want to see legislation that expands coverage, improves quality and brings down costs. Some of my critics are trying to score "political points" at the expense of health care reform. I want my reforms done now. If there are no deadlines, nothing gets done in Washington. Remember, this isn't Washington sport, this isn't about who's up and who's down. This is about solving an enormous problem for the American people. This isn't about me. This isn't about politics. This is about a health care system that is breaking America's families, breaking America's businesses and breaking America's economy, and we can't afford the politics of delay and defeat when it comes to health care not this time, not now.

Vorpal - with thanks to President Obama for giving me the words to use.

[vorpal blade]

This is from Organizing for America, the successor organization to Obama for America. http://www.barackobama.com/issues/healthcare/
[quote]The Current Situation

Making sure every American has access to high quality health care is one of the most important challenges of our time. The number of uninsured Americans is growing, premiums are skyrocketing, and more people are being denied coverage every day. A moral imperative by any measure, a better system is also essential to rebuilding our economy -- we want to make health insurance work for people and businesses, not just insurance and drug companies.

The Solution

[Nanti-SARRMM]

So, the Obama supporters make insurance companies the bad guys. They talk about holding them accountable. They talk about making health insurance work for people and not just insurance and drug companies.

But isn't there a bit that is their fault? That they refuse service or payment for pre-existing conditions? Not all of it is there fault obviously and other things need to be done, but I think a small portion of the problem lies with the insurance companies.

[vorpal blade]

Sam,

If an insurance company refuses to insure a person with a pre-existing condition the insurance company is doing what it is supposed to do. There is no fault in this.

Insurance is supposed to be about protecting you against unforeseen high costs. It is a way for people to hedge against risks, but not a way to share anticipated costs. You wouldn’t expect to be able to rush down to your local home insurance company and say, “My house is on fire! I need fire insurance quick!” The fire insurance company would not be at fault for refusing to agree to sell you a fire insurance policy under those conditions. It would not be evil for checking to see that the house was not already engulfed in flames. It could also legitimately verify that your house was not already a fire hazard just waiting for the right conditions.

To insist that an insurance company take all comers, regardless of the condition of their house, or the condition of their health, forces the company to charge higher premiums to cover the almost certainty of greater expenses in reimbursement costs. This isn’t fair to the healthy people, or the people with safe houses, to pay for the ones with known problems and hazards.

If you lie to the insurance company and tell them you have no serious health problems, covering up some pre-existing condition just so you will qualify for the insurance, the health insurance company should legitimately be able to deny you any payments.

So, I don’t really see what the problem is with the insurance companies.

[Waldorf and Sauron]

And this is why the free market is fundamentally incapable of providing universal insurance.

No amount of deregulation will help the ineligible uninsured become insured—the main incompatibility is that many people will have their insurance policy end involuntarily, either due to losing their job or their policy being rescissed by the company (vorpal, this is the problem with the problem with insurance companies, the rest of the problems are due to the structure of the system). And then they are unable to be accepted on another policy if they have pre-existing conditions. They were paying their insurance premiums, but their policy ended.

The only way employers are able to get insurance for all their employees is by pooling risk. You say that insurance "is a way for people to hedge against risks, but not a way to share anticipated costs," yet, within a company insurance pool, that cost is shared and comes out of everybody's paycheck.

[vorpal blade]

It is possible to obtain insurance with pre-existing conditions. Generally you have to pay a lot more, because the risk is a lot higher for the insurance company. In some cases the rates will be unaffordable. It is also possible to enroll in some insurance plans with pre-existing conditions if you go to work for the right company, or join the right group.

While it is desirable that everyone have health insurance, many people are willing to take the risk of saving the money not spent on health insurance and paying for health care out of pocket. Others rely on charity or free service at emergency rooms. As long as people exercise free choice there will never be universal insurance. But the lack of universal insurance does not mean the lack of universal health care, a distinction too often blurred in today’s debate on health care.

The problem you refer to, that of having your insurance policy involuntarily ended when you are fired, and then not being accepted on another policy because you have pre-existing conditions, has I think a simple solution. There really is no reason why health insurance should be tied to the company you work for. If everyone had an individual health insurance plan it wouldn’t matter if they were fired, or what the company did. Under the present system the company pays a portion of your health insurance, which you don’t have to pay taxes on. If the company just gave you the money it spent on health insurance, and the government made that money tax deductible, you could select your own health insurance plan and it wouldn’t cost you any extra. Several proposals of this nature have been suggested by conservative members of Congress, but the Democrats have always voted them down.

I don’t believe it is the company that is pooling the risk; it is the insurance company that pools the risk. In the present system some big companies can negotiate special deals with insurance companies. I’m in favor of giving individuals or groups the freedom to make their own decisions regarding health insurance. I think it is fair that those who discover they have serious health problems and then go out to buy insurance should have to pay more.

So, I still don’t see it as a problem with the insurance companies.

[Nanti-SARRMM]

But is how much the individual company takes out for health insurance plans uniform, or does it vary company to company?

[vorpal blade]

It varies from company to company, as well as plan to plan. For example, in the company I work for I have the choice of many different plans, from many different insurance companies. I could enroll in a plan that would require me to pay $91.49 every two weeks, while my employer pays $155.66 every two weeks. Or I could enroll in a plan costing me $77.89 every two weeks, and $233.69 for my employer every two weeks. Both plans are available to me. I'm sure if I worked for another company there would be a different amount I'd pay, and my new employer might pay more or he might pay less than my current employer pays.

The sum of what I pay and my employer pays should remain fairly constant from employer to employer, though the insurance company might decide that the employees of one company are on the whole less healthy than other companies, and correspondingly charge higher premiums.

[Nanti-SARRMM]

So wouldn't it be difficult to do what you proposed since every company pays different amounts for health plans?

[vorpal blade]

There are a lot of ways it could be done. One way would be to require every employer, who has a company health plan, to offer an option that the company pay the employee directly the average amount the company would have contributed to his health plan, had the employee elected to enroll in a company health plan. This would result in some companies giving more of a bonus pay for health care insurance than other companies. The employee would then take whatever money his company had given him for health care insurance and buy his own health care insurance. The employee would deduct from his taxable income the amount paid him for health care insurance that he uses for health insurance premiums. In this plan the health insurance plan the employee has is not tied to his employment, and would then be fully portable if he left the company and went to work for another company.

Another proposal would have the employer put a certain amount of money into a tax-free Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA). Depending on how the law was written, this could be left to the employer to decide, or could be a fixed amount. The money in one of these accounts belongs to the employee. The employee can use some or all of the money in his HSA or HRA to pay for health insurance. The rest of the money in his account would be used to meet routine medical expenses, with all of the unused portion being available after retirement for whatever the employee wished to do. You might make a career decision based on salary plus how much your prospective employer pays into your HSA or HRA, since different companies probably would pay different amounts.

For other ideas, not all of which I approve of, see http://spectator.org/archives/2009/05/2 ... h-care-alt

[Damasta]

So I haven't read this thread, but after reading this article, I have to wonder how long a nationalized health care system would take to reach a similar conclusion: why don't we admit new patients only ever other day? That way we can cut costs!

It's obvious that there needs to be health care reform. But having the government insure lower-income families or (even worse) a single-payer system seems to be a "go from bad to worse" solution.

[vorpal blade]

So I haven't read this thread, but after reading this article, I have to wonder how long a nationalized health care system would take to reach a similar conclusion: why don't we admit new patients only ever other day? That way we can cut costs!

It's obvious that there needs to be health care reform. But having the government insure lower-income families or (even worse) a single-payer system seems to be a "go from bad to worse" solution.

You should read this thread.

Let's hope it doesn't get so bad that they admit new patients only every other day to cut costs. I can see them making economic decisions such as a person is too old to make it cost effective to prolong their life another 5 or 10 unproductive years with an expensive procedure, so they are giving pain killers to ease their deaths instead. Or, if they make you wait long enough for some expensive procedure people will die before the health care system has to pay for it. Or you will not have a choice of medications, you'll have to take whatever is cheap and available. Or there is no money for medical research. Or people will be prioritized as to their value to the state and given health care accordingly. Or it is cheaper to perform an abortion than to pay for expensive health care after birth, so some abortions will be mandatory. Certain "unhealthy" activities, or "dangerous" activities such as mountain climbing or riding motorcycles will be prohibited because of the burden it places on the health care system. Yes, I think you are seeing a fore-taste of things to come.

[Damasta]

You bring up a good point, vorpal (though my point was simply that government-run systems are invariably fraught with financial trouble and inefficiency*). The current system is flawed and can be abused in some ways (e.g. my parents knew a doctor who was giving LDS women (and only LDS women) hysterectomies that they neither needed nor wanted (he also tried to tie my mom's tubes against her will)). But a single-payer health care system would drastically inflate the potential for abuse--especially when in a misguided attempt to compensate for its own inherent weaknesses.

*But what do you expect when you let a bureaucrat (who has no experience running a business) run a business instead of letting a businessman run a business?