Posted by: jzinn3 | November 8, 2009

Week 12 Discussion: Health Care Bill Passes House

This morning I woke up to a CNN text that the House has passed the historic health care reform bill.  According to USA Today, “A triumphant Speaker Nancy Pelosi compared the legislation to the passage of Social Security in 1935 and Medicare 30 years later.”

CNN is providing comprehensive coverage on the internet with the Healthcare In America section on their site.

Since the Speaker and others are comparing this initiative to those of the 1930s, it is appropriate for us to pause and consider the issues of healthcare reform this week.

1.  Has there been a failure in the healthcare market?  That is, is there evidence that the market is performing so poorly that government intervention is necessary?

2.  What are the anticipated benefits of health care reform?

3.  What are the anticipated consequences of healthcare reform?

4.  We know that when government interferes in the market, inefficiencies and unintended consequences result.  Is it possible that the social benefits of health care reform will outweigh the social costs of the program?

The news will be filled with reports and resources this week.  Be sure to share appropriate media that supports your position.

 

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Responses

  1. In regard to the anticipated consequences of healthcare reform passed:

    The current bills won’t offer most Americans any appreciable decline in the cost of their health insurance nor clear improvement in the efficiency or quality of the health care they receive.

    Those who will benefit won’t see the benefits until 2014 at the earliest. All this is partly a result of Obama’s sharpest break from Clinton — whose ambitious health care plan drew immediate fire from Big Pharma, the American Medical Association, and health insurers: The Obama White House bought off the medical-industrial complex by promising it fatter profits, bolstered by tens of millions of new paying customers.

    Was it broken or government wanting to control another area of ordinary American’s lives?

    • There will also be tax increases and cuts to Medicare and Medicaid, all of which are opposed by the Unions.

      • The benefits of Medicare and Medicaid would actually be increased not cut.

        http://www.whitehouse.gov/MedicareFactSheetFinal/

      • Medicare has tried to cut costs. They have implemented studies and have found them useful But they cannot institute policies nationwide without Congressional approval and Congress is unwilling to make any changes.

        This article gives a few examples, a heart bundling program that saved time. paperwork and money but Congress will not approve it.
        Another was medical equipment suppliers. The study proved a 20% savings.

        http://www.mcclatchydc.com/congress/story/78261.html

        This a an example of the bureaucracy that will have to be dealt with if this bill is passed. Why not institute the cost savings policies instead of changing the whole system.

      • I would be leary of using a White House.gov position paper in the same way I would be using a John Boener or Eric Cantor webpage. They’re not going to put anything out that will hurt them. On the other hand, President Obama’s promises on healthcare have not necessarily matched up to the realities of the current bill.
        This is the same guy who five years ago in front of labor unions said he favored a single-payer system but that the political realities didn’t allow that and they would have to move slowly.

        President Obama is not stupid. He realizes that people in this country won’t accept single-payer over night. This current piece of legislation creates an environment where the rigged market nudges people into the public option which inevitably could became a single-payer system and a monopoloy. This way he can say you’ll keep your insurance yet makes that unlikely you will be able to choose a non-government regulated option at some point.

      • I’m glad you mentioned unions. Have they run their course or are they still a vital component of our society?

      • catstd:

        Thanks for the article!!

    • Unfortunately the current bill has been whittled down by Republican arguments that only water down the effectiveness of an actual attempt at reform.

    • This article gives ten ways health incoverage will change if the bill is passed.

      Several have already been mentioned so I will only give the ones not mentioned so far:

      Sets up health insurance “exchanges,” or marketplaces, where consumers can easily compare coverage and rates.

      Imposes a 5.4 percent surcharge on adjusted gross incomes of more than $500,000 for individuals and $1 million for joint filers.

      Imposes penalties on people and businesses who fail to comply with the new law.

      Small business are the backbone of this country supplying many of its jobs. How much more taxation, fines, and penalties can small business absorb without going under and closing its doors. It seems to me this would further burden the businesses we need to boost the economy

      http://www.mcclatchydc.com/congress/story/78519.html.

      • Our president often says he earns more money so he should pay more in taxes. Will everyone earning over 500k feel the same way?

  2. In regard to the social benefits outweighing the social costs………..my vote is not. We cannot afford unfortuneately the social fiscal costs before this was done.

    • Here is a website highlighting some of the major social issues of inherent flaws in our healthcare system:

      http://www.photius.com/rankings/

      The U.S. doesn’t stack up very well against a lot of countries in the health category.

      #72 on the Health Performance rank

      Preventable deaths = ouch

      Human Development Index….beaten by many socialized healthcare countries

      Healthy life expectancy # 24.

      THIS IS THE REASON WE NEED SOME REFORM TO OUR HEALTHCARE SYSTEM

      • Our system certainly has ample room for improvement. The question boils down to what is the BEST way to encourage improvement. I think if people would move past the partisan arguments, we might actually see some constructive dialogue.

  3. Interesting note: The public option portion of the Health Care Reform Bill is only for those people who do NOT have employer sponsored health insurance. This means that it would not be available to anyone who has health insurance through their workplace, which still represents a large portion of the population. People can sign up and pay premiums for the government-run plan, just as they would for a private plan. President Obama championed health care reform throughout his candidacy, and like President Clinton, feels strongly that whatever the exact wording the final bill includes, health care in our country is overdue for a serious overhaul that benefits “the forgotten man”. Issues such as more competitive pricing, better quality of care, more coverage for more people, realistic hospital and doctor payments, and higher accountability regs for the insurers are all on the table for examination.
    “On Nov. 7, the House passed its health reform by the narrow margin of 220-217. The vote came only after Ms. Pelosi agreed to weaken the public option provisions. Instead of basing its charges on Medicare’s fee schedule plus 5 percent, the plan would have to negotiate rates with hospitals and doctors, just as private plans do. The change meant that the public option would be likely to deliver less in terms of savings, but it reassured enough conservative Democrats to win passage.”
    To me, it will be interesting to see, after all the hype and all the political posturing, what the final bill says and, more importantly, how it affects us.
    http://www.nytimes.com/2009/11/08/business/economy/08view.html?_r=1&scp=1&sq=health%20care%20market%20failure?&st=cse

    • I think the goal for this Administration and the majority of the Democrates in Congress has been the public option. I am concerned that we are not aware of the details of the structure and that conditions will exist to allow the public option to grow and take over. I would expect that my employer would choose the public option (if it became available) for the cost savings and I would have no voice in that choice.

      • cjm1406,
        I’m will you on this I think it is a way for the government to control one sixth of the economy. Then it will control every aspect of our lives.

        The AARP supported this bill many say as a backstabbing event to senior citizens. This is a huge portion of the voting public. AARP makes money from this population. They are looking out for their interests not the public. Stuart Barton president of ASA (Americans Seniors Association) says it is because they will be given charge of the coop program. He also states that AARP has received over 2 billion dollars from the federal government.

        http://www.onenewsnow.com/Politics/Default.aspx?id=762590

    • I think so many Americans want to know the bottom line:

      1. How much extra is this going to cost me?

      Right now, at 43, my unsubsidized insurance is $516 a month. Not cheap!

      2. Will healthcare and service improve or get worse?

      Will we see longer or shorter waits? Will we be able to see the doctor of our choice? Many health care plans now dictate who you can see and when.

      3. Will someone be telling me how much healthcare I can have?

      Insurance companies tell us what we can and cannot have. I was SHOCKED when my mom was diagnosed with breast cancer 6 years ago. The menu of treatments depended directly on the type of insurance she had. Thank goodness she has very good insurance. But what about those who do not?

      • You made some very good points and these would be the same questions that I wonder about. Health Insurance is not cheap and I understand about your insurance because my husband and I are facing high rates as well.

        I may have over looked it, but I was wondering about the choice of doctors as well. I have had the same PCP and OBGYN since I was 19 years old and I would HATE to have to change them. I never thought about if the healthcare plans would dictate who we can see and when and how much healthcare I could have. You are so right when you mentioned about how now we are faced with certain stipulations with our health insurance, but now I am worried about how many stipulations would be made with this new healthcare they are trying to implement.

  4. This is what I want: the “new” Mayo Clinic type of healthcare reform. This has my vote hands down.

    “…[At] least some health plans, like that of the Mayo Clinic in Minnesota…have sidestepped the incentive problem by putting doctors on salary and operating their own hospitals. Such plans, which provide superb care and high patient satisfaction at significantly lower cost than conventional fee-for-service plans, would become more attractive under the proposed legislation.”

    http://www.nytimes.com/2009/11/08/business/economy/08view.html?_r=1&scp=1&sq=health%20care%20market%20failure?&st=cse

    • The Cleveland Clinic also has a similar type of program. They were profiled on CNN some months ago.

  5. I have been looking to see if this changed, but one issue that existed with previous versions of the house bill is that it eliminated new private individual insurance plans after 2013 while mandating individuals get coverage. In essence unless a company has a contractual obligation to provide healthcare, they could dump their employees’ coverage and force workers into the public option. A lot of employers may just pay the fine for not covering their workers and it would still be cheaper.

    I honestly do not see this bill passing unless it is significantly amended. Considering Joe Lieberman has declared he will filibuster anything with a public option, as Lindsey Graham put it, the bill is “dead on arrival.”

    I think it is interesting to note that countries that have universal healthcare, the ones doing better are those without the public option such as Germany and Japan. On the other hand we hear more of the horror stories and accounts of “rationing” in countries with a public plan like Britain and Canada.

    • redsawks82 – you bring up some very good points as well. Thank you and I agree!

    • Here’s why Japan’s health care system works so well: just like President Obama’s plan, Japanese employers are required by law to provide coverage. Insurance premiums are set at about 8% of an employee’s salary, regardless of the salary amount and the employer matches that amount. And for seniors, the government picks up the tab (instead of the employer similar to Medicare).
      “The intent of the plans is to cover all grounds of basic healthcare and preventative medicine. And when co-pay amounts are predictable (the maximum a Japanese citizen pays for an operation/procedure is 10%-30% in some cases), the Japanese go get medical check ups much more frequently than Americans. Not only is the co-pay predictable, the price of your total operation/procedure is equally predictable as those prices are set by the Japanese Ministry of Health. Guess what happens then? Life expectancy shoots up to No. 1 in the world.
      If the Japanese feel like their healthcare package isn’t robust enough with their public option, they can supplement their insurance by purchasing private insurance plans that are more specialized and tailored to their specific needs. However, unlike in the United States, Japanese insurance companies are heavily regulated in a way that it makes it illegal for them to charge for basic healthcare, it is illegal for them to deny services based on a pre-existing condition, and it is illegal for them to deny services based on arbitrary reasons like oh, say an insurance company employee inputting a wrong weight number.
      The best part of the deal is that the Japanese can go to any doctor they want, when they want (reasonably-speaking), and know exactly how much they’re going to pay. In addition, they can go see any specialist they want without getting a prior referral from an primary care physician. In other words, Japanese patients actually have a choice on which doctor they want to go to.”
      http://www.apaforprogress.org/why-talk-about-canadian-healthcare-talk-about-japanese-healthcare

      • I looked back through post and saw that I put Japan as not having a public option. I meant Germany and Switzerland. For some reason I was thinking all World War II when I was typing.

        I will make a comment about the Japanese system. You have to remember that part of the reason in Japan for lower costs in health care is that Japanese live a healthier lifestyle that originated way before universal healthcare with dets employin lots of soy, omega threes, minimal dairy. There is concern as this newer generation grows older, it will suffer than effects of smoking and fatty foods that the previous generations did not embrace.

        I found an article in the “Washington Post,” which is by no means a conservative paper which states that while Japan’s system is great now, its’ not sustainable. http://www.washingtonpost.com/wp-dyn/content/article/2009/09/06/AR2009090601630.html

        That is the problem with the current proposal. We are frontloading the costs with four years of taxation without the services before this plan comes online. In ten years the plan will be more deficit neutral, because its ten years of taxes paying for six years of benefits, but in the long run this thing will be unsustainable.

      • This raises some very good points regarding what the Japanese do.

        You also bring out problems with the current Obama proposal. (i.e. frontloading the costs with four years of taxation without the services before this plan comes on line. Thanks!

    • Rationing is one of the horrors but also an aging of the equipment because money is not available. Doctors do not have the newest equipment to take advantage of advancements in medical science.

    • Glad you mention rationing. One problem when the consumer does not pay the full price of something, they tend to consume MORE of that good or service. One long-standing argument about insurance is that it masks the cost of health care and by doing so, the market (through the price mechanism) does not properly ration output. Basically, those with better health care (and cheaper co-pays) overuse the system.

      But, isn’t it a good idea to have preventative care? Isn’t that why we go for dental cleanings every six months?

      One thing to keep in mind is how much money is made on treatment. I heard a report recently that stated it is far more profitable to treat disease rather than to cure it. Could the profit motive be working against us?

  6. There’s an interesting episode of Frontline on PBS right now, but it’s also available to view online at:

    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

    It’s called “Sick Around the World” and takes a look at five different healthcare systems around the world: the UK, Japan, Germany, Taiwan, and Switzerland. It’s an interesting and easy-to-understand documentary that shows some of the good and the bad of each system.

    It’s worth a viewing!

    • In this program, there were three basic characteristics that most of these systems have implemented in one way or another:

      1. Insurance companies must accept everyone, little or no profit on basic care.

      So, no denial of coverage for pre-existing conditions or other reasons. Insurance companies don’t compete on the basis of profiting from basic healthcare. In some system, the insurers sell various additional products, like coverage for elective procedures, etc. and make profits that way.

      2. Everyone must buys insurance, government pays or subsidizes premiums for the poor.

      If certain individuals (generally the healthy ones) are allowed to opt-out of insurance, only sicker individuals will be in the system, and will therefore pay out more than it could possibly take in. So everyone is mandated to purchase health insurance; those who can’t afford the premium, or a portion of it, are provided government subsidies.

      Another benefit of universal insurance coverage is that more people will be able to easily access primary care, and enjoy the benefits of preventative medicine, rather than visiting an Emergency Department with an advanced disease.

      3. Doctors and hospitals must accept a standard set of fixed prices.

      Most of the systems profiled have some kind of price control mechanism for basic services and drugs.

      • What about the time it takes to see a doctor or schedule a prodedure? That is a factor that is frequently mentioned when comparing health systems.

      • Thank you for pointing out this PBS program. These should be basic concepts.

      • cjm1406: As you might expect, wait times vary by system, and for different reasons. The answers make more sense in context, so it’s worth watching the video, but I’ll go ahead and summarize the program (it’s a long program, not everyone will have time to watch it):

        UK: No medical bills for patients, waiting lists are getting shorter, but still generally not short enough. Good for primary care, emergency care; not as good for elective care (e.g., hip replacement). Used to be 18 months for a new hip, in last ten years, reduced to less than 6 months, most people now 2-3 months. Done in part by introducing competition among hospitals (which are publicly owned) for government money and allowing patients to pick which hospital they want to go to.

        Primary care doctors (general practitioners) are the “gatekeepers” and must provide a referral to specialists. Paid a fixed amount based on number of patients (average list is 1800 people). Get bonuses for keeping their patients healthy (preventative care).

        Downside: mostly center around wait times that are longer than other systems. Higher taxes to fund the system.

        Japan: Mostly private doctors and hospitals. Spends half as much as the US on health care, per capita. Everyone must have health insurance, can get it through employer or community insurance plan. Government subsidizes those who can’t afford it. Japanese go to doctors three times as often as Americans. No “gatekeepers” – can go to any specialist they want. Patients just stop in for primary care, no appointments needed. Basically no waiting for health care.

        Japanese health ministry controls the price of health care. Every two years, physicians and the ministry negotiate a price for every single procedure and drug. Price is fixed everywhere in Japan. A private hospital room in Japan is $90 a night. Doctors must accept the government-mandated price, unless they can find patients who will pay out of pocket, which is rare. So everyone plays by the same rules.

        Lose job? No loss of health insurance, switch to community health insurance. Must take everyone, do not make profit.

        Downside: 50% of hospitals are having financial difficulties – because prices may be set SO low that it’s hard to keep hospitals within budget.

        Germany: 90% are in national health system (NOT single-payer), although wealthy can opt-out. Delivery of health care is largely carried out by private doctors and hospitals.

        Primary care wait times: if serious, same day; normal concerns, maybe a week or two. Elective operations may take about 4 weeks. All of these times are roughly comparable to the U.S.

        Co-pays: Up to $15 every three months.

        Health insurance continues even after you lose a job. Health insurance does not exist for a profit, just cover costs. Administrative costs are around 6% (about 22% in U.S.). Insurers, doctors, and drug companies negotiate for a fixed price for services and pharmaceuticals every year on a state level.

        Malpractice insurance costs about 10% of what it does in the U.S. Medical school costs NOTHING.

        Downside: doctors earn about half of what they might earn in the U.S. (partly because of price controls – hospitals must economize to offset procedures that are expensive for the hospital to provide).

        Taiwan: system was created by looking at 15 wealth countries and their systems, trying to take the best from each.

        Principles: equal access for everyone, no waiting time, lots of competition among medical providers.

        Financed by national insurance system that mandated everyone to join. One government insurer collects money, can’t opt out. Works a lot like Canada’s system or U.S. Medicare for elderly. Covers vision, dental, medical, etc.

        Clinics open on weekends. No waits, even for specialists. No referrals needed to see specialists.

        Use technology to take advantage of efficiencies. Smart card stores patient’s entire medical history electronically, which reduces medical errors, paperwork, and administrative costs.

        Downside: system strained, same problems as Japan. Spend too little to support all services offered. Solution would be to increase premiums, but politicians don’t want to anger voters who pay these premiums.

        Switzerland: reformed health care system in 1994. Used to be like America now – coverage linked to employers, lose job, lose insurance. Now have universal coverage. Everybody must buy insurance, government subsidizes the poor. Swiss voted in a referendum to go for this system – by a 50/50 margin, just a bit more on the “let’s do it” side.

        Insurance companies can’t deny coverage. Can’t profit on basic care, only on supplemental policies.

        Difference from Americans at outset: most Swiss insurers were already non-profit, in contast to the situation in the U.S. So transition to the new system was easier, in that sense, than it might be in the U.S.

        Administrative costs are around 5.5% (~22% in the U.S.).

        I didn’t hear any real mention of wait times in this segment on Switzerland.

        Basic conclusion:

        Many of these countries provide universal coverage with private insurance, private doctors, and private hospitals using market ideas. But all impose limits, and don’t leave it all to the market. Three big limits seen in most countries profiled:

        1. Insurers must accept everyone, no profit on basic care.
        2. Everyone is mandated to buy insurance, government subsidizing the poor.
        3. Doctors and hospitals have to accept one standard set of fixed prices.

        Take a look at Kim’s post below for details on premiums and co-pays in these countries.

    • Davidmurr:

      Thanks for the link… I really enjoyed it and the co-pays and family premiums were very interesting:
      • In Japan the average family premium is $280 per month, with employers paying more than half. Their Co-payments are 30 % of the cost of a procedure, but the total amount paid in a month is capped according to income.
      • In Germany the average family premium is $750 per month and the premiums are pegged to patients’ income and 10 euros ($15) every three month and some patients, like pregnant women, are exempt.
      • In Taiwan the average family premium is $650 per year for a family for four. The Co-payments are 20% of the cost of drugs, which is up to $6.50, up to $7 for outpatient care and $1.80 for dental and traditional Chinese medicine. They offer exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.
      • In Switzerland the average monthly family premium is $750, that is paid entirely by consumers and there are government subsidies for low-income citizens. The Co-payments are 10 % of the cost of services and up to $420 per year.
      • The United Kingdom have no average family premium because it is funded by taxation and there are no Co-payments for most services with some co-pays for dental care, eyeglasses and 5% of prescriptions. The younger people and the elderly are exempt from all drug co-pays.

    • davidmurr,
      We had this discussion in my Social problems class. Eleven students each chose a country and researched their health care systems. No one had a better health care than the US. The other countries may have a public plan or universal care but these countries were bankrupting themselves because of it. They have had to scale back, ration, and cut programs to try and fix the problem.

      We already have a huge deficit how can this help without adding trillions more to the debt.

      Then another point Prof. Moorefield brought out was the amount the US spent on research for drugs and other health related problems. Other countries especially Canada take advantage of our research because they cannot afford it.
      What will happen to cancer research and Aids research. Will that be a priority anymore when the system will need all the money just for operating expenses.

      • I think it’s difficult to make a blanket statement like “x is better than y,” or the converse, in this context. “Better” is subjective. How was your other class defining the term, to reach that conclusion? (Serious question, I’m not trying to be snarky.)

        You’re absolutely right, though: finding a way to pay for universal coverage (which does not necessarily mean a public plan, single-payer, etc.) is one of the biggest challenges. Costs must be lowered somehow—lots of suggestions are out there: efficiencies in administrative overhead, negotiated price structures, a different payment system for physicians just to name a few. Whichever we pick need to be the least disruptive.

        In any case, I sincerely believe the current system in the U.S. is not sustainable either. Nor am I sure that any of the myriad of bills that have come before Congress are the answer. It’s hard for the average person—or, let’s face it, the “experts”—to know what is even being considered on any given day, since the language seems to change hour-by-hour. The bill passed by the House means nothing unless the Senate also passes some kind of bill, and then those differences have to be reconciled in Conference. Who knows what will result. And, yeah, that bothers me.

        I’m glad your social problems class was taking a look at this issue, though—I wish more people would! It would be a shame for us to repeat the “mistakes” of other countries in this area, rather than learning from their experiences to try and create a better system for ourselves, whatever that might look like.

      • davidmurr,
        Each system was thoroughly researched into how the plan works, cost issues, pros and cons and any problems associated with it.

        As each health care system was presented it became obvious to the class that for overall service, care, availability, and cost the US plan was giving the most options to the consumer.

        Just to hear about hospital stays in some of the other countries proved the warnings of never getting sick when away from home.

    • Great resource – thanks for sharing!

  7. I feel that there has been a failure in the healthcare market, but I do not feel that this is something that the government should have control over. Some evidence that I feel that the market is performing poorly is:
    • Medicaid System
    • Medicare System
    • FAMIS
    • Pre-existing conditions
    • High Premiums for self-employed
    • Increased rate of uninsured Americans, especially working Americans

    I have also attached the website HealthCare Reform.gov and I enjoyed the link for the state of VA. I have attached it in case anyone was interested.
    http://www.healthreform.gov/reports/statehealthreform/virginia.html

    • Kim – these are excellent points and the state of VA information is very good. Thanks!

    • Interesting that the top three on your list of concerns are government programs. Medicaid and Medicare bill signed into law in 1965 basically closed a loophole that the Democrats felt had been left over from the 1935 Social Security Act. The FAMIS is a Virginia program, a state-run program that extends Medicaid’s reach for those families that make just enough money to disqualify them but not enough to buy private insurance. With all that said I do think they are needed, but are easily abused and manipulated by those who don’t see the money spent as “real” money paid for by very real taxpayers. It’s that very small minority that needs to be cleaned out because they give these programs a bad name.

      I have yet to hear anything new on the radio or news casts about the universal health care bill that is any better than Medicare, Medicaid and FAMIS other than pre-existing conditions can’t be used as an excuse; certain abortion criteria are covered; and people and businesses pay a penalty fee for civil disobedience.

      I do think there are things wrong with the current health care system. The biggest is doctors and their offices have to treat people, their patients, more like numbers or statistics. The personal touch has been driven out of the offices in the drive for profit. I get that a business needs to make money in order to survive. I get that patients sue doctors and hospitals for silly things and that drives some of the cost, but I wish the doctors could take the time they wished to get to know the people behind the charts and urology numbers.

      Maybe that’s the real purpose of the universal health care debate, a reckoning. Just like we as a nation have been holding our educational system accountable for what goes on behind the scenes in the schools this bill is forcing the health care industry and all the companies latched on to it like parasites to begin accounting for what they’re doing to help, or not help, the people of our nation.

      • Megamuphyn:

        You made a very good point, but I am not sure how the Universal Health Care system will really work, but in order to qualify for Medicaid you have to make little or no money & they cover pregnant mothers and children under the age of 19. You then have FAMIS for Moms- who are working mothers, but if they make over a certain amount of Money, then they do not qualify & that goes as well for children.

        http://www.famis.org/welcome.cfm?lang=English

        Ex. My neighbor is a hard working single mother who daughter just started college. She is very proud of her, but effective last month because her daughter turned 19- no longer is covered under FAMIS. The mother’s job does not provide healthcare coverage and now her daughter is stuck w/out insurance while she is in college.

        Ex. My best friend was shot nine years ago by her abusive ex-boyfriend & she is paralyzed from the waist down. Her SSI/Disability is only $750.00 a month. She does not qualify for Medicaid or any other assistance. She has to go down MCV for all her services, which is completely out the way & family & friends helps her w/her medications. Social Service told her either to have children (yes-they said that) to get assistance or she has to max out a $9,000 spend down to qualify. If she only make $750.00 a month imagine how long it will take her to reach a spend down of $9,000.00 for just medications and doctor visits?

        The Universal Health Plan has to be better than what we have right now.

      • In response to the example of the daughter in college. A lot of colleges offer a health insurance plan through the school. In fact, some colleges are even mandating insurance either through a private employer or through the school, so it possible that insurance is available down that avenue.

        Also, without pre-existing conditions, an individual private plan for someone that young is not that expensive and can be about 100-120 a month if searched. A summer job or part-time job could pay for this or even taking low interest student loans to fund it would be an option. While in college, I waited tables forty hours a week and found it possible to pay rent, gas, food, insurance. I am planning on attending law school next year and I will probably take out loans to help cover living expenses like this in addition to what I can save before this.

        In regards to the example of your best friend, there does need to be some kind of safety net on the state level for people who are A) financially incapable of meeting their medical expenses, and B) disabled. Someone like your friend I believe would qualify for such a program. It’s truly terrible the situation she’s gone through and she’s proof that there are times when government can step in.

        While these are tough situations though, it doesn’t mean we have to reorganize the system for 270 million Americans to address the needs of thirty million.

      • *meant to say private insurer and not employer in the first paragraph

      • redsawks82:
        Old Dominion University does not offer student health. I looked into that first for her. The advisor just forwarded us to private insurance companies like Anthem, Cigna, etc.
        http://studentaffairs.odu.edu/healthservices/announcements/healthinsinfo.shtml

        This is her first year so she is trying to get adapted to being in college before she starts working. She is there on all Scholarships, so I am not sure if she is interested in Student loans to cover health insurance, but I will bring that point up to her. Thanks.
        I worked for Social Services for years and I tried everything I could to get all the help that would be available. She was able to get an apartment based on subsidized housing, which is based on her income and she can get her medications from MCV. The only thing with that is the less she spends on medicine, the longer it takes her to reach her “spend down”.
        You are right, her situation is terrible, but there are many more people who suffer worse situations than these with no help of the government. That is one of the reasons why I resigned my position with Social Services.
        You may be right that it does not mean we have to reorganize the system for 270 million Americans to address the needs of thirty million, but there are many more who have “no” health coverage at all. You made a very good point though Thanks!! 

      • Kim,
        The House democrats added a requirement to the bill for insurance programs to allow young people(college students ) to have coverage on their parents policy until age 27.

      • catstd:

        Very true about the Insurance-my mother carried both of my siblings, but as I said-her Mothers job does not offer health coverage;thefore the mother does not have coverage nor could her child.

  8. Some anticipated benefits of the health care reform according to healthcarereform.gov (http://www.healthreform.gov/reports/statehealthreform/virginia.html)states:

    • Ending the Hidden Tax which will save Americans Money.
    • Providing Health Insurance Premium Relief/Credits.
    • It will help strengthen Small Businesses by becoming more affordable.
    • It will help Reduce Costs by preventing the insurance companies from annual or lifetime caps on the coverage we receive and abide by the yearly limits on how much they can charge us for out of pocked expenses.
    • Provide insurance stability and security by giving us guaranteed choices of quality, affordable health insurance during the lost of a job, switching jobs, if we move or get sick.
    • It will Eliminate what it called Discrimination for Pre-Existing Conditions, Health Status or Gender.
    • One-Stop Shopping by putting families in charge where we can easily and simply compare insurance prices and health plans and decide which quality affordable option may be right for us and our family.

    These are just some of the benefits of the healthcare reform

  9. One social cost of the bill is a decrease in personal liberties and an overeach of constitutional authority by the federal government in mandating health coverage. Mandating health coverage forces Americans into a system that will be regulated by some form of government like the health exchange which is run by a government commissioner or the public option. Lifestyle decisions could be dictated by the state in the name of healthcare.

    Advocates of the plan like President Obama claim that the individual mandate is just like auto insurance.(http://blogs.abcnews.com/politicalpunch/2009/11/interview-with-the-president-jail-time-for-those-without-health-care-insurance.html)

    Unfortunately that logic is incredibly flawed as Americans are not forced to get auto insurance by reason of their existence. They are required to buy auto insurance in order to have the privilege of driving on the public roads. The individual health mandate is like forcing an eighteen year old who rides the bus everyday to buy auto insurance. Yes, there are many people who are freeloaders who don’t have insurance. God knows how many people in the restaurant industry I worked with who refused to buy insurance yet spent hundreds of dollars on bar tabs and less conventional “pharmaceuicals.” On the other hand, there are individuals who can afford healthcare without insurance who would get unnecessarily penalized.

    Where I do believe health insurance should be like auto insurance is that there should be tiers of insurance. For instance, individuals could buy coverage for catastrophic situations like cancer, surgery, accidents while paying out of pocket for GP visits. This would be like auto insurance in that we do not pay insurance for oil changes and tire changes but we do have insurance for catastrophies like accidents. This may drive down the cost of office visits and routine lab work as costs could not be passed onto insurance providers who then pass it off as higher premiums, forcing doctors to compete.

    • This is the approach that I think would be more successful…a focus on the costs. Drive down the cost of the services.

    • Decrease in personal liberties? Wow.

      • I mean it is. Practically any time government acts, it takes liberty in exchange for security. The problem is when there is an unnecessary or over-reaching exchange of one for the other.

      • I had a student in another class express her concerns regarding the ‘paternalistic’ nature of health care reform. Why should the government force citizens to have health care? Shouldn’t rational, self-interested individuals take care of their own health care needs? If they decide not to have health care, isn’t it their problem?

      • Prof: Jzinn:

        I use to ask the same question, what if someone decides not to have health coverage why should they be forced to-just as we are forced to (and a law) to wear a seat belt. The state is telling you that when you get into “your” car that you are required to wear a seat belt.
        Not, saying I disagree because I always wear mine, but I did not understand the reasoning behind that

      • The overreach of government thought depends upon which school of American government philosophy one subscribes to. Jefferson and his Republican party advocated a minimal national government involvement with the bulk of governing coming from the state legislatures. On the other end there was Hamilton and the Federalists championed a large national government passing legislation to the people via the state house(s).

        With that said within the opening statement of the Constitution, which both parties and the States ratified, lies the words: “promote the general Welfare” and this can be applied to our current health care debate. I do agree that this whole exercise smacks of taking steps toward converting our fabric to socialism.

        Either way we as a nation really should help people, regardless of income, help themselves. To show Americans that there are affordable benefits to working hard.
        As my husband said about this, “I think all American children should be covered from birth to 18 years, regardless. The actual universal health care, free for everyone, I liken this debate to being given a choice between a court-appointed attorney or hiring one when you’re arrested. If you’re sitting in a jail cell and you can afford your own attorney you’re not going to take a court-appointed one. Just like health insurance, if I can afford it then I’ll pick what I want, but if I can’t then I’ll need one “appointed” to me, and that’s what free government health care is to me. They will tell us what, where and deny of coverage just like the private industry does. Also this government health care plan is basically telling those that work in America will be responsible for supplementing those that won’t work.”

      • Prof. Zinn:

        Just some thoughts…

        If a person *decides* to not have health insurance (a different situation from one who is *unable* to acquire health insurance, but wants it), then that’s great UNTIL they need health care. At that point, it’s not just their problem.

        If we’re going to follow that line of thought, it seems to me that the only realistic outcome is for that person to NOT receive health care, even when they need it, unless they can pay for it out of pocket. After all, no for-profit insurance company is going to underwrite a policy on them once they’re sick. If they don’t want to pay into an insurance system when they’re healthy and financially capable of doing so, why should they be covered when a need arises?

        People who declare themselves “young and healthy” and therefore do not need health insurance are kidding themselves. Things that affect your health are not always in your control—you might get cancer, you might get T-boned on the way to work, etc. The vast majority of people won’t be able to pay for these treatments out of pocket. So, what then—you want the hospital to write it off? You want other people’s premiums to go up as a result of your *decision* to not have health insurance? Well, your “rational” decision to forego health insurance just became an avoidable cost to society.

        Our individual decisions in this area have an effect, in one way or another, on society at large. This concept of the Individual, existing only in her own silo, even in America, seems divorced from reality.

        “The right to swing my fist ends where the other man’s nose begins.”

  10. The political problem with my version of insurance is that there is a contant battle in the minds of voters between liberty and security. A system that might longterm be better is a little more scary because they are own their own.

  11. Is health insurance a public good? This is something that really puzzles me. A public good is something that benefits society but is not likely to be produced by the private sector due to the profit motive. That is, the good is so expensive to produce, or it is difficult to charge those who benefit, so the government (society) decides to enter production. Examples include public parks, lighthouses, street lights, etc.

    When there are segments of the population that are denied insurance, or the insurance is too cost prohibitive, I wonder if this is indeed a market failure. Consider the cancer survivor, or the HIV/AIDS patient who are denied coverage. Has the market failed them or are they just the victim of bad luck?

    • I would say that health insurance is not a public good, but there is some place for it on a state level if the citizens agree to it. For the most part the system we have now satisfies nearly 80% of Americans. Granted a good number of those respondants are probably on Medicare. I’ll refrain from making comments on Medicare.

      http://www.washingtonpost.com/wp-dyn/content/article/2009/07/27/AR2009072701372.html

      With 80% satisfaction, you really can’t say the market has failed. There are a lot of public parks yet some are prohibited from visiting them because of lack of transportation. It’s kind of the same with healthcare. Just because some can’t afford insurance doesn’t make it a failure of the entire system.

      On the other hand, people can be compassionate and try to help those in need. The healthcare debate though gets into a gray area when you talk about pre-existing conditions. There are two very strong sides to the debate. Forcing insurers to cover pre-existing conditions is kind of like making All-State underwite a new insurance policy for your car while its sitting smashed into a tree after an accident. On the other hand, there are real people sick out there who by no fault of their own cannot pay for healthcare. Honestly, a good solution would be to expand medicaid on a state level to citizens suffering from the pre-existing conditions for a limited time. If they suffer from a disease that is not preventable, manageable or curable like ALS or MS after the probationary time, then they can qualify for a more permanent medicaid so long as they fall under a certain income.

      • Ok -but what about the people that are denied healthcare? Would it not be like being denied the benefit of a lighthouse? Ok – for whatever reason, your journey must be more difficult and we are not going to offer you assistance . . .

      • To Prof Zinn:

        I’ll start first with a cold statement. Life is not fair in general. Some individuals will always get the short end of the stick in one way or the other and will not be reached by either the private or public sectors. Its a cynical yet realistic observation I think. On the other hand I don’t believe that government should fight unfairness with more unfairness by taxing one group to give to another if the receiving group can take care of themselves, even if it is more difficult.

        I’ll continue with a more warm-hearted statement. As I said before though, I think that states should create a “medicaid” for those who truly cannot afford medical care on their own and have a real disability like a spinal accident, neuromuscular disease, cancer. It should be limited in who can qualify so that it cannot compete with the private market and eventually draw people away from the private sector.

        In regards to health care being a public good. Health care in America primarily is being produced in by the private sector (even though we do have Medicare, the VA, and university hospitals) and government is looking to fill in the gap where it is not being covered. Unfortunately, the current bill isn’t projected to do so. As I said before, no good is ever going to be utilized by everyone who wants it.

        An example of a public good would be communication. Initially, the government was tasked constitutionally with creating the post office, the only means of communication during the 18th Century. As time went on, entrepreneurs came up with FedEx, UPS, courier services, phones, cell phones, and wireless internet. Would we say that communication is a public good if government was first to fill the need though there are numerous private companies that provide the same service?

        I also think that part of the reason why health care is so expensive is not a market failure but partly a government failure. It was the failure of a Republican President Richard Nixon who tied health insurance to employment in 1973. Government stepped in and created a situation where people lost their insurance if they lost their jobs and it made it easier to pass medical costs onto an insurer who could pass it on to a large company thus creating inefficiency. If government had not stepped in, things may not be so costly now.

        Sorry if this was long.

    • I read an interesting article that talks about how “we the people” decide what qualifies as “public good”. Example: Public vs. Private Schools.. We decided, as a people, to create a “public version” of a “private good”.
      And we did it cuz it either: 1) works better, or 2) it’s more “just and fair”.
      “Countries with public roads, universal public education, and national armies are richer and more powerful than countries that don’t provide these as public goods.”
      We are having a huge problem with this choice, because we’ve forgotten that this is a country that is ALL about choices.
      Perhaps we’ve lost sight of the choice itself: “…to ensure “that all citizens, rich and poor, get decent health care when they need it. Can the free market ensure this? No, no more than the free market can ensure that every child gets an education. Only the government can ensure that everyone is guaranteed decent health care. That doesn’t mean that the providers have to be government; they can be private doctors and hospitals and insurers. But the guarantee of coverage for those who can’t afford it has to come from government. That is the public good we’re talking about here: universal health insurance.”
      http://www.economist.com/blogs/democracyinamerica/2009/10/universal_health_insurance_is.cfm

      • I also do not believe that government can insure decent healthcare for all its citizens. The current bill as projected by CBO doesn’t even guarantee coverage for all citizens let alone decent care.

      • What about the protection of individual freedoms and rights? If the government is going to provide insurance for those who cannot afford it, those who can afford it must be forced into the plan.

    • Prof Zinn,
      In answer to your question is it a public good I would further ask is it within the enumerated powers of Congress to control health care?

      The general welfare clause according to James Madison argued in The Federalist Papers it does not give it unlimited power.

      The necessary and proper clause also does not give it unlimited power.

      I read over the Clauses and I saw no place where the regulation of health care was given as a power for Congress. Must we stand by and idly watch as our freedoms are ripped away from us. The people have made their voices heard through phone calls, tea parties, and town hall meetings. What part of “Hands off my health care” do they not understand. This may bring with it a new revolution. Over 4 million pink slips were sent to Congress warning them what would happen if they followed through with the passage of this bill. A pink slip in the form of voting them out of office. I think this is the issue that just might force people to take a stand and fight for their freedoms.

      This is the article that lays out the issue much better than I can.

      http://www.wnd.com/index.php?fa=PAGE.view&pageId=106694

  12. There are lot out there claiming that the current healthcare reform proposal will drive down costs. Something that strikes me though is that the plan places new fees and taxes on medical providers and medical supply manufacturers. http://www.cbsnews.com/stories/2009/10/30/business/main5459414.shtml

    My question is how is the bill going to cut costs when it legally makes the cost of care more expensive? I doubt that the company making the MRI machines is going to eat the extra expense. They will pass it on to the hospitals buying the equipment which will in turn be passed on to the consumer. It’s things like this that make me believe that all of this is a shellgame to score political points.

    I’ve also heard arguments that this will be a wake up call to doctors who care more about profit. Why is it that doctors have to be noble and perform their services after spending hundreds of thousands of dollars and countless hours on medical school and charge minimal amounts for their services, but everyone else is allowed to profit. I think there is something hardwired in all of us that loves economic liberty as long as we make money but not as long as we have to pay for something we want regulation.

    • As the cost of care increases, in the years to come taxes will increase to cover the cost. That’s us, again!

    • redsawks82,
      So true no one knows what the final cost will be, the price keeps escalating and the program has not even been voted in yet.
      Many legislators are having a hard time understanding how this bill will lower cost. They are also struggling with explaining it to their constituents. How can they in good conscious convince anyone if they don’t have an understanding of the cost themselves.
      This bill is almost 2,000 pages in length. I’m sure there are only a handful who have taken the time to read it to find out what it contains.

      • “I’m sure there are only a handful who have taken the time to read it to find out what it contains.”

        These people in Congress are paid to vote on legislation and are elected to do what’s right for American citizens. Isn’t the most concerning factor the fact that most don’t even read the proposed legislation?

  13. The only anticipated consequences of healthcare reform that I have read about seem to be the money issue.

    I do feel that the social benefits of health care reform will outweigh the social costs of the program.

    • CNN reports that the bill is 1.1 trillion over 10 years. It is difficult to even imagine how much money that is, plus interest. This will be in addition to the debt for the stimulas. There may come a time when the United States will not be able to borrow any more money from other countries. When the Administration spends so much, what happens to social benefits when the well is dry?

      • Piggy-backing on CJM1406, President Obama said the reform package was only going to cost 900 billion during his address to Congress. In two months, the bill has already grown to over a trillion. It scares me to think how much this will really cost in ten years, seeing that government usually low balls the figure.

      • George W. Bush said the Iraq war wouldn’t be that expensive as well. The government doesn’t exactly have the easiest accounting practices. At least the costs of the healthcare bill actually benefit people.

    • Social benefits and social costs, good! There are many social benefits to good healthcare, not the least of which is increased productivity.

  14. Anticipated consequences of the healthcare reform are when government interferes in the market, inefficiencies and unintended consequences result.

    • One of those consequences could be loss of financial privacy. According to Tom Giovanetti with the Institute for Policy Innovation the “The House health “care bill, H.R. 3200, expressly gives the new Health Choices Commissioner the right to look at an individual’s tax return to determine what medical benefits or subsidies that person qualifies for. Section 431 of the bill allows the new commissioner to view individuals’ filing status, adjusted gross income, number of dependents, and tax credits taken.”
      The bill allows the govt to check your Social Security to see if you qualify for care, to look at your bank records to see if you can pay for medical care. CAN WE SAY BIG BROTHER? Scary to even think about.

      http://www.onenewsnow.com/Politics/Default.aspx?id=660856

      • They already do this. IRS. Fafsa. Credit check with employment. Background checks for virtually every privilege. Mortgage companies require bank statements, tax returns, etc. to qualify for a loan. Big Brother already knows exactly what you have and how much you make. It’s not really that scary.

  15. I don’t think government intervention is necessary. I don’t agree with Clinton and Obama urging the Senate to vote for any bill and perfect it later. http://www.washingtonpost.com/wp-dyn/content/article/2009/11/10/AR2009111017413.html?wprss=rss_politics/congress
    Think about signing a contract and working out the details later! Would anyone agree to that?

    Clinton contends that the worst thing to do is nothing. I don’t agree. He claims that when helath care did not pass during his term that the Democrates lost control, health care costs increased, and the number of Americans without insurance increased. The structure of health care was not the only factor impacting those results.

    I don’t think anyone knows the benefits of this health care bill or the consequences if it passes. We know what the media tells us, and that is different depending on which media you listen to. We don’t know or understand the amendments, the deals to get votes, or the fine print. The media do not understand the details and I would bet that the Congressmen voting do not understand the details.

    Minority Leader Mitch McConnell promises lengthy debate and many amendments
    http://www.philly.com/inquirer/front-page/20091109_Health_bill_faces_battle_in_Senate.html.
    39 Democrates voted against this bill in the House. Concessions on the public option and restrictions on abortion were necessary to get the votes. Liberals object to the concessions and the restrictions.
    I don’t think the social benefits of health care reform outweigh the social costs of the program. This is 1.1 trillion dollars over 10 years with increased taxes and Medicare and Medicaid cuts.

    I am opposed to any public option because I fear that it will drive the private option out. Private insurance companies will close one by one over time. I do not trust Congress to structure a public option that will not have an inroad to take over.

    I would prefer that the focus be on reducing the cost of hospital and medical services and the cost of drugs.

    Governor-Elect McDonnell has stated that if the states have an option to “opt out” Virginia will not participate.

    The rush to pass a bill this year is an indication to me of the fear of not getting the votes if the debate is lengthy. It feels like this is all about politics rather than the quality of the bill. I also worry that if it does pass that we are “stuck” with it. I think we will be trading bad for bad.

    • The fact that the Governor of Virginia wouldn’t even allow the citizens of the state to have a choice doesn’t sound like a smart decision. What would be the downside? I don’t think giving people an option is such a bad thing.

  16. In regards to has there been a failure in the healthcare market? Here is a interesting article link that was published in 2007.

    http://www.prospect.org/cs/articles?article=ten_reasons_why_american_health_care_is_so_bad

    Here is another interesting article regarding Britian’s healthcare system.

    http://spectator.org/blog/2009/10/20/want-private-health-care-work

  17. I still feel that this Healthcare reform is going to be a 50/50 situation. The Americans who “can” afford health coverage and have it will more than likely be against it. The Americans who want coverage or affordable coverage-will more than likely be for it.

    My husband pays $400 a month for our health coverage through his employer. We both only go the doctor probably just once year- our children once a year/with the exception of our 2 year old. We barely use it, but it cuts into our household income every month for $400.00. We are adjusted to it, so either way I guess we will be o.k.

    I have heard so many “wonderful” arguments in our blogging that I am more concerned and confused than I was before. I have been provided w/ very good sources of information… Thanks!!

    • Concerned and confused is a perfect statement. I do not take my employers health care plan. I opt out and use my wifes plan. Why? For the plan we have we pay about $300/month now. If we took the plan that is closest to what we have now through my employer we would be out almost $1200/ month. Both plans are through Anthem. Both plans are for family coverage. To all that say we do not need healthcare reform I am gonna have to disagree. Oh and to top it off….I work for County government and my wife for a private company.

      • There are so many apparent inconsistencies with coverage options and premiums. When I worked for a small independent school our premiums were super high because we had a large number of ‘older’ faculty on the plan who had chronic health conditions. The cost of their ailments was spread across our small population.

      • 1soxnut:

        WOW!!

        I wonder why there is a such a difference in costs if they are both through anthem? Very intersting!!

        My employer offers health coverage for us and he do pay for it, but about three years ago he increased the copays which to me was to expensive. The plan w/my employer is $500 ER visit $40 PCP, $50 Specialist and outpatient is $300. I do not use my insurance that much, but I would have to pay a pretty penny to add my husband and our children since he pays for his employees only.
        Imagine if I had to use that insurance for my children!! My 10 year old is asthmatic and has a heart murmur & my youngest has psoriasis- so we are always at a specialist.

        Maybe things will change in the near future-how I don’t know. 🙂

  18. I agree with Obama’s contention that the cost of doing nothing to reform healthcare will cost Americans more than any reform cost no matter how expensive it may be in the form of future taxes or a defeceit. Healthy people are more productive people. Without basic care people cannot be productive members of society. People without healthcare live in fear of illness and injury. Even those that have insurance can lose everything from the cost of healthcare expenses. No one in the richest country in the world should live in fear of preventable illness.

    • I think ignoring deficits and higher taxes is not prudent. For being a nation that has such a terrible health care system, we have managed to be one of the most if not the most, productive over the last few decades. Yes, maybe some people would be more productive but its benefits likely would be offset by the massive debt and devaluation of our currency.

      • Productivity in the US is actually pretty flat.

        http://data.bls.gov/PDQ/servlet/SurveyOutputServlet

      • There are many studies that clearly state that healthier people perform better at work and the savings to the companies are dramatic. Healthier Americans do work harder. More healthy people working also would mean more tax revenue.

      • That is because we are in a global recession that is making a lot of nation’s GDP’s flatline. Over the last half century though, GDP has consistently risen.

      • You are assuming that just because people are covered by health insurance that people will make lifestyle choices that are healthy. I know a lot of people with health insurance who are incredibly obese. Sure, they get their medical care paid for, but they’re still unhealthy and not productive.

      • “You are assuming that just because people are covered by health insurance that people will make lifestyle choices that are healthy. I know a lot of people with health insurance who are incredibly obese. Sure, they get their medical care paid for, but they’re still unhealthy and not productive.”

        VERY VALID POINT> I know that Americans are extremely unhealthy but it doesn’t mean we shouldn’t all be afforded the same healthcare benefits.

      • GDP growth rate chart:

        http://www.google.com/publicdata?ds=wb-wdi&met=ny_gdp_mktp_kd_zg&idim=country:USA&q=us+gdp+growth+rate

      • Another GDP growth rate chart….not so great:

        http://www.tradingeconomics.com/Economics/GDP-Growth.aspx?Symbol=USD

      • Yes, but you’re only narrowly looking at GDP growth in this country by itself. That’s like seeing a car going twenty miles an hour on the interstate and you say “hey that car is sure going slow” when failing to look at the other cars that are going slower. While we average about 3-4 percent growth in GDP a year (barring the current year which is in recession), that is competetive with the rest of the world. The only countries with significantly higher GDP growth rates are third world countries and former Soviet countries, where any growth will look larger proportionately because they were starting off with way less in terms of GDP.

        So, if our nation is so sick and so unproductive because of it and health care and wellness are so great in Europe and other countries, why is our GDP per capita constantly hanging out around the top five or six in the world above Sweden, France, Spain, Japan, Germany to name a few?

      • In addition to increased productivity, there are the positive externalities in that healthier people are not spreading disease.

      • Gnoel:

        It is funny that you mentioned that because the other day my husband and I were required to fill out a health assessment online from his employer. At the end of the assessment it gave us a score which my husband scored 85% and I scored 86%. The assessment was telling us what we needed to do to get a better score.

        I was so nervous thinking now his insurance company thinks we are unhealthy people. Of course my assessment said I needed to exercise more and my husband needed to cut back on his fatty foods-he thought it was funny since he only weighs 145 pounds

  19. I really like the statistics and facts in this website:

    http://www.nchc.org/facts/coverage.shtml

    “Studies estimate that the number of excess deaths among uninsured adults age 25-64 is in the range of 22,000 a year. This mortality figure is more than the number of deaths from diabetes (17,500) within the same age group.8”

    “Rapidly rising health insurance premiums are the main reason cited by all small firms for not offering coverage. Health insurance premiums are rising at extraordinary rates. The average annual increase in inflation has been 2.5 percent while health insurance premiums for small firms have escalated an average of 12 percent annually.7”

  20. Here is an article published in 2006 discussing the flaws in healthcare:

    http://abcnews.go.com/Health/PrescriptionForChange/Story?id=2577974&page=2

    Great quote from the article:

    “The blame is not with doctors, nurses and health-care providers; most would serve their patients ethically and compassionately were it not for the financial, organizational and policy constraints placed on them by the entrenched and powerful American “institution” of medicine.”

    • This is a good article discussing the flaws! Thank you.

  21. I believe that if the current healthcare system were not so inept then we would not have been discussing this very same issue for the last several decades. Profits for insurance companies are astronomical and yet many people still don’t have coverage. Government intervention is necessary because corporations have only the bottom line and shareholder benefit to consider. Health insurance companies mission statements may have deceptions that they’re interested in the well-being of Americans, but the dollar signs are the primary focal point. For profit organizations are not in business to help people, Period. I don’t care what organization we discuss, whether it’s banks, insurance companies, or drug companies. The point of an organization is to make money. The movie “The Rainmaker” with Matt Damon is a great example of the corruption inside insurance corporations. I think that there are a few guarantees that American citizens should have available, and adequate healthcare is definitely one of them. Can anyone truly put a price tag on human life? For those that are in the “have” group, imagine you were one of the “have-nots” and it was your mother/wife/child/sister/brother, etc that was sick and dying. Is there a cost you could put on their life? I can’t.

    • Here is an article pretty much saying that health insurance profits being obscenely high is pretty much a myth. http://apnews.myway.com/article/20091025/D9BI4D6O1.html

      WASHINGTON (AP) – Quick quiz: What do these enterprises have in common? Farm and construction machinery, Tupperware, the railroads, Hershey sweets, Yum food brands and Yahoo? Answer: They’re all more profitable than the health insurance industry. In the health care debate, Democrats and their allies have gone after insurance companies as rapacious profiteers making “immoral” and “obscene” returns while “the bodies pile up.”

      Ledgers tell a different reality. Health insurance profit margins typically run about 6 percent, give or take a point or two. That’s anemic compared with other forms of insurance and a broad array of industries, even some beleaguered ones.

      • They could probably make more if the big wigs didn’t pocket the profits:

        Ins. Co. & CEO With 2007 Total CEO Compensation

        ■Aetna Ronald A. Williams: $23,045,834
        ■Cigna H. Edward Hanway: $25,839,777
        ■Coventry Dale B. Wolf : $14,869,823
        ■Health Net Jay M. Gellert: $3,686,230
        ■Humana Michael McCallister: $10,312,557
        ■U.Health Grp Stephen J. Hemsley: $13,164,529
        ■WellPoint Angela Braly (2007): $9,094,271
        L. Glasscock (2006): $23,886,169
        Ins. Co. & CEO With 2008 Total CEO Compensation

        ■Aetna, Ronald A. Williams: $24,300,112
        ■Cigna, H. Edward Hanway: $12,236,740
        ■Coventry, Dale Wolf: $9,047,469
        ■Health Net, Jay Gellert: $4,425,355
        ■Humana, Michael McCallister: $4,764,309
        ■U. Health Group, Stephen J. Hemsley: $3,241,042
        ■Wellpoint, Angela Braly: $9,844,212

      • Yes this is a big issue with the CEO’s in this industry and other’s. The CEO’s make the bigger dollars and then the company turns around and asks for stimulus or bailout money…………what are we missing?

    • gnoel54:

      WOW!! Very well put. I totally agree with you about putting a price tag on a human life. I was talking about that in my previous posting. It seems that so many are so worried about costs. I understand that costs and taxes are very important to the American people, but we are paying for Virignia Medicaid and some people who receive Medicaid don’t even want to work. The US spends money on so much, so why not health insurance???

      Many people do not believe a lot of what Micheal Moore says, but I watched his movie fahrenheit 911, which may not all have been true, but it made you think. He also has another movie called Sicko which is also very intersting and make you says hmmmmm….. any one interested you should check out the Movie.

      http://sickothemovie.com/checkup/
      (he also provides other websites to view along w/his arguments)

  22. Tons of interesting info:

    http://americanhealthcarereform.org/bankruptcy.html

  23. Good interview comparing America/Canada healthcare.

    http://www.medscape.com/viewarticle/571038

    • As an American who lived in Canada for some time, and utilized Canadian primary care and emergency departments, I can add a few observations:

      1. It’s nice to not have to worry about medical bills, or having the added stress of no health insurance while unemployed. (None of these were an issue for me personally while living in Canada, but not having to worry about it is nice).

      2. Wait times in the ER were not considerably longer, in my experience, than in American hospitals.

      3. Wait times for a primary care appointment were roughly comparable to my experience in the U.S.

      4. Elective procedures (e.g., hip replacements, MRIs, CT scans for non-emergent conditions) take longer to schedule than in the U.S.

      5. In 2003, the Canadian government studied their health care problems to try to come up with some solutions. In general, Canadians like their system, but there’s always room for improvement—particularly in the area of wait times. The main conclusion of the study was that the system itself had numerous strengths, but that spending on health care was too low to allow it to operate optimally. I guess the question is, how much money do you throw at a problem before deciding the system, as a whole, is too expensive? Obviously, Canadians haven’t reached that point—at least not yet.

      While the idea of a single-payer system interests me, I do have some concerns about how viable of a model it would be for the United States, based on my experience in Canada.

      On a societal level, I think there’s a significant difference between Americans and Canadians with regard to their perspectives on health care as a basic human right.

      Here in the U.S., we’re fond of saying that no one will go without basic health care thanks to EMTALA. But what we’ve set up is an unfunded mandate for hospitals to treat people regardless of their ability to pay–but without any corresponding subsidy. So hospitals either lose money, or have to try and make it up on their insured patients. These costs are even higher than they otherwise would be because the uninsured will seek treatment for uncomplicated illnesses or problems in the emergency department rather than a primary care office. This practice overburdens EDs and costs the facility significantly more. None of this would be necessary with universal coverage (however it’s achieved).

      Since insurance companies must cover their costs, or make a profit, those costs eventually get passed on to the insured through higher premiums, co-pays, and deductibles. I’d like to be able to quantify this a bit better with some real numbers (time for more research!), but suffice it to say that we’re already paying for health care for the uninsured, it’s just harder to point a finger at a specific “tax.”

      • Thank you for sharing your perspective regarding Canada’s policies!

      • davidmurr:

        Very interesting!! Thanks for sharing that information. It is nice to hear some things from experience rather than articles.

  24. I don’t always agree with flat tax initiatives, but sometimes I see the validity. If there were a tax on fatty foods, cigarettes, alcohol, and other things that aren’t so good for you, would that be enough to cover healthcare expenses? Would you be willing to pay 5-10% additional in income tax to never have any out of pocket costs for healthcare?

    • gonel:

      They have taxed cigarettes extremely high, but it seems the sales have not went down, but I could be wrong. 😦

      • Percentage of smokers has decreased from approximately 40% of the population in the mid-60s to around 20% currently. However, experts agree that some of the decrease is due to societal bias, as well as changes in the tobacco industry’s marketing.
        However, there’s no arguing that there are less people smoking, with the result that less people suffer from tobacco-related illnesses. Would the same influences (tax, societal pressures) work on alcohol? I’m not sure about that….look what happened during Prohibition.
        Instead of penalizing people with poor health habits, wouldn’t it be great if we rewarded those people with healthy lifestyles with premium reductions? Positive incentives always produce more, longer lasting results.

      • The demand for cigarettes tends to be inelastic -that is, because of their addictive qualities, they tend to be necessities.

      • Here is a timely article I found yesterday regarding a slight increase in adult smoking:U.S. adult smoking rate rises slightly in 2008

      • Slrhbdavis:

        Thanks for the information!! I agree it would be great if people were rewarded for healthier lifestyles w/ a reduction in premium

    • slrhbdavis – you bring out some positive points regarding the number of smokers having decreased. Has anyone looked at what it costs today for this continued habit? It is very expensive to say the least.

      Then when you look at the health issues that surround this issue; if less people participated the result would be that less people would suffer from tobacco-related illnesses as well.

  25. The argument against healthcare reform is always made by those with adequate coverage. I imagine many would change their tune if they were on the other side of the equation.

    • You are absolutely right about that. I do have adequate coverage but I see people everyday at work who do not.

      What a great social experiment that could be. Similar to the slumlord in Richmond who is confined to one of his rundown houses.

      • 1soxnut:

        Just to lighten your day. I have sued Oliver Lawrence on several of his prorperties (public information) for delinquent taxes and he came in the office the other day- I think it was Tues or Wed. to pay his taxes on the property he is forced to stay so he could get a building permit to fix it up.

        He is horrible!!!

      • I’d like to see something like the movie “Trading Places” from the 80’s. Take the health insurance from a wealthy individual and give it to someone from the inner city that has none. I think the wealthy person would change their tune quickly.

  26. I like to play with numbers….This one is hurting my eyes trying to count the zeros….

    If there are 250million adult Americans and we need 1 trillion $”s for 10yrs of healthcare reform, how much would it cost per American citizen? It’s either 400 or 4000….I can’t see straight anymore. HELP>

    • It’s roughly 4000 a person. After the first ten years, it will be more expensive as the current first “ten” years only provide six years of actual benefits. The second ten years will have to pay for the entire ten year period.

      • So $4000/person over ten years? Lets break it down further into simple numbers. That equals $400/year and about $34/month per person. For the first ten years? I can honestly say that I spend more than that a month on coffee and beer. I can give up a few 6 packs and couple cups of coffee a month so that others may be able to recieve care that might save their life. I know its not a perfect option or plan…but its a start. Even FDR had to start somewhere.

    • 1soxnut:

      Exactly my point. I think stronger people should be there to help weaker people. That, I think, is the purpose of humanity.

  27. This is what my congressman Randy Forbes had to say about the passage of the bill,

    Congressman J. Randy Forbes (VA-04) released the following statement after voting against the House healthcare bill, H.R. 3962:

    “Ironically and sadly, I believe history will judge this 2,000-page bill more for what it is missing than what it contains: the missing care for those that will wait on long lists for rationed health services; the missing jobs that will result from the legislation’s crushing taxes and regulations; the missing voice of our doctors who will be increasingly controlled by Washington bureaucrats; the missing ideas of reasonable, impactful, and bipartisan alternatives proposed by Republicans and moderate Democrats; the missing integrity of an institution marred by months of infighting and political maneuvering; and most importantly – the missing voice of the American people.”

    Not only will it cost more than a trillion dollars it raises $730 billion in taxes on individuals and small businesses. when the unemployment rate is in some estimates 22% will this bill cause even higher unemployment numbers.
    I have a friend in the health insurance business he is scared he will lose his business if this bill is passed.

  28. After reading most of the posts above I have a question. I dont think it has been mentioned yet. The insurance companies have setup monopolies in areas of the country where they are the only insurance company that you can have. They set the rates and plans and you are stuck paying what they tell you. Is this similar to what the banks did before the depression? They setup banks in areas where they were the only bank and would not let other banks compete with them. They could set the interest rates and repayment plans to what they wanted. You had no choice and had to deal with it.

  29. I understand there are millions of lines that can be removed and are not needed in this healthcare reform bill. However, there are a lot of good things too.

    We need something to break the cycle we are already paying for. Here is a perfect example of what I mean by circle:

    I go to someones house because they called 911 and said they are sick. We respond and gladly take them to the hospital. They have no insurance. They get a bill for $400 for the trip (a little below the average from what I am told). They do not pay this bill because they can’t afford to. The county still pays the salary of the responders, the maintenance of the ambulance, the cost of the supplies, and the equipment that is used. The person who owns the house we just transported from pays property taxes (or rent which goes to taxes). These taxes pay for the county to operate the ambulance they just took a ride to the hospital in, recieved a bill from, and did not pay because they have no insurance. Madenning I know. Now, take a look at if they had government provided health insurance. The insurance gets the bill, the county gets reimbursed, and it is paid for by everyone in the U.S. over a ten year period. Ridiculous I know. Compare it to the TVA (Tennessee Valley Authority) Cheap electricity was sold to 5% of the U.S that was being subsidized by 95% of the U.S. who did not get any electricity from the TVA. (If you have followed me this far you are doing great)

    Is this bill the fix. We may never know.

    • 1soxnut:

      I have a question for you- what happened to Volunteer Rescue squads??
      I live in Ashland and I always thought they were Volunteer-please do not think I am crazy-but does that mean the worker is volunteer & you still have to pay or the service is Volunteer?? Just wondering because we donate to them when we get requests in the mail.

      • It can be complicated, depending on where you live. Here’s the loooong answer:

        I volunteer at a rescue squad in Henrico County, which has three volunteer squads and the fire department (which has career firefighter/paramedics and their own ambulances). The difference in Henrico, though, is that the county doesn’t charge a user fee for EMS. It’s paid for mostly through property taxes and, of course, donations to the volunteer squads. So everything is “free.”

        In Hanover, as in Henrico, there are volunteer squads AND paid, career EMS providers. A couple of years ago, Hanover implemented a user fee (these programs are called “revenue recovery”). But as 1soxnut said, no one is refused treatment or an ambulance ride because or in spite of their ability to pay. Most programs allow for a reduction or elimination of the charge depending upon the patient’s income. Otherwise, private insurance or an appropriate government program like Medicare is billed. I’m not familiar with the exact distribution of funds in Hanover, but the volunteer squads still need community donations to operate. The fees usually got more towards supporting the career side. Revenue recovery programs rarely make the system a *ton* of money; but, every bit helps and they’re one piece of the funding puzzle that many systems are trying. Hanover has a pretty good explanation on their website, here:

        http://www.co.hanover.va.us/pio/ambulance/FAQ.pdf

        So, to sort of answer your question: at the volunteer rescue squads, the EMTs and paramedics are not paid for their time and services. At the career services, they obviously are. But in either case, the status of the worker doesn’t necessarily have much to do with whether or not there is a user fee. It just depends on the county.

        In SOME counties, usually less populated ones, the volunteer squads will hire paid EMS providers to work at the squad during hours they have trouble getting volunteers (like week days), instead of having a separate paid service. See, told you it could be confusing! 🙂

        1soxnut – you work in Chesterfield, right? Or am I thinking of someone else? Maybe you can explain it better, especially for Chesterfield. I’m not as familiar with their system, although I know they have career and volunteer down there as well.

      • davidmurr:

        Thanks for the explaination & the website !!!

      • davidmur did an excellent job explaining it. In Chesterfield, yup thats me, we have both paid and volunteer. Depending on the ambulance that shows up will depend on if you are billed. Our volunteer system has seen a decline in its staffing and we have had to supplement it with paid people and paid ambulances. Yes, the volunteer squads are mostly volunteer and do not charge for services. There is one in the county that does charge for services and has 2 or 3 paid people. The volunteers do count on your donations to operate. I am not sure where the rest of the money comes from for their operating costs.

        I hope this helps. I know it is confusing.

  30. Well it is clear the topic this week is being thoroughly considered! Each time there is a post to the blog, I receive an email. During my 3 hour class last night, I received more than 35 emails . . .

    • I feel that this topic you have given us-being a current issue is a great concern for all of us-whether for it or against it.

      I truly enjoyed this one!!

    • This sure has been a very busy blog this week. The subject of health care is important to everyone. It has been interesting hearing all the opinions and seeing new information and ideas I never considered before.


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