Universal Healthcare

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Hmmm... It will really help once we start getting some details from Congress. I thought a "public option" would be separate and distinct from existing insurance companies. In fact, because there are people who will not be accepted by current insurance companies I thought the whole concept of the public option was to accept people, even if they had pre-existing conditions. If they are run by the insurance companies, then why is Obama saying a public option would "keep the insurance companies honest?"

The same thing happened with my birth - although it was slightly different as my mother actually was pregnant before the hire. My father started receiving health benefits in January, and I was born in May, so I was considered a pre-existing condition.

 

I guess the public option could be (effectively) an extension to Medicare. The insurance companies can also be kept honest by having a free market with the plans -- those companies which abuse the program would be penalized (or even withdrawn from the program). Loss of revenue is always a good equalizer for businesses.

The definition of pre-existing condition appears to be a moving target at times -- it appears to be gravitating to "I did not have insurance when the issue was discovered." A universal health plan would make the pre-existing condition clause obsolete.

 

Aldeth, ALL companies are for-profit. McDonalds makes more money by selling you less food, does that mean that, without strict government control on how much food they can sell you, McDonalds will end up starving people to make higher profits? No, because there's competition, there's reputation. Ultimately, if it's the profit of the insurance companies that are the problem, people could just go without insurance and save up the money they would spend on it to pay for emergencies themselves. The fact that no one, not even the rich it seems, does that tells me that the profits of the insurance companies aren't exhorbinant. The fact that people pay insurance means that it is beneficial to them. It seems to be the medical bills that are the problem.

It's an incentive to hire people. You get payed less, but you get this great dental plan!

That's pretty standard. Everyone has waiting periods, usually of several months, and all of them that I've ever heard of judge it by when you're 'diagnosed' rather than when you 'contracted' the condition. It's actually a pretty reasonable system, if you think about it.


All in all, the only problem I really see with a National Requisite Insurance program of any kind is that it'll have HUGE negotiating power. Any default system is pretty much guaranteed to get the majority of the people, which means they can negotiate for the lowest prices. The government health insurance programs already inexistence are already paying way lower than anyone else, to the point that many doctors won't take them. What happens when you expand those programs a hundred fold?

 

Um... what? I honestly do not understand anything you're writing here. There's such a thing as non-profit companies. So yes, while all companies seek to make money the distinction between profit and non-profit applies. And I'm totally missing something on how McDonalds makes more money by selling fewer burgers.

Only if one version is superior to all the others. Car insurance is obligatory, but we still have tons of auto insurance companies...

 

...like if they were to ... say ... remove a piece of cheese (at $0.05 per slice) to save money and increase profits....

 

Actually, that's a good point. The problem with going without insurance is that hospitals charge more, generally, for uninsured patients - and it ain't just a small amount either.

 

I don't think that if an insurance company refuses coverage for a pre-existing condition it's such a bad thing. It's just common sense. They would not be able to turn a profit if people never paid premiums until they needed the coverage. I mean the whole point of insurance is that when things are going well, you pay for when things end up going poorly.

It's like my Dad dying and the next day I try to take out life insurance on him. They're gonna turn it down!

 

The problem, again, is that it can tie you to your employer. There are some insurance companies that will no longer insure you once you leave a comapny with a condition that is still being treated (I think this varies by state law), and some that will. But some insurance companies will not pickup a pre-existing condtion that was being treated while you were with a different employer. So you may find yourself in a situation in which you are forced to stay with an employer.

I saw this happen with another woman I used to work with whose son had downs. She had a better job offer but had to turn it down because the particular insurance company would not take her son's pre-exising condition. That was a real heartbreak to see.

 

Hmmm... That's a complicating issue indeed. It suggests that if you are going to have universal health coverage that cannot exclude on the basis of a pre-existing condition, you need to make participation mandatory. If you don't, then people will only start paying for coverage AFTER they get sick. And that doesn't work.

On the bright side, it would seem like the uninsured population is probably a fairly healthy segment of society as a whole (and I know that's counterintuitive but let me explain). Medicare and Medicaid pick up the old and a portion of the young, who are the two groups that require the most health care. I don't have figures to back up this assertion, but it seems like the vast majoirty of uninsured Americans are over 18 and under 65, and they generally require less health care per capita than those outside those ranges. Furthermore, it would seem like younger adults would be less likely to be insured than older adults. Sure, there are some people who have conidtions that have thus far gone untreated because of lack of coverage, and these people would start immediately receiving more benefits than they are paying out. But taken as a whole, I think the possibility exists that the uninsured population may represent an overall healthier slice of American society than the insured - as ironic as that statement initially appears.

 

... Yes, I meant putting less food in each meal, but selling it at the same price. Sorry about that.

And as for companies, ok, I was subconsciously excluding non-profit entities because I don't really think of them as "companies" per say. Again, my fault, but the point remains. There are a multitude of companies that could make great profit by screwing their customers, but they would generally only make that profit for a very short period and then go out of business entirely.

Having car insurance is mandatory. There is no (to the best of my knowledge) government car insurance program that you are automatically enrolled in if you cancel your other car insurance program.

Yes, that's a terrible thing, and I would advocate for a federal law to change that, if it's worded carefully.

And there's the slipery slope. Walk carefully around that one, because it's a doosey.

 

One thing I would like to add - when I say participation is mandatory, I meant participation in some type of health insurance. I don't mean you'd have to enroll in the government program - you can still go through your employer or through a private company if you wanted, but you need some type of insurance.

But I stand by my point that the only sensible way to enact universal health care is if it is truly universal. I know there is no such thing as a government run auto insurance company (just government run auto companies) but just like all licensed drivers must have auto insurance, the only way it's going to work is if everyone has some kind of medical insurance.

That said, you'll have to point out where the slippery slope is, as nearly every western country in the world has UHC, and I don't see what that has degenerated into. Today UHC, tomorrow America turns into a Communist Dictatorship?

EDIT: One more thing - in another thread it was asked if moving to UHC would have a large negative impact on doctor salaries, so I did a quick search and found out the following about salaries for general and family practice doctors (which I'm assuming are the most common):

Average salary for your run of the mill doctor:

United States: $135,000 USD
Canada: Equivalent of $116,000 USD
United Kingdom: Equivalent of $109,000 USD

So doctors do make more in the US, but it's not like they're destitute in other countries.

 

Let me elaborate. The slipery slope is:
If you exclude based on pre-existing conditions, you miss a number of the people that really need the coverage. If that's the case, what was the point?
If you don't exclude based on pre-existing conditions, but allow people to sign up whenever, then people can just sign up when they need help and drop it when they don't, leaving the taxpayer with all the bills. Unless you make it mandatory, that is.
If you make health insurance mandatory, you are basically saying that every adult everywhere must give money to one of a select group of people for this service, even if they don't want to or don't see the point. The option of paying for it yourself instead of insurance goes out the window. Even with mandatory car insurance, if you don't want to pay, you can just give up your car (quite practical in some places). You would have people up in arms over that.

 

Could not history be our guide in this regard? I do not recall riots the world over when other countries instituted UHC. Also, in most countries, paying for it yourself IS still an option according to Silvery - she says people in the UK opt to do that all the time.

The US was not up in arms when we started Social Security or Medicare either. That's a case where you're giving money to a group of people for a service you may never receive, even if you don't want to or don't see the point (if for example, you don't live long enough to benefit from SS or Medicare).

Of course no one likes giving up their money for something they hope they don't have to use. That's true of all insurance. You hope you don't need your car insurance, you hope you don't need your life insurance, you hope you don't need your home owners insurance, and you hope you don't need your health insurance. While it is true that so long as you don't own a home or drive a car that you aren't legally obligated to carry any of these insurances, most prudent people prefer to have some kind of safety net.

Sure, I don't necessarily WANT to have life insurance, and I certainly hope I don't NEED life insurance, but if I die at least I know my son can still go to college some day. But that's an extreme example - in the case of health insurance why would anyone say they would not want to have or see the point of having health insurance? I don't know anyone who NEVER needs some form of health care throughout their life.

 

First off, there's a difference between the US and UK mentalities on a lot of things. Things they may accept without a second glance may cause riots in the street here.

Secondly, Social Security and Medicare were both instituted in rather interesting times of US history (and at least Social Security was billed as being good for you now, it'd be payed by the future). Nowadays, they're accepted as establishment.

Think about it this way. How do you think the US would react if it were legally required that everyone over 21 had to visit a doctor for a regular checkup every X years (whatever's recommended)? How do you think the medical industry would respond? Sure, it may be a good idea for most people, and it may save lives, but I'll bet a lot of people would be very angry with the gov't telling them they had to do it.

 

Ok, seriously, I doubt we would see riots on the streets if the US gets an optional public health plan or all children get a mandatory insurance - grumbling, sure, but the only way I see anything close to riots is if certain politicians or public figures start actively working for that.

Besides, these are interesting times as well, don't you think?

 

It can be done another way than 'telling citizens what to do', let alone forcing them. The state can offer incentives for cooperative behaviour.

Think of dentist visits. Brushing your teeth regularly aside, it is sensible to go to the dentist, say, at least once or twice a year to prevent caries. Tooth replacement is expensive. Regular visits to the dentist are not only good to preserve the teeth (i.e. health) of the citizen, but also to keep medical costs down generally.

In Germany it is that way: The government doesn't tell you to do it. It recommends you to do it. It is considered due diligence to go to the dentist regularly. If you don't do it, however, there will be disadvantages for you as far as payment for tooth replacement is concerned. If you didn't go to the dentist regularly, you will have to pay a larger part yourself.

People can decide it for themselves, and face the consequences if they don't want to go to the dentist.

You're free of public health care when you earn enough to cover your medical care yourself, and insure yourself privately. You can then still choose to stay in the public health care system.

 

That doesn't solve the insurance problem, though. The issue of mandating insurance for all came up when we were talking about how gov't insurance would handle pre-existing conditions. Look back to post #113 for my breakdown of that. You can't effectively recommend that people get health insurance when they don't have a medical problem if they can just buy into the program when they do have one (see sentence 3 on post #113).

Sorry if I confused you, Rags, the going to the doctor thing was just an analogy.

 

Is there anyone else besides me who is starting to have doubts as to whether or not this is going to get done? The fight in Congress right now is about how to pay for this. While they haven't revealed what the bill will look like yet, of the options that have been talked about so far, the 10-year operating costs are between $600 billion and $1 trillion.

This seems like a time for Obama to ask for a tax increase. He had said during his campaign that he wouldn't raise taxes on those making under $250K. Well, what about a tax increase on those making more than $250K? I'm not getting good vibes here though. I think there's no chance that Congress passes a bill before the August recess, and I think there's now a realistic chance this doesn't get done at all.

 

I've been really doubting whether this will actually get done since the beginning. One of the biggest problems was always that it'd cost a fortune to do, and Americans hate paying for anything (like most people). Any politician that votes for this may well have a hard time getting reelected, simply because it will require massive funding, which means massive taxes on someone.

On the up side, at least this gave the idea a serious look, and a lot of problems and potential solutions were brought up. I think, for anyone that payed attention, we're all much better educated about it, no matter what comes of this.