The problem with using insurance companies is that it prevents taking advantage of buying in bulk. If the Federal Government is going to be picking up the tab for millions of people, they should negotiate the price down. That’s how countries with socialized medicine can provide a similar level of care at half the price. They pay much less for drugs and other equipment by taking advantage of buying in bulk. I don’t buy that it can’t work in this country either. The Veterans Administration pays much less for their drugs than Medicare because of their ability to negotiate prices.
Then have the government set the prices for drugs. The HMOs will still pay for them (minus the deductibe), but at government rates.
It’ll hurt the pahrmaceutical companies, but a) who cares? and b) it won’t hurt them as much as you think. Since everyone will have insurance, a lot more people will be buying drugs, so what they lose in prices they gain back in bulk.
Assuming we go with a nationalized system, why would we still need HMOs and the various insurance companies?
I don’t know how much of the total amount spent on research in the US is represented by the NIH, but they do support a not insubstantial amount of research. From the NIH website:
I think that US medical research would be in one sorry-ass state if we left it all up to pharmaceutical companies and equipment manufacturers! Can you imagine how many new disorders would be in the DSM?
Yes, there may be people who still fall through the gaps. But I think it would be far superior to the system we have in place today, don’t you? You can’t judge something against the standard of the ideal; you judge something against the standard of whether or not it would improve the current situation.
Medicaid does not, in fact, necessarily cover catastrophic insurance. Medicaid is a hodge-podge of different programs that cover different things for different people in different states. In some states Medicaid recipients are enrolled in managed care which is essentially an insurance program. In others it is a fee-for-service program where the government only pays for certain procedures. Some preventative care measures are covered by Medicaid in some areas. Usually it covers the very expensive procedures that can lead to huge medical bills, but not necessarily.
I don’t know why I’m accused of not understanding HSAs and catastrophic insurance. I understand them perfectly well. And those who are accusing me of not understanding them have lost sight of an important point: they may be the bees knees for people who are reasonably well off, but for people living from paycheck to paycheck, as tens of millions of American are, they’re worse than useless.
You guys talk about the $5,000 a year or so that a family might have to pay out of pocket as if it were nothing, or as if the tax exemption somehow made it go away. For a whole lot of Americans, that’s a laughable proposition – they don’t have the money. Not to pay for the deductibles, not to shield in an HSA. So what do they do when they’re forced into high-deductible plans? They defer care. That blood in the stool, they hope it’s hemorrhoids, and not colon cancer; that severe fatigue, that it’s overwork, and not the precursor to a heart attack; that pain in the leg, that it’s a muscle ache, and not sarcoma or a blood clot that will travel to their lungs and kill them.
This is not just a hypothesis. The landmark Rand Health Insurance Experiment proved that when low-income people are faced with high deductibles, they defer care. It’s literally true that for some people, high deductibles are a killer.
That’s why liberals will be loath to support such a plan. That’s why such a plan does not represent a convergence of liberal and conservative views.
No, you guys need to hearken unto your ideological brother Starving Artist, who has proposed a plan that does represent such a convergence – and that, by some striking coincidence, is almost identical to the plan proposed in the OP!
Just as there’s something in my plan to annoy conservatives, this is the thing that annoys liberals. Here are the two big reasons for keeping the HMOs and insurance companies:
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They already exist and have the infrastructure. That means you can get going with the new scheme quickly. It also means you don’t have to dismantle an entire industry and throw hundreds of thousands of people out of owrk.
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They preserve market forces as a component of the system. Insurers would compete with each other for insurees, compete to operate efficiently, and force providers (hospitals and doctors) to compete on price, quality and service.
Because your descriptions on how they work lead me to believe you don’t know much about them.
So it’s better to have no insurance than high-deductible insurance? It’s better to have $100,000 in hospital bills rather than a $5,000 deductible?
And the RAND study also indicated that for everyone else, introducing more consumer control of health care reduced the level of usage without reducing health.
So give the poor Medicaid (even though that’s pretty crappy). For everyone else, though, let’s move to more consumer-directed care. Health care reform should not be stuck on just dealing with the very small percentage of hard-core uninsured. It should also focus on the people who are uninsured by choice, people who are uninsured because they move jobs, and people who have insurance but are getting ripped off by it. For everyone except the hard-core, low-income uninsured, catastrophic insurance coupled with an HSA is a much better alternative than our system today. And even for people who are quite poor, it is much better to have catastrophic insurance than no insurance.
Well, I suppose we could cut the minimum wage or something, to balance out the effect of giving poor people health care.
IOW, of course UHC is going to result in income redistribution. If everyone could afford decent health care, UHC would be a solution in search of a problem. But since a lot of people can’t afford decent health care, ultimately it must be financed by those who are in much better shape financially.
Next question.
Sigh. That’s why I proposed the plan in the OP – everyone would be covered. *No one *would be hit with a $100,000 hospital bill. You seem to have missed the basic point of this thread: to try and find a plan that would satisfy both liberals and conservatives. Your plan, dismissive as it is of the needs of the poor, is clearly not the answer.
Of course, these plans do little to address the huge amount of regulation on health care that drives up the prices of both health care and insurance. It seems a better plan would be to try and make health care more affordable by cutting regulation than by using even more tax dollars to fund a system that is unnecessarily expensive.
Let’s see: as of 2005 (table A2*, all races), we had about 77 million families, and 49 million people living alone.
77,000,000 x $15,000 + 49,000,000 x $7,500 = $1,522,500,000,000.
Also as of 2005, tax revenues to the general fund were $1,576,400,000,000.
We’d have had to run the rest of the government on $48 billion that year, but other than that, it’s a perfectly feasible idea.
*CSV=comma separated variables. IOW, save the file in Notepad, then open it in Excel. Check ‘Delimited’ in Step 1 of the import wizard, and ‘comma’ in Step 2.
I was discussing UHC in the most general terms, without any regard to specific plans mentioned in this thread, since I was simply addressing the redistribution aspect, which is inherent in any attempt to include large numbers of people who can’t afford care.
In Europe, UHC comparable to our level of care costs about half as much per capita, so UHC doesn’t inherently drive up prices. Comments about the cost effects of specific plans mentioned in this thread can be directed at their proponents in this thread.
Nah, we’d just increase taxes on business to the amount they’d save on insurance premium payments. Republicans will support that, of course.
(Sometimes I crack myself up.)
You might well be right that it would be better than what we have now. But it doesn’t address the overhead in the current system. It seems to be predicated on the assumption that people today are wasting money on unnecessary doctors visits. I’ve never seen any data to back this up. In the past ten years co-pays have come into existence, and have increased. (I’m not against co-pays, by the way.) This should reduce the number of unnecessary visits - has it?
There will always be people who use too many resources - if they pay for them or not. I’m fine with triage if necessary. I’d need to see some evidence that this is a major problem, and not just intuition.
Just noticed this. Could you provide a link? I’m not sure what consumer control means. I have insurance, but no one is forcing me to go to the doctor. On the other hand, when I got rejected from donating blood because of an irregular pulse, having insurance meant that I didn’t have to think twice about going to the doctor and getting the right tests. Which was lucky, since it turned out that I had suddenly developed a case of atrial fibrillation, which could have killed me. Now a poor person might have ignored it, since it didn’t affect my everyday life, and keeled over dead.
However, I must admit that I am now accumulating my fair share of medical bills.
By consumer control I meant things like cost-sharing. Perhaps its not the right phrase to use. The way I think about “free” health care (whether provided by the government or insurance companies) is that there is little consumer control. Where you pay for it yourself you have the control. So that’s why I used that phrase.
Anyway, the study can be found here: http://www.rand.org/pubs/reports/2006/R3055.pdf
On p. 25 through 27 the authors discuss the effects on health care. Basically, people who had to pay a part of their health care used less health care. But for the average person, their health was the same as the people who had free care (poor people showed worse health if they had cost-sharing).
Thanks, Voyager and Hentor, for the additional information regarding government involvement in medical research.
You know, running the government on $48 Bil/yr doesn’t sound bad to me, maybe we could dial the federal government back to what it was supposed to be, you know, like in the Constitution? I’m trying to see a downside, but it’s eluding me. 
Fantasies aside, your post does bring up two points that I think are very germain to this conversation. #1: Instituting true socialized health care is a massive, MASSIVE expansion of government. Using your population numbers and figuring the proposed tax credits as fair approximations of actual costs (which I think they are, if a tad bit high; nothing outrageous though), we would be basically doubling the total federal budget in one fell swoop. Even as pro-government intervention in our lives as you are, I think that you’re smart enough to have some trepidations about that. #2: Your post is a complete red herring, because people proposing tax credits and HSAs as a solution to the problem are proposing them as an add on to the existing system, not as a replacement for it. The majority of those people you mention in your post are going to continue to get their coverage from their employers, Tax credits, HSAs and the like are only proposed as solutions for those of us who have to pay for our own insurance, and as ways to move more of those oft mention 45 million uninsured (itself a very misleading figure) to the insured side of the ledger.
I agree that the system we have now is painfully flawed, and I have excellent health insurance. My problem is that since I have such good insurance, the doctors won’t cure me until they’ve spread the wealth with every specialist, clinic, and hospital in the south part of this county. Tests, bloodwork, more tests, pre-op visits, post-op visits, follow up visits, to the doctor and all of the specialists, are absurd. I don’t have time to go to work because of all the appointments.
I mean, seriously. The doctor wants to schedule an appointment to discuss the results of my sleep study? Doesn’t he own a telephone? Why do I have to sit in his office for two hours for something he can tell me on the phone?
And why can’t anyone tell me how much a UPPP surgery (for sleep apnea) will cost? I mean, if I want to buy a pound of tomatoes at the grocery store, it is right there, but for something as costly and serious as a surgery, it’s a world secret.
The surgery is Feb. 20 and I have to have bloodwork within 30 days prior. I had bloodwork January 7th, but that isn’t good enough. I guess in 13 days it will change drastically. I also have to go back to my GP to get a clearance for surgery. Again, he just saw me January 7th.
Now, it’s bad enough with my $20 copays that keep adding up, but my insurance company is probably coughing up another $100 per visit.
So, it might seem I’m blaming the doctors, but the insurance is the one that insists on this. And they insist on it because of the trial lawyers on the back of the doctors on the back of the insurance companies.
I think those three groups are the key to health reform:
- Tort reform
- Eliminate the medical monopoly
- Have a pay-as-you-go for regular coverage and only insurance for catastrophic care.
- Change the drug laws
- Allow market forces
Because under my plan, my UPPP surgery could be in and done. No pissing around with tests and checks. I’m 31 years old and healthy, and I will take the chance. If I die in surgery, then my family can’t sue you because of the new tort laws. I don’t need to worry about insurance company rules because the market forces have driven what is a minor surgery down to an affordable price. If I can’t afford it, then the government kicks in with Medicaid (like they do now)
And to end my random, jumbling narrative: Why do insurance companies insist on a thousand tests to determine I really, really need this surgery? Do they think I’m doing it for fun? Like I had nothing else to do that week, so I want a doctor to cut on my throat? I think a “need” for surgery is pretty self-selecting. How many perfectly healthy people demand heart surgery, for instance?