If Not For Medicare, How Would Seniors Get Health Care?

Great Debates
201

I’m hardly surprised. I’ve spent the past four years in the US listening to propaganda that at times makes me wonder how I survived growing up in Canada. According to Magiver everyone in my family should be dead, and I should still be waiting for treatment.

When I started investing in the stock market I did a lot of reading about trading psychology. One of the more interesting phenomenon is that the pain from a loss feels stronger than the gain from a win of the same amount; if you gain $20 on one stock and lost $20 on another, you walk away even, but will feel as if you lost.

I think the same thing can be applied to this debate. It’s very easy to line up perceived costs and hardships and feel that pain; things like wait times, rationing, increased taxes. But very difficult to feel the potential benefit from the gains.

So a critic will say, “OMG Obamacare will cause increased wait times, just look at how long Canadians wait!”

I can’t refute that because I agree, I think there will be increased wait times. Wait times cause a perception of pain.

But as a Canadian, I’m okay with those wait times because I never have to worry about medical costs bankrupting me. I don’t have to set aside $8000 in cash to cover out of pocket expenses. I don’t have to sit with my wife once a year when open enrollment happens and try to guess how many times we might need to go to the ER. And if I end up in the ER I don’t have to spend the entire time asking, “how much is that going to cost? Is it needed? What if I don’t get it?” I don’t have to worry that if we lost our jobs we’d ALSO lost our health coverage. That if we want to change jobs we also have to factor in their health plan. When my mother got cancer we didn’t need to have a fundraiser to make sure she received care, or worry about having to sell her house to cover expenses.

There are very real benefits to UHC, but it’s harder to put those in terms of a dollar value. The cost of HRC was some where in the $90gagillion range which causes a massive perception of pain. What do you get for all that money, what are the benefits? It’s hard for me to even articulate them because they are second nature to me. What is the benefit to you if someone you don’t know gets medical coverage? Is there a benefit?

It took about a year and a half of living in the US before I developed an overwhelming sense of anxiety for all things medical.

When I used to ski, I would access risk based on perceived pain and risk of death: I have an x% chance of crashing into a tree, that will cause x degrees of pain, with a x% chance of death. Now all I think about is the cost of medical care should I crash into a tree. How much will the air ambulance cost? Should I take it, or try to get a drive? How much is an xray, do I need more than 1? How many stitches do I need? How many cc’s of morphine?

My wife loves playing soccer, but 4 of our friends shattered their ankles costing them thousands of dollars. We had to have a long discussion about whether or not her enjoyment of soccer was worth the risk of $8000.

After four years, the cost of that anxiety has taken its toll. I now want to go back to Canada, pay higher taxes, wait in longer lines, and get lower quality of care, because those are cheap in comparison to the US system.

202

You

I asked for details of the conservative’s plan for HCR. You posted a link to the Republican “plan”. I posted a couple of points that I got from it on a quick read between classes that seemed disengenuous. Now you distance yourself from the “plan” you yourself linked to. Can you delineate some of the compelling arguments presented in this thread by conservative’s or in the Republican “plan” you linked to? I don’t recall *any *plans presented by the conservative’s in this thread please refresh my memory.

203

I am not distancing myself from anything I said before. When I said “While I might not necessarily agree with a HCR plan that they (the conservatives) put forward,” I mean a potential plan that they put out now or in the future. I should have made that more clear.

What I agree with is the viewpoint espoused by some of the conservatives in this thread. Pushing me to identify/align myself with a specific plan is not going to move this conversation forward.

204

Is there any way you’d be willing to elaborate on what you mean by, “the viewpoint espoused by some of the conservatives?” There are very few moderates in this world, so I’m deeply curious to hear what you think.

205

You are correct. I should have mentioned operating costs, but felt that they would be obvious and not that significant a persentage vis-a-vis my main point, which was thata 56% increase in their 3% profit margin was not all that significant. Which it isn’t. Most companies in this country operate on profit margins several times that rate.

Again, it’s in the percentages. $12.2 billion in profits is not a significant amount when weighed against $203 billion in premiums. Like I said, it would reduce payments to these companies’ policy holders by only $30 on a $500 monthly premium.

I’m sure you would. I’d like to pocket the profit the dealer makes when I buy a car. I’d like the profit from the groceries I buy and the gasoline I pay for. But I realize that in order to remain in business and to develop even better automobiles and better and cheaper groceries, these companies have to make a profit. Profit is not a bad word, and removing profit from health care costs would only serve to drastically reduce the quality and quantity of care while simultaneously lowering the cost only a few percentage points.

Why is it my responsibility to compensate you for the small amount of profit an insurance company makes on your policy? Sounds like you have an entitlement mentality.

Indeed, it is. And since gonzo’s cite, through verbal sleight of hand, was intended to inflame people, what I’m trying to do is educate them as to how his cite was little more than verbal sleight of hand intended to do just that.

There are several problems with this statement.

[ul]One: it’s entitlement mentality. Why are you or anyone else deserving of insurance paid for by the left over profits of a group of insurance companies? [/ul]

[ul]Two, what would be the incentive for these companies to stay in business if they aren’t making any money?[/ul]

[ul]Three, what about all the expenses not covered by your high deductible plan? Plenty of people on the pro UHC side want all their expenses covered, or at least all but a small co-pay. And what about bankruptcy? Pro-UHCers think it’s the government’s responsibilty to indemnify them from bankruptcy. Many people can be driven to bankruptcy by debts of only a few thousand dollars. What about them?[/ul]

Have you ever given any thought to why UHC has had such a tough go of it over the many decades that it has been proposed? No, it’s not because of right-wing lies and bullshit, it’s because so many people have seen how government operates. They’ve seen the waste, the bureauocracy, the red tape, and the irresponsible and frankly stupid way the government spends money by mortgaging the nation’s future. They see how Medicare and Social Security are always under threat of insolvency, how one tax increase after another is required in order to keep them afloat, and how each tax increase is only a temporary fix.

Simply put, many people on the anti-UHC side of the debate have simply seen too well how government does things and they don’t want it funding (and making decisions about) the health care of themselves and their families.

206

How do we debate a potential plan that might or might not be put forth now or in the future?

What specific viewpoints that some conservatives have put forth in this thread do you agree with?

207

First of all, to set the record straight, I do not have an entitlement mentality. That carries about as much weight as calling me a communist, and helps as much as me saying you have a me-first mentality. I don’t expect anything from anyone, I don’t expect to get a free ride. I am well enough into the upper income brackets to never benefit from social entitlement programs. You made the comment that $30 a month is nothing, chump change. You are okay paying it into corporate profits, but not into government coffers. What mentality does that describe?

I have thought long and hard about why UHC has such a tough time, and have since concluded that 99% of it is the result of lies and bullshit from both sides of the isle. And as I’ve said before, the same lies and bullshit are dished out in Canada keeping our system the way it is, and preventing the fixes we need. When I move back, I plan to dish out the same dose of realism when people talk about “American style health care.”

You said, “it’s because so many people have seen how government operates. They’ve seen the waste, the bureauocracy[sic], the red tape, and the irresponsible and frankly stupid way the government spends money by mortgaging the nation’s future.”

I say bullshit. It’s the stuff they DON’T see that’s the problem. They don’t see how the private insurance system works or doesn’t. They don’t see people dieing needlessly, suffering needlessly. They don’t see the effects of lower average life spans or higher infant mortality. They don’t see that people take out mortgages to pay for medical expenses. They don’t see the stupid way medical expenses are driven up in a system designed to game the consumer.

Comments are made like, “taxes will go up every year to pay for Medicare,” that are meant to scare the lowly tax payer. But oddly enough, they forgot to mention that my insurance premiums go up every year too, faster than tax increases. Why is a $30 a month increase in my insurance premium okay, but a $30 a month increase in taxes becomes “entitlement.”

They also aren’t aware that most of the problems Medicare and Medicaid suffer from are the RESULT of the patchwork system that is US health care. If Medicare pays less for something it’s considered “a loss for the Mayo Clinic,” and not a gain for the American tax payer.

Like I said in my previous post, it’s easy to line up criticisms of UHC, but very difficult to describe the benefits to society. So instead, my only option is to try and line up all the shit that happens in the US system. To quote an article I recently read, "when you’ve spent your whole life surrounded by alligators, it’s hard to imagine a world without them. " It’s time to wake up and see the alligators.

208

I can point back to arguments in the thread that I agree with, but then we will just be rehashing the same thing.

Instead, I’ll lay out the basis tenets that I would like to see in HCR. I want a system that does the following:

•Provides a safety net that takes care of an individual’s basic needs, with proper incentives to dissuade them from staying in the net forever (barring extraordinary circumstances).
•Reigns in the future costs of healthcare, including entitlement spending.
•Enacts tort reform, to decrease:
[INDENT]o The cost of medical malpractice insurance [/INDENT]
[INDENT]o The current environment which promotes unnecessary tests and procedures that just CYA against lawsuits[/INDENT]
•Promotes healthy living by:
[INDENT]o Emphasizing preventative care and evidence-based medicine [/INDENT]
[INDENT]o Providing economic incentives to maintain a healthy lifestyle (I like, but am not bound to, the idea of a sugar and/or fat tax whose proceeds go towards subsidies for fruits, veggies, etc.)[/INDENT]
•Aligns the financial incentives of the different players in the healthcare industry (doctors, hospitals, insurance companies, and patients).
•Provides measures that disallow insurance companies from performing rescissions and denying coverage based on pre-existing conditions
In terms of actually implementing these concepts into a workable solution, I would like it to be performed by the private sector as much as possible. The government should create the rules that bound the playing field in which private companies will then compete.

I know this is a very broad overview, but that should make it easier to come up with a solution that is workable, even if it doesn’t perfectly address all of my desires above.

209

Humor me, I can’t see any conservative’s promoting any thing in this thread except: “I don’t want to pay. Get sick without insurance/go broke/die.”

What do you mean by basic needs? Is cancer treatment included? What do you consider proper incentives? What if you are 55, worked your whole life, have a heart attack and get laid off? See one of the posters above.

How about reigning in insurance company profits? Would you include that in your plan? What is your definition of entitlement spending?

Agreed

Would you need tests to do this? I think so. Which ones are you ok with and which ones are you not ok with. Who decides? Does this conflict with your statement above.

How about we just provide economic incentives for the actual sale of produce at a low prices in economically disadvantaged areas.

How do we do that when the primary motivation of insurance companies is profit?

Totally agree. How?

Who in the private sector are you suggesting implement these concepts. The private insurance companies. Wolves, hen houses I would think.

How is this fundamentally different than what the Dem’s have suggested. Be specific.

Show me where conservatives want to do any of this and their plan to implement it. Thanks.

210

I agree with the following:

I am not going to argue specific cases, because I think it’s a waste of time - all it does is start another argument. I am looking to find an overarching, rough agreement, not get caught up in some examples.

No, I do not believe in “reigning in” profits, i.e., a limit on the amount of profit a private company can make.

Entitlement spending = exisiting obligations, including but not limited to medicare and medicaid. I know this is a delicate area, and I am not sure of the best solution here.

I believe that the Wikipedia entry on evidence-based medicine is close to what I would like. Evidence-based medicine - Wikipedia. As to the specific ranking systems detailed in the article, I have not looked into it sufficiently enough to form an opinion yet. I don’t see how this conflicts with my statement above - can you elaborate?

Again, I am not going to argue specifics. I will look at the proposals by the lawmakers themselves and see if they roughly fit in to my own viewpoints.

I think that there should also be economic incentives to move people away from unhealthy products. A tax is one solution but I am open to others.

You set up the system so that the way they profit is by providing the patient with low cost, high quality healthcare. This incentive is currently distorted by the fact that the patient often does not directly pay for his/her own health care plan. I think that the idea of getting rid of the tax benefit to business and having each person buy his own healthcare is worth exploring.

Laws in whatever HCR bill is proposed. I think that the insurance company also needs to be protected in the same bill, in that someone shouldn’t be able to avoid buying insurance during their healthy years and only pick it up once they start experiencing health issues.

The same economic actors that are currently in the system - doctors, hospitals, insurance companies, etc. I disagree with your wolves/henhouse assertion. If the rules are properly created, the competition will provide a better product to the consumer.

It isn’t too different. But a lot of this isn’t in the bill, as I understand it.

Why? I am not one of those “conservatives,” so I feel no obligation to defend them. I am telling you why I, a moderate, am disenchanted with the current HCR bill, and why I currently do not support it. I’ll address any challenge you have to my ideas, but I am not going to offer up other people’s ideas for you to attack.

211

Insurance does not require an insurer’s ability to allocate premium according to expected costs of coverage at the individual level.

Employer based group health plans are a good example. They generally don’t conduct health exams, “pre-existing conditions” don’t matter and they don’t ask the employer how many packs of cigarrettes a particular employee smokes. The insurance company simply uses broad actuarial data to set a premium that will cover their costs.

You can do the exact same thing at a national level and determine the total premium that needs to be paid and then have people pay their premium on an “ability to pay” basis.

With that said, I prefer the term universal health care as well.

212

Not totally true. If an employer is unlucky enough to have a few employees with expensive health care claims, the health insurance company can single his company out and jack up his premiums to cover it.

213

Many large employers fund their own healthcare plans and use the insurance companies as administrators only. it is not scientific, but in 30 years or so of this I haven’t heard any complaints about refusing coverage. We have had some cases where the company rejected a claim, but they were always mis-filing by the doctor’s office. It is more or less the same, though, since actuarial data and experience set the expected price, and thus the amount that employees and the employer pays.

214

Hodoggity:

Hodiggity:

Concerns and a platform are not a plan.

You then come back with a laundry list of items that you in particular want to see in a HCR bill, many of which I agree with, but still no reference to any plan or bill put forth by conservatives.

Hodgoggity:

You were the one that brought up the conservative’s HCR plan (even though you won’t commit to agreeing with it if and when it suddenly springs into existence) in the first place. How can we argue/debate about a non-existent plan that you somehow find more compelling? Concerns =/plan.

When come back bring plan.

215

If you want to talk about concerns here are mine:

  1. I am concerned about my colleagues who are in their fifties getting laid off after decades and thus losing their insurance. They have kids in high school and college. Yes they can get cobra at a ridiculously high price for a limited amount of time. Then what?

  2. I am concerned about my children and their friends who either can’t find jobs that offer health insurance or are locked into a job because it does have a health care plan.

  3. I am concerned about my friends that have individual health care plans whose costs are rising at an alarming rate who can’t even be sure that their health care bills will be paid due to insurance company chicanery.

  4. I am concerned about my friends who can’t get insurance at any cost due to pre-existing conditions.

  5. I am concerned about about my own job provided insurance because it changes every year and I have no fucking choice.

How does the conservative plan address my concerns?

216

Step 1: why is it the responsibility of society to solve these problems?

217

My last post was basically to hodiggity and his concerns. But since you ask, right back at ya; what’s the point of society?

218

If society/government isn’t responsible for the solutions how should those problems be solved? Or do you think that they shouldn’t be solved at all? Sink, swim or die and get out of the way?

219

Bricker’s totally cool with watching people drop dead if it means he doesn’t have to contribute to health insurance that may benefit them.

220

And parroting the word “plan” over and over is not a debate. You are showing off one of the big reasons I get turned off by the liberal side of these arguments on the board. You’re attacking me because I don’t have a plan? You, as one who wishes to change the status quo, have to convince voters like me that we should support the change you are requesting in YOUR PLAN. And you’re not doing a very good job at it.

I’ve even given you alternatives that I would support. Show some leadership and discuss how my concerns are addressed by your bill, or why those concerns won’t be a problem going forward.

Unless, you don’t think that the democratic party needs the support of people like me…?