I thought you were going to do that yourself:
FTR it’s not my bill, I am not a democrat.
That’s right, I **am **doing that myself already. If you want to try to influence my opinion, then you need to look at what I’m saying and address my concerns, or even attack my positions. If you make a good point (which does not include demanding a plan), I’ll be happy to reconsider where I stand. If not, I’ll be making up my mind just fine without you.
I’m curious, what are you looking to do here? You seem to just want to try to tie people up in knots. I’m here because I’m trying to reconcile my political/social leanings (which is normally FOR something like HCR) with who I’m ending up siding with in this thread.
I don’t have a clue how to influence your opinion because I have no idea what your opinion is. You said you found the conservative arguments in this thread more compelling. I asked which ones and the only one you came up with was Bricker’s that health care is not an entitlement. Well how do I influence that? It’s a fundamental difference of opinion.
You said:
But you couldn’t come up with a conservative HCR plan. How can I argue against something that doesn’t exist?
You then listed what you personally wanted in HCR, some of which is in the Senate bill, as you know, if you have read up on it. I think you are just pulling our collective chains and no HCR bill will satisfy you.
You contradict yourself. You say that you don’t know what my opinion is, but then state that I have one and that it’s fundamentally different than yours. Which one is it?
That’s incorrect. I state my conditions for an acceptable HCR bill in posts 208 and 210. I know the major bullet points, and I also know which one of my ideas are addressed by the proposed bill. For example, I know that the individual mandate provision addresses my concern about legislation forcing the insurance companies to accept people with pre-existing conditions. But you don’t bring that up, which makes me wonder if you have read up on it yourself.
What isn’t addressed in the legislation is probably my biggest concern - that there are no reforms to the current system of economic incentives for the different actors/stakeholders in the health care industry. Doctors get paid on a fee-for service business model. Companies receive tax benefits for suppling insurance to their employees. Insurance companies control co-pay amounts, while drug companies can issue rebate cards. Patients don’t see the real costs of procedures. And etc, etc… Without meaningful reform to this specifically, all we are doing is further entrenching the existing system, with all of its market-distorting economic effects. This is not what reform is about, IMO.*
So, what to do about this? I’d like to debate it, if we can get over the fact that I have no “conservative plan” to cite. Do you agree or disagree that the proposed HCR bill needs to address this concern?
Otherwise, all we doing is rehashing the past and I have no interest in doing that.
*And, also IMO, allowing individual states to experiment with the structure of their healthcare system, which the proposed bill allows, is not enough.
That was the one and only “compelling argument” given by the conservatives in this thread that you mentioned. I see no way to argue/debate that with you.
I didn’t realize it was my job to tell you what was in the Senate/House bills. You said you read them yourself.
Is your the list absolute? Do you see any points of compromise?
Which concern? No entitlements, sorry disagree. Job based insurance, public option takes care of that if only we could get it included. Drs working on a fee schedule, you want them on a salary? Should we do the same for lawyers? auto mechanics? Is that what you’re suggesting? I have no idea what you are on about drug companies issuing rebate cards or insurance companies controlling co-payments or patients not seeing the real cost of procedures. Do you really think patients have procedures just for the fun of it? Well unless they are suffering from Munchausen’s. Don’t insurance co-payments discourage unnecessary procedures?
I’ve read and heard summaries of the major points of the bill, same as you I suspect. The Senate bill itself is 2000+ pages.
You raise a lot of questions, and they all boil down (in my view) to the economic incentives.
Personally, I have Kaiser Permanente, which pays doctors a salary. I am happy with the level of care I receive. It is not a perfect system, but it is a viable option, depending on the geographic market.
For a good synopsis on what I’m talking about re: co-pays and rebates, check out this podcast by NPR’s Planet Money (audio):
It talks about how drug companies are offering rebates (or “co-pay assistance” cards) to circumvent the insurance companies’ attempts to control patented drug costs by raising the associated co-pay fees. Naturally, this is a good deal to the consumer, who used to be dissuaded from buying the patented drug due to the high co-pay costs.
On an individual level, I understand and agree with why each of the actors in the scenario act the way they do - they are maximizing their returns and/or minimizing their costs. However, when you get to the macro level, you see that it is a market distortion. Customers aren’t seeing the true cost (or even a representation of the true cost, when you include the co-pay minus the rebate) of a patented drug, and they make decisions accordingly. Without reforming the health care system so that there are not these perverse incentives, you really aren’t enacting any meaningful reform.
Regarding salaried physicians, both the Mayo Clinic and Cleveland Clinic use salaried physicians and are considered among the best providers of health care in the country.