Obama's Health Care Plan

Great Debates
21

Debating over the relative merits and demerits of any plan is somewhat pointless, in my mind.

The goal is to get “coverage” for everyone, and pretty much any plan is going to do that. Point in fact, we already have universal coverage. You can always go into the emergency room and get taken care of.

What I want to know from a candidate is what they are considering to be minimum coverage. From there, pretty much all plans are going to have it such that no private insurer will be able to touch anything less than that (though it might go through them), and anything above it will be business for the private insurance companies. It’s fairly well impossible to pass any plan which would demolish the private insurance industry, so it’s not worth considering.

If Obama or McCaine want to sell me on a plan, they need to say what they’re planning to guarantee for every American before we get into the specifics. 1 checkup per year? Your own choice of doctor? Any prescription there is? Any test there is? Any surgery there is?

22

[QUOTE=Sam Stone]
Obama isn’t going to use FEHBP. He’s setting up a government-run health insurance system. The system will use a schedule of benefits similar to what FEHBP offers, but it’s a totally new, government-run program.
[/QUOTE]

Wrong. It is based off the FEHBP model. I can see how you can get confused about it, but it is clear from this description of the plan

that it will be insurance companies providing the services.

23

[QUOTE=Liberal]
That’s crazy. What will you then do about the immediate and massive unemployment spike?
[/QUOTE]

At least if they lose their jobs, they’ll still have healthcare.

24

[QUOTE=Liberal]
That’s crazy. What will you then do about the immediate and massive unemployment spike?
[/QUOTE]

Well, the government could nationalize all the health insurance companies and merge them into a single quasi-public entity like the Federal Reserve – the consolidation would mean some layoffs but not across the board; but that would be expensive as the Fifth Amendment would require compensating the stockholders, whereas no compensation is required if they companies are simply functionally replaced by UHC and driven out of business. In the latter case, there could be a policy to give laid-off health-insurance workers first place in line for jobs in the new public system. There’s always a way. Anyway, anybody who works for the industry now should have some skills transferable to other fields of insurance. And I don’t think the numbers of workers involved would be statistically significant (compared to the national labor pool) anyway.

25

[QUOTE=Sam Stone]
But wait, won’t they already do that? Sure they will. You can get insurance for anything, so long as you’re willing to pay the premium. When people say they can’t get health insurance because of a pre-existing condition, what they mean is that they can’t get inexpensive health insurance they can afford because of their pre-existing condition.
[/QUOTE]

Cite?

26

[QUOTE=Liberal]
That’s crazy. What will you then do about the immediate and massive unemployment spike?
[/QUOTE]

I trust you were as concerned about the buggy whip makers?
It is not clear how much value most of these people are adding to the economy, and that includes staff at doctor’s offices fighting with insurance companies full time. I say that though my future son-in-law was working for one of these places before getting laid off. Not that he is going to be contributing to the economy any better - he’s starting law school in the fall. :slight_smile:

27

[QUOTE=Renob]
Be careful about believing information about public policy from films. As this report discusses, Medicare and private insurance are set up in ways that don’t lend to an easy apples-to-apples comparison about overhead. But when you actually crunch the numbers, it appears Medicare has only slightly less overhead costs than regular insurance. And, yes, the report comes from the insurance industry. I’ve read it, though, and can’t find any flaws.
[/QUOTE]

I’d heard/read that other places, but the film was the only prominent mention of it I could think of. When the film came out, there were many small discussions in the media about the efficiency of Medicare, and it came out in a favorable light. Before, I’d always thought of it as this big government nightmare monster.

28

Siam Sam: I heard a story on NPR a while ago about Thailand’s health care system. From what I recall the government looked at systems used by other countries and then used the best bits for their own. The story said that anyone could walk into any doctor’s office (GP or specialist) and be treated without a wait. The patient presents his health card, and the government pays the bill. They said that the system needs more money, but if they added the funds it would still be operating at a percentage of the budget about half of what the U.S. pays with its private system.

Can you provide any information about Thailand’s health care system?

29

[QUOTE=Johnny L.A.]
Siam Sam: I heard a story on NPR a while ago about Thailand’s health care system. From what I recall the government looked at systems used by other countries and then used the best bits for their own. The story said that anyone could walk into any doctor’s office (GP or specialist) and be treated without a wait. The patient presents his health card, and the government pays the bill. They said that the system needs more money, but if they added the funds it would still be operating at a percentage of the budget about half of what the U.S. pays with its private system.

Can you provide any information about Thailand’s health care system?
[/QUOTE]

What? Thailand has a health-care system? Why wasn’t I told about this?? :smack:

Seriously, it sounds like NPR’s research involved reading the government’s PR handout. The system you heard of is complete and absolute Third World shit, and I pity the poor shlub who is forced to rely on that and cannot afford private health care. It is called the 30-Baht Health-Care Scheme and was the brainchild of Thaksin Shinawatra, the prime minister who was ousted in our military coup the year before last. Looks great on paper. Show up, get treated, pay 30 baht, which at today’s exchange rate is just under a buck US. Unfortunately, in practice it leaves a lot to be desired. It covers everyone and no one. If you have a minor problem that can be treated with a topical ointment, then this is the plan for you. If it’s anything even remotely serious, chances are there’s not a doctor who knows anything about the particular problem, and even if there is, there’s a proviso in the scheme excluding the problem. Especially upcountry it’s pretty much all GPs, because the specialists all head for the private hospitals and big cities where the real money can be made. To counter this, there’s a law that says doctors must work in a public hospital in an assigned area for X amount of time after graduation, but they’re just biding their time until they can get the hell out, and there are not enough specialists to go around anyway. The ones who stay are the incompetent ones who cannot be hired by the private places.

I have no idea where they came up with that “no wait” BS, because that’s what it is. Does NPR think there are so many doctors sitting around here that the unwashed poor who crowd the public hospitals can just waltz in for their treatment and leave like they’re ordering a Big Mac? You’re in for a pretty long wait.

But the situation is not all doom and gloom. Thailand has much better public medical care than most countries in the area. But you have to pay for it in many cases. There is a lot of fine print in the 30-Baht Health-Care Scheme that gets glossed over, a lot that is not covered. You still have to pay money if you want service. The scheme IS running short of money, because the poor go in, get told they can’t be helped under the scheme for whatever reason, then the doctor charges the government. I’ve seen enough government hospitals to know I’d rather operate on myself than trust them.

Fortunately, we excellent private hospitals here in Bangkok. I myself am eligible for the 30-Baht Health-Care Scheme because of my particular situation in country. Come September, I will have shoulder surgery in September, but I’m paying for private care rather than trust the 30-baht quacks.

Here’s a small example: I know of a Frenchman who was married to a Thai. When it came time for her to have her baby, they went to the local public hospital. The 30 baht covered the delivery itself, but no extras like painkillers. Drugs were extra. The Frenchman insisted no, this was the government scheme and so they wanted only what came with that. The poor wife was not even consulted. :frowning:

30

Well that’s quite a bit different from how it was portrayed on NPR! Unfortunately I don’t remember the date of the report, or even whether it was during the morning or the afternoon commute.

31

[QUOTE=Johnny L.A.]
Well that’s quite a bit different from how it was portrayed on NPR! Unfortunately I don’t remember the date of the report, or even whether it was during the morning or the afternoon commute.
[/QUOTE]

I have no doubt what you heard *sounded * attractive. Even though the government that introduced the scheme was ousted, the present government keeps it around, because it IS popular. Better than nothing, which is what it was before. But many doctors advocate its abolishment, saying it does more harm than good, I guess mainly by causing mass disgruntlement by raising unrealistic expectations.

32

Johnny L.A.
I’m not familiar with Thailand’s system, but what you’re describing sounds like Taiwan’s system. Are you sure the report was on Thailand? I’m not trying to insult you by saying you don’t know the difference, but it sounds like you may have conflated the details of Taiwan’s system.

Watch:

33

[QUOTE=Lobohan]
Johnny L.A.
I’m not familiar with Thailand’s system, but what you’re describing sounds like Taiwan’s system. Are you sure the report was on Thailand? I’m not trying to insult you by saying you don’t know the difference, but it sounds like you may have conflated the details of Taiwan’s system.

Watch:

[/QUOTE]

What he described could conceivably be Thailand’s program – except for the “no waiting” part – but reporting only the government propaganda. I don’t know anything about Taiwan’s. Is **gitfiddle ** out there? He’s in Taiwan.

34

[QUOTE=Lobohan]
Johnny L.A.
I’m not familiar with Thailand’s system, but what you’re describing sounds like Taiwan’s system. Are you sure the report was on Thailand? I’m not trying to insult you by saying you don’t know the difference, but it sounds like you may have conflated the details of Taiwan’s system.
[/QUOTE]

Upon reading the Taiwan section of the link, that does sound like what I heard on NPR; especially this paragraph:

This was a month or two ago, and I was going from memory – probably clouded by the fact that I was driving and tend to pay more attention to traffic than the radio.

EDIT:

[QUOTE=Siam Sam]
What he described could conceivably be Thailand’s program…
[/QUOTE]

It really sounds as if the NPR report was on Taiwan’s system. The users they interviewed seemed very satisfied. Also, Lobohan’s link mentions that they based it on European systems, and I remember that bit.

35

No worries. I’m often asked what it feels like to be living in an island country and if I’m worried about China invading. :smiley:

36

Thanks to Lobohan’s clue, I found the article on NPR.org.

37

[QUOTE=Siam Sam]
I’d heard/read that other places, but the film was the only prominent mention of it I could think of. When the film came out, there were many small discussions in the media about the efficiency of Medicare, and it came out in a favorable light. Before, I’d always thought of it as this big government nightmare monster.
[/QUOTE]

Medicare and Medicaid are, indeed, not that great (Medicaid especially). But the idea that Medicare has a fraction of the overhead costs of private insurance is something that is often stated as fact by single-payer advocates. The reality, though, is that it simply is not true. It’s one of the many myths that underlies our current debate over health care.

38

Where’s the promised thread on McCain’s — for lack of a better phrase — health care plan?

39

[QUOTE=Sam Stone]
Take that first clause. NO insurer will be allowed to deny someone insurance due to a pre-existing condition. Got that? You can be a diabetic AIDS patient with an artificial heart, and an insurance company has to insure you.

But wait, won’t they already do that? Sure they will. You can get insurance for anything, so long as you’re willing to pay the premium. When people say they can’t get health insurance because of a pre-existing condition, what they mean is that they can’t get inexpensive health insurance they can afford because of their pre-existing condition.

Tell me where I’m wrong.
[/QUOTE]

This is wrong. I am American and used to live in Nevada. After losing my day job after 9/11, I applied for private insurance with every company licensed in Nevada and was turned down. One in particular (Anthem BCBS) told me that they would not sell me insurance at any price as I had a pre-existing condition. Most others told me not to bother applying.

I now live overseas and have insurance though a UK company - there was no problem and they cover my pre-existing condition (which I have never needed treatment for in all my life).

40

So the scorecard is:

Wrong that you can get insurance with a pre-existing condition now.

Wrong that the mainstay of Obama’s proposal is a government run insurance program (although, once again, Medicaid and SCHIP will be expanded), rather than relying on managed competition between existing carriers.

But then let’s follow out the logic from there, if we accepted those wrong assumptions.

Yup wrong there too.

Would requiring all carriers to accept those with pre-existing conditions and to sell them the same product as others can buy for the same price result in massive price increases across the board? Highly unlikely. There are huge administrative costs that would be saved by not having to out-cherry pick the competition any more. Also the care that these uninsured people with pre-existing conditions receive is still ultimately paid for by the carriers, albeit in a roundabout way - these folks still end up needing care but getting it more emergently and more expensively, not being able to pay it, going bankrupt, and stiffing the hospitals, who pass those expense on as inflated bills to everyone else, which the insurers pay for.

Would a hypothetical government run insurance company, such as Sam falsely claims is the mainstay of Obama’s plan outcompete the private payers and run them out of business? It is possible that the government can be more efficient than the carriers but I doubt it, if so then the private carriers would deserve to be out of business, and it would be easy to require that such an entity must not run a deficit or have any other advantage over plans purchased through the national registry.

So where are you wrong? It would be easier to tell you where you are right since that is in so few places. I guess the main place you are wrong is in just repeating claptrap you read in The National Review. Of course their illogic goes past even yours - confusing what the Commonwealth Fund experts interviewed propose with Obama’s plan and assuming that a government run insurance company could force doctors to participate at their prices and that private payers routinely negotiate with doctors … oh sure with a few big groups, but generally it is take it or leave it, the same as with Medicaid and Medicare. Which many docs just do not take.

So wrong wrong wrong and wrong. I may have missed one, but you get the idea. Obama’s plan is not perfect, and it will probably be modified before it passes. But this attempt by conservative forces to create a fictional boogeyman of a fast track to a national government run monopoly on health care is silliness.