Republicans: Please Define Health Care Reform

Great Debates
281

A pre-existing condition is something you had at the time you bought your insurance policy. It might have been something you were born with, it might be something like polio that left you with a weakened leg that needs continuing therapy or it might be something like diabetes that will require treatment for the rest of your life.

It isn’t a question of morality, because health insurance in the United States is a business. A life insurance company may determine that smokers have a higher mortality rate than non-smokers, and charge them a higher rate (or refuse to cover them at all.) Similarly, a health insurance company may determine that a person who has been treated for cancer may have a higher risk of getting cancer again, and thus charge them higher premiums, not cover any cancer-related condition, or refuse to insure that person at all.

In theory this allows a person greater flexibility in choosing health insurance. If I am young, healthy and able to afford routine medical care, I may choose to forego purchasing insurance entiorely, or purchase one that only covers catastrophic illness. If my family had a history of heart disease, I may choose more comprehensive coverage that includes frequent examinations.

However, as you have seen in this thread, it also means the insurance providers also have the right to examine my medical history and decide what type of coverage they will choose to sell me, or refuse to cover me at all.

282

:eek: So you can be at a disadvantage from the time of your birth in the U.S… If one happens to be born into a poor or poorer family it would be that much harder to attain health insurance for the newborn. I`m beginning to realize that not all people are on equal footing in the U.S., and not all have the opportunity to be successful in life. It now appears that some are at a disadvantage from birth.

Smoking I can understand. Its a proven, risky lifestyle choice. Its like expecting to pay higher insurance premiums if one is a skydiver or likes to play russian roulette. But charging higher premiums (or refusing coverage) to those who are innately ill of no choosing of their own, simply because they were born with an illness, or its in their family history, or its developed in some way of no fault of their own, to me I find coldhearted. There should be rules or redundancies built into the system so that these people do not fall through the cracks. There should be a back up plan for those who cannot afford or are unable to get insurance. Showing up at a hospital, near death, before getting government assistance must put a major strain on the system. It would be alot cheaper for the government not to wait until this point and help people to get the proper medical care that is necessary before. Do people pay more for auto insurance in the US if they get more speeding tickets? Do they pay more in auto insurance if they are caught driving drunk? Do seniors pay more in auto insurance because the are more prone to blindness, or other eye and reaction time problems? Here its yes, because driving is a lifestyle choice, but living is not. It just is. No one asked me if I wanted to be alive or not. I`m here, in good health and I am willing to pay for those who are not (do my part), because one day, I too, could get sick.

This is a ridiculous theory. Its like saying, “Im not going to pay X% of my taxes because X% of the tax money is going to pay for the local hospital, and since Im not sick, what do I need a hospital for?”

If insurance costs were fed by everyone, with one organization that could negotiate the best price, dont you think that you could get the best bang for your buck? There would be no worry about getting sick, or having an accident. Or finding out that Aunt May has diabetes, and now your insurance rates are going up or maybe discontinued, and you can change jobs if you dontt like the one your in, without worrying about changing insurance. If one organization (i.e. government) negotiated or tendered the insurance companies to cover everyone in the US, everyone would be covered with minimal premiums (the payments made by those healthy offset the amount paid for the ill) and all the insurance companies would scramble for such a lucrative contract. This would be a win-win situation for everyone.

The for profit model of any company is designed in and of itself so that not all can have it. Running healthcare for profit is like running a school system or emergency service system for profit. Private schools are for profit institutions that not all children can attend, only a chosen few. (those who can afford it) But in the education system, there is a redundancy, its the public school system. Imagine there was no public school system and only those fortunate enough, (i.e. no mental problems at all, only those with a higher than average I Q, only those who have a certain amount of money, etc. ) could go to school, the U.S. would be no better than those who they are fighting against in Afghanistan.

And the U.S. calls itself enlightened. Phooey.

283

In fairness to the insurance companies, I don’t think I’ve ever seen a policy that doesn’t automatically cover a newborn through its parents. Of course, if the parents don’t have any type of insurance at all, I suppose its possible.

Again, I point out that in the U.S. health insurance is seen as a business, not an innate right. If the business loses money insuring high-risk customers and therefore can’t pay for anyone’s coverage, who does that benefit?

Does your universal health care pay for treatments for drug addiction? Does it cover joint replacements for obese people? Do you treat lung disease for people who smoke? Weren’t those lifestyle choices?

We as a society have already decided that we will give X% of our taxes to the local hospital. We as a society have not decided that we will give X% of our taxes to universal health coverage. In fact, that’s what a great deal of the current debate is about. Your nation may have decided this issue decades ago. Ours hasn’t.

Mind you, I am not arguing that the U.S. healthcare system is superior to any others. But I do understand the foundation on which it’s built. Merely dismissing our historical experience and business model isn’t going to win any points.

284

So, in theory, the US could have a bunch of white elephants in their cities and towns. Beautiful hospitals. But if no one buys health insurance, no one can use the facilities. :smack: Its like building a bunch of public toilets in a community, but only those who decide to buy toilet insurance can actually use it.

Probably. And I have no complaints. If my neighbor is a drug addict, I have a personal reason to see him get care for his/her problem. Obesity could be linked to other forms of disease. Lung disease could occur in those who dont smoke as well. We cant pick and choose who we will help and who we wont. We blanket cover everyone in the system. Who are we to decide who gets help and who doesnt?

What people fail to realize is that simply because they are healthy right now, does not mean it will be the same in the next day, month, year etc. Where I am, if I have a small rash on my finger Ill wait a good long time to see a doctor, but if Im in a car accident, Ill get an ambulance ride to the hospital and be seen by a doctor in seconds. Health situations can change that quickly. And I dont have to worry about a bill to pay. I don`t have to worry about loss of coverage. We have a needs hierarchy which appears to be backwards in the US.

Im not saying the system where I am is perfect. There is obvious room for improvement (which I wont get into here), but in general it works for the great majority.

I personally hope the US never attains reasonably priced universal health coverage because that would lead to manufacturing and other business moving back to the US from here in Canada. But I would have thought that the idea of reasonably priced universal health coverage would be a “slam dunk” in the minds of the American people. I pay higher taxes than you, yes, but those taxes are split between the various services offered to me, if needed. I will probably never need most of the services offered to me, but I`m not offended to paying a few dollars a year for them if the need arise. (i.e. public transport tax.) I use my car all the time. But if necessary, the bus is always at my disposal. And because of the blanket taxation for public transport, this lowers the cost for those who actually need it, which may also be me one day.

285

So, in theory, the US could have a bunch of white elephants in their cities and towns. Beautiful hospitals. But if no one buys health insurance, no one can use the facilities. :smack: Its like building a bunch of public toilets in a community, but only those who decide to buy toilet insurance can actually use it.

Probably. And I have no complaints. If my neighbor is a drug addict, I have a personal reason to see him get care for his/her problem. Obesity could be linked to other forms of disease. Lung disease could occur in those who dont smoke as well. We cant pick and choose who we will help and who we wont. We blanket cover everyone in the system. Who are we to decide who gets help and who doesnt?

What people fail to realize is that simply because they are healthy right now, does not mean it will be the same in the next day, month, year etc. Where I am, if I have a small rash on my finger Ill wait a good long time to see a doctor, but if Im in a car accident, Ill get an ambulance ride to the hospital and be seen by a doctor in seconds. Health situations can change that quickly. And I dont have to worry about a bill to pay. I don`t have to worry about loss of coverage. We have a needs hierarchy which appears to be backwards in the US.

Im not saying the system where I am is perfect. There is obvious room for improvement (which I wont get into here), but in general it works for the great majority.

I personally hope the US never attains reasonably priced universal health coverage because that would lead to manufacturing and other business moving back to the US from here in Canada. But I would have thought that the idea of reasonably priced universal health coverage would be a “slam dunk” in the minds of the American people. I pay higher taxes than you, yes, but those taxes are split between the various services offered to me, if needed. I will probably never need most of the services offered to me, but I`m not offended to paying a few dollars a year for them if the need arise. (i.e. public transport tax.) I use my car all the time. But if necessary, the bus is always at my disposal. And because of the blanket taxation for public transport, this lowers the cost for those who actually need it, which may also be me one day.

286

And actually, thinking beyond whether or not you will ever use it personally, you can still benefit from good public transport in your city:

  • It keeps other cars off the road so your commute is not so congested
  • It enables people without cars to get to work. People you might like to have at work, like your waitress in the coffee shop.
  • It helps to lower the pollutants from cars in the city center.

So it’s not like you are getting no benefit at all from your transit tax.

ETA: To make it explicit - the same can be said of paying to keep the population of your society healthy - you do have indirect benefits.

287

I would guess no more than two or three, per company. But if you’re relying on the market to provide efficiency, the market needs to work efficiently. That means that some insurance carriers have to go out of business, because of their failure to compete. It means that new carriers need to spring up, to provide previously unthought-of innovations, while existing carriers move into new territories, or abandon them when they cease to be profitable.

And of course, market share will open up when Delaware reduces its reserve fund requirements to 0.02%, and insurers who move there are able to expand at a tremendous clip until they find themselves stuck with more liabilities than they can cover, at which point they will collapse and leave their policyholders high and dry.

There is a reason Newt Gingrich never tried to get any of these things passed when he could have.

288

It seems that opening the market should then result in higher efficiency and less waste for companies lest they go out of business. Your point about the reserve fund is a good one. It would seem that federal regulation could take care of this problem. Some basic minimum standards have to be in place nationwide to prevent such a scenario from actually happening.

289

A lot of insurances require yearly recredentialing - which is a 20+ page form for each. Each one different, of course, with required attachments & etc.

That is, of course, if you just want to sign whatever they hand you, trusting in the beneficence of the company to pay you fairly. Good luck with that.

Otherwise, you have to go through the contract and allowable schedules with a fine tooth comb, to figure out if you can actually make enough money on those patients to survive. That has to be done yearly, as well, as they change the codes and fee schedules. (Or not, if you want to keep getting paid at previous rates.)

Of course, physicians don’t actually do most of this themselves. They hire office staff for that. Which gets back to the “overhead” problem.

Then you have all of the claims filing and followup, because the insurance companies frequently mispay or fail to pay. Amazingly enough, they usually notice when it’s in your favor and demand money back. Not so much the other way. That’s more staff and overhead.

My doc estimated years ago that he could drop his basic office call fee by at least one-half if he didn’t have to pay all the staff for insurance. I don’t know how he figured that up; we haven’t discussed it. But I know that his practice put in a cash-only clinic. Unfortunately, they didn’t have enough business from people with no insurance but enough cash to pay the bills, so they ended up having to start taking Medicaid - and promptly had to raise their rates to cover billing staff.

I’ve got a friend who’s a therapist. A couple of years ago, she sat down and figured up how much she was getting paid from insurance companies, how much time she was spending (or paying someone to spend) to fight with insurance companies, etc. The outcome? She no longer takes insurance. It killed her to do that - she really didn’t want to drop all of those patients, and not take patients that really needed help just because of their insurance. But she couldn’t afford not to.

There is an incredible amount of work that goes into dealing with all the different insurance companies, which translates to very high overhead on the physician side. Not even counting the admin costs at the carriers.

290

One could also say, that a great many of the Republican’s call themselves Pro-Life but do not want to pay taxes(which are necessary in many cases) to support the child once it is born. The child needs support for at least 18 years,if a person has more children than they can afford someone has to support them, or they will die or starve to death like many do in 3d world countries. Services cost money and charitable organizatios do not provide enough. If responsible parenthood isn’t taught, and people have children they cannot afford, then it add to the problems. In such a case the Government can step in and ask for tax money to support the children of the poor, or not provide the services. One has to decide what they want done.

291

There is no question that there would be some increase in cost to the physician to accept more plans. But, the question is whether the increased competition would make up for all or more of the increased expenses. You seem to be suggesting that increased competition is not a good idea…this is the very thing that many on the left blame for a lot of the problems with insurance. Or, are you starting with the assumption that ONLY a single payer system will decrease costs (albeit artificially) so other ideas must be dismissed?

292

Being pro-life does not assume that people must support the life of others.

293

Unless the pro-life crowd think newborns should be left on the curb to die, they do assume this.

294

That’s idiotic…try again. Unless you are assuming that the opposite of pro-life, pro-choice, is indeed in favor of leaving newborns on the curb to die.

295

Perhaps it should be a question of morality, and thus health insurance in the United States should not be a business.

We know that corporations can’t always, and don’t always, act morally because they are obliged to their stockholders to make as much profit as legally possible. Profit-making is a corporation’s entire raison d’etre. They simply aren’t in business to be polite, nice, and moral, nor should they be. You wouldn’t last very long if you were that angelic, and you wouldn’t be being fair to your stockholders. You would be a bad corporation.

That being said, unless it is Evil Inc., most corporations likely don’t go out of their way to choose immoral policy if-- all other things being equal (profit especially)–they can employ a moral policy instead. That’s just good business, and frankly, just human nature (at least for non-sociopaths). Further, I don’t doubt that any given individual working for a corporation–up to and including the CEO–is just as moral (or just as immoral) as any other individual.

But why would anyone ask an insurance company to treat their policy-holders fairly if it hurts the company’s bottom-line? As long as they don’t break laws and are not so obviously cruel as to harm their reputation; as long as they satisfy just enough of their customers to enable them to continue being profitable, then they are properly fulfilling their obligations. It would be unfair to ask anything else of them.

Therefore it is clear to me that the role of paying for the care of sick people is not best handled by an entity that exists only to maximize profit; an entity who’s very livelihood depends on denying care to as many customers as they can get away with while still avoiding PR nightmares.

Corporations and paying for health care treatment just aren’t a good mix. Because in order for policy-holders to get the treatment that their doctors deem necessary at a price that won’t force them to sell their home and/or declare bankruptcy, the industry would have to be so heavily regulated that they would lose almost all freedom to manage their own affairs. That’s just not the way a corporation should have to operate.

The conclusion I reach is: most types of health insurance should not be sold and/or managed by private corporations. It’s not fair to the patients, the caregivers, or to the corporations.

We need another way, and I think that we might benefit from looking at countries who have by-and-large achieved affordable healthcare for all, with better healthcare outcomes and longer lives–all while expending a far smaller proportion of their GDPs. We should closely examine how they have done this–and then do it even better.

For better or for worse, we live in a largely capitalist society. Let’s not water-down free-market capitalist enterprise by asking it to perform a function it is not well-situated to handle. Leave the corporations alone to do what they do best. Leave the health insuring to someone who doesn’t have the headache of trying to profit from something that–when administered properly–is virtually impossible to profit from.

296

That is true;that is why I call them pro_birth as people who are pro-Choice are pro the life of the all ready born.

297

Pro-life and pro-choice have nothing to do with this debate. The distinction I think you are trying to make is between conservatives and liberals. Conservatives think you are mostly responsible for your own life. Liberals think we are a bunch of children who need to be taken care of by the public sector because we, the unwashed masses, don’t have the brains to take care of ourselves. This is the very heart of HCR…liberals think that we cannot make the proper choices ourselves so we need the government to do it for us.

298

I think the biggest driver of high medical costs in the US is overutilization of services by the insured. It’s similar in concept to taking your car to the mechanic and saying “do whatever you think needs doing, the more you do the more money you make, and I’m not paying for it so I want everything possible done.”

Medicare had a study of two areas of the country one around Dallas and one in Oregon. The costs per enrollee were twice as high in Dallas because there were so many more doctors. Supply creating its own demand.

So I think putting poor people who are paying nothing into the system into such a system would simply bankrupt the country even faster.

The people currently getting the gold plated, spare no expense care, have no reason to want to change. Anecdote, my friends’ daughter hit her head. Didn’t pass out but did feel tired later. They insisted on a cat-scan ordered and why not? It’s not their money. Repeat millions of times and you have our predicament. Cancer which killed surely and cheaply 30 years ago is now “curable” or at least “treatable” but only at great, great expense. This is a good thing, but it’s expensive too.

The problem is not in the profits of “insurers” or “getting the government to ‘compete’ with them”, or even in pharmaceutical prices. Pharmaceutical companies create drugs and as far as I know, it’s illegal for medicare not to pay for a drug just because it “costs too much”. Brilliant. So if a drug can extend a 95 year old’s life 3 months at $100K per month? Yep, they pay it. It’s untenable.

Back to the OP, I wouldn’t mind paying for “basic” care…broken arms, pre-natal, immunizations, chronic conditions maintenance for poor people. Even expensive treatment on otherwise healthy people if it will do some actual good.

It’s the gold plated care I don’t want to pay. The cancer, heart bypass operations, expensive surgeries on elderly people…“but wait, does that mean you’d just let them die?”. Unfortunately yes. Don’t have enough money for everything, sorry. The UHC in the UK have to make choices like that, as far as I know. They have a budget and have to stick with it. There isn’t an infinite amount of money and needs will grow and grow as technology advances.

As for insurance being unavailable for pre-existing conditions, maybe high risk pools could be subsidized by the gov’t. I don’t have any easy solutions to that. It’s not realistic to expect the insurance companies to take on very sick people for the same rate as healthy people. Adverse selection means the policies will be very, very expensive.

As to the other “the UK has a higher life expectancy”. I think it’s a canard. Life expectancy isn’t a good measurement. Does the UK have unlimited guns like we do? Crime? Rampant obesity? Drunk driving? Give me the life expectancy of a person in the UK with stage 3 breast cancer vs. a person in the US (with insurance). That would be relevent.

One way I’ve heard it phrased is “what give you (the person with insurance) the right to have better medical care than some poor person?”. My answer is that if you pay for something, it’s yours. If you have to get something through moral or government coercion, it’s not the same. If you have the money you should be able to spend it (through insurance) on great medical care if you want it. There’s no reason the poor should expect the same medical care just as they shouldn’t expect the same house, car or university for their kids. That’s just the way I see it.

299

The vast majority of the 30 million new enrollees under the House’s public option plan would be paying a premium to the government. A much smaller number of the truly indigent would be completely subsidized by the government. The biggest deception being spread about health care reform is that it will institute free, unlimited health care for anyone who has none now.

300

Isn’t this overgeneralizing? Should everyone with cancer or a damaged heart be pushed aside because of the costs?
As for the elderly, there’s a lot of variation. They’re not all feeble or lying in bed somewhere waiting to die. Does “elderly” mean anyone over a certain age?
I have an 83-year-old family member who chose a mastectomy last year to get rid of breast cancer and is now doing better than ever. In the meantime, a 46-year-old friend of a friend just died from diabetes. So I don’t think it’s necessarily an issue related to age.