Would like to see something done here. I think I should be able to keep them on my insurance as long as I want. I understand that I may have to pay a little more, but I could ask my son to pick up part or all of the increase just like I do with his car insurance.

 

I think that this is a problem that needs to be dealt with. Perhaps moving the age up to 25? BTW...what is the age cut off now? I assume that you can keep kids that are in college on your policy as long as they are full time, perhaps?

I have a problem letting people die. Or suffer with breast cancer and have their insurance drop them while they are undergoing chemotherapy.

 

I wish to discuss, not partake in anything argumentative.

 

You inquired about my opinion and I gave it to you. All I asked was at what point does the requirement to have insurance any insurance end?

 

I choose also not to let people die or waste away either, and that is why I work with the handicapped.

 

I have had to use my health insurance via a heart attack over six years ago, and I have seen my rates and those of my employer raise to a point that the cost is getting tough to handle but the cost of gas, food, electric, water is getting higher and higher also.

 

Should the insurance companies be allowed to drop someone because they are sick? Of course not and the Federal Government should require that the insurance keep up there end of the bargain as I am sure that if your friend wasn't sick, then the insurance company wouldn't have dropped her.

 

One question about your friend, has she over spent her maximum amount allowed per her plan? Could that be why she was dropped. Just wondering?

You inquired about my opinion and I gave it to you. All I asked was at what point does the requirement to have insurance any insurance end?

 

I choose also not to let people die or waste away either, and that is why I work with the handicapped.

 

I have had to use my health insurance via a heart attack over six years ago, and I have seen my rates and those of my employer raise to a point that the cost is getting tough to handle but the cost of gas, food, electric, water is getting higher and higher also.

 

Should the insurance companies be allowed to drop someone because they are sick? Of course not and the Federal Government should require that the insurance keep up there end of the bargain as I am sure that if your friend wasn't sick, then the insurance company wouldn't have dropped her.

 

One question about your friend, has she over spent her maximum amount allowed per her plan? Could that be why she was dropped. Just wondering?

 

I do not know the in depth details of her situation. I know that she had two chemo treatments left and they dropped her.

 

I think that health insurance is a basic for a civilized country. Good teeth, eye sight, funerals and tombstones are not as basic as your survival.

If I may continue with this line of thinking...do we force the doctor/hospital to care for the person in this situation and hope that a charitable person/group will them pay his/her debts? What if no one does?

I assume that you are speaking about when this person from the hypothetical is brought into the ER...As far as I know, ER's now do NOT check for insurance (especially in cases where it is life-threatening). How do ER's deal with these types of patients? (I'm asking because I don't know). This isn't meant to be a copout- explain more what you are saying, and I'll try and answer.

1. Especially for those that are opposed to large scale health care reforms- how would you feel about "healthcare vouchers"? Many who support small government, myself included, think that school vouchers are a great idea. They increase competition, accountability, and promotes more equality in who is getting subsidized. Would this be an idea that could work for healthcare as well?

 

I think this is an interesting idea. However, the healthcare market is much different than other markets. A few quick thoughts:

 

1. Some people will need far more care than others. For instance, healthy citizens may rarely, if ever, go to the doctor. Some citizens may suffer from terminal illnesses or chronic diseases that require constant and expensive treatment. How will the voucher system work in this situation since, unlike education, all recipients will not be looking at similar cost? Will there be unlimited vouchers? Will there be something similar to a co-pay with vouchers, i.e. will vouchers need to be purchased so as to keep care affordable but reduce frivolity?
   
2. Following from the previous thought, how will vouchers be financed? Taxes? I think, at least theoretically, an education voucher has the potential to pay for itself in that a student won't be taking those resources from the public school. While that isn't reality in terms of cost, they could be cost-neutral. How can this translate to healthcare since vouchers won't be negating any costs?
   
3. One of my biggest problems with the current healthcare situation is that consumers lack information and feedback since a third-party pays their costs so they don't factor that into their medical decisions. How will a voucher system change this since a third party is still paying the tab? Will vouchers come with a maximum price for each procedure, forcing the consumer to be more frugal or pay the difference? If that is the case, how will that work in terms of consumers who need immediate care and don't have time to shop or in terms of which entity sets the price limit?
   
4. As far as my understanding goes right now, I don't see terribly much difference between a voucher system and government insurance.
   

 

2. Habib told us that, from his understanding, part of the healthcare reform is to make it illegal to not have healthcare. I find this to be incredibly intrusive. However, today I was thinking about how it is illegal to drive without auto insurance. What are the similarities and differences between health insurance and auto insurance?

 

From the proposed bill, insurance would be mandated. It wouldn't be illegal to not purchase insurance, but a non-insured person would pay a steep supplemental tax.

 

From an abstract view, auto insurance is designed to, at the least, prevent one person's negligence to cost another a great deal of money. As that translates to healthcare, if one person chooses not to purchase insurance and develops a medical problem that is expensive to treat, yet can't afford it, the rest of society will be paying the tab when this person shows up at the emergency room. Costs here will be moth monetary and temporal as this patient will contribute to overcrowding and increased patient load on the staff. Furthermore, mandating auto insurance catalyzes competition in the insurance market since everyone must have it. The same would go for healthcare.

 

To tie this back to cch's first point, both an individual mandate and a voucher system seem to achieve the same result: universal coverage. Is universal coverage inherently intrusive, or is it merely the route to that destination that is intrusive?

Edited August 10, 200917 yr by Habib

I assume that you are speaking about when this person from the hypothetical is brought into the ER...As far as I know, ER's now do NOT check for insurance (especially in cases where it is life-threatening). How do ER's deal with these types of patients? (I'm asking because I don't know). This isn't meant to be a copout- explain more what you are saying, and I'll try and answer.

 

For example, a guy that I dated several years ago was involved in a major car accident in which he was in a coma for two weeks and in rehabilitative care for an additional 6 weeks. He was not the one at fault in the accident, so I assume that the insurance of the other driver (who died) was on the hook for his care.

 

What if he had no insurance and was at fault? Surely liability only wouldn't cover the costs, do they? So what do we do in that situation? I assume that he would receive basic care in the ER, but someone somewhere has to pay for that care. If the injured can't, who does?

First of all, let me say that I appreciate the response:

 

This sounds like an excellent idea- however, it doesn't clear up the issue with those who cannot afford insurance. Any thoughts on "healthcare vouchers"?

 

Don't really know what a health care voucher system would look like. Would have to see some info first.

I think that this is a problem that needs to be dealt with. Perhaps moving the age up to 25? BTW...what is the age cut off now? I assume that you can keep kids that are in college on your policy as long as they are full time, perhaps?

 

My insurance (most I think) is 23 as long as they are in college. For mine they don't have to be full time student - just continuous. They could go 6 hours per semester if they wanted. But that would mean they are off my insurance before they graduate.

Let me start my saying that this idea is hardly developed- I came up with it on my own, so it's not like I've read about it.

I think this is an interesting idea. However, the healthcare market is much different than other markets. A few quick thoughts:

 

1. Some people will need far more care than others. For instance, healthy citizens may rarely, if ever, go to the doctor. Some citizens may suffer from terminal illnesses or chronic diseases that require constant and expensive treatment. How will the voucher system work in this situation since, unlike education, all recipients will not be looking at similar cost? Will there be unlimited vouchers? Will there be something similar to a co-pay with vouchers, i.e. will vouchers need to be purchased so as to keep care affordable but reduce frivolity?

 

Following from the previous thought, how will vouchers be financed? Taxes? I think, at least theoretically, an education voucher has the potential to pay for itself in that a student won't be taking those resources from the public school. While that isn't reality in terms of cost, they could be cost-neutral. How can this translate to healthcare since vouchers won't be negating any costs?

One of my biggest problems with the current healthcare situation is that consumers lack information and feedback since a third-party pays their costs so they don't factor that into their medical decisions. How will a voucher system change this since a third party is still paying the tab? Will vouchers come with a maximum price for each procedure, forcing the consumer to be more frugal or pay the difference? If that is the case, how will that work in terms of consumers who need immediate care and don't have time to shop or in terms of which entity sets the price limit?

As far as my understanding goes right now, I don't see terribly much difference between a voucher system and government insurance.

How a voucher system would work is that private companies compete for taxpayer-subsidized vouchers. Therefore, potential losses to taxpayer would be limited to the vouchers as insurance companies couldn't pass the costs onto consumers (unless others were willing to pay more than the voucher, which is there right). It is a matter of whether or not you think that insurance companies could adapt to lowering costs enough to accept the vouchers, provide affordable care, and make a profit. I think that they could- but the current system of employer-sponsored healthcare encourages them to decrease quality and increase costs.

 

The main difference between voucher and government insurance is that the potential losses to the taxpayers are limited in one (vouchers) and unlimited in the other (government insurance). There is no reason why government can run a healthcare system and keep costs lower than anyone else. By giving everyone the ability to purchase healthcare with a voucher, it will increase competition among private companies who will have to offer quality to stay in business. Taking the employer out of the equation is a good thing...

 

 

From the proposed bill, insurance would be mandated. It wouldn't be illegal to not purchase insurance, but a non-insured person would pay a steep supplemental tax.

 

From an abstract view, auto insurance is designed to, at the least, prevent one person's negligence to cost another a great deal of money. As that translates to healthcare, if one person chooses not to purchase insurance and develops a medical problem that is expensive to treat, yet can't afford it, the rest of society will be paying the tab when this person shows up at the emergency room. Costs here will be moth monetary and temporal as this patient will contribute to overcrowding and increased patient load on the staff. Furthermore, mandating auto insurance catalyzes competition in the insurance market since everyone must have it. The same would go for healthcare.

I see your point here. It just seems like a tough pill to swallow that someone should be forced to use health insurance, but it is similar to auto insurance in this regard. So long as it was legal for an individual to pay more medical procedures outside of their healthcare plan, I guess I could handle it.

 

To tie this back to cch's first point, both an individual mandate and a voucher system seem to achieve the same result: universal coverage. Is universal coverage inherently intrusive, or is it merely the route to that destination that is intrusive?

Universal coverage is not inherently intrusive, it is the route that is. This partly has to do with the fact that Medicare and Medicaid are NOT sustainable.

For example, a guy that I dated several years ago was involved in a major car accident in which he was in a coma for two weeks and in rehabilitative care for an additional 6 weeks. He was not the one at fault in the accident, so I assume that the insurance of the other driver (who died) was on the hook for his care.

 

What if he had no insurance and was at fault? Surely liability only wouldn't cover the costs, do they? So what do we do in that situation? I assume that he would receive basic care in the ER, but someone somewhere has to pay for that care. If the injured can't, who does?

This is a difficult scenario. The scenario I've proposed does have health coverage for all, but you are providing a hypothetical about a person who refuses coverage and then turns out to have made a bad decision. I don't have an answer. Furthermore, Habib has made some good points that I have hard time arguing against in regards to how health insurance is similar to auto insurance. Does that mean that my scenario is undermined? I guess that's for you to say, but the ethical dilemma you've provided me is far beyond my paygrade. :lol:

I'm really starting to like the idea, and apparently its already popular. Rahm Emannuel's brother Ezekial (BTW, Ezekial Emmanuel is a legendary name) and Victor Fuch (sp?) did a big study recommending that for the Brookings Institution. Check this article out, as well:

 

Under a voucher program, there is no government takeover, no price fixing, no rationing, no centralization of medical records, and no healthcare boards. Indeed, government involvement in the healthcare industry would be substantially reduced by eliminating Medicare and Medicaid.

 

And further on:

 

Special interests won't like this voucher program because it thwarts their ability to manipulate the system. Liberals won't like it because they don't trust markets. Conservatives won't like it because it is too radical. But if conservatives, libertarians, and independents are as frightened of nationalized healthcare as they claim to be, they should take advantage of this opportunity to move the system sharply in a free-market direction while dealing with the problems of cost-shifting caused by uninsured persons. If they don't, it's only a matter of time before another attempt is made to nationalize healthcare.

CCH, Habib, TB&G

 

This is one of, if not the, most constuctive thread on health care that I've participated in.

 

1) IMO any viable healthcare reform must have some form of TORT reform in it. I have not seen that anywhere in the current proposal. If I have missed it someone please point it out for me.

 

 

http://www.gnyha.org/3283/File.aspx

 

This article deals a lot with New York State but goes well into the nation wide malpractice crisis. IMO it is non partisan, sources include CBO, Lewin Group, American Hospital Assoc, US Department of Health and Human Services.

I. Escalating Hospital Premiums

Hospitals and physicians in many states have experienced dramatic increases in medicalmal practice premiums since the late 1990s. According to the United States Congressional Joint Economic Committee, malpractice premiums have increased, on average, by 8.1% per year from 1992 to 2001—a rate that is three times higher than the overall rate of inflation for that period and double the rate of medical inflation. The United States Department of Health and Human Services (HHS), in a March 2003 report, and the Congressional Budget Office (CBO), in a 2004 issue brief, similarly report sharp increasesin medical malpractice premiums over the past few years. These studies are citedthroughout this report as the 2003 HHS Study and the CBO Issue Brief, respectively.

 

Hospital Premiums

Nationally, hospital premiums are increasing precipitously (see figure 1). An American Hospital Association/Lewin Group survey showed that in 2001, over 82% of hospitals responding to the survey experienced premium increases of more than 10%, with 28% of respondents experiencing premium increases of more than 50%. The data from 2002 suggest that the crisis is worsening, with 85% of hospitals experiencing premium increases of more than 10%, and 44% of hospitals suffering premium increases exceeding 50%.

 

2) It is my opinion that a public option is a recipe for the destruction of competition. The private sector cannot compete with the public option. The private sector must make a profit to stay in existense. The government doesn't have to. The gov can force prices lower that is sustainable in a competitive market. If they lose money, they don't care, they just tax, and eventually all private businesses are gone and you are left with a single payers system. Which in my opinion is violation of our constitution. The government is supposed to govern not compete with the private sector. If we allow this to happen we will be left with what the UK and France have or what Canada has. Based on that beleif I cannot support any reform that has the current public option plan.

 

3) I need to do more reading on a voucher system.

 

4) I like health care accounts. It would take several years to put them into effect but I can envision a generational family health care managed account. A form of group account for a family. My work insurance is around 7000 per year for insurance. I would prefer to see that go into a health care fund that could be used for bills or insurance (I haven't thought it through fully) for several generations of my family. As I get older and contribute less but take more, my kids and their kids will contribute more.

 

5) I believe in personal responsibility. I think it is one of the most important foundations of our country.

 

That's it for now

Let me start my saying that this idea is hardly developed- I came up with it on my own, so it's not like I've read about it.

 

How a voucher system would work is that private companies compete for taxpayer-subsidized vouchers. Therefore, potential losses to taxpayer would be limited to the vouchers as insurance companies couldn't pass the costs onto consumers (unless others were willing to pay more than the voucher, which is there right). It is a matter of whether or not you think that insurance companies could adapt to lowering costs enough to accept the vouchers, provide affordable care, and make a profit. I think that they could- but the current system of employer-sponsored healthcare encourages them to decrease quality and increase costs.

 

That clears a lot up as I was misinterpreting the voucher system as an insurance bypass. And according to at least one source, a voucher-like system is already in place for Medicare recipients who would rather purchase private insurance. I couldn't corroborate that, though.

 

The main difference between voucher and government insurance is that the potential losses to the taxpayers are limited in one (vouchers) and unlimited in the other (government insurance). There is no reason why government can run a healthcare system and keep costs lower than anyone else. By giving everyone the ability to purchase healthcare with a voucher, it will increase competition among private companies who will have to offer quality to stay in business. Taking the employer out of the equation is a good thing...

 

I very much agree about moving away from the employer-based system.

 

My problem right now with the vouchers is that medical services are still incentivized to charge high rates, over prescribe, and recommend superfluous procedures and tests. That's one of the biggest problems in terms of costs and an area that needs to be more competitive. A voucher system would appear to make the insurance industry more competitive, which is necessary. However, there would have to be laws put in place concerning pre-existing conditions, dropping coverage, and catastrophic coverage or not much would change. The problem with private insurance is that they really aren't going to be very profitable without dropping or denying expensive coverage and I don't see any market incentive that would correct that.

 

The best solution, if at all feasible, would be to eliminate insurance. Or, at the least, reserve insurance only for major health events rather than small or routine services. This third-party mechanism seems to be the largest hindrance to competitive health markets, or rather the benefits of a competitive market.

 

I've read arguments for managed care, which from my understanding would entail paying an annual premium directly to the medical provider and going there for service. That seems to be a decent bypass of insurance. Yet, the incentive for the medical providers to deny care or provide poor service (long waits, bad hours, etc.) would be extremely heightened, especially where one of these providers has a monopoly. Additionally, emergency care would continue to be a problem for competitiveness. As someone who believes in markets, I'm not sure if all aspects of healthcare are compatible with the market, which, I suppose, is what has led me to support some of the reforms proposed.

 

I see your point here. It just seems like a tough pill to swallow that someone should be forced to use health insurance, but it is similar to auto insurance in this regard. So long as it was legal for an individual to pay more medical procedures outside of their healthcare plan, I guess I could handle it.

 

I see where you are coming from. It's a bit of a conundrum for me given my libertarian streak, but at the end of the day I think it not terribly intrusive for an important benefit.

I'm really starting to like the idea, and apparently its already popular. Rahm Emannuel's brother Ezekial (BTW, Ezekial Emmanuel is a legendary name) and Victor Fuch (sp?) did a big study recommending that for the Brookings Institution. Check this article out, as well:

 

Under a voucher program, there is no government takeover, no price fixing, no rationing, no centralization of medical records, and no healthcare boards. Indeed, government involvement in the healthcare industry would be substantially reduced by eliminating Medicare and Medicaid.

 

And further on:

 

Special interests won't like this voucher program because it thwarts their ability to manipulate the system. Liberals won't like it because they don't trust markets. Conservatives won't like it because it is too radical. But if conservatives, libertarians, and independents are as frightened of nationalized healthcare as they claim to be, they should take advantage of this opportunity to move the system sharply in a free-market direction while dealing with the problems of cost-shifting caused by uninsured persons. If they don't, it's only a matter of time before another attempt is made to nationalize healthcare.

 

You must have posted this while I was typing. I will read it tomorrow. Have to go to bed now. I have to work in the morning, and 4:30 comes early.

I very much agree about moving away from the employer-based system.

 

My problem right now with the vouchers is that medical services are still incentivized to charge high rates, over prescribe, and recommend superfluous procedures and tests. That's one of the biggest problems in terms of costs and an area that needs to be more competitive. A voucher system would appear to make the insurance industry more competitive, which is necessary. However, there would have to be laws put in place concerning pre-existing conditions, dropping coverage, and catastrophic coverage or not much would change. The problem with private insurance is that they really aren't going to be very profitable without dropping or denying expensive coverage and I don't see any market incentive that would correct that.

I have no answer to the healthcare problem entirely because of what you've just stated. In short, here is the conundrum:

 

Health care costs are too high because of the overprescribing of treatments and tests by doctors. There are two ways to curb this. One is by setting up laws and standards that set limits on testing and such- however, this beuaracracy getting in the way of our individual medical decisions. The other way to curb it is to have each individual be responsible for their own insurance, and understanding how much everything costs; however, even if this were done, you still have the problem of the uninsured going to ER and keeping costs high for everyone else.

 

 

The best solution, if at all feasible, would be to eliminate insurance. Or, at the least, reserve insurance only for major health events rather than small or routine services. This third-party mechanism seems to be the largest hindrance to competitive health markets, or rather the benefits of a competitive market. .

Agreed. Now how do we do this? Can laws accuarately define "Catastrophic"? Would Democrat politicians compromise for something like this?

 

I've read arguments for managed care, which from my understanding would entail paying an annual premium directly to the medical provider and going there for service. That seems to be a decent bypass of insurance. Yet, the incentive for the medical providers to deny care or provide poor service (long waits, bad hours, etc.) would be extremely heightened, especially where one of these providers has a monopoly. Additionally, emergency care would continue to be a problem for competitiveness..

What about a monthly premium? It would increase flexibility and therefore accountability.

As someone who believes in markets, I'm not sure if all aspects of healthcare are compatible with the market, which, I suppose, is what has led me to support some of the reforms proposed.

I suppose you do believe in markets for a Palin-hating left-wing terrorist-harboring unpatriotic socialist.

 

Of course I believe in markets too. The only reason I've considered (and sympathized with) some of the reforms is because of the enormous (and growing) costs of Medicare and Medicaid. I know that single-payer is not the way to go. But I'm understanding that the government is going to have to play some role in health care. On the other hand, if so much of the current problem is caused by employee-sponsored health care, how much of it would be cleared up by government-sponsored health care? There is so much to the issue that I can hardly keep a paragraph on topic. It's maddening!

I have no answer to the healthcare problem entirely because of what you've just stated. In short, here is the conundrum:

 

Health care costs are too high because of the overprescribing of treatments and tests by doctors. There are two ways to curb this. One is by setting up laws and standards that set limits on testing and such- however, this beuaracracy getting in the way of our individual medical decisions. The other way to curb it is to have each individual be responsible for their own insurance, and understanding how much everything costs; however, even if this were done, you still have the problem of the uninsured going to ER and keeping costs high for everyone else.

 

Yes, but even if individuals are purchasing insurance themselves they are not going to see the costs of the medical procedures, prescriptions, services, etc. The system needs to reward good outcomes, not high costs, which have been confused.

 

I suppose, if insurance companies are limited in what they charge by vouchers, they may press the medical industry harder into being more selective with care, but I don't see how they could do this anymore than they currently do.

 

Agreed. Now how do we do this? Can laws accuarately define "Catastrophic"? Would Democrat politicians compromise for something like this?

 

Who knows? I used catastrophic simply because that epitomizes the type of care where consumers don't get to be consumers.

 

 

 

What about a monthly premium? It would increase flexibility and therefore accountability.

 

Even so, the problems of monopolies, such as in rural areas, remains.

 

I suppose you do believe in markets for a Palin-hating left-wing terrorist-harboring unpatriotic socialist.