AP Article

So the GOP released their health care bill today.

Here are the basic points:
-Removes requirements for Health Insurance companies to meet regulations in each state they operate in (Buy Across State Lines)
-Caps medical malpractice suit damages.
-Allows insurance companies to deny coverage on the basis of pre-existing conditions, but creates pools of "high risk" patients for those who fall under this category to buy insurance, albeit at very high rates.

That's basically it, mild tort reform, buying across state lines, and pooling for individuals and those denied coverage via normal channels.

To me, its just treading water, and doesn't actually DO anything (and I would imagine the buying across state lines provision, without any further restrictions, would result in a "race to the bottom" not unlike the credit card industry). "High Risk" pools exist in 30 states, and while they do expand access coverage to those otherwise denied coverage, gaps in coverage can be over a year and the expense drives out most from being able to afford it. The bill also does nothing to expand coverage to the uninsured, leaving our same problems with those paying in to the system paying for the uninsured's care, while leaving the medical bankruptcy problem intact.

Anyways, discuss at will.

oh look, a sticking plaster, that will help with this shotgun wound!

Are you suggesting that Boehnercare is too soft on the current healthcare problems we have?

Don't get sick, and if you do get sick, die quickly

Not much worse than the current reform bill. Does nothing to solve the problem!

It certainly doesn't drill very deep into key issues.

In your eyes, what is the problem and solution?

Alan Grayson?

1) too many poor people
2) pork prices currently too expensive

Like my learned friend Mr Swift, I think the solution is both self evident and fairly modest.

(Note to GV, I'm not actually parodying you here, I just saw this as a chance for some fun)

Indeed, 'tis his quote.


translation: don't get sick


translation: and if you do get sick, die quickly (before you bankrupt you and your entire family)

Simply put:
The primary problems are that we pay too much to care across the board because providers charge too much and are remarkably inefficient, combined with third-party payment that makes people insensitive to prices in large chunks of the marketplace that basically end up punishing people that get tossed into the individual market, combined with ever raising AMOUNTS of healthcare that all Western nations experience, but is especially bad here because of our employer based healthcare system and already high costs that ultimately makes the employer-based system unsustainable and will end up hurling everyone into the VERY inefficient individual market. And then you have uneducated consumers to make the whole situation even worse.

As for solutions: take the Baucus Bill and tack on more aggressive cost-control measures with an income tax decrease and a corresponding sales tax increase. Unfortunately, I don't have a very good idea of what we can do to improve cost control and inefficiency in healthcare providers themselves. We may have to just mandate withholding funds from inefficient providers, even if it reduces health-care outcomes a bit. I would also shift the drug market from a patent system to a reward system, probably throw in some higher hurdles for tort reform.

We'll see how things go from there and what more we need to fix in a few years.


Oh I can take a joke

I think you're misunderstanding how insurance works. You apparently think that someone who buys a house that sits on the side of an active volcano should pay no higher homeowners' insurance premiums than someone who buys a house in Southern California.

It's simple mathematics (unless you're actually suggesting that everyone with insurance should be paying significantly higher premiums). If you have a potential customer who (statistically speaking) is going to cost you 100,000 times as much as they're going to pay you, you do not take them on as a customer.

Let me ask you this: if you owned a plumbing business and I needed a plumber but lived 3,000 miles away from your plumbing business, would you fly someone out to my house on the first available flight to fix my sink and charge me the same as someone who lived 3 miles away from your business? My sink is backed up and it's quickly becoming a hazzard for me; I need someone to help me. I need you to spend $2,000 flying a plumber to my house to do a $40 job. Please?

Finally, removing state-line restrictions.

I suppose people think companies having 75% monopolies in states because of artificial regulations makes no difference.

Also...its estimated that just 8 million legal citizens genuinely are unable to access non-emergency care.

Even better, insurance companies should only insure non-smoking vegetarians who don't own guns between the ages of 18 and 35, that way they would have rock bottom premium prices.
Because everyone know the only true yardstick of a community's prosperity is low, low prices, everyday!

That's not what anyone who likes markets believes in

True, but it's far easier to just toss something out there rather than thinking it through first.

Apparently so

This, minus the Baucus bill, sales tax, income tax, drug reform and tort reform, plus a single-payer system with provisions for hiring/retraining displaced insurance employees

Solves most of those problems. Overhead and inefficiency greatly, greatly decreased, greater bargaining power to drive down drug prices, gets rid of the unsustainable employer-based system, universal coverage, more incentive for companies to hire older workers unemployed in recent downturns, much lower costs for individuals and businesses and ultimately for the government...

You want a single-payer system? Fine. I'll give you it. At $30,000 per quality year of life, scaled to inflation.

Yeah, there isn't much overhead when the only people on the payroll are the ones cutting checks 40-hrs a week. And hey, if the mob gets rich off the fraud buffet, maybe they won't spend as much time putting out hits out on people.

Ah Dahl is getting people to fall for his bait again.

Oh is Dahl another RV?

Are you seriously implying single payer healthcare costs $30k a head?

EDIT: I don't support going to single payer, but it IS cheaper. The question is quality delivered.

No, I am saying that we won't pay your healthcare bill unless it adds a quality year to your life for LESS than $30,000


http://en.wikipedia.org/wiki/National_Inst...ife_year_gained

The only thing that can be cheaper about it is the overhead. As shown with Medicare, that lower overhead in the US comes at a major cost in terms of fraud. What he's implying is that - in the US - if everyone had the opportunity to run to the doctor for every sniffle, cough, and major surgery, they would. And the costs of all that extra care would spike to unbelievable heights.

Medicare currently only pays 80% of allowed costs. Medicaid only pays an average of 58% of allowed costs. Between the two of them, they're bankrupting the United States Federal government already. Expanding them to cover 100% of costs for 100% of Americans is suicidally stupid.

Ahh, fair enough. I misunderstood what you were getting at. Carry on.

Stop for a second.

"The only thing that can be cheaper"

Most countries, just about ALL countries, pay less for healthcare per capita than we do. Some countries get better results.

Switzerland pays way less per head than we do, with better results across the board. These things are not theoretical pie in the sky ideas, they really do occur.

EDIT: Inb4 someone responds without understanding what Switzerland's system actually is.

Switzerland's system is magic, as with all things.

Given that Switzerland is in fact all private insurance and does what they do, it IS damn near magic

True, but that doesn't take into account the legal system differences, population density differences, demographic differences, and a whole host of other major differences. Per PriceWaterhouseCoopers, the biggest source of waste in our healthcare system (and according to them, half the spending is waste) is defensive medicine related costs. That's the cost of all the lawyers, settlements, arbitrators, and extra tests and procedures that are done every year. When your OBGYN is paying $100,000 a year in malpractice insurance, guess who's actually paying for it. She's not out mowing lawns to raise the money; she's jacking up your rates to cover it.

Anything but the actual healthcare system is responsible, mirite?

Do you know how Switzerland's healthcare system works, or did you use these things as an excuse not to learn?

With HEAVY regulation. They are not allowed to make a profit off their basic insurance, which has a individual purchase mandate.

So essentially they've provided a minimum of health care for everyone without a profit motive.

And they've done so while still keeping the insurance companies solvent. Damn impressive.

Oh, by all means, ignore all differences between two countries, then compare one aspect of the two to show how dumb the other one must be.

Stupid Americans, not adopting the perfect policies of other countries that function flawlessly in each and every possible set of circumstances...

You ignored my question.

EDIT: There are also other reasons the Swiss system cannot be implemented here in the short term. A pity.

You ignored the mountain of other factors involved.

And even if we had a zero-profit health insurance industry in the US, care to take a guess how much that'd save? A whopping 3 - 4% at the high end. We already have some non-profit health insurance companies, but the ones that do profit make about 3 - 4% profit a year per their SEC filings.

So yeehaw, we save 3 - 4% there and now we've got some 30 million people who have a mandate to buy something they can't afford.

What's next? A mandate for everyone to buy a new Ford pickup truck each year? Oh, not everyone can afford a brand new Ford pick-up truck? Let's subsidize it with magic money from Uncle Sam's arse. There surely couldn't be any negative consequences from that, right?

There's a lot we cannot get in the short-term, but what we are getting is an expansion of care, higher taxes, and gutting the insurers without real cost control in the hopes that we can get it done later. Hell, I'm surprised that we can even TALK about the cost cutting in Medicare/Medicaid and I have my doubts about whether those measures are going to be fully implemented.

This makes me worry, since it requires Congress to take a lot more additional steps to actually implement full reform. If we don't get it done, we just have a bigger time-bomb than we did before.

Oh great, I hate when people fall back on American exceptionalism to avoid making changes.

"Health care reform, which has been shown to work in a multitude of different ways in a multitude of different places, won't work here because We're Americans."

If there are reasons one system or another won't work here, please, give details. Some of them may even be valid.

Er, if you're talking about the current health reform bills in Congress, I actually probably agree with you as to their effect. At the very least, they need to include the Kucinich amendment to allow state experimentation with single-payer.

Reason number one why most western nations' healthcare systems won't work here is our tort system. If the NHS were being sued constantly to the point where a large percentage of its operating funds went into lawyers, lawsuits, settlements, and unncessary tests and procedures, it'd collapse. It's already running into major cost issues per the IMF which has warned Britain to take cost-cutting measures immediately to avoid major problems in the future with it.

Reason number two why it makes no sense to compare healthcare systems in small, densely and largely homogenously populated European nations to the US would be our exceptionally diverse, ridiculously spread out population. Demographics in the UK make healthcare planning a lot simpler. The population is 90% white and lives in a relatively small area. In the US, however, it's all over the place depending on which state you're talking about. Even within individual states, there's a huge difference. In New York state, you've got everything from New York City (massive metro area) to people up in the mountains without telephones or electricity.

Single payer still won't help very much. Medicare pays less than private insurers, to the extent that the cost differentials between Medicare and other nations spending, while big, isn't HUGE. The government, though, still spends more than most nations do to cover a much smaller part of the population. And Medicare spending is growing FASTER than private sector spending

And Medicare only pays 80% of the costs. Medicare, as it exists today, is actually subsidized by the private insurance industry. On top of that, it loses ridiculous amounts of money to fraud.

http://www.youtube.com/watch?v=CpwdF7BCnoI
http://www.youtube.com/watch?v=-1tv9lZMA1c
http://www.youtube.com/watch?v=19R__PCNHAQ
http://www.youtube.com/watch?v=xdpWijgOAkc
http://www.youtube.com/watch?v=V-QY9my334Y

Subsidized might be going a little far. I am not sure to what extent cost-shifting actually exists, and if health providers are overcharging because they are a monopoly, all Medicare is doing is charging what SHOULD be the market rate.

However, that it pays lower per unit, covers less, and still ends up growing faster is concerning

No, Medicare (by law) pays only 80% of allowed costs. Medicare agrees the item is worth $100, but pays only $80. The other $20 must be recovered by the healthcare provider from Medigap insurance, the patients themselves, or the private insurance companies of other non-Medicare patients who are charged an average of 130% of the allowed costs.

So yes, the premiums you and I pay for our health insurance are subsidizing the underpayments of Medicare and Medicaid. The two single-payer plans we already have are only paying part of the cost, are forcing everyone else's insurance premiums higher, and are still bankrupting the Federal government while crowding out a lot of state budgets.

If you don't mind me asking, a big wtf to the first one? If they are going to do that, why not further cut down on the red tape and create a federal regulation for it? Why have this inconsistent nonsense where each and every state has their own different regulations?

If I'm reading the first one right, that means an insurance company can operate in a state without complying with the regulations of that state? Doesn't that completely undermine the whole idea of separate states? It might have positive practical outcomes for price or services, though that doesn't seem likely, but it seems dangerous.

Capping the amount people can sue the health system for has to be a good thing.

The high risk pool sounds like a token gesture to make it look like they're trying to help the uninsured without actually giving them anything. 'Sure, you can have insurance ... for $100,000' is not really any different to not being offered any.

It's good that health care is being debated enough that even the hardcore privatisers are thinking of doing even a little bit about it, though.


Britain's financial problems are caused by the 'free market' and banks taking unreasonable risks, not the NHS.


Australia. Canada. Also, what does being '90% white' have to do with anything?

OMG a healthcare bill that WILL lower costs!!! Run for the hills!!!!!

While the bill doesn't cover everyone the above reforms will cause insurance premiums to go down which means more people can afford it and more businesses can afford to offer to their employs. More people will have coverage. It's simple economics people.

I don't think anyone was saying 'run for the hills'. The only problem with a bill which has a minor positive effect is that it makes it less likely that more major changes will now be agreed on.

considering that no insurance company in the country pays the full price charged by hospitals when they bill them, this is a bit of a spurious argument

The alternative to pools sorted by risk is that healthy peoples' premiums spike because the insurance company has to take on customers where they're paying out hundreds of times more in benefits than they're taking in in premiums. For every cancer patient, HIV patient, and other serious illness having customer they take on, my rates go up higher than they already are. If we were talking about a situation where my rates were artificially low due to cherry picking, the situation might be a little different. As it stands, health insurance is already insanely expensive because healthcare is insanely expensive. By forcing the insurance companies to do things that'll raise their outlays (they're only making 3 - 4% profits), already terribly high coverage costs will be forced even higher. The money's going to come from somewhere. In the meantime, every rate increase means more people who can't afford it or who are forced to make impossible choices (choosing between paying rent/the car payment/gas/food and paying the health insurance premium).

Britain's NHS has financial issues looming if you listen to the IMF. I'm not talking about the global situation currently in progress, but about unfunded liabilities on the horizon. The IMF has crunched the numbers and said that something must be done (raising the retirement age, charging for services, etc) or the NHS will be so badly in debt that it'll create major problems for the rest of the government's finances.

And having a homogenous demography means it's vastly simpler to plan for healthcare issues. If 90%+ of your population is one race, you can plan accordingly for the most common problems experienced by that race. That's impossible on any sort of large scale here in the US. We have very sizable populations of whites, blacks, hispanics, and asians all across the country moving freely at will. It's a logistical nightmare in terms of pre-planning for needs.



It's true that insurance companies negotiate fees with providers, but with Medicare only paying 80% of allowed costs and Medicaid only paying 58%, who do you think is making up the difference? I don't see a lot of cardiologists mowing lawns on the weekend to make up the missing chunk.