Health Care/Insurance Reform

sure have! and would love to see a fair, frank, open discussion on the relevant points expressed in a polite courteous manner. Any takers?

Perhaps an introductory discussion on how the system works at present and how any future proposals would affect the people of the US would be helpful, to me at least. I know little of your system other than visiting your country and the insurance policies I had to take out to cover myself during my stay.

Good idea Genevieve....

There is an artifact of health insurance in the US that probably doesn't exist anywhere else.

During WWII, wages were frozen. In order to entice workers to join them (or stay), employers began offering medical insurance plans, and that became engrained in the American health system. That was fine for the days when you went to work for the phone company or the auto manufacturer and stayed there for the rest of your life. That became such a huge part of American life and American companies that the joke now is that General Motors is a health insurance company that makes cars, too.

But then times changed, and people found themselves without health insurance when they changed jobs. So just the connection to employment is a huge problem, especially in times of massive layoffs. That debate is about "portability," having your insurance go with you when you change (or lose) your job. And since health insurers are regulated by the states as well as the federal gov't, even changing where you live can affect your health coverage (in Canada, the Provinces have different rules, too).

More later, about costs.

Interesting - I wasn't aware of the origins of the medical insurance plans.

Thanx Ian, that history is fascinating. As you say, I have never heard of other countries going down that path. The great thing about a site like this is finding out stuff you weren't aware you didn't know.

Ian what entitlement does everyone have to basic health care? Is that governed by insurance also or can one receive a decent standard of care paid for by the government/state? Is dental care available to those without insurance also? It seems to be a very complicated system by all accounts. How on earth can it be resolved in a fair manner.

Gen.

I guess the conversation must have come to an end then. Are there no more contributors to the discussion?

Gen.

Gen: There is no entitlement to basic health care in the US, although there are lots of programs which are available to people without money, and people in certain categories like pregnant women.

One peculiarity of US law is that no one can be turned away from an emergency room. So that becomes the primary care facility for many people, i.e., they may have a bad cold or an ache, and at some point they go to the emergency room of a hospital. They may have some chronic, even fatal, disease, too, which is not discovered until they go to an emergency room.

There is no dental care routinely available, but if you are indigent, many dental schools run charitable clinics.

Fairness is a matter of perspective. Should taxpayers (working, middle-class) fund medical care for someone who spent his money on an automobile instead of preventive care?

I guess it depends on one's ideas about what government should do and what the individual should do.

Probably the worst aspect is unnecessary testing. The reason that happens is that, over the past 30 years, nearly all health care and health insurance have become for-profit industries. So the more a doctor bills, the more profit there is, for him and for the company.

But at the very same time, the health insurers want to pay out as little as possible. So there is a constant battle between inflating costs unnecessarily and denying payment when it is quite legitimate and needed.

I wonder if the solution might be to allow only health care providers, including hospitals, to offer health insurance. That way, they would have to balance what are now competing interests...spending as little as possible vs. spending as much as possible, with the consumer/patient caught in the middle.

Have to think about that one...

Ian, if you tried that solution wouldn't it make for the hospitals and care providers becoming too self-interested in profit rather than health care, trying to generate extra income and passing on the cost to the patient in an expensive health care plan? On top of creating some kind of exclusivity which would result in some hospitals being underfunded, poorly staffed and only able to offer a basic health care insurance?

Gen

Yes, I haven't thought it out completely. But a hospital which overbilled a patient, if it were also the insurer, would only be billing itself. The danger might be that the hospital would be sorely tempted to forego treatment which was not covered by its own insurance plan and the patient clearly could not afford.

Why not separate the functions of health care provision and health care insurance?

What are people's thoughts on the initial offering from President Obama? I would like to comment more, but I feel I don't know nearly enough about it to add anything at this stage.

Gen.

I find that the articles in US sources are either decrying the end of the world if it happens or the end of the world if it doesn't. Its very hard to find a balanced view.

I am left wondering whether the health care system is the same throughout each state? Does any state have the power or control over how a new system could work individually, within said state? It doesn't seem feasible to pare down the system as it is, and enable/enforce everyone to pay for a basic health care plan. As you pointed out Ian, some may choose to spend their money on other luxuries to the detriment of their own health. That is their concern, but then they may be foregoing any rights to healthcare, unfair to have to choose though, especially if an unexpected illness occurs.

Gen - Hopelessly lost at this point, foot in mouth. Wine glass attached.

Political options are narrowing as the debate goes on. As it stands now, the US Gov't will not be getting into the health insurance business. But what is likely is that every citizen will be required to have health insurance of some sort, and those who don't will be taxed accordingly.

Mary, you're all too right about the polarization and exaggeration. Yet everyone agrees that the entire health industry (drugs, hospitals, doctors, insurers) needs overhaul. The care itseslf is very good, it's the surrounding industries that are at issue, and access to care as well as its cost. The real flashpoint is gov't actually getting into the insurance business.

And as far as the separation of the care itself vs. insurance, that's what we have now. So the insurance companies must be consulted before many procedures are undertaken, any they frequently find excuses not to pay (the operation is experimental, cosmetic, is to correct a "pre-existing condition," et cetera.) In order to make more money, hospitals and doctors inflate costs by extra, unneeded tests and procedures.

There is an anarchistic streak in the American psyche, partly for good reason. We don't like government, in general; and yet some on the left clamor for it, but they are usually part of it.

To be continued...

Ian, you say that 'As it stands now, the US Gov't will not be getting into the health insurance business', but as it will tax those who do not take out health insurance...isn't that 'getting into the health insurance business'? The attitude that many Americans appear to have for their duly elected Gov is confusing to those of us outside the US. Would you go so far as to say that to many Americans Gov is a 'necessary evil'?

That's a good point, Mary. It depends on whether funds collected through taxing the uninsured go into the General Treasury or are put into a special account for medical care, presumably for the indigent and/or willfully uninsured. That is not yet clear.

Yes, I think most Americans are very suspicious of gov't. I certainly am. It is almost a new aristocracy, providing comfort for itself, exempting itself from the most onerous laws it puts on the citizenry, and simply deciding to extract more money when it is irresponsible in spending.

There is a grim joke where I live that, if you want an easy life, plenty of money, and no work, you can either win the lottery...or get a government job. And since gov't is notorious for doing things badly, and at far greater cost than necessary, many of us are horrified that health care might become of gov't function.

But the present situation is intolerable, so something has to change.

May I ask, what happens to the homeless/those suffering from mental illness or a similar circumstance, and/or those who cannot be taxed for lack of money? Do you think they would then be sent to prison for tax evasion or fined or? A very simplistic question but there would be many thousands in that situation no?

Gen.

That was probably a comment that should be deleted in retrospect. It probably has no bearing on the outcome of the 'reforms'. My apologies.

Gen.

Late...very late...Saturday night, the legislation passed our House of Representatives by a vote of 220-215. A rocky path awaits in the US Senate, and probably worse during the process of "reconciliation," when the two chambers meet to iron out differences.

The necessary votes in the House were negotiated by the inclusion of a prohibition on the use of federal health subsidies for abortions. Will passionate gov't health care advocates who are also strongly pro-choice reject the package as it now stands?

Just saw the thread and decided to dive in. My husband works at a private hospital now, and was a federal employee prior to that for 25 years, so my views vary drastically from Ian's. I don't view the government as suspiciously as Ian, and believe in "the social contract," the view that it is the role of the government to redistribute wealth to ensure a certain minimum standard of life for all (the European model). We have that here to an extent through federally-provided health care for the very poor. The problem is the "working poor" who do not receive insurance through employment and don't make enough money to buy insurance or pay for health care. Also, the insured are all at risk of having coverage denied or cancelled when they become chronically ill so hte insurer can aovid "excessive" costs. These are the issues Obama is trying to address through federal legislation: federal regulations of insurers to prevent onerous practices, and a federal option which would basically be providing the coverage now available to the poor and unemployed to everyone, but at a cost which would be based on ability to pay. It is this latter issue which is threatening passage of the health reform bill in the senate which just left the House of Representatives. The public option is viewed by many as the death of democracy because insurance companies have waged a billion-dollar media blitz saying this is hte case. Obama's hope is that if private insurers have to "compete" with the public option, they will improve costs and coverage practices or go out of business, leaving room for efficient and fair insurers, and the public plan.

Hey Terry, thanx for your input.It is a complex issue and extremely confusing to those of us outside the US, and, judging by the rabid response to the mis-information campaigns, many of those inside it.

Rabid is the word. The notion that we're not paying now for the health care costs of the uninsured is simply ill-informed. Medical providers have no choice but to inflate charges to paying care recipients to cover the costs they would otherwise absorb (at least 20% of billables are never paid). They do this across the board, and not by ordering extra procedures. The procedures are expensive, and more and more lab tests, imaging services, etc., are performed by separate independent entities to which patients are referred. Malpractice lawsuits have forced providers to practice "defensive medicine" whereby testing to rule out all possible scenarios, no matter how unlikely, is done so as to limit liability in the event of a missed diagnosis or bad outcome. Obama was not initially pushing malpractice reform as an integral component of health care reform (lawyers not generally big fans), but he has come to see the light. $100,000 medical malpractice insurance premiums are the norm, and after costs, a physician may have to bill -- and COLLECT -- $500,000 just to pay the insurance. The whole system in this country is broken and has got to be fixed.

I see the issue has been clouded further by the abortion provisions. The story continues.....

Are abortions state-funded in other countries with national health care plans?

I don't know, Terry. I suspect that, in most countries where they are legal and there is public health care, they are state-funded. A few countries still prohibit abortions altogether, of course.

From childrenbychoice.org

"Countries that totally prohibit abortion, or permit abortion only to save the life of the woman, contain 25% of the world's population, and include Indonesia, Philippines, Chile, Iran, Ireland, Sudan, Kenya and Nigeria."

Maybe I'm missing something, but it looks like the House version of health care reform was written by the insurance companies and the trial lawyers.

Insurance companies still have immunity from anti-trust laws, cannot operate across state lines, and will get about 35 million new subscribers, paid for by tax money.

There have been no reform on malpractice laws.

What gives?

The following is what I THINK is the case (Mary's right about it being so confusing). The bill which forced millions to buy private insurance was written by a Dem (!) who is one of the biggest Dem recipients of insurance industry campaign contributions. His is not the version that was voted out of the House this week and went to the Senate. That one has a public option instead of mandatory private insurance. Whether it addresses the antitrust issue and operaitng across state lines (which I believe are both necessary for real reform) I don't know.

I'll rephrase my question. In countries where elective abortion is legal and where the state funds health care, are abortions ever funded? If not, are the grounds religious or that the procedure is elective/not a "health" issue?

In Australia (except Queensland) they are legal and covered by medicare.

Thanks, Mary. France, Fiona?

Anyone?

Just came across this forum...I'm happy to see that it has engendered interest of those across the pond so to speak, but where are the U.S. voices? We are the ones who should be talking and listening to shared ideas or viewpoints that may help us become more informed.
Ian and Terry have presented the differing viewpoints quite nicely I think. I am still trying to understand much of it.
My take is very similar to Terry's and for many of the same reasons. Both my hubby and I were employed by the Federal Government for many years. We worked hard as did most of those around us. Pay of course depended on what was brought to the table by those in a variety of fields...some were very highly paid, while others simply earned livable wages. Some were professional employees while others weren't. this same state of earnings was the yardstick across most occupational pursuits.As a rule, most government employees did not appreciate the off- putting 'joke' that Ian spoke of in his comment. Like many stereotypes...it was thought to be true of all to many government employees, and caused much mistrust by those not working in our areas. The same type of mistrust has been created about those employed by unions, without any thought given to why unions came into being. This in no way denies the facts that in both areas, totally unacceptable behavior and practices do occur.
I was taught that the government was to take care of its people, yes...that's the social contract part...I also believe that 'We The People' have an obligation to act in a responsible manner by using our vote to keep those we elect to carry out our interest do so in an honorable manner. Those that Ian speaks of who have sought only to fill their own pockets at the expense of the greater majority, should be thrown out on their ...ear!
Government has proven its ability to create and run successful health programs such as Medicare...a highly touted system that has gained favor for all that it has done to help maintain better health care for the elderly and disabled and Medicaid, a system that provides care for the poor of all ages. It is capable of coming up with a plan that will START to unravel the corruption and offer the populace with needed health care reform. We should not be scared away from this challenge simply because it is complex or unpopular among greedy Insurance companies that don't want to see any change that may threaten their profit margins.
It most likely will not be done in one fell-swoop, but will need to be crafted over time.
Something has got to be done to improve the system.There is plenty of blame and shame to go around...Now is the time for action...and using this opportunity to score political points is totally unacceptable to me.

Hey Mamacita, great to see another US input. The more rational debate on the issues the better. We, 'over the pond', mainly get to see the more radical extremes. Sources whipping up hysteria for their own limited agendas are not good anywhere. I think that the 'for the people' bit tends to be too often forgotten.

Welcome, Mamacita, and ditto to all you had to say. Unfortunately, you're probably right about real reform taking a while. It sounds as though the bill that's coming out of the Senate is Hubert Humphrey's "half a loaf." A start that will have to be improved on later. E.g., no public option yet.

It doesn't get much worse that what's going on right now.

Instead of crafting reform that finds broad support, a sliver-thin majority (of elected officials, not of the citizenry) is maneuvering to shove their ambitions down the throats of 49.9% of their partisan opponents...and 90% of the population.

Senator Reid has quietly removed his own provision, revoking the immunity that the insurance industry enjoys from anti-trust sanctions.

Senator Landrieu of Louisiana is selling her vote for a $100-million gift which will ensure her re-election.

And of course, nothing about tort reform. The trial lawyers saw to that.

A vote bought here, a vote bought there, and pretty soon you've created a monster which will go down the same road as military spending, the Savings and Loan debacle, and the criminal conspiracy which has destroyed the financial infrastructure of this country.

This generation's children and grandchildren will not have enough money (after they pay taxes to service the national debt) to afford decent, private health care.

Good luck to all of us who have ever stood in line for an auto registration. We'll be doing the same for surgery---and running into the same hard-working, caring government employees who run motor vehicle registration.