Health Reform Buffet

[Greenbeard]

You see arrayed before you a smorgasbord of potential elements for reforming the health care system. You can pick and choose which ones you'd like to put into practice (though not all of them make sense together). Of course there are lots of additional options that don't fit in a 10-item poll--these are meant only to be a starting point. Feel free to bring in other things (maybe you like the new extension of dependent coverage up to the age of 26 and want to retain that, or maybe you'd like to see a public insurance option, or maybe you want something completely different).

The idea here is to pretend this is two years ago (or that the new reform law has been partially or completely repealed) and cobble together health reform proposals so we can discuss. Unless you think no reforms are needed and prefer the status quo. So what would you like to see? What does your ideal health reform package look like?

Some questions and factors to keep in mind (no need to actually answer these here, just think about them while you're browsing and adding your own items to the buffet):

• What should be the role of government and of the private sector.
  • What level of regulation, if any, do you want to see (and what level of government--federal, state, or local--is the driving force behind it)?
  • What mix of public and private payers and providers do you prefer?
  • Who will be primarily responsible for reigning in costs and how will they do it?
• The relative importance of cost, quality, and access.
  • Are the uninsured a problem to be solved? Or is insurance itself a problem?
  • What are you willing to sacrifice to achieve lower costs?
• How do you want health care to be paid for?
  • Do we keep using insurance or switch to more out-of-pocket spending (possibly using HSAs)? And, if we do that, how do we deal with people who can't afford high deductibles?
  • Should the government continue to reimburse hospitals for uncompensated care? Should we remove the legal requirement that emergency rooms stabilize patients without ascertaining ability to pay?
  • Do you want to get insurance through your employer as a benefit or would you rather shop for it on your own? And if you want to buy it on your own, what do you want the marketplace you're shopping in to look like?
  • Should there be favoritism in the tax code for health care over other goods (i.e. should there be any tax deduction for health care at all)? If so, should it be the same for people who get insurance through their employer and people who buy it on their own?

And so on. Just some items to get your thinking started.

So what would you like to see? Something resembling "ObamaCare" or something completely different? Let's try and actually have a real discussion about the merits of various ideas.

 

[Greenbeard]

Only 8 votes so far and no discussion but let's see what's on the plate. The two most popular items so far are portability and deregulation (across-state-lines purchasing). A note about portability: that really means transitioning everyone from the group market into the individual market over time, so that plans are associated with you and not the group (e.g. job) you're temporarily in. But that means, since most of you are probably in the group market, that if you like your current group plan you probably won't be able to keep it. But aside from that initial growing pain, it's a good idea and I'm onboard.

Across-state-lines purchasing in the absence of some base standards, however, I can't support. A few points:

• This is asking the feds to give states the authority to enforce their laws in (potentially) 49 other states. Besides being a logistical nightmare, as a practical matter it seems that making state officials into de facto national officials would be very difficult.
• This move empowers insurers relative to consumers, but could also disempower them relative to providers (although it's also possible that the market clout of the big insurers in each state wouldn't change all that much due to this). Neither of these involves a good outcome for the average Joe.
• There are some inconsistencies in the poll answers for this one. One of you who supports deregulation also supports ending pre-existing condition exclusions, which can't happen if you do this. Three of you want to privatize Medicare and Medicaid by giving the poor and elderly vouchers to buy private insurance--but these are high-risk, expensive populations that would need consumer protections if they're to be accepted into insurance pools. Money for buying private insurance is useless if private insurance won't accept your money. And no one supported both deregulation and high-risk pools, which raises the question of what you think ought to happen to those who have trouble buying insurance.

Can anyone explain why they favor this idea?

 

[johnrocks]

I would love to se government at the STate and Federal level get completly out of the business of health insurance except for things such as making sure contracts are enforced,policing for criminal acts such as fraud and things of this nature.

Repeal the HMO Act of 73,ERISHA, Employer Tax credits, etc. Regulations,mandates and third party payors has driven costs up, not free markets, we haven't had that in generations.

 

[Greenbeard]

That doesn't address the question of what becomes of the poor, elderly, sick, and otherwise uninsurable. Certainly our system could save a lot of money if it stopped treating the sickest (read: most expensive) among us. So perhaps we have to ask ourselves: do we want a system that treats the sick?

 

[johnrocks]

Those that are already sick don't need insurance;which is designed to protect assets and spread risks; they need health care;pure and simple.

Louisiana had a Charity Hospital in New Orleans in the early 1800's forward, Huey Long took it State wide during his Administration before the New Deal and well before Medicade and Medicare and it worked pretty well without Federal interference, still works reasonably well.

 

[CrusaderFrank]

LOL

Reform first, ask questions later.

I'm going to miss you Progressives when you go extinct...nah, not really

 

[Greenbeard]

Those that are already sick don't need insurance;which is designed to protect assets and spread risks; they need health care;pure and simple.

Louisiana had a Charity Hospital in New Orleans in the early 1800's forward, Huey Long took it State wide during his Administration before the New Deal and well before Medicade and Medicare and it worked pretty well without Federal interference, still works reasonably well.

I don't disagree that care is the key here. It sounds like you're advocating public (i.e. government-owned) hospitals, somewhat in the spirit of the U.K.'s NHS. In that case it doesn't sound like you'd exactly be ending Medicaid and Medicare, but rather extending the program from being on the payer-side to being fully on the provider-side as well (i.e. setting up a specific public provider network for that population). Is that what we're talking about here?

 

[CrusaderFrank]

Green can you please explain what Section 9002 requiring everybody to report purchases over $600 to the IRS has to do with Health Care?

 

[johnrocks]

Those that are already sick don't need insurance;which is designed to protect assets and spread risks; they need health care;pure and simple.

Louisiana had a Charity Hospital in New Orleans in the early 1800's forward, Huey Long took it State wide during his Administration before the New Deal and well before Medicade and Medicare and it worked pretty well without Federal interference, still works reasonably well.

I don't disagree that care is the key here. It sounds like you're advocating public (i.e. government-owned) hospitals, somewhat in the spirit of the U.K.'s NHS. In that case it doesn't sound like you'd exactly be ending Medicaid and Medicare, but rather extending the program from being on the payer-side to being fully on the provider-side as well (i.e. setting up a specific public provider network for that population). Is that what we're talking about here?

No, I'd like to see a separation of insurance from the healthcare debate, it is much more complicated than what I'm prepared to sit and type out but my overall philosophy is government completely out of the picture, now, we both know that is not going to happen but I think two people can have a reasonable discussion on this and perhaps agree that the system we have is broken, we have a system where most people's insurance is tied to their job; to me; that just plain stupid, millions are out of insurance now due to them losing their jobs and COBRA is cost prohibitive for most and it's only a temporary fix.

I'll tell you this though, I'd much rather spend the money here on Americans than overseas on foreigners "spreadin mockracy" or foreign aid, for every billion that we took out of that pool of resources, we could build ten 100 million dollar hospitals or send 10000 people or more through Medical School and I think we are wasting our resources when so much could be accomplished here with it, preferably in the private sector but even a domestic public plan beats the crap we have had;imho.

 

[Greenbeard]

I'll tell you this though, I'd much rather spend the money here on Americans than overseas on foreigners "spreadin mockracy" or foreign aid, for every billion that we took out of that pool of resources, we could build ten 100 million dollar hospitals or send 10000 people or more through Medical School and I think we are wasting our resources when so much could be accomplished here with it, preferably in the private sector but even a domestic public plan beats the crap we have had;imho.

I agree.