Insurance reform, necessary, but is it sufficient?

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Wry Catcher, Sep 1, 2009.

  1. Wry Catcher
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    Wry Catcher Platinum Member

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    Being opposed to health care insurance reform suggests support for the status quo. Support for the current system is incomprehensible, unless the supporter profits from the current system, or is opposed to reform because thay have been scared by the propaganda put forth by those who profit.
    Most Americans understand that health care has become an albatross around the neck of American business and families; yet, even if the insurance companies are brought under control, is that enough?
    I think not, and that is why I support a public option.
     
  2. veritas
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    veritas OBKB

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    Except for the VA, there is no "system". The rest of it is ill informed chaos.
     
  3. Wry Catcher
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    Wry Catcher Platinum Member

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    What are the arguments against a public option? And why are the pros and cons of a public option not debated?
    Is it because the issue of systemic reform of how medical care in America is provided is too complicated?
    Or is it that change is scary for most people, and powerful interests exploit fear of change out of self interest?
    Having read the 'arguments' against reform, I have concluded that those opposed are incapable of critical thought, or, hold an ideological bias and choose to be willfully ignorant.
     
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  4. gcomeau
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    gcomeau Member

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    Actually, I'm not that big a fan of the "public option". It's being presented as a kind of "single payer lite" as a sop to the people who want single payer but the part that makes it "lite" removes pretty much every advantage single payer actually offers.

    The thing is, single payer works mostly because of the SINGLE part. As in, the one and only insurance provider. If the "single payer" plan isn't a single payer then it's crippled. It's hardly better than a private insurer. It's got some administrative cost advantages in running the insurance plan itself, but that's about it.

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    Being the only provider for specific coverage in the market means doctors and hospitals only have to deal with one provider with one claims department and one coverage plan. It reduces their administrative overhead ENORMOUSLY.

    A "public option" on the other hand just means you've added one more insurance entity on top of the several hundred they were dealing with alreasdy. Administrative savings for care providers? ZERO.
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    Being the only provider for specfic coverage means you wield massive leverage in pricing negotiations. If you insure 95%+ of the population and doctors want to see patients, they need to see YOUR patients. They can't screw you around. They can't threaten to deny your patients treatment in favor of some other insurance provider's who will offer to pay them whatever exhorbitant prices they want to charge then just pass that on to their customers as higher premiums. A single payer plan is REALLY good at keeping prices under control.

    The 'public option" on the other hand will just be one more small fry in the ocean. At least medicare, when it was created, had this HUGE pre-existing patient population just waiting to be instantly enrolled, this new "public option" thing? Not so much. Doctors or hospitals don't like the rates they want them to charge for a procedure? They can just tell them to go screw themselves and spend all their time seeing patients from whatever private insurers who are willing to pay them way more. Who cares if they lose access to the relatively tiny percentage of patients the new plan will cover? So, ability to control costs with effective pricing control? Damn near none.
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    Single payer plans insure pretty much everyone... so there are pretty few people trying to fraudulently access the system. Everyone is already in after all. So spending massive amounts of money on fraud prevention? Not really necessary. Issue decent quality photo ID cards and take minimal steps to prevent them from being duplicated and you're mostly covered.

    A "public option"? Well, you get the idea.

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    Single payer unites a large population into a single insurance risk pool for maximum efficiency. Insurance works better the larger the patient population it is dealing with. It allows systemic risks to be more accurately and modelled and predicted so premiums can be set lower without risking catastrophic point failures overwhelming the funding of the system.

    The idea of the public option is it will "compete" with private insurers to keep them honest. Competition in the marketplace is a great thing for MOST products and services, but it's largely counterproductive in an insurance market. The only way to have competition is to divide the population into smaller and smaller piecemeal segments each served by a different provider. Every time you make the size of the population being served by any individual provider smaller you're degrading their ability to operate efficiently. So any benefits you might expect to see from "competition" are eliminated by the negative effect you're having on their ability to operate at the top of their game.
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    Etc.

    If you want public sector provided insurance, do it properly and just institute single payer for cripes sake. Otherwise don't be surprised when half-assing it with this "public option" doesn't get the job done then people point at that and say "SEE! I told you the public sector couldn't do that!"

    The public option will have some very limitted beneficial effects. Maybe. But nothing major and nowhere near sufficient to deal with the problem that exists in the US insurance system, which is massive and requires a proportional remedy. You either have to go full out on single payer, or you have to get *serious* about the regulation of private insurance providers to the point where you're practically requiring them to act as public sector subcontractors by the time you're done. And I don't see either of those things happenoing right now because congress isn't showing the spine to do either.
     
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    Last edited: Sep 2, 2009
  5. Wry Catcher
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    Wry Catcher Platinum Member

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    Wow, an informed and intelligent response. I was beginning to believe such was an illegal or prohibited activity on message boards, in general.
    My thinking of a public option, which was never fully explained to my satisfaction was a means for the government to insure those the industry would not, at a cost those excluded could afford. It might include preventative health care at no or little cost as well as medicines necessary to control chronic condiitons (diabetes, for example) which, without treatment eventually requires more and at greater expensive medical care (which we, the taxpayer will pay eventually).
    It's too bad most of the posts regarding health care on this and other message boards are limited to persons posting the talking points and repeating the propaganda which supports their own ideological agenda.
     
  6. gcomeau
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    gcomeau Member

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    Well, that is the general idea, but here's the problem... that "at a cost those excluded could afford" part.

    You can only get there in so many ways.

    1. You lower costs for providers so they're able to in turn lower prices while maintaining profitability.

    2. You force prices to remain at reasonable and affordable levels in price negotiations.

    3. You just eat a loss and charge the people you're insuring less than their care is costing you.

    4. You force PROVIDERS to eat a loss.

    From everything I've seen about it so far the 'public option" is going to lack the power to do anything really significant on 1 and 2. And 4 is just a bad, bad, bad idea in general. Which leaves 3. And frankly, the US isn't in any position to be taking on any more deficit inflating programs at the moment which means making cuts elsewhere to pay for it... but that's a stopgap at best.
     
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  7. Wry Catcher
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    Isn't it a fact that the anyone injured or ill will be treated, and that includes the uninsured American citizen as well as citizens of other countries who become ill or injured? Those without insurance are treated today in public hospitals, and their care is payed for by the tax payer. Of course some of the injured are treated by law in private, for profit, hospitals. And once stable sent to the nearest county hospital so the taxpayer is responsible.
     
  8. veritas
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    veritas OBKB

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    I think the hospital is on the hook and that leads to the whole "readmissions" thing which is a problem. I had a friend that was hit by a car while he was on a motorcycle. The Hospital rushed him out as fast as they could and he developed cellulitis and almost lost his leg. He went back to the hospital and complained but they turned him away. He eventually had to track down the original ER consult doctor who was in private practice and the doctor knew he had screwed up and he readmitted my friend and he had to spend a month in the hospital to get back to where he would have been if they had treated him properly. The hospital had to eat it.

    The consulting doctor did a bad job sewing his foot back together and my friend spent 50k on rehabilitative care from a specialist and his foot is still not right. He has a dead tendon that the doctor didn't tie off and it is still in the wound area and needs to be filed off periodically. This was 4 years ago.

    So the hospital spreads the losses to the insured and OOP payers. In the meantime they have people that are employed just to constantly apply for grants.

    The culture of treating uninsured people shoddily leads to more malpractice and more waste.
     
    Last edited: Sep 2, 2009
  9. gcomeau
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    That's... kind of true now. Hospitals are legally required to provide medical treatment to anyone who shows up at an emergency room for example. Of course exactly what "medical treatment" you're entitled to is another story. Try walking into an emergency room, telling them you've been diagnosed with cancer, and getting admitted for chemotherapy without showing any ability to pay for it. Have fun.

    But I believe your broad point is "well, they're already getting treated and someone is already paying for it". And preventative care could help reduce those costs so overall the nation as a whole saves money regardless. Which is pretty much true, but doesn't matter. Yes, people are currently paying for those emergency room visits through higher insurance premiums and such, but they're not doing so in an explicit, transparent way. The costs are hidden. Most people have no clue it's happening. Nobody ever gets a bill from their insurance agency telling them that "X" amount of their insurance premium this month is being used to pay for Joe Schmoe's emergency trauma care at the local hospital last week that he couldn't pay for himself.

    But switch that spending to an explicit line item on a government budget that will be perpetually in the red and very, very visible? At a time when the US has been running crippling budget deficits for almost a decade already? Totally unworkable. The government budget simply can't take that on.
     
  10. DamnYankee
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    DamnYankee No Neg Policy

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    Describe, please, "health care reform", in your own words. If that's comprehensible, perhaps there's something to talk about.
     

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