Universal health care

[Chris]

Hi, Obama," from a nervous Geri Punteney as she rose in the front row to ask her question.

But it wasn't a question, really. "I have a brother who's dying of cancer," she said, and as soon as it was out she had broken into sobs, and then apologies for her sobs, and more sobs. Obama stepped forward, as if knowing what was expected of him and yet slightly embarrassed by it. He took her hand with some consoling mumbles. Punteney, 50, collected herself enough to tell the rest: her 48-year-old brother was working as a truck driver despite having cancer, so as not to lose his insurance. She herself had stopped working at a riverboat casino to care for her mother, and so was forgoing needed dental surgery. "I don't think it's fair that my brother has to work when he's dying of cancer just to keep his insurance," she said.

And here Obama parted from his two main rivals in the race, Clinton and John Edwards, and from the only Democrat elected president in the past 30 years, Bill Clinton, and from the whole tradition of politics that had prevailed in his party for the past few decades as it tried to maintain its historic bond with the common man. He did not get angry. He did not wrap Punteney in a hug. Instead, he stood still and said in a level voice, "First of all, we're all praying for you." He then told her that he had lost his mother to cancer in her early fifties. And only then looking up at the crowd, he segued into a policy conclusion that was startling for its cool rationalism. Punteney's and her brother's plight, he said, was a sign of the problem in tying health insurance to work without real alternatives. It was wrong that the US was the only developed nation not to guarantee health coverage for its citizens, even as it spent more per person on health care than anyone else. "We don't spend it wisely and we don't spend it fairly," he said.

http://www.newstatesman.com/north-america/2008/10/voters-obama-clinton-mccain

 

[Turboswede]

Looks like time for a Universal Healthcare Post.

First off, we will have universal state (i.e. government sponsored) healthcare eventually because that’s what just about everyone else on earth has decided is the best. We are a conservative people and will hang on to our archaic notions of healthcare for some time, but I know at some point universal healthcare will arrive.

1. Medical school is too expensive; the poorest professional I ever met was a 1st year resident in a medium sized city hospital. He worked 14 hour shifts for less money than I did and had over twice my student debt (from a state subsidized medical school). In order for Doctors to pay back this crushing debt Med School thrusts on them they need to charge large fees. Figure the monthly payment on a $250,000 mortgage and that is the kind of debt we are talking about.

2. The marginal utility curve for medicine is vertical; What this means is that, if you are sick and there is a cure, you will pay all that you have (and more with financing) to get it. For the past few centuries governments have found that where there is an area with a vertical marginal utility curve the private sector fails to provide services efficiently. That’s why people used to have fire insurance, so that the fire department would come to your house if it was in flames. I am a staunch fiscal conservative but I know that in a capitalist economy if you have a business and you don’t charge as much for services as the market will bear, you quickly find that no one wants to invest in your company any more.

3. There is no incentive to control insurance costs; If people will pay whatever it takes to stay alive or keep their kids alive, why should the private sector not charge as much as possible for services. That forces insurance companies to raise rates and avoid paying benefit claims whenever possible as that’s just good business. While all states regulate insurance, Health insurance is (for the most part) exempt from state regulation due to the Employee Retirement and Income Security Act of 1974 (ERISA).

4. There is a huge profit motive that must be eliminated; It has been argued that government administered universal health care is inefficient when compared with private sector insurance. Only on one side, cost. The amount of resources it takes to run a health insurance plan must be the absolute minimum required to avoid legal action. If its not then the profits used to pay investors drop and investors find more “efficient” insurance companies to invest in.

5. It’s killing American Industry; This is going to be what brings us universal healthcare, as costs rise and it becomes more and more difficult for employers to provide health insurance there will be more and more clamoring that it is a job for the government. Think about it, lots of folks that are small business owners seem to oppose universal state funded healthcare as they fear it would increase their tax burden. How might their opinions change if the Federal government mandated that every employer with more than 5 employees was required to provide health insurance benefits to its workers and their dependents?

On this last point I like to point out that one of the largest political backers of Medicaid happens to be Wal-Mart. Due to the wages paid by Wal-Mart and the schedules worked by employees it knows most of its workforce will be covered by Medicaid, thus eliminating the need for Wal-Mart to provide insurance for the majority of its employees.

 

[Diuretic]

A good analysis Turbo. Now, I do ask this question from time to time but I haven't got a satisfactory answer and I'm keen to pursue the idea to see if I'm able to make sense of it. What would happen if health care was no longer treated as a marketable commodity?

 

[AVG-JOE]

...

You keep talking about freedom as if you own it.

Is England a free society?

How about Canada, Sweden?

How about America .. because after all we have elements of socialism in our society?

What evolution...

Freedom, as many desire it was lost when the last arable property on the planet was flagged by someone.

You have 2 choices... kill off enough of each other that the survivors can 'stretch out' again, or learn what combination of free enterprise and public direction, service and pooling of funds it takes to build a society that can reach for the stars.

Current book bets on this planet are still about 50 / 50, but they're slipping...

-Joe

 

[Chris]

A good analysis Turbo. Now, I do ask this question from time to time but I haven't got a satisfactory answer and I'm keen to pursue the idea to see if I'm able to make sense of it. What would happen if health care was no longer treated as a marketable commodity?

Healthcare will still be a "marketable commodity." There will only be one insurance company, the government. Doctors and hospitals and medical supply companies and drug companies will still be privately owned.

 

[Diuretic]

Healthcare will still be a "marketable commodity." There will only be one insurance company, the government. Doctors and hospitals and medical supply companies and drug companies will still be privately owned.

Then can it have a dual nature? Can it be a marketable commodity when the single payer agency deals with providers and can it be a service when people use the products and services the single payer agency has negotiated as commodities?

 

[RetiredGySgt]

Then can it have a dual nature? Can it be a marketable commodity when the single payer agency deals with providers and can it be a service when people use the products and services the single payer agency has negotiated as commodities?

The only way a Government can control costs for health care is if they own and control every step of it. And such an arrangement will drop us back into the dark ages in regards medicine.

 

[Turboswede]

Then can it have a dual nature? Can it be a marketable commodity when the single payer agency deals with providers and can it be a service when people use the products and services the single payer agency has negotiated as commodities?

Ah, see that’s the key, while there will still be healthcare costs with doctors, nurses, MRI machines, etc. With the government as the sole customer there would be some legitimate element of cost control.

Private companies would still have the option of selling products to other markets, but as all other markets are also regulated it will level the playing field. It would no longer be cheaper to buy prescription Drugs in Canada and Mexico because the Feds would be “collectively bargaining” with the drug companies and medical providers.

I have talked to a lot of Doctors that would welcome such a change from an administrative and care provision perspective. Its and costly administrative burden for doctors to keep track of all the different insurance providers, the different plans they offer, the different payment options and reimbursement procedures.

The only people who should be against this are the insurance companies, and they are. Somehow they have convinced the American public that the Government will dictate what doctor you are allowed to see, when you can have an MRI, etc.

Well I would rather have the government make those decisions in the people’s interest rather than have an insurance company make those decisions based on their bottom line.

 

[Chris]

Ah, see that’s the key, while there will still be healthcare costs with doctors, nurses, MRI machines, etc. With the government as the sole customer there would be some legitimate element of cost control.

Private companies would still have the option of selling products to other markets, but as all other markets are also regulated it will level the playing field. It would no longer be cheaper to buy prescription Drugs in Canada and Mexico because the Feds would be “collectively bargaining” with the drug companies and medical providers.

I have talked to a lot of Doctors that would welcome such a change from an administrative and care provision perspective. Its and costly administrative burden for doctors to keep track of all the different insurance providers, the different plans they offer, the different payment options and reimbursement procedures.

The only people who should be against this are the insurance companies, and they are. Somehow they have convinced the American public that the Government will dictate what doctor you are allowed to see, when you can have an MRI, etc.

Well I would rather have the government make those decisions in the people’s interest rather than have an insurance company make those decisions based on their bottom line.

The liability lawyers, Big Pharma, and the insurance companies would be against it, because they make money off the sick. The latest surveys show that most American doctors are for it because it simplifies their paperwork and allows them to do what they are trained to do....take care of sick people.

 

[Chris]

The only way a Government can control costs for health care is if they own and control every step of it. And such an arrangement will drop us back into the dark ages in regards medicine.

That is not true.

Every other Western democracy has universal healthcare, and they are not in the "dark ages."

All it would mean is that we would all have one insurance company that would represent our interests instead of the interests of its stockholders.

 

[Navy1960]

While your idea to provide Universal Healthcare to all is a noble one it is as is proposed here not authorized under the constitution. From what many are talking of here, the nationalization of whole medical industries and health insurance industries puts the government in the business of providing medical care. Which is not provided for in the constitution. What some do not seem to grasp is that there is no specific mention in the constitution of "Right to Healthcare" in the constitution and those rights not mentioned under the constitution are under the 10th Amendment reserved to the STATES. So in order to even begin to implement this you would need pass a constitutional amendment providing for such a right or limiting the rights under the 10th Amendment. Then you will need 2/3rds of the States to ratify it. So the universal healthcare that is touted is not as of today provided for under law.

The other issue you have to deal with here is the complete decimation of a 10 trillion dollar industry. Is the government going to simply buy these hospitals, and medical companies and place their staffs on government payrolls, or do you propose they simply just take it? If that is what is being proposed I suggest that some of you take the time to read the constitution of the country in which you call home and make sure this is the country in which you want to live in.

Under our system , there is a way for government to control the price of health insurance and the costs of drugs, its called regulation which congress does have the authority to do. It is a simple matter of getting them to do it. No, they will never be able to cover 100% of the people in this country , however if congress were in the regulatory business they can make it affordable to the point where if someone does not have it they are doing so bu choice.

 

[Red Dawn]

The only way a Government can control costs for health care is if they own and control every step of it. And such an arrangement will drop us back into the dark ages in regards medicine.

You're not very educated or informed, are you?

Britain's NHS is an exception. Most countries have a combination of government-financed health care, and also have privately employed doctors and nurses. Its called a single payer universal health insurance. That's different than socialized medicine. Google is your friend. You should learn the difference, or you should stay off this thread.

per capital health care costs

 

[Diuretic]

The only way a Government can control costs for health care is if they own and control every step of it. And such an arrangement will drop us back into the dark ages in regards medicine.

I was thinking of the power of a monopoly to bargain with a range of suppliers.

 

[Turboswede]

While your idea to provide Universal Healthcare to all is a noble one it is as is proposed here not authorized under the constitution.

I know this and that’s what makes me sad, we will not have federally backed universal healthcare coverage without a constitutional amendment. It’s still just a matter of time until the Amendment comes a long, but in the meantime we will need to live with what we have (assuming we have something).

I do want to make it clear that the compassion side of the argument is nice and all and would be reason enough to institute universal health insurance; but the reason we will get the Amendment will be fiscal NOT based on compassion, then everyone will be behind it even conservatives because when it does come it will be pitched by the Republicans.

After all, only Nixon could go to China.

 

[Navy1960]

I know this and that’s what makes me sad, we will not have federally backed universal healthcare coverage without a constitutional amendment. It’s still just a matter of time until the Amendment comes a long, but in the meantime we will need to live with what we have (assuming we have something).

I do want to make it clear that the compassion side of the argument is nice and all and would be reason enough to institute universal health insurance; but the reason we will get the Amendment will be fiscal NOT based on compassion, then everyone will be behind it even conservatives because when it does come it will be pitched by the Republicans.

After all, only Nixon could go to China.

I honestly think that Amendment will have a LOT of trouble getting ratified on a statewide level. I just cannot understand if the goal here is to allow access to low cost health insurance which is a noble one mind you, then whip congress in the backside till they regulate it into being. To me it seems as a matter of regulation congress could easily regulate interstate floor and caps for health insurance under the interstate compact. It also seems to me that one of the main reasons for this not happening is because of the number of people on capitol hill that do not do the peoples business.

 

[Turboswede]

I honestly think that Amendment will have a LOT of trouble getting ratified on a statewide level. I just cannot understand if the goal here is to allow access to low cost health insurance which is a noble one mind you, then whip congress in the backside till they regulate it into being. To me it seems as a matter of regulation congress could easily regulate interstate floor and caps for health insurance under the interstate compact. It also seems to me that one of the main reasons for this not happening is because of the number of people on capitol hill that do not do the peoples business.

Can't do it, Commerce Clause. Still need an Amendment

 

[Red Dawn]

Can't do it, Commerce Clause. Still need an Amendment

We already have universal health care. For everyone over 65 anyway. Medicare. It passes constitutional muster.

 

[Navy1960]

Can't do it, Commerce Clause. Still need an Amendment

I don't know Turbo I could make a pretty good arguement under the Commerce Clause where congress does have the power to do just that.

Justice Rehnquist echoed this point in his opinion in United States v. Lopez, stating: Since (Wickard), the Court has ....undertaken to decide whether a rational basis existed for concluding that a regulated activity sufficiently affected interstate commerce. See, e.g., Hodel v. Virginia Surface Mining & Reclamation Assn., Inc., 452 U.S. 264, 276-280 (1981); Perez v. United States, 402 U.S. 146, 155-156(1971); Katzenbach v. McClung, 379 U.S. 294, 299-301(1964); Heart of Atlanta Motel, Inc. v. United States, 379 U.S. 241, 252-253(1964)

Rational basis review begins with establishing the factual predicate upon which the exercise of Congressional power is based. This factual basis might come from a variety of sources. It might come from factual determinations made by Congress, passed in the legislation itself, or found in the Congressional Reports issued to accompany the legislation. It might come from the record of testimony complied in Committee Hearings. It might come from facts posited by proponents in their briefs in support of the legislation. For example, in Katzenbach v. McClung, the Court referenced extensive testimony presented in hearings in support of the conclusion that discrimination in public accommodations has a deleterious impact on interstate commerce. The Court wrote:

Of course, the mere fact that Congress has said when particular activity shall be deemed to affect commerce does not preclude further examination by this Court. But where we find that the legislators, in light of the facts and testimony before them, have a rational basis for finding a chosen regulatory scheme necessary to the protection of commerce, our investigation is at an end.

Similarly, the Court upheld a ban on the growth of marijuana intended for medical use on the grounds that Congress could rationally conclude that this growth might make enforcement of drug laws more difficult by creating an otherwise lawful source of marijuana that could be diverted into the illicit market:

In assessing the scope of Congress' authority under the Commerce Clause, we stress that the task before us is a modest one. We need not determine whether respondents' activities, taken in the aggregate, substantially affect interstate commerce in fact, but only whether a “rational basis” exists for so concluding. Given the enforcement difficulties that attend distinguishing between marijuana cultivated locally and marijuana grown elsewhere, 21 U.S.C. § 801(5), and concerns about diversion into illicit channels, we have no difficulty concluding that Congress had a rational basis for believing that failure to regulate the intrastate manufacture and possession of marijuana would leave a gaping hole in the CSA. Gonzales v Raich

Your talking about regulating interstate commerce which congress is well within it's constitutional power to do. What it can't do is use the commerce clause to tell states what insurance programs they will and will not choose though. However, it can regulate the insurance industry under this.

 

[Navy1960]

We already have universal health care. For everyone over 65 anyway. Medicare. It passes constitutional muster.

Congressional Record, Nov. 11, 1971.

AAPS WAS ORGANIZED to maintain the highest ethical integrity of the medical profession, to protect the responsibility, independence, and freedom of patients and doctors, particularly from encroachment upon their liberty by government...It does not seek any subsidy of any kind from the federal government. All we want is to be left alone to exercise our best judgment and skill for the benefit of our patients.

Mr. Roosevelt knew that the Federal Government did not have Constitutional authority to interfere in social welfare problems and said so quite effectively before becoming President of the United States. The Founders clearly did not intend to grant such authority to the Federal Government, as shown in the Federalist papers and other writings.

Social Security legislation, including Medicare, violates Constitutional principles. In a speech to the employees of the U.S. Department of Health, Education, and Welfare, on October 23, 1962 (U.S.D.H.E.W. 17, US Govt Printing Office: 1963, O-685-624), Frances Perkins explained how the Social Security Act was used to subvert the Constitution:

``Before I was appointed, I had a little conversation with Roosevelt in which I said perhaps he didn't want me to be the Secretary of Labor because if I were, I should want to do this, and this, and this. Among the things I wanted to do was find a way of getting unemployment insurance, old-age insurance and health insurance. I remember he looked so startled, and he said, `Well, do you think it can be done?' I said, `I don't know.' He said, ``Well, there are Constitutional problems aren't there?'

`` `Yes, very severe Constitutional problems,' I said. `But what have we been elected for except to solve the Constitutional problems?'

`` `Well,' he said, `Do you think you could do it?' `I don't know,' I said, but I wanted to try. ``I want to know if I have your authorization. I won't ask you to promise anything.'

``He looked at me and nodded wisely. `All right,' he said. `I will authorize you to try, and if you succeed, that's fine.' ''

``This, then, was the genesis of the whole bill. We did a great deal of educating by one kind of propaganda or another, chiefly hearings. We had a number of Senatorial Committees which we asked to look into this or that...for the purpose not so much of advice as of propaganda-that is of educating the public. The result was a bill that finally was presented to Congress and as you know was debated very briefly, really quite briefly when you think of the problems that were involved....and we gave way on all kinds of things. We gave way on washing out universal insurance; that is, universal coverage. We let them take out one group after another; no objections, just so we got the basis of the bill.''

Pamphlet No. 1050, June 1996
Medicare

It still suffers from the same lack of constitutional issues that a Universal Healthcare system would, however by going the tax route they felt pretty much anything they wanted to do was okay.

 

[elvis]

Funny how it works elsewhere. Hawaii is incompetent.

Republican?

Do you have it in Australia?