US Healthcare in Simple Terms

[Dr Grump]

I've been reading some of the threads on this subject, but haven't contributed much to it:
1) it's about the US
2) Sounds complicated

However, the subject matter is interesting. Can somebody explain in simple terms what the hell it is all about?

What is the current system and what does Obama want to do with it.

Our system is relatively simple. Some people have health insurance and get treated quicker than those who don't. That's about it really. If you have public, you go on waiting lists for elective surgery, and if you have a heart attack or somesuch you go to the head of the queue and get treated straight away.

 

[PoliticalChic]

I've been reading some of the threads on this subject, but haven't contributed much to it:
1) it's about the US
2) Sounds complicated

However, the subject matter is interesting. Can somebody explain in simple terms what the hell it is all about?

What is the current system and what does Obama want to do with it.

Our system is relatively simple. Some people have health insurance and get treated quicker than those who don't. That's about it really. If you have public, you go on waiting lists for elective surgery, and if you have a heart attack or somesuch you go to the head of the queue and get treated straight away.

Your wish is my command.

Rep. Ryan was interviewed 2/28/10 on Fox News Sunday re: President Obama’s latest plan:
1. The plan will raise premiums 10-13%
a. Large group policies will see 0% to 3% decrease
b. Individual policies will see a 10-13% increase (but with more inclusive policies as federally mandated)
c. The individual buyers may receive subsidies which will reduce the costs to less than they pay now: This will increase deficits

2. But since there will be less competition, experience has shown that the premiums will increase. And more federal mandates in the bill will not only increase premiums, but will infringe on states rights in this area.

3. CBO “bill cuts deficit by $132 billion in first 10 years…”Rep, Ryan indicates that this is illusory:
a. The bill double counts Medicare savings
b. And double counts increased taxes for Social Security
c. And double counts increased premiums for the CLASS (Community Living Assistance Services and Supports) Act, in which workers are stipulated to send a monthly premium in order to purchase coverage, usually via their employer. They need to pay into the program for five years at the very least in order to qualify for the benefits for the disabled, poor, or elderly people -which is believed to be least fifty dollars per day and assumed by the nonpartisan Congressional Budget Office to reach up to seventy-five dollars per day.
d. Without the ‘double count’ aspect, the bill actually results in a $460 billion deficit in the first 10 years and a $1.4 trillion deficit in the second ten years.

4. The double count aspect is explained as follows:
a. The bill raises taxes $ ½ billion and cuts Medicare $ ½ trillion during the first 10 years, but provides only six years of ‘benefits.’
b. While the extra money derives from the premiums for the new CLASS Act entitlement, but then these premiums are then also counted as deficit reduction.
c. And, while additional money in Social Security taxes is supposedly reserved to pay for Social Security benefits, it is also claimed in the bill to be a form of deficit reduction. So, why is it tapped as both payment for benefits, and as reducing costs?
d. The administration claims that all the Medicare cuts are to increase the solvency of Medicare, as a reserve for the program, but if this is so then it is unethical to use the ‘saved’ funds to create another government program.

5. CBO: “[the bill] would not cause a net increase in deficits in excess of $5 billion in any year of the four 10-year periods beginning after 2019.”
a. In the original version of the bill, members of labor unions would not have to pay taxes on “Cadillac” healthcare plans, a pay-back by Democrats to the unions- but everyone else who had to pay increased taxes on these plans, and this would pay most of the costs of the new healthcare ‘reform.’ When this became public news, the administration changed the proposal to this: everyone would pay said taxes, but not until 2018! But, of course, logic suggests that the Congress in existence eight years from now would not impose a $1 trillion tax that this Congress had not the nerve to impose.
b. A new unelected bureaucratic Commission would be in charge of Medicare, to ration care and wring out even more cuts than the $1/2 billion in the bill. If unable or unwilling to do this, of course, the CBO estimates are invalid.
c. The Chief Actuary in the Centers for Medicare and Medicaid Services in the Obama Health and Human Services department issued a memorandum stating that HR 3200, the basis for the President’s plan would increase healthcare costs by $ 234 billion over the first 10 years. Obama on Health Care: Half Right | Cato @ Liberty

6. Malpractice and Defensive Medicine as drivers of increased healthcare costs.
a. CBO: “tort reform would reduce US healthcare spending by about 0.5% (about $11 billion in 2009)
b. But CBO are based on legal and liability payments, and are unable to measure defensive medical costs, i.e. the additional tests and procedures ordered by doctors to reduce liability. Tort reform would go far toward reducing these peripheral healthcare costs.

7. The President’s bill covers more Americans
a. Senators Coburn, Burr and Representatives Ryan, Nunes offer a bill that would do the same, without the onerous tax burdens, based on a refundable tax credit. http://coburn.senate.gov/public/ind...Store_id=b8876db7-2be0-4c84-b833-3d77dc4afa83

I know you said simple terms, but...

 

[Dr Grump]

Interesting, but not quite the simplicity I was looking for...

 

[jillian]

I've been reading some of the threads on this subject, but haven't contributed much to it:
1) it's about the US
2) Sounds complicated

However, the subject matter is interesting. Can somebody explain in simple terms what the hell it is all about?

What is the current system and what does Obama want to do with it.

Our system is relatively simple. Some people have health insurance and get treated quicker than those who don't. That's about it really. If you have public, you go on waiting lists for elective surgery, and if you have a heart attack or somesuch you go to the head of the queue and get treated straight away.

It's not as complicated as some like to make it. The reality is that 70% of people in this country are happy with their health care. As anyplace else, people with money can get any treatment they want for anything they want. People who are poor are covered by government programs. There is a group of people in the middle who have jobs, but no health insurance. They can't afford health coverage because they don't earn enough to pay for private insurance and their jobs don't provide it. And they earn too much or are too young to qualify for government programs.

Our health care, for a number of reasons, also costs twice per capita what other 'western' nations pay for coverage. Health insurers can deny coverage to people for having a 'pre-existing condition' or drop them for getting an 'expensive' illness. This bankrupts people, driving up the societal cost of health care. Additionally, it is anticipated that within 10 years, we will be paying 50% of our GDP for health costs.

the issues:
1. how to get affordable coverage to the maximum number of people;
2. how to make insurance portable if someone changes jobs
3. how to keep companies from not covering certain high risk people
4. how to bring down the cost of medical care

 

[Ame®icano]

Simple as that...

 

[SFC Ollie]

I've been reading some of the threads on this subject, but haven't contributed much to it:
1) it's about the US
2) Sounds complicated

However, the subject matter is interesting. Can somebody explain in simple terms what the hell it is all about?

What is the current system and what does Obama want to do with it.

Our system is relatively simple. Some people have health insurance and get treated quicker than those who don't. That's about it really. If you have public, you go on waiting lists for elective surgery, and if you have a heart attack or somesuch you go to the head of the queue and get treated straight away.

It's not as complicated as some like to make it. The reality is that 70% of people in this country are happy with their health care. As anyplace else, people with money can get any treatment they want for anything they want. People who are poor are covered by government programs. There is a group of people in the middle who have jobs, but no health insurance. They can't afford health coverage because they don't earn enough to pay for private insurance and their jobs don't provide it. And they earn too much or are too young to qualify for government programs.

Our health care, for a number of reasons, also costs twice per capita what other 'western' nations pay for coverage. Health insurers can deny coverage to people for having a 'pre-existing condition' or drop them for getting an 'expensive' illness. This bankrupts people, driving up the societal cost of health care. Additionally, it is anticipated that within 10 years, we will be paying 50% of our GDP for health costs.

the issues:
1. how to get affordable coverage to the maximum number of people;
2. how to make insurance portable if someone changes jobs
3. how to keep companies from not covering certain high risk people
4. how to bring down the cost of medical care

Great issues, to bad the current bills don't exactly address number 4 but does the exact opposite.

 

[jillian]

I've been reading some of the threads on this subject, but haven't contributed much to it:
1) it's about the US
2) Sounds complicated

However, the subject matter is interesting. Can somebody explain in simple terms what the hell it is all about?

What is the current system and what does Obama want to do with it.

Our system is relatively simple. Some people have health insurance and get treated quicker than those who don't. That's about it really. If you have public, you go on waiting lists for elective surgery, and if you have a heart attack or somesuch you go to the head of the queue and get treated straight away.

It's not as complicated as some like to make it. The reality is that 70% of people in this country are happy with their health care. As anyplace else, people with money can get any treatment they want for anything they want. People who are poor are covered by government programs. There is a group of people in the middle who have jobs, but no health insurance. They can't afford health coverage because they don't earn enough to pay for private insurance and their jobs don't provide it. And they earn too much or are too young to qualify for government programs.

Our health care, for a number of reasons, also costs twice per capita what other 'western' nations pay for coverage. Health insurers can deny coverage to people for having a 'pre-existing condition' or drop them for getting an 'expensive' illness. This bankrupts people, driving up the societal cost of health care. Additionally, it is anticipated that within 10 years, we will be paying 50% of our GDP for health costs.

the issues:
1. how to get affordable coverage to the maximum number of people;
2. how to make insurance portable if someone changes jobs
3. how to keep companies from not covering certain high risk people
4. how to bring down the cost of medical care

Great issues, to bad the current bills don't exactly address number 4 but does the exact opposite.

which bill? there's more than one. and it wouldn't bother me to hear constructive input from the right side of the aisle. but i think they're too invested in wanting to make health care obama's 'waterloo'. I really wish that wasn't the case.

 

[Baruch Menachem]

Essentially, because of a long history of tax laws, most insurance is handled as an employee benefit through your employer. This started back during the last world war, when there were wage controls and employers were desperate to attract employees, but couldn't pay them over a set rate if they were military contractors.

The second issue was that the government pension plan (Social Security) taxes wages, but employee benefits were not considered wages subject to taxation. Employers began the practice of offering health insurance as a way to evade wage controls, but it continued as a way of giving employees an expensive extra kick for their net monthly earnings without raising their tax rates.

Buy buying large group plans, employers also could get relatively cheap rates as well.

It is now very expensive to get health insurance outside of a company plan. Right now, as an unemplyed person, my health insurance is over $400 per month. As an employee, my kick was $50 per month.

If you don't have insurance, you pay the doctor as you use the service, just like any other service. Just like if you have your engine tuned up, you go in, you get the fix up done, you pay as you leave. If you have insurance, the insurance covers most of the cost of the service. A standard doctors visit is billed at around $200, plus any tests. Depending on the plan, tests are free, cheap,or paid up front and applied to an annual deductible.

the kicker is, medical care has gone way up in price since the government began getting involved in big way in the 60's. Also, basic insurance differs from state to state, as legislatures have made mandates over what companies are required to offer in the way of a plan. Companies used to not offer pregnancy coverage for single people, for example. Or insurance for family members ended on the family members 18th birthday.

Other things also have raised the price of medical care.

One of the huge costs medical centers have to deal with is that emergency room care is given first, questions of payment come later. Emergency care is expensive, but it is often the only kind of care some folks can get. People use emergency rooms and then walk away from the bill. This cost has to be recovered some how, so that just makes the set fee for the care that much higher for insured people to pay.

One story I remember from 20 years ago was from a guy I knew at the artists market here. His son was involved in an auto accident that required a helicopter ride and 20 hours of surgery to keep the kid alive and healthy. After he showed up at the hospital to see the kid, he met with the business office where they told him the bill was $125,000, and when could they expect payment. This guy was a craft vendor who in a good month made $1500. He said he just sat and laughed. the kid stayed in the hospital another week, and the hospital had to write the whole thing off. No insurance, no funds, no resources. Ce al vie. This is not unusual, and hospitals have to recoup.

The other big part of this is something called medicare/medicaid. Medicare is insurance provided to all folks 65 and over for free. Period. (There is more to it, but for sake of clarity, this is the basis of discussion. There are actualy four different levels of medicare insurance) Medicare pays doctors for care according to set schedules. Medicare will pay for some things, not others. Private parties have to cover any gaps. (AARP is a big vendor of 'medigap insurance') Doctors have the advantage with medicare of guaranteed payment, but they have to give huge discounts for the service

Medicaid is health insurance for those who qualify for low income reasons. Like Medicare, it has guaranteed payments, but steep discounts.

So there are lots of little complications.


Now, since the provision of medical insurance is voluntary on the employer, only really large employers provide it. Small businesses generally don't. Also, in heavily unionized businesses, it is the union that buys the insurance, also in cases where the union is for small contractors. Plumbers, barbers, Truck drivers, electricians, all these folks would get insurance through the union. (Also The UAW also has its health insurance plans)

insurance, like banking, is heavily regulated on a state by state basis. Lots of states have very expensive insurance, others have relatively cheap insurance)

Here, there are no wait lists. You get the care you need right away. It costs a ton. Insurance is available through various Byzantine processes.

Obama basically wants one streamlined insurance market provided by private insurance carriers with an expanded medicaid system to make sure everyone can have insurance somehow.


The route he is going about it is through a very large and complicated bill which would start to provide services in 2018, but taxes to support it would start now.

Since a large portion of the system would depend on medicaid, which is paid for and administered by the states, there is a lot of angst in the states over how the states would get stuck for the charges.

Simply put, the system is confusing, expensive, and bureaucratic, and Obama wants to make it worse.

 

[SFC Ollie]

It's not as complicated as some like to make it. The reality is that 70% of people in this country are happy with their health care. As anyplace else, people with money can get any treatment they want for anything they want. People who are poor are covered by government programs. There is a group of people in the middle who have jobs, but no health insurance. They can't afford health coverage because they don't earn enough to pay for private insurance and their jobs don't provide it. And they earn too much or are too young to qualify for government programs.

Our health care, for a number of reasons, also costs twice per capita what other 'western' nations pay for coverage. Health insurers can deny coverage to people for having a 'pre-existing condition' or drop them for getting an 'expensive' illness. This bankrupts people, driving up the societal cost of health care. Additionally, it is anticipated that within 10 years, we will be paying 50% of our GDP for health costs.

the issues:
1. how to get affordable coverage to the maximum number of people;
2. how to make insurance portable if someone changes jobs
3. how to keep companies from not covering certain high risk people
4. how to bring down the cost of medical care

Great issues, to bad the current bills don't exactly address number 4 but does the exact opposite.

which bill? there's more than one. and it wouldn't bother me to hear constructive input from the right side of the aisle. but i think they're too invested in wanting to make health care obama's 'waterloo'. I really wish that wasn't the case.

Well mostly everyones been talking about the Senate Bill. I do not pretend to have the solutions, if i did i would be in Washington. But I do know that we cannot afford to add even more to the deficit and that is what this does. I also know that during a recession is not the time to raise taxes, and the Bills in congress do that too. Whats the answer? Beats hell out of me.

 

[jillian]

Great issues, to bad the current bills don't exactly address number 4 but does the exact opposite.

which bill? there's more than one. and it wouldn't bother me to hear constructive input from the right side of the aisle. but i think they're too invested in wanting to make health care obama's 'waterloo'. I really wish that wasn't the case.

Well mostly everyones been talking about the Senate Bill. I do not pretend to have the solutions, if i did i would be in Washington. But I do know that we cannot afford to add even more to the deficit and that is what this does. I also know that during a recession is not the time to raise taxes, and the Bills in congress do that too. Whats the answer? Beats hell out of me.

I'm actually sorry they're talking about the Senate bill. It's no where near as good as the House bill and it will end up costing us way more than necessary without solving the problems that need to be addressed, at least from what i've seen of it. I understand the concern about costs. But we can't really afford not to fix things either. I don't pretend to have all the answers. I just know what sound like the better answers to me.

 

[Dr Grump]

What I find interesting, is that some say that everybody should have private insurance. Are there enough health practitioners in the US to cover everybody if they all had health insurance? I know they don't in NZ and Australia..

 

[SFC Ollie]

What I find interesting, is that some say that everybody should have private insurance. Are there enough health practitioners in the US to cover everybody if they all had health insurance? I know they don't in NZ and Australia..

Actually there is a shortage of medical professionals and from what I've seen and heard it will get worse under obamacare. My family Doctor told me he will retire early if medicare payments get cut. He says he barely breaks even on medicare and medicaid patients as it is.

 

[Dr Grump]

I wonder how he judges that "breaking even"....

 

[Baruch Menachem]

He has to have a staff to handle paperwork, he has licensing fees, malpractice insurance, office space, local taxes....


Medicare and medicaid just barely cover the costs of doing business.

The usual charge for an office visit to the insurance carrier is about $180. Medicare/medicaid are paying around $70, and are threatening to lower the payments further.

 

[SFC Ollie]

He has to have a staff to handle paperwork, he has licensing fees, malpractice insurance, office space, local taxes....


Medicare and medicaid just barely cover the costs of doing business.

The usual charge for an office visit to the insurance carrier is about $180. Medicare/medicaid are paying around $70, and are threatening to lower the payments further.

Sounds right.