CDZ Why I Want a Two Tier Single Payer Health Care System

[JimBowie1958]

Our health care system, prior to Obamacare, was a tangled mess of corporate inspired laws and regulations. For example, in VA if you have Uninsured Motorist coverage, your Body Injury coverage does not 'stack' like you Medical Expenses coverage does, with each additional vehicle on your policy. No, it only stacks with each other vehicle you have on DIFFERENT polices. And since your health care insurance company can put a lien on your benefits, there is little way to have cash left over in a very expensive operation and you still get left with a hefty tag even with a fairly low catastrophic cap to your obligations. Now with Obamacare, it is worse, almost designed to fail with an explosion of new regulations and government oversight bodies that don't necessarily help at all. It amounts to using the efficiency of the Veterans Administration on all private polices by force of law.

The whole system today is adversarial and complex by design with the chief aim of the design to be to confuse people and discourage them from continuing in the process. And if you don't have a lawyer, you are going to get screwed in all likelihood if you find yourself in any 'gray areas', so its good business for the legal theft class also.

We need a better system, that much is obvious, and so I think these should be the priorities in any new system:
1. EVERYONE should have medical coverage. And I mean everyone from the richest billionaire all the way down to the poorest street person.
2. Any system must remain profitable to the businesses involved. There is, however, a reasonable amount of profit and when those in need of care are often bankrupted by medical costs the profits are too high.
3. While the government uses tax money to assist the purchase of medical insurance for the poorer folks, those who wish to participate in a private system should not be penalized as long as they continue to contribute to the public system also.
4. While the government is best for providing services to remote or poor areas that do not attract private services as much, the innovation and aggressive market development of the private sector must not be extinguished. When private business confronts a market shortage they see that as a business opportunity to make up that shortage, while the government always resorts to rationing and regulatory restriction. Which do you want the life of your loved ones to depend on? I would want the private system if I could afford it and the public one if I cannot. The private sector health care system would continue to spur innovation and expand and improve services while the public system would still be available for the poorer of our society.

Any single payer system has to include provisions for a second parallel private system to exist along side it.

And so I would like to see a government fund voucher system where everyone gets a voucher for X to buy insurance from a pool of providers. If one voluntarily wants to supplement their voucher and purchase more expensive insurance then they could do so from a menu of insurance providers similar to what federal employees have today.

Why not?

 

[paddymurphy]

Our health care system, prior to Obamacare, was a tangled mess of corporate inspired laws and regulations. For example, in VA if you have Uninsured Motorist coverage, your Body Injury coverage does not 'stack' like you Medical Expenses coverage does, with each additional vehicle on your policy. No, it only stacks with each other vehicle you have on DIFFERENT polices. And since your health care insurance company can put a lien on your benefits, there is little way to have cash left over in a very expensive operation and you still get left with a hefty tag even with a fairly low catastrophic cap to your obligations. Now with Obamacare, it is worse, almost designed to fail with an explosion of new regulations and government oversight bodies that don't necessarily help at all. It amounts to using the efficiency of the Veterans Administration on all private polices by force of law.

The whole system today is adversarial and complex by design with the chief aim of the design to be to confuse people and discourage them from continuing in the process. And if you don't have a lawyer, you are going to get screwed in all likelihood if you find yourself in any 'gray areas', so its good business for the legal theft class also.

We need a better system, that much is obvious, and so I think these should be the priorities in any new system:
1. EVERYONE should have medical coverage. And I mean everyone from the richest billionaire all the way down to the poorest street person.
2. Any system must remain profitable to the businesses involved. There is, however, a reasonable amount of profit and when those in need of care are often bankrupted by medical costs the profits are too high.
3. While the government uses tax money to assist the purchase of medical insurance for the poorer folks, those who wish to participate in a private system should not be penalized as long as they continue to contribute to the public system also.
4. While the government is best for providing services to remote or poor areas that do not attract private services as much, the innovation and aggressive market development of the private sector must not be extinguished. When private business confronts a market shortage they see that as a business opportunity to make up that shortage, while the government always resorts to rationing and regulatory restriction. Which do you want the life of your loved ones to depend on? I would want the private system if I could afford it and the public one if I cannot. The private sector health care system would continue to spur innovation and expand and improve services while the public system would still be available for the poorer of our society.

Any single payer system has to include provisions for a second parallel private system to exist along side it.

And so I would like to see a government fund voucher system where everyone gets a voucher for X to buy insurance from a pool of providers. If one voluntarily wants to supplement their voucher and purchase more expensive insurance then they could do so from a menu of insurance providers similar to what federal employees have today.

Why not?

Great idea. Republicans would never let it pass.

 

[JimBowie1958]

Great idea. Republicans would never let it pass.

They really haven't had a chance top weigh in, have they? Obamacare was passed without a single Republican asked to participate in its writing and so got not one Republican vote.

Had the whole thing been a more bipartisan endeavor it would have been far more successful.

 

[Statistikhengst]

Our health care system, prior to Obamacare, was a tangled mess of corporate inspired laws and regulations. For example, in VA if you have Uninsured Motorist coverage, your Body Injury coverage does not 'stack' like you Medical Expenses coverage does, with each additional vehicle on your policy. No, it only stacks with each other vehicle you have on DIFFERENT polices. And since your health care insurance company can put a lien on your benefits, there is little way to have cash left over in a very expensive operation and you still get left with a hefty tag even with a fairly low catastrophic cap to your obligations. Now with Obamacare, it is worse, almost designed to fail with an explosion of new regulations and government oversight bodies that don't necessarily help at all. It amounts to using the efficiency of the Veterans Administration on all private polices by force of law.

The whole system today is adversarial and complex by design with the chief aim of the design to be to confuse people and discourage them from continuing in the process. And if you don't have a lawyer, you are going to get screwed in all likelihood if you find yourself in any 'gray areas', so its good business for the legal theft class also.

We need a better system, that much is obvious, and so I think these should be the priorities in any new system:
1. EVERYONE should have medical coverage. And I mean everyone from the richest billionaire all the way down to the poorest street person.
2. Any system must remain profitable to the businesses involved. There is, however, a reasonable amount of profit and when those in need of care are often bankrupted by medical costs the profits are too high.
3. While the government uses tax money to assist the purchase of medical insurance for the poorer folks, those who wish to participate in a private system should not be penalized as long as they continue to contribute to the public system also.
4. While the government is best for providing services to remote or poor areas that do not attract private services as much, the innovation and aggressive market development of the private sector must not be extinguished. When private business confronts a market shortage they see that as a business opportunity to make up that shortage, while the government always resorts to rationing and regulatory restriction. Which do you want the life of your loved ones to depend on? I would want the private system if I could afford it and the public one if I cannot. The private sector health care system would continue to spur innovation and expand and improve services while the public system would still be available for the poorer of our society.

Any single payer system has to include provisions for a second parallel private system to exist along side it.

And so I would like to see a government fund voucher system where everyone gets a voucher for X to buy insurance from a pool of providers. If one voluntarily wants to supplement their voucher and purchase more expensive insurance then they could do so from a menu of insurance providers similar to what federal employees have today.

Why not?

Good posting.

With just a couple of extra details missing, you just described the 120 year old German health care system, which is single payer and 2-tiered.

 

[Statistikhengst]

Great idea. Republicans would never let it pass.

They really haven't had a chance top weigh in, have they? Obamacare was passed without a single Republican asked to participate in its writing and so got not one Republican vote.

Had the whole thing been a more bipartisan endeavor it would have been far more successful.

Actually, that's not quite true, but let's stick to YOUR OP, which I think is a good one.

 

[PratchettFan]

Our health care system, prior to Obamacare, was a tangled mess of corporate inspired laws and regulations. For example, in VA if you have Uninsured Motorist coverage, your Body Injury coverage does not 'stack' like you Medical Expenses coverage does, with each additional vehicle on your policy. No, it only stacks with each other vehicle you have on DIFFERENT polices. And since your health care insurance company can put a lien on your benefits, there is little way to have cash left over in a very expensive operation and you still get left with a hefty tag even with a fairly low catastrophic cap to your obligations. Now with Obamacare, it is worse, almost designed to fail with an explosion of new regulations and government oversight bodies that don't necessarily help at all. It amounts to using the efficiency of the Veterans Administration on all private polices by force of law.

The whole system today is adversarial and complex by design with the chief aim of the design to be to confuse people and discourage them from continuing in the process. And if you don't have a lawyer, you are going to get screwed in all likelihood if you find yourself in any 'gray areas', so its good business for the legal theft class also.

We need a better system, that much is obvious, and so I think these should be the priorities in any new system:
1. EVERYONE should have medical coverage. And I mean everyone from the richest billionaire all the way down to the poorest street person.
2. Any system must remain profitable to the businesses involved. There is, however, a reasonable amount of profit and when those in need of care are often bankrupted by medical costs the profits are too high.
3. While the government uses tax money to assist the purchase of medical insurance for the poorer folks, those who wish to participate in a private system should not be penalized as long as they continue to contribute to the public system also.
4. While the government is best for providing services to remote or poor areas that do not attract private services as much, the innovation and aggressive market development of the private sector must not be extinguished. When private business confronts a market shortage they see that as a business opportunity to make up that shortage, while the government always resorts to rationing and regulatory restriction. Which do you want the life of your loved ones to depend on? I would want the private system if I could afford it and the public one if I cannot. The private sector health care system would continue to spur innovation and expand and improve services while the public system would still be available for the poorer of our society.

Any single payer system has to include provisions for a second parallel private system to exist along side it.

And so I would like to see a government fund voucher system where everyone gets a voucher for X to buy insurance from a pool of providers. If one voluntarily wants to supplement their voucher and purchase more expensive insurance then they could do so from a menu of insurance providers similar to what federal employees have today.

Why not?

I think that moves in the right direction, but I think it still leaves significant problems that ultimately costs both the patients and the tax payer. Public health is a public concern and thus a valid issue for the government. But an insurance company is in the business to maximize profits and that is one of the major reasons for the fact that the cost of health care in this country is at the top of all first world countries and at the bottom in terms of overall quality.

Let me give a quick example. If you look at the statement provided by the carrier when you see a doctor you will note the cost of the care presented by the provider is considerably higher than what the carrier actually pays. This is due to contractually negotiated pricing between the provider and the carrier. Now, the provider obviously knows what those prices are, yet what the provider charges is much higher. Further, if the provider negotiates a price, that price must be considered appropriate by the provider. Yet, again, the actual charges are much higher. So why submit charges the provider knows are going to be reduced? There is a reason. The carrier has a subsidiary with the job of reviewing charges. That subsidiary charges a fee for doing this, back to the parent company. That is not a flat fee but a percentage of the amount of the reduction. The more the provider charges for services, the greater the reduction and the higher the fee. The carrier then calls that part of its overhead costs and this goes into the price of the premium. So while the carrier may pay $100 to the provider, it actually books it as $130 to the policy holder. Even though that extra $30 it paid to itself.

This is just one of a myriad of ways the insurance carriers maximize profit from health care without actually providing any objective product. The insurance carrier has become a parasite on the system.

So I agree that we need a single payer system that covers everyone. But I don't think keeping the insurance companies as the interface between the provider and the patient works. It just adds costs without adding benefits.

 

[Mac1958]

Just expand the current Medicare/Medicare Supplement/Medicare Advantage system to everyone.

Take a massive monkey off the backs of American business, significantly improve preventive/diagnostic access to decrease long-term health problems, maintain a dynamic and competitive private insurance component and mercifully end this psychotic health care "system" of ours that features seven (7) different delivery/payment systems that do not coordinate with each other.

Makes too much sense for our elected "leaders", though. They're afraid voting for something that makes so much sense might cause them to lose their cushy gubmit jobs.

.

 

[paddymurphy]

Great idea. Republicans would never let it pass.

They really haven't had a chance top weigh in, have they? Obamacare was passed without a single Republican asked to participate in its writing and so got not one Republican vote.

Had the whole thing been a more bipartisan endeavor it would have been far more successful.

You do realize that what you have described was closer to what the President and the Democrats proposed? That the ACA was based on FEHB, the federal employee health care plan? The one congress and its employees are part of, contrary to the false claims of Republicans? The changes that eliminated the public option and other provisions were at the request of republicans and conservative democrats. The notion that a plan more government based, as your is, would have garnered Republican support is ridiculous.

 

[paddymurphy]

Great idea. Republicans would never let it pass.

They really haven't had a chance top weigh in, have they? Obamacare was passed without a single Republican asked to participate in its writing and so got not one Republican vote.

Had the whole thing been a more bipartisan endeavor it would have been far more successful.

Republicans wrote most of the provisions of the ACA two decades ago. Romnetcare, which is nearly identical to the ACA, was based on republican proposals offered in response to Clinton'screwworm plans.

 

[paddymurphy]

Just expand the current Medicare/Medicare Supplement/Medicare Advantage system to everyone.

Take a massive monkey off the backs of American business, significantly improve preventive/diagnostic access to decrease long-term health problems, maintain a dynamic and competitive private insurance component and mercifully end this psychotic health care "system" of ours that features seven (7) different delivery/payment systems that do not coordinate with each other.

Makes too much sense for our elected "leaders", though. They're afraid voting for something that makes so much sense might cause them to lose their cushy gubmit jobs.

.

How in the world would Medicare for all get passed? They falsely called the ACA socialized medicine. Medicare for all IS socialized medicine. All republicans and too many Dems would be against such a plan.

 

[Mac1958]

Just expand the current Medicare/Medicare Supplement/Medicare Advantage system to everyone.

Take a massive monkey off the backs of American business, significantly improve preventive/diagnostic access to decrease long-term health problems, maintain a dynamic and competitive private insurance component and mercifully end this psychotic health care "system" of ours that features seven (7) different delivery/payment systems that do not coordinate with each other.

Makes too much sense for our elected "leaders", though. They're afraid voting for something that makes so much sense might cause them to lose their cushy gubmit jobs.

.

How in the world would Medicare for all get passed? They falsely called the ACA socialized medicine. Medicare for all IS socialized medicine. All republicans and too many Dems would be against such a plan.

Oh, I'd be stunned if it did.

It's far more likely we'll continue to limp along with the absurd seven-headed beast we have now.

.

 

[JimBowie1958]

The state exchanges pooling peoples data and working to reduce charges is a good idea, but more could be done with interstate competition and utilizing existing federal programs and consolidating them.

IF we have a two tiered system, it is not socialized medicine, and Mac1958's idea of expanding Medicaid would seem to fit right in. Roll in Medicare as well.

And let people pay MORE for more services if they want them.

Just keep a choice between private care and public and it isn't socialism.

 

[warf]

It seems to be too difficult to look at the plans other industrial countries are using and take the best from each plan to come up with a better one.

We have to make sure the deep pockets are not offended and stop their legal bribery. So we get what we've got.

 

[Statistikhengst]

The state exchanges pooling peoples data and working to reduce charges is a good idea, but more could be done with interstate competition and utilizing existing federal programs and consolidating them.

IF we have a two tiered system, it is not socialized medicine, and Mac1958's idea of expanding Medicaid would seem to fit right in. Roll in Medicare as well.

And let people pay MORE for more services if they want them.

Just keep a choice between private care and public and it isn't socialism.

Interesting way of looking at it.

However, no matter how you slice it, Single-Payer = generational contract (in order to pay for it) = at least partial socialism. There is no getting around this. Which is not bad. We live in a wonderful capitalistic economy with an island or two of socialism floating out there. Not shabby.

The long and short of it is that the Germans already have what you are looking for. In fact, the German system provides more choice.

 

[Greenbeard]

And so I would like to see a government fund voucher system where everyone gets a voucher for X to buy insurance from a pool of providers. If one voluntarily wants to supplement their voucher and purchase more expensive insurance then they could do so from a menu of insurance providers similar to what federal employees have today.

Why not?

Sounds like you essentially just want everyone to move into the exchanges. The good news is that once they're fully geared up and have completely found their footing, they can serve as the platform for the sort of things you're describing.

 

[Sun Devil 92]

Did Hawaii reopen their exchange ?

 

[PratchettFan]

And so I would like to see a government fund voucher system where everyone gets a voucher for X to buy insurance from a pool of providers. If one voluntarily wants to supplement their voucher and purchase more expensive insurance then they could do so from a menu of insurance providers similar to what federal employees have today.

Why not?

Sounds like you essentially just want everyone to move into the exchanges. The good news is that once they're fully geared up and have completely found their footing, they can serve as the platform for the sort of things you're describing.

Not my quote.

 

[Greenbeard]

And so I would like to see a government fund voucher system where everyone gets a voucher for X to buy insurance from a pool of providers. If one voluntarily wants to supplement their voucher and purchase more expensive insurance then they could do so from a menu of insurance providers similar to what federal employees have today.

Why not?

Sounds like you essentially just want everyone to move into the exchanges. The good news is that once they're fully geared up and have completely found their footing, they can serve as the platform for the sort of things you're describing.

Not my quote.

Sorry, should be directed at the OP.

 

[JimBowie1958]

Sounds like you essentially just want everyone to move into the exchanges. The good news is that once they're fully geared up and have completely found their footing, they can serve as the platform for the sort of things you're describing.

I think the exchanges can serve to lower insurance cost once they work more efficiently and have many times more members, but it should be strictly a voluntary choice.

Allowing for choice of insurance plans and providers I think prevents single payer from becoming a full fledged socialized medical system.

 

[Greenbeard]

I think the exchanges can serve to lower insurance cost once they work more efficiently and have many times more members, but it should be strictly a voluntary choice.

Allowing for choice of insurance plans and providers I think prevents single payer from becoming a full fledged socialized medical system.

Agreed, if exchanges can foster competition that holds down cost growth and still provide people access to needed services, then you don't need single-payer.