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VinBucFan

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« #15 : June 19, 2013, 10:21:01 AM »

http://news.investors.com/061913-660419-local-governments-cut-hours-to-avoid-obamacare-mandate.htm


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« #16 : June 19, 2013, 10:22:55 AM »

I don't think you quite understand how the PPACA works, Vince. If anything, it's inherent flaw is that it doesn't put hardly anything in the hands of government. It's essentially going to be a huge windfall for private insurers, because the mandate requires that everyone purchase their product.

That would mean a windfall for healthcare companies/providers and drug companies, because insurance is used to PAY for healthcare.  Insurance would make profits if the apple cost $1 or $15:

"Bay State pharmaceutical companies stand to boost their sales and rake in larger profits thanks to Obamacare as the uninsured legions get health care coverage and greater access to drugs and medical devices starting next year, experts said yesterday

“This will be a big win for the pharmaceutical industry since many big pharmaceutical companies are headquartered in Massachusetts,” said Jonathan Gruber, an MIT economics professor and Affordable Care Act adviser to the Obama administration.

“It will be a big win for the Massachusetts economy.”


http://bostonherald.com/business/healthcare/2013/05/obamacare_to_boost_drug_companies
« : June 19, 2013, 10:31:58 AM VinBucFan »


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« #17 : June 19, 2013, 10:30:26 AM »

My wife is an RN at TGH.....it's a constant buzz among the staff about how Obamacare will impact the industry.

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« #18 : June 19, 2013, 10:36:07 AM »

I don't think you quite understand how the PPACA works, Vince. If anything, it's inherent flaw is that it doesn't put hardly anything in the hands of government. It's essentially going to be a huge windfall for private insurers, because the mandate requires that everyone purchase their product.

That would mean a windfall for healthcare companies/providers and drug companies, because insurance is used to PAY for healthcare.  Insurance would make profits if the apple cost $1 or $15:

"Bay State pharmaceutical companies stand to boost their sales and rake in larger profits thanks to Obamacare as the uninsured legions get health care coverage and greater access to drugs and medical devices starting next year, experts said yesterday

“This will be a big win for the pharmaceutical industry since many big pharmaceutical companies are headquartered in Massachusetts,” said Jonathan Gruber, an MIT economics professor and Affordable Care Act adviser to the Obama administration.

“It will be a big win for the Massachusetts economy.”


http://bostonherald.com/business/healthcare/2013/05/obamacare_to_boost_drug_companies

Hospitals too:

"Hospital stocks

The best way to profit on the long side from Obamacare is to buy hospital stocks as utilization rates will increase and uncollected receivables will go down.

Under Obamacare, the pool of paying patients will increase. It is estimated that currently about 30 million Americans are uninsured. The increase in the number of paying patients will be huge.

By law, hospitals have to serve all patients who show up at their emergency rooms including indigents as well as those with no insurance. Hospitals also have difficulty collecting from low income Americans who may have no insurance or are underinsured. Some hospitals aren't able to collect as much as 30% of their billings.

The earnings of some hospitals may increase by as much as 25%.


Sounds like Obamacare is actually corporate welfare for healthcare providers.  Instead of bearing the costs of some care (all companies have waster and losses), thoise losses will now be born by taxpayers. Thatn should mean healthcare companies drop their prices right? Because one of the justifications for $15 apples here, as opposed to $1 apples in Canada, is uncompensated care, right?

LOL, an investment site would not be touting healthcare stocks if prices were going to drop.
« : June 19, 2013, 10:39:02 AM VinBucFan »


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« #19 : June 19, 2013, 11:06:57 PM »

Then what's the point if it doesn't address the problem?

Costs aren't the only problem. Access is also a huge problem in the US. I think it deals with the access problem better than the cost problem, although it doesn't address either as efficiently as it should. It isn't the plan that progressives were calling for, but it's a start, I suppose.

1. I thought you suggested in another thread that access was a problem because of cost?

The cost of insurance, Vince, not the cost of individual procedures as charged by the hospital. Even if you were to cut the price of every procedure billed by hospitals in half, it still wouldn't increase access all that much if people were required to pay out of pocket. Insurance is what provides the access.

CBW . . .  talk about fundamentally flawed thinking . .  .insurance costs $$ because the health care costs money . . . . . a lot of money.  Insurance is NOT what provides the access, MONEY is what provides the access and unless you do something about the underlying COST of health care NOTHING will change because somebody still has to pay for the insurance. You are just changing from a premium to a tax.

Vince, insurance provides access because they are the payer of services rendered. A person who makes 20,000 a year and a person who makes 200,000 a year would be entitled to the same level of care provided that they have the exact same coverage, whereas simply addressing the fee-per-service aspect of care and ignoring the insurance aspect does not ensure the same level of access.

Now, this is not to say that I don't believe the fee-per-service aspect needs to be addressed, as you are inaccurately suggesting that I don't. What I am simply suggesting is that your focus and villainization only on this aspect of the system is at best, an oversimplification, and at worst, a diversion.

Here's a very simple example of what you are proposing, you tell me if it make sense:

Farms in Florida grow apples for .50.  People buy inurance to pay for apples because they are essential to life.  BECAUSE THE GOVERNMENT gives corporate welfare to the apple farms, apple farmers sell apples all over the world for $1 BUT in the United States they sell apples for $15 dollars AND (back to the coroporate welfare) do so with the protection of the US Government which threatens to throw people in jail if they but their apples from  outside the US borders.  For some this means they cannnot walk a few blocks or over a bridge to pay $1 for apples, they must pay $15.

Your "solution" is NOT to have farmers sell for $1 to US citizens (by removing the corporate welfare) but rather to give more people the ability to pay $15.  That makes no sense . . . . and worse .....we have seen what happens when the government injects money into a system, just look at the cost of tutition for colleges. More demand for apples does not make apples prices go down, just like more demand for college did not make college tuition go down

You're a health care person I think . . . sounds to me like you want universal care so long as it is not your ox that gets gored.  Helath care providers and drug companies make a FORTUNE in this country, if you really want universal health care, do something about the COSTS. 

CBW . .  your solution explains this:



Not only is there a fundamental flaw in what it is you are suggesting that I am advocating for, but there is also an ideological disconnect in what it is that you are arguing for.

1. Your characterization that this can be fixed by simply removing "corporate welfare" is a ridiculous assertion. The reason hospitals are charging so much for care has absolutely nothing to do with them receiving anything from the government. There are essentially three reasons that hospitals charge as much as they do in the US: 1) to cover the costs of providing care to people without insurance who never pay their bills, 2) to cover the additional administrative overhead that comes with having as complex a payer system as we do, and 3) good ole' fashioned greed.

2. Your assertion that "my solution" entails simply giving more people the ability to pay without addressing costs is flat out manufactured. That is not my solution, and I have never suggested even remotely that it was. It can be argued that this is what the PPACA does, and if that is your argument, then to an extent, I'd be inclined to agree. But the PPACA isn't my solution, so if you wish to continue this debate, might I suggest to you that you cease from attributing to me arguments that I've never made. It's dishonest, as I'm sure you are aware.

My argument is for a single payer system, or at the very least, a heavily regulated system with an option for publicly funded and managed insurance. In either case, the government would maintain the discretion to negotiate price controls and expand access without the need for regulatory reforms (such as those imposed by the PPACA). In such a scenario, the government would be a payer that represented such a huge portion of potential customers that it would force the industries hand in the negotiating process. They would either have to negotiate better prices, or risk going out of business by being denied an essential stream of revenue.

The disconnect that lies in your position is that you are both criticizing government intervention while simultaneously calling for government intervention. You are arguing that corporate greed is a good thing in relation to for-profit insurance, but a bad thing in relation to hospitals. You are suggesting that there is a difference in which part of the system gouges consumers. I am suggesting that there isn't.
« : June 19, 2013, 11:16:56 PM CBWx2 »


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« #20 : June 19, 2013, 11:18:36 PM »

Then what's the point if it doesn't address the problem?

Costs aren't the only problem. Access is also a huge problem in the US. I think it deals with the access problem better than the cost problem, although it doesn't address either as efficiently as it should. It isn't the plan that progressives were calling for, but it's a start, I suppose.

1. I thought you suggested in another thread that access was a problem because of cost?

The cost of insurance, Vince, not the cost of individual procedures as charged by the hospital. Even if you were to cut the price of every procedure billed by hospitals in half, it still wouldn't increase access all that much if people were required to pay out of pocket. Insurance is what provides the access.

CBW . . .  talk about fundamentally flawed thinking . .  .insurance costs $$ because the health care costs money . . . . . a lot of money.  Insurance is NOT what provides the access, MONEY is what provides the access and unless you do something about the underlying COST of health care NOTHING will change because somebody still has to pay for the insurance. You are just changing from a premium to a tax.

Vince, insurance provides access because they are the payer of services rendered.

The payer is actually the insured or insureds. giving the same access to a 20K and a 200K earner is fine, but someone has to PAY for both. increasing demand (more insured people) without reducing costs is a recipe for disaster because prices will do up, not down . .  and so will premiums as a result  ..  . and because the government will be subsidizing all of this I assume . .  that means more debt . . or taxes .  . or both


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« #21 : June 20, 2013, 12:36:33 AM »

Then what's the point if it doesn't address the problem?

Costs aren't the only problem. Access is also a huge problem in the US. I think it deals with the access problem better than the cost problem, although it doesn't address either as efficiently as it should. It isn't the plan that progressives were calling for, but it's a start, I suppose.

1. I thought you suggested in another thread that access was a problem because of cost?

The cost of insurance, Vince, not the cost of individual procedures as charged by the hospital. Even if you were to cut the price of every procedure billed by hospitals in half, it still wouldn't increase access all that much if people were required to pay out of pocket. Insurance is what provides the access.

CBW . . .  talk about fundamentally flawed thinking . .  .insurance costs $$ because the health care costs money . . . . . a lot of money.  Insurance is NOT what provides the access, MONEY is what provides the access and unless you do something about the underlying COST of health care NOTHING will change because somebody still has to pay for the insurance. You are just changing from a premium to a tax.

Vince, insurance provides access because they are the payer of services rendered.

The payer is actually the insured or insureds. giving the same access to a 20K and a 200K earner is fine, but someone has to PAY for both. increasing demand (more insured people) without reducing costs is a recipe for disaster because prices will do up, not down . .  and so will premiums as a result  ..  . and because the government will be subsidizing all of this I assume . .  that means more debt . . or taxes .  . or both

Preaching to the choir in regards to the PPACA, although I don't subscribe to the same level of doom and gloom, as there are some price control measures that are identified in the PPACA that often get overlooked that will have some impact, albeit not nearly as significant an impact as it could. The ultimate price control mechanism for both private insurance and runaway healthcare costs would have been the inclusion of a public option.


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« #22 : June 20, 2013, 02:11:24 PM »

My argument is for a single payer system, or at the very least, a heavily regulated system with an option for publicly funded and managed insurance. In either case, the government would maintain the discretion to negotiate price controls and expand access without the need for regulatory reforms (such as those imposed by the PPACA). In such a scenario, the government would be a payer that represented such a huge portion of potential customers that it would force the industries hand in the negotiating process. They would either have to negotiate better prices, or risk going out of business by being denied an essential stream of revenue.





I do not disagree with your general position, but some parts of it need "tweaking" IMO.

First off, I am against a Federal single payer system (SPS). It is just an issue of size. Too big geographically and population wise and too diverse in make up for a single centralized system to work efficiently. Now I do think a SPS could work in some states like Wyoming or Delaware or Conn. where small population or small geographic size keeps things manageable. I think in heavily populated and culturally diverse states like Cal, your "heavily regulated system with an option for publicly funded and managed insurance" would work better. A combo of public option and private insurance all competing will help keep costs down while spurring innovation (for instance a new insurance co. that caters to Spanish speaking clients might spring up since a mandate will provide the needed demand). In any case I prefer a decentralized federal system where the Fed's role is limited to dispersing $$$ to the state systems and making sure that each state system meets required guidelines and benchmarks. The Fed would also have to insure that some sort of State to State portability exists. This State by State approach would be similar to SNAP (Food Stamps) where the Fed is mostly just the money collector and distributor, and the States do the bulk of the admin work and determine eligibility and amounts.


Second, your statement "the government would maintain the discretion to negotiate price controls" needs clarification and expansion. "How" the govt. does this will be the difference between a real solution and abysmal failure. Simply having Congress or the CBO negotiate costs would fail. Your statement that "the government would be a payer that represented such a huge portion of potential customers that it would force the industries hand in the negotiating process." is clearly wrong when you look at our nation's other SPS, the Military Industrial Complex. The Govt. is the primary payer in all military equipment contracts, but the record of cost control there is laughable.$500 hammers, $20k toilet seats, etc. etc.The size and scope of the contracts in both HC and the military is sure to breed wanton corruption. Votes and favors WILL BE BOUGHT.

Now if the cost control was done via an appointed committee that included Medical Personnel/HC providers, Insurance Co. reps, Pharma reps, and patient advocates, then you would get truly negotiated prices. Each state would have a HC Price-Cost Committee with 3 reps nominated by the Private insurance cos. in that state, 3 reps nominated by the Pharma industry, 3 Reps nominated by the State AMA and a consortium of Hospitals, and 4 people elected that have no connection with insurance, pharma, or HC industries. This committee would then set maximum prices for prescription drugs, medical devices, procedures, hourly rates for general Drs. and specialists, etc.


Third, I have a small issue with "with an option for publicly funded and managed insurance''. Publicly funded is okay, but publicly managed? I think in some states a quasi-public NPO that is free from party politics might be a better option. An organization who's employees are NOT state employees (especially top management), but an organization that does have to report regularly to the State Legislature and is subject to Public governmental and/or independent audits. Even here you now have 2 options for the structure of this. 1) a NPO insurer that accepts everyone and is fully subsidized and would compete with private insurers. 2) an "Insurer of last resort". A NPO set up in a similar way to the Federal Reserve where the private insurers would {be required to} own stock in it, and nominate its BoD. This insurer would then take the people "too risky to insure privately". It would funded both by the State AND by private insurers (private insurers have to make an annual contribution AND an additional contribution for every person they move from their pool to the NPO's pool.) This would enable insurers to keep their rates down by atleast moving the administrative costs of very high risk insurees to the "Last Resort" NPO, but they'd still have the actual medical cost risk. Which of these 2 structures will be up to the individual states as each has different merits.


These are my tweaks, I'm sure you may not agree with all or may have additional tweaks to add. Post away.


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« #23 : June 20, 2013, 02:16:45 PM »

Interesting discussion


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« #24 : June 22, 2013, 09:39:30 AM »

IMHO; the federal government has no business in the administration of healthcare, welfare, retirement, unemployment, etc. actually any social program for that matter, as most public servants do not have the necessary backgrounds or skillsets to OBJECTIVELY set up and administer these types of enterprises. Let them write laws and protect us with the military. Return all social programs to a competetive private sector where innovation, accessability, competetion, customer service and fair pricing are common. You may scoff at the last sttement but if you want an example, just look at Google who is providing a ton of services and cutting edge innovation at affordable prices for the masses. If you want to do something, Mr. Congressman, start at Tort reform. By the way, if you have 77 million Baby Boomers out of 300 million Americans, how the hell can the Gen X´ers ever hope to pay for the aging population as we all die a prolonged death from cancer, heart disease and alzheimers. It is pure math and the math doesn´t add up.Who is doing the acturial calculations in Washington anyway. An Economic Tsunami is about to befall our children and grandchildren. Piling on more social problems and more bueracracy is not the answer. In theory it´ś a nice idea, access for all, in reality, it will be a nightmare. Forget the details for a moment, pure math says we are going to go over the economic cliff.
« : June 22, 2013, 09:41:50 AM Rusty »

                \'Every day above ground is a good day\'

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« #25 : June 23, 2013, 09:05:29 AM »

Nice post Rusty. 

\"A Great Coach has to have a Patient Wife, A Loyal Dog, and a Great Quarterback. . . . but not necessarily in that order\" ~ Coach Bud Grant

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« #26 : June 23, 2013, 09:38:59 AM »

Thanks Dave. I´m 63 and plan to work until I drop dead. I have always been able to pay the bills but I watch my five adult, married, two income children with families scuffle every day and all are in professional positions and are solid citizens with no lifestyle issues or divorces. It´s going to be even worse for my 21 grandchildren because a combination of economic easing and massive continued borrow will someday have to be paid. I don´t think any of us can imagine what a 15 trillion debt  really is in terms of order of magnitude and by the time my gradkids start paying , that debt will reach geometric proportions. It keeps me up at night, for sure.

                \'Every day above ground is a good day\'

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« #27 : June 25, 2013, 04:37:51 PM »

My argument is for a single payer system, or at the very least, a heavily regulated system with an option for publicly funded and managed insurance. In either case, the government would maintain the discretion to negotiate price controls and expand access without the need for regulatory reforms (such as those imposed by the PPACA). In such a scenario, the government would be a payer that represented such a huge portion of potential customers that it would force the industries hand in the negotiating process. They would either have to negotiate better prices, or risk going out of business by being denied an essential stream of revenue.


I do not disagree with your general position, but some parts of it need "tweaking" IMO.

First off, I am against a Federal single payer system (SPS). It is just an issue of size. Too big geographically and population wise and too diverse in make up for a single centralized system to work efficiently. Now I do think a SPS could work in some states like Wyoming or Delaware or Conn. where small population or small geographic size keeps things manageable. I think in heavily populated and culturally diverse states like Cal, your "heavily regulated system with an option for publicly funded and managed insurance" would work better. A combo of public option and private insurance all competing will help keep costs down while spurring innovation (for instance a new insurance co. that caters to Spanish speaking clients might spring up since a mandate will provide the needed demand). In any case I prefer a decentralized federal system where the Fed's role is limited to dispersing $$$ to the state systems and making sure that each state system meets required guidelines and benchmarks. The Fed would also have to insure that some sort of State to State portability exists. This State by State approach would be similar to SNAP (Food Stamps) where the Fed is mostly just the money collector and distributor, and the States do the bulk of the admin work and determine eligibility and amounts.

I have no problem with the Federal government acting solely as the distributor of funds, and having each state in charge of implementing and overseeing their own health care insurance plans, just so long as a set level of basic standards are met. Asking each state to fit it's own bill, however, is essentially asking for a system riddled with inequality and dissatisfaction. I don't need a crystal ball to tell you that in that situation, Maryland (the wealthiest state in the country) will have the best healthcare system in the US, and Mississippi (the poorest state in the country), will have the worst.

Second, your statement "the government would maintain the discretion to negotiate price controls" needs clarification and expansion. "How" the govt. does this will be the difference between a real solution and abysmal failure. Simply having Congress or the CBO negotiate costs would fail. Your statement that "the government would be a payer that represented such a huge portion of potential customers that it would force the industries hand in the negotiating process." is clearly wrong when you look at our nation's other SPS, the Military Industrial Complex. The Govt. is the primary payer in all military equipment contracts, but the record of cost control there is laughable.$500 hammers, $20k toilet seats, etc. etc.The size and scope of the contracts in both HC and the military is sure to breed wanton corruption. Votes and favors WILL BE BOUGHT.

Now if the cost control was done via an appointed committee that included Medical Personnel/HC providers, Insurance Co. reps, Pharma reps, and patient advocates, then you would get truly negotiated prices. Each state would have a HC Price-Cost Committee with 3 reps nominated by the Private insurance cos. in that state, 3 reps nominated by the Pharma industry, 3 Reps nominated by the State AMA and a consortium of Hospitals, and 4 people elected that have no connection with insurance, pharma, or HC industries. This committee would then set maximum prices for prescription drugs, medical devices, procedures, hourly rates for general Drs. and specialists, etc.

Sounds perfectly reasonable. I believe this, or something similar to it, is the way that most countries with universal health care approach cost control.

Third, I have a small issue with "with an option for publicly funded and managed insurance''. Publicly funded is okay, but publicly managed? I think in some states a quasi-public NPO that is free from party politics might be a better option. An organization who's employees are NOT state employees (especially top management), but an organization that does have to report regularly to the State Legislature and is subject to Public governmental and/or independent audits. Even here you now have 2 options for the structure of this. 1) a NPO insurer that accepts everyone and is fully subsidized and would compete with private insurers. 2) an "Insurer of last resort". A NPO set up in a similar way to the Federal Reserve where the private insurers would {be required to} own stock in it, and nominate its BoD. This insurer would then take the people "too risky to insure privately". It would funded both by the State AND by private insurers (private insurers have to make an annual contribution AND an additional contribution for every person they move from their pool to the NPO's pool.) This would enable insurers to keep their rates down by atleast moving the administrative costs of very high risk insurees to the "Last Resort" NPO, but they'd still have the actual medical cost risk. Which of these 2 structures will be up to the individual states as each has different merits.

Either model would be an improvement, but am more in favor of the 1st option. Simply having insurance doesn't guarantee access. What matters is how much people will be forced to pay out of pocket. One of the major gripes I have with the PPACA is that it forces people to get private coverage, which, or course, due to costs, will lead to a bare minimum level of care for poor individuals. People will be forced into cheap policies that meet compliance with the law that don't actually "cover" anything.

I feel as though the "insurer of last resort" option will simply be a moderate improvement on this concept, as you will see a large number of people who make just enough money not to qualify for the public plan, but not enough money to afford to pay for decent private coverage. It also doesn't do much to lower costs, because if private insurers were capable of negotiating cheaper prices and lowering the cost of coverage effectively, they would have done it already. The only real competition and price controls will come from a robust public option that can cover more people for less money by negotiating better prices from hospitals and Big Pharma. There should be no requirements to receive coverage from the public plan.

I also would like to eliminate, or at least greatly decrease employer sponsored health care coverage. The whole reason we fell into that system was due to the labor market in the 1940's that forced employers to offer fringe benefits to attract labor due to federal wage restrictions. It's antiquated, and places an unfair and unnecessary burden on the business community. It shouldn't be the responsibility of private business owners to provide insurance for the American public. It should be the responsibility of the government of the people, by the people, and for the people.


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« #28 : June 26, 2013, 01:19:28 PM »

My argument is for a single payer system, or at the very least, a heavily regulated system with an option for publicly funded and managed insurance. In either case, the government would maintain the discretion to negotiate price controls and expand access without the need for regulatory reforms (such as those imposed by the PPACA). In such a scenario, the government would be a payer that represented such a huge portion of potential customers that it would force the industries hand in the negotiating process. They would either have to negotiate better prices, or risk going out of business by being denied an essential stream of revenue.


I do not disagree with your general position, but some parts of it need "tweaking" IMO.

First off, I am against a Federal single payer system (SPS). It is just an issue of size. Too big geographically and population wise and too diverse in make up for a single centralized system to work efficiently. Now I do think a SPS could work in some states like Wyoming or Delaware or Conn. where small population or small geographic size keeps things manageable. I think in heavily populated and culturally diverse states like Cal, your "heavily regulated system with an option for publicly funded and managed insurance" would work better. A combo of public option and private insurance all competing will help keep costs down while spurring innovation (for instance a new insurance co. that caters to Spanish speaking clients might spring up since a mandate will provide the needed demand). In any case I prefer a decentralized federal system where the Fed's role is limited to dispersing $$$ to the state systems and making sure that each state system meets required guidelines and benchmarks. The Fed would also have to insure that some sort of State to State portability exists. This State by State approach would be similar to SNAP (Food Stamps) where the Fed is mostly just the money collector and distributor, and the States do the bulk of the admin work and determine eligibility and amounts.

I have no problem with the Federal government acting solely as the distributor of funds, and having each state in charge of implementing and overseeing their own health care insurance plans, just so long as a set level of basic standards are met.

Yes that is imperative. Such standards must include universal access, reasonable co-pays, affordable premiums (with subsidies for lower income families) etc.




Asking each state to fit it's own bill, however, is essentially asking for a system riddled with inequality and dissatisfaction. I don't need a crystal ball to tell you that in that situation, Maryland (the wealthiest state in the country) will have the best healthcare system in the US, and Mississippi (the poorest state in the country), will have the worst.
Quote


That is already the case. There are far more and better Hospitals and clinics in Md than in Ms.

The key is "set level of basic standards" and how the funds are distributed by the Fed. Govt. The distribution of funds to the states must be based on a formula that includes a states 1) tax contributions (medicare payroll taxes) 2) population 3) demographics 4) tax base and needs.  So Md has a higher pop. and contributes more in fed taxes than Ms, but Ms. has poorer demos. and a poor state tax base (prop values and sales taxes) so the funds should somewhat level out with Ms. getting a "little more than their fair share" to help with their greater need.

While I ma not a fan of more successful individuals having to bare a heavier load to compensate for poorer individuals, I don't mind the wealthier states having to bare more of their load to help the poorer states.


Second, your statement "the government would maintain the discretion to negotiate price controls" needs clarification and expansion. "How" the govt. does this will be the difference between a real solution and abysmal failure. Simply having Congress or the CBO negotiate costs would fail. Your statement that "the government would be a payer that represented such a huge portion of potential customers that it would force the industries hand in the negotiating process." is clearly wrong when you look at our nation's other SPS, the Military Industrial Complex. The Govt. is the primary payer in all military equipment contracts, but the record of cost control there is laughable.$500 hammers, $20k toilet seats, etc. etc.The size and scope of the contracts in both HC and the military is sure to breed wanton corruption. Votes and favors WILL BE BOUGHT.

Now if the cost control was done via an appointed committee that included Medical Personnel/HC providers, Insurance Co. reps, Pharma reps, and patient advocates, then you would get truly negotiated prices. Each state would have a HC Price-Cost Committee with 3 reps nominated by the Private insurance cos. in that state, 3 reps nominated by the Pharma industry, 3 Reps nominated by the State AMA and a consortium of Hospitals, and 4 people elected that have no connection with insurance, pharma, or HC industries. This committee would then set maximum prices for prescription drugs, medical devices, procedures, hourly rates for general Drs. and specialists, etc.

Sounds perfectly reasonable. I believe this, or something similar to it, is the way that most countries with universal health care approach cost control.

Third, I have a small issue with "with an option for publicly funded and managed insurance''. Publicly funded is okay, but publicly managed? I think in some states a quasi-public NPO that is free from party politics might be a better option. An organization who's employees are NOT state employees (especially top management), but an organization that does have to report regularly to the State Legislature and is subject to Public governmental and/or independent audits. Even here you now have 2 options for the structure of this. 1) a NPO insurer that accepts everyone and is fully subsidized and would compete with private insurers. 2) an "Insurer of last resort". A NPO set up in a similar way to the Federal Reserve where the private insurers would {be required to} own stock in it, and nominate its BoD. This insurer would then take the people "too risky to insure privately". It would funded both by the State AND by private insurers (private insurers have to make an annual contribution AND an additional contribution for every person they move from their pool to the NPO's pool.) This would enable insurers to keep their rates down by atleast moving the administrative costs of very high risk insurees to the "Last Resort" NPO, but they'd still have the actual medical cost risk. Which of these 2 structures will be up to the individual states as each has different merits.

Either model would be an improvement, but am more in favor of the 1st option. Simply having insurance doesn't guarantee access. What matters is how much people will be forced to pay out of pocket. One of the major gripes I have with the PPACA is that it forces people to get private coverage, which, or course, due to costs, will lead to a bare minimum level of care for poor individuals. People will be forced into cheap policies that meet compliance with the law that don't actually "cover" anything.

I feel as though the "insurer of last resort" option will simply be a moderate improvement on this concept, as you will see a large number of people who make just enough money not to qualify for the public plan, but not enough money to afford to pay for decent private coverage.

I need to clarify "insurer of last resort" cause you are missing it. It has nothing to do with premiums or ability to pay. It is all about RISK to the insurer. For instance, a healthy 35yo male (non-smoker) is a low-risk client. The insurer expects that his premiums will far outweigh his costs for the next 5-10 yrs or so. But after 1 yr, he contracts ALS and is now a Very High Risk client. Since the insurer can no longer just cancel or refuse to renew his policy, they must pay all the claims AND be burdened with enormously more paperwork for this client. The "insurer of last resort" can take over the policy of this ALS patient in exchange for payments from the original insurer, they would then handle all the extra paperwork and some of the additional costs.

The idea is say an insurer expects 12% of their policy holders to develop a terminal long term high cost disease (AIDS, cancer, ALS, Alzheimer's, etc.) and they base their premium structure on this. But their rate of high cost diseases shoots up to 20%, they can then move 8% of those to the "insurer of last resort" instead of changing premiums, co-pays, or coverage amts to compensate.

Basically I am talking about a quasi-governmental company that would insure the insurers.


 It also doesn't do much to lower costs, because if private insurers were capable of negotiating cheaper prices and lowering the cost of coverage effectively, they would have done it already. The only real competition and price controls will come from a robust public option that can cover more people for less money by negotiating better prices from hospitals and Big Pharma. There should be no requirements to receive coverage from the public plan.

The cost lowering would be done by the cost control board mentioned 2 quotes above. The purpose of the "insurer of last resort" is to prevent insurers from going belly up or from having to make drastic changes due to unforseen circumstances.




I also would like to eliminate, or at least greatly decrease employer sponsored health care coverage. The whole reason we fell into that system was due to the labor market in the 1940's that forced employers to offer fringe benefits to attract labor due to federal wage restrictions. It's antiquated, and places an unfair and unnecessary burden on the business community. It shouldn't be the responsibility of private business owners to provide insurance for the American public. It should be the responsibility of the government of the people, by the people, and for the people.


I have no problem with voluntary employer sponsored HC coverage. If a company wants to use that to attract better and more employees, then great. But I absolutely agree that it shouldn't be required or forced like it is under PPACA. That puts faaaar to much of a burden on the small to mid sized employers.


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« #29 : June 26, 2013, 06:42:17 PM »

I have no problem with voluntary employer sponsored HC coverage. If a company wants to use that to attract better and more employees, then great. But I absolutely agree that it shouldn't be required or forced like it is under PPACA. That puts faaaar to much of a burden on the small to mid sized employers.

QFT.

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