The health care thread

[HM-PuFFNSTuFF]

So Obama is attempting health care reform in the USA. If any of you Americans would care to oblige me, I'm just curious about some things.

Are you happy with your (family too) current health care plan? Do you support a public option? Do you think the final legislative bill will have a public option? If so, will the bill pass?

Do you have major concerns about the coming reform?

[Deathshroud]

To be perfectly honest, I watched Obama's press conference about health care, and all I got out of it was a vague notion of how health care will be reformed.

I feel like no one is revealing any specific details, but rather giving vague outlines of how this new health care will form.

[Fender]

mostly
probably, depends on implementation. I'm scared that we'll fuck it up, even if intentions and the plan are good.
No.
No.
I've heard that single payer will reduce costs enough to pay for itself, but haven't really seen evidence for it. Mostly my fault, I haven't really gone looking.

[werldhed]

Yes, though I don't really use it
Yes, though that's not really the root of the problem
No
No

It won't pass because the repubs will get out and start slinging shit everywhere. All the mouthbreathers will start moaning about socialism and how they don't want to have their taxes pay for other people's healthcare.

News flash for the legions of morons: your taxes already pay for health care for the uninsured. Only providing everyone with an affordable option to induce preventative care will reduce your taxes.

Letting the free market control your health is stupid anyway.

[menkent]

i had good health care through my previous employer, but i also never got sick so they never had an opportunity to screw me.
now that i'm sort of "between jobs" i doubt that i have any coverage at all and certainly can't afford a private insurance plan. afaik the premiums would be about the same as my car payment.

i'll be surprised if anything passes. the republicans think stopping this by any means necessary is their one chance at the midterm elections in 2010. combine that with the massive propaganda coming from the industry and the basic and all-consuming fuckwittery of the american public (encouraged by some successful whisper campaigns)... fail.

[seremtan]

i thought obama's universal healthcare plan was a lame duck from the start. typically, countries with a public, universal healthcare system spend between 7% and 8% of their GDP on it (compared to 15% for private in the US). in the UK, this translates into a ringfenced 10% national insurance tax, and furthermore the NHS costs nearly £200bn and is the world's 3rd largest employer. there was just no way obama was ever going to pull off anything even remotely like that

[R00k]

Yes, I'm happy with mine.
I support a public option, although I would prefer single payer.
I think the final legislative bill will have a watered-down excuse for a public option that will not be worth the cost to implement it, and I believe it will pass, and the republicans will capitalize on that, because it proves that government can't do anything. (If it fails, they'll try to capitalize on that too, but I'm not sure they would be successful since so many people support reform).
My major concern about the coming reform has to do with the party that is trying to enact it. The democrats couldn't grow a collective spine if they were buried lengthwise in tree sap for 40 thousand years. Or a collective message, for that matter. They took single-payer off the table before the negotiations even started, and the finance committee's "compromise" would only insure a few million people, and add some regulations to the insurance industry.

The only thing that has heartened me in the process so far was the progressive caucus vowing that they would all oppose the bill if it didn't have a robust public option.



More than anything, I'm just so tired of all the idiots in this country who play into ideological roles, and contribute to how fucked up our political system is, simply by being willfully ignorant. Have you seen all the tea-baggers following orders from republican lobbying groups to completely crash town hall meetings and prevent discussions being held in them?

Those mobs are just a spark away from exploding somewhere.

And what makes me really proud to be an American is that old people, republicans and southerners still refuse to believe Obama is an American citizen.

My grandmother watches Glenn Beck, and honestly believes that if Obama passes healthcare reform, then a government social-worker will decide when it is time for her to die.

But it's okay for Fox News to be on the air, because the free market is just so darned good at policing itself.

[/rant]
sorry.

[Hannibal]

Unless he can get something through that has real teeth, there is a very good chance he'll be a one term wonder. Only 8 months in and yet...this is the final battle. I just hope he knows it.

[Dukester]

No
Yes
No
No
No

Anything that will reduce the amount I pay a month for medical insurance I am for!

[GONNAFISTYA]

I simply can't comprehend why supporters of private insurance get so upset about the prospect of paying slightly more in taxes for public health insurance but don't blink an eye paying even more money - out of their own pocket no less - to insurance companies...only to not get the help they need. Somehow they just accept it as normal.

Some questions for Americans regarding the argument of "freedom of choice" when it comes to private insurance: If your employer decides who they buy insurance from do the staff have a choice or any say in the decision? When you're hired and you go through the procedure of getting your healthcare plan explained to you, can you say you want insurance from another provider? Or are you forced to use the company's insurance choice?

If you have to take what your employer gives you then you really don't have a choice at all...which makes the whole private vs public argument the dumbest thing since the pet rock.

[GONNAFISTYA]

Unless he can get something through that has real teeth, there is a very good chance he'll be a one term wonder. Only 8 months in and yet...this is the final battle. I just hope he knows it.

Bill Mahar said it nicely about Obama's plans and the "help" he's getting from his fellow Dems:

Obama's like Micheal Jordan playing on a really bad team...there's nobody to pass the ball to.

I really feel sorry for Obama and anyone else who actually wants to get things done in American politics. Good luck but all they'll accomplish is grey hair and high blood pressure because they're dealing with nothing but children.

[R00k]

I simply can't comprehend why supporters of private insurance get so upset about the prospect of paying slightly more in taxes for public health insurance but don't blink an eye paying even more money - out of their own pocket no less - to insurance companies...only to not get the help they need. Somehow they just accept it as normal.

Some questions for Americans regarding the argument of "freedom of choice" when it comes to private insurance: If your employer decides who they buy insurance from do the staff have a choice or any say in the decision? When you're hired and you go through the procedure of getting your healthcare plan explained to you, can you say you want insurance from another provider? Or are you forced to use the company's insurance choice?

If you have to take what your employer gives you then you really don't have a choice at all...which makes the whole private vs public argument the dumbest thing since the pet rock.

Choice isn't the argument. The argument is with people who ideologically oppose the government doing anything at all.

Aside from determining whether or not Terri Schiavo lives, of course. And whether kids can be taught what condoms are for.

In other words, the argument is with intellectually dishonest people. Over 70% of the public supports at least having a public option.

[Fender]

If you have to take what your employer gives you then you really don't have a choice at all...which makes the whole private vs public argument the dumbest thing since the pet rock.

We do have to accept what our employers choose. There really is no choice, especially in times like these, when people will take ANY job just to be employed. No job, or crappy job w/ crappy insurance? People "choose" to have a job.

Barring real reform, I'd really like to see the insurance-employment tie broken. Increase my pay by the cost of insurance and let me pay for it out of pocket. Give consumers real choice and make all insurance premiums and all non-elective health care costs deduct directly from taxable income. At least that would be a start to re-introduce competition back in to the mix. And somehow make insurance when not employed cost less than a house payment. That's what it was for the couple of months when I quit FedEx before my coverage kicked in at my new job. $1200 a month for 2 adults and 2 children.

[menkent]

People are scared. They have some sort of Stockholm syndrome attachment to the current system and are afraid that if they let it go their entire world will crumble... because that's how it is in the private insurance system. You live your life one denied claim away from eviction and bankruptcy.

[GONNAFISTYA]

I simply can't comprehend why supporters of private insurance get so upset about the prospect of paying slightly more in taxes for public health insurance but don't blink an eye paying even more money - out of their own pocket no less - to insurance companies...only to not get the help they need. Somehow they just accept it as normal.

Some questions for Americans regarding the argument of "freedom of choice" when it comes to private insurance: If your employer decides who they buy insurance from do the staff have a choice or any say in the decision? When you're hired and you go through the procedure of getting your healthcare plan explained to you, can you say you want insurance from another provider? Or are you forced to use the company's insurance choice?

If you have to take what your employer gives you then you really don't have a choice at all...which makes the whole private vs public argument the dumbest thing since the pet rock.

Choice isn't the argument. The argument is with people who ideologically oppose the government doing anything at all.

Aside from determining whether or not Terri Schiavo lives, of course. And whether kids can be taught what condoms are for.

In other words, the argument is with intellectually dishonest people. Over 70% of the public supports at least having a public option.

I completely understand all that...especially the fact that most of your countrymen want the public option available. I guess - in short - I was asking why there's even an argument at all.

[Fender]

http://tauntermedia.com/2009/07/28/unconscionable-math/

[Hannibal]

I completely understand all that...especially the fact that most of your countrymen want the public option available. I guess - in short - I was asking why there's even an argument at all.

Money talks. That's all it is. The lobbying efforts are incessant, well funded, and increasingly draconian. When you add this to a big dollop of false consciousness (i.e., the repubs convincing a sizeable number of their constituents to (again) rage AGAINST their own interests), you have a recipe for a faggy half-measure bill that will please no one and keep the insurance industry at the top of the foodchain.

[GONNAFISTYA]

[Massive Quasars]

Given the legislative process behind any such bill, I worry about what may come out of congress.

Single payer won't be cost-neutral to govt. accounts; insurance premiums will be replaced by some offsetting tax and ambiguous efficiency results. Ultimately however, save the switch-over structural costs, I doubt either system will much affect health care cost trends as it relates to national income.* Most developed countries have opted for single payer-esque options on distributional grounds; and that alone may be sufficient if one is realistic about tangible costs and benefits.

* Health care is ubiquitously expensive across developed countries, regardless of implementation. Costs trend upward in real dollars and (for now) also in share of GDP. The explanation is more fundamental to health care demand, research, capital costs, procedures, etc. than to market/mix/command distribution mechanisms.

[seremtan]

yes it is expensive, however

1. most countries with public healthcare pay 7-8% GDP instead of double that for the US;
2. a single publicly-funded system creates economies of scale impossible for HMOs;
3. a publicly funded system doesn't require an army of lawyers and bureaucrats to assess your claim, saving money;
4. capital costs in a public system can be covered by the kind of low-cost loans only govt can get (or PFI, which seems to be the preferred UK option - bit of a dodgy option);
5. healthcare costs are partly explained by the ridiculous costs imposed by private sector vendors, for example: http://www.independent.co.uk/opinion/co ... 67257.html

[R00k]

Some might find this heartening.

http://www.fivethirtyeight.com/2009/07/ ... -been.html


And these are the kinds of morans crashing town halls:

http://thinkprogress.org/2009/08/04/gen ... -townhall/

Last night, Rep. Gene Green (D-TX) hosted a rowdy town hall meeting to discuss health care reform. Fox’s local Houston affiliate reporter, Duarte Geraldino, reported that he talked to the participants and found that “some attendees admit they don’t live in the district.” How did they get there? Geraldino noted “an internet campaign” by far right activists urging their allies to attend and heckle Democratic Representatives.

[...]

During the town hall, one conservative activist turns to his fellow attendees and asks them to raise their hands if they “oppose any form of socialized or government-run health care.” Almost all the hands shot up. Rep Green quickly turned the question on the audience and asked, “How many of you have Medicare?” Nearly half the attendees raised their hands, failing to note the irony.

[Massive Quasars]

yes it is expensive, however

1. most countries with public healthcare pay 7-8% GDP instead of double that for the US;
2. a single publicly-funded system creates economies of scale impossible for HMOs;
3. a publicly funded system doesn't require an army of lawyers and bureaucrats to assess your claim, saving money;
4. capital costs in a public system can be covered by the kind of low-cost loans only govt can get (or PFI, which seems to be the preferred UK option - bit of a dodgy option);
5. healthcare costs are partly explained by the ridiculous costs imposed by private sector vendors, for example: http://www.independent.co.uk/opinion/co ... 67257.html

1. Yes, it's something like an OECD avg of 10% to the US 15%. Marketing, private markups, and market distortions may go to explain some of this but not all. The quality of service is generally higher where received, and the wait times typically lower; neither of which is discounted for in cost calculations. Meanwhile, drug R&D cost burden is borne disproportionately by Americans while the benefits accrue to all OECD.

2. Risk pooling gains may be modest here. Most HMOs are large and don't seem to particularly suffer from the adverse selection of traditional insurance markets. Some evidence exists that they reap benefits of virtuous selection by insuring the risk-averse healthy financially capable types. The uninsured as a group are only slightly less healthy because many are young and simply unwilling to commit to the costs of insurance. Many of course are not, and their stories are sad indeed, don't get me wrong.

3. Administrative cost savings are potentially real, but don't appear significant under most proposed plans.

4. It's something, but likely not much. Here I concede to ignorance about the NHS.

5. It's difficult to generalize. Drug R&D is an extremely expensive high risk endeavor. When a drug is finally secured for use in humans, defending the patent from arbitrage across markets when it's sold at significant discount becomes difficult. It's managed across developed countries with regulation and negotiation; but in poorer countries with a need for greater discounts, the risk of arbitrage is higher and the resources to contain it lower.

Govt. can tax away some of this loss while engaging in philanthropic endeavors, but it cannot fiat extinguish the burden it places on accounts without consequence.

[Dark Metal]

Why are you discussing Drug R&D? I don't know how it is anywhere else, but in Canada, medication is not covered under the government health plan, unless it's administered in Hospital. I fail to see how R&D for drugs is an issue when it's private companies spending their own money not the taxpayers.

[Massive Quasars]

Point 5 links to a piece on drug company profits, I was responding to that.

I'll add that I missed the last portion of the article on Stiglitz's plan.

Stiglitz's plan is simple. The governments of the Western world should establish a multi-billion dollar prize fund that will give payments to scientists who develop cures or vaccines for diseases. The highest prizes would go to cures for diseases that kill millions of people, like malaria. Once the pay-out is made, the rights to use the treatment will be in the public domain. Anybody, anywhere in the world, could manufacture the drug and use it to save lives.

Interesting proposal, I require more details though.

This takes us OT, but development efforts and preventative measures are potentially less costly interventions measured by lives saved, extended, bettered. If that is the metric we decide upon to determine success.

[Dark Metal]

That's fine, but Drug Care and Health Care aren't necessarily the same thing. Unless you're trying to devise a national plan that includes it, it's fairly irrelevant to discuss it.