Is Healthcare Reform Preparing for Collapse?

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Tim_P's picture
Tim_P
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Is Healthcare Reform Preparing for Collapse?

While doing a little thinking the other day, I started to wonder if the issue of healthcare reform is aimed at putting something in place for the collapse of the economy.  The way healthcare reform is being approached is absurd given a functioning economy and could very well be the tipping point into collapse.  But, if you knew that the economy was about to collapse, could socialized health care be an attempt to put something in place to prevent a collapse of the healthcare system along side the collapse of the economy.

I am not a fan of the current healthcare reform project in any way shape or form and see it as an abomination.  The current plan simply does not make sense and most arguments for it are dubious at best.  The only way it makes sense is from the perspective that the government knows that total collapse is imminent and this change will create a system that will keep some level of healthcare available until the economy is re-invented.

Sound plausible?  I know it gives the government credit for having more intelligence than they've displayed in decades, but could this be the underlying reason?

Tim

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Re: Is Healthcare Reform Preparing for Collapse?
Tim_P wrote:

Sound plausible?  I know it gives the government credit for having more intelligence than they've displayed in decades, but could this be the underlying reason?

Tim -

Highly unlikely that the gov has finally gotten smart.  Why spend the effort to engineer the simultaneous continuity of health care and the failure of the economy?  It's like washing and waxing a car with no wheels or an engine.

Most of our elected officials couldn't pour water out of a boot if the instructions were written on the sole.

Shame on us for putting (and keeping) them in office.

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Re: Is Healthcare Reform Preparing for Collapse?

The idea that the proposed health care plan is in part connected to an expectation of collapse has crossed my mind several times in the last month or so. It seems clear that the "Government" as a whole is unlikely to have the savvy to think through such a scenario, however I think it is possible that a minority in the right positions are thinking along these lines.. Even though I don't always agree with many of them, some are very intelligent -- it seems hard for me not to believe that collapse thoughts play a part in their thinking. At least I'd like to think/hope that is the case.

Orlov, in his writings on the Soviet collapse makes a big point of the government services including health. food and transportation as being  the elements of the Russian system that proved  invaluable when everything was failing.

So, whether planned  as part of a collapse strategy or not, universal health care is likely to be an invaluable asset in our future. Similarly, the current insane bailout strategy may work out to be the golden opportunity for many of us to be better prepared for the worst by giving us time to prepare -- I am surprised by how long it takes (me at any rate) to change the way I think about and do things. Seldom a day goes by that my wife and I don't re-examine some element of our daily life to find more changes we hadn't previously considered.

Jim

 

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Re: Is Healthcare Reform Preparing for Collapse?

I cannot believe that the healthcare bill is the government preparing for collapse.  Our healthcare system is messed up because government got involved in the first place.  Check this article out:

 

http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universa...

 

Well researched and documented ( some 69 references ).  Let me know what you think of this article.

 

Lucas

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Re: Is Healthcare Reform Preparing for Collapse?

Coolhand

Good article in some ways - I agree that our health care is a mess and that our health care should not be tied to our employment (reminds me of the song by Tennessee Ernie Ford "I owe my soul to the company store"), but that is close to the end of my agreement with the article.  The idea that the government is the cause of the unworkable system we have doesn't stack up in my book. Certainly there is enough blame to go around for everyone, but all one has to do is to look at the practices of the insurance companies to see that they are a  serious part of the problem. The lobbying efforts at all levels of government by the insurance and the drug companies have a great deal to do with how we got to where we are. They appear to be ready to go to almost any length to get rid of  people in poor health and enlist young, strong people in good health. Develop a heart condition and lose your job, run out COBRA (if you can afford it) and you will never have health insurance again in your lifetime even if you have indirectly paid into the insurance system for 30 years with no claims otherwise.

Many of the comments to do with the Canadian system are one sided and biased. The comments about breast cancer survival rates in Canada are not as good as the US fail to include that Cuba is better that the US and that the 3 best countries in the world for survival are Cuba, USA and Canada in that order  see http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080716/cancer_statistics_080716/20080716/  Additionally, the African American survival rate is less than the Canadian survival rate when taken separately - presumably because they have less access to health care.  Also left out of the commentary is the fact that Canadians have a longer life expectancy than Americans by about 3 years and have a much better infant mortality rate than the US.

I am a recipient of Medicare and have never had the slightest problem seeing a GP doctor or specialist in a timely manner by simply calling and asking for an appointment with the doctor of my choosing. While I agree the system as it stands may need some restrictions   that currently are not there to make it more affordable to the country, it works better than anything else in the marketplace.

The article tries to pin the problems of ER expense and waits on Medicare patients - I don't know the statistics, but any time I've been around an ER, the majority of people in the waiting rooms are not on Medicare -

The article suggests that somehow we can rely on charitable organizations to pick up the slack in health care is way over the top -- why aren't they doing that now?

I think the bottom line is that  only a universal care system that is all inclusive can possibly work in the longer term because it is the only way to equitably spread the cost. It won't work with insurance companies picking the healthy and leaving the rest to the scap heap. Yes some method of rationing needs to be included or we can't afford it - but we are already spending more than any other country in the world on a per capita basis and on average have a system that is outshone by most industrialized countries. In the aggregate, our health care costs need not be higher to allow everyone excellent care -- we just need to get smart enough to sort out the details of how to do it. The health care professionals are certainly there as are the facilities, so we only need to get out of our own way and get the job done. I'd like to puke when I hear the comments by some congressmen that Health care is the issue we can break Obama on. That is not what I want from any politician I might support -- this is too big a problem to play politics with.

I am a great believer in the Fellowship of the Rope -- which refers to mountain climbers tied together on a rope, each being responsible for the others in the sense of keeping them strong and helping them to make the right moves because in the end one fall by anyone endangers (and maybe kills) everyone.

Jim

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Re: Is Healthcare Reform Preparing for Collapse?
Dogs_In_A_Pile wrote:

Most of our elected officials couldn't pour water out of a boot if the instructions were written on the sole.

Now *THAT* is funny. 

I think (especially given O'Bama's abandonment of a "Public Plan" element yesterday [Mon]) that it's mostly window dressing and will be used to bash about in the '10 and '12 elections.  ("Those dang Dumbocrats tried to spend your hard-earned dollars on healthcare for welfare queens!" and "Those dang Repubs voted to deny YOU healthcare!") 

I really think whatever gets "agreed" upon is going nowhere new, no way fast.

Viva -- Sager

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Re: Is Healthcare Reform Preparing for Collapse?

Well said Jim!

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Re: Is Healthcare Reform Preparing for Collapse?

No, I do not believe that our government possesses anything close to the insight necessary to attempt to ensure the survival of its citizens through universal healthcare, while otherwise fiddling as the republic itself burns.

In answer to Jim's comments regarding universal healthcare, can you reasonably expect that our government can truly reign in costs, establish equitable rationing of care, and administer such a plan in a financially solvent manner? As I have argued elsewhere on this site, I think I a much better answer is the elimination of traditional (in the past 70 years, or so) health insurance, in favor of catastrophic medical insurance in combination with health savings accounts (HSA). Catastrophic medical insurance, used for instances of unexpected and/or severe illnesses and injuries (cancer, heart attack, trauma), would restore the traditional role of insurance, akin to why we may purchase auto or home insurance. HSAs, essentially an IRA for medical needs, would be used to fund routine medical care, such as physician visits, medications, diagnostics, basic procedures, etc. In combination, I believe this approach would prompt individuals to be more cognizant of their medical expenditures, promote healthier lifestyle decisions, result in savings from competition between healthcare providers, hospitals, pharmaceutical companies, insurance companies, etc.

Finally, the comparison of healthcare between different countries is fraught with difficulties. Many countries report results using different criteria. Infant mortality, for example, may be vastly underreported in some countries, as premature infants who do not survive may not be counted as an death in infancy, as they are in the U.S. Perhaps more importantly, however, is the lack of risk-stratified data. For example, in cardiac surgical databases, we commonly report not only our results regarding mortality and morbidity, but also relevant patient factors that may influence those results. If Hospital A has a coronary artery bypass grafting (CABG) mortality of 3%, while Hospital B has a CABG mortality of 1%, this does not necessarily mean that Hospital B is better than Hospital A, as there may be relevant patient factors (advanced age, decreased heart function, other medical problems) that may account for the difference; and may, in fact, offer evidence that Hospital A has better results than Hospital B. The same argument can be made between countries, but has not been examined, to my knowledge. For example if the U.S. has a lower life expectancy than some other country, but has a higher incidence of obesity, diabetes, etc. (very true, in many instances), the difference in life expectancy may not reflect an inferiority of medical care in the U.S., but underlying differences in the general state of the health of the populations in the different countries. Again, to my knowledge, such an analysis has not been performed.

So, while I could agree that in some ways the health of the U.S. populace is worse than in some other countries, the difference may not be due to our medical care, but the lack of personal responsibility among our populace for their own health. Would a government run healthcare program enhance personal responsibility and improve our overall health, or do the opposite?

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Re: Is Healthcare Reform Preparing for Collapse?

ccpetersmd

Hard to imagine that the Government ( as inept as it may be) could do worse than the system currently in place. The Government does to an excellent job on Medicare from the point of view of the patient

My concern with the idea of catastrophic insurance coupled with health savings accounts is that there is no place in that system for the chronically ill, the young and the old -- and others that fall between the cracks -- what happens to them ? We are then all still at the mercy and whim of the insurance industry that may or may not want to cover an autistic child, someone with a congenital heart defect etc.

Try getting sick, lose a job and medical coverage and then try to get re-insured. You can't if there are any lasting impairments from the illness -- so now what ?

It all comes back to the only real answer being some form of universal care that is paid by all. Great if incentives can be built in to encourage healthy life styles and only use the medical services really needed. I can't believe that we can or should tolerate a tiered system that metes out care based on station in life, birth happenstance and skin color.

Jim

 

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Re: Is Healthcare Reform Preparing for Collapse?

Jim,

I dont know  you, and you dont know me.  So I hope nothing I say is taken the wrong way.  I am more than capable of agreeing to disagree. 

While I am glad that you read the article, I dont appreciate the way you cherry picked very small portions of it to discredit it. It appears that you did not read it in its entirety ( I may be wrong ).  I say this because you misrepresented the main point(s) of the article.  The article is rather lengthy and points out many problems with our current system.  You said:

The article tries to pin the problems of ER expense and waits on Medicare patients - I don't know the statistics, but any time I've been around an ER, the majority of people in the waiting rooms are not on Medicare.

 

Actually the article blames the problems on many things, here are just a few:

  1. Government giving preferential treatment and economic advantages to one insurer (and its health plans) over others
  2. Government making employer provided health insurance non-taxable.  Causing individuals with employer-purchased policies have little or no say about the policy under which they will be insured, and anchoring many employees to their job from fear of losing the benefits they do have, and typically overpay for.
  3. Federal and state Govts mandating what services will be provided
  4. Lack of choice with regards to insurance companies
  5. Lack of choice with regards to insurance policies
  6. Violations of the rights of businessmen, doctors, and patients to act on their own judgment
  7. Medicare determines what procedures and treatments are “appropriate” and “medically necessary.”
  8. Medicare determines the monetary “value” of a diagnosis, treatment, or procedure.
  9. Doctors are paid so poorly by Medicare and burdened by so much paperwork that about 28 percent are turning away some or all new Medicare patients. ~ http://www.hschange.org/CONTENT/811/#ib2. ( Private insurance isnt much better )
  10. Only about 52 percent of doctors accept new Medicaid patients ~ http://www.hschange.org/CONTENT/866/?topic=topic02#ib1
  11. Eligibility for these programs continues to expand, and, in some states, families with incomes as high as $55,000 are now eligible for Medicaid benefits.
  12. Federal, state, and local governments now pay 50 percent of every dollar spent on health care, even though government health insurance covers only 27 percent of the population.

You also said: 

The article suggests that somehow we can rely on charitable organizations to pick up the slack in health care is way over the top -- why aren't they doing that now?

 

It did not so that you can rely on charitable organizations, however it does say "Those unable to afford any particular medical services would have to rely on voluntary charity, not on the empty promises of government."  There is a big difference between "can rely" and "have to rely."  Its stating it more as a fact of reality that you "have to rely" on charity, because the government cannot give limited services and goods to all.  Just like government cannot mandate that we all have a house on beach front property.

The article does say:

"As to the question of how those who cannot afford medical care will receive it, we must bear in mind that government is not taking care of them now and is logically incapable of ever doing so, for the simple reason that government does not and cannot produce goods or services. Insofar as people who cannot afford medical care are receiving it, the care is being provided by productive American citizens, doctors, and hospitals. And we must bear in mind that, in the words of Philosopher Leonard Peikoff, Americans who cannot afford medical care “are necessarily a small minority in a free or even semi-free country. If they were the majority, the country would be an utter bankrupt and could not even think of a national medical program."

One of the main points of this article is that we dont live in a free or capitalistic system at all.  It is a heavily government mandated system already, and increasing the amount of government control will only exacerbate the problem.  If the government were capable of providing a sustainable insurance policy for all, then we wouldnt have a 40+ Trillion dollar unfunded Medicare, Medicaid liability.  Imagine the total unfunded liability of healthcare if the government takes complete control.

The biggest problem I personally have with the entire healthcare reform debate, is that no one seems to ask "What is the constitutionality of government run health insurance?"  People who are for it want to steal from those who are not.  Those of us who do not want it, will have to pick up the tab for others expenses.  We will have more rights and freedom of choice taken from us.  As patients we will be told what coverage we can have, and when.  As doctors we will be told what services we can provide, to whom, and when.  This is an outright infringement of our rights as Americans protected by the Constitution.  There is no Liberty anywhere in a government run solution.

 

Lucas

 

 

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Re: Is Healthcare Reform Preparing for Collapse?
jpitre wrote:

ccpetersmd

Hard to imagine that the Government ( as inept as it may be) could do worse than the system currently in place.

Jim

 

It is not hard for me to imagine how the government could do a worse job. They usually do manage to screw up what ever they get involved in. Medicare is not a stand-alone system; it is an add-on to the private system. In addition, does anyone belief that Medicare is not going to require enormous amounts of more money to continue in existence? No doubt in my mind.

 

Ken

 

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Re: Is Healthcare Reform Preparing for Collapse?

Lucas

Point taken about the cherry pick - yes I did because I chose a few points to illustrate the weakness in the articel and I didn't want to go into the level of detail required to refute each point.

I think you have done a good job of laying out your position, and while I understand your concerns, I think we will just have to agree to disagree about the solution. Perhaps there is no perfect solution.

Our perspectives are tend to be shaped by life experience. In my case, I spend time in Canada where I see a far more satisfied public as far as health care than in the US -  I've had knee/cartilage surgery done in Sweden where the cost was 20% of the cost in the US for a procedure that was not "approved" here by the insurance companies in a private clinic that was more professional and better run than and surgi-center I been around in the US.  Back in the '80s I was insured directly by Blue Cross for over 10 years, went to work for a company and was on their plan for a year and a half - when I came back to Blue Cross after the hiatus, it was a great hassle to even get any coverage because they decided that I had developed an allergy while away - they finally did agree to cover me, however excluded any coverage for allergies. If the allergy problem had been a more serious issue like heart disease or cancer, I would not have been able to obtain coverage at all. As the years went by, my premiums crept up to over $800 per month to cover just me even though I changed the deductible to $5,000. If it were not for Medicare, I would not be covered at all right now. Imagine a retired couple having to pay $2,000 per month for coverage plus medications if needed  -  cuts out most of the population from any coverage.

Tell me more about how the free market will look after sick people  -- it would and does bankrupt and dump the old, sick and infirm on the street to fend for themselves

On a positive note, we did re-affirm that the system is broken and badly needs repair or replacement, so let's hope that as the dialog continues a better answer will emerge.

Jim

PS - Speaking of inept Governments - drop a few un-needed wars and along with cutting military spending and we'd have enogh to pay for our medical needs

J.

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Re: Is Healthcare Reform Preparing for Collapse?

My take on Obama's proposed health care reform is more cynical than most here.  I think it gives the government control of your health.  They decide (through bureaucrats) what care you will get and they decide when. 

Our health benefits are already too high; if they add the 40 million or so uninsured people, the costs to maintain similar quality will also go up.  The program is flexible from their point of view as it is loaded with gate keepers that will ration the care to comply with a budget.  If there isn't enough money, they can simply throttle back on the amount of care given.

It is bad enough that we allow the government to pass debt to unborn citizens (taxation without representation) but now, we will be enabling them to ration care for our elderly and those with chronic disorders - this will reduce the quality and quantity of their lives.

I think it is important to remember that we (U.S.) have excellent health care.  Our doctors, health professionals and hospitals are second to none.  We don't wait for procedures or care and we, along with our doctors, ultimately decide what treatments are needed.

We have two problems that need addressed.  First, the care is expensive.  There are many great suggestions for increasing efficiency and reducing parasitic loads through out the system.  

Second, many of our ERs are over-flowing with patients.  The problem is greater in areas that have concentrations of illegal aliens.  This can be fixed by making it very difficult and expensive to hire illegals.  That's why they are here - to make money (who can blame them for taking advantage).

The answer is always less, not more government.  I want them out of my wallet, out of my private health issues and out of the way in general.

Larry   

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Re: Is Healthcare Reform Preparing for Collapse?

Larry you are 100% correct.

This is another example of an entitlement program a certain political party affiliation has thrived on for decades.  Promise those willing to let others do the work for them the world and they will put and keep you in office.

This has been the historical tipping point into anarchy that has characterized every democratic republic in history.  At some point, usually when it is too late, the parasites in our community will realize that the people they have put into office can't deliver on their promises.  So they protest, they join ACORN, they become "Community Organizers", they advocate civil disobedience in the name of equality and activism and "spreading the wealth" and ultimately they get elected President.

And so goes our Republic.

If you don't want it to go down that path, then vote the boneheads out.  It's time WE took control of OUR government back.

Instead of spreading the wealth, we should spread the work ethic.

(I just noticed this is my X Files post)

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Re: Is Healthcare Reform Preparing for Collapse?

Jim,

A few additional points I would like to share:

Medicare, whether perceived as providing good care or not, is simply unsustainable. It survives now only from lack of political will to greatly pare down covered services, or abolish it entirely. If a government program that covers only those 65 years of age or older is financially insolvent, how can we expect that a similar program extended to the rest of the populace will fare any better?

Government interventions in healthcare, through Medicare, Medicaid, business regulations prompting employer-provided health insurance, etc., are largely responsible for our current problems. Before our government got involved, medical care was largely fee-for-service, with only a fairly small involvement by insurance companies. This undoubtedly led to some inequity of care, with the wealthy able to pay for better care, but charity also played a much larger role than it does today. Government-sponsored social interventions, to include Social Security, Medicare/Medicaid, Welfare, etc., have done much to decimate charitable organizations and community-run programs, while arguably providing less effective services at much greater cost (mostly in the form of unnecessary bureaucracy). I simply cannot see how more government involvement will improve the situation.

I would favor community-based healthcare organizations, such as a healthcare cooperative, as I have mentioned previously on this site. Such a model would include regular (but fairly small) payments to a community-run program, that would guarantee reasonable reimbursement for primary care physicians, and provide a standard level of routine care to participating citizens. Such routine care might include wellness counseling, physician visits, basic testing (screening exams, for example), and possibly access to a generic pharmacy. For those in the community that could not fully participate financially in the program, the community cooperative could decide to subsidize some or all aspects of care.

Basically, I strongly favor less centralization of these important healthcare decisions, minimizing governmental involvement, decreasing the impact of the insurance and pharmaceutical industries, and empowering individuals, communities, and their healthcare providers to develop local, creative solutions.

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Re: Is Healthcare Reform Preparing for Collapse?

Also, a community-based healthcare cooperative could be developed that would be even more comprehensive, to include a group rate for catastrophic medical insurance, and/or a community-wide (but voluntary) HSA program. I suspect such a program would make communities remarkably more attractive to newcomers, and promote the growth of local businesses and industries.

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Re: Is Healthcare Reform Preparing for Collapse?

 Chris

You have thought out your ideas about health care well and in many ways I agree with what you say. My problem lies in the areas where people fall between the cracks.  Dogs in a Pile says there are too many parasites that need find the error of their ways the hard way. For instance, most civilized societies believe in supporting the "parasitical" older people who are no longer able to actively participate in productive labor, so how do we look after them?

Sometimes I think younger people have a greater sense of invincibility and have less sense of their own frailty than those of us who have had a few more hard knocks. Try on for size the idea that any one of us could be without care, homeless and no support given the right circumstances. Being sick, cold and hungry laying under a tree somewhere would make most  a believer in universal health care in an instant.

As you say, most things work better on a smaller scale such as a community based program, however those kind of programs may have similar problems to the HMO model -- what happens if you move away or get sick somewhere else?

I am still of the opinion that the medical cost burden has to be equitably spread over the entire population. Exactly how may not make much difference, however we are sort of doing that now however we not spreading anything equitably and leaving way too much to whim of some insurance or government bureaucrat administering some backwards, convoluted legislation. 

JIm

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Re: Is Healthcare Reform Preparing for Collapse?

 Chris

 

A couple of links I found interesting - an interview by Bill Moyers with Wendell Potter

 

Jim

 

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Re: Is Healthcare Reform Preparing for Collapse?

Interesting videos, Jim, thanks! I don't agree with the conclusion, but still appreciated some of the observations.

I cannot comment regarding all countries that have government-sponsored healthcare, but many countries, including most in South America, end up with a two-tiered system. There exists the public system, with public hospitals, salaried healthcare workers, and typically less than stellar care. In parallel, there exists a private system, with private hospitals, pay-for-service physicians, and generally excellent care. I fear that would be the outcome in the U.S., if we proceed down the path of furthering government-sponsored healthcare.

The best answer I see for care of the poor in the U.S. is charity, as it has been throughout most of our history. Most healthcare providers (doctors, nurses, etc.) are very willing to extend their services without expectation of compensation. Historically, that has been true of communities and fraternal societies, too. The birth of our entitlement-state (Welfare, Medicare, etc.) has done great damage to charitable societies and individuals in the U.S. Furthermore, with less taxation upon those who actually generate jobs in the U.S., we would see less unemployment, and fewer uninsured citizens requesting a government-sponsored program.

Again, I would like to see us move away from the fairly recent trend of comprehensive healthcare insurance, in favor of "true" medical insurance, HSAs, and possibly community-based healthcare cooperatives. I am certainly not arguing in favor of the status quo.

I also think that we may begin to see less mobility of U.S. citizens, and community-based healthcare cooperatives might prove to be a remarkable inducement not to migrate to the next job available.

In any case, I do not pretend to know all the problems, let alone all the answers. As knowledgeable as I thought I was regarding healthcare concerns, the more I have investigated the problem, the more I have learned how much I still need to learn. This is indeed a pressing and complex problem, and I'm still working my way through it. Accordingly, I reserve the right to change my opinions as my knowledge base expands. Still, I am fairly well convinced that more government involvement is not the answer, and would only worsen the problems we currently face.

Thank you for your cordial discussion, by the way! It is nice to know that we can disagree, and still be civilized.

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Re: Is Healthcare Reform Preparing for Collapse?

 Chris

As you say "I reserve the right to change my opinions as my knowledge base expands" to which I agree wholeheartedly !

 

One more video - a bit long but does give a good view from the universal health care point of view and I found it worth the time

Jim

 

 

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Re: Is Healthcare Reform Preparing for Collapse?

Here's a good opinion piece from Investor's Business Daily:

http://www.investors.com/NewsAndAnalysis/Article.aspx?id=482299


Let Customers Control The Money And Market Will Cure Health Care

As it turns out, "universal coverage" may not be so inevitable after all. Much to the chagrin (and apparent surprise) of President Obama and congressional Democrats, squabbling has erupted in earnest over who will spring for the exorbitant cost.

Fortunately, Obama has an exit strategy: "If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way."

Well, there is a way: Let individuals control their health care dollars, and free them to choose from a wide variety of health plans and providers. If Congress takes those steps, innovation and market competition will make health care better, more affordable and more secure.

Experts suggest that one-third of U.S. health care spending, or about 6% of GDP, is pure waste. The reason is simple: Government controls half of our nation's health care dollars, and lets employers control an additional quarter. And nobody spends other people's money as carefully as they spend their own.

Office of Management and Budget director Peter Orszag told Congress last year: "Imagine what the world would be like if workers (understood) that today it was costing them $10,000 a year in take-home-pay for their employer-sponsored insurance, and that could be $7,000 and they could have $3,000 more in their pockets today if we could relieve these inefficiencies out of the health system." Nothing will increase consumers' understanding like giving them that $10,000 directly.

Letting consumers control the money requires two steps.

First, Congress should give Medicare enrollees a voucher, let them choose any health plan on the market, and let them keep the savings if they choose an economical plan. Medicare could even give larger vouchers to the poor and sick to ensure they could afford coverage.

Second, Congress needs to give consumers who purchase their own coverage the same tax break as workers with job-based coverage.

Leveling the playing field — whether with tax credits, a standard deduction for health insurance or "large" health savings accounts — would boost purchases of non-job-based coverage, which is critical to cutting the overall number of uninsured.

As important, it would give workers control over the entire $10,000 Orszag mentioned, for a total effective tax cut of $532 billion each year. Consumers would eliminate wasteful spending quickly, because they would keep the $3,000 in savings.

We should also eliminate harmful regulation. State health insurance regulations prevent people from purchasing health plans available in other states, and increase premiums by 15%. Similar regulations block competition from more efficient health plans and providers by preventing doctors from taking their licenses from state to state.

Americans deserve the freedom to purchase coverage across state lines. One study estimated that that move alone could cover 17 million uninsured Americans without costing taxpayers a dime. Compare that with Sen. Ted Kennedy's reform bill, which spends $1 trillion and covers just 16 million uninsured.

Giving clinicians the freedom to practice medicine across state lines would eliminate barriers for retail clinics and economical health plans like Kaiser Permanente, which leads the market in electronic medical records and coordinated care. If we did that, Congress wouldn't need to throw $30 billion at ineffective pilot programs that try to coordinate care.

Critics fear that market-based reforms would leave sick workers unable to obtain coverage. Yet that is already happening as employers drop coverage or eliminate jobs. In reality, these reforms would relieve, if not erase, that problem.

Leveling the playing field will force employers to give sicker workers more than the average $9,000 or $10,000 "cash-out," which will help them purchase coverage. When workers buy coverage directly from an insurer, far fewer will end up uninsured when they lose a job.

Finally, large HSAs would provide a tax relief even to those who are too sick to obtain coverage at all.

Perfection is not possible, of course. Former Senate Majority Leader and would-be Obama adviser Tom Daschle acknowledges, "Even if we achieve 'universal' coverage, there will be some percentage of people who still fall through the cracks."

The same is true of a free market. The advantage of markets is that innovation and competition fill in those cracks. A government-run, "universal" system makes them wider.

Tim_P's picture
Tim_P
Status: Gold Member (Offline)
Joined: Feb 23 2009
Posts: 298
Re: Is Healthcare Reform Preparing for Collapse?

While my original intent was not to start a healthcare debate, it is good to see a great discussion come about.  My opinion is that the system is not broke, but it does have some areas that need fixed.  To be honest, I think a decent percentage of those that are uninsured are uninsured through choice.  I've seen it in my own family.  The cost of individual coverage is pretty high and even though it's affordable, it is painful and one member of my family decided to take their chances.  This same segment of the family owns several new vehicles and a $8000 touring bicycle.  I wonder how many other uninsured families choose to have a higher level of discretionary spending over having medical coverage.  Catastrophic coverage is reasonable affordable.  There is a huge amount of choice available now and personally, I like having the ability to choose to have anything from an HSA plan to a high deductible catastrophic plan to a gold plated traditional plan.  Just like I can choose to drive a BMW or a Hundyai.  

Before teh entire system is tossed, there are things that should be tried.  The problem of a person that has insurance for years, who gets sick and can no longer work and then cannot continue insurance coverage needs to be fixed.  How about trying something like offering insurance for their insurance.  In other words, pay a small sum each month to reduce risk by insuring your health care insurance.  Get sick, can't work, this coverage kicks in and continues your premiums until you can work again.  How about government clinics to handle basic health care for those that cannot afford insurance.  These may not be great ideas, but I'm sure great ideas exist that do not throw away the quality of health care in the US for a socialistically managed government plan.  The government already manages senior medical benefits and that program is rife with corruption.  The government does not want to invest in fraud and abuse recovery exercises, which makes the over 65 system a ripe target for corruption.

There sure are things that need fixed, but I don't think it's time to pull the plug on a system that works pretty well right now.

Tim

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