Healthcare Reform Failure

[jsteele]

Anonymous wrote:Howard Dean's op-ed today in the WaPo calls for the health care reform plan currently in the Senate to fail. I mostly agree with his points, but need some help with one.

He complains that seniors pay 3x the insurance rates of younger, healthier individuals - why is that wrong? If I have a car accident and a DUI my car insurance will skyrocket - or be canceled while the driver in the car next to me with a spotless record pays a whole lot less. This makes sense, because it is a risk assessment. I can assure you that my mother uses far more than 3x the medical services in a year than I do - probably closer to 10x. I can see capping the spread - but capping it less than 3x seems foolish, and seriously penalizes the younger or healthier individuals whose rates go up to cover the "my mothers" of this world who, because of lifestyle choices and poor luck consume enormous amounts of health care resources.

Your difference with Dean is rooted in fundamentally different approaches to the provision of healthcare in our society. Dean believes that healthcare should be treated much in the way that education is treated in our society -- as something that not only benefits the individual recipient, but the society at large as well. Just as our society benefits from an educated population, it benefits from a healthy population. In a privatized education system, special needs students might be expected to pay more because of the extra requirements for educating them. In our public education system, special needs students pay the same as regular students (nothing). Our society is enlightened enough to understand the value of educating those children even though that shifts some resources away from regular students. People like Dean yearn for the day that society will be similarly enlightened regarding healthcare.

Dean's view runs into trouble when healthcare costs are treated as business opportunities and viewed purely from an actuarial perspective. Then, questions such as yours are provoked. There is probably not a solution that would satisfy both you and Dean. To my disappointment, Obama has apparently decided to cast his lot with you over Dean (and me for that matter). As a result, those of us holding views such as Dean will now be treated much like those who opposed the Iraq war (which I also did). Just a bunch of fringe lunatics.

[Anonymous]

Anonymous wrote:Howard Dean's op-ed today in the WaPo calls for the health care reform plan currently in the Senate to fail. I mostly agree with his points, but need some help with one.

He complains that seniors pay 3x the insurance rates of younger, healthier individuals - why is that wrong? If I have a car accident and a DUI my car insurance will skyrocket - or be canceled while the driver in the car next to me with a spotless record pays a whole lot less. This makes sense, because it is a risk assessment. I can assure you that my mother uses far more than 3x the medical services in a year than I do - probably closer to 10x. I can see capping the spread - but capping it less than 3x seems foolish, and seriously penalizes the younger or healthier individuals whose rates go up to cover the "my mothers" of this world who, because of lifestyle choices and poor luck consume enormous amounts of health care resources.

It is certainly a rational argument to say that a person's age is information that affects the calculation of risk. The question is how much knowledge you should use. The extreme answer would be to use ALL available knowledge, which you can do by discarding insurance and charging individuals for exactly the care they use. The point of insurance is to spread the risk, and the ultimate spread is to share it equally. Note that if you feel it is wrong to ignore information that affects risk, you ought to be checking, for example, how often the one has sex and with whom, or perhaps how often one goes to church. Should insurance companies be able to gather full lifestyle data on each of us?

At least ignoring age is fair in the sense that those who are penalized by their youth will eventually (with a bit of luck) graduate into the ranks of the aged, and benefit from the policy that is now stacked against them.

[Anonymous]

jsteele wrote:

Anonymous wrote:
The downside is most MDs, particularly in specialties (cardiac, ortho, etc.) consistently report that Medicare reimbursement for many procedures does not pay for their cost to provide them. So the idea of expanding the Medicare covered population for them is a non-starter. And while your heart may not bleed for the doctor, it is logical to expect that they will take steps to either limit the number of Medicare patients they accept in their practice, or not accept them at all. If the overhead for your medical practice (rent, utilities, staff, supplies, MD compensation) is $250 an hour and Medicare only reimburses at $200 an hour, you would be crazy to keep doing this (I pulled the numbers out of my a$$ for illustration only). In this sense, the doctors themselves would begin to ration care and who receives it. Guess what? Private insured patients would go to the head of the line! Fine for me, not so much for my grandmother. If it was my grandma at the town meeting, she too would say Keep the govt. out of my medicare!

Doctors report the exact same problem with private insurance. A few years back, I almost couldn't find a dentist that took my insurance. I finally went to one who did and quickly decided it was better to go to someone else and pay out of my pocket. I have no problem with increasing payment rates where it is justified. In addition, there is considerable medicare and medicaid fraud. I'd like to see a greater emphasis on combatting that. If the amount of fraud were reduced, perhaps payments could be increased and there would be a wash as far as overall costs were concerned.
[/quote

Jeff, I don't think that you understad how far off Medicare is WRT payments. Most doctors feel a need for a tripling of payments for us to approach comparable professional fees charged by other comparable professionals. So meidacre is not the answer.

Obama should have tried a small fix first, to give the public time to think about it.

I wish that he had just simply proposed guaranteed federal insurance for children under 18 (from conception) whose parents qualify based on income. That would have made everyone happy. The prolifers would see him as protecting the well being of the unborn, we would look more civilized, and most of all, it would be relatively cheap because children are usually healthy. That should have been the start, he could have even stopped there.

[Anonymous]

jsteele wrote:

Dean's view runs into trouble when healthcare costs are treated as business opportunities and viewed purely from an actuarial perspective. Then, questions such as yours are provoked. There is probably not a solution that would satisfy both you and Dean. To my disappointment, Obama has apparently decided to cast his lot with you over Dean (and me for that matter). As a result, those of us holding views such as Dean will now be treated much like those who opposed the Iraq war (which I also did). Just a bunch of fringe lunatics.

Insurance companies are businesses. What you describe, if I understand you correctly, is that healthcare should be a state responsibility to provide to its citizens (or more loosely residents as the case is here). Following that , then off course we should be taxed to provide healthcare for all.

I think that is the fundamental difference in approaches. You and Dean vs. those of us who think society should help the less able among us, but don't see a fundamental responsibility of the government to do the providing. These are not fringe loonies - just differences of opinion.

I would like to see a more level and fair playing field legislated for the insurance industry, which involves some give on their part (portability, no denial of coverage, reasonable upper $$ limits) and some on the part of STATE governments, allowing purchase of insurance that meets a federal minimum standard (basic coverage) across state lines. Right now each state has its own particular list of "must haves" in health insurance policies that is becomes absurd. I think the issue of ins. co. overhead would be improved with the simplification too.

[jsteele]

Anonymous wrote:
Insurance companies are businesses. What you describe, if I understand you correctly, is that healthcare should be a state responsibility to provide to its citizens (or more loosely residents as the case is here). Following that , then off course we should be taxed to provide healthcare for all.

I would probably explain my position with more nuance, but that's close enough. I'd probably also settle for health insurance being provided by non-profit corporations rather than the government. I don't think there is any escaping the fact that for-profit insurance companies will always have a profit motive to provide as little coverage as possible. In addition, stock holders and executives will seek to divert as much money as possible from the provision of care to corporate profits. This puts the customer at a constant disadvantage. One could argue that a long term view might incentivize insurance companies to provide higher levels of service in order to retain customers, but I've never seen the companies act that way (nor or they incentivized to do so given that short term cost is normally the deciding factor for customers).

To make an analogy outside of the insurance field, if I discovered the cure for a currently incurable disease, how would I price the medicine? According to Econ 101, I would produce the most units possible until the marginal profit started to go down. If that meant that some people would not get the cure because they lacked the needed funds, that's their bad luck. My goal should be to maximize profit, not save lives. This is exactly how insurance companies act. They put profit before life. That's the equation that I would like to see changed.

I appreciate that you don't consider me a fringe lunatic. Unfortunately, such forbearance does not extend to David Axelrod who has already described my ilk as insane.

[Anonymous]

Now Ben Nelson is aboard. It looks as though a little bribe to Nebraska was enough, rather than further weakening of Roe v Wade. Am I right about that?

Now MoveOn is urging support for Bernie Sanders to pull a Lieberman/Nelson and block the bill unless it is strengthened. I assume that would amount to killing it, since it seems impossible to please Sanders and Lieberman. I lean toward the position that the provisions on lifetime limits and pre-existing conditions, along with the principal that everyone ought to be insured, are enough to make me support the bill. Where do others stand at this point, and why?

[Anonymous]

Anonymous wrote:Now Ben Nelson is aboard. It looks as though a little bribe to Nebraska was enough, rather than further weakening of Roe v Wade. Am I right about that?

Now MoveOn is urging support for Bernie Sanders to pull a Lieberman/Nelson and block the bill unless it is strengthened. I assume that would amount to killing it, since it seems impossible to please Sanders and Lieberman. I lean toward the position that the provisions on lifetime limits and pre-existing conditions, along with the principal that everyone ought to be insured, are enough to make me support the bill. Where do others stand at this point, and why?

I haven't been following this as closely as I should (having no vote in Congress tends to make me feel like it's hopeless to pay attention sometimes) but this is something I've been wondering about. Once the public option is gone and with Dean saying to vote against it, I've been wondering whether this bill is really worth the money we would be spending. These are good things indeed. Will we get enough good things to make it worth passing this?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Now Ben Nelson is aboard. It looks as though a little bribe to Nebraska was enough, rather than further weakening of Roe v Wade. Am I right about that?

Now MoveOn is urging support for Bernie Sanders to pull a Lieberman/Nelson and block the bill unless it is strengthened. I assume that would amount to killing it, since it seems impossible to please Sanders and Lieberman. I lean toward the position that the provisions on lifetime limits and pre-existing conditions, along with the principal that everyone ought to be insured, are enough to make me support the bill. Where do others stand at this point, and why?

I haven't been following this as closely as I should (having no vote in Congress tends to make me feel like it's hopeless to pay attention sometimes) but this is something I've been wondering about. Once the public option is gone and with Dean saying to vote against it, I've been wondering whether this bill is really worth the money we would be spending. These are good things indeed. Will we get enough good things to make it worth passing this?

I have to agree. It is a mess. They need to start over. I still say, start small and insure children first, then see how that works, and then expand it.

[Anonymous]

According to a Politico article (http://www.politico.com/news/stories/1209/30816.html), the head of Nebraska's pro-life group says she told Senator Nelson (concerning the compromise that got him to okay the health care bill):

“If this is so good for pro-life, why would Sen. Boxer and Sen. Schumer agree to this?” Schmit-Albin said she asked Nelson. “I am personally devastated.”

I don't know whether she worked out the logic of her position, but if she is opposed to anything that Boxer and Schumer accept, she is saying that she does not want a health care bill. In other words, she supports the Republican position. Why didn't she just say so?

[Anonymous]

HC is not dead, but the way they make the sausage in the Senate is appalling - see http://www.nytimes.com/2009/12/21/health/policy/21healthcare.html?pagewanted=1&_r=1&ref=todayspaper

Literally, the majority leader was handing out taxpayer money to Senators' pet projects in return for votes.

If the HC bill is so wonderful, one wonders why they would have to buy votes to pass it?

[Anonymous]

jsteele wrote:

I appreciate that you don't consider me a fringe lunatic. Unfortunately, such forbearance does not extend to David Axelrod who has already described my ilk as insane.

David Axelrod is an ass - criticism from him is the highest form of flattery. Congratulations.