General Question

marinelife's avatar

Are Americans ready this time around for some health care reform?

Asked by marinelife (57939 points ) September 2nd, 2008

It seems to me the holes in our employer-based system are getting bigger and bigger. Have people had enough?

Last time the Clinton Administration tried to introduce reform huge advertising campaigns by insurance companies who stood to lose billions stopped their efforts cold. Are we any wiser now?

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26 Answers

allengreen's avatar

I have had enough, and am ready for reform. Sadly, I do not believe the masses are wiser. Some 527 will run scary adds through fly over country and all the rednecks will be voting McCain. The elections of 2000–2004 proved that folks do not vote for their own interests. So unless the health care plan includes hand guns and an abstinence pledge—foghet about it!
The insurance industry will not just roll over and let this happen, and if we do not, go into their homes and sodomize the CEO’s on their granite counter tops, it will not happen.
Short of a French Revolution kind of change, we will continue to be wagged around by the insurance industry.

Poser's avatar

So everyone (except those who vote Democrat) is too stupid to know anything about “their own interests,” right? If I don’t vote for someone who will set up a plan that is going to tax the shit out of me, I’m just too stupid for my own good, right? I guess I just need some politician to safeguard my money and decide what it ought to be spent on. Today it’s someone else’s health coverage. Tomorrow, who knows?

allengreen's avatar

I would say that you are underinformed with regard to proposed tax policy, and true it is the role of government to ensure health care. Ever been to Europe, Asia, or S. America? Their health care systems make ours look third world. And Poser, I’d like a job where you work, since you are making 226k yrly, and are going to get taxed the shit out of to use your words. I did not imply Repubs are stupid, only that they vote against their own interests.

Poser's avatar

Alright then, inform me. How does the government propose to pay for health care for every American, without using revenue from taxes? I guess they could just print more money, right? But then what about inflation? Oh shucks! I guess the only solution is to tax those who make over 226k yearly, then. Oh well, they’re rich, they don’t deserve to keep their money anyway. I mean, from each according to his ability, to each according to his need, right? Isn’t that what it says in the Constitution?

Speaking of which, where does it mention health care in the Constitution? Funny, I don’t remember ever reading about where it’s the government’s job to ensure health care. Which page is that on, because I can’t seem to find it in my copy?

allengreen's avatar

OK Poser, McCain will win, you will have your way. And your peeps have done such a great job over the last 7 yrs, Right?

scamp's avatar

Nothing will change where health care is concerned. If you think it will, BOHICA. I bought that lie once. they won’t fool me again.

JackAdams's avatar

I think we are ready for it, but we’ll never get it, as long as the insurance industry continues to rape the pocketbooks of everyone they can.

September 2, 2008, 8:58 PM EDT

Poser's avatar

@allen—Actually, I’m not voting for McCain. Neither will I be voting for Obama. Either way, I don’t see much of anything changing. For the better, that is.

robmandu's avatar

Third world?!?! Oh, compared to this… indeed.

@allen, I know several Canadians. And I know where many prefer to get their healthcare (south of the border). Stories abound of having to wait months just to see a doctor for a non-life-threatening illess (like bad knees), plus even more wait to actually get the surgery.

That said, the mess that privatized healthcare is in in the U.S. is precisely due to past government meddling. There’s no incentive to minimize costs for services being paid by government. Plus, oftentimes, the government will delay (or even skip) payment, which then incents the provider to ensure they bill for everything possible to cover the gaps.

Those of you with private insurance look at your EOB. See how your insurance company only pays a fraction (often 1/10 – 1/4 the original billed value)? That’s because private industry has figured out how to work the system towards profitability for all (even at just 1/10 – 1/4, the provider is still making his profit, too).

I agree: the current system is a mess. It’s not accessible to all who need it. I don’t think the government mis-managing more of my money is the way to fix it. (Hello… social security, anyone?)

I point out that anyone can walk into a hospital right now for care and walk away without paying a dime. Undocumented workers and the poor use it every day for primary healthcare and often pay nothing.

Poser's avatar

@Rob—Bravo.

JackAdams's avatar

The story is told of the woman who was praying to The Creator, and she said, “My Lord, will there ever be true healthcare reform in the United States of America?”

To her astonishment, Gawd answered her, saying, “Well, all I can tell you is that it’s not gonna happen during MY lifetime.”

September 2, 2008, 9:02 PM EDT

robmandu's avatar

Really? Is that what he said, @Marina? ;-D

basp's avatar

poser, our taxes already pay for Heath care in the most ineffectuve and inefficient way…...it’s called medicaid ((MediCal in California). Unfortunately, this form of socialized health care is killing us. We need to put the money up front instead of chasing the problem after the fact. Including preventative care would save us millions. There is no reason why our country with it’s resources should have a broken health care system comparable to a third world country. And it couldn’t possibly cost more money than the mistakes we are currently making are costing us.

Poser's avatar

So since the government screwed up Medicare/Medical, Social Security, and pretty much everything else it’s ever touched, we are somehow supposed to believe that some savior is going to sweep into office and fix everything with the latest buzzword: Universal Health Care?

I agree—the medical industry is fucked up. But I trust the government to fix it about as much as I trust anything else they do.

I’m always wary of anyone who touts a Utopian view of the government’s judgments or motives.

tinyfaery's avatar

I work a poor social service job. I get paid shit, while my clients who are on SSI almost make more in a month that I do, and have better health insurance. (I’m not saying they do not need or deserve it, but it just doesn’t seem right).The insurance that is offered here is ridiculous. My co-workers complain of not being able to afford a root canal or get an MRI. Plus, we have so few employees, it’s virtually impossible to take a vacation or take a mental health day—and trust me, we need it. Add all this to the stress of the job, and the need for medical services go up, but coverage is going down.

Good thing I am on my wife’s insurance; she works for the LAUSD and has awesome health benefits. However, while a normal married couple would not be taxed for a spouse’s insurance coverage, my wife is taxed because we are not officially married. Think about that when voting this year. Domestic Partnerships and Civil Unions DO NOT equal marriage.

marinelife's avatar

Looking back at my original question, I do not see that I proposed government reform. I would challenge those of you who do not approve of the government taking a hand to offer alternative reform.

Currently, there is no incentive for private health insurers to create reasonable cost programs for the uninsured or to offer them group coverage.

Further, employer plans cover less and less than in the past, have increased employee cost and co-pays, and are now excluding the ill.

I trust corporations less than I trust the government.

I am open to new ideas of all types from all sides.

@Rob I agree about Canadians choosing to have elective procedures here. Still, would not basic coverage for everyone be worth it? Perhaps we should look not to the Canadians, but to the French or germans for better models.

Poser's avatar

@Marina—I trust corporations more than I trust government. Corporations have one singular goal: to make money. We could argue all day about whether this is ethical, or should a large corporation have some sort of “social conscience.” All that is irrelevant. The point is that, knowing a corporation’s singular motivation is profit, it isn’t difficult to manipulate those corporations to provide a better service.

Free markets simply work. Free markets work simply. The corporation that provides a better service to its customers makes more money.

The problem with health care (and anything else government gets it shitty little paws into) is that when government starts mucking things up, the markets aren’t free, and things cease to be simple. The end users of health care—patients—aren’t the customers of the corporations. Government is, and the government doesn’t give a shit about how good someone’s health care is, or how much liberty they take away from citizens by managing their health care, or even how much health care costs. They are simply the middleman. They take the money from citizens and act as an intermediary between the taxpayer, the patient, and the insurance company.

Of course, I’m speaking of government generally, in all it’s bureaucratic glory. Individual politicians may not be as heartless as I’m describing. But I guarantee you, if Obama and McCain didn’t believe that talking about health care would affect the outcome of elections, we wouldn’t be hearing them speak the words.

I can’t fault a business for trying to turn a profit. That is what businesses do. But I would fight to the death a government that’s outgrown it’s usefulness and sees no place for individual liberty and freedom of choice.

augustlan's avatar

I am definitely ready for some kind of reform. My husband and I have very minimal coverage through his employer, and it is getting worse and more expensive every year. Even with insurance, my prescription costs are outrageous, and physical therapy was not covered AT ALL. There may not be a perfect solution to this mess, but surely something can be done to improve it. Every big change comes with a high price, and we have to be willing to pay it. Let’s bite the bullet, and get it over with!

kevbo's avatar

@poser, please note this recent study showing that since 1948 the U.S. economy has done significantly better under Democratic administrations than Republican administrations for all but the wealthiest 5%.

http://www.dailykos.com/story/2008/9/3/01930/39388
http://www.nytimes.com/2008/08/31/business/31view.html?_r=1&em&oref=slogin

We may pay higher taxes, but we are also making more money.

@marina and others, you may be interested in this open letter written by the CEO of the healthcare org that I formerly pledged my allegiance to (as an employee). This is a non-profit system that encompasses hospitals, physician clinics, and health plans statewide. Of note:

Having a large chunk (roughly 25% in NM) of uninsured ”... is a catastrophe because the costs of providing care to the uninsured are continually shifted to those who buy health insurance.”

In other words, (the royal) we pay for it either way.

He advocates a private-public partnership that insures everyone and provides incentives for efficiency (technology) and efficacy (patient health).

Sadly, our state legislature continues to balk at our governor’s priority demand for universal coverage citing cost as the main issue. Not even being dragged back in for a special session was enough to get them to figure out how to make it work.

With respect to the national picture, the next administration doesn’t even need to come close to hitting it out of the ballpark to chalk this up as a win. Just give us the equivalent of $3.50/gallon gas, and I’m sure our gratitude will last at least four years.

Poser's avatar

So I should be happy about giving a third of my income to the government simply because I’m making more money that my parents were when they were my age? I’m sorry, but it’s my money. I earned it. It doesn’t belong to any politician, no matter how generous. It’s easy to be benevolent with other people’s money.

allengreen's avatar

Poser—you pay 1/3rd of your income in taxes? Did you arrive in America and build the infrastructure yourself? Do you show up at a Country Club and demand benifits without paying dues? Is your water clean, streets safe, grandma on SSI? And you’ve got the arrogance to insult the very programs that created a middle class—Poser you are the prime example of a failed educational system—public school or private?

Poser's avatar

Alright then, allen. You keep saying that everyone who disagrees with you doesn’t know what’s best for them. I assume then, that if I just give you my paycheck each week, you’d spend it much better than I ever could right? Isn’t that what you’re saying the government should do?

So no corporation or individual has the ability to build infrastructure? The government is simply a middle man. How many construction workers out there building infrastructure do you think are government employees? No, they’re contractors and subcontractors. Civilian workers and corporations on government contracts. Their paychecks are being paid by yours and my tax dollars. In other words, the government takes my money (without giving me any recourse if I don’t like the “services” they provide me) and hands some of it over to contractors who can’t be fired. The rest of my money goes to pork, earmarks and “social programs.”

And yes, close to one-third of my earned wealth goes, in some manner or another, to the government, and only a small fraction of that goes to building the infrastructure that I use. I have no problem paying for those things that are of use to me, but since when is it my responsibility to “create a middle class”? Shouldn’t our goals be set much higher than creating a class that merely struggles to get by? Don’t liberals typically want to do away with classes?

You have the gall to call me arrogant for believing that my efforts should benefit myself, yet I’ve twice seen you claim that you know what’s best for me more than I do. You, sir, are the epitome of arrogance.

augustlan's avatar

Poser, so you have no problem paying for those things that are of use to you, but you do have a problem paying for those that aren’t of use to you personally? So, if a person has no children, he should not have to contribute to the cost of building, maintaining and running public schools? If a person isn’t a criminal, he should not have to contribute to the cost of building, maintaining and running prisons? So many things that we don’t personally have a use for are of benefit to society as a whole. You, personally would suffer the ill effects if either of these institutions did not exist. Without public funding for schools, we’d produce far fewer qualified employees and leaders, which would surely impact us all. Without prisons, we’d have far more criminals roaming the streets, committing more crime. Maybe you’ll be lucky enough not to have that impact you, but…maybe not. Are you willing to chance it? The very same principle applies to health insurance. Fewer and fewer people can afford coverage, which means more and more: go without preventative care and end up REALLY sick; miss many work days due to said illness; get routine “sick” care at the emergency room; etc. Who, exactly do you think pays for this now? It’s ALL of us…in the form of lost productivity, higher insurance costs for those that have it, and higher medical costs. I’ve tried to make the point that reform will benefit you, because that seems to be your whole argument against it. But really, is it even ok to declare “I’ve got mine, what do I care what happens to you?” Something to think about.

drhat77's avatar

the problem with health care is that we, as a society, have an ethic that states we should give people medical care whether or not they can afford it. because of this, all standard economic analyses break down – they cannot even begin to explain the phenomenom. we can try to promote preventative care, but we cannot force it because it would not be constitutional, and a large proportion would ignore preventative health options because it is tedious, and sometimes painful (colonoscopies, YIKES!). so these people would still come in the health care system through the more expensive option, the episodic/acute care door.

SO: we either roll over, admit that as a society, we cannot turn away someone who needs medical care, and just allocate the necessary funds, or fight it, and make it more confusing and loop-hole ridden than before. We could also tell people who don’t have money to go screw themselves, but very few people would stomach this idea – i’m just including it for the sake of intelectual completeness.

BOTTOM LINE: this isn’t even a break-even option, we will constantly bleed through this issue.

wundayatta's avatar

Americans’ love of “competition” means we will do anything to make us feel like we haven’t broken our values. In health care, this means that we guarantee a profit to the health insurers in the name of competition. We allow the health insurers to “compete” over who gets to insure the healthy people, while we insure the unhealthy people using public funds.

We have two public programs for the unhealthy people: Medicaid, which insures the poor; and Medicare, which insures the elderly. No one would insure these populations if they had to purchase insurance privately, since the cost of that insurance would be prohibitive for all but the most wealthy. It goes without saying that the poor are not wealthy. It turns out, as well, that the elderly are overrepresented amongst the poor.

Having any private insurance market at all would be impossible if we, the people, didn’t guarantee to private insurers that they don’t have to insure people they can’t make money on. So, this country has perpetrated an enormous fraud upon Americans. We have played their love of compeition, and fooled them so they will accept fake compeition,. We essentially subsidize the health insurers profits, by making sure they don’t have to deal with people that might hurt their profitability. If they can’t make money insuring healthy people, they have to be idiots. We, the people, guarantee them a profit.

The most efficient way to run an insurance system where everyone gets the product, whether they can pay for it or not, is to put everyone in the same insurance pool. This way the risk is spread out over the largest group, instead of artificially segmenting it into the expensive health care users group, which the public pays for, and the less expensive health care users group, which the health insurers get to fight over. A single payer system is the way to go. It is most efficient, and fair. There’s a reason why so many other nations in the world use it. Americans are blinded by ideals, and we end up shooting ourselves in our feet, as a result.

A single-payer system would actually cost less than the current system. Right now, an enormously high percentage of every dollar spent on health care goes to administration, instead of actually delivery of health care. The last time I looked at it, the US spent about 24 cents of every dollar on administration. It’s probably up to 30% by now. Canada, back when we were spending 24%, was only spending 11% of every dollar on administration. Medicare and Medicaid, believe it or not, are at 3% to 4%.

Administration is all the time our doctors and hospitals spend dealing with insurance and getting paid. If you assume we can be as efficient as Canada (and why not, since the major public programs in this country are alreayd more efficient than that), if we go to a single payer system, we’ll spend less, as a nation, to provide more health care.

Of course, here’s the problem. Right now, we pay premiums to Health insurers, instead of taxes to the government for health care. People don’t mind being robbed blind by health insurers, because they are private industry and “competitive.” God forbid we should make employer-provided insurance illegal, and pay taxes for health insurance. We wouldn’t want to save money, and provide more and better care. On no. That would be communism!

So, instead, let’s have real competition, and eliminate the mandate to provide care to all, and let people die. Folks will pay for their own insurance, or pay out of pocket for medical care, and those with no money, get no service. That’s the McCain plan. Well, except for eliminating the mandate for care. And, as drhat77 points out, if you don’t do that, you can’t get a free market system, and any system other than a single insurance pool will be gamed and waste not billions, but trillions of dollars, to subsidize profits for insurance companies who add no value to their product, other than shuffling paper.

The Obama plan is little better. Any system that doesn’t go to single payer will be wasteful, and will not cover people fully. There are a variety of reasons for this, but I will go into them at some other time.

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