Issues 2004 - Health Care

With this post, I think I am caught up with Jeff's Issues 2004 posts.

This one's in response to his first post of the series, on healthcare.

We had dinner last night with some good friends who are American but have lived in Toronto for almost 20 years and have raised a family there. We asked them about the Candian system. They told us that its not that bad. The quality of care is fine, but you have to wait for treatment. They ration healthcare in Canada to keep the costs down. They told us that compared to the US, if you are poor or lower middle class, their system is much better. If you are middle class, or upper middle class, our system is better for you. For the rich, it sort of doesn't matter. It's true that you can't "buy" healthcare in Canada, but if you "know a doctor" and its more likely that the rich people will know the right doctor, you can go to the front of the line. Worst case, if you are rich, you can go to the US. Buffalo, Detroit, and Seattle all have wealthy Canadian patients.

It sounds a lot like our public school system. The poor mostly benefit because they couldn't get an affordable education elsewhere. The middle class might suffer because if they could pay for education, they might be better off. And the rich mostly do pay for education, so it doesn't matter.

So, with that all said, let me tell you what I'd like to see in a healthcare system for the US:

1) Everyone must be insured. If you live in the US, if you vote, or go to a public school, or drive a car, or get social security, or are employed, or anything that requires that you deal with our government, you must have health insurance.

2) Kids must be insured. All children who reside in the US regardless of who their parents are must be able to get healthcare, and not in a hospital emergency room, but in a clinic or a doctors office.

3) Employers must stop footing the bill for healthcare. This is crazy that our employers are at the front line of the healthcare food chain. They aren't equipped to make those choices and they shouldn't be burdened with them.

4) Insurance must be collected in the same way as social security. It should be a payroll tax deduction. If you work and are paid, then you pay for your insurance.

5) For those who are unemployed or unable to work, healthcare must be an entitelment. The indigent end up in our hospital emergency rooms anyway, so we ought to do it right upfront.

6) We must have a preventive, wellness oriented healthcare system. We should vaccinate everyone. We should require annual physicals. We should eductate the children on how to eat properly. Etc, etc.

I don't get too excited about who runs this system. It's going to be run by a combination of government and industry. The whole idea of a government "take over" of our healthcare system was in my opinion more of a scare campaign by the healthcare industry than reality.

I believe that doctors, and hospitals, and the other companies that have the expertise to make the required investments in our healthcare system should be incented to do that. The goverment should be in the business of collecting the payments and moving the money around. They already do that for social security and other taxes. They are good at that.

One more point and then I am done. I went to Bush's healthcare page and was turned off by the emphasis on Healthcare Savings Accounts. This is all part of his "ownership society" nonsense. It works great for those of us who are in a position to save, but won't work for the majority of this country that lives paycheck to paycheck.

Then I went to Kerry's healthcare page and was embarassed. He has no plan for healthcare that he's willing to share with the american public right now. I'll gladly give him mine if he wants one.

Comments

[Dave]

Then I went to Kerry's healthcare page and was embarassed. He has no plan for healthcare that he's willing to share with the american public right now.

And you are OK with this?!? This is YOUR candidate, and you are willing to vote for a guy who doesn't share any of his ideas (probably because his ideas are a moving target and he doesn't want to write any of them down).

Seriously, this is a major issue, and Kerry doesn't provide an answer. Nor did he address any answers at the DNC - which is THE time for the candidate to step up and declare his position on the issues for the election, etc.

How would you feel as a VC going to put your monies into a company where the CEO and management team didn't explain what they were going to do with the monies, etc. "Oh, we don't have a business plan - we'll show that to you AFTER you give us the money."

I seriously doubt you would give them a dime. Yet you will vote for Kerry in blind faith.

SIlly. Just plain silly.

[slim999@hotmail.com]

Again with this wrong-thinking! Is the Insurance Instititue's propoganda campaign THIS GOOD?

You say: "2) Kids must be insured. All children who reside in the US regardless of who their parents are must be able to get healthcare, and not in a hospital emergency room, but in a clinic or a doctors office."

And you say this AS IF:

1) Kids in the US without insurance do not get health care
2) The only way to get health care is to have insurance

PLEASE, please: separate the HEALTH-CARE CRISIS from the INSURANCE-AGENT-MY-HOUSE-ISN'T-BIG-ENOUGH-CRISIS.

One can get health care in this country without insurance. I know. I do it ALL THE TIME. Who pays? Why, those WITH health insurance pay! In the form of higher premiums.

Please do NOT KILL MY GRAVY TRAIN ... unless that is your motivation (which, it must be).

It seems like anytime there is a discussion of the healh-care crisis in this country, it's always centered on how many people dont' have insurance... and the solution is to FORCE PEOPLE TO BUY INSURANCE either through

a) lower wages ... and the difference is paid by their employer to insurance companies who have zero incentive to contain costs, or

b) higher taxes

So, which is it: Do you want everyone to have HEALTH CARE? No problem, that's already taken care of. Do you see injured and sick people milling about hospital emergency wards begging to get in? Of course you don't.

Or is it that you just don't like PAYING for my health care in addition to your own?

I can understand that sentiment. When I'm forced to pay for someone else's tab at my local restaurant so that he can continue to be healthy and not starve to death ... well that just burns me up.

Wait! That's never happened. Why should I buy his asprin?

[jackson]

Well where can I sign up for your plan Slim? Sounds great. And Dental? Let me get this straight, you get medical attention when you need it by just dropping by the hospital, then you don't pay your bill? Is that it? You are a model citizen Slim, we need more leeches like you in this world. I like Fred's plan better, it's not so slimy.

[Don Mynack]

What if I don't want health insurance? What if it makes more sense economically for me to pay for health care out of my own pocket? That should be my choice, not yours, and certainly not the government's.

Your example from Canada is a perfect illustration - the gov't saves money by rationing health care. That's right - you can be pushed back in line for necessary surgery because the government decided it for you, and you have no method or mechanism for appeal.

My Canadian relatives have told me quite a few horror stories about their system, from its rampant closing of small town hospitals (no economic incentive to keep them open - they aren't allowed to compete for patients), from unclean conditions in hospitals (a major and unreported reason why SARS was such a huge problem there and barely made an impact here), lack of beds for surgery patients (a "bed" in a Canadian hospital often means a gurney in a hallway), to substandard and incompetent doctors due to a "brain drain" to the U.S. And guess what - You Can't Sue Them! Yeah!

Canada is a wonderful, beautiful country filled with tremendously nice people, but I would not wish their health care upon anyone, let alone the entire U.S.

[slim999@hotmail.com]

Jackson,

I am illustrating a point. Fred's CONTENTION is that there is a HEALTH CARE problem in this country. He reinforces this contention by suggesting that kids are not getting health care (see #2 above, when he knows this is not true.)

What he really wants is for everyone to equally share the costs - this is otherwise known as socialized medicine.

I, on the other hand, want whoever goes to the hospital to pay their own bill.

This isn't a health-care debate, but some are CASTING it as that, in an attempt to obfuscate their true purpose.

Let's debate the merits of institutionalized, government-provided health care, paid for by all citizens through tax revenues. THAT is the issue at hand ... not how many people do or do not have health insurance.

[Chris]

Instead of focusing on who pays for health care, we need to focus on market based reforms that reduce the cost of basic health care. Some stuff, like fighting cancer, is probably always going to cost a fortune, but there is no logical reason why a simple visit for the the flu or something similar should end up in a $200 bill, of which the insurance company only pays $120 anyway. Health insurance should work like car insurance - basic expected expenses are out of pocket. I'm a libertarian more or less, but I can live with helping fund a safety net for catastrophic health issues - but not for routine care. That is just silly.

At one point early in the campaign Kerry was talking about the federal government acting as a re insurer by picking up the tab on any expenses in excess of 50K for any individual patient in a given year. Since 80% of the cost is 20% of the patients - this would allow insurance companies to have more predictable costs and lower premiums knowing that they were covered for catastrophic cases. I thought that was an idea with a lot of merit - but it sort of vanished into the ether.

[Chris]

Here is a good takedown on what Bush and Republicans in general are doing to screw up health care.
http://www.mises.org/fullstory.aspx?Id=1616

[jackson]

Well slim, you lost me then. I don't get your point at all. I don't need insurance because why? I can't afford either insurance, or a visit to the clinic. What about me?

[slim]

Jackson:

I'm having a hard time understanding what you mean:

What you seem to be saying is that you don't NEED insurance, you NEED health care and you don't care who pays for it.

If you visit a clinic and you don't have health insurance, or an ability to pay, they will treat you regardless, and pass the cost on to those who do have the means to pay.

My point is that one's ability to pay for medical care in America is UNCOUPLED from who or how the bill gets paid. Of course, if you HAVE insurance, the clinic wants to know the name of your insurer. But if you do not, they are required to treat you anyway.

Again, this is not a CARE issue; it's a WHO PAYS issue.

Right now, not EVERYONE contributes, even though EVERYONE gets treated. It's unfair. Kerry, and others, want everyone to pay. They just frame it as a health CARE issue to make it seem like they are compassionate - when in reality, they want socialized medicine ... like that practiced in Canada.

So, if that's what they want ... let's debate that.

I for one am against socialized medicine. What about you?

[slim]

Chris,

Here is a good takedown on what John Edwards has done for 20 years to screw up health care.

http://www.washingtontimes.com/functions/print.php?StoryID=20040816-011234-1949r

[Easycure]

Health care is not an entitlement, not should it be. Forcing people to have health care is not the way to go. It's almost to the point where I can't afford health care now, and I'm considering having catastrophe insurance and paying cash for the rest.

Besides, if you add everyone to the rolls, I know darn well I couldn't afford it. Then, guaranteed, the quality of care will go down even further. (See: Canada, U.K.). And forcing questionable vaccines on the general public is ludicrous. This is The United States of America. Maybe we should start acting like it and stop trying to socialize everything as it clearly doesn't work (See: Social Security). Give me my money back (Read: cut more taxes) and give me more choices (Read: Privatize).

Enough said.

[Chris]

Slim,

I wasn't implying that Edwards was clean. OB's all around the country are getting out of the baby business because they can't afford the liability insurance. A lot of that insurance cost is driven by medical malpractice judgments. Doctors are people - they make mistakes. A mistake by a doctor should not equal a lottery payout for the victim. We do not live in a perfect world - shit happens, as they saying goes.

Of course, that does not apply in the case of gross negligence. However, there is a difference between gross negligence and an honest mistake.

Neither side has a good answer for health care. Kerry's re insurer idea seems like its worth exploring. I would prefer a much more free market approach to health care - but we are not going to get that from either Kerry or Bush.

[hey]

health care in canada is fine if you know alot of doctors

otherwise it sucks

the point of HSAs is to get around the current issue in the US of 3rd party pays. When consumers don't have a direct cost, they are nowhere near as good at getting good pricing, and when they get it free (medicaid) they are in little place to work on the quality.

HSAs are designed to replace standard healthcare policies Fred, not simply for people who can save.. the idea is to enable higher deductibles, enlist consumers to keep prices down as they see the price list and have an incentive to hammer down the cost thus reducing premiums for insurers and individuals, and increase the number of people that buy or receive health insurance from their employers.

see steve forbes' explanation of how his company uses HSAs to provide health insurance to employees at a much lower cost than previously.

i have an idea about funding.. i think that there's a venture capital crisis in this country, where the rich decide whats get funded and that the funding isn't allocated properly. we need to have government control how and to whom funding is given and ensure that evil vcs don't steal investors money (or take too much for themselves) and that they invest in the "right" things...

that idiotic socialist/communist proposal is just as bad and just as stupid as your ideas on healthcare.

governments cause healthcare costs to rise by writing rules (its very hard/illegal to buy solely catastrophic coverage... liberals like yourself have forced minimum standards so that birth control and other procedures are covered). get the government out of health care and insurance, and you'll have lower costs and broader coverage.

free all people (not just educated manhattanites) and free all markets (not just technology ones)

[scott partee]

3) Employers must stop footing the bill for healthcare. This is crazy that our employers are at the front line of the healthcare food chain. They aren't equipped to make those choices and they shouldn't be burdened with them.

All other points aside, I see this as the #1 Problem with healthcare. When the insurance companies deal with individuals instead of companies, we'll all win because they'll be forced to compete for our business. As it is now, it's a negotiation between employers and insurers... notice that EMPLOYEES is nowhere in that equation.

Plus, Fred has a good point: Businesses have no "business" making health care decisions unless they are in the business of health care.

[slim]

Scott,

Could NOT agree with you more. We could fix health care costs (notice I did not say "health care", because there is no health "care" crisis) in this country in ONE FELL SWOOP by eliminating the ability of companies to pay for medical insurance for their employees.

(Of course, they should have to give me a non-taxable raise also, when they cut this benefit.)

[Helmar]

Hehe... you guys are really funny. Has it ever occured to you that the primary responsibility of health care lies with you? That if you don't treat your body as if you have a spare one lying around somewhere? That your teeth may actually be healthy and sound until you die if only you cut back on refined foods and sugars in general?

Goodness, the notion that the government or the health care providers owe you anything is scary. Sure, the latter's made a business out of your irresponsible and unsustainable lifestyle, and as with most (listed) businesses, they take you to the cleaners. Have some friends in government, and this type of robbery gets institutionalised (as slim suggested: "and the solution is to FORCE PEOPLE TO BUY INSURANCE either through a) lower wages ... and the difference is paid by their employer to insurance companies who have zero incentive to contain costs, or b) higher taxes").

If people took individual responsibility for their lives and their health, there would be enough money around to treat those really need medical attention due to circumstances not of their own making. For most, however, your illness/disease/sicknes is plain home-made. Face up to it!

[Kristen]

It's kind of funny to see how many different opinions people have. I, personally, am not for either candidate becuase they are both complete morons (can we ever have a educated and mature person in office?) but i do agree with helmar when they said that the primary responisbility of health care belongs to the individual. Forget the stupid debates and what candidate is doing what and why and just take care of yourself. Why doesn't anybody ever think of that? You can't depend on everybody else for the rest of you lives. Try growing up.

By the way my opinion probably doesn't count because I am only 16 but, whatever. I take my first ammendment very seriously.

[Kristen]

It's kind of funny to see how many different opinions people have. I, personally, am not for either candidate becuase they are both complete morons (can we ever have a educated and mature person in office?) but i do agree with helmar when they said that the primary responisbility of health care belongs to the individual. Forget the stupid debates and what candidate is doing what and why and just take care of yourself. Why doesn't anybody ever think of that? You can't depend on everybody else for the rest of you lives. Try growing up.

By the way my opinion probably doesn't count because I am only 16 but, whatever. I take my first ammendment very seriously.

[insurance]

thai Insurance: "The Importance of Travel Insurance
By: Karen Zastudil "

thai insurance: "What Is Term Life Insurance?
By: Tim Gorman "

thai insurance: "How Do I Lower My Auto Insurance Premiums?
By: Tim Gorman "

[cherry]

http://financeschool.ivtcscs.org belongimaginationlent

[heart]

http://www.prijen.com/wwwboard/messages/15485.html beganironrare

[alita]

I want to here some arguments against government run healthcare. I am doing a debate about this and I am on the con side any help would be appreciated. Any stories from different countries especially the problems they have.

[Adam]

1. "Everyone must be insured" What if I don't want insurance? What if I (gasp) want to pay for my own services? What if I have a religious objection to insurance?

6. "Wellness-oriented health care system" What you're describing is a forced system, where the government takes control of my health, because I'm obviously too stupid to take care of myself. What if I don't want vaccines, because maybe I don't think that they're effective? Why does the gov't need to get involved in my health anyway?

The bottom line...Gov't run health care is communism, where the healthy care for the sick, and there is no personal responsibility for your own actions. If I smoke and get cancer, someone else pays for the treatment, and it always Chemo, surgery, and radiation! Government run systems won't allow the alternative treatments, because they don't make very much profit for Merk or Phisor. Essiac costs about $200, and Chemo is $100k. Guess which one wins?

[Herbal Store]

Herbal supplements are often standardized to contain stated levels of active phytochemicals. Standardization can be done in a number of different ways. Many companies extract the supposedly active constituents and add them back into a base like rice fiber. Visit http://www.allherbalstore.com for more on herbal supplements. Also see this herbal treatments: http://www.allherbalstore.com/naturalacnetreatment/, http://www.allherbalstore.com/ibstreatment/, http://www.allherbalstore.com/natural-colon-cleansing/ and http://www.allherbalstore.com/natural-pain-relief/.