Health Care Politics Thread

Some reporting in the NY Times today on the ongoing Congressional public/private health care debate:

Schumer offers Middle Ground on Health Care

Scorched by Republican opposition to the idea of a new public program like Medicare, Senate Democrats are looking for a middle ground that would address the concerns of political moderates. One way they propose to do that is by requiring the public plan to resemble private insurance as much as possible...

Click to expand...

Some details:

The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:

¶The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

¶The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

¶The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

¶To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.

In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers.

Click to expand...

magerette said:

I doubt it makes much difference to the person losing the house, and before that person defaults on their mortgage, the money has indeed gone to paying hospitals and doctors instead of the mortgage--but I'm sure from your business-oriented point of view, you're perfectly correct.

Click to expand...

The point was mainly that losing the house isn't helping anyone (except maybe the person buying it in foreclosure).

magerette said:

Some reporting in the NY Times today on the ongoing Congressional public/private health care debate:

Schumer offers Middle Ground on Health Care

Some details:

Click to expand...

I like most of what it says, but honestly, I don't think it will be able to be done without some form of taxation. Unless the plan is simply better in some form than existing private plans, the only people that are going to buy into it are people that can't get health insurance elsewhere, which means the most expensive pool to insure, which means the savings over existing private plans will be little or none (especially if this plan excludes all pre-existing conditions).

It also doesn't seem like it will do much to improve the overall efficiency of our system, which is one reason why there are so many under-insured people in the first place.

blatantninja said:

I like most of what it says, but honestly, I don't think it will be able to be done without some form of taxation. Unless the plan is simply better in some form than existing private plans, the only people that are going to buy into it are people that can't get health insurance elsewhere, which means the most expensive pool to insure, which means the savings over existing private plans will be little or none (especially if this plan excludes all pre-existing conditions).

Click to expand...

I think the idea is that it won't exclude anything--the concept being coverage for every American. I think as long as the plan is equal and even slightly less expensive, not necessarily better, a lot of people would be attracted to it, especially if it allowed them to use their preferred providers and so forth at a lower cost.

It also doesn't seem like it will do much to improve the overall efficiency of our system, which is one reason why there are so many under-insured people in the first place.

Click to expand...

A lot depends on the details of how it's worked out. I had some pretty high hopes for this initially, but after the mixed bag of financial industry and economic initiatives , I'm afraid this legislation with the current Congress may not be written very well either.

I do believe it could be done, however. I'd like to see a true bipartisan approach, because I think the solution needs to be different than a European one, however well they work there, or a simple expansion of Medicare without significant reform. If the Republicans had any committed and responsible legislators, they could contribute some practicality and stability to this instead of shooting it down on general principles, because I don't think anyone would argue that the existing system isn't a burden on most businesses, particularly small businesses, as well as the uninsured.

My hope at this point is that some sort of workable program will emerge that combines all the best ideas into something which may not be perfect, but improves on what we have right now. It's quite possible there may have to be some sort of taxation as support, but I feel the same way about that as you do about having to pay a bit more to reform Social Security--I'd be willing to pay a bit more for it to be done right.

I honestly doubt that taxes will never be raised again in my lifetime, and if they have to be raised to support an efficient health care system which works for everyone, I could think of far worse things for the government to spend my tax dollars on.

magerette said:

I think the idea is that it won't exclude anything--the concept being coverage for every American.

Click to expand...

I didn't write that correctly. I meant that it doesn't allow the excluding pre-existing conditions, thus raising the cost.

I think as long as the plan is equal and even slightly less expensive, not necessarily better, a lot of people would be attracted to it, especially if it allowed them to use their preferred providers and so forth at a lower cost.

Click to expand...

I agree, I'm just not sure they can make it equal or less expensive than the average private insurance plan is now. If you take a standard health insurance company and told them they couldn't exclude any pre-existing conditions and that they had to accept anyone that came in the door, their costs definitely go up. The only way they might not would be if the efficiency realized by more people now having access to preventative care would be greater than the increased cost of treating all those conditions. I don't think there is any chance it will be.

To make it work, there needs to be other efficiencies that it is exploiting (such as cheaper drugs, etc.).

blatantninja said:

...I agree, I'm just not sure they can make it equal or less expensive than the average private insurance plan is now. If you take a standard health insurance company and told them they couldn't exclude any pre-existing conditions and that they had to accept anyone that came in the door, their costs definitely go up. The only way they might not would be if the efficiency realized by more people now having access to preventative care would be greater than the increased cost of treating all those conditions. I don't think there is any chance it will be.

To make it work, there needs to be other efficiencies that it is exploiting (such as cheaper drugs, etc.).

Click to expand...

I think it could do all those things but the legislation would have to include strong, unambiguous provisions that allowed the following:

• Reform of medical records and billing
• Incentivized prevention care
• Malpractise protection
• College incentives for GP's emphasizing preventive medicine
• Corporate partnership in drug cost reduction,health club membership, R & D, and facilities maintenance.(Maybe through tax credits/ vastly increased sales volume for participating industries or something?)
• Paid premiums for everyone with an income, including scaled ones for entitlement program recipients

IOW, I don't think it's impossible to improve on what we have, even if government does get involved.

Well well, everybody's favorite Nobelist Paul Krugman is excited about a development in health care politics: the villains who are responsible for such wonderful things as a law that prevents Medicare from bargaining when buying drugs has presented a proposal which is, on the face of it at least, constructive and helpful:

[ http://www.nytimes.com/2009/05/11/opinion/11krugman.html?_r=1&ref=opinion ]

Personally, I trust the American medical-industrial complex to be sincere about this about as much as dte trusts Iran on their nuclear program, but if the Krugster thinks this is good news, I guess there's some room for optimism.

Medicare Part D is pretty much the poster child of good intentions, horrible execution.

I agree with much of what Krugman says in his article.

This is why I am EXTREMELY distrusting of the government running our healthcare (and yes I realize it is Fox News):

Dead People Being Sent Stimulus Checks

Thousands of Americans are receiving federal stimulus checks in the mail, this week. Only problem: many of them are deceased.

Recently, a Long Island, New York woman was shocked when she checked the mail and received a letter from the U.S. Treasury -- but it wasn't for her.

Antoniette Santopadre of Valley Stream was expecting a $250 stimulus check. But when her son finally opened it, they saw that the check was made out to her father, Romolo Romonini, who died in Italy 34 years ago.

Romonini was a U.S. citizen when he left for Italy in 1933, but only returned to the U.S. for a seven-month visit in 1969.

The Santopadres are not alone. The Social Security Administration, which sent out 52 million checks, said some of those checks mistakenly went to dead people because the agency had no record of their death. That amounts to between 8,000 and 10,000 checks for millions of dollars.

The feds blame a rushed schedule, because all the checks have to be cut by June. But strangely, some of the checks were made out to people -- like Romonini -- who were never even part of the Social Security system.

Click to expand...

blatantninja said:

This is why I am EXTREMELY distrusting of the government running our healthcare (and yes I realize it is Fox News):

Dead People Being Sent Stimulus Checks

Click to expand...

There's a simple reason stuff like this happens. It's the same reason illegal immigrants (and their employers) can cheat the system so easily.

You have chosen not to have a unique identifier for each citizen, a centralized registry of those identifiers, and an official identity document linked to the registry.

That means that you simply have no unambiguous way of identifying a citizen, nor tracking whether they're alive, dead, or wandering the night in ghostly torment.

There are valid reasons for that choice, but it doesn't come without consequences. One of the consequences is that anything that requires positive identification of a citizen -- whether it's for taxation, stimulus checks, social security, health care, or anything else -- involves a certain amount of guesswork, opens up lots of possibilities for fraud, and results in mistakes.

Prime Junta said:

There's a simple reason stuff like this happens. It's the same reason illegal immigrants (and their employers) can cheat the system so easily.

You have chosen not to have a unique identifier for each citizen, a centralized registry of those identifiers, and an official identity document linked to the registry.

That means that you simply have no unambiguous way of identifying a citizen, nor tracking whether they're alive, dead, or wandering the night in ghostly torment.

There are valid reasons for that choice, but it doesn't come without consequences. One of the consequences is that anything that requires positive identification of a citizen -- whether it's for taxation, stimulus checks, social security, health care, or anything else -- involves a certain amount of guesswork, opens up lots of possibilities for fraud, and results in mistakes.

Click to expand...

We tried - the Democrats and ACLU said it was unconstitutional and a violation of people's rights - because, you know, we have no legitimate reason for making sure people are who they say they are.

Prime Junta said:

There's a simple reason stuff like this happens. It's the same reason illegal immigrants (and their employers) can cheat the system so easily.

You have chosen not to have a unique identifier for each citizen, a centralized registry of those identifiers, and an official identity document linked to the registry.

That means that you simply have no unambiguous way of identifying a citizen, nor tracking whether they're alive, dead, or wandering the night in ghostly torment.

There are valid reasons for that choice, but it doesn't come without consequences. One of the consequences is that anything that requires positive identification of a citizen -- whether it's for taxation, stimulus checks, social security, health care, or anything else -- involves a certain amount of guesswork, opens up lots of possibilities for fraud, and results in mistakes.

Click to expand...

I hate to bust your bubble, but the social security system sent out 52MM of those checks. The IRS uses the social security's system for identifying individuals, and your social security number is indeed a unique identifier (though certainly people steal them).

The guy got a check from social security despite never having been in their system.

Rithrandil said:

We tried - the Democrats and ACLU said it was unconstitutional and a violation of people's rights - because, you know, we have no legitimate reason for making sure people are who they say they are.

Click to expand...

The Brits have tried, and failed, for the same reason. It's an Anglo-Saxon thing, I think, 'cuz the rest of us have it, and it works generally pretty much like it's supposed to. It hasn't turned continental Europe into a police state or anything. I'm sympathetic to the concerns behind the rejection of the idea, but IMO the benefits outweigh the costs.

It clearly does limit individual liberty, though, no doubt about it. But then so do speed limits and traffic lights.

blatantninja said:

I hate to bust your bubble, but the social security system sent out 52MM of those checks. The IRS uses the social security's system for identifying individuals, and your social security number is indeed a unique identifier (though certainly people steal them).

The guy got a check from social security despite never having been in their system.

Click to expand...

Trust me, BN -- it's not the same thing. We have a central population registry that keeps track of people by social security number, and the system is built in such a way that the registry stays up to date with extremely few problems. You have social security numbers, but you don't have the mechanisms in place that keep the registry up to date -- and, as per your example, not everyone is even in the system.

In Finland, for example, a change of address automatically propagates into the system -- whether the address is above or below ground. It's very convenient, really, because things like banks and insurance companies and other large corporations are connected to the system, so we don't have to notify them separately when we move.

The downside is that yes, the system really *does* know who and where you are, and there really is a potential for abuse there.

So I'm not saying that sort of thing absolutely couldn't happen with a central population registry, but I am saying that it would be a genuinely anomalous event.

Prime Junta said:

The Brits have tried, and failed, for the same reason. It's an Anglo-Saxon thing, I think, 'cuz the rest of us have it, and it works generally pretty much like it's supposed to. It hasn't turned continental Europe into a police state or anything. I'm sympathetic to the concerns behind the rejection of the idea, but IMO the benefits outweigh the costs.

It clearly does limit individual liberty, though, no doubt about it. But then so do speed limits and traffic lights.

Click to expand...

I've never understood the opposition to it. I remember when George R. R. martin tried to say that having to show Photo ID at the airport was like the Nazis asking for movie heroes' "papers" and thus was bad and fascist and evil etc. I think it's...stupid. If you want to partake in public life and not have to live in a cave somewhere you have to give up some "freedom". I think creating a national registry that accounts for everyone - who they are, where they live, etc etc - would only BENEFIT everyone, and would also have a good side effect of making a census much easier to conduct every ten years. But then again, I also don't believe in a constitutional right to privacy, so I'm probably an outlier on this.

I did not see this thread yet so I want to give my few cents. Acctually I am a little bit extreme about health care, I think the swedish system is a bit too generous, like if you join a fighting sport with the goal of hurting the other person or getting hurt. I think you should need to pay a health insurrance or pay the costs for recovering your damages. If you are smoking I also think you should need to pay an extra health insurrance, etc etc.

GothicGothicness said:

I did not see this thread yet so I want to give my few cents. Acctually I am a little bit extreme about health care, I think the swedish system is a bit too generous, like if you join a fighting sport with the goal of hurting the other person or getting hurt. I think you should need to pay a health insurrance or pay the costs for recovering your damages. If you are smoking I also think you should need to pay an extra health insurrance, etc etc.

Click to expand...

Very good point, IMO - I think if we *do* institute a public health care system here in the U.S. that's exactly the sort of thing we need to deal with. Because, you know what? I'm overweight. I should either be ineligible for the service or have it not cover as much.

There's a random line from the west wing, when they're talking about the Tobacco industry case:

Josh:Are you saying that people who start smoking and get addicted to nicotine are too stupid to live?
Senator Rossitter: No, I'm saying they're too stupid to be protected by the courts.

I think that should hold true with the health system. If you stupid your way into bad health you should have to suffer the consequences on your own dime.

GothicGothicness said:

I did not see this thread yet so I want to give my few cents. Acctually I am a little bit extreme about health care, I think the swedish system is a bit too generous, like if you join a fighting sport with the goal of hurting the other person or getting hurt. I think you should need to pay a health insurrance or pay the costs for recovering your damages. If you are smoking I also think you should need to pay an extra health insurrance, etc etc.

Click to expand...

I'm all in favor of that... in principle. The devil is in the details, though -- because in order to enforce it, you'd have to keep track of who does what, and how dangerous it is, or else you'd have judgment calls going on all the time.

What's more, risk factors are extremely fuzzy -- for example, how do you classify someone who's overweight and an occasional smoker, but also plays tennis and does a heavy workout at the gym four times a week? If he pops his knee while playing tennis, should he be rewarded for taking care of his health by exercising regularly, or punished for endangering his joints by playing tennis even though he's overweight?

(Yes, this is a real person I'm thinking of, right down to the knee injury.)

In other words, whenever I try to imagine how this sort of thing would actually work in practice, it would imply either extreme government intrusion into perfectly legal activities lots of people do, or wildly arbitrary judgment calls that probably need to be sorted out in courts later.

Besides, there are public-health measures that have been proven to work to resolve problems like this. Physical education and nutritionally balanced meals at schools, that sort of thing.

Prime Junta said:

Trust me, BN -- it's not the same thing. We have a central population registry that keeps track of people by social security number, and the system is built in such a way that the registry stays up to date with extremely few problems. You have social security numbers, but you don't have the mechanisms in place that keep the registry up to date -- and, as per your example, not everyone is even in the system.

Click to expand...

I'm not saying it's even remotely close to perfect, however, my point is that even in an imperfect system that doesn't accurately keep track of who is currently alive and who is not, it should be easily expected that the system would not send a check to someone that is not currently or ever was in the system! That type of error would occur, even if the system did accurately keep track of who is alive, since the error is outside those parameters.

The guy can't have been completely outside the system, else they wouldn't have known where to send the check, though. No?