Still thinking about the possibilty of a national health insurance

[enjoy the ride]

I have tried thinking of ways a national health insurance might work- one way to avoid the free for all in emergency rooms anyway so my first thoughts are below-

Basically having a national health insurance plan where costs are under control down comes down to:

1) Who pays- the user, the employer or the taxpayer, or a combination

2) What do they pay for, everything or limited care,

3) How much do they pay the providers,

4) Who bares the liability if things fo wrong, the provider or the consumer?

IF you don't decide these things as a group, then they are decided by the market- everyone charges the maximum they can, the liability is decided on a case by case basis in court and the taxpayer or provider pays for those who can or won't, and the insurer decides who costs too much to cover.

I would like to see a taxpayer funded plan that covers basic, minimum costs for any basic care that is mandated by the government- in otherwords, if the state or Feds require a hospital to treat in an emergency room or urgent care, schools mandate vaccinations, or certain public health agencys demand treatment for communicable diseases, then it is covered period. If society can not get it together to make decisions about what is good enough diligence for a hosptial not to get sued if something goes wrong, then society should pay for it's ambivalence by paying lawsuit judgements.
Then other "basic" care would be a shared cost- only the absolute poorest with no source of income would be exempt from a share. If you get welfare, than a small precentage of that welfare benefit pays into a health plan that can be billed for the cost of your care. Everyone else pays on a sliding scale based on income AND resources- if you choose not to pay, then you only get the mandated care- if you croak because you refused to pay into the plan, you made your choice and are responsible for your own care-sad but true. Or you buy a private insurance and hope for the best.
People could get a tax break for the cost of this basic national insurance to index the cost somewhat - richer people see less of a break, poorer or people in special circumstances more.

Then private insurance could devise and sell plans to cover what is not deemed "basic" care by the national insurance plan. Each man for himself or employers could group their emplyes as could associations, clubs, etc.


Every procedure above the mandated ones would require a co-pay- small for those subsidized as above and larger for those at the top of the cost scale. The co-pay amount should be just large enough to be noticable but not prohibitive. This should be adjusted with any increase if benefits for those receiving them.

Re: lawsuits- for the basic are items, there should be limits on pain and suffering and punitive awards unless there is gross negligence by the provider as set out in the basic plan. A hospital, for instance, should not be a party to the suit if they provided the required basic service in a manner consistant with good practice and reasonable judgement in the situation. Minimum staffing, training and equipment requirements should be part of the certification of mandated or supplemental "basic care." Those provided, only actual damages are payable. I would like to see lawyers limited to a schedule payment based on services but good luck on getting that. But at least any punitive award would not be part of the patients' award- it would be put into the national basic insurance plan to offset costs.

The major decision is what is basic care and what is elective- that will be hard but needs to be done if costs are to be contained at all.
The debate about who is covered for what in "basic" care could start with determining levels of success- in otherwords, if the life expectancy or quality of life index after a procedure is 10 per cent or less ten it does not belong in basic care insurance- but this is always gong to lead to sad cases for example, the parent of a premature baby who is denied that slim chance is always going to be distraught and angry. Or an older person who is not reasonably able to be aware after a surgery is not a basic insurance risk. Just because it is possible doesn't mean that the taxpayer can afford it for all.

Anyway- just IMO

 

[angie68]

Great post! This is a subject I have been thinking on rather hard myself. After losing my job several months ago, I have been forced to buy health insurance on my own. I have researched all the senerios and still haven't found a plan i think is worth the money. It would be great to have some reform when it comes to health insurance!

 

[k0xxx]

Let me see if I understand this. You would like for the same organization (the Federal Government) that brought us such efficiently run, and fiscally responsible entities such as the Post Office, the Social Security Administration, Medicare, Medicaid, the Dept. of Defense, and Congress itself, to run health care? Just the thought of it makes think of $640 toilet seats, $436 hammers, and $797,400 outhouses.

I know that there has got to be a way, is a country as wealthy as ours, to provide health care for those those that cannot afford it and to get costs under control. However, I have yet to see a single program, that has been put forth by the Federal Government, end up working as it should. Frankly, with Social Security, Medicare, and Medicaid accounting for over a trillion dollars of the Federal budget (in 2004), the very idea scares the heck out of me.

I wish that I had a solution, but I do not feel that our politicians can be trusted to not screw it up.

Just my two cents.

 

[enjoy the ride]

I do believe that social security, which has had it's upa and downs, is generally well run with very, very little fraud or waste.
It gets money out to millions every month, resolves endless problems -creates a few too. But generally all you hear is complaints that it will not be there as some point in the future- which is like most end of the world stories, hasn't happened yet.
Medicare though does seem to have fraud problems, not so much within the program as a collusion between doctors, patients and hospitals to get more than is legal. But Medicare is organized by the government which then hands out contract for the program to be administered by private contractors like Blue Cross. Social Security is administered by the government, which is one of the things that makes me think that this is a more successful approach. Your expencive toilet seat is a contract issue too. Hmmmmm...........leads a person to believe that government is not as much a problem as private business.
But I could wish the phone company, gas company and others were run on the same administration cost level as Social Security.
When greed is the issue, you only have two options- legislate to make it illegal or the government does it themselves. And there are a million clever little minds out there to think of ways to abuse any system.
I just don't think profit is a feasible manager of health benefits. Or at least it hasn't worked yet. To much ability to lobby Congress for lots of money in profit.

Willing to hear how others think that the problem can be resolved without government intervention. So list your plan.

 

[VT-Chicklit]

k0xxx

I know that there has got to be a way, is a country as wealthy as ours, to provide health care for those those that cannot afford it and to get costs under control. However, I have yet to see a single program, that has been put forth by the Federal Government, end up working as it should. Frankly, with Social Security, Medicare, and Medicaid accounting for over a trillion dollars of the Federal budget (in 2004), the very idea scares the heck out of me.

I agree with you fully. The nimrods that keep being sent back to Washington to "represent us" are only filling their pockets and election coffers with money and gifts form the lobbiests. There aren't many lobbies bigger than those from the medical field. This is why pharmaceuticals are so high here in the US. This is also part of the reason why health insurance is so expensive. Congress has passed laws that effectivly prevent compatition between health insurances. You cannot shop around for policies from all over the country to get the lowest cost. You cannot buy from out of your area.

I do not want these idiots incharge of my health care. They are incompitant and greedy. Just look at all the bail outs and how the mess our financial system is in got started. Both sides have their finger prints all over it (if you want to be truthful). Privatization needs to happen. Unfettered competition between the insurance companies. Businesses should have to kick in some of the cost. They will dump their policies if a government plan is started. I

Insurance must be viewed as a necessity, not a nice to have. There are many people, especially in their 20s and 30s who are uninsured yet they buy new cars, pools, go on vacation etc... They play the odds. They either think or hope that nothing will ever happen to them. I personally know people like this. They dont want to take the $300 a month to pay for an insurance policy. I was told "I can't afford $300 a month" from someone who had just bought a new car and had a large pool in their back yard. They also smoked, drank and went on vacation. All of which cost a lot of money a year. These people need to get their priorities straight!

I do realise that not all the uninsured can afford it but choose not to. For some the cost is prohibitive even if insurance prices were lowered thru compitition. For those people the government should provide a safety net.

 

[enjoy the ride]

OK people- solutions needed or at least discussed.

If you who don't want the government involved, can you throw out some ideas as to how current problems can be resolved? The unisured showing up at emergency rooms, working people who can't afford that $1500 per month policy with a $10000 deductible for a couple? Doctor's offices where the billing people outnumber the medical people? People with a preexisiting condition who can't get medical benefits at all? Medical costs that inrcease at three and four times the rate of inflation over all?

 

[johnElarue]

Interesting discussion,

To give an idea how the National Health Service works here in Japan:

My family of 5 pays about $500 per month for medical and dental. It is based on income, the wealthy pay more, the poorer, less. When it was just two of us we paid about 180$ per month.

Everyone pays a 30% detuctable for ALL visits. But this 30% is very affordable. For example, you get the flu. Go to your choice of private clinic or public hospital, wait an hour or so. Get your shot and prescription. Pay about 8-15$ for the visit , and 3-5$ for the meds. It ain't free but it's cheap.

Children and elderly are cheaper, kids up to 3 or 6 , I forget which are free. Oh yeah the gov't actually pays you 50$ per month per child just for the heck of it.

A cat scan , MRI or the like will run you about 100$.

Have a baby in the hospital you pay about 3,000$ well after you and baby return home. But you get about 90% back from the gov't within the year, like a tax return. Usually stay in about 10 @days, and the nurses look after you like maids. I splurged for the private room for my wife for all 3 children. Cost about 18$ per day, nice private room.



Doctors salaries start at about the same as the USA 75,000$ out of med school. But unlike in the US they max out at about 200,000$ if you work in a public hospital. If you want to be a doctor and get filthy rich you have to join or start your own clinic , which is needless to say very expensive.

Tell a US doctor he can make only 200K and he'll slap you silly.
My friend is an MD in the US and his hospital is hiring docs, they're offering 350K to start, and no one wants the job! I wouldn't want the job either.

Anyway, it's true there is absolutely no reason why gov't run health care shouldn't be affordable for all. If you're paying 20-30% of your income in Federal taxes, why the heck shouldn't you get insurance. Income taxes here are very low, around 5% up to 200,000$, but everything else, goods, food, commodities, is crazy expensive. The tax system favors the middle class not the upper class. If you wanna make the big bucks you have to pay the piper. If you live frugally and simply the system works well.

 

[sylvie]

I am extremely impressed with Medicare and how smoothly it has run for my DH. We had heard the negatives and horror stories but that hasn't been our experience for the 3 years he has been on it. I'm jealous and I want it. So, I'm all for the government sponsored Universal Health Care system. I absolutely want it modeled on the Medicare system.
I would change the drug Part D model to raise the premiums and spread the cost out over the 12 months instead of the ridiculous coverage gap/donut hole that now exists. The government must be able to negotiate for lower drug costs, not have their hands tied as they do now.
If someone wants to purchase or keep the insurance they now have, give them a tax credit or enable them to negotiate a price comparable to Medicare's.

I can't add to your Social Security evaluation~we are in complete agreement. Our experience has only been positive with SS.

 

[Woodland Woman]

I am not that old but I still remember before hmo's I could go to the doctor without insurance and pay $17 to $25 for a visit. If you didn't have insurance doctors were open to negotiating with you. Medicines were relatively inexpensive. Before that when I lived in Chicago there were neighborhood clinics that used a sliding scale system. A lot of doctors would volunteer one day a week. It seems the more bureaucracy involved the more expensive things become. Now it is illegal for doctors to give individuals discounts. I have no confidence that the government would do a good job providing health care for everyone. We could not afford it.

 

[Cassandra]

I am not that old but I still remember before hmo's I could go to the doctor without insurance and pay $17 to $25 for a visit. If you didn't have insurance doctors were open to negotiating with you. Medicines were relatively inexpensive. Before that when I lived in Chicago there were neighborhood clinics that used a sliding scale system. A lot of doctors would volunteer one day a week. It seems the more bureaucracy involved the more expensive things become. Now it is illegal for doctors to give individuals discounts. I have no confidence that the government would do a good job providing health care for everyone. We could not afford it.

I remember that, too. There was a doctor in our city, Dr. Lott, who charged $5 per visit. He operated his office in an economically disadvantaged part of town, but we were not too good to go there! I guess that was around 30 years ago. Dr. Lott has since passed away and there is a statue erected to him in the part of town near where his office was.

It's a shame you don't find them like that any more.

Cassandra