Socialized medicine

arbilad · Head Chef

Socialized medicine

Cat Herder · Understander of unimportant things

Could we retitle this thread to something like "National Health Care: Pros and Cons"? The title "Socialized medicine" is already slanted as we all have an opinion when it comes to "socialism".

Let's try talking about the concept first and not the politics. Perhaps we can identify areas that can be helped by a form of national health care, and areas that can not or should not. Clearly, we can learn from the examples of other nations that have various forms of nationally guaranteed access to health care of what not to do. But, just because their systems are screwed up doesn't necessarily mean they are worse than our own current system of health care (which is pretty screwed up in it's own right thanks to lawyers, malpractice, health insurance, and making a buck run amok).

Roper · Senior Bucketkeeper

Is health care a basic human right? Why or why not?

We already have national health care (Medicaid and Medicare) for segments of our society. Are these programs evil? Why or why not?

eta: A clarification--I did not describe socialized medicine as a wonderful thing. I referenced national health care as a program that would be a great benefit to the children with whom I work. I believe such a program is worthy of consideration, and should not be dismissed as "evil socialism."

-- Edited by Roper at 12:51, 2006-12-27

lundbaek · Profuse Pontificator

"Is health care a basic human right? Why or why not?" A very appropriate question here.

Do I have a right to take wealth in any form, money or whatever, from someone else to meet my needs? If everybody on this forum decided any one of you must give us money to meet our needs, does that make it right? I may give as much or as little as I wish for the welfare of any other person. But I do not have the right to force others to contribute or take money from them to support whateveer charitable cause I wish to support.

A couple of items which answer the "But what if" and which some of you might find enlightening:

1.) http://www.redhotlogo.com/MACBFAC4.htm The full text of "Many Are Called But Few Are Chosen" by the late 70 H. Verlan Andersen

2.) http://www.zionsbest.com/proper_role.html The test of "The Proper Role of Government" by Ezra Taft Benson

3.) http://www.freelythinking.com/davycroc.htm At story by and about Davy Crockett taken from "The Life of Colonel David Crockett", compiled by Edward S. Ellis, 1884

Roper · Senior Bucketkeeper

lundbaek wrote:

Do I have a right to take wealth in any form, money or whatever, from someone else to meet my needs?

Our government seems to think so. We do it through taxes to meet the needs of society. So the question then becomes "Should national health care be considered as a measure to meet the needs of society."

Do citizens whose homes and businesses are destroyed by natural disasters have a right to receive aid from FEMA? How is a health disaster any different?

Thank you for the links, Lundbaek. I'll be able to respond more intelligently after I've read them.

rayb · Hot Air Balloon

I don't want to pay money for things like medicine. I want to spend my money on my pleasures. Things like family vacations or really yummy food. I think everything else should be free. I also don't like paying for car repairs, or when my computer breaks down.

--Ray

Roper · Senior Bucketkeeper

After more study and thought, I've modified my position. At this point, I think national health care for everyone has more disadvantages than advantages. Except for one area: I think we as a society, should provide free health care for children (pre-natal to age 18) just as we provide free education. In education, parents have the choice of private, parochial, and home school. That type of choice should be preserved for health care--parents should have the choice to provide health care for their children in whatever way they choose. Publicly-provided free health care should be one of those choices.

rayb · Hot Air Balloon

that seems a rather reasonable compromise, in that adults can choose the level of care they want to have.

I do like the idea/compromise Romney came up with in Massachussets, doing deals with insurance companies to buy down pricing in basic medical costs as well. Buying medical care in bulk does have certain benefits over having to pay really steep prices for the same basic care.

I also wouldn't mind seeing the elimination of certain medical hurdles, the ability to self-diagnose and such, more freedom, perhaps more ability to research medical conditions onlline, etc, will bring this about... but why should I be forced to go to a clinic to get told that I have a virus and there's nothing they can do? Perhaps even simple diagnostics could be outsourced or moved to the home-remedy level? I mean that strep test for example? Can't they have a Home Strep test, like they have Home Pregnancy tests? Easier to obtain vaccinations, and do-it-yourself gene therapy kits... more diagnostic tools to the masses, you might could remove some of the "rushes" to the E.R. during cold season, and only those who were "really sick" would end up getting the treatment they need...

--Ray

-- Edited by rayb at 22:06, 2006-12-29

Roper · Senior Bucketkeeper

Lundbaek, thank you for the links. As I read the referenced material, I was able to look at this issue from another perspective.

I have also been trying to square the realities of the poor health conditions of the kids I teach with the convictions I have about the role (and size) of government and my opposition to increasing government regulation in the lives of citizens.

I remain convinced that an investment in the health of our children will yield great benefits to our society. And the conditions in which some children live break my heart. But at the same time, I'm beginning to understand that it's not the government's job to take care of that. Considering the failure of so many government programs with similar aims, I think the government administration of such a program would also end in failure, and that would be particularly disasterous for the population it intended to serve--children.

I don't accept the status quo that fails to meet the health and medical needs of so many children. What are other options for reform?

rayb · Hot Air Balloon

What about preventative medicine? Are they advanced enough to be at all effective?

Would vitamins, vaccines and hygeine products help those you mention, or would they only create dependency?

--Ray

TitusTodd · Senior Member

I remain convinced that an investment in the health of our children will yield great benefits to our society. And the conditions in which some children live break my heart. But at the same time, I'm beginning to understand that it's not the government's job to take care of that. Considering the failure of so many government programs with similar aims, I think the government administration of such a program would also end in failure, and that would be particularly disasterous for the population it intended to serve--children.

I have a big concern with parents who do not have their children's health as high a priority as it should be. What they can "afford" appears to be elective. The children's health plan here in Texas (Chips) got a lot of guff when it worked to reduce enrollment. How did they do it? They included in the application for qualification a request for what autos the applicants had (including model, year and etc.). It is a matter of priorities and I've all too often seen a fancy truck or SUV as a priority over health insurance and the State's action addressed that problem.

I agree putting government in charge is not the answer. I'll point you to my blog where I addressed the issue of universal healthcare. I postulated on what would happen if we went that route (largely based on what has happened in Canada). I apologize for deferring to my blog but I did a lot of exploration on the topic that I don't have the time to rehash here.

One thing I do like about the plan Romney was instrumental in placing in Massachusetts is mandatory coverage. The rest I'm still working through.

Cat Herder · Understander of unimportant things

I have a problem with saying that anything is mandatory with regards to insurance. Mandatory access to health care is one thing, but mandating that all have insurance as a prerequisite to health care is wrong. It is a pernicious form social engineering. Sure, there are going to be people who will not choose to take as high a priority on being insured as others, but is it not their decision?

Too often, many other things get attached to that sort of social engineering. Think about how auto insurance has gone over the years. It is now law in nearly every state (if not already so) that in order to obtain the license tags (or renewal stickers), proof of the auto being insured has to be provided. Likewise, it may not be long before proof of being insured is a requirement for obtaining a license stating you may drive a vehicle (if it isn't already).

Sure, there is the argument that if something catastrophic happens, that everyone ends up having to pay for the person who is not covered. But, my contention against being required to have insurance is as follows: If the individual(s) who have to pay for that insurance do not put claims up against the insurance policy in at least the same amount as is coming out of pocket to pay for the covereage and deductibles, then the only one that is benefiting from the mandate for the individual to have coverage is the insurance carrier. It amounts to nothing more than government / institutional mandated extortion in the form of "protection money"...

{Godfather voice} See, if yous pay us dis money each month, if'n Vinnie here or some other bozo comes and accidently breaks yo leg, well we gonna make sure to pay some of da bills. See you is treated like part of da family... But if yous don't pay us dis money each month, well when Vinnie comes and breaks yo leg, we ain't gonna pay anything and you'll be without da help of da family... And well, we can't let you not be a part of da family, so we've advised da elected officials to remind you that you are going to be part of da family... {/Godfather voice}

Pt314 · Senior Member

Cat Herder wrote:

I have a problem with saying that anything is mandatory with regards to insurance. Mandatory access to health care is one thing, but mandating that all have insurance as a prerequisite to health care is wrong. It is a pernicious form social engineering. Sure, there are going to be people who will not choose to take as high a priority on being insured as others, but is it not their decision?

Too often, many other things get attached to that sort of social engineering. Think about how auto insurance has gone over the years. It is now law in nearly every state (if not already so) that in order to obtain the license tags (or renewal stickers), proof of the auto being insured has to be provided. Likewise, it may not be long before proof of being insured is a requirement for obtaining a license stating you may drive a vehicle (if it isn't already).

Sure, there is the argument that if something catastrophic happens, that everyone ends up having to pay for the person who is not covered. But, my contention against being required to have insurance is as follows: If the individual(s) who have to pay for that insurance do not put claims up against the insurance policy in at least the same amount as is coming out of pocket to pay for the covereage and deductibles, then the only one that is benefiting from the mandate for the individual to have coverage is the insurance carrier. It amounts to nothing more than government / institutional mandated extortion in the form of "protection money"...

{Godfather voice} See, if yous pay us dis money each month, if'n Vinnie here or some other bozo comes and accidently breaks yo leg, well we gonna make sure to pay some of da bills. See you is treated like part of da family... But if yous don't pay us dis money each month, well when Vinnie comes and breaks yo leg, we ain't gonna pay anything and you'll be without da help of da family... And well, we can't let you not be a part of da family, so we've advised da elected officials to remind you that you are going to be part of da family... {/Godfather voice}

Interesting that you bring up mandatory car insurance, since that is what the massachusetts health plan is compared to, (It's no big deal, it's just like car insurance). I am not so sure, and still studying the issue.

TitusTodd · Senior Member

One of the problems with cost of healthcare are those that aren't paying for it. They go to the emergency room, receive care and never pay for it or for very little. Someone has to pay for it so those who do pay for their healthcare are paying for those who don't as well.

My mandatory comment was typed on the run so I wasn't able to explain further. I would like everyone to either have some sort of coverage - insurance (employer or individual) or medicaid (or other government provided assistance to those who truly cannot afford insurance and/or care) - or certify they will pay for their own care. I don't think anyone should be forced to pay for insurance they don't need.

rayb · Hot Air Balloon

MY current problem with health care is that I can't afford it.

--Ray

TitusTodd · Senior Member

I ran into this comment today:

“If you think health care is expensive now; wait until it is free.” Political Satirist P. J. O’Rourke

Cat Herder · Understander of unimportant things

TitusTodd wrote:

One of the problems with cost of healthcare are those that aren't paying for it. They go to the emergency room, receive care and never pay for it or for very little. Someone has to pay for it so those who do pay for their healthcare are paying for those who don't as well.

My mandatory comment was typed on the run so I wasn't able to explain further. I would like everyone to either have some sort of coverage - insurance (employer or individual) or medicaid (or other government provided assistance to those who truly cannot afford insurance and/or care) - or certify they will pay for their own care. I don't think anyone should be forced to pay for insurance they don't need.

See that is the quandry of the model we operate under for health care. From a consumer standpoint, it is very much a commodity. Demand does not decrease. From the provider standpoint, it is a for profit enterprise. Providers control the supply and market prices in concert with the insurance companies. Laws often prevent hospitals from turning people away regardless of ability to pay, hence the price is higher for everyone else because the hospital is going to still recoup cost and potentially profitability from all the others who can pay out of pocket or via insurance.

Now, if we change the current model to where everyone can receive health care without having to worry about paying for anything directly, does it really change the industry? In my mind, it threatens the profitibility of healthcare corporations. Then, you run the real risk of lower quality care as the workers in the industry will have little compensation incentive to stay in their A game. The financial abuses of the industry and by the industry will only be shifted to other areas. If the government "insures" payment of medical claims (funded by whatever means they devise, yes, most likely via taxation), then some sort of elaborate means of bilking the system will come into play so that as much money can be siphoned off as possible. We see it currently in the mental health arena with medicaid / medicare... multi-layered shell organizations taking their cut for every billable service that is billed back to the government. They provide no value added services or products, are simply "administrating" things, and by the time the actual provider of services get's paid it is a small fraction of what was billed to medicaid / medicare to begin with.

But, perhaps the answer is forcing the industry to stop doing this by way of making sure no person is without insurance... put everyone in the same healthcare pool, everyone on the same insurance, and thus make the cost of health care affordable for everyone. The government would pay for the premium for everyone's policy to a consortium of insurers. The consortium would actually be providing the payment of claims, and each consumer would have a set, affordable co-pay tiering, based solely on the service provided, regardless of where it is provided. If something like this is what you had in mind for "mandatory health insurance" TT, then that is probably a good idea. Nothing changes the basic model except who pays the premiums, and perhaps the negotiated price for services goes down due to economy of scale, and everyone ends up a winner. Providers because they don't have to worry about eating cost, consumers because they all will be on equal footing as to what they pay and no one will have to worry about not having access or coverage, insurers will simply be getting the revenue streams from a different source and can still do what they do to earn a profit, and the government can get out of "health care" from the sense of having to micromanage (in an ideal system...).

PT314, the problem with mandatory insurance as I see it is that the government mandates it (ostensibly as a way of lowering the social cost to everyone else) and the consumer has to pay for it out of pocket. The result is insurance companies know they have a captive consumer base, and rates start going higher. There are many where insurance premiums are a true financial hardship. In Michigan, where proof of auto insurance is required for obtaining your tags, the law is no-fault concerning accidents. Therefore, everyone's rates are higher because your own insurance company pays your claims, even if you are not at fault for the loss, accident, etc. And, on top of that, as a hedge against uninsured motorists, the insurance companies are able to get away with tacking on an additional assessment (which can equal a couple hundred extra dollars per policy period) that goes into some sort of "pool". The government has no control over the pool or what the rate determined by the licensed insurers in the state decide to make it for the year, and each insurer can decide whether they want to charge even higher than that rate (which many do). Consumers have no say.

To give you an example, I have a perfect driving record. No tickets, no My wife was cited in one fender bender (which only broke a turn signal on our vehicle and scratched some paint on the other vehicle) about 5 years ago. We drive two vehicles, both 8 years old. Pretty low risk, wouldn't you say? Well, even with all the discounts we get for using the insurer for our home insurance, etc., we're still paying around $1600.00 or more a year in auto insurance. Why? Because of the state we live in and it's laws. Have we gotten benefit back from having this insurance anywhere equal to the amount we have paid for it? H-E-DOUBLE HOCKEY STICKS NO! But, we are legally mandated to have to pay it or else we are breaking the law if we start up either of the cars.

But, in another example, I used to work for a small business. It consisted of probably 5 people at it's peak while I managed it. The owner wanted to have the opportunity to bid on jobs with big companies and to be a subcontractor to specific construction jobs and certain government entities. But, in order to be considered qualified to bid, bidders had to carry a certain level of business liability insurance (considerably higher policy value than what he carried). That was a cost he didn't want to pay for a long time. And he didn't. So, he was never invited to bid. But the business still did well. It just couldn't grow the way he would have liked to see it. Eventually, he decided the expense was a worthwhile investment as it enhanced relationships with several customers, so he obtained the insurance. But see, it was his choice, not a mandate by law simply to do business generally with the public.

Okay, sorry... I'm rambling, aren't I?

TitusTodd · Senior Member

From another thread:

And in these cases, the government(s) has not mandated socialized medicine, they have mandated everyone have health insurance. Why? I can think of only two reasons... so that 1. everyone has universal access within the citizenry of the jurisdictions; or 2. to provide corporate welfare to insurance companies by making sure they have revenue coming in from every person in the geographic area / provide corporate welfare to hospitals and health care providers to make sure they get some money for all services they provide.

A reason you haven't cited for why government would mandate health insurance is because private companies do a better job of managing cost and care than the government. An example of this is with Medicare's new prescription drug plans (Medicare Part D). Costs since put into place have been lower than expected. Some of the credit for that result should go to the approved providers of the plans. When you put the government in control, cost management is, if ever achieved, by force and not by true "negotiation" with providers. If government were in charge we would see politics and beaucracy inflate costs.

Care access has already been achieved but cost containment has not been. With all the cost shifting coming from uninsureds who do not pay and Medicare and Medicaid with their limited cost reimbursements, cost is diproportionate to those who do pay for care either directly or through health insurance coverage. No, that it is not nearly that simple but it is part of it.

So, another reason for mandating coverage is to force people to be responsible for their healthcare by some means, namely insurance. Many are already doing fine on their own but the thorn in the side are those few that are not. We often suffer and are sometimes punished for the few.

arbilad · Head Chef

This article talks about a hospital in the UK that is going to allow people to pay for operations in order to jump their place in line. It also talks about all the financial woes that the UK system is having.
This goes to show how expensive and inefficient government managed healthcare is. I don't like the idea of providing government health care to any group, because that would be the camel's nose under the tent door. If you can provide it for poor children, why not for low income mothers? And then for people who are only a little over the poverty line. Eventually everyone would want it, and it would spread.
Besides, the article points out the inefficiencies of such a system. Wouldn't it be better to serve those kids by setting up private charities for the purpose? Indeed, some amount of that happens already. My Bishop is a dentist, and a whole group of dentists got together one Saturday and donated 60 hours of work to fix homeless people's teeth. In our church we provide for many needs of the poor in our church through a fast offering. Such a charity would remove the burden on the paying patients.

Cat Herder · Understander of unimportant things

So, are you saying that a "charity" to help the burden of those paying the bills is a good thing or a bad thing? I'm not clear there.

Seems to me there are a number of those out there already, though it is not comprehensive unless it is a certain income level or affliction.

Shriner's Hospitals for burn victims, for example, lots of things for terminally ill kids, and there is even the welfare related type things (United Way, etc.) for need based off income or disability.

No one has commented yet on what they see as the merits or problems of the government mandating health insurance coverage and then picking up the tab for the insurance premium. I'm not saying they pay the health care bills... just the insurance for making sure everyone is covered.

I think part of the problem with the health care system in the UK is that it is treated as a commodity, and since there is no or little financial burden directly on the user, it gets utilized inefficiently. I could be wrong. I don't know much about it. But, the truth is that with the way malpractice and stuff is going, we are heading ever more and more towards something like this where primary care givers are doing less and less and everything gets referred to a specialist or to a hospital. About the only thing a doctor's office is good for anymore is to incurr a office visit fee every time you walk in the door and maybe get a prescription or two. Need an x-ray? They send you to the ER. Need anything but simple tests run? They send you to the ER. Need stitches or a sprain examined or a broken bone set? Go to the ER. And every single different doctor you see results in an additional charge. And of course, don't forget the followup visits you have to do. No, it isn't a one fee for the whole condition. It is a set fee per visit to the office / ER / hospital, regardless of if the doctor spends 5 minutes with you to say "you've got a sinus infection, here is a prescription to take care of it" or spends 30 minutes with you in consultation about your health and provides a full physical...

I'm probably a little closer to this than many of you... our family hardly goes a month here the past several years where we haven't had someone in the hospital for a day or two or a visit to the ER (and all this in addition to the ridiculous amount of visits to the pediatrician and various specialists). Just had a daughter get out of the hospital yesterday afternoon after spending over three days there with pneumonia. Is anyone going to help us with the bill? No. Our insurance will pay a nice hefty sum, and we'll be left with a hefty co-pay that we will be paying on for months to come. And this is in addition to all the other medical bills we have over the past couple years.

For you naysayers of anything close to socialized medicine, let me just say, you don't really know how our "capitalist" market based system of a basic need all have (or will have a need for at some point) really impacts a family financially until you have had to face the failure of our system... It should not cost a sizeable portion of a family's income just to pay those bills, which is in addition to the taxes paid for government provided welfare related medical care for certain select groups in the population, and the cost of insurance premiums (which, by the way if they are deducted from your paycheck as pre-tax dollars you don't get to include in your actual annual medical expenses for itemized tax deduction purposes).

arbilad · Head Chef

I think it would be a good thing if charities picked up more of the slack.
And yes, our current system has many failures. But moving towards any kind of socialized medicine guarantees that the cost goes up, whether you're paying it out of your pocket or in paycheck withdrawals for taxes. The article I linked to was an excellent demonstration of that.
Ultimately we should be thinking of ways to both make healthcare cheaper and increase people's ability to pay for it, not look for ways to force someone else to help pay for it.
I agree with you Cat, our current system is way too expensive.
Of course, one way we deal with that in my family is to use herbs and natural medicine for most of our needs, and only go to the doctor for stuff that herbs and stuff won't handle.

Cat Herder · Understander of unimportant things

One of the things a lot of people may not recognize about health insurance they may get through their employer is that it does have an impact on them indirectly if the policy(s) provided by the firm are what is termed self-insured. What this means is that the company ends up funding the payment of the bills "covered" by the insurance. I don't know if it is 100% or if it is a portion. But, the greater the cost to the self-insured policy provided by an employer, the more cost the employer has. And the greater the cost to the employer, the harder it is going to be for the employer to have funds that can then be utilized to increase payroll and salaries. Hence, less take home pay for all employees. And this is why so many companies end up lowering coverage on health insurance, so that it doesn't cost them as much. It is not the company's portion of the insurance premium... it is the actual cost of paying the bills that become their responsibility under a self-insured plan.

From that perspective, I really do not agree that it would be more expensive to all if the government came into the picture from the limited model I suggest. Maybe I'm being simplistic. The government basically gets in there and just pays the premiums. Government pays your premium, you have a tax withholding and that is less than what is deducted from your paycheck or out of your pocket for your employer's or self-insured health plan. The insurance companies still gather their revenue (and probably more since all would have coverage and have policies). The insurance companies negotiate the rates (perhaps with some assistance from the government) on everything so that no provider is allowed to charge whatever they want for something, but it is a fair and reasonable amount. The insurance companies still do what they do to have positive cash reserves via investments and by paying out less than they take in. And, along with this, major tort reform needs to occur in every state to limit the amount on malpractice. Get lawyers out of the health care equation, and the prices of everything should come down. With anything where money is involved, though, there is going to be the propensity for corruption. That is the reason it will always fail, regardless of what is done.

Roper · Senior Bucketkeeper

Previously, a comparison was made between auto insurance and health insurance, and that the government requires auto insurance so why not health insurance.

As I understand it, the government requires auto insurance at the liability level to ensure that citizens remain responsible in meeting their obligations to other citizens when harm is done. I believe that is a legitimate role of government.

Health insurance, on the other hand, addresses the consequences of environmental factors and/or lifestyle choices. Those considerations are not the legitimate role of government.

The distinction becomes less clear when children are involved. Many children, who are citizens, suffer health consequences because of environment and choices of their parents, who are also citizens. In these cases, one can argue that the legitimate role of government in protecting citizens from the harmful actions of other citizens warrants a government requirement for health insurance for children. The question then becomes "Who provides the insurance?" Should the government require legal guardians to provide health insurance for children? Or should the government provide the insurance?

TitusTodd · Senior Member

One of the things a lot of people may not recognize about health insurance they may get through their employer is that it does have an impact on them indirectly if the policy(s) provided by the firm are what is termed self-insured. What this means is that the company ends up funding the payment of the bills "covered" by the insurance. I don't know if it is 100% or if it is a portion. But, the greater the cost to the self-insured policy provided by an employer, the more cost the employer has. And the greater the cost to the employer, the harder it is going to be for the employer to have funds that can then be utilized to increase payroll and salaries. Hence, less take home pay for all employees. And this is why so many companies end up lowering coverage on health insurance, so that it doesn't cost them as much. It is not the company's portion of the insurance premium... it is the actual cost of paying the bills that become their responsibility under a self-insured plan.

Regardless whether a plan is fully insured or self-insured, the cost of providing the benefit impacts salary and/or whether or not an employer continues to provide that benefit. Most self-insured plans are set-up to provide a certain amount per employee and for dependents into an "account" from which claims are paid. Each year the amount of claims are reviewed and the amount put into the self-insured "account" are adjusted. Most self-insured plans have stop-loss coverage that picks up the liability for claims should they reach a certain point (usually above what is in the claims "account"). Fully insured plans just put all that responsibility onto an insurance company rather than internally by the employer or by a third-party administrator (usually the case).

I really don't see how your setup works, Cat. You get the government involved too much and you might as well just go for a government run system rather than mucking up a market system with the government. The states with the highest costs for health insurance are those where the state governments have decided to intervene with coverage and rate mandates. Kentucky, for example lost all but one provider of health insurance due to rate mandates and had to reverse course somewhat to get them back.

As I understand it, the government requires auto insurance at the liability level to ensure that citizens remain responsible in meeting their obligations to other citizens when harm is done. I believe that is a legitimate role of government.

Health insurance, on the other hand, addresses the consequences of environmental factors and/or lifestyle choices. Those considerations are not the legitimate role of government.

The mandating of health insurance is meant to ensure that citizens remain responsible in meeting their obligations to healthcare providers rather than passing on those obligations to other citizens causing inflated care costs. Auto insurance also addresses the consequences of environmental factors and/or lifestyle choices - driving habits.

I'm not saying I'm all for mandating health insurance. At least, not yet. I do lean that direction but I would like to see how Massachusetts does with their program. I do think it could be avoided if all the current problems were addressed (see my blog post previously linked). Government intervention is a last resort measure (mandating coverage of some kind) and when it does happen, it has to be minimal, leaving choice intact.

Cat Herder · Understander of unimportant things

You're in the insurance industry, aren't you TT?

At least you sound like it. I have a brother-in-law who is an actuary.

I think you understand where I'm getting at with the idea of government paying the premiums for the mandated insurance policies though. Like several have indicated though, unfortunately I don't think it would stop there either, and there would not be any thing put in place that would keep the insurers from jacking up premium prices.

The mandating of health insurance is meant to ensure that citizens remain responsible in meeting their obligations to healthcare providers rather than passing on those obligations to other citizens causing inflated care costs.

Okay, that is a clear indication that the system is broken badly. There is all this talk about people being in control of their own health care and taking responsibility for it. Now, I'll wager there are those out there who don't do anything about it. But, all the rhetoric rings pretty hollow for individuals who have to utilize the system a lot more than others. 'Oh, well you are just not managing it very well.' 'Go to some different doctors then, shop around.' Once you go to any doctor, you are not in control of your health care again until that incident is taken care of. You have no power in negotiating a price with them, or getting a free trial period with them to see how they really are as a provider, and if you are sent to a specialist or the hospital for anything, you are not in control of who sees you or the prices or anything for that matter. The only thing that is in your control as a patient is to say yes or no to treatment, and then that is not even assured if you are in the ER or the like. The providers (due to fear of malpractice, etc.) will not let you go if you are not "stable".

Just the mere fact a person has health insurance, mandated or not, does not provide a guarantee that the person (or the insured individual the policy is under) is going to meet their financial obligation. It is no guarantee that the individual has the money to pay the co-pay, deductable, or other things that are not negotiated away by the insurance contract. And, there is no guarantee that just because a person has health insurance that a provider is going to accept it. And if they don't accept your insurance, well guess what, you are liable for the full charge.

So, the point I'm kind of getting at is that one way or the other, like it or not, we all are paying for other people's health care either in the form of higher incremental costs directly to us or to our insurance policy (which then is passed on indirectly to us as consumers). This way the providers cover their loss for non-payment / bad debt. So, what then is the real difference of instead of everyone paying a variety of rates to a variety of different insurers, why not just have the government, who mandates that everyone have insurance coverage for the very reason providers don't eat the losses, charge everyone a flat rate for that premium in the form of a tax and be done with it. It is simply moving the money out of our pocket from one bucket to another, with the chance that some of the money moved out of the first bucket gets to stay with us now since not all of it needs to go in the other bucket.

arbilad · Head Chef

I don't have time for a long reply, but I see several problems with what you suggest, Cat. You are right in that insurers will always pass the cost of non-paying customers on to the paying customers. There's probably no way around that. But, some form of that will always occur, even with your plan. For instance, people who earn more typically are healthier than those who are very poor. One of the reasons is diet. Diet is one of the most important factors in health. Granted, a good diet will not guarantee good health. But it is very hard to be healthy with a bad diet. And guess what? Poor people tend to eat at fast food places very, very often. It doesn't make sense to me, since it's cheaper to buy and prepare your own food. But it's a fact established by several studies. So, with the government guaranteeing that the health care premium will be paid, a lot of poor people with bad diets will now be covered by insurance plans. Note, I am not saying that this is a bad thing. It would be a very good thing for the poor people. But everyone's premium would go up because of it.

Add to that the fact that government is never efficient. Take, as a totally random number, $600 for the average health insurance premium (I know it's much higher than that, but I can't find a good number at this point). Not only will a bureaucracy have to be established, but the government feels the need to regulate whatever it gets involved in, so part of the bureaucracy will be an organization that checks that the insurer is controlling costs, not committing fraud, etc. The insurer will have to add bureaucracy to comply with the new regulations and to report their cost controlling efforts. They will pass that cost on to the consumer. The government won't take $600 out of your paycheck. They'll take significantly more to cover the cost of insurance provided to poor people, who it is politically unwise to tax. Then, after paying for your portion and some of the poor people's portion, there is an additional amount that is the government's cut. Money that passes through a government agency always gets trimmed. So, the average premium is no longer $600, because of the insurer's additional costs. The government takes out significantly more for its cut and to provide for the poor. I don't have hard figures (and I doubt that they're available) but that figure could easily double by the time everything gets started.

Don't forget other potential fallout. The government feels that it can control anything that it contributes money to. Ask any teacher how they feel about federal programs, and they are likely to get bitter. The government, if it was paying the premium for healthcare, would feel the need to dictate what sorts of care get funded. If there's a promising new treatment that may provide very good results for a certain group of people, but it's really expensive, the government is likely to lean on the insurance companies not to pay for the procedure. It's not like they're eager to pay for pioneering new procedures anyway. The quality of healthcare would inevitably go down.

Cat Herder · Understander of unimportant things

Thank you. Someone has finally pointed out specific problems that either would not be addressed or that would be created, and not just generalities that this is evil and / or goes against constitutional principles. (I think I now know how a high school English composition teacher feels trying to get folks writing essays to give concrete supports to their thesis statement instead of 'This is bad because it is bad'.

)

So, why then is it a good thing for government to mandate health insurance for all people within its jurisdiction? And if it is not really a good thing (under the economic model we operate in), what specificially is bad about it? Can it be both good and bad at the same time?

Euphrasie · Senior Bucketkeeper

'This is bad because it is bad'

Hey. What's wrong with that?

TitusTodd · Senior Member

Arbilad gave you a good response, Cat. I'll emphasize "Money that passes through a government agency always gets trimmed."

Just the mere fact a person has health insurance, mandated or not, does not provide a guarantee that the person (or the insured individual the policy is under) is going to meet their financial obligation. It is no guarantee that the individual has the money to pay the co-pay, deductable, or other things that are not negotiated away by the insurance contract. And, there is no guarantee that just because a person has health insurance that a provider is going to accept it. And if they don't accept your insurance, well guess what, you are liable for the full charge.

The presence of insurance provides a lot closer to a guarantee that the person and/or the insurance company is going to meet their financial obligation than no insurance. Most health insurance coverage these days is of the managed care variety (HMOs and PPOs), so the provider networks already have an agreement in place with the insurance company to provide services for a pre-negotiated price. If someone chooses to go out-of-network that this their responsibility. For a PPO plan there is still coverage out-of-network but for HMOs, often there is no out-of-network coverage. In the case of emergencies, most plans will cover you no matter where you go (because often you can't tell someone which hospital is in your network in such a situation). So, after so many words, there is a very good chance that someone with health insurance is going to have at least a good portion of their care paid for by them and their insurance company. Who would you rather admit to your hospital or care facility? Someone with health insurance or someone without?

So, why then is it a good thing for government to mandate health insurance for all people within its jurisdiction? And if it is not really a good thing (under the economic model we operate in), what specificially is bad about it? Can it be both good and bad at the same time?

There is no simple answer to that. It depends how much government tries to control the mandated health insurance, who the mandates fall on and how (employer and individuals). I think people should have the opportunity to self-pay if they have the income to do so. Encouragement should be provided to have some kind of coverage with the inclusion of self-pay. Choice in plans and care need to be protected to maintain the benefits of competition both in the insurance and healthcare industries (which are more apt to keep costs down than government intervention). There is definitely some good and bad involved. It is not attractive to mandate anything but with more people being in the pool of risk, coverage costs will go down as the risk is spread and more healthcare obligations are being met. However, I can picture government being tempted to do more. I can see another bureaucracy being created to manage the mandates and overseeing compliance perhaps costing us more in taxes (though that burden would largely fall on providers).

You're in the insurance industry, aren't you TT?

How could you tell? The insurance agency I have worked for for the last 11 years sells health insurance. At one time my primary responsibility was as a employee benefits specialist for the agency (it is now one part of many of my responsibilities). Health insurance is not our primary product so we sell it upon request and do not actively solicit it. Health insurance is a labor intensive product to sell and to service so it is a hard product to make a living on. I'm also a member of the National Association of Health Underwriters. I'm not a "salesman" but provide sales support. As I job hunt, however, I'm looking to get out of insurance and maybe into human resources.

arbilad · Head Chef

Euphrasie wrote:

'This is bad because it is bad'

Hey. What's wrong with that?

In my opinion, it's the difference between saying "Tobacco is bad because it's against the Word of Wisdom" and saying "Tobacco is bad for the following health reasons..." What we were saying earlier, Cat, was just relating the principle of the thing. Socialism is bad. In my recent post I gave you some of the reasons. But prophets have said it is bad, so it is still indisputably bad.

Cat Herder · Understander of unimportant things

How could you tell?

I'm smarter than the average bear! How does that saying go, the fool speaks while the wise man has the wisdom to hold his tongue? I've purposely been playing the part of the fool in this discussion so that I could encourage someone with some industry wisdom in the area to share some insight. I figured there had to be someone in our august body that was more than just a consumer.

I know of a couple men in my ward who are in HR. And one of the areas of emphasis for my MBA was in HRM. Unfortunately, I've never been in able to work in the area. In my situation, too educated for the trenches and too inexperienced for the officer corp...

One thing I do wonder in the terms of cost controls in health care, and I do know that all stake holders in the payment side of things have it in their best interests to get prices down and expense under control, is on the provider side, how much do market forces really incent them to keep prices down (this is not only the doctors and hospitals and facilities, but the vendors and suppliers to the providers). Is this perhaps also an area where the model is broken? In the auto industry, for example, the manufacturers (Ford, GM, Daimler-Chrysler, Honda, Toyota) do not just go to their suppliers and say send us 100 of this part every 2 hours for the next year and we'll pay you for it. When they are forced to tighten their belt, they go to their Tier 1 suppliers and tell them you will continue to provide us 100 of this part every 2 hours for the next year and this is what you will be selling it to us for. Yeah, I know it sounds awful, but if the supplier doesn't comply, they lose the business and/or could go out of business altogether. Somehow, I don't think this is how the relationship between suppliers and providers in the health care industry operate. I think it is more or less you want this Mr. Provider, well it is going to cost you x and guess what, since our expense has risen, we can't let our profit margin erode, so next month it is going to cost you x+y.

Euphrasie · Senior Bucketkeeper

But prophets have said it is bad, so it is still indisputably bad.

So, it's not 'bad because it's bad' but 'bad because the prophet says it's bad?'

I agree that there are always reasons, but we don't always know what they are. Word of Wisdom is a pretty good example of that. I don't think it's too far of a jump from 'it's bad because it's bad' to 'I believe it's bad even though I don't know why.'

Cat Herder · Understander of unimportant things

arbilad wrote:

Euphrasie wrote:

'This is bad because it is bad'

Hey. What's wrong with that?

In my opinion, it's the difference between saying "Tobacco is bad because it's against the Word of Wisdom" and saying "Tobacco is bad for the following health reasons..." What we were saying earlier, Cat, was just relating the principle of the thing. Socialism is bad. In my recent post I gave you some of the reasons. But prophets have said it is bad, so it is still indisputably bad.

The thing is in order to not end up sounding like zealots of ultra-conservative reactionary political ideology, more needs to be said in a manner that does not end up getting viewed as mere rhetoric. With the exception of those individuals who will accept what someone says at face value of this is bad and the person saying it is a General Authority, often a more compelling argument (or explanation) is useful. Not that people are all as skeptical as to be from Missouri (e.g. Show Me), but they need concrete concepts on which to base their views, not just the rally cries.

I know that socialism is simply a milder form of communism, and I know that communism is not a philosophy that is compatible with Christ's Gospel. And I know that there have been several General Authorities and a couple three or four Presidents of the Church who have made specific statements concerning this. I don't think there are many people who have been members of the Church most of their life who aren't aware of this same thing.

The reason why these philosophies are not compatible is due to the influence to remove freedom of choice and from thence the ability to be self-sufficient. In other words, they enslave the mind and soul. Socialized medicine is a great example of how this works. The spiritual principle needs to be brought down to a more temporal demonstration of how a concept passes or fails a litmus test.

See, in my mind, there is very little difference from an enslaving viewpoint between mandating insurance by a government and a government then paying for the insurance premium it mandates. Some folks don't have a problem with a law being made that requires folks to carry insurance. I do, because it removes my ability to choose. Is it a wise thing to carry insurance? In our society and culture, yes. But, in the eternal scheme of things, will it matter? Don't know. Do we become enslaved by assuming the risk of not having insurance and being financially ruined should something happen, or do we become enslaved to the payment of insurance premiums to the point that our life revolves around not losing coverage so we can be financially solvent should a crisis occur? Maybe because pretty much my whole married life it has been one or the other most of the time, and neither has been an easy thing financially, I have not seen a lot of difference between the two as far as being "free". And from even an early time in married life, health care expense has been an issue for my family that a lot of others take for granted or don't have, I guess one could say our current system has a very "enslaving" aspect about it. Do I want things to become socialized for health care? Absolutely not. But, there is also a lot of similar problems in our system that already exist, and in all honesty, it probably won't be too much longer before more and more people are so fed up with the expense they have to bear to get care for their health issues that they will gladly vote something into place only looking at the short-term benefit.