The most critical issue in years

[firstandten]

As a people we are going to need to address this in a big way really quick. You may not like this but we may have to go to a single payer health care system. Ether that or we may see financial ruin for millions of people in this country. This is the issue thats either going to make Obama a one term president or one of the greatest presidents this country has ever had.


"Since the day she was laid off in October, Ms. Walker and her husband, Russ, co-owner of a struggling feed store here on the outskirts of Houston, have mounted a largely fruitless quest to find affordable coverage for Jake’s pre-existing condition. Their odyssey has become all too familiar to millions of newly uninsured Americans who suddenly find themselves one diagnosis away from medical and financial devastation.
The Walkers, both 46, are among nine million people who have lost employer-sponsored insurance since December 2007, according to projections by the Kaiser Family Foundation. Some have qualified for government insurance, and others have bought individual policies. But an estimated four million have joined the ranks of the uninsured, heightening the urgency in Washington to close the coverage gaps in American health care"

http://www.nytimes.com/2009/04/21/us...nsured.html?hp

[Stosh]

I absolutely agree that some sort of national health care is needed. Question is, how will it be funded? Can we expect that the government will be picking up the tab, or a more likely option of a national sales tax, ala Canada?

[firstandten]

I absolutely agree that some sort of national health care is needed. Question is, how will it be funded? Can we expect that the government will be picking up the tab, or a more likely option of a national sales tax, ala Canada?

I like your option, its sure is better than folks going to the emergency room to get routine health care.

[oladub]

I absolutely agree that some sort of national health care is needed. Question is, how will it be funded? Can we expect that the government will be picking up the tab, or a more likely option of a national sales tax, ala Canada?

We don't need a 'national health care' system. We instead need a more 'affordable health care' system. Government agencies in the US already spend more than government agencies in Canada per capita yet our medical costs are about twice as high as in Canada. The key seems to be eliminating administators, lawyers, and insurance companies [[ALI's) from medical care. The few doctors in this country who operate on cash only no lawsuit contracts with their patients charge half as much for office visits for instance. That, at least, brings the cost of office visits down to Canadian per capita levels.

After doing everything possible to get the ALI's out of the cost of medicine, there will still be some US citizens who will not be able to afford medicine. They presently get some free medical care in the emergency room of hospitals which is payed by other patients. It would be cheaper for states to have medical care programs to cover the indigent than having the destitute wind up at emergency wards.

from Wikipedia-
"the administration and delivery of health care [[in Canada is) a provincial concern."
Medicare is a collection of 10 different provincial agencies with each province having its own established universal health care plan. The federal government collects much of the money and then doles it out to the privinces.
"About 30% of Canadians' health care is paid for through the private sector. This mostly goes towards services not covered or only partially covered by Medicare, such as prescription drugs, dentistry and optometry. Some 65% of Canadians have some form of supplementary private health insurance"

[d.mcc]

Why is it that we are the only "First World" Industrialized nation without a national health care system? Is it the same reason we also have one of the highest infant mortality rates? What about a huge percentage of our population overweight and bordering on diabetic???

[Stosh]

We don't need a 'national health care' system. We instead need a more 'affordable health care' system. Government agencies in the US already spend more than government agencies in Canada per capita yet our medical costs are about twice as high as in Canada. The key seems to be eliminating administators, lawyers, and insurance companies [[ALI's) from medical care. The few doctors in this country who operate on cash only no lawsuit contracts with their patients charge half as much for office visits for instance. That, at least, brings the cost of office visits down to Canadian per capita levels.

After doing everything possible to get the ALI's out of the cost of medicine, there will still be some US citizens who will not be able to afford medicine. They presently get some free medical care in the emergency room of hospitals which is payed by other patients. It would be cheaper for states to have medical care programs to cover the indigent than having the destitute wind up at emergency wards.

Streamlining the national health coverage that is in place now [[Medicare and Medicaid) should be done, I agree. The medical costs are out of control, agreed as well. But realism would dictate that the problems you mention above, [[free care at hospital emergency rooms, spending overcharges) are purely a result of a system that allows the abuses and under coverage to continue. Our medical costs are twice that of Canada? Why is that? Could it be that national coverage is actually WORKING to bring costs down?

This "free" care at hospitals is a big part of the problem. Sooner that people have accerss to doctors or clinics that would treat minor ailments than having the hospitals soak paying patients as well as insurance companies.

[firstandten]

From what I seen thus far I don't think Obama is in favor of single payer health care, he did say that he saw a role for insurance companies. As a matter of fact I don't think Conyers and the single payer proponents were even invited to that WH health care pow-wow they had a few weeks ago. What will the insurance companies role be ? How do you keep them under control ? According to Obama part of the stimulus package is to steamline health care paperwork etc. Would that be the precursor to a comphensive health care package ?

I just hope DC doesn't have to build more hotel rooms to handle the flood of health care lobbyist that will soon be showing up.

[oladub]

Stosh, I was trying to make two points. One way or the other, the administrative, legal, and insuance costs must be brought under control to make health care affordable as has been done in Canada. I have not heard a word about President Obama reducing the presence of lawyers in health care. As firstandten points out, it sounds like Obama is also going to keep insurers in the game. Administrative costs follow the inclusion of legal and insurance costs. Is he also going to provide medical care for illegal aliens? All in all, it sounds like Obama is more interested in a national plan than an affordable plan.

The second point I brought up was that in Canada, each province has its own health care system. So why do people who want the Canadian system want, instead, a national system here? Why not have state run plans to imitate Canadian provencial plans instead? Massachusetts already has such a plan.

[firstandten]

All in all, it sounds like Obama is more interested in a national plan than an affordable plan..

I sure hope that isn't the case. That represents only incremental improvement over what we have now, but based on what you said that is a reasonable conclusion.

[Bobl]

Something is wrong when it is not economically feasible to get preventive care when one is between jobs, because of the possibility that a preexisting condition might be found that will disqualify the patient from future health insurance options.
It is not acceptable that nearly fifty million citizens are rationed out of care because they are without health insurance.
It is ridiculous that the wealthiest nation has mediocre infant mortality rates, and many citizens are one illness or accident away from financial ruin.
Yet, the need for reform seems to be a partisan issue, with one side urging change, the other claiming the system is not broken, and both sides in the pocket of the insurance companies!

[Stosh]

Is he also going to provide medical care for illegal aliens? All in all, it sounds like Obama is more interested in a national plan than an affordable plan.

The second point I brought up was that in Canada, each province has its own health care system. So why do people who want the Canadian system want, instead, a national system here? Why not have state run plans to imitate Canadian provencial plans instead? Massachusetts already has such a plan.

Illegals? I'd hope not. Or at the least find a way to bill their national government for their care and feeding. Maybe subtract it from their government's foreign aid payments.

Each province has it's own health care system in Canada, but is it portable between provinces? No. A sticking point in the health care negotiations at Chrysler Canada was the insurance that Chrysler provided that allowed members to get health coverage outside the province. I don't know how Massachusetts runs theirs, and I really don't know if I'd want Michigan running ours. Really.

[oladub]

Stosh, The Canadian collects the 'medicare' money and distributes it to the province health care systems. How can politicians at any level turn down an opportunity to sift money through their fingers? The provinces take it from there. In places like Louisiana and New Jersey, maybe voters wouldn't put up with so much corruption if their health depended on it. Maybe someone else can answer whether the Canadian government distributes the collected money to provinces on a per capita basis or adjusts for such things as poverty, age, other demographics, or political allegiance.

[ccbatson]

Whatever the mechanism...their system is failing rapidly.

[Gannon]

I don't care WHAT you all do with your health faith and economics, as long as there is ALWAYS an exemption for indigineous folk to NOT participate.

Those who wish to take their health in their OWN hands should be able to do so.

If we need to donate our fair share to a common emergency system, I'm happy to do that as long as my estate gets back what I didn't use in my lifetime.


You can give me NO excuse for joining your healthcare foolishness.

[firstandten]

I sure hope that isn't the case. That represents only incremental improvement over what we have now, but based on what you said that is a reasonable conclusion.

After I posted this as a response to Oladub statement that Obama seems to want a national health care program rather than an affordable program, I ran into a description of Obama's politics that I never heard before and that description was that of a "radical incrementalist". If thats the case him not pushing for single payer health care and keeping insurance companies in the game makes perfect sense. However I do think that given his bottom up political strategy and understanding whats in peoples self - interest the plan, however it looks will be affordable.

[rb336]

Whatever the mechanism...their system is failing rapidly.

and your evidence of this? oh, that's right -- you don't have any and by virtue of your ideology never have to have any. it goes against your dogma, ergo it is failing

[ccbatson]

Rb...wait times and rationing are all the evidence needed. The cherry on top being the FACT that Canada uses the US as a safety valve for their health care shortcomings.

Gannon, well put and very libertarian of you. One huge problem though. Like public schools, you can refuse to participate in the benefits, but you can't refuse to pay for it.

[Stosh]

I don't care WHAT you all do with your health faith and economics, as long as there is ALWAYS an exemption for indigineous folk to NOT participate.

Those who wish to take their health in their OWN hands should be able to do so.

If we need to donate our fair share to a common emergency system, I'm happy to do that as long as my estate gets back what I didn't use in my lifetime.


You can give me NO excuse for joining your healthcare foolishness.

Fantastic. Just as long as you are willing to pay for your behaviors with your own funds, more power to ya, I suppose. But for the possibility of a serious medical condition that would be paid for [[unless you are independently wealthy) on the backs of those that either have health care, OR have means to pay.

Not every serious medical emergency kills you, you know.

[rb336]

Rb...wait times and rationing are all the evidence needed. The cherry on top being the FACT that Canada uses the US as a safety valve for their health care shortcomings.

Gannon, well put and very libertarian of you. One huge problem though. Like public schools, you can refuse to participate in the benefits, but you can't refuse to pay for it.

Saying there is rationing and providing evidence of it are two different things entirely Bats. and no matter how BIG you type FACT, it doesn't make it so. We have FAR worse rationing here -- like 45 million with no health care [[or roughly 133% of the Canadian population)

[oladub]

Bobl & rb, Not to argue with your lists of our shortcomings but governments in the US already spend more per capita than do Canadian governments. Therefore, the problem is affordability rather than not enough government spending.

firstandten, I hope that Obama's "Radical incrementalist" health care policies don't benefit the lawyers, administrators, and insurance companies as much as Obama's "radical incrementalist" agenda has comforted the major banks. It sounds like a rationalization to me.

[Det_ard]

From http://keithhennessey.com/2009/04/09...ers/#more-1637








How many uninsured people need additional help from taxpayers?


Posted Thursday, April 9th, 2009, at 12:46 pm
When discussing health insurance we frequently hear that there are “46 million uninsured� in America. This figure is from a monthly survey of about 50,000 households done by the Bureau of Labor Statistics and the Census Bureau. This Current Population Survey [[CPS) then uses statistical techniques to paint a picture of the entire U.S. population.
Advocates for expanding taxpayer-subsidized health insurance, and their allies in the press, repeat this 46 million number constantly. It paints the following technically accurate but misleading picture:



This looks really bad. At least there are more than 250 million people with health insurance – that is clearly a good thing that we never hear it in the press. Still, there’s a lot of red there. It means that in 2007 [[15%) of Americans lacked health insurance, according to the CPS. Advocates, some elected officials, and the press round that number up to “1 in 6 Americans�. We hear that there are “46 million uninsured,� and then we jump to the conclusion that government needs to help 46 million people buy health insurance, subsidized by taxpayers.
Let’s look inside that 45.7 million number and see what we can learn. Here is our key graph:

First, I need to make a technical disclaimer. I had this same detailed breakdown for 2005 data, done by health experts when I was part of the Bush Administration. I now have a 2007 total [[45.7 million), and so I have proportionately adjusted the components to match that new total. It is a back-of-the-envelope calculation, but I am confident that it is solid, and it does not move any component by more than two hundred thousand. In addition, the expert analysis I am using ensures that the subdivisions shown above do not overlap. I will slightly oversimplify that point in the following description of the breakdown to make the explanation readable.
Let us walk through the graph from top to bottom.

• There were 45.7 million uninsured people in the U.S. in 2007.
• Of that amount, 6.4 million are the Medicaid undercount. These are people who are on one of two government health insurance programs, Medicaid or S-CHIP, but mistakenly [[intentionally or not) tell the Census taker that they are uninsured. There is disagreement about the size of the Medicaid undercount. This figure is based on a 2005 analysis from the Department of Health and Human Services.
• Another 4.3 million are eligible for free or heavily subsidized government health insurance [[again, either Medcaid or SCHIP), but have not yet signed up. While these people are not pre-enrolled in a health insurance program and are therefore counted as uninsured, if they were to go to an emergency room [[or a free clinic), they would be automatically enrolled in that program by the provider after receiving medical care. There’s an interesting philosophical question that I will skip about whether they are, in fact, uninsured, if technically they are protected from risk.
• Another 9.3 million are non-citizens. I cannot break that down into documented vs. undocumented citizens.
• Another 10.1 million do not fit into any of the above categories, and they have incomes more than 3X the poverty level. For a single person that means their income exceeded $30,600 in 2007, when the median income for a single male was $33,200 and for a female, $21,000. For a family of four, if your income was more than 3X the poverty level in 2007, you had $62,000 of income or more, and you were above the national median.
• Of the remaining 15.6 million uninsured, 5 million are adults between ages 18 and 34 and without kids.
• The remaining 10.6 million do not fit into any of the above categories, so they are:
  
  • U.S. citizens;
  • with income below 300% of poverty;
  • not on or eligible for a taxpayer-subsidized health insurance program;
  • and not a childless adult between age 18 and 34.
  
  

As a policy matter, we care not about the total number of uninsured, but about the subset of that group that we think “deserves� taxpayer-subsidized health insurance. That is a judgment call that involves some value choices.
I will make one value choice for you and boldly assert that, if you are already enrolled in or eligible for one free or heavily subsidized health insurance program, we can rule you out as needing a second. That simple statement reduces the 45.7 million number down to 35 million, by excluding the Medicaid undercount and Medicaid/SCHIP eligible from our potential target population.
I think most people would also say that the 10.6 million I have labeled as “remaining uninsured� and shaded in yellow above are the most sympathetic target population.
It then gets tricky.

• Should people with incomes near or above the national median get health insurance subsidized by taxpayers?
• How about non-citizens? Should we distinguish between documented and undocumented non-citizens? Between those who pay taxes and those who do not? Remember that we are not talking about who should get emergency medical care, but instead who should get taxpayer subsidies to finance the purchase of pre-paid health insurance. Does that change your answer?
• Many young adults and childless couples are in good to excellent health. Do they deserve subsidies, when they may be making what they believe to be a rational economic decision and using their financial resources for things other than buying health insurance? Should a 25-year old Yale graduate triathlete making $30K per year get his health insurance subsidized by taxpayers if he chooses not to buy it because his budget is tight?

There is no clear right or wrong answer to the above questions. You need to make your own value choices for them.

[Det_ard]

Now let us look at the effects on the totals for several hypothetical answers to these questions. Remember that the advocates, some elected officials, and press tell us that the numbers are: 46 million uninsured, 15% of the population, and 1 in 6 Americans “are uninsured.� I suggest you try to figure out which of the following is closest to your view.

1. Ann wants to subsidize everybody, but agrees that we don’t need to double-subsidize. She excludes the Medicaid undercount and Medicaid/SHIP eligible from her target population and ends up with 35 million people. That is still an enormous amount, but it is 10.7 million less than the headline number she heard in the news. Her target population is now 11.7% of the total U.S. population, down from 15%. Put another way, she would like taxpayers to help between 1 in 8 and 1 in 9 Americans who she feels are deserving of subsidies to buy health insurance, rather than the 1 in 6 she heard in the press.
2. Bob agrees with Ann, but thinks that subsidies should go to the poor, or at least not to those who have above the median [[or near median) incomes. His target population is therefore about 25 million people, way down from 46 million. That is 8.4% of the total U.S. population, or 1 in 12 Americans. That is still a huge problem, but it is very different from 1 in 6.
3. Carla agrees with Bob that subsidies should not go to those with incomes near or above the national median. She also thinks that undocumented citizens should get emergency medical care, but not taxpayer-subsidized pre-paid health insurance. I will guess a 50/50 split between documented and undocumented of the 9.3 million uninsured non-citizen, and I would appreciate it if someone could help me refine this. With this assumption, Carla’s target population is about 21 million, or 7% of the total U.S. population. That is roughly 1 in 14 Americans.
4. Doug thinks only American citizens with incomes below the national median [[and who are not already eligible for another program) should be eligible for additional aid. His target population is therefore the bottom two bars on the graph, or 15.6 million people. That is 5.2% of the U.S. population, or 1 in 19 Americans. If Doug were to further limit subsidies to those below 200% of poverty or 150%, his target population would be a few million people smaller.
5. Edie agrees with Doug, but thinks that if you are a young adult without kids, you should fend for yourself. Her target population is 10.6 million people, or 3.5% of the total U.S. population. That is 1 in 28 Americans.

These are, of course, not the only possible answers, but I think they are a representative bunch. Even for the most “liberal� set of answers [[Ann’s), the headline numbers we hear in the press overstate the extent of the problem by more than 10 million people.
Now even Edie’s narrowest 10.6 million target population is still a lot of people who lack health insurance. So why does it matter that the press gets the numbers wrong?

1. If we misdiagnose the problem, we could easily design the wrong policy solution. A solid quantitative understanding of who we would like to help and why is important.
2. Health insurance subsidies cost taxpayers tens of billions of dollars each year. If we target these funds well and prioritize, we can help more of the people whom we think are deserving of additional assistance, and fewer of those who need less help. If we target those funds poorly, we will waste a lot of money. This point is independent of the total amount we spend on subsidizing health insurance.
3. Health insurance competes with other policy goals for an enormous but still ultimately limited pool of taxpayer funds. We should neither overstate nor understate the problem to be solved, so that the tradeoffs with other policy goals can be considered fairly.

When you hear “46 million uninsured,� or “1 in 6 Americans don’t have health insurance,� remember that this is technically correct but misleading. The more important question is, “How many uninsured people need additional help from taxpayers?�
What’s your answer?

[rb336]

Bobl & rb, Not to argue with your lists of our shortcomings but governments in the US already spend more per capita than do Canadian governments. Therefore, the problem is affordability rather than not enough government spending.

firstandten, I hope that Obama's "Radical incrementalist" health care policies don't benefit the lawyers, administrators, and insurance companies as much as Obama's "radical incrementalist" agenda has comforted the major banks. It sounds like a rationalization to me.

Our costs per capita for health care are higher, without doubt. look at thedifference in administrative costs as a percent of health care in the US private sector -- it is FAR higher than for our govt. run system, which is higher again than Canada's and the European's

your second comment -- Obama is a corporatist. not as much as the bushes, or reagan or clinton [[who was more of one than bush 41, less than dubya), but still a corporatist

[ccbatson]

The troubles in the private sector do not find origin in a true private sector system. How so? 2 reasons:

1. Private insurers follow closely in the footsteps of Medicare/caid.
2. The government endorsed and promulgated paradigm where employers become the purchasers of insurance, adding at least 2 intermediaries separating the customer/patient from the purchase and utilization of services. The employer is driven to the lowest prices, the insurer is driven to minimize payout on claims. Both are vested interests contrary to the 2 primary parties...the patient, and the health care provider.