I think that's part of the problem with what's going on right now. The new plan is supposedly over a thousand pages long and from what I've seen, hardly any politicians have read the whole thing. Instead, they cherry pick parts that they either spin as a good or a bad thing. I was alarmed by some proposing that the plan require every citizen to get private health insurance or else face a fine for not doing so. It seems that this whole thing is gearing up to be a government enforced pipeline from the wallets of the 40 million or so uninsured people out there into the coffers of the insurance companies.
Great Discussions going on here...to chime in with my 2 cents 1.) I think we all need to take a step back and see what we are mostly bitching and griping about. Everyone is worried about paying to much money for health insurance weather it be because they have zero insurance or are considered under insured. The real problem with American health care only comes up in the worst 1% of illnesses and injuries. ex.) Cancer, Car Accident, Piano falling on your head etc..... As an average American with average health insurance 99% of the time this insurance policy works great I get sick with something I go to the doctor tell him it burns when I pee he writes me a script and I go home happier and only about $40 poorer. Basically I don't understand why because we are so worried about the worst of the worst happening to us we would feel the need to blow up a system that works quite well for us most of the time. 2.) Point two is easy AMERICAN has the BEST health care on the face of the planet everyone with money from any other country comes here to get there medical operations taken care of. This is because we have the best doctors, best facilities and newest and best medicine. You know what else is cool I know as an American Citizen if the worst does happen and I am in a car accident or the such I will get the best treatment on the planet and sure I might be screwed because I might owe a million dollars but personally I rather be alive and living a full and normal life bitching about how much I owe then to be dead. 3.) When it comes to why drugs are so cheep in other countries American: http://en.wikipedia.org/wiki/Pharmaceutical_industry Rest of the World: http://en.wikipedia.org/wiki/Generic_drug American Companies produce and develop the vast majority of the drugs today under American patent law they own the rights to that drug for about 15 years on average however it takes about 12 years to develop it and millions of dollars to research and comply with all the the trials necessary to make it available to the public. Once a drug is developed and ready for us its actually pretty easy to mass produce. This is what happens every where else a French Company takes the drug breaks it down and mass produces it and sells it at cost plus 20% without having to recoup any of the development costs. This leaves the American Drug companies trying to sell in the US the drug at the highest price possible in order to make money off of a product they developed.
You could get a plan that still covers the major medical but calls for you to pay a little more for your doctors visists. That would lower your insurance cost.
Keep in mind both bills contain significant new taxes, some of which are NOT INFLATION ADJUSTED taxes on income, in order to create subsidies for the working poor. This is obviously a problem, just as the AMT tax is, in that as you go forward in time, and nominal wages rise with inflation, more and more of the middle class will be subject to a tax intended to hit only the highest earners. The most disturbing aspects of the individual mandates to me are when you evaluate the costs of the House of Rep's insurance policy premiums - they would be in the neighborhood of 15k a year, which is much more than I pay out of pocket now, plus it wouldn't be tax deductible like it is when my employer pays those premiums on my behalf to Aetna. So, in other words, if my employer decides he would rather pay an 8% payroll tax on my income, and opt out of providing me with insurance, I would lose a significant part of my benefit package, and end up paying 15k out of pocket to pay for insurance to the government's public option plan. The inherent problem with the models of "reform" being pushed through right now is that it changes the entire system for everyone, instead of targeting the very real human problem of dealing with 30+ million uninsured Americans. When I hear "if you like what you have, you can keep it" I don't believe a word of it, because the politicians don't talk about downstream decisions an employer would make when faced with new taxes that are LESS expensive that dropping coverage for its employees.
Sure it can be argued that we have the best health care in terms of facilities and doctors, the issue here isn't really centered around that. The focus is more towards the accessibility to those doctors and facilities. In terms of accessibility we're nowhere near the best. What good are the best doctors and facilities in the world if they're financially inaccessible to a lot of people, especially in an economic climate where quite a few people are losing their jobs and can't afford to keep their benefits.
No. Stop watching Glenn Beck. Just to start - did you seriously say that no country other than the United States honours patents held on pharmaceuticals? I mean, really? Every other country in the world just doesn't give a fuck about patents on pharmaceuticals, and pharmaceutical companies don't take these violations to court?
That is very true. He did not say that no other country honors patents held on pharmaceuticals. He said countries like France produce it which would mean they don't honor our patent laws which is not uncommon for SOME countries. Other than stop watching glenn beck, what solutions do you have?
Maybe "every where else" means something different to you. By the way; very few countries still do "compulsory licensing", which is what this guy is trying to say happens everywhere else in the world, but actually doesn't. In any case, the patent holder still collects money on compulsory licences. India allows it, for example. Recently a generic company there was making an anti-retroviral (read: anti-HIV/AIDS) medication, which they could sell for cheap to the third world (which if you'll recall, is in desperate need of cheap anti-retrovirals), and the manufacturer, Norvatis if I recall correctly, filed a lawsuit to stop it. Wonderful stuff.
I may be in the small minority here, but I actually do think that the government has a responsibility to take care of its citizens, when speaking of health, and I think that all citizens have a right to have some basic health care from a system that they already pay into. I think of it as a government investing in its own country's future, in the simplest terms. What that means is a health care system that provides basic care - routine check-ups and doctor's visits. Maintenance care. Preventative care. Things that can keep you in check and allow you to address issues at the onset of problem or symptom. Preventative care and regular check-ups have the ability to save people more money in the long run. I'm pretty sure that many people these days go to the doctor when they are sick, and usually for no additional reason. After that, basic insurance should be considered, and I think it should be mandatory, with a tax penalty. Honestly, that tax penalty should be in the form of a government sponsored, federally controlled insurance plan. That gives the individual the choice of private or government-run healthcare. It already pretty much is mandatory today, if you want somewhat "affordable" insurance. If you currently opt out of insurance for any given reason in the U.S., you're likely going to meet some problems and extra expenses the next time you pick up a policy. So, if you would rather be blind to that and get angry with a system that does the same thing, but actually gives that transparency, then so be it. Just realize that our current insurance companies work much like auto insurance. If you had it and go without for longer than 30 days, you're going to pay for it. The insurance that should be mandatory is catastrophic coverage. Basic insurance coverage for the common cold or any other minor office visit (say to treat any minor symptom that may come up in your routine check-ups) should be completely optional. Keep plans like Health Savings Accounts, as well, because these can greatly benefit and supplement non-catastrophic coverage, and they're tax free. ER visits should be for emergencies only. I think that a person should be referred out if they are bringing their child to the emergency room because he or she has a cold, or for anything else that is not life-threatening. I think insurance companies should be regulated more, but should be left to be regulated by the state. Federal regulation does not work. It shouldn't be considered as a benefit of employment, either. We need private, individual options, and we need that big pot of our tax dollars in each state so that we can lower the cost of private medical insurance for everyone. None of this honestly matters, though, if we don't have responsible people running the show, though.
With the current reform bill a trial lawyer will salivate if an ER turn your child away with a runny nose and then the child died from the swine flu. There is no mention of reform on lawsuits in this bill. Personally I feel it is up to every individual to provide for their health care if possible. I understand some people cannot and those are the ones we need to focus on helping. However the goverment is rarely the answer we need. We have had politicians (democrat and republican), overseeing and regulating our financial system and look where that got us. I do not care to give them control of health care.
If you refer someone to another doctor and they don't follow up, then blame should not get placed on the ER. That is what referrals are for - the doctor feels it is better for you to see a specialist, because your issues are out of their realm. Treating the flu is out of the realm of the ER - their focus is on saving lives in immediate danger, not someone who will have to be tested, have their tests be sent off to the CDC, then await results. Tort reform is tricky and was a little too out of my own realm when I posted that message. What we have to recognize on that is that we still have to keep an avenue open and accessible for individuals in order to have that protection to seek compensation when they are due, and to keep practices in check. The issue that I have with current tort reform movements is that it strips away entirely too many protective rights against the individual in favor of the business, and that is dangerous for all of us. The individual and the business need to be allowed equal culpability, based on their actions.
I want more price transparency. I had health coverage for a year that didn't include drug coverage. So when I was prescribed medication, I asked two questions. 1) Is this a generic drug, or is there one available? 2) How much will this cost? My doctors were able to answer (1). Fairly often they changed the prescription from a brand name drug. But doctors had NO idea about cost. I asked them what were my options if I found out the drug was too expensive for my tastes. Outlined a few scenarios and went on my way. Now Walmart and Costco were on their game and answered my price questions immediately. Generic drugs there rarely cost me more than $10. I don't have dental coverage in my current plan. So I'm calling dentists asking how much a cleaning is. After some confusion and a tentative answer, I tell them to knock off 30% because I'm paying cash, or I'll go elsewhere. When healthcare providers have their rates negotiated with insurance and its so convoluted that they don't even know their own rates for walk-ins, then there's a problem. I want to order services from my primary physician like I'm at McDonalds.
To the people saying that a business is more trustworthy/ efficient than the government-- Sure, that may be true in an actual free market. The health insurance companies are like the energy companies or the cell phone companies (how much do you pay per text? how much does it actually cost any phone company to send your text?). There is not perfect or true competition. They are pretty much monopolies; and abusive ones at that. I personally don't care about giving those companies the shaft and personally, I don't mind individually profitting from some rich billionaire's increase in taxes (he surley exploited a million poor people to get it anyway) in order to pay for my doctor's bills.
So if you're rich/successful, it's a given that you exploited people on your way to the top? Forget the risks they've taken, the people employed, commerce created, etc. If you're rich, you must be an asshole. I'll make a similar assumption and say all middle class and the poor are lazy. Kind of stupid, isn't it?
You can't be serious. You're taking very extreme examples to make a general argument that fits your worldview? Because the 359 billionaires in a country of 300+ million people are evil and destroying the country through corruption and greed. It's not like Bill Gates provided anybody with anything valuable or employed thousands upon thousands of people. And it's not like the cell phone companies had to spend a shit load of money to get their satellites and antennas placed around the nearly 4 million square miles of America to provide service to millions of people. How about this, if someone is charging way too much money for services that don't cost very much, why don't you start your own company and charge significantly less. With the lower prices for similar services you'll certainly have far more customers and make money. The evil people at Verizon and Alltel will make billions while you will be more ethical by charging a fair price and not "exploiting millions of poor people" and only make a few hundred thousand dollars, thus confirming your moral superiority over the rich folk. Or maybe the easier answer is that they have millions or billions of dollars invested in their company, employ tens of thousands of people, and they make money because they provide a service that people can afford and desire. If someone is paid 100 million dollars, it's because they make more than that for their company and therefor provide a service to the company that is worth 100 million dollars. Sure, some people exploit and steal and are the shit stains of humanity, but just because they dominate the evening news doesn't mean that they make up a majority of rich people. Not all rich people are like Paris Hilton and Bernie Madoff. Most of them work very hard and take a lot of risks to earn the money that they do. Just like not all poor people are crack smoking scumbag free loaders waiting for their next welfare check so they can drink and gamble it all away because they are too lazy to get a job. Keep the extremes out of this debate. Are you really arguing for extreme sweeping change in 20% of the economy because a few hundred people make a shit ton of money? That's like arguing for the elimination of welfare and food stamps because 300 people abuse the system. How stupid would that be? Oh, and those evil rich people, the top 20% in the country, they pay more than 80% of the federal budget. So yeah, if they didn't exist we would all be so much better off. EDIT: They make a little over 3% more than they spend. The problem is far more complicated than "Insurance companies charge way more than they should and deny services so they can egregiously fuck over the little guy."
Did you listen to what I said? I know the richest of the rich provide at least 80% of the taxes in this country. That's PRECISELY why I want them to STICK AROUND, not leave. In fact, I'm saying that I want them to pay EVEN MORE. Why? Because I profit, that's why. And yes, the cell phone companies charging exorbitant prices for sending 'text messages' - infintesimal packets of data - and counting texts over 160 characters as two texts, etc. IS exploitation, you brainless dolt. Maybe I should start my own energy/ cell phone company? Oh, that's a good one. That's would be akin to me telling you in the 19th century to make you're own oil company or create your own steel company to compete with the Trust of Mr. John D. Rockefeller. I guess you've liked taking it up your big brown stinkhole from the energy and phone companies for so long you've stopped complaining.
And here I thought we were having a civil discussion free from name calling and vitriol. To address your latest argument, no, I don't think I take it up my big brown stinkhole from the energy and phone companies. I willingly give them money in return for services. And while I might not know how much it costs, I'm fairly certain that setting up the infrastructure to send "infintesimal[sic] packets of data" costs a shit load of money. So me paying a few dollars a month for that service seems reasonable to me. If it didn't think it was reasonable, then I wouldn't sign up for their services. I saw what you wrote, but I'm not sure what point you're getting at. It seems here that you're arguing for less government intrusion and more freedom for the companies to participate in the free market. And here it seems like you want them to make a shitload of money, in a system free from government intrusion (as suggested above), but pay even more in taxes. Probably more than 90% of the federal budget. And here you're saying that they only make money because they fuck over the average citizen. And you would like to personally profit from other people's hard work and risk taking and exploitation of millions of poor people. Seems a little unethical to me. So to recap, basically you're arguing for the government to leave these companies alone, except when it comes to confiscating their profits. Profits that are made from the exploitation and unethical treatment of poor people. But have no problem taking that unethically acquired, dirty money for your own personal gain. Forgive me if I seem a little more than confused. Companies spend a lot of money and take a lot of risks because if they're successful, then they stand to make a lot of money. If the government takes the vast majority of the money they make, then there isn't as much incentive to take risks and spend money. This isn't a very complicated idea. Or telling someone in the mid 1990's to create a company that can compete with the monopolistic yahoo.com
Who would have thought that cell phone service would cost what it does today. Unlimited texting is very cheap to add to an exisitng plan. Companies like Verizon and Walmart are teaming up to provide even cheaper cell phone service plans. I am only using your anology to show that if BIG companies were forced to actually compete then prices for plans will go DOWN. I am not saying that pharmacuetical, insurance and health care companies don't need to change. Right now there are goverment regulations that protect each one of these from competition. All we need to do is make them compete. There is no way a company can compete with the goverment, however, because the goverment can operate at a loss and still pump billions of taxpayer dollars into the system. And who are the rich? Everyone with a job is now considered rich because you will be paying for this plan. It says in the plan that if you don't have "sufficient" insurance you will be fined. Now the last time I went uninsured and had to go to a doctor, I paid for it out of my pocket. The goverment (ie american people), didn't have to pay for it. A friend of mine shot himself in the hand (dumb ass), he doesn't carry insurance, but the hospital treated him and sent him the bill. He is currently paying it. What is wrong with that? In reality look at what is going to be changed most with this health care bill. It is not just the cost that worries me, but the quality. There is no way a goverment who is in trouble of going under because of the health care cost it already incurs can possibly provide the same level of care as private industry and still add millions more people to their health plan, without cutting some services. I am not alone in being able to take care of myself and those who truly need it. If a person is not responsilbe or doesn't have enough self worth to want to take control of their health care, then it is not my responsibilty to provide it for them at the expense of my families health care options.
This is a serious, serious issue and I don't think the majority of the Americans fully comprehend this. A few people alluded to this in prior posts, but what a lot of Americans don't realize is that the cost of healthcare is not easily compartmentalized. The so-called "margin" that big-healthcare earns is very, very misleading. I have been in healthcare finance in some form or another for the better part of the last decade. The fact that an ambulance ride costs $500 is somewhat arbitrary. Those big beautiful state-of-the art healthcare facilities (and the equipment therein) that we've been constructing over the past decade cost money - lots of it. On top of that, those facilities only stay state-of-the art for so long. Every 20-30 years, those $100MM+ buildings need to be replaced or substantially upgraded in order to satisfy America's belief that it "deserves" the best, regardless of whether or not he/she is willing to pay for it. The ambulance scenario might not be the best example of this, but think about it, if you walked into a Ritz Carlton, would you expect to pay Ramada prices, just because you are getting a bed and some room service? Believe it or not, those new Taj Majal hospitals don't necessary get "Ritz Carlton" rates from payors anymore than the 30-year-old hospital down the street (not entirely true, but there is not as much disparity as you would expect). The fixed cost to provide healthcare (i.e., new buildings and equipment) has to be built into the rates in some form or another. If you want to bolster short term profit margin, sure, go ahead and neglect your physical plant. If you think that's a sustainable operating model that will be well-received by your patients and the community, you're absolutely nuts. Quality is a HUGE factor in consumer choice, which is essentially what the American demand for healthcare provision comes down to. The company I currently work for owns/operates hundreds of healthcare facilities across the country. A number of those buildings are skilled nursing facilities (nursing homes). The margin we make on those buildings is nickels on the dollar. For every 10 patients that we lose in a given facility, or 3% Medicaid cut we receive, those nickels on the dollar become pennies (or less). The only way for us to keep our beds full (and stay profitable) is to offer high end services and re-invest our profits into the business. Cost cutting does not work in my industry. The more nursing hours you skim and the more antiquated your facility is, the less likely you are to attract new patients. In the nursing industry specifically, many of the buildings are aging and are no longer appropriate for higher acuity rehab patients. In order to bring your building up to snuff, you have to invest millions of dollars just to attract that type of patient. In 2009, for every $ of pre-tax operating cash flow we generated, we are turning around and re-investing 100% of it into capital improvements for our buildings in 2010. So basically, I've just taken that nickel out of my shareholders pocket and put it back into my buildings. My P&L doesn't reflect that investment though. Not today anyways. We also operate nearly a hundred hospitals, and while the operating model is not exactly the same, the issues related to increasing costs and quality of care certainly are. The truth is, there is no simple answer. In order for a 64 slice CT scanner to improve to a 128 slice to a 256 slice and beyond, it costs money. It costs substantial $ from an R&D standpoint and it costs $ for the providers to keep up with the consumer demand for technology. Would you be willing to walk into a healthcare facility and opt for the "bargain basement" scan that costs you less $, but uses older, out-dated equipment? Would you be willing to walk into a nursing home and tell them you would be willing to stay in an older wing that does not have air conditioning or a television for a lower rate? It just doesn't work that way, and it never will. Americans believe they are owed something, regardless of whether they paid for it or not, and that is a problem that is not (and will probably never be) adequately being addressed. /ramble