After the economy and the Iraq war, health care is the top concern for voters this fall. It is certainly a hot topic on this blog. We had a roaring discussion going a couple of months ago thanks to Wizzle's post, but I would like to review it again, specifically looking at Obama's and McCain's health care proposals and comparing them to my own ideas of what should change.
The symptoms of the health care crisis in America are too many uninsured and underinsured Americans, but the root cause is inflationary medical costs - not a new problem. (In fact, HMOs were created in 1973 to address medical costs that were rising faster than the rate of inflation. Didn't work out so well.) In my opinion, the top three contributors to rising medical costs are:
- For-profit managed care - This website gives an excellent historical overview of the rise of HMO's (Health Maintenance Organizations) and why they have been so damaging to health care in the U.S.
- Skyrocketing medical liability insurance for doctors - The average premium for emergency care doctors was $53,500 in 2003. Other medical specialists, like neurosurgeons and Obstetricians pay $200,000-$300,000 (wonder why it is so expensive to have that baby?)
- Uninsured receiving expensive mandated emergency care - half of all emergency room care in the U.S. goes uncompensated (even after government pitches in, and government pays roughly 44% of ALL medical expenses in the U.S. through Medicaid and Medicare), meaning hospitals have to write it off as charity or bad debt
Rising medical costs lead to rising health insurance premiums lead to increasing numbers of uninsured people leads to uninsured people waiting until small health concerns become emergencies meaning doctors provide the care but don't get paid, which leads to rising medical costs for everyone else, etc. etc. We are caught in a spiral. We need real solutions that curb the rising cost of medical care so insurance and medical care ARE affordable and available to every citizen in America. In my opinion, a real solution to the health care crisis in America needs to encompass the following:
- Repeal of for-profit managed care - When investors are making money off of health insurance, it means that money is coming from the pockets of doctors or patients. And if it is coming out of the pockets of doctors, you can bet it is coming out of the pockets of patients. And when an HMO is making decisions on what care will be covered and what care won't, that ties a physician's hands on providing the best care. We need to go back to non-profit, traditional insurance plans.
- Mandated minimum health insurance coverage - When someone doesn't have health insurance but does require expensive emergency medical care and doesn't pay for it, hospitals and the government pay for it, which really means that the rest of us taxpayers, insured, and those without insurance who DO pay their bills pay for it. I think that just as it is the law for drivers to carry at least a minimum liability insurance, we should have a law that requires every individual to at least care a minimal traditional health insurance policy so that if something big happens, it will be covered.
- Change insurance from employer-based to individual-based - Individuals should purchase insurance on the open market, but employers can retain the choice to supplement part of the premium as a benefit if they choose (or, better yet, salaries will increase). That way, if an employee loses their job, they don't lose their insurance (known as "portability").
- A tax on health insurance premiums that goes into a government fund (a REAL trust fund - none of this Social Security Trust Fund crap) for one of two reasons - 1. to subsidize private insurance premiums for low-income families, or 2. (see #5)
- A government-sponsored, non-profit health insurance plan to provide insurance for those who don't have it otherwise. Likely, this means that it would have a disproportionate number of "pre-existing condition", unemployed or low-income people in the pool. To off-set this, see #4 (yes, me, a conservative, proposes adding this tax - mostly because I think that the overall costs to individuals will decline this way, so even with the tax, individuals will be paying less for health care overall)
- Expanded use of retail clinics
How would I accomplish these objectives? Instead of HMO's, I would go back to traditional insurance plans. Individuals can choose what level of coverage they want in terms of deductible and coinsurance (up to a maximum $20,000 deductible for mandated coverage, with all expenses over $20,000 covered at 100% for "essential" care). And the coverage would be per family or "per insured".
It works like car insurance. You are required to have a minimal level of coverage for liability purposes (to protect OTHERS), but you can choose how much coverage you want according to your needs/budget. When we were poor students, we knew that if something happened to our car, we were toast. So we budgeted in higher premiums in return for full coverage with a low deductible (something like $250). Now that we have a bit more cushion and can afford a higher deductible, we pay a lower premium. Currently with health care, people obtain coverage through their employer, so the employer works out the details of the coverage. Basically, you get what you get as an employee. But, with individual, portable insurance, each individual could choose the coverage appropriate to them - from a small $250 deductible to a large $20,000 deductible, and from a 99/1 split to a 50/50 split on coinsurance (with all "essential" expenses over $20,000 covered at 100%). Since everyone is putting into the pot, the premiums would be reduced.
Therefore, the max that an individual could possibly pay out-of-pocket (above premiums) in any given year is $20,000 if they purchase the minimal mandated health coverage and have an accident or catastrophic illness. If they are healthy and don't want any other health care, they wouldn't pay anything besides their very small insurance premium.
On the other hand, a low-income family could choose a plan like the 99/1 split with a $250 deductible. If they meet income requirements, part or all of their premium would be subsidized. For a very poor family whose premium is completely subsidized, the most they would possibly pay given an accident or catastrophic illness is $2225 ($250 deductible plus 1% of any costs up to $20,000, covered completely after that), which could be financed with the hospital.
In return for a pretty low premium, a family like mine might choose a $5,000 deductible with an 80/20 split. In a typical year, we would likely pay for any care received just out of pocket, but in the case of an accident or catastrophic illness, we would pay a maximum of $8,000 (and be able to deduct it on our taxes given current tax laws that allow deduction for medical expenses once they exceed 7% of income. Plus, we would use a Health Savings Account to save up the $5000 deductible tax-free).
The reason I like this plan is that it addresses the costs while ensuring coverage for every American in a way that returns the power, responsibility and "profit" back to doctors and patients. Individuals can make all of their own decisions. They are not limited to "in-network" providers; they can choose how much risk to assume; they can decide what care they want. Any decision to seek medical care comes knowing that you will pay a portion of that care that you already decided is reasonable and affordable for you. Free market principles are at play. Operations like MinuteClinics can flourish that make simple health care more accessible and affordable.
Under this plan, hospitals that provide expensive emergency medical care will be paid (at least above and beyond $20,000) because everyone would be covered for that "essential" care through their mandated minimal insurance.
Also, I support nationwide tort reform to reduce medical liability insurance premiums, which will further reduce the cost of medical care (particularly for surgeons and OBs - we need more specialists, not less!)
So, with that as a background, let's evaluate Barack Obama's and John McCain's health care proposals. I have to say that I was pleasantly surprised to read both. Obama's is not the socialized medicine nightmare, and McCain's is not the uncompassionate status quo that I thought they were. In fact, they actually have a lot in common.
Similarities between Obama's and McCain's healthcare proposals:
- Both propose an optional national health plan that does not replace existing private insurance plans, but that does provide coverage to anyone, regardless of illness or pre-existing conditions.
- Both propose subsidizing health insurance premiums for low-income Americans.
- Both support making health insurance portable.
- Both support reducing drug costs through allowing importation of American drugs from other countries and increasing availability of generics.
- Both emphasize prevention and early detection of chronic illnesses.
- Both think we should utilize technology to streamline records and care.
- Both want to bring transparency to medical costs.
- Both specifically mention bringing more attention to autism.
Differences (Obama):
- Obama's national health plan is managed care that covers all "essential medical services".
- Obama's proposal requires a lot more regulations and reporting data from insurance companies and doctors.
- Obama supports taxing employers who do not provide (enough) health insurance to pay for the national plan.
- Obama proposes that the government subsidize employer health plans for a portion of catastrophic costs.
- Obama plans to expand eligibility for Medicaid and SCHIP programs.
- Obama supports mandatory disease management programs.
- Insurance reform: Obama will strengthen anti-trust laws to prevent insurers from overcharging physicians for their malpractice insurance and will promote new models for addressing errors that improve patient safety, strengthen the doctor-patient relationship and reduce the need for malpractice suits.
- Obama supports [forcing] insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profit and administration. His new National Health Exchange will help increase competition from insurers.
- A bunch of other stuff that I perceive as government getting more involved than necessary.
Differences (McCain):
- McCain will reform the tax code to offer more choices beyond Employer-Based Health Insurance Coverage. While still having the option of employer-based coverage, every family will receive a direct refundable tax credit -effectively cash - of $2500 for individuals and $5000 for families to offset the cost of insurance. Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.
- McCain supports Health Savings Accounts so families can save money tax-free to pay for medical expenses.
- McCain supports expanding walk-in clinics in retail outlets.
- McCain wants to reform the system that pays Medicare and Medicaid providers.
- McCain wants tort reform that eliminates lawsuits aimed at doctors who follow clinical guidelines and adhere to safety protocol.
- McCain proposes a plan to help seniors by giving them a monthly stipend to use for in-home care. (not really sure where the money to pay for that is supposed to come from)
Both Obama's and McCain's plans have some things that I like: an optional, affordable plan that is available to everyone, subsidies for low-income Americans, portability. Neither actually goes as far as I would like in eliminating for-profit managed care and mandating coverage (do I sound like a liberal or what?).
BUT, overall (and not surprisingly), I prefer McCain's health care proposal, and his vision is why:
John McCain's Vision for Health Care Reform John McCain believes the key to health care reform is to restore control to the patients themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make. Families should be in charge of their health care dollars and have more control over care . . . An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people's needs, lower prices, and portability . . . When families are informed about medical choices, they are more capable of making their own decisions and often decide against unnecessary options. Health Savings Accounts take an important step in the direction of putting families in charge of what they pay for.
Ooh, the empowerment. The control. ME making decisions about MY health care. I LOVE it.
49 comments:
This is one of the most excellent, thought-out posts I've read on the site. What a great commentary on health care. I'll be back after work for a second read and some comments.
Thank you, Mike. (blushing)
Another thing I like about control over health care dollars is that when new innovations come along, you can take advantage of them. For example, say you need a hip replacement. Managed care will pay for one type of replacement, or will pay for hip replacement by a few contracted doctors in your area. But, now there's a new alternative to having a total hip replaced - doctors can resurface the bone instead. What if you want that but your insurance doesn't cover it, or none of the doctors who do it in your area are under your plan? Well, you would have to pay for all of it or most of it yourself. So, you've paid all these high premiums for medical care you don't want. Or, you get the inferior surgery because that's all you can "afford" since you paid all your money out in premiums. You would have been better off to pay a lower premium to the insurance company and out-of-pocket to the doctor.
Things like this happen to me all the time. I am constantly paying doctors for things not covered under my health insurance plan, but that are definitely necessary or highly preferable for our health (adult tetanus shot, hearing screenings, composite fillings rather than metal fillings, waterproof cast, etc.) The doctor we saw in the emergency room was out-of-network (even though the hospital was in-network). I paid nearly $1000 for that. The same thing happened when my baby was in the NICU and had one doctor out-of-network. Our "great, comprehensive" coverage didn't seem so great or comprehensive when I kept receiving bills to pay that I didn't anticipate. And I'm not even on an HMO right now - I have a PPO. Managed care = YUCK
What a great post, Stephanie, wow! It must have taken you a long time to compile and write all this. I've gotta say, I agree with you on most counts, too.
A couple things that you didn't mention that I think would be interesting to explore:
1. On the point of "portability," I think that if we are to have some sort of required minimum insurance, we also need to ensure that insurance companies are prohibited from discriminating against people (or imposing higher premiums) for preexisting conditions. If everyone is required to pay for insurance, then the costs even out anyway. Besides, the fact is that the vast majority of people do not choose to have poor health, and it's not fair to require them to pay for insurance at a higher cost.
2. Regarding malpractice coverage, I think there are other options than tort reform. Could we, perhaps, abandon the tort system for medical malpractice cases? Instead, we could turn to a system like worker's compensation. That way, people will be compensated for their injuries, but doctors will not have to pay exorbitant malpractice insurance premiums--costs would be socialized across the system and, in the end, everyone would pay lower prices.
Interesting post, Stephanie. I'm not going to say such a plan wouldn't work, because it might. I just have to say that it sounds so complicated, at least for me who has never had to worry about what kind of insurance to buy, whether my doctor will cover this and that, etc. For me personally, I get more peace of mind knowing that everything (except for perhaps a few things that may not be under rare circumstances) is covered for me and everyone else in the country because I pay taxes.
If I had to decide what kind of insurance to get, how much coverage, how much deductible, etc, where would I start? I could say I'm healthy now, but what about 6 months from now? No one can see into the future, so it's still a gamble. I don't doubt that your plan would be a step-up from the current system. Then everyone should at least have SOMETHING. I just wonder whether it's enough. Theoretically, the premiums could still sink me. ($2225 is A LOT of money for a very poor family and $5000-$8000 is a lot for almost all families. A lot of families don't have that kind of money saved up in their bank account.) But, I must say that even $8000 sounds a lot better than $40,000 or $200,000 -- or more. This "sky's the limit" system that America has now has to stop and it seems that your plan would do that.
Haha, love that last line Steph.
A major problem with healthcare for minorities (until they show up in the emergency room) is that illegals will often go without healthcare for as long as possible because they are afraid that if they go to the doctor, they will be documented or tracked somehow and will be deported. What happens to our friends who are here illegally? (in a perfect world their care would be made up of donated time, knowledge, and resources...but it isn't a perfect world unfortunately)
I think America needs to use more midwives for non-risk pregnancies. A midwife birth costs around $5000, a hospital OB birth costs around $20000. Has anyone here seen The Business of Being Born? Basically Ricki Lake's documentary shows how back around 1900 there was 100% home births with midwives. In the 1930s it was like 60-70% home births, and by the 1950s almost everyone was having babies in hospitals. And the cost of having babies skyrocketed. It is a great show because it shows how so much of laboring in the hospital is for the convenience of healthcare providers, not for easing the process (including the birth position). I know a lot of people who use midwives now, and they always love their experiences. And I firmly believe that if every woman was guaranteed a complication-free labor/delivery than everyone would choose a home birth with a midwife. People go to the hospital for births out of fear.
ok, sorry, that was totally me on a soapbox about the midwife thing. But---I think it would go a long way to lowering medical costs/malpractice/etc in that area.
Interesting about midwives, Amy. In Norway, virtually all babies are delivered by certified midwives. Doctors only get involved when there are complications or if the patient wants it. I thought it was strange at first, but Norway's mortality rate is one of the lowest in the world and it seems to go off without a hitch. The babies are still usually born in the hospital, but the midwives are the ones who deliver the baby and they provide most of the care from the first pregnancy check-up, to birth, to follow-up. Since the midwives work right at the hospital, the doctors are there when they need them, like in the case of a c-section, for instance. I haven't heard any figures, but it probably saves the tax payer a lot of money for a routine pregnancy when the doctors don't have to get involved for everything.
I think most pregnant women deliver at hospitals because they don't know there are better options. The Wizzle and I have two kids; the first was delivered in a hospital and the second at home. Now I didn't deliver the babies, obviously, but witnessing both experiences first-hand, I don't see why any woman with a low-risk pregnancy would choose to deliver in a hospital if she was well-informed of the alternatives.
The care my wife received from her midwife was vastly superior to the hospital; everything was just more pleasant for her. She had two people who had nobody else to care for that day waiting on her hand and foot. Shoot, our midwife even made my wife a full hot breakfast while she labored. :)
We paid $4000 out of pocket for the hospital birth and under $500 for the home birth. And yep, kid #3 coming next month will be delivered at home as well.
More to come; I haven't even read the initial post yet. :)
The hospital I delivered at has midwives affiliated with it, who also have relationships with the OBs so if they have a patient that develops preeclampsia (risk for seizures) or is breech and not turning, or a decelerating heart rate during labor, they can get that patient with a doctor pronto. I believe they deliver in the hospital or at home, the woman's choice. A girl I visit teach had a midwife with her second baby and she's going to stick with midwives for her future babies as well. I just think the midwife's approach is a lot more traditional and natural than the OB's modern medicine approach for healthy pregnancies, so thats why I like the idea of getting more women educated about it.
My guess is that the reason why most women deliver in a hospital by a doctor is that hospital deliveries are what most insurance plans cover. Some still don't cover midwives at all. Some cover them part-way. Hardly any cover home births. A lot of women who have HMOs find that it is cheaper out-of-pocket to deliver in the hospital than at home - even though home deliveries are cheaper than hospital delveries.
ANOTHER reason to adopt my plan! More choices for the birthing mother. Keep them coming!
Hi. Stephanie, I admire your work and thought that went into this post. It makes my head spin (like FD) to think about all that. In fact, I can hardly make heads or tales of it, and I am a college educated white male in my late 20s. That is a big problem, IMO. I think that a large problem with America's Healthcare System is that it is so dang complicated. Where as with MOST of the other first world nations, as FD pointed out, those concerns simply aren't there (taxes=healthcare) with us, we have premiums and deductibles and...geeze, you have to take a class from an accredited university to figure it out at all. Joe Trailer is not going to bother, and is, therefore, going to end up being taken for a chump - and, as I've said in other posts, Joe Trailer is much more common in America than the posters and contributors of this blog. I just think in this system, simpler is better.
Imagine if the same were true with the libraries. You could get a library card, through your place of employment, that could get you access to some books, but other books you would just need to buy out of pocket (at grossly inflated rates) if you wanted to read them. But your work-provided library access would only cover some books - but not the really important books that would help you with your lives (pre-existing condition) So, eventually the government came in and said, we'll help you check out some books not covered by the other library card if you qualify by your literacy level, a complicated series of tests, and if you can't afford the inflated costs of buying the important books.....it is a rediculously absurd scenerio. I see the Healthcare situation much the same way, except libraries are not necessary for life, and medical care is. Instead, US cities generally say, if you pay your taxes, and you live in the city...you get a Library card free of charge that will allow you access to any book in our library. Seems alot simpler.
I just can't get excited about either of those classes, because I didn't take US Health Coverage 111 at BYU.
By the way, the midwife thing seems to be catching on. My wife just found a while ago the Korean Midwife's association...kind of scary, but she REALLY wants a midwife so...what do you do?
Rick, if you're having trouble understanding what Stephanie has detailed her...well, the only excuse I can think of is that maybe you haven't had to work for a real company or institution that made you choose your own health insurance plan, HMO or PPO or whatever. At least the Faithful Dissident isn't American so she's had government hc most/all of her life so she hasn't had to think or read through all the stuff as her excuse. Compared to what we had to read through when we chose our healthcare plan Stephenie's posting is on the Little Golden Books level.
oops, should have written "has detailed here..."
You could get a library card, through your place of employment, that could get you access to some books, but other books you would just need to buy out of pocket (at grossly inflated rates) if you wanted to read them.
Um, this happens to be true for most public libraries. We can get a lot of books we want and usually just stick to what is available, but half the time, the book I need (for me or for my children) isn't there or is already checked out, so I go pay full-price at Barnes and Noble. In fact, our library doesn't even carry the "Childhood of Famous Americans" series, so I have paid a lot out of pocket for those.
Rick and FD, you are helping to illustrate another "difference" I perceive between liberals and conservatives. Conservatives seem to believe that, for the most part, individuals make rational and wise choices. For the most part, they will educate themselves, so when given a choice, individuals will make the best choice for themselves.
Liberals seem to believe the opposite (at least that is what I gather from reading your comments here and on other posts). Liberals seem to believe that, for the most part, individuals make poor choices. For the most part, they don't educate themselves, so when given a choice, they make the wrong decision because they are too ignorant to make the right decision. They need someone else (government) to make the decisions for them.
HOW SCARY! Who is government? A bunch of politicians - regular, old ignorant people. To believe that they are any "better" or "smarter" than me or other individuals, is to believe in elitism. I'm no idiot, and I don't appreciate the assumption that I am. I don't need "government" to make my choices for me. I have enough faith in the people of America that most are smart enough to figure it out. If they can't figure out something like this, I don't have a whole lot of faith in them figuring out the right person to vote for (besides "Vote for me. I'll give you money. I'll give you free healthcare. I'll tax that rich, smart guy who got his education and worked his tail off over there to pay for you who didn't and won't.") Besides lots of seeming evidence to the contrary, I STILL have faith in the people of America (and in the people of other countries, too - I have more faith in individuals than in government).
Stephanie wrote: Liberals seem to believe the opposite (at least that is what I gather from reading your comments here and on other posts). Liberals seem to believe that, for the most part, individuals make poor choices. For the most part, they don't educate themselves, so when given a choice, they make the wrong decision because they are too ignorant to make the right decision. They need someone else (government) to make the decisions for them.
I can't speak for all liberals on this, but I contend that the government should step in when there is a failure of the open market. So many market failures are caused by asymmetric information, i.e. consumers not having information that is available to producers.
It's not that I don't trust consumers to educate themselves when information is readily available, it's that there are extremely powerful corporations and other special interests that often prevent information from getting to consumers. Information is the most powerful force in our world today (cue Ben Kingsley in Sneakers) - those who have it control the world. And those that don't are at the mercy of those who do. Government should be in the business of rectifying this imbalance, not perpetuating it (coughBUSHcough).
Sure, bbd, I completely agree. But it doesn't seem to me that that's what Rick was saying - Rick was specifically saying that people aren't smart enough to figure it out.
Given the internet and how easy it is to obtain information and disseminate information, it seems to me that we have more of an argument to turn decision-making over to individuals, not less.
Stephanie said:
"HOW SCARY! Who is government? A bunch of politicians - regular, old ignorant people. To believe that they are any "better" or "smarter" than me or other individuals, is to believe in elitism."
One big difference that I've noticed between Americans and Norwegians is how they view gov't. In talking and communicating with Americans, I often get the feeling that they view the gov't as "the enemy." The gov't is "a bunch of politicians," as Stephanie put it. She even questions "who" government is. Gov't is often seen as corrupt, meddling, secretive, and controlling. So, if I felt that way about my own gov't, I would absolutely agree with Stephanie. The less gov't, the better.
I'm going to give the Norwegian point of view, simply because it's where I live and there is a lot of gov't "meddling" here, as some of you would put it. The gov't has a hand in a lot of what a Norwegian does in his or her life, from birth to death. I'm surronded by gov't, whether it's by going to the doctor, buying gas, building a home, throwing out my garbage, or going to work. I work in a nursing home, therefore I technically work for the gov't.
So, as I've said before, Norwegians pay taxes and lots of them. Norwegians complain about taxes and gov't fees like Americans do. However, I don't think Norwegians generally view the gov't as the enemy, or just an elite few that control everyone's lives. The gov't = the people. Norwegians democratically elect their leaders just like Americans do. If they're not happy with one gov't, they'll vote them out in the next election. It just happened a couple of years ago. Over time, Norway, along with the other Scandinavian countries, has adopted the social democratic system and although the different parties have their own platforms and vary on different issues, the bottom line is that Norwegians are pretty happy with socialized health care and all the social benefits that they are entitled to via paying those hefty taxes. People here live very well (best in the world according to the UN) and they know it. Yes, they complain about taxes, but if you came to Norway and wanted to find someone who wants to scrap the entire system, you'd have to search a while. I think that virtually every rational Norwegian would admit that their gov't, despite its flaws (yes, the system DOES have flaws), is serving its purpose well. That is to say, providing its citizens with a guaranteed minimum standard of living, maintaining a safe and clean environment.
Now I know, Stephanie, that you are against the socialist system. And to be truly honest, if I had grown up in America, then I would probably feel the same way. When gov't is something that you fear or mistrust, then of course you want less gov't involvement. It makes perfect sense. What I'm saying, though, is that gov't doesn't always have to be a bad thing. A healthy dose of skepticism is important because no gov't should ever be immune to criticism or change. That goes for every country, including Norway. However, assuming that gov't always has to be some sort of Big Brother or group of elitists can be detrimental to a country and society. Gov't should be more about serving the people and keeping order than controlling it. I feel that mine generally is, which is why I don't fear or always object to more gov't involvement. However, when one has had bad experiences with gov't, of course it sounds looney to want more of it.
Given the internet and how easy it is to obtain information and disseminate information, it seems to me that we have more of an argument to turn decision-making over to individuals, not less.
That sounds great in theory. The trouble is, when the government isn't involved, the power is in the hands of corporations rather than individuals (think insurers, Wal-Mart, drug companies, big oil, big tobacco, Monsanto).
I think the fundamental difference between conservatives and liberals is not bigger vs. smaller government, it's whether or not big business is good for society. Milton Friedman, conservative economist, in 1970 famously wrote in the New York Times that "the social responsibility of business is to increase its profits". In fact, that was the title of his article.
Now Milton Friedman is a smart guy, but in my opinion, if corporations aren't socially responsible, specifically in terms of providing consumers the information necessary to make informed decisions, governments must force them to be. Do you really think Wal-Mart has your best interests in mind with their "always low prices ... always" mantra? They absolutely don't - they have their bottom line in mind, no matter how many of their suppliers and competitors they put out of business.
Check out this article for an excellent discussion on this issue between Friedman himself, John Mackey (CEO of Whole Foods), and TJ Rodgers (CEO of Cypress Semiconductor). For the record, I agree with everything Mackey writes.
I don't think I am making myself very clear. No, fd, I don't fear or mistrust government. What I am saying is this:
Rick believes that the "average Joe" makes poor decisions (on the environment, on healthcare, etc.), so we need "government" to make those decisions for us.
I believe that the "average Joe" (when given all the information available - good point BBD), makes rational decisions in their best interest. So, if individuals make good choices when given all the info, why do we need someone in government to make those choices for us?
BBD, I am honestly not sure what point you are making. Are you saying that because corporations have so much power, we should give government more power in the form of decision-making to protect us from corporations? Or that government should regulate corporations so that individuals do not receive false information? I agree with the latter.
I view government dealing with companies in the same way I view government dealing with individuals. Government should stay out as much as possible unless a business is somehow harming individuals. In that case, government has a responsibility to protect. Passing responsible legislation does that, so I have no problem with it.
BBD, I am honestly not sure what point you are making. Are you saying that because corporations have so much power, we should give government more power in the form of decision-making to protect us from corporations? Or that government should regulate corporations so that individuals do not receive false information? I agree with the latter.
I view government dealing with companies in the same way I view government dealing with individuals. Government should stay out as much as possible unless a business is somehow harming individuals. In that case, government has a responsibility to protect. Passing responsible legislation does that, so I have no problem with it.
I agree 100% with what you said - the government should be regulating business to enable consumers to make decisions. Regulating business when business doesn't regulate itself is protecting the consumer.
Back to the topic at hand, Stephanie, I commend you for your research and common sense approach. That post must have taken a long time to put together, and I agree with nearly everything you put forward. If designing a system from scratch, I firmly believe a single-payer system would be the best, but your plan would be a monumental step forward from the disaster that is the current "health care" system.
However, I'm not sure eliminating profits for one of the most powerful lobbies in the country is even possible given the current political climate. And for that matter, it may not even be necessary if the government dares to cut its ties with the insurance giants and pass sensible legislation. And some of that sensible legislation should actually be in the form of deregulation (gasp).
For instance, allowing individuals to purchase insurance from vendors in any of the 50 states needs to happen NOW. A little competition would do wonders to drive down costs and improve both quality and portability.
BBD, I agree with everything you said in that last comment.
I just wanted to add my two cents here. Very often conservatives argue that government is some big bad thing. Have we forgotten that our government is supposed to be a government BY THE PEOPLE? If it has become some big bad thing, why are we not out doing something about it, such as taking it back through the tried and true methods of citizen action (aka. citizenry)?
If we need to be afraid of government as much as conservatives would like us to be, then why do they argue against broadening democratic control of the government so much? Add to this the fact that conservatives seem more than willing to give one part of our government, our military, great power and money. This has never made sense to me.
For me it's like this:
Not everyone can afford healthcare.
Not everyone can rely on individual charitable donations for their healthcare.
Therefore healthcare must involve the community in some way.
So the choices come down to this; would I rather my healthcare was in the hands of share holders and executives focusing on the bottom line, or in the hands of a democratic system known as "THE GOVERNMENT" (ominous music here please).
Also, healthcare is cheaper in nations where they have instituted single payer programs. PBS Frontline did a great documentary about the different options for healthcare around the world, both from the left and right. It's called "Sick Around the World" and you can watch it online at PBS.org/frontline.
Here is a link to a graph showing how America stacks up in terms of healthcare costs to other nations:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/graphs.html
If you go to that last link, don't forget that you can click on the tabs above the graph to view other information as well such as life expectancy, infant mortality, etc.
One last link. I swear :)
This one is to a link showing the 4 basic models for healthcare around the world:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html
john, did you even read my post? It doesn't sound like it. You launched straight into a diatribe of how conservatives are "bad" because they don't want socialized healthcare. It's hard to take you seriously when you completely ignore or disregard everything that doesn't fit into your "box" of what you want.
For example, I addressed every one of these issues:
For me it's like this:
Not everyone can afford healthcare.
Not everyone can rely on individual charitable donations for their healthcare.
Therefore healthcare must involve the community in some way.
So the choices come down to this; would I rather my healthcare was in the hands of share holders and executives focusing on the bottom line, or in the hands of a democratic system known as "THE GOVERNMENT" (ominous music here please).
You just didn't even read it, did you?
Stephanie, that isn't a fair accusation. How do you know?
Rick, I think it is very fair. Based on John's comments, it sounds like he didn't read the post. It sounds like he saw that the post was on healthcare and threw lots of links at us to push his view without considering anyone else's view (when it may even have a lot of similarities to his own view).
If he claims otherwise, I apologize. And, if he has read my post, I would like to know how he feels my proposal fails to address his concerns.
Okay, so I have been thinking about fd's and rick's comments. Comments like these:
For me personally, I get more peace of mind knowing that everything (except for perhaps a few things that may not be under rare circumstances) is covered for me and everyone else in the country because I pay taxes.
It makes my head spin (like FD) to think about all that. In fact, I can hardly make heads or tales of it, and I am a college educated white male in my late 20s. That is a big problem, IMO. I think that a large problem with America's Healthcare System is that it is so dang complicated.
These are legitimate concerns. Not everyone wants to calculate out their health expenses and evaluate risks, and it would be unfair of me to impose that on everyone else. So . . . how about we keep HMOs for those people who want them but also change the system from employer-based to individual-based so that everyone buys their insurance on the open market? This would ensure availability and portability. It would also give people more options so that those people who choose could take advantage of the traditional insurance/HSA plans. That way, I am happy because I am in control of my health care dollars, and you are happy because you don't have to worry about what you are covered for. That's even better than my original proposal because it has MORE options and MORE choices.
It actually sounds a whole lot more like John McCain's health care plan, too.
Stephanie said:
john, did you even read my post? It doesn't sound like it. You launched straight into a diatribe of how conservatives are "bad" because they don't want socialized healthcare. It's hard to take you seriously when you completely ignore or disregard everything that doesn't fit into your "box" of what you want.
I say:
Seriously Stephanie, what is up with your hostility towards me? Once again you are putting words in my mouth. When exactly was it that I said you were bad for not wanting socialized healthcare, because I entirely missed that part (even though I was the one that supposedly said it!). Was it the same time that I supposedly called you privileged, or when I supposedly questioned your testimony? Come on now, let's act like adults here! I'm expressing my views, your expressing yours. This is a forum for political debate is it not?
Perhaps I should have spent more of my time posting an entire thesis on how I think healthcare should be implemented and the reasons why I do not feel your posts address the problem, but the truth is, I already waste too much time going back and forth here.
The thing is I disagree with both Obama and McCain on healthcare. This is why, if you've noticed, I keep referring to SINGE PAYER healthcare (just like the majority of my fellow countryman according to recent polls). You focus on costs, yet when I direct readers to where they can find information showing that single payer care is cheaper than private run care, AND produces better infant mortality rates, life expectancy, etc, thus supporting my position on the issue, you go hostile on me again!
The thing is I am for UNIVERSAL healthcare, anything else necessarily means that someone is not getting the care they need, otherwise it would be UNIVERSAL. Even forcing people to have minimum healthcare would not work in my opinion. I'm from California, drivers have been required to have car insurance here for years but people still don't. We also have MediCal, which is meant to cover those who can't afford care like you mentioned. Guess what? Many Californians still aren't covered. I fundamentally disagree with your entire plan on this basis alone: it is not universal, so why even bother going into a long post about it?
Okay john. I agree to disagree. I guess I am doing exactly what you are doing: I am categorically rejecting socialized healthcare the same as you are categorically rejecting anything that is NOT socialized healthcare. So, I suppose I will pay as much attention to your links as you paid to my post.
That came across as snotty. I don't come across very well online. I am not trying to be snotty - just trying to be clear.
The thing is I disagree with both Obama and McCain on healthcare. This is why, if you've noticed, I keep referring to SINGE PAYER healthcare (just like the majority of my fellow countryman according to recent polls).
...
I fundamentally disagree with your entire plan on this basis alone: it is not universal, so why even bother going into a long post about it?
John, this is a really silly argument. Obama DOES support a single-payer plan, just like you and I. But the trouble is, we're not starting from scratch here. We have an existing system, and broken as it may be, it will take decades (at least) to get to a single-payer plan given the way our political process works. Obama may be an idealist, but he's much more of a pragmatist than people give him credit for. He, like Stephanie, is interested in finding practical solutions given current political realities.
I would love to see this country adopt a single-payer system, but even given the extremely unlikely scenario of a cloture-proof Democratic majority in the Senate, a Democratic majority in the House, and a Democrat in the White House, I wouldn't expect to see such a drastic change from the status quo in my lifetime. I hope I'm wrong, but this country doesn't make drastic changes that fast.
I actually did read you post Stephanie.
I think I understand why you disliked my post so much. You obviously put a lot of time and effort into thinking out your plan, comparing Obama's and McCain's plans, then writing out your post. Then you got a whole thread of people complimenting you for it. Then I come along and not only do I not compliment your well thought out plan, but I reject it.
Now I apologize if this is why you are so upset with my post, but I think you are missing what I'm saying as well. First of all, I am not a Republican nor a Democrat, so my posts come directly from left field, not center and certainly not from the right, and this has a tendency to upset people who usually think in terms of liberal, conservative, republican, democrat.
As I said before, my main problem is that it is not universal. Universal simply means everyone is covered, it doesn't mean it is socialized (although I am certainly advocating for socialized care myself). My major problem with your well thought out plan is that by definition it would exclude some, if not many. I know you tried to account for this by suggesting government funded care for those who could not afford the costs you spoke of that are involved in your plan, but I just don't see it covering everyone.
There are many ways that universal care could be given, and this is why I think you are misunderstanding the difference between universal and socialized. For instance, look at the models for businesses within the agricultural sector, or the defense sector, or the private contractors that our government hires for all kinds of services (for instance the infamous military contractors in Iraq) they all operate within the public sector, but compete not for consumer funds, but for government funds. The government renews contracts occasionally, and if another business is able to offer the services needed at a lower cost, or better quality, than they win the contracts for those government funds. In fact, I used to work for a company that did just that. It was called Maximus and we bid each year for federal and state funds to operate drug rehab programs for minors and Native Americans.
Now here is a way that services could be universal from a more centrist or moderate viewpoint. It is not excluding the business world, it still allows private healthcare to operate outside of the government funded program, and it would enable companies to still claim profits while holding them accountable if they want to keep their contracts each fiscal year. Now I am not advocating such a plan, but at least it would be universal.
So my point here is, it's hard for me to debate about a plan that I find fundamentally flawed. It would be like a fireman asking someone who's kids were in a burning building "would you like me to go after the older ones or the younger?" while the parent is just thinking "save them all!"
And one last thing, in my original post, I was more concerned about pointing out that government isn't the boogeyman you were making it out to be than I was about addressing your plan point by point.
big bald dave said:
I hope I'm wrong, but this country doesn't make drastic changes that fast.
I actually used to think the same way Dave, but is that true? Look at how swiftly civil rights legislation was passed, or social security, or the eight hour work day, or how quickly neo-liberalism and neo-conservatism became the dominant ideologies, or even how quickly the gay rights issue is moving. Just a few years ago the vast majority of Californians opposed gay marriage, now nearly 50 percent support it. I'm being just as pragmatic here. Mark my words, Obama will implement his plan and it either go two ways; it'll either be hugely successful for the majority of Americans (at the expense of some) and therefore no one will see any need for stepping it up to universal coverage, or it will lag and get caught in the same trappings that our current system did, and it'll be dismantled by conservatives years from now.
We have the Republicans on the right and Democrats talking about the left while actually implementing centrist policies. All this does is let Republicans win the long term victories while Democrats make small short term victories.
I like Obama, at least compared to McCain, but Clinton's plan for healthcare was much better, and even more pragmatic in my opinion.
Civil rights legislation passed quickly? I guess it only took them 200+ years. ;)
I hope you're right, I really do. Perhaps I'm just jaded by how slowly things have progressed since the Dems took back Congress in January 2007.
And for the record, I prefer Clinton's healthcare plan as well.
Also, both the majority of Americans AND the majority of American Doctors support a single payer plan. With Democratic control of Congress, the support of American Doctors, and the support of the American people, I just can't buy Obama's argument on this.
Civil rights legislation passed quickly? I guess it only took them 200+ years. ;)
HAHA! Yeah, guess I didn't factor that in!
=)
But you gotta admit, with the introduction of TV, the civil rights movement had made huge strides in short amount of time.
I suppose it's very un-Obama of me to be so pessimistic. Hopefully Barack will bring in Hillary as Secretary of Whatever and have her run the health care show. Maybe they can surprise us all. :)
I think I understand why you disliked my post so much . . . Then I come along and not only do I not compliment your well thought out plan, but I reject it.
No, I got so upset because you just rejected it without giving any reason why - as if explaing to me why you disagree is too bothersome because you are the only one who could possibly be right. BUT, now that you have explained your support for universal health care and your reasons for why you don't like my proposal, I better understand your position. Thank you.
I understand that you feel the only way to achieve universal coverage is by a single-payer system. The main reasons I do not want a single-payer system is that 1. I want more control over my health care dollars, which means I think I could get better and more innovative care for myself and my family for a lower cost to me, and 2. I don't want to be responsible for other people's poor choices with regard to "my" health care dollars (not saying I don't think that illnesses shouldn't be covered. I am saying that I think people make more economical choices when they recognize there is a scarcity of resources). I felt that my proposal would cover both that aspect of universal coverage while retaining invididual choice and responsibility. I respect that you disagree.
I don't think that the government is the "bogeyman" - I just don't think that the "government" is any smarter or more economical than me. I want to give the government as little control over decision-making in my life as possible (and in the lives of other individuals).
I hope it takes a loooooooooong time to go to a plan like you are talking about implemented - like after I am dead. :)
Oh no, Dave - you are making my worst nightmare come try. Hillary, please stay AWAY from Washington!
*true* (what is up with my word choice today? I am thinking faster than my hands can type)
I just got my wisdom teeth pulled. My insurance paid for 80% of the procedure but NO general anesthesia (just local). I guess it's just not "necessary" to have anesthesia when someone is cutting into your gums and digging out your teeth. (I paid for the laughing gas myself - well worth it)
I've only used laughing gas once during a dentist visit. It wasn't for me. The doctor said I'd fall asleep, but instead I sat there for about 30 minutes feeling EXTREMELY claustrophobic. It got so bad that my dentist noticed I was gripping the arm rests and sweating bullets and asked if I was alright. I lied and said yes, finished my visit and never asked for the gas again.
The doctor and the nurses probably thought I was weird. I guess I should have just told them the laughing gas was freaking me out.
LOL!
I don't blame you for wanting a little more than local anesthesia. It's not like getting wisdom teeth pulled is a walk in the park.
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