Public option for healthcare
 

I'm curious what people here think about the idea of having a new public option for healthcare created. I'm personally all for it as long as its just an affordable option (which it will be).

So far I've yet to hear a good arguement against it.

Re: Public option for healthcare
 

It's a poor idea for three key reasons:

1. Government intervention has historically raised health care costs, and will continue to do so if the government's role is increased (did you know that the government created today's insurance/HMO/PPO companies?).

2. A single-payer system and/or an insurer of last resort is a flawed idea, as Medicaid and Medicare have both proved to be flawed programs.

3. We have no money left. Our treasuries are depleted.

I can expand upon these three points if necessary, but I can't see this discussion end happily.

Re: Public option for healthcare
 

Bond would you say the current state of US's health care is better then countries that have adopted this system? I don't. So using historic results for something they have not directly tried doesn't hold much water. And it shows that its not a flawed idea.

I'd rather not compare this specific plan to other plans that are not the same thing. The overall model itself has shown to work.

Last numbers I heard, US is the country that pays the absolute most for healthcare per year, and has the 37th best coverage. That's unacceptable. What would you propose we do to fix this system and change the results? (I only bolded because I'm curious about this and don't want it overlooked.)

I think the problem a system that is private-only is that the companies are more built to make a profit off of the healthcare industry. So they will take more steps towards trying to turn a greater profit opposed to trying to care for people's health. Which is the most simplistic problem with this system.

One thing to keep in mind is that healthcare is something that people need. Once again, lets throw in the example of education.. Private schools still exist, and public schools still exist. Just because a public school insures that everybody gets a chance, doesn't mean there won't be a place for private schools. Could you imagine if a country allowed their education system to be completly privately run? High costs for schools at all levels, and if you don't have the money you're just out of luck and have to be put into a world of debt?

Would you really be shocked if their system yielded bad results?

Re: Public option for healthcare
 

Before I reply, I would like to point out one potential issue with this discussion:

Health care reform is a very wide and complex field. To debate something that broadly would be nearly impossible. I would suggest the scope of the discussion be limited.

So, before I answer your many questions, I would first like to explain a little more of my argument, if possible, using my previous three points:

1. Government intervention has historically raised health care costs, and will continue to do so if the government's role is increased (did you know that the government created today's insurance/HMO/PPO companies?).

Allow me to first use a few relevant and important statistical charts:



This chart depicts health care expenditures as percent of GDP and per capita. As you can see health care expenditures have nearly tripled as a percent of GDP since the 1960s, as well as the cost per capita of health care. This begs the question: what has lead to this enormous increase in the cost of health care?



This chart depicts average annual CPI change (%) by component. Once again we see the rise in medical care significantly outpacing the change of all other items. And, again, this begs the question, why?

For the answer to this question, I harkon back to my original point, that the rapid (and recent) rise in health care costs is primarily due to the advent of insurance/HMO/PPO companies, which were mandated by, and heavily regulated, by the government. In fact, the health insurance industry is perhaps the most heavily regulated industry in our country.

For an exact explanation of what HMO/PPO companies are and how they function, I would recommend outside sources, as I don’t want to go into too much detail concerning them. Suffice to say, they are a middle man, between you and your doctor. Middle men naturally raise the price of any good, as they have raised the price of health care.

Let’s consult one more chart, which depicts who is paying for health care costs:



Here again we see a stark contrast from the 1960s to present day. During the 1960s, the majority of health care was paid by out-of-pocket, and a small fraction was paid by the federal government. Present day, only a small fraction is paid by out-of-pocket, and payments by the federal government have quadrupled. I would, again, correlate this back to the rise of the HMO/PPO, as mandated by the federal government.

(These charts are derived from numbers provided by the Bureau of Labor Statistics.)

2. A single-payer system and/or an insurer of last resort is a flawed idea, as Medicaid and Medicare have both proved to be flawed programs.

There are many misconceptions surrounding programs such as Medicaid and Medicare. Let me use an example from Medicaid to explain this. Medicaid is the federal health program for low income families and individuals. Now, many assume that, when an individual enters a hospital and requires immediate surgery that the government pays fully for this procedure, as the individual is covered under Medicaid. This, is not so. The government pays a mere 40 cents on the dollar, and the hospital must pay the remaining 60 cents. The hospital is, in effect, paying for the hospital to perform the procedure. This extra cost, that the hospital must legally incur, is passed on to the hospital’s paying clients (those with private insurance). This, in turn, raises the rates of private insurance. Of specific note, is that private hospitals that are not religiously affiliated will often pass Medicaid customers off to religiously affiliated hospitals, as they know that those hospitals will not turn them down. As I hope you can see, this is a broken system for the hospital, and those who own private insurance. A single-payer / insurer of last resort system would logically function in a similar way, and be equally damaging.

3. We have no money left. Our treasuries are depleted.

This is perhaps the simplest of my three points. In an ideal world, where our government has a surplus of funds, a public option may make sense financially (although number one and two would still be an issue), but this is not the case. Our country has an enormous debt, a devalued currency, and overstretched empire. If there is one thing we simply cannot afford, it is public health care. Perhaps if we had saved more wisely as a country that would not be the case, but, it is not.

Please reference this chart (which shows personal savings as a percent of disposable personal income) to enforce my point:



(Source: Federal Reserve Statistical Release: Flow of Funds Accounts of the United States, Historical Data [1975-200])

Lastly, I should note the majority of my knowledge concerning this subject is derived from an internship that I had last summer at a Top 30 health care system.

--------

I will now try to address a few of your questions.


I don't which one is "better." This seems to be your personal opinion on the matter. I would say they are different, but without evidence to support your claim, it is hard to reply.

Evidence? I would in fact introduce the opposite, reference England's National Health Service, which in 2006 had a deficit of around 500 million pounds.

Source? What was the methodology for these ratings?

Generally speaking, I would advocate a return to less government intervention, when more payments for health care were made out-of-pocket. This would proportionatly decrease the cost that the individual pays for health care, as government intervention in industries inherently raises prices. I do not have a more specific proposal, as I have not given this issue the adequate amount of research it would deserve.

Not entirely sure who the pronoun "their" refers to. If you are referring to the public option, then no, I would not be shocked if it yielded bad results.

Re: Public option for healthcare
 

I don't care much about what system is used, but I'll tell the situation in Holland.

We have had a system of public healthcare for tens of years now. In the last 10 years or so they're slowly privatizing it again. Right now it's sort of an combination of governmental and private.

First of all: everybody has to have a health insurance. At the moment you have to pick a insurance company yourself. Prices, quality, services etc. vary a little, but not much. You have many options, for example a dental insurance.

I pay around €100 a month. I think it's like €90 basis + €10 optional insurances.

Here comes the interesting part: the government finances you, based on how much money you earn. I get almost €60 a month, which is probably around the max, because I'm a poor student.

So effectively I pay €40 a month.

I can go to any hospital, dentist, etc. I want, and give them my insurance information.
I'll have to pay the first €150 of my yearly costs myself, but after that 80%-100% gets paid by my insurance.

I like it. :) It works.

Re: Public option for healthcare
 

I said:
You said:
Wiki says: http://en.wikipedia.org/wiki/Health_..._United_States
I couldn't tell you about the methodology directly, that'd be something for you to research.

My reply to your first and second points would be the fact that the public option will only be an option. If the quality/prices of private healthcare are better then people can easilly just stick with them or go back. The point of the public option is to keep these companies in check without directly setting more regulations on top of them, to improve the quality of healthcare, and lower the price.

The public option isn't medicare, or medicaid.

As for the third point if there being no money.. I think healthcare is one of those things that government has to have a foot in period. Its not a luxury, its a basic human need. (If it isn't, then take it out of prisons) And as you pointed out, simply adding regulations to the existing companies doesn't work. And giving out govt money to people to pay for it does not solve the problem of quality or change anything for people who have coverage.

I would agree with the idea of the goverment backing out as far as regulations that raise the costs for the existing companies.. however I think that doing that alone won't cause prices to go down or quality to go up. In my opinion the public option needs to be made to help mode the standards for insurance. If the private companies want to offer better services and charge more, then they're free to do that.

Re: Public option for healthcare
 

Actually, the burden of proof is on you to clarify evidence that you used to support your claim.


Other than that, I have very little to say in reply to your post, as you have presented your personal opinion, which is fine, but I cannot offer a rebuttal against a personal opinion.

I would only note that I have presented a historical overview of why healthcare costs are so high, along with statistical charts and graphs to support my view.

I hope that I have presented to you a "good" argument against a public option.

Re: Public option for healthcare
 

I provided a reliable link to you that shows where the numbers came from(a link to a completly neutral online encyclopedia), and quoted the part that shows the source of the numbers. Which is more then you did to support those graphs. If you feel the source of the numbers are unreliable, and weren't suitible for this arguement (or suitable to be posted on wiki), then its your choice to persue that.

With that said, mind posting a link for everyone to see that shows those same graphs in that same context?

I think the base problem with your arguement is that you fail to acknowledge the fact that a public healcare option is different from medicare and medicaid. Since the point of the public healthcare option is to help with the prices for people who CAN (or... shall I say 'should be able to') afford medical insurance and people who do have jobs, along with the elderly and people in poverty. This is a universal system, not something aimed directly at people who can't help themselves to an extent.

And you fail to acknowledge that fact that healthcare is not something that should be ran completly by the private sector, and that its a human need instead of a luxury. You completly ignored my comparision to public schooling. (The last thing you quoted in your second post was the closest you came to acknowledging it, and you completly missed the point making a reply out of context)

Do you honestly think the healthcare field is something that the government shouldn't have a foot in whatsoever?

Re: Public option for healthcare
 

Wait, Wikipedia is completely neutral now? LOL
And I don't think our Public school system is exactly a shining example to base health care on.

Re: Public option for healthcare
 

I would move to end this discussion, as I see it going no where positive. But, at the risk of sounding rude and/or a cop out, I will reply to your last post. I took care to reply to every single one of your sentences, as you criticized me for not doing in the past.

Your position on this matter is not logical. You introduced evidence. I then questioned you as to the methodology of the evidence you presented. The burden is on you, in a logical argument, to explain that methodology. You can refuse to do so, which is fine, but I am just letting you know that is where the burden rests.

Secondly, I am not so sure if I would classify Wikipedia as a "reliable link." Perhaps it is, but this is debatable. I would also note a strong criticism of the methodology used within your very quotation of Wikipedia. See the bold sentence:


The CPI composite information is provided by the Bureau of Labor Statistics archives, found here: http://www.bls.gov/cpi/cpi_dr.htm

The time composite of savings rates was compiled from the "Federal Reserve Statistical Release: Flow of Funds Accounts of the United States, Historical Data [1975-200]" as I already noted in my original post.

The charts were compiled by a professor that I worked with last year. He holds a PhD from Wharton, and teaches at the #2 Risk Management & Insurance school in the country. I consider him a reliable source.

My showcase of medicare and medicaid is to use historical evidence that will infer how a public option would function. While I agree that medicare, medicaid, and a public option are different beasts, they are beasts that have the same mother. The inherent problems of medicare and medicaid as far as reimbursements (reference my hospital example in my second post) will remain, as well as other inherent issues of government intervention in the private sector.

This is the same logic that the government used to create the very HMOs and PPOs that are now blamed for driving up the prices of health care.

Okay.

That is your opinion, which I respect, but you should be aware that there are adversarial opinions.

I did not consider your "public school analogy" to be germane to the discussion of a "Public option for health care." I did not want to divert our discussion to the education system. I acknowledge your comparison.

I answered this question previously:

Re: Public option for healthcare
 

I think our base disagreement is that in your opinion healthcare should be handled by the private setor, and in mine I think that healthcare is something that the government has to have a foot in no matter what because its a basic human need. Also you don't seem to trust that the government can make a change for the better, while I do.

Just because a collection of old programs that are completly different didn't work holds no bearing on on if this program will work or not. All I know is the system as is, is extremely broken and its going to take some major changes to fix it.

I guess my trust lies in the government, and I'm willing to give them a chance to change.. while your trust lies in the corperations. I personally think that it makes more sense to trust people who are pushing for fairness, then trust people who are pushing to make money and line a CEO's pocket. If regulations were lightened up, I wouldn't hold my breath for prices to drop. Though I could see those corperations getting their most profitable years.

Re: Public option for healthcare
 

"Health Care Stories for America"




Three of many more stories.



The health care system is broken if stories like these can happen. Health care is a basic need, and I think that there should at least be a public option that anyone can get.

Re: Public option for healthcare
 

I am by no means orthodox in this area, but I am not surprisingly against public healthcare as the main source of healthcare for Americans, although I do support it as a backstop for those who have limited access. I've also written on this subject more than a couple times due to my experiences with public healthcare and it's mistreatment of my father in law, so I've exhausted most of my details on this matter.

Instead of rehashing ideas listed above, I'll try and simplify a few of my thoughts on this:

1) The current single payer proposal asks healthcare companies to reduce costs associated with healthcare. At the same time the goal is to add a supposed 40 million people on to healthcare benefit plans. IMO this will inevitably lead to a reduction in services or rationing them (basic mathematics). I know that part of the control is intended to help reduce waste and such, but see my comments below.

2) While government can be good at regulating and policing private bodies, it's always been proven to be woefully inadequate at RUNNING anything. Waste, quotas, corruption and politics tend to make decisions instead of professionals (see public education for an example). I've always found it curious that every public societal function that is controlled by the government is continually and unendingly ridiculed, yet the answer to all of this criticism is "make it bigger/throw more money at it".

3) While single payer systems are quite good at general health maintenance, they are HORRIBLE at providing specialist care and often deny service to those who need it (rationing) due to age, current health issues, lifestyle, etc. Manasecret cited several horror stories of American healthcare, and I'm sure there are many more, and I could cite just as many horror stories of people being denied care or dying while waiting for a specialist. There will always be these stories no matter who is in charge, and I don't see them getting any less frequent if the provider of halthcare gets larger and even more topheavy and impersonal.

4) We have to think about the insurance costs and how they are involved in all of this. Malpractice insurance is so high due to lawsuits and exorbinate payouts. Tort reform has to be part of this conversation or else much of our tax money for healthcare will be going into the pockets of lawyers when we think it's going towards service.

5) Before scrapping the American way of providing healthcare, we need to think about how that will affect the world's healthcare. America is currently the leader in creating and providing the highest level of individual healthare in the world. We are the home bases for international pharmacutical companies and when someone wants the best doctor in the world in any one particular area, they come to the US. These pharm companies and doctors created the latest and most innovative techniques, drugs and medical equipment in the world, which is then used by the rest of the world. To essentially castrate the center of medical innovation the world over could have disasterous effects on world health, not just American health.

6) Logistics need to be a part of this discussion. We're not talking about socializing the healthcare of th small country. We're talking about socializing the healthcare of the better part of 400 million people.

I'm not one to say hat the American healthcare system is perfect, it's absolutely not perfect... but nothing is. We keep pushing forward with these radical ideas with no real thought towards unintended consequences all because there are flaws in what we deem should be perfect.

We need to keep what makes American healthcare great for the best of us, and work to improve it for the rest of us.

Most importantly, we can't this become a means of controlling human behavior. Single payer options could quickly become a means for legitimizing intolerance and Big Brother like mandates in the name of the "greater good".

Re: Public option for healthcare
 

The Democratic health care bill appears to not be deficit neutral (as claimed), according to the CBO:

Re: Public option for healthcare
 

I hadn't seen this point before, prof you bring foward a very reasonable arguement.. But once again my base disagreement is in the fact that this should be handled 100% by the private sector.

The point of the public option is for healthcare to be available to anyone, instead of it just being a luxury. While you can talk bad about government run things like public schooling, social security, law enforcement etc.. the point of these things are to make these human needs available to everyone.

A public school is not the best for a student to go to, that's why there's private schools. Law enforcement isn't the best security for everyone, that's why people hire bodygaurds. I don't see any direct complaints from the public about social security.. but I'm sure if they hate it enough they don't have to go through such systems. (but good luck getting private insurance for a reasonable price if you're old and sick)

The point is to give people an OPTION that is not based in making a profit off of you, and that is not trying to deny you care when you really get sick.

If the government programs are so bad, why aren't politicians openly fighting against it. Why isn't anyone trying to get rid of medicare and medicaid? Why isn't anyone trying to get rid of the public schooling system? Of course I know why nobody does that, and yes there reasons for not doing it is reasonable.. But I think healthcare is something that should fit into the same category and shouldn't be handled by a regulated private sector.

I think the public option should be made, and once its there.. when it has some issues we should dow hat we can to try and fix it.

I'd rather it be in this position then where it is now. Where politicians are taking 'donations' from these private health insurance companies to vote with them, even though its clear that they're breaking the system as it is now.

I'm a supporter of capitalism, but the fact is that it doesn't work for everything. These companies mindset is to make as much money as possible, while spending as little money as possible. That's the true reason for all of the stories in manasecret's post.

At this point, I don't think there's any reasonable regulations that can be done on the private healthcare insurance companies without pretty much destorying what makes them profitable in the first place. Like setting regulations in there about renegotiating healthcare or dropping healthcare, or making it manditory to provide it to anyone regardless of age.. or no longer being able to discriminate on the price based on age... like wild things like that.. And even if things like that were set in, they'd either find loopholes, or blame the government directly for all of their problems based on the regulation in an effort to get the regulations lifted.

So why waste our time and money regulating them? We should make them compete with a proper healthcare system to start.

Why shouldn't healthcare be a right instead of a luxury?