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The Healthcare Bill debate in the US
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norcalgolfer



Joined: 06 Jul 2009
Posts: 38
Location: Ranch Cordova, CA

PostPosted: Tue Aug 18, 2009 5:57 pm    Post subject: Reply with quote

dick wrote:

As long as profit is involved, I don't think insurance of any kind will be "fair," because insurers have more sources of information than insurees will ever have and can more readily configure the odds in their favor.


Insurance companies are definitely there to make a profit, they are a business. But is that really bad? There are strict state and federal guidelines governing insurance, and in CA at least an insurer must have their rates approved by the Insurance Commissioner before charging them. Plus there are many more laws to protect the consumer, such as a broker must make a serious effort to find insurance for an insured from an "approved" insurance company before they can legally set somebody up with a non-approved carrier. There are strict laws regarding whether insurance companies can refuse to renew coverage, or cancel existing coverage.

Insurance companies are similar to casinos in that they make their money off the law of large numbers. By gathering information they are able to fully assess the risk factors and ensure that they can minimize adverse selection, an example of that would be someone who goes to get car insurance after they have had an accident, this is why insurers want a picture of your car first. Gathering information also allows insurers to charge lower rates for people that are less risk.

Insurance companies are in a bad position because if all goes well for everybody, an insured pays premiums and never files a claim. Most of us don't like to pay out money and never "see" a return, but we all sure love having the insurance if something happens and that is of course why we have insurance. The most insurable risk is the most unpredictable risk.

I feel the insurance companies are currently well regulated, with the exception maybe of Health care, and even there most of the problem is not regulation, but lack of national health care to ease the burden on insurance companies along with a prevalence of law suits.

Just because some companies as well as people are constantly looking for a way to "get over on you" doesn't mean all or even a majority are. Many have a genuine interest in benefiting everybody involved, both consumer and producer. This doesn't mean one shouldn't question motives when money is involved, just don't assume the worst.

For an interesting perspective from a lawyer who works for an insurance company check this out:
http://news.yahoo.com/s/csm/20090818/cm_csm/yfreiberg
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CD



Joined: 15 Sep 2007
Posts: 665
Location: London, UK

PostPosted: Tue Aug 18, 2009 10:15 pm    Post subject: Reply with quote

This has been a really interesting thread to read - thank you all!

I'm British so have grown up under the NHS and "free at the point of delivery" health care. The NHS is one of those very British national institutions, like the BBC and the Royal Family (and the weather Wink), that we all gripe about on a regular basis but actually regard with no small amount of genuine affection. Ok, maybe not the weather. The NHS could indeed stand to be a bit more efficient, but then so could many things. And although it is easy to take it for granted, I do value the fact that health is not something I have to worry about from a financial point of view. There will always be a safety net - and from my experience as a user, a pretty good one at that.

However, I remember reading somewhere that the different attitudes towards health care between Europe and the US just highlights our pretty fundamental cultural differences. From my observations, in Europe there's more of a tendency, rightly or wrongly, to trust national institutions over private enterprise, whereas the reverse seems to be true in the States. Also, this is a huge generalisation but in the give-take between liberty and equality, I would say Americans are generally more tolerant of sacrificing equality for liberty than Europeans. Or perhaps I should word it differently saying that Europeans are generally more tolerant of sacrificing liberty for equality ie in taxes and increased government regulation. My personal opinion as a European is that you can't have any liberty without a certain amount of equality. But then I reckon you could turn that one around as well Wink.

On the first point, one thing I've noticed in my sector since I started in Haiti is the sheer number of American "for profits" working in the development/humanitarian aid sector. To me, brought up with a fundamental distrust of enterprise and firmly ensconed in the non-profit sector, this seemed crazy. Why would you trust an organistation whose stated aim is to maximise profits, with a project whose stated aims are to GIVE to the community? It made no sense to me, and this topic fueled many a lively after dinner discussion! Rationally, I have managed to see the value that for profits can make to the public sector (with the proper regulation which is whole topic in itself), but there's still a part of me that's just feels that it's just unnatural, dammit!

Anyway, to stop rambling and get back to the point, I do feel that the recent "my health care system is better than yours" spat across the Atlantic seems fueled on both sides by both misinformation and also by just plain cultural misunderstandings. I remember watching SICKO and being horrified by what was portrayed as an awful inhumane health care system. Then, when it moved to Britain, Canada and France - it portrayed those countries as absolute nivanas for health care: something I know not to be the case in Britain and France. It then hit me that perhaps the first half was not really portraying the full story of health care in the States. I'm sometimes a bit slow with these things.

Don't get me wrong, I still VASTLY prefer my health care system to what is provided in the US. But then I am British Wink.
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dick



Joined: 22 Mar 2007
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PostPosted: Wed Aug 19, 2009 9:31 am    Post subject: Reply with quote

to norcalgolfer: I assume that the regulation of insurance that you speak of applies to California. That degree of regulation does not occur in all states.

I'm aware that insurance companies try to spread risk; but, as with any business, they also try to maximize profit. And most lay individuals dealing with them do so from a less than advantageous position. I know one employee of a nationwide insurance company whose only job was to do whatever necessary to avoid paying claims. I had to threaten to take out a double page newspaper add detailing the sequence of events to make the same nationwide insurance company pay a claim after I hit a deer.

I've lately been dealing with another very large insurance company about a long term care insurance policy, the premiums of which have increased 25% per annum for the last four years. Just this year they changed that portion of their business to what they claim will be non-profit; the 25% increases continue. Per the state commissioner's office in my state, it has no power to limit those increases. Of course, the company offers to change the benefits of the original contract and thus reduce the premium, but before long, the policy either will be gutted and/or the premiums will be so high I will have to cancel, losing the 14 years of premiums already paid.

I have to agree with CD--striving for profit and altruism rarely coincide in the same entity.

I read the article you cited; in my reading, the author more or less agrees with me, doesn't she?
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Donna Lea Simpson



Joined: 23 Mar 2007
Posts: 249
Location: Canada

PostPosted: Wed Aug 19, 2009 9:43 am    Post subject: Reply with quote

I am certainly one of those who doesn't understand why many Americans distrust the government, over whom we have the control of the ballot box, but do trust private industry, whose sole purpose is to deliver profits to the shareholders. Profit is not very often aligned with what is best for people. I'm not saying I have blind trust in the government; they have their fair share of screw-ups. But I think it is easier to hold a public official accountable for those screw-ups than it is to take a private company to task. This does, I think, point up some fundamental differences between Americans and Canadians. Perhaps, as per a post earlier in this conversation, Canadians are more in line with European thinking.

Ultimately, though, this doesn't come down to a 'we're right, you're wrong!' scenario. There is more than one model of how health care delivery can/should efficiently work. I suspect it will be different for every country.

However... I will fight with my last breath to keep our healthcare system here in Canada from being privatized! In the US I would one of the uninsured, I suspect.
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Karaa



Joined: 17 Apr 2008
Posts: 103

PostPosted: Wed Aug 19, 2009 10:01 am    Post subject: Reply with quote

A couple of survey points, submitted for your consideration.

U.S. stalls, ranks last in "amenable mortality", preventable with timely and effective access to health care

Quote:
In a Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, researchers found that the United States placed last. While the other nations improved dramatically between the two study periods—1997–98 and 2002–03—the U.S. improved only slightly on the measure.






Quote:
The rate of amenable mortality is a valuable indicator of health care performance, say the authors—one that can point to potential weaknesses in a nation's health system that require attention. "[T]he findings presented here are consistent with other cross-national analyses, demonstrating the relative underperformance of the U.S. health care system in several key indicators compared with other industrialized countries," they say.


As so often, the bottom line seems to be money:

A 2008 survey of chronically ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States found major differences in health care access, safety, and efficiency, with U.S. patients at particularly high risk of forgoing care because of costs and experiencing errors or inefficient, poorly organized care.



Quote:

Key Findings
* More than half (54%) of U.S. patients did not get recommended care, fill prescriptions, or see a doctor when sick because of costs, versus 7 percent to 36 percent in the other countries.
* About one-third of U.S. patients—the highest proportion in the survey—experienced medical errors, including delays in learning about abnormal lab test results.
* Similarly, one-third of U.S. patients encountered poorly coordinated care, including medical records not available during an appointment or duplicated tests.
* The U.S. stands out for patient costs, with 41 percent reporting they spent more than $1,000 on out-of-pocket costs in the past year. U.K. and Dutch patients were most protected against such costs.
* Only one-quarter (26%) of U.S. and Canadian patients reported same-day access to doctors when sick, and one-fourth or more reported long waits. About half or more of Dutch (60%), New Zealand, (54%), and U.K. (48%) patients were able to get same-day appointments.
* A majority of respondents across the eight countries saw room for improvement. Chronically ill adults in the U.S. were the most negative; one-third said the health care system needs a complete overhaul.
* In the past two years, 59 percent of U.S. patients visited an emergency room (ER); only Canada had a higher rate (64%). In both countries, one of five patients said they went to the ER for a condition that could have been treated by a regular doctor if one had been available


I also recall several recent studies that took a look at the cost of maintaining millions of "poor, sick, un/underinsured, and soon dead" the to U.S. economy in form of lost economic output and productivity. Nations with universal health care seem to have an economic advantage when it comes to those chronic conditions and preventable deaths, and keeping their tax-payers and money-makers fit and contributing instead of draining resources.

Hidden Costs, Value Lost: Uninsurance in America

Quote:
In the report, the Committee concludes that the estimated benefits across society in health years of life gained by providing the uninsured with the kind and amount of health services that the insured use are likely greater than the additional social costs of doing so. The potential economic value to be gained in better health outcomes from uninterrupted coverage for all Americans is estimated to be between $65 and $130 billion each year.


Care Without Coverage: Too Little, Too Late

Quote:
The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million - one in seven - working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country.

The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
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norcalgolfer



Joined: 06 Jul 2009
Posts: 38
Location: Ranch Cordova, CA

PostPosted: Wed Aug 19, 2009 4:39 pm    Post subject: Reply with quote

to dick: The regulation I speak of is for California, I cannot say for sure about other states because I haven't studied insurance for them. I do know that most states have very similar regulations, and because the Supreme Court deemed that insurance should be regulated on a state level and not federal, it is up to the voters of each state to insist on regulation.

There will always be someone looking for "easy money", that is why we have a certain amount of government regulation for industry, and the media to help us be aware of changes needed. The Internet has become an incredible resource to allow all of us to be as informed as we want to be.

Having established that, it doesn't mean that profit is by nature counter to public interest. The previous example is the extreme of the bell curve, on the other end we have the people that freely allow themselves to be taken advantage of without making any effort at all to mitigate it. In the middle of the bell curve, which makes up a majority of business, we have the businesses that are in it for the long haul. If your product is crap, you will want to make your money quick, then move on to something new. The businesses that want to last, understand that the key to that is customer satisfaction. Businesses understand that their customers talk, and many rely on this as nearly their sole form of advertising. A company wants to continue selling their products to the public, both present products and future, with the prevalence of media in America they are also very concerned with public image. All this means that happy customer=more money.

How many of you do business somewhere because a friend told you of their great experience?

Businesses looking to maximize profits for their shareholders this way are doing an incredible service to the entire public sector. They employ current workers, and many of the shareholders are people on retirement. Regardless of the retirement fund, if it works it invests. How many people are worried about losing their pension fund because of financial losses within that funds investments?

There are different pools of consumers for different insurance companies. Some customers are looking for the absolute best coverage, this includes more risks for the insurer, so in order to provide that coverage and remain in business they charge a higher premium. If you want an insurance company that will pay all your claims without so much as a question you will have to pay more for the insurer absorbing more fraudulent claims. It is estimated that 50% of all auto claims are fraudulent. I personally have met people or heard stories from others about people they personally know that have committed insurance fraud, and so does everybody I've talked to. If you want to pay a lower premium, you have to allow the insurer to lower their risk factor, this includes fraud investigators whose sole job is to find a reason to not pay a claim...because of fraud.

If national health care is going to work in the U.S. we must get rid of the mentality that money from the government or corporations like insurance companies is free. The money has to come from somewhere, and if you file fraudulent insurance claims that money will come out of the pocket of future insureds. Insurance premiums rise not because the insurers are trying to gouge you, it is because they are insuring a large pool of people and premiums must be more than claims paid in order to remain solvent. Competition and regulation and customer satisfaction keep the premiums as low as possible to provide the coverage requested, while abuse and fraud and "free money" attitudes work to keep costs high.

P.S. The link I posted was simply because it was a good perspective, not because it supports or disagrees with my opinions, I try very hard to look at an issue from all sides and perspectives.
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norcalgolfer



Joined: 06 Jul 2009
Posts: 38
Location: Ranch Cordova, CA

PostPosted: Wed Aug 19, 2009 9:58 pm    Post subject: Reply with quote

I think this article makes some pretty strong points.

http://money.cnn.com/2009/08/18/news/economy/obamacare_alternative.fortune/index.htm?postversion=2009081905
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dick



Joined: 22 Mar 2007
Posts: 2505

PostPosted: Thu Aug 20, 2009 10:39 am    Post subject: Reply with quote

to norcalgolfer: I don't know, but it seems to me that the many law suits of the past two decades against Ford, GMC, large insurance companies, manufacturers of medicines and medical supplies--most of which they've lost--suggest that for the greater majority of companies, especially the very large ones, self interest is the driving force. Further, many of them have such a large share of the market that a buyer has only a few places to go shopping. Many of the very regulatory bodies you speak of, require the individual shopper to buy the very product--such as auto insurance--that the company provides, thus insuring that the company has a market. Those companies also have the wherewithal to influence those same regulatory bodies far more than the individual who will use their product.


I read the article you cited with great interest. And I agree with the basic ideas suggested therein. But don't you think the writer ignored some things? For example, even though wage-earners would have more money to take home, isn't he assuming, when he states they could buy insurance with it, that they will do so? And if they don't do so, and if they don't save some of that money to pay for the large copays, what would happen? Would the public again be faced with meeting the cost of their medical care, just as it is now? He assumes, I think, that the majority of people will use the extra money in a sensible way.
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norcalgolfer



Joined: 06 Jul 2009
Posts: 38
Location: Ranch Cordova, CA

PostPosted: Thu Aug 20, 2009 12:54 pm    Post subject: Reply with quote

to dick: I definitely agree that some of the large companies have far too much of a monopoly, like PG&E for instance. But I don't feel that applies much to insurance as there is a huge variety of companies offering options. For the consumer too, there is a system in place to make sure they get what they need even if they don't know much about insurance. The system is insurance brokers. Insurance brokers, unlike Insurance agents, work for the insured. Now some Insurance brokers can be sharks, but many are excellent people, and since they are working for and paid by the insured not the insurer, they have your best interest at heart. Another key to options in the market is taking away a lot of the limiting regulations specific to Health Insurance. That article I cited mentioned some, but an option I would like available is the option to agree to not sue for pain and suffering. That option is available some places for auto insurance, and saves the policy holders a tremendous amount of money in premiums. The fact that it saves so much shows how much of our premiums are to cover those lawsuits. The amount of money you would save on health insurance I suspect would be even more. Currently, regulations keep insurers from offering those plans.

Yes, large companies are fully about their own self interest, but free market is what makes that self interest be the same as public interest most of the time. Look at how much trouble U.S. auto makers are in, they are in that much financial trouble because the products they have been making, by and large, are not as good as products from Toyota or Honda. The only way those companies will be able to stay alive will be by producing better products, and changing public opinion from how it stands now.

dick wrote:
Many of the very regulatory bodies you speak of, require the individual shopper to buy the very product--such as auto insurance--that the company provides, thus insuring that the company has a market.


I'm not sure if I follow you, yes California regulations require you to have auto insurance, or file a $35000 bond with DMV (to be self-insured) in order to register your car. Plus fines for driving without insurance are hefty. But as someone who had their car totaled by a hit and run driver, I fully agree with that legislation. There is a tremendous variety of auto insurers, and brokers like Cost-u-less are booming, because they are brokering the same coverage for their customers at a much reduced premium. By law, nobody, whether it be a company, or DMV can force you to purchase auto insurance from a specific company, and the penalties for attempting to force you are stiff. I don't feel at all that CA requiring auto insurance is creating a false market, the market has been there and will continue. The only thing the requirement to obtain auto insurance is doing is legislating morality. Morally you have an obligation to indemnify someone if you are at fault in an accident. For the most part I tend to disagree with attempts to legislate morality, but in this case I agree, I don't think anyone has any business driving if they can't provide auto insurance. If you happen to have $35000 cash to invest, you don't have to buy a policy, you can just file that bond with DMV and you are self insured.

Regarding the article, I completely agree with you. It is making the assumption that people will use it in a sensible way, and people, especially when money gets tight, tend to take money away from things that don't seem currently to be the highest priority. The idea certainly has some things that would need to be ironed out, and I'm definitely not saying it is the solution. But I really like the idea of putting the consumer back in charge. I think if the Medical industry had to act like every other, we would see a ton of improvement, in every area, from customer service, to efficiency and so on. I would also like insurance to be provided for those whose employer doesn't offer it, as well as the many unemployed workers.

The problem I have with giving the government full control, is the horrible efficiency they have shown in the past, as well as the nearly complete lack of accountability. Many of us have problems with government agencies, but there is rarely, if ever anything we can use to take them to task. Large enough issues are dealt with through elections, but many of the smaller problems are left alone, and we have no real power over them. Private industry on the other hand, when we have a real market, not like the energy monopoly PG&E has, we as the consumers have a tremendous amount of power. We can take our business somewhere else. If something is completely run by the government though, well, forget it if you have a problem, chances are they will just say tough %$&*. A great example of this is DMV, I have found one DMV around that gives great customer service, and I drive an extra hour out of my way for it. Most DMV's I have been to are rude, and totally unconcerned about how you feel about their behavior. My fiance and I had an appointment at the local one, and we had to wait 2.5 hours past our scheduled appointment, and although we eventually were helped, DMV made an error that ended up costing my fiance $600, and they don't care. They suspended her license because of their error, and since we can't prove that it was their error we just have to eat it and pay the money, again. I am asking you to take me at my word that what I have just said is true, but I doubt many will be surprised, because I suspect most people have had an experience where our governments inefficiency or errors cost them money. These experiences make it very hard for many of us to trust the government to be efficient and error free when it comes to anything, and if our lives are on the line it's a pretty big deal.

Look at the opportunities available in the U.S. and you can see that a free market system works, it's not perfect, people fall through the cracks, but that happens with every system though, and all it takes is a little travel for me as an American to realize how incredibly lucky I am. Using the success of the free market system along with government subsidies I think could very well be the answer we need for universal health care, but I am not convinced yet. Don't take this to mean I am against socialized programs, I just want to benefit the most people possible, and if there is a way to provide universal health care while utilizing the power of the free market system that is my preference, because I feel it puts the power in my hands, and that's where I want my health to be.
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KarenS



Joined: 23 Mar 2007
Posts: 870
Location: Florida

PostPosted: Thu Aug 20, 2009 9:44 pm    Post subject: Reply with quote

It is my understanding that between 77% to 83% of Americans favor health care reform so let's see if our elected representatives do right by us. If you support health care reform or do not, you should let your feelings be known. Write your letters, make your phone calls to your US Senators and Congressperson and let them know where you stand. Then encourage your family, friends and co-workers to do the same.

I obviously support the public option. Would I like to see Medicare for all? Yes, that would be fine. It would be the easiest to implement since we have Medicare in place now. Medicare for all would certainly stick it to the insurance companies and frankly, I feel they deserve it. They really don't give a s**t about the American public. All they care about is their obscene profits. It is the private insurance companies that are already regulating care, rationing care, deciding what is covered and what is not, who is covered, defining what pre-existing conditions are and basically making insurance unaffordable for so many people. Why would anyone want to maintain this type of system?

Government isn't meant to be efficient. Safeguards are placed in the system so that it's slow and ponderous for good reason. Even though it can be annoying at times do you think anyone over 65 is willing to do away with Medicare? If they are, let them turn in their Medicare card.

Medicare was passed in the mid 60s to give a hand-up to retirees who were struggling with their health care costs. Back then everyone(more or less) was covered with insurance except for those who were no longer working(i.e.retired). It seemed like a great idea at the time since the 60s was a fairly affluent decade. Life was good as people were paid decent wages(a working man could actually support his family while the wife stayed home). So Medicare was passed. It has basically been the last progressive program our country has passed. Sadly, that was forty years ago.

I am concerned for my son(20) and daughter(eighteen) and their generation. Hopefully, they won't have to worry about health care once health insurance reform is passed. Not having to worry about being denied coverage, not worrying about less care for more cost, not worrying about medical bankruptcy nor diminishing access to care would be a tremendous load off their shoulders. Without reform, health care costs will only skyrocket straining their future budgets.

Either we maintain the status-quo(which is pretty sorry) or do what other industrialized countries around the world do. Then our businesses can compete with other countries. I do feel there is a correlation with our falling standard of living as we have simply not kept up. Other countries have moved on, progressed forward, while we decry socialism and refuse to help our own people. We are willing to fight wars in foreign countries, give money to failing corporations but refuse to help American families stay healthy and financially solvent.
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CD



Joined: 15 Sep 2007
Posts: 665
Location: London, UK

PostPosted: Thu Aug 20, 2009 11:51 pm    Post subject: Reply with quote

Again, thought provoking posts here - a lot of them going completely over my head I have to say. For those of you who are interested in a pretty balanced comparison between the British and the American health system, you can listen to this BBC World Service programme here:

http://www.bbc.co.uk/worldservice/documentaries/2008/07/080715_better_health.shtml

It was done over a year ago so obviously doesn't incorporate recent events and issues, but it's good at giving both the advantages and disadvantages of both systems.


norcalgolfer wrote:
The problem I have with giving the government full control, is the horrible efficiency they have shown in the past, as well as the nearly complete lack of accountability. Many of us have problems with government agencies, but there is rarely, if ever anything we can use to take them to task. Large enough issues are dealt with through elections, but many of the smaller problems are left alone, and we have no real power over them. Private industry on the other hand, when we have a real market, not like the energy monopoly PG&E has, we as the consumers have a tremendous amount of power. We can take our business somewhere else. If something is completely run by the government though, well, forget it if you have a problem, chances are they will just say tough %$&*.


Again, this probably comes down to "who do you trust more". In my dealings with the public sector in Britian, both professionally and personally, there is always an avenue for complaints and for redress, and a mind-boggling amount of service delivery indicators that departmental performances are judged by. I don't konw about the States, but in Britain, most social services are also run by elected local councils who normally have quite wide discretion in service delivery, so there theoretically is accountability at the local level. I'm sure it's probably not as responsive as it sounds on paper but personally I feel I'm in a better position to negotiate with public rather than private organisations as I know that helping me is the very reason for their existence.

What sort of redress do we have against private corporations? Yes, we can take our business elsewhere but that only works when we're in a consumer driven as opposed to a supplier-driven market, or if we're negotiating from a position of strength. In many cases, you effectively don't have any real choice - either because of your income or your job or simply the nature of the market out there. No markets are perfect in reality. And if all suppliers are basically offering similar services (as they tend to do in a mature market), then there's not much you can do.



Quote:
Look at the opportunities available in the U.S. and you can see that a free market system works, it's not perfect, people fall through the cracks, but that happens with every system though, and all it takes is a little travel for me as an American to realize how incredibly lucky I am. Using the success of the free market system along with government subsidies I think could very well be the answer we need for universal health care, but I am not convinced yet. Don't take this to mean I am against socialized programs, I just want to benefit the most people possible, and if there is a way to provide universal health care while utilizing the power of the free market system that is my preference, because I feel it puts the power in my hands, and that's where I want my health to be.


I'm all for keeping power and choice in your own hands!! The only issue is that I'm pretty sceptical about how much power and choice you have in reality with a free market system unless you're pretty well-off.

Market forces obviously do work but the issue is that the market as a means of allocating resources/services is by nature amoral. To me, health care, along with education and basic social welfare, are too important and crucial to leave to the vagaries of the market. The people who fall through the cracks will normally be the most vulnerable, and I imagine we would all agree that societies are judged on how well we treat the most vulnerable among us.

Having something in the middle does make a certain amount of sense - I believe that's the system they have in France and Germany. Cora seemed rather sceptical about the German system but the French system seems to work pretty well when I was living there. Not being used to it, I found it initially rather annoying to have to get out my wallet for visits to the doctor, but it was a pretty minimal amount actually.

Not sure we could really do that in Britain as we're too spoilt by the NHS and I can't imagine any politican brave enough to take that on despite the serious financial and budgetary issues. Anyway, exciting times ahead for our cousins across the pond!!
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dick



Joined: 22 Mar 2007
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PostPosted: Fri Aug 21, 2009 10:24 am    Post subject: Reply with quote

to norcalgolfer: You've obviously had different experiences with insurance than I have. For example, I was once denied car insurance by a company because my elder brother was killed in an automobile accident in which he was not at fault. Further, the number of companies offering auto insurance at a reasonable cost, in my area at least, is limited, usually to those with nationwide offices; economies of size, in my experience, do not translate into value for the individual. I cancelled with the company which tried without success to avoid paying the claim for hitting a deer--a company I had been with for more than 20 years without a single claim. I have never had an an accident--except with the deer--nor even a ticket, yet neither my loyalty nor my near faultlessness made a difference. I certainly wasn't trying to defraud the company.

In effect, the law requiring one must have auto insurance or have resources to cover any possible accidents, insures that auto insurance companies have a rather extensive market because there are few who have the resources to avoid buying it. Then, like most large industries with associations, they also have the resources to influence rates, requirements, etc, through lobbying, resources of time, money, and data which the average consumer does not have.

As to health insurance, I am presently covered by Medicare plus Medigap policy, and I can readily state that I've had no bad experiences with either. I cannot state the same with private insurance provided by employers. In one instance, I was assured, when I checked with the insurance company before proceeding, that I would be responsible only for the copay. I wound up paying several thousand dollars from my own pocket, even though the surgery had been pre-approved; a mistake by the person with whom I had checked, it asserted. In another, after shoulder surgery, therapy was abruptly cut off before the number of sessions provided by the policy had occurred. Only after considerable heated lobbying was the therapy extended.

I have to agree with CD; the ethics of large companies and the free market is suspect.
Certainly the state of the economy presents considerable evidence of that.

As it happens, I don't think there is such a thing as a "free" market--except perhaps in local farmers' markets, and probably not there. In many instances, the law precludes it, as with patents, copyrights, and so on. For example, the law that prohibits inhalers from being powered with flurocarbons, which effectively doubled the price of them for all asthmatics. I doubt the amount of fluorocarbon the originals released into the atmosphere was that great or that production of a different propellant required doubling the cost.
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norcalgolfer



Joined: 06 Jul 2009
Posts: 38
Location: Ranch Cordova, CA

PostPosted: Fri Aug 21, 2009 2:00 pm    Post subject: Reply with quote

Thanks CD, that was a great report and I thoroughly enjoyed listening to it. I think Jill did a great job highlighting exactly what is both good and bad about both systems, without trying to use extreme examples.

I think for the most part I totally agree with you CD except I'm a bit more to the corporate side of the middle of the spectrum, but I am by no means a full supporter of corporations, and you are totally correct in what happens in some markets. I think we should definitely create a balanced system, that utilizes the benefits society receives from both socialism and free market. I feel that if you go too far to either side you end up with more bad than good, and that is true with pretty much everything in life, IMO. I have perhaps come across as more of a large corporation supporter than I actually am. I do recognize that business will do whatever it can in order to maximize profit. There are also a lot of ways for businesses to take advantage of the consumer, and most will take any advantage they can get. This is why a completely free market system fails just as badly as a completely socialist system. But when you work hard to find the right balance between the two you end up with a very successful society, with a great many benefits and opportunities for all, regardless of wealth(to some extent; more money always means more opportunity). I'm not trying to say that we have perfected that system in any way in the U.S., however I do believe that is the goal for most Americans. There are a lot of reforms we need in order to get closer to that goal, and a lot of reforms we need to reverse because they have done more bad than good.

Your example dick of the asthma inhalers is a perfect example of when government involvement has hindered the public instead of helped. The same is true with insurance regulation, State's are given that power, and I generally agree with having the power more local. However in many states throughout the country, poor regulation intended for "protection" has actually had the opposite effect. I am lucky that in California we have a tremendous amount of options with regards to auto insurance so I am able to find very reasonable rates. Another thing to remember is the relationship between auto insurance and cost of health care. A large amount of the premium is to cover possible medical costs the insurer may incur through coverage.

Not all my experiences have been good with insurance, but it hasn't all been bad either. Also there are times when I have felt that a company ripped me off, but there are many more times that I have been able to get exactly what I wanted, for a reasonable price and with great customer service. I also have the same good and bad experiences with the government, and I feel that government and corporations are basically two sides of the same coin.

Yesterday I spent some time looking at the Australian system, after a friend had told me about the excellent care they received there, completely free of charge. From what I have learned so far I think they have a pretty good plan. They have coverage for everybody, and the coverage is partially funded by a 1.5% medicare tax, as well as an additional 1% tax for people who earn over $70,000 a year or $140,000 a year for couples if they don't purchase private health insurance. There are several other incentives, both in the form of fees and in the form of subsidies to encourage people to buy private insurance if they can afford it. The important part to note though is that everyone is covered regardless, and everyone for the most part receives the same level of care, or so it seems from what I have been reading. Australia also focuses on preventive care, which most people seem to agree is absolutely crucial. From everything I have seen so far, a lot of which has either come from those on this thread, I find myself more and more leaning to the Australian method which seems to me would reap the benefits from the free market, while reaping the social benefits of health care for everyone and all of this while keeping the cost manageable.

I noticed in the graphs posted by Karaa, Australia ranks pretty high, except for in the last one, in which it was only better than the U.S. I also know that typically Australia has had excellent cancer survival rates. I would be very interested in hearing any experiences people have had with Australia's system, especially people who have been living there.

to dick: It sounds like you have had some pretty bad experiences with insurance, I'm sorry to hear that. I wasn't trying to suggest you were committing fraud if you felt that way. People who work in insurance claims can often become jaded, the same as people who work for police departments taking victim statements. It's not the crimes that stand out, you expect those; it's the sheer number of "victims" who lie through their teeth, that is what is surprising. When literally half of the people you deal with are trying to scam you, you can develop a very cynical attitude very quickly. I know this isn't all of what happens with insurance, the insurance companies are trying to make as much profit as possible, and many have used what I would consider unscrupulous means to do so. But there is a certain amount of attitude when dealing with an adjuster due to the amount of time they are lied to as well as a large part of the premium due to fraud.

I have probably defended the large corporations enough, but I will go ahead and say just one more. By far the majority of donations received by charities come from large companies, as well as everybody who has any retirement whatsoever, which is most people over 65, is likely to have the majority of their money in stocks. This to me argues that large companies do more for the elderly and the needy than a whole hell of a lot of people.
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cheri



Joined: 22 Mar 2007
Posts: 1350
Location: michigan

PostPosted: Sat Aug 22, 2009 9:06 am    Post subject: Reply with quote

I have a firm and definite opinion that this should have been in place years ago. I don't care about ANY wait but I do care about our Shi**y medical insurance and the lives that are being lost. This is an age old debate between me and my brother in law. Nothing anyone says can make me change my mind. I'm all for Obama passing this, I would be doing a Snoppy dance. Anyone who hasn't seen Sicko by Micheal Moore should check it out too. AMAZING what England, Canada and France do for their people. Just Amazing! cheri
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CD



Joined: 15 Sep 2007
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PostPosted: Sun Aug 23, 2009 10:15 am    Post subject: Reply with quote

norcalgolfer wrote:
Thanks CD, that was a great report and I thoroughly enjoyed listening to it. I think Jill did a great job highlighting exactly what is both good and bad about both systems, without trying to use extreme examples.


I thought so too. I think it's very easy to go to the extremes and demonise/idealise a particular system.


Quote:
I think we should definitely create a balanced system, that utilizes the benefits society receives from both socialism and free market. I feel that if you go too far to either side you end up with more bad than good, and that is true with pretty much everything in life, IMO. I have perhaps come across as more of a large corporation supporter than I actually am. I do recognize that business will do whatever it can in order to maximize profit. There are also a lot of ways for businesses to take advantage of the consumer, and most will take any advantage they can get. This is why a completely free market system fails just as badly as a completely socialist system. But when you work hard to find the right balance between the two you end up with a very successful society, with a great many benefits and opportunities for all, regardless of wealth(to some extent; more money always means more opportunity).



FYI, in Britain at least, the word "socialism" relates to a whole complete political ideology rather than a method of service provision regarding a particular good. I just wanted to point that out because it's a pretty loaded word with particular historical connotations which could cause misunderstandings. In somewhat more neutral terminology, I think what we're talking about here is more how to create the ideal split between the public (paid for by the public through taxation) and the private sectors. Although the NHS was set up by a proudly socialist government after the war, the original blue-prints were actually drawn up by Winston Churchill before the tories unexpectedly lost the 1944 election. I think he would have been aghast to find out that he was actually a socialist!

What you are describing though appears to be the generally accepted social democratic model in Europe. All the main political parties would agree that the role of government to ensure that the basic needs of all its citizens are met and that there is equality of opportunity for all. However, the devil as always is in the details - and it's in these details where you find the right-left political split, particularly the details on where exactly to draw the line between public and private responsbility.

Health to me is clear cut - I can't see of anything more fundamentally basic than that. Whatever methods used, governments should ensure that ALL its citzens have access to primary care, emergency care, and life-threatening secondary care. That's completely a no-brainer for me. These types of care represent a public good and should therefore be funded by the public to ensure that these services are provided to all - and I believe that's the general consesus among all our major political parties.

Where you get sticky in terms of funding and matters of individual choice is with quality of life type care, especially with the elderly and those whose lifestyle choices led to their deteriorating healthcare. There, I believe, you would make different decisions on how these costs would be funded/the individual's choice depending where you fall on the political spectrum. I still haven't made up my mind about that myself...

Quote:
Yesterday I spent some time looking at the Australian system, after a friend had told me about the excellent care they received there, completely free of charge. From what I have learned so far I think they have a pretty good plan. They have coverage for everybody, and the coverage is partially funded by a 1.5% medicare tax, as well as an additional 1% tax for people who earn over $70,000 a year or $140,000 a year for couples if they don't purchase private health insurance. There are several other incentives, both in the form of fees and in the form of subsidies to encourage people to buy private insurance if they can afford it. The important part to note though is that everyone is covered regardless, and everyone for the most part receives the same level of care, or so it seems from what I have been reading. Australia also focuses on preventive care, which most people seem to agree is absolutely crucial. From everything I have seen so far, a lot of which has either come from those on this thread, I find myself more and more leaning to the Australian method which seems to me would reap the benefits from the free market, while reaping the social benefits of health care for everyone and all of this while keeping the cost manageable.


You didn't mention if health care is public or private in Australia and that's the crucial difference - from what you're saying, it sounds like it's private. In Britain, NHS doctors and other medical/admin personnel, hospitals, clinics etc are all employed/owned by the State and paid for through general taxation. For another comparison, in France, primary healthcare is mostly private but effectively heavily subsidised by the government - around 70% to 80% if I remember. So despite being notionally private, the government exerts a huge amount of control over the industry as you can imagine. These are French politcians/mandarins here so autocrat as hell here... Secondary health care ie hospitals are mostly State-owned so again free at the point of delivery.

France spends significantly more than the UK on health care (although still not as much as the US per capita) and it apparently does have the best health care in the world (but you wouldn't know it to hear the French complain), but then primary health care is still not free at the point of delivery the way the British system is. It works on a reimbursements system for most levels of income which is sometimes a pain that my family, especially the older members, complain incessantly about. However, at least you know that you will be reimbursed for the majority of the costs by the government and that you will either pay the rest out of pocket or take out insurance for the rest. Insurance companies in France are actually non-profits or work based mutual cooperatives so are not meant to make a profit which keeps premiums reasonable.

If I understand the current debate in the US, the main option proposed by Obama is no way near as radical as the NHS - you're not planning on nationalising or even part-nationalising all doctors' clinics/hospitals etc anytime in the near future. If I understand, the option is simply to set up in effect a public insurance company which will compete with the exisitng private companies but will insure those who cannot pay for free. Is that the case? If so, then excepting insurance companies I can't see there could be that much opposition from the right. I imagine the left will probably think it doens't go far enough.


Quote:
I have probably defended the large corporations enough, but I will go ahead and say just one more. By far the majority of donations received by charities come from large companies, as well as everybody who has any retirement whatsoever, which is most people over 65, is likely to have the majority of their money in stocks. This to me argues that large companies do more for the elderly and the needy than a whole hell of a lot of people.


Well, in my sector, that is not my experience at all. The majority of our funding by far is from governments or international public institutions such as the EU - the rest is largely through foundations and public donations, with corporate donations significant but pretty minimal relatively. Aid from private corporations as well as government/inter-governmental bodies can often be seen as largely political in motive - could just be my cynicism on both here.


cheri wrote:
I have a firm and definite opinion that this should have been in place years ago. I don't care about ANY wait but I do care about our Shi**y medical insurance and the lives that are being lost. This is an age old debate between me and my brother in law. Nothing anyone says can make me change my mind. I'm all for Obama passing this, I would be doing a Snoppy dance. Anyone who hasn't seen Sicko by Micheal Moore should check it out too. AMAZING what England, Canada and France do for their people. Just Amazing! cheri


Yep, but as we were discussing, our system is now where near as perfect as it's portrayed in the film. However, if I had a choice, I would much much rather have our system than yours - the paperwork alone would stress me out no end, not to mention the co-pays and deductibles.

Edited for clarity. I hope.
_________________
"Socialism to help sick people - bad.
Socialism to help billionaires - good."
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