Archive for Saturday, January 9, 2016

Letter: Rising costs

January 9, 2016

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To the editor:

This letter is in regards to my cost of health insurance since the Affordable Care Act became effective. Two years ago, prior to the ACA start date, I was paying $286 per month for a Coventry major medical plan. It had a $1,000 deductible.

Now, two years later, after being forced out of that plan when ACA was implemented, my premium is $450 per month with a $6,600 deductible.

Let me do the math for you. Under my new plan, I have to pay $5,400 in premiums and incur $6,600 in a deductible, before I benefit from my health insurance. That’s $12,000 per year before I benefit from my health care.

Now for some good news. My plan is required to cover me for what the ACA refers to as “essential benefits.” These include: doctor visits, prescriptions, hospitalization, preventative care and maternity and newborn care.

Thank goodness my plan covers me for maternity and newborn care, because my plan prior to the ACA didn’t cover me for that. This is of particular benefit to me since I’m a 57-year-old male. You never can be too safe.

The ACA has done some good things like removing the lifetime limit on benefits paid by the insurance company, as well as removing the pre-existing condition limitation so people can switch carriers without being discriminated against.

My concern is not a political one but an economic one. If you don’t qualify for a tax credit, the cost of health insurance through the exchange is becoming prohibitive.

Comments

Bob Forer 1 year, 3 months ago

A single payer plan is the solution. .

Barb Gordon 1 year, 3 months ago

The US is the most expensive system in the world, and yet it is not the most effective. It does not have the best outcomes. It's extremely inefficient. We spend about a third of our health care money on bureaucracy, not care. On CEO salaries, insurance processing, etc. Insurance companies are the real faceless rationing panels, and they're rather good at clamping down on those innovative treatments you're sure we're developing for the rest of the world.

If you want proof of this, just look at Canada. Where their health care costs are lower and their health outcomes are better. Because they were obviously doomed.

Barb Gordon 1 year, 3 months ago

Correction. If you're rich and get regular routine checkups complete with more frequent screenings, your best bet might be to be an American - or you might just have just had a positive screening for a condition that required no treatment but still allowed you to be included as a "survivor" for the sake of statistical argument. http://www.factcheck.org/2009/08/cancer-rates-and-unjustified-conclusions/

Even as flawed as the data is, Canada spends 60% less on health care but does not have 60% of the cancer survival rate.

Marc Wilborn 1 year, 3 months ago

Canada's health care system restrict health care assets, such as hospitals and other facilities. That is not the approach used in the US. Many Canadians have to travel many miles to see specialists or acquire service. We wouldn't stand for that.

Barb Gordon 1 year, 3 months ago

Wrong. The USA restricts health care assets by ability to pay rather than urgency of need, but it does restrict access. There's not an infinite amount of hospital beds anywhere, and every system will have to figure out how to cope with supply/demand problems. Canadians travel a long distance to see specialists or acquire services for the same reason that many Americans do - because the specialists are more likely to live in a large metropolitan area than they are to live in a rural area.

Marc Wilborn 1 year, 3 months ago

You clearly do not understand the differences between the US and Canadian health care systems. US citizens travel to the best of the best provider because they can. Canadians travel long distances because the government restricts the physical allocation of money and facilities. US citizens can travel anywhere, anytime to see whoever they want.

Barb Gordon 1 year, 3 months ago

You clearly do not understand the difference between your fantasy of the American healthcare system and the reality. Rich Americans may travel to the best provider because they can. Rural Americans travel to the nearest provider because they must. "Only about ten percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas." http://www.ruralhealthweb.org/go/left/about-rural-health Also look at the distribution of specialists and other care providers. No Canadian governments were involved in that disparity. It turns out that American doctors prefer living in the big cities. Not such a big stretch (or government plot) to see that the same thing goes on in Canada.

But hey, what does all that driving around really mean?

When surveyed against other industrialized countries, Americans were more likely to delay or avoid care. Because they couldn't pay for it. Remember - this is the most expensive healthcare system in the world, and we don't get the best outcomes.

Carol Bowen 1 year, 3 months ago

Bart, Do you really think what you describe is not happening with insurance companies?

Greg Cooper 1 year, 3 months ago

Bart, that is B/S and you know it. Your words are not backed by any study or experience, ever. The "free market" you so blithely bandy about is great to a point, but fails miserably when dollars become the telling statistic in health care. Deregulation was the guiding force in, for instance, the financial crash that took a large part of Americans' retirement savings. Lack of regulation has never been a financial boon to anyone but those "deregulated". Get off that bus, Mr. Johnson. History and theory both deny your Utopian "ideals".

Greg Cooper 1 year, 3 months ago

It wasn't then, Bart. And not so tightly, even now.

Renee Patrick 1 year, 3 months ago

There are already wait lists for services in this country.

Bob Summers 1 year, 3 months ago

Single payer advocates should be forced to use VA care. To make them feel emotionally secure, allow the VA care free of charge.

Let the government mentality take care of their healthcare needs. The same government mentality that fires employees by mistake and promotes plastic ice skating rinks.

Transparent VA care will be much better for single payer advocates than transparent Obamacare.

http://www.naturalnews.com/052544_Obamacare_gun_control_doctors.html?AID=7236

Lawrence Freeman 1 year, 3 months ago

What's wrong with VA care? And why shouldn't VA care be free?

Richard Heckler 1 year, 3 months ago

VA care is not necessarily free for it is covered by way of our tax dollars. Which also means that veterans are also paying for their VA care.

Single Payer could not be free because tax dollars would be covering the cost which means all of us would contributing to our own health care coverage. What's wrong with that?

In reality 24/7, no questions asked and no insurance industry interference is very good use of our tax dollars.

Lawrence Freeman 1 year, 3 months ago

You are partly right VA care is not free. It was earned the old fashioned way. By hardship and deprivation.

Sam Crow 1 year, 3 months ago

What wrong with the VA health care system?

To begin with, apparently you missed the recent system wide scandal where VA hospitals, including the one in KC, were manipulating the wait list for health care. This was done so that government employee bureaucrats running the system could maximize their pay incentives .

Lawrence Freeman 1 year, 3 months ago

And that is different from private care? Or any business for that matter. Any place there is money and people you will find crooks. I've had no problems with the Topeka VA.

Brett McCabe 1 year, 3 months ago

Bob makes a good point because private entities never make mistakes unless you count the Savings and Loan collapse, the banking collapse, the Ford Pinto gas tank, the Edsel, General Motors (in general), Volkswagen emissions and the fact that 80% of new businesses fail within the first 18-months (Bloomberg). If not for a long history of private entities failing, cheating on their taxes, screwing their customers and abusing their employees, then I'm sure we'd all sit back and let private companies turn our worlds into a big slice of heaven, while they give us a colonoscopy.

Brett McCabe 1 year, 3 months ago

And we have the collective power to enforce change on government entities as opposed to the dispersed and far less effective that we have as individual consumers. It's a myth to say that, once something is government run, that we have not control.

John Middleton 1 year, 3 months ago

And how is the change you enforced working for you in the DMV lines? Or trying to renew your driver's license?
Once a government system is in place, you are pretty much stuck with it.

Kendall Simmons 1 year, 3 months ago

So..."In a free market, those firms that provide quality products and services at low prices get rewarded with repeat customers. Those that don't lose customers and fail"...means that, in a free market, Walmart would have failed years ago, right? I mean, you can't seriously argue that Walmart provides "quality products and services", now can you?

Dorothy Hoyt-Reed 1 year, 3 months ago

Brett, you forgot KanCare, and all the crud going on with programs that have been privatized. Bart and Bob are perfectly aware of the fact that the private sector needs to make a profit, and not just a little profit, their profit must grow in double digits, or they are considered a failure. They are probably invested in insurance companies, and know they will lose out with a single payer system.

Besides they are $christians. They don't believe that Jesus healed people for free, like Christians do. They believe that he made a huge profit from it and went to the money changers in the temple and made even more money with them.

A single payer system would not be free though. It would mean everyone paying their fair share. Some doctors who became doctors, because they wanted to get rich will probably drop out of the system and set up luxury clinics and hospitals for Bob and Bart if they can afford them, but other than that, a single payer system would mean that no one has to wait years to be seen by a doctor, because they can't afford it, just weeks.

Bob Summers 1 year, 3 months ago

You left out the billions paid by the private entities for their mistakes.

How much is the VA paying for their mistakes?

Richard Heckler 1 year, 3 months ago

"premium is $450 per month with a $6,600 deductible.

Let me do the math for you. Under my new plan, I have to pay $5,400 in premiums and incur $6,600 in a deductible, before I benefit from my health insurance. That’s $12,000 per year before I benefit from my health care."

The above represents medical insurance rationing and under insurance at the same time = a double whammy. Remember the medical insurance industry WROTE Obamacare as they have always writing the coverage. The medical insurance industry is all about profiteers not heath care.

After sending all of that dough to the medical insurance industry we discover that the medical insurance industry does not provide 1 single second of health care. Why is this industry getting paid for not providing health care?

Wait times have beeb around for about 70 years or more. Making an appointment is wait time. Waiting to see the doctor or nurse on the day of the appointment is more wait time. Yes been around for decades.

Richard Heckler 1 year, 3 months ago

According to the Washington Post the health insurance and pharmaceutical industries were among the contributors spending $1.4 million health care dollars A DAY to prevent single payer.

meanwhile .....

“The people in favor of a public alternative can’t scrape up the millions of dollars Baucus has received from the health sector during his political career. In fact, over the last two decades, the current members of the entire finance committee have collected nearly $50 million from the health sector, a long-term investment that’s now paying off like a busted slot machine.”

http://www.pbs.org/moyers/journal/blog/2009/10/bill_moyers_michael_winship_in.html#more

If you’ve been watching the Senate Finance Committee’s markup sessions, maybe you’ve noticed a woman sitting behind Committee Chairman Max Baucus. Her name is Liz Fowler.

Fowler used to work for WellPoint, the largest health insurer in the country. She was its vice president of public policy. Baucus’ office failed to mention this in the press release announcing her appointment as senior counsel in February 2008, even though it went on at length about her expertise in “health care policy.”

Now she’s working for the very committee with the most power to give her old company and the entire industry exactly what they want – higher profits – and no competition from alternative non-profit coverage that could lower costs and premiums.

A veteran of the revolving door, Fowler had a previous stint working for Senator Baucus – before her time at WellPoint. But wait, there’s more. The person who was Baucus top health advisor before he brought back Liz Fowler? Her name is Michelle Easton. And why did she leave the staff of the committee? To go to work – surprise – at a firm representing the same company for which Liz Fowler worked – WellPoint. As a lobbyist.

You can’t tell the players without a scorecard in the old Washington shell game. Lobbyist out, lobbyist in. It’s why they always win. They’ve been plowing this ground for years, but with the broad legislative agenda of the Obama White House – health care, energy, financial reform, the Employee Free Choice Act and more – the soil has never been so fertile.

The health care industry alone has eight lobbyists for every member of Congress and more than 500 of them are former Congressional staff members, according to the Public Accountability Initiative’s LittleSis database.

Just to be certain Congress sticks with the program, the industry has been showering megabucks all over Capitol Hill.

Richard Heckler 1 year, 3 months ago

"If you’ve been watching the Senate Finance Committee’s markup sessions, maybe you’ve noticed a woman sitting behind Committee Chairman Max Baucus."

http://www.pbs.org/moyers/journal/blog/2009/10/bill_moyers_michael_winship_in.html#more

Max Baucus one of the loudest voices AGAINST single payer provided his constituents in Libby,Montana with single payer more commonly known as Medicare.

Just so you know....

I believe Max Baucus left capitol hill well sort of. To be among the 8 health insurance lobbyists per elected official..

Are consumers paying more yet in reality getting less?

http://www.dollarsandsense.org/archives/2008/0508harrison.html

Thomas Bryce Jr. 1 year, 3 months ago

As long as we have a For Profit Healthcare system in the US, the price of healthcare will always rise. There is no incentive to reduce costs. Profits over People. Healthcare, in this country, is a Privilege not a Right.

Sam Crow 1 year, 3 months ago

The largest 25 health insurance companies in the country fully insure over 90,000,000 total patients. They administer programs for tens of millions more by contract for companies.

Fourteen of those 25, or well over half, are non profit. Blue Cross Blue Shield of Kansas in Topeka ranks 39th with 675,000 patients fully insured.

Of all hospitals nationwide, 58% are non profit such as St Lukes in KC which is church owned, and 21% are government owned, such as LMH or KUMC.

Where is all this for profit health care going on ?

Carol Bowen 1 year, 3 months ago

Medical equipment, pharmaceuticals, and the cost of working with more than one insurance company.

Bob Smith 1 year, 3 months ago

If you want to see how socialized medicine works, google England national health scandal. Over 3.5 million results just a couple of minutes ago.

Thomas Bryce Jr. 1 year, 3 months ago

So, Socialized healthcare doesn't work in England and the average American is having a hard time affording our Privileged Healthcare System here in America. What do you suggest, Bob?

Thomas Bryce Jr. 1 year, 3 months ago

Wrong. There is a solution but Greed stands in the way. The Millionaire/Billionaire CEOs would have to do with a little less and that is not about to happen. Corporate Greed is the Reason for most of Americas Problems including Healthcare. The True Evil facing America is Capitalism without Conscience. "Free Market" is another name for it. Unregulated, it becomes Social Darwinism. The rich can be rich without owning everything. When they own everything, what will drive the economy? They are shooting themselves by starving the Economic Engine known as the Middle Class. If the Economy really falls, all of those billions of paper dollars will be worthless. They may be able to go to another country with what they have left but, where does that leave us? Bottom line is they don't care.

Bob Summers 1 year, 3 months ago

You are thinking in the pretransformation mindset America. Americans were warned the transformation was coming.

What did you think was meant by transformation?

Thomas Bryce Jr. 1 year, 3 months ago

Do you think this Transformation will come about Peacefully? Get ready. You think a Riot with a few hundred was bad in LA or Baltimore? Try a 1000 next time. 10,000 the next and so on. Hope you will be happy living in a 3rd world country because that is where we are headed. Think I am joking? History repeats itself. Everything that can happen has already happened in one form or another and it will replay in larger scale. Hope you all are ready. It gets Rocky from here on out.

Barb Gordon 1 year, 3 months ago

First hit was a highly critical piece that said, "It is really only against the American system – which even after ObamaCare still struggles with adequate universal cover, and because of legacy issues, is hugely inefficient – that the NHS can be counted a socially more desirable model."

In other words, it's still better than what we have.

Kendall Simmons 1 year, 3 months ago

Nope. You will NOT "see how socialized medicine works" by the nonsense you suggest.

I mean, do you truly not realize that your "over 3.5 million results" don't refer to the "England national health scandal"? Good grief! This is the 21st century, for crying out loud. Google has been around for almost 30 years now. Do you mean to demonstrate to us that you still don't know how to use it properly???

I mean, SURELY you realize that almost all...I repeat, ALMOST ALL those results simply have just ONE of those search terms in the results?

Want to get a MUCH more accurate figure? Then put + signs between each word, as in England +national +health +scandal You know why? Because doing that tells Google that you want ALL these words in the results. That you are searching for something SPECIFIC.

And you know how many results there are when you do that??? 141. YUP!!! A mere 141 results. Hmmm. Not quite "over 3.5 million results", now is it?

P.S. Had you bothered to actually look at your own Google search results, you'd have found you couldn't have gotten through the SECOND page of results (that's a total of TWENTY search results) without coming up with things that did NOT have anything to do with any national health scandal in England. Whoops!

Again. This is the 21st century. Please. Learn how Google actually works.

Marc Wilborn 1 year, 3 months ago

The ACA was misbranded so that short attention span voters would agree with it. The ACA was not supposed to control costs. Rather, it was meant to expand coverage and be funded through penalties, higher deductibles and premiums and ultimately taxes. The insurance industry fell for it because the government promised them "risk corridor" reimbursements for any incurred losses due to ACA consumers. LOL! The first reimbursements under ACA for these actual incurred losses to the insurance industry was 30 cents on the dollar and now many insurance companies are threatening to pull out.

Gruber spelled it all out for everyone to understand. That's your government at work regardless of your political affiliation. There is as much fraud and corruption in the government as there is in the for profit sector because they are one in the same.

Barb Gordon 1 year, 3 months ago

Actually, it was supposed to control rising costs (and it has). RomneyCare didn't control costs, but ObamaCare took RomneyCare and added tweaks. .....By transferring them onto the consumer. Higher deductibles, coinsurance, etc. Those are intentional. What's supposed to happen is that we then shop around ourselves. This is the "free market" at work. Isn't it fun?

It was also supposed to be less horrific for the truly poor with expanded coverage, but y'all know how well that part worked out.

Marc Wilborn 1 year, 3 months ago

The ACA has passed costs onto middle class consumers with the hope that young consumers would sign up which have not. It is just impossible to offer unlimited cheap health care to everyone without someone paying for it.

Barb Gordon 1 year, 3 months ago

Actually, enrollment by younger people has been very strong: http://obamacarefacts.com/sign-ups/young-adult-enrollment-numbers/

And, once again, every other country in the world manages to offer cheaper healthcare than we do. Yes, someone has to pay for it. We're just overpaying.

Chuck Wehner 1 year, 3 months ago

In my opinion this Letter to the Editor is bogus, I think its probably one of those crazy right wingers trying to scare people as they always do into voting against the ACA by voting for more crazies. I agree the VA is messed up, but I have heard of nothing but good things about the ACA from the people I know that use it. As for myself I'm on the single payer plan called Medicare which has been fantastic for the 10 years I have been on it. It has always been beyond me to understand what the republicans have against it, insurance companies are big business which republicans have always supported to the grief of everyone else.

Marc Wilborn 1 year, 3 months ago

Chuck, your perspective is from someone currently using a medical program that is currently underfunded and would bankrupt our country if left untouched. Please respond on how you would feel if the government told you to start paying an extra $1,000 per month for Medicare because I can cite many examples of where the pre-65 cost of medical insurance has skyrocketed.

Face it, our country cannot promise unlimited cheap health care to everyone without taxing everyone to death, disbanding the military or kicking everyone else off of every other social entitlement program. Your choice.

Barb Gordon 1 year, 3 months ago

And yet we have the most expensive healthcare system in the world (both in terms of tax and private spending) and do not have the highest health outcomes to show for it.

Marc Wilborn 1 year, 3 months ago

We also have the most obese poor people in the world. How does the US diet affect US health care costs?

Barb Gordon 1 year, 3 months ago

Well, I'm not clear what you mean by "most obese poor people" - most poor people who are also obese as opposed to just general obesity rate? Do you have a citation? There are countries with higher obesity rates than the US that also have higher poverty rates. I'm not saying you're wrong. I'd just like to see your data.

It's a chicken and egg thing, really. Obesity can be (but isn't always) a health concern for which there are medical treatments, including medically supervised diets, prescription medication, and surgery. If we all went to doctors a little more regularly for preventative care, we might also be able to schedule time with a nutritionist before "overweight" turns into "obese."

Marc Wilborn 1 year, 3 months ago

http://www.bloomberg.com/news/articles/2016-01-05/a-longevity-puzzle-why-do-poor-costa-ricans-outlive-poor-americans-

Plenty to read. Being poor and obese has nothing to do with the gym or personal trainer. I guess everyone should be obese prior to Planet Fitness.

Barb Gordon 1 year, 3 months ago

Actually that just compared Costa Rican poor to American poor and made no claims about the world in general. "Matching that kind of data isn’t possible in many places, Rosero-Bixby said, so it’s hard to tell whether the pattern is similar elsewhere."

Coincidentally (or not) Costa Rica's universal healthcare system also outranks the USA according to UN reports.

Nobody said anything about the gym and a personal trainer. That's you bringing a strawman argument to the table. The relationship between obesity and poverty in the USA is complex, but it is not the only reason we spend more on healthcare than any other country in the world.

Dorothy Hoyt-Reed 1 year, 3 months ago

Let me educate you on being poor. Poor people who can't afford much buy foods that are filling and cheap. For example, when I was a single parent and on a tight budget, we ate at least 1 mac and cheese supper a week, no fresh fruits or veggies (unless they were on sale), and no meat. I grew up even poorer than when I was a single parent, and we often had potatoes and gravy with the cheap meat we could afford, because potatoes and gravy are filling and go a long way in feeding 5 people. So, yes, poor people do get obese, but nutritionally are starved. Obviously you have never been that poor before, so lucky for you.

And poor people can't afford the gym, and the poor, that I know nowadays, often work 2 jobs, so they don't have time for exercise and no money to hire a personal trainer. Also, food is sometimes the only entertainment that poor people can afford, and comfort their stress.

Kendall Simmons 1 year, 3 months ago

I feel I need to point out that obesity is NOT just "caused" by being poor or eating too much.

The fact is that numerous medications, for example,can have a side effect of significant weight gain. Certain types of insulin, for example. Or certain antihistamines and blood pressure medications. Then, of course, there are medications for the treatment of a variety of mental illnesses. Medications I've even seen advertised on TV...like Elavil or Zoloft and Paxil.

So don't just blame obesity on diet. Or poverty.

Chuck Wehner 1 year, 3 months ago

Underfunded like the Part D plan, homeland security, two wars and two tax cuts for the wealthy?

Dorothy Hoyt-Reed 1 year, 3 months ago

Conservatives think we can afford to send to Israel and have wars, but spend it on our own citizens? Horrors.

Marc Wilborn 1 year, 3 months ago

Does not mean that Medicare isn't going to bankrupt us.

Barb Gordon 1 year, 3 months ago

Spoiler alert: it won't. A sovereign country with its own currency cannot be bankrupt unless it wants to be. There are certainly consequences for spending choices, but if anyone tells you that a program will literally bankrupt the treasury, they don't know what they're talking about.

Marc Wilborn 1 year, 3 months ago

Don't listen to the likes of Paul Krugman, etc as they just want to keep printing money. Who would have thought that we would get our debt downgraded? All time high debt at all time low interest rates. How will we get out of that?

Barb Gordon 1 year, 3 months ago

Nobody brought him up, but let's unpack that. It's not like he's a Nobel-winning economist and you're just some guy on a newspaper forum, right?

This is just basics. You can't default when you control the currency. You can make things unpleasant, but you can't go broke unless it is on purpose. Governments are not households. Their budgets do not work the same way.

We got our credit rating downgraded from AAA to AA+ by S&P because of things congress did on purpose with political brinkmanship games. They said as much when they did it. We're in no danger of bankruptcy - unless, again, we do it to ourselves.

People are still more than willing to own American debt. No need to print extra dollars. We don't have our all time highest debt to GDP ratio, btw. That happened in 1946.

Marc Wilborn 1 year, 3 months ago

No, Paul Krugman is the guy who said in 1998 that the internet would have no greater impact on the US economy than the common fax machine.

The guy is a money printing tool.

Barb Gordon 1 year, 3 months ago

Oh my goodness. He said one thing that turned out to be wrong! Never mind the part where it was also taken out of context. One thing wrong means that some dude on a newspaper forum is obviously a better economics authority. For a follow-up, I suggest you double-down and take that quote about housing bubbles out of context, too. That's always fun. This particular quote devoid of context turns out to be so unimportant that the only people who are quoting it are bitcoin fans. That's just sad.

In the now long-deleted article, we see that he explains that economists are always wrong about predicting the future and then he makes a snarky future prediction that turns out to be totally wrong. Hmmmm. https://web.archive.org/web/20130313212935/http://web.archive.org/web/19980610100009/www.redherring.com/mag/issue55/economics.html

Meanwhile, we can mine the comments you've made on this very page and find more things you've said that turned out to be wrong. But yes. I'm sure it's the Nobel-winning economist who is the tool. The Nobel-winning economist that you brought up on your own, btw.

Meanwhile, you're still wrong.

Dorothy Hoyt-Reed 1 year, 3 months ago

And Marc, you need to answer the question. Which is more important 1. taking care of our citizens 2. taking care of Israel and having endless war?

Marc Wilborn 1 year, 3 months ago

Why not reduce all foreign aid until we can run a budget surplus? That includes all foreign aid.

Barb Gordon 1 year, 3 months ago

Less than one percent of our budget goes to foreign aid.

Marc Wilborn 1 year, 3 months ago

Thanks for the fact. I still don't care. Stop it until we can take of our own.

Barb Gordon 1 year, 3 months ago

We spend more of our budget on our military than any other country in the world and dedicate less of our budget to foreign aid than most industrialized countries. And yet much of that aid could be argued to do more to stabilize our security than any nuclear drone program could ever hope to achieve (and yes, we're working on nuclear drones. Sleep tight when you think of that idea.)

And you don't care. You'd rather symbolically get rid of less than 1% of our budget because you don't actually understand how budgets or economies work. Even if economies worked the way you thought they did, ending the foreign aid budget to do things like provide tetanus shots to prevent infant deaths in Sierra Leon is pretty damned harsh. That aid costs the nation less than a Starbucks trip. Babies would die because you wanted your latte. You don't care. Might wanna rethink that phrasing.

Carol Bowen 1 year, 3 months ago

There are many variables that we may or not be aware of. We only know what we have. We don't know what we don't have. It's difficult to compare the past to the present. They are not the same. Here are some items to think about.

  • Before Obamacare, many parents were helping adult children carry independent policies. The premiums were high. The coverages were low. Some of the policies were junk policies.
  • Health insurance premiums were increasing rapidly. As far back as the 1990s, employers were feeling the squeeze and dropping health benefits.
  • Around 2005, Anthem (Blue Cross) requested a 30% rate increase in California. Companies were increasing premiums every year in all states.
  • Some insurance companies have recently dropped Kansas. I don't remember why.
  • Insurance companies were more likely to deny a claim and drop the insured, often tied to a pre-existing condition.

I don't deny that Obamacare has flaws. It makes more sense to fix the flaws than to go back to where we were. There is no barrier to tort reform. Let's do it. There is resistance to negotiating lower prices for prescription drugs. Obamacare address some cost incentives, but there is probably more that could be done.

Kendall Simmons 1 year, 3 months ago

We don't NEED tort reform!! That's just been an excuse. Heck, Texas passed tort reform in 2003 and the results have been extensively studied:

"A major study of the Texas civil justice system and its implementation of caps conclusively proves that caps do not lower healthcare costs by eliminating physician’s perceived need to practice “defensive medicine.”

In 2003, Texas adopted “tort reform” through a one-size-fits-all cap on medical malpractice victim compensation. The June, 2012 study compared Medicare spending trends in Texas and the nation and found “no evidence of reduced spending in Texas post-reform, and some evidence that physician spending rose in Texas relative to control states.”

The study also compared spending in Texas counties that had relatively high rates of medical malpractice claims (“high risk counties”) and counties with low rates of claims (“low risk counties”). The authors “found no evidence that spending levels or trends in high-risk counties declined relative to low-risk counties and some evidence of increased physician spending in high-risk counties” post-tort reform.

The study also found that caps did not increase the supply of doctors. From 2003-2010, Texas’ physician/population ratio increased 3.4%, compared to New York’s 4.2%. In 2003, Texas had the nation’s 42nd lowest physician-to-population ratio. In 2009, its ratio sank to the 44th lowest. In contrast, New York, a state without caps, had the nation’s 4th highest physician-to-population ration in both 2003 and 2009.

A 2011 study by Public Citizen on the impact of caps in Texas found that after Texas enacted caps [emphasis mine], both Medicare expenditures and health insurance premiums in that state rose faster than the national average. Furthermore, the percentage of Texans who lacked health insurance increased. In 2010, a major study of Medicare spending and medical malpractice claim rates in Texas after the enactment of caps concluded: “In sum, we find no evidence that Texas’ 2003 tort reforms ‘bent the cost curve’” and, “We thus offer evidence that those interested in a magic bullet that will limit the growth of heath care spending should look elsewhere.”
< https://cardozo.yu.edu/fallacies-medical-malpractice-tort-reform >

Carol Bowen 1 year, 3 months ago

Tort reform could be a % cap on attorney fees.

Barb Gordon 1 year, 3 months ago

And it still wouldn't lower healthcare costs.

Richard Heckler 1 year, 3 months ago

The VA is not messed up it is the on going wars that is placing huge demands on the VA generating 10's of thousands of vets not to mention thousands with service connected disabilities that become the responsibility of the VA if demanded.

These new vets of the ME war for oil which has been ongoing since Reagan/Bush ..... about 36 years. In addition to all of the Nam vets. These modern wars are doing more human damage backed with newer technology that keeps these vets alive.

With this number of vets the USA government should agree to pay for disabled vet care at the most convenient medical facility in all communities no matter what. This would be best for vets and provide the VA with some relief. The VA has other responsibilities that which are also important to the veteran community.

Richard Heckler 1 year, 3 months ago

Shocked Shocked To Find Socialism in Ameirca

East Otis, Mass. - The less some Americans know, the more strident and voluble they become. Take socialism. The wailing about it over healthcare reform proves my proposition.

Shrill critics menacingly brandish "socialism" to terrify the unthinking, forgetting – or willfully ignoring – that while the United States is capitalist, it's also hip deep in various modes of socialism.

Republicans apparently don't know that it was their beloved President Theodore Roosevelt who in 1912 proposed national health insurance for all.

Some American critics of socialized medicine cite nightmarish accounts of bungled medical treatment abroad, boasting that America has the best medical system in the world.

As a foreign correspondent, I lived in Britain, Germany, Israel, and the Soviet Union and did not discover any sapping of a nation's vital essences because the public enjoyed publicly funded national health insurance.

As a US citizen who lived more than two decades abroad, I found socialized national health insurance programs are often more compassionate and charitable than what I have seen with profit-driven, private insurance companies in the United States.

Some years ago my former wife took my sons on a driving tour of Britain and became involved in an accident. My elder son had a badly broken leg and was taken to a hospital for six weeks until his leg healed. Although I didn't live in Britain at the time, the British National Insurance system paid all his hospital and doctor bills. When I offered to reimburse the hospital, the British charitably declined and only charged me $35 for a crutch my son used to hobble aboard a plane home to America.

A decade ago, a federal report shocked the nation by suggesting that our modern medical system was one of the leading causes of death in America. It called for cutting the rates of medical mistakes in half within five years. But it's only gotten worse. Today, preventable medical injuries kill some 200,000 Americans each year.

http://www.csmonitor.com/2009/0916/p09s02-coop.html

Dorothy Hoyt-Reed 1 year, 3 months ago

One question that no one has asked this letter writer is "Have you shopped around for a better policy?" Has he gone to one of the people hired to help people find affordable insurance, or has he just stayed with the same company?

Steve Jacob 1 year, 3 months ago

While I think ACA is good, it does have consequences. Large insurance companies have merged, doctors turning "concierge", and the price will only go higher as the years go on, especially for the over 50.

Thomas Bryce Jr. 1 year, 3 months ago

Yes. My doctor of 20+ years just recently turned to Concierge Practice. I could not justify paying $1,650 a year out of pocket just for the privilege of being seen and that is on top of Healthcare premiums I already pay. Luckily, I am in very good health for mid 50's and only see a Dr. twice a year for a full physical and a 6 month follow up. I will do my best to keep it that way. Can't afford to be sick. Had no problem finding another good Dr. to add me to his client list either. He was recommended by my original one.

Richard Heckler 1 year, 3 months ago

BERNIE SANDERS ON HEALTHCARE

Bernie believes that the challenges facing the American healthcare system need to be addressed immediately—they are a matter of life and death. He has always believed that healthcare is a human right and should be guaranteed to all Americans regardless of wealth or income.

He prizes the health and wellness of individuals over corporate profits. Additionally, he supports future legislation to curb drug costs and tackle fraud in the industry. Altogether, universal healthcare serves as a strong foundation for his policy goals.

http://feelthebern.org/bernie-sanders-on-healthcare/

PRESS RELEASE

Polls Show Sanders Gives Democrats Best Chance to Win White House

JANUARY 9TH, 2016

DES MOINES, Iowa – Bernie Sanders gives Democrats the best chance to win the White House in 2016 because he performs significantly better than Hillary Clinton against Republican presidential candidates.

“Sanders runs markedly better than Clinton” against Donald Trump and U.S. Sen. Ted Cruz of Texas, the leaders in their party’s field of candidates in Iowa and New Hampshire, according to a memo by Sanders’ pollster Ben Tulchin.

The analysis of public polling on the White House race also yielded these key points: Sanders is viewed more favorably by Americans than any other candidate for president from either party.

He … READ MORE

https://berniesanders.com/news/

Kendall Simmons 1 year, 3 months ago

Perhaps you could stop using Bernie Sanders' own website for "proof" that anything he says is true?

Richard Heckler 1 year, 3 months ago

Strengthen Social Security, Rein in Drug Prices, Sanders Tells Iowa Seniors

JANUARY 9, 2016

NEWTON, Iowa – Meeting on Saturday with Iowa seniors, U.S. Sen. Bernie Sanders challenged Hillary Clinton to support his proposal to boost Social Security benefits and strengthen the retirement program for decades to come.

Under Sanders’ plan, the wealthiest Americans who make more than $250,000 a year would pay the same share of their income into Social Security as everyone else. Current law now caps the amount of income subject to payroll taxes at $118,500.

“I hope that Hillary Clinton joins me because I believe that we’ve got to stand with seniors,” Sanders told the crowd of 160 at the Jasper County Community Center. Clinton has said raising the cap is “something we should look at” but she has stopped short of endorsing the proposal. She also has left open the possibility that she would support raising the retirement age at which seniors become eligible for Social Security. “I would consider it,” she told a town meeting in New Hampshire last Oct. 28.

Sanders’ proposal to lift the cap would raise taxes only on the wealthiest 1.5 percent of Americans. The new revenue would expand Social Security benefits by an average of $65 a month, increase cost-of-living adjustments and lift seniors out of poverty by boosting benefits for low-income beneficiaries.

For only the third time in 40 years, seniors on Social Security this year are not receiving a cost-of-living increase. Sanders’ legislation would increase COLAs by accurately measuring the spending patterns of seniors.

Under current law, the consumer price index used to calculate annual benefit adjustments does not accurately reflect how inflation in health care costs and prescription drug prices impact seniors

https://berniesanders.com/press-release/strengthen-social-security-rein-in-drug-prices-sanders-tells-iowa-seniors/

Richard Heckler 1 year, 3 months ago

Remember the medical insurance industry has been increasing the cost of insurance annually for the past 50 years. It is an industry favorite sport.

After all their CEO's retire with a golden parachute bonus package of $73 million and perhaps stock options as well.

Richard Heckler 1 year, 3 months ago

There is no way to justify spending/wasting health insurance dollars on:

*sales commissions

*Shareholders CERTAINLY increases the cost of insurance. Why are health insurance dollars going to shareholders?

*Health care tax dollars becoming special interest campaign dollars. Why are health insurance dollars being spent on political campaigns?

Truly the only way consumers are going to get ahead is to begin paying out of pocket and investing insurance premium dollars wisely to cover expenses. Why contribute to reckless and corrupt spending that finds its way to golden parachutes,over charges,political campaigns,shareholders and corp jets?

Medical insurance is no bargain.

Jonathan Becker 1 year, 3 months ago

The scrivener of the LTE omits the fact that his $5,400 in health insurance premiums and his $6,600 deductible are tax deductions on Schedule A. Unless his income is more than $160,000, he is entitled to take some of those expenses as tax deductions.

Does anyone fact check these LTE anymore? And if they are fact-checked, who? A member of the Flat Earth Society?

Marc Wilborn 1 year, 3 months ago

What does the application of tax policy have to do with the discussion of higher health care premiums? Why not perform some calculations of your own assuming various gross income amounts and enlighten us?

George Lippencott 1 year, 3 months ago

Single payer can be made to work. It can be made to deliver whatever quality of health care we desire. The variable is cost.

In a system where half the people pay all the government operating expenses ( assumes medicare, medicaid, etc go away and are folded into the single system) means you have at least half the people opposing the concept not because it will not work but because the quality of their care will decline and they will pay even more than they do now. There is no free lunch.

Worse, health care will be even more dictated by politics. So when people who want lower taxes recapture the government funding for health care will be cut (see National Health Service). Do you really want health care determined by political loyalty?

As to Canada just consider the size of the country. Our system is many times theirs. Does theirs scale?? Don't think so.

Single payer will lead to many winners and losers. Perhaps the advocates should consider a way to minimize the losers as they search for the holy grail!!??

Barb Gordon 1 year, 3 months ago

Would you quit perpetuating the 47% myth? It just makes you look ignorant. http://www.nytimes.com/2010/04/14/business/economy/14leonhardt.html

The American healthcare system is the most expensive system in the entire world, and it doesn't provide the best health outcomes. All of the worries about having to pay more for a system that would be lower quality are just missing the mark. For all the complaints about NHS, they're not clamoring to switch over to the American model. We're like the story the other healthcare systems tell each other around the campfire when they want a good scare.

George Lippencott 1 year, 3 months ago

Copied from article you listed

"The 47 percent number is not wrong. The stimulus programs of the last two years — the first one signed by President George W. Bush, the second and larger one by President Obama — have increased the number of households that receive enough of a tax credit to wipe out their federal income tax liability..""

That has been y argument all along.

Barb Gordon 1 year, 3 months ago

Your argument all along has been to repeat a now-outdated, cherry-picked data point that drives people to the wrong conclusion? And then to make that wrong conclusion yourself? Ok then. You said, "Only half the people pay the government's operating expenses." That's either faulty reasoning, or it's a lie. Now that you've had a chance to read an article showing you why you were wrong, you instead cherry-pick a paragraph out of context to try to double-down on the same faulty argument.

From the paragraph right after the one you quoted: But the modifiers here — federal and income — are important. Income taxes aren’t the only kind of federal taxes that people pay. There are also payroll taxes and investment taxes, among others. And, of course, people pay state and local taxes, too.

Later on, the article dismisses the argument that somehow payroll and other taxes don't count as a "government operating expense." Ergo, it is completely untrue that we have a system where "half the people pay all the government operating expenses." We have a system where, in one year due to a specific set of temporary tax cuts, a larger group of people did not pay a very specific type of tax, but they still paid lots of taxes. A system where the wealthiest actually pay a lower percentage of their income towards taxes than the masses you're implying are freeloaders.

You're not looking ignorant anymore, George. Now you're looking intellectually dishonest.

Dorothy Hoyt-Reed 1 year, 3 months ago

Why do you think only half would be paying into it? Are you counting children and retired people? Retired people have already paid into Medicare. Payments through your payroll may include how many dependents you have. That would maybe slow population growth too. Medicare and SS taxes are not optional for anyone. Some people get tax credits if they work for poverty wages, but they don't get to opt out of their SS and Medicare.

Also, and very importantly, companies that already pay for insurance, or part of the insurance for their employees, must be required to give that money to the employee. They can't just go WooHoo more profit for us.

George Lippencott 1 year, 3 months ago

"The American healthcare system is the most expensive system in the entire world, and it doesn't provide the best health outcomes. "

Would you please provide your source so I may vet it??!!

Thomas Bryce Jr. 1 year, 3 months ago

http://www.reuters.com/article/us-healthcare-costs-sb-idUSTRE5504Z320090601 This is just one article from a pretty reliable source. There are many more if you search. http://www.entrepreneur.com/article/228152 This one is a little more recent than the Reuters article.

Barb Gordon 1 year, 3 months ago

There are lots of reliable sources, including WHO and OECD. This isn't new information. We've known for a long time. the USA has the most expensive healthcare system in the world, and that includes both tax and private health spending, so it isn't just that other system shift the burden from private spending to taxpayers.

http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

Drilling down into OECD data, we can easily see that it's the most expensive in the world: https://data.oecd.org/healthres/health-spending.htm

And when we compare WHO rankings to look at more than just expense, the USA ranks behind Costa Rica for 37th place internationally: http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/ (from here: http://www.who.int/whr/2000/en/)

George Lippencott 1 year, 3 months ago

Thank you.

There are many factors (financial, medical, patient, etc) that must be part of any comparison.

For example you may have a government system in a country where the average annual cost of living and income is much lower than here. The cost per patient there will be much lower and the availability of medical services may also be more problematic making any comparison highly distorted (apples and mustangs) That may apply to the WHO data.

I would tend to direct my analysis on mirror countries with a focus on whether all costs are captured in the comparison. I would also factor in a patient factor. Are there long waits for services? Are medical facilities readily available. Is specialist care easily obtained.

Simply adding up costs where costs may be calculated differently and costs centers are not comparable provides answers that while valid on their face do not accurately reflect the whole situation.

For example our system offers primary care at many locations that are in general readily available both from a travel and time standpoint. Other systems offer primary care in centers that are more centrally located and where appointment times may be longer. Perhaps we would prefer the convenience and accept the costs..

Your argument while valid on the surface may not consider many of these other factors that if considered would balance the comparison.

Off to do my homework.

Barb Gordon 1 year, 3 months ago

Yes. There are many considerations, including cost of living, which is why expense is calculated as a percentage of GDP. USA is still the most expensive in the world.

Yes. All costs are captured in the comparison. Taxes. Private expenditure. Public expenditure. Yes. They look at waits for services, which they also have in the USA. Yes, they look at availability of services - which is also an issue in the USA. There's an unequal distribution of providers to patients in the USA, as doctors prefer to live in the big cities in numbers disproportionate to the population. There are shortages of specialists in less lucrative fields. There are complications of insurance bureaucracy that create artificial waitlists and restrict access to providers and services in the USA. All the potential downsides to other systems are already things we have here.

By all means do the homework, but know that others have already gone there. The American healthcare system is not the best in the world.

George Lippencott 1 year, 3 months ago

By your reckoning. I prefer to do my own homework. % of GDP is fine - it is the detail as to what makes up the numerator that I question.

I can debate each of your points but IMHO that would be a waste of time as you will once again throw out generalities.

For example a single payer system does not necessarily have to employ all the providers as government employees. If it does it will have to pay enough to attract the quality of provider necessary to offer quality service, to go where the government wants, to specialize in what the government considers necessary and to work where the government tells them to work. If it doesn't - well it looks a lot like what we have. The government would have to compete with private enterprise for the quality of providers needed so it would not be able to dictate remuneration. The people in south potunk (populations 200 and 200 miles form the next town) may still suffer the same short falls as they do today.

The VA is a single payer system for some of our veterans. It has recently exhibited the very issues I mentioned above. Politicians do not always provide the necessary funds to offer the services desired, to attract the quality of providers needed,, to go where the patients are and so on.

Barb Gordon 1 year, 3 months ago

It's not by my reckoning, George. Look it up for yourself by all means, but I'm telling you that the math has been done. The USA has the most expensive healthcare system in the world. Not by a little bit. By quite a lot. It's not because they forgot to carry a zero or did tricky math in how they counted healthcare workers or because they're counting real dollars in countries with lower costs of living.The USA has the most expensive healthcare system in the world because we pack inefficiency into every step of the process.

No. Not every system positions all healthcare workers as government employees like the NHS does. They're still cheaper. Some systems do allow private care to compete with public options. They're still cheaper. A variety of these alternate systems still offer better overall quality of care. Canada does suffer from the same problem the USA does with unequal provider distribution, but they still manage lower cost care and better patient outcomes.

The VA system isn't actually single payer. The entire USA isn't covered. Not even all veterans are covered. This creates a level of bureaucracy to first prove you qualify (and a long wait) and then a system of faulty incentives for low wait times that was gamed by administrators (another long wait). Insufficient funding is also an issue, yes. Scale the system and it actually becomes easier to find such obvious flaws. You don't think voters wouldn't notice if the legislators didn't adequately fund healthcare - if everyone had to live with those consequences?

George Lippencott 1 year, 3 months ago

So say you. I will do my homework.

I repeat, however, that some of our costs are there because we want them there.

The VA is a government run system comparable to my example. Hiring providers and making them available remains a challenge (they can not draft people). I can access care but in my many years of association I have never been treated by a physician. To get to one requires a referral from an assistant or a prolonged wait in a "sick" call process. Not the institutions fault but a discouragement to the patient.

I can access a private physician with minimal delay. Delivery here must go

Barb Gordon 1 year, 3 months ago

It's not just my word, George, and you know it even if you don't want to admit it.

Yes. The costs are there because we want them there. "We" being the people who profit from the inefficiency built into our system in every step of the process and the legislators who take their lobbying money to keep it in place. We, the patients, do not get superior care in exchange for our superior costs. We do get better food menus in maternity wards and unnecessary tests in order to milk our insurance claims, but we don't get to live longer or be healthier.

I know that you imagine the VA must be like the NHS or whatever, but it's not a true single-payer system, nor would it have to be the universal American system. I've lived in a country that actually had actual universal healthcare. Have you? I never had to wait to be seen. I always had same-day appointments when I called, and I didn't spend time waiting in a waiting room. I walked in at my appointment time, and they saw me at that time. They did not act like they were in a hurry to move on to the next billable procedure because they didn't overbook the office. Oh, and their system was cheaper. Because all other systems are cheaper.

George Lippencott 1 year, 3 months ago

Ok, I finally had some time to check your sources. The first led nowhere and referenced earlier versions of itself. Where the original data came from was unclear. I did note the part of the evaluation tied to whether the country in question had national health care. There was even a note that the data is pre-Obama care. Seems to me that data is a bit suspect

I looked at the OECD data and they do have a definition for the numerator but no sourcing as to where the actual numbers came from. I can only suspect that the countries in question provide the data. Now I might observe that several African countries that recently had outbreaks of Ebola scored much better in cost then we did. Of course they were not well prepared to address the problem they faced due to shortages of most basic medical care (doctors, nurses, etc.) The rest of the world had to kick in. That suggests that we may not be comparing apples and oranges.

Of course the most important element of this discussion is the issue of comparison. You can spend whatever you like and rational thought indicates by varying that amount you can vary the rest. We spend a lot and we get a lot. Are we the most expensive – BEATS ME. But to me that is not the issue. The issue is whether we get what we pay for.

Now I did not and do not wish to argue national health care because the entire argument is highly emotional and replete with bogus, unsubstantiated and fabricated data. My biggest problem with the entire discussion is a common agreed upon definition of quality i.e.: what makes for quality health care. Given such a definition one might then be able to develop rational cost models to make a comparison. Even then the opportunity for manipulation is very great and there does not seem to be any neutral parties that one could trust to do the calculation.

I do note that between 50 and 70% of us think our health care is just fine. (answer depends on how the question is asked).

I am reasonably sure that the generally negative attitude toward Obama Care is linked to cost and quality issues that have not been adequately presented to the American Public. Somewhere between 50 and 70 % of us get our medical care through our employer. To change that model and get agreement on the replacement will require a lot more than arm waving and the presentation of data that is incomplete or even self-serving.

Good luck and go find somebody else to insult, vilify and demonize. I am not your guy!!

Barb Gordon 1 year, 3 months ago

The first is a report issued by the Commonwealth fund, and the data comes from the OECD. That's also what I already told you when I linked it. OECD/WHO data is the most authoritative source you're going to find. 2014 is pretty recent. It's not "suspect" unless you really think that Obamacare magically improved costs in a year? I don't think you'll even find an Obamacare fan that optimistic, LOL.

A number of countries kicked in for ebola aid, which wouldn't have thrown off the numbers even if it were counted as domestic spending, as it didn't change the trendlines.

Weird that you couldn't find information about how they collect data, since it's right there along with the methodology used for statistical validity. You'll note that Guideline 2 asks each respondent to provide a source for their data along with a website URL if applicable. I'm sure you drill down enough you can find even more information.

Every data source collected says we're the most expensive. Every. One. I've yet to find any reliable source that says otherwise. Find one if you're so determined to disprove it. Just one.

Quality, by most measures, has to do with outcomes. Do people live? Do they get better? Do they have access to care? We don't have the longest lifespans. We don't have the longest lifespans after age 65 (eliminating most accidents and childhood illness). We don't die of cancer as much, but if we're not living as long, other things are probably killing us first. We're not the most obese or the biggest drinkers or smokers. So we can't just handwave it all as a lifestyle thing.

We could look at things like who has the most doctors. Oopsies, not us. We also don't have the most hospital beds, radiology equipment, or CAT scanners. But we do have the most MRIs. (Which also happen to be very pricey.)

So exactly how would you propose to define quality health care? Don't just Gish gallop your way out of that. http://rationalwiki.org/wiki/Gish_Gallop Make an argument on what you consider quality to be, and let's test it.

50-70% of non-experts saying they like what we have (provided you can cite a source on that) is not a data point. It's just an argumentum ad populum. I'm sure that 50-70 of Americans (at least) have also never experienced a different system.

I'm reasonably sure generally negative attitudes about the ACA are linked to generally negative propaganda released about it. You're right that changing the system would require more than data. You've made it abundantly clear that you don't actually make any decisions based on data.

Good luck on all that flouncing you're doing.

George Lippencott 1 year, 2 months ago

This is what I wrote that started this discussion:

"Single payer can be made to work. It can be made to deliver whatever quality of health care we desire. The variable is cost.

In a system where half the people pay all the government operating expenses. I assume Medicare, Medicaid, etc. go away and are folded into the single system) means you have at least half the people opposing the concept not because it will not work but because the quality of their care will decline and they will pay even more than they do now. There is no free lunch.

Worse, health care will be even more dictated by politics. So when people who want lower taxes recapture the government funding for health care will be cut (see National Health Service). Do you really want health care determined by political loyalty?

As to Canada just consider the size of the country. Our system is many times theirs. Does theirs scale?? Don't think so.

Single payer will lead to many winners and losers. Perhaps the advocates should consider a way to minimize the losers as they search for the holy grail!!??"

You still seem to want to ignore my comments and keep selling your own. I repeat I don't know whether we are the most expensive. I do know that all sorts of surveys reflect that we want what we have (except for costs). Is $/GDP the right metric? That has been my argument as we demand many things that are in our numerator that are not in the numerators of other countries.

I don't buy your entire approach as it is cost based and avoids quality and choice. I am not going to debate quality with you as I am not qualified. However, that should be a broader debate then just the academic community defining metrics that are as slippery as the one you have chosen to sell the concept

The bottom line is that you want half the people to accept higher costs for possibly lesser care. If I could convenience myself that national health care would continue to delivered the care (quality/availability/etc.) I am used to receiving (or better) while the costs would not escalate to the point where my quality of life suffers than maybe.

Until then the burden is on you to make a convincing argument. In this case you have chosen costs and asserted that a national health care system would be cheaper by using comparison with other nations who offer a very different level of care and in some cases a very basic level of service.

Barb Gordon 1 year, 2 months ago

Should I copy and paste the response I already gave you on that? You're dead wrong about "only half" paying for it. You're still wrong, in spite of having been corrected on it with cited sources. You refuse to believe that our current system is the most expensive in the world, in spite of authoritative data. You say "I don't know" as a means to avoid the cognitive dissonance that you do know, George. You just don't want to believe. Find me any evidence to the contrary. Just one piece. Anything that says we're not the most expensive system in the world. You seem to hope that repeating the same assertions (Without any citations) will eventually make your misconceptions correct. That's not very scientific.

Will Canada's system scale? Yes. Single-payer systems gain efficiency with scale. They do not lose it. That's basic economics of scale. Our current system packs inefficiency into every step of the process. World healthcare experts also say it's the most expensive system in the world.

You also confuse single-payer system and socialized system. There is a difference. In a single-payer system, the government doesn't directly employ the healthcare workers.

Healthcare is already controlled by politics in this country - the politics that make it inefficient and costly. The politics that make doctors lie to patients and restrict their choices. Let's reverse that trend. You people who have never experienced another healthcare system freak out over the silliest and stupidest of things. Trust me. I've experienced it, and the scary bedtime story they tell their kids is about the American healthcare system. Which, you may have heard, is the most expensive one in the world.

You're not qualified to debate any of it, and yet you do. I've shown you data. I've shown you authoritative sources. There's no "half the people accepting higher costs." Only 11.4% of adult Americans are uninsured. Single-payer is a more efficient form of insurance. The whole point is to lower costs to patients. The irony being, of course, that as a senior citizen, you're probably already using our baby single-payer system right now.

There's no burden on me to make a convincing argument. I've done it. You've offered no citations, no rational counter-arguments, and you keep doubling down on the same sad, tired, misconceptions that have already been corrected. OECD data already shows that our money (which we spend more of) doesn't buy us more doctors. It doesn't buy us more hospital beds. It doesn't buy us a longer life expectancy. So exactly what is this downgrade in care that you think we'd be getting?

You're on at least flounce number three by now. Did it stick? Are you taking your ball and going home?

George Lippencott 1 year, 2 months ago

(continued) In fact, I have had to guess at exactly what you mean by national health care. Is it totally government with all required to accept the same level of care? Is it like Obama Care where the government uses the insurance industry to provide the financial path to services that are determined by the government and cost shared between the individual and the government? Is it some hybrid? Do the rich continue to get care outside the system??

It is difficult to debate an amorous concept using metrics chosen by the advocates. As I wrote, I opt out. If the polls are accurate on this topic I am not alone

Barb Gordon 1 year, 2 months ago

There are many forms of healthcare in the world, George. And of them, ours is the most expensive. Here are three (but by all means not the only three) types of national healthcare systems. You can socialize the system and make all the doctors work for the government. You can go with a single-payer system, like Medicare, where doctors and hospitals are still private, but the government organizes payments and controls the costs. You can go with competitive insurance systems with minimum mandated coverage. Of the three systems, socialized medicine is the most cost effective, but many people do not like it because it is so centrally managed. Competitive insurance is the most expensive. But when done correctly (true competition and legal minimums on coverage) it still lowers costs. We almost have this third system, but we still have gaps in coverage and remove competition by tying insurance to employment.

Other countries went through this journey. We're doing the opposite of trying something new. We'd be the last country to get around to doing it. We really could pick and choose and find the best of all worlds, but we're too busy screaming "death panels" to even think rationally about it.

It's difficult to debate anything with you - using data. If you look at the OECD reports, they're not advocating any particular style of universal coverage. They're listing the facts and trends. They're a world consortium, of which the USA is a member. They're not a lobby group. Advocates choose their data because it is a quality source. If you want alternate metrics, show me the source.

George Lippencott 1 year, 2 months ago

Noted

The OECD report does not say what you say it says!

cost is not the only metric ffor determining health care. Quality, Availability, equity and so on matter immensely

How the system is configured has an immense impact on whether one supports it or not. How could it be otherwise.

Since a hefty percentage of us have reasonable health care changing it to an unknown with unknown means of funding certainly leads to legitimate reluctance to go where nobody has gone before (whatever system you produce from your infinite liist)

Essentially your argument is that any form of national care is better than what we have. By no means have you supported that nor dos the OECD report support that! In effect all it says is the broader the health care offered the more costly it will likely be!

Just exactly why would I want to pay more tax to get less health care.?? Seems to me you are spouting the old Democratic Party mantra that whatever is good we should have regardless of the cost (and who pays it) Followed by it is an honor to pay more taxes so somebody else gets something you may not in fact have.

Barb Gordon 1 year, 2 months ago

The OECD report lists exactly what you think it does not, as I've already pointed out. Yes, you can see availability of care, life expectancy, causes of death, obesity rates, and more. You can see all of that. Look. At. The. Data. The USA is not on top. We don't have more doctors or hospital beds or people covered, and we don't live longer or get better medical care. We pay more than anyone else in the world, and we get less. We don't get more.

A "hefty percentage" is not all of us, unlike what other countries manage. For cheaper. Not only would it not cost you more, what a dumb argument. How many people have to die from lack of care because you personally like your plan?

How the system is configured is exactly why the American system is too expensive and too inefficient. We would not be changing it to an unknown with an unknown means of funding. How many times do you need this repeated? You have an illegitimate reluctance because you're too stubborn (and unscientific) to actually examine any of the data on the matter. This is the opposite of the unpaved path.

Any form of universal care is cheaper than what we now have. And there are many systems that would be improvements both in quality and price. Universal care would cover more people than we do now - because we do not cover everyone.

You wouldn't pay more taxes in order to get less care. First off, you wouldn't get "less" care - unless somehow you've found a plan that offers a 24/7 physician to follow you around and offer you a Kleenex every time you sneeze. Secondly, under the only serious proposal for single-payer that any of the politicians have currently offered this time around, the only people who would pay more in taxes are those earning the top 5% of incomes. I'm assuming that's not you. If it is, well, cowboy up.

I'm not a Democrat. I'm pragmatic. I don't like paying more for less, and that's your "devil we know" argument in a nutshell. Paying more and getting less. A lot of what I'm already paying is in taxes to pay for other people's healthcare needs. Probably yours.

Other countries have worked this out. I've both studied it and experienced it first hand. Only in America do we have a bunch of silly ostriches like you refusing to even consider alternate systems.

George Lippencott 1 year, 2 months ago

Noted.

Same argument over and over We pay for what we get. In comparison to most countries we offer a very broad scope of medical care. We also provide that care broadly. Yes, there are people here who do not get what they should. That said we would have to sort how much of the shortfall is the result of actions/inactions of the patient. Multiple rehabs add cost and is not an option in some of the other nations.

Yes, the OECD report says we are the most expensive among those who it measured (mostly single payer systems). What I continue to argue is that different systems offer different care to different segments of their populations. Some third world countries offer very little resulting in a low cost per gdp. You continue to compare apples and mustangs.

Cost in not the only factor. Quality, availability and the like count. While the OECD report deals with those to some degree it does not factor the difference into the cost elements. Arguing to the contrary is disingenuous. If you are going to use costs as a comparative (or as in your case the key argument) you must represent how the data presented addresses difference in quality, availability, equity, geography, etc., etc.

Last time I looked it was about 70% whose care is through their employer (including me). We got there in MHO because of the ridiculous tax rates we charged at the time this inefficient system became embedded. Now the transition will face a significant challenge which you just gloss over.

You are the advocate. It is incumbent on you to convince the rest of us that we would not lose ground and not have to pay more. You have asserted that but your support for the assertion is sorely lacking. You have only provided options to address funding but have neither costed those options nor explained how we get there from here. You have nor addressed actual care leaving it to the reader to assume the level will not decrease.

Absolutely, for me it is the devil I know over the devil I do not know. At least if you are going to argue for a single payer system you should not misrepresent data in order to make a general case. The OECD report does not make your case for the very reasons I have written and that you have avoided addressing except with misrepresentation.

The majority of us are still very suspicious of a single payer system. I might note that the continuing cost uncertainty in Obama care does not help your case.

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