More on Health Care: Public Options Co-Ops, Other Paul Losch's Community Blog, posted by Paul Losch, a resident of Palo Alto, on Sep 8, 2009 at 6:11 pm Paul Losch is a member (registered user) of Palo Alto Online
I will admit that I have little or no expertise around health care policy. I have tried to stay engaged and informed these past few months.
And my small company that I run got its monthly health care bill today, and the charges, DURING THE CONTRACT YEAR!, were up about 50 bucks per employee with no explanation. So, I follow this at both a policy and personal level right now.
The big show stopper in terms of how to solve the health care challenges the country faces is around the so-called "Public Option." The general notion is that the United States government offers an alternative to private insurance, with various benefits to those who use this option.
Another idea that has been getting teed up is the "co-operative" program. This would not be government administered, but would serve to "pool" people who fall between the cracks of the almost entirely private health care system and in some form or fashion have access to health care that they do not have at present.
I have a limited understanding of how these two compare and contrast in the minds of DC policy makers right now, and how well either option meets certain key objectvies, such as universal coverage, no pre-existing condition denials, reducing overall costs of health care.
That all said, I do have a few thoughts about my own experience with the US government option and co-ops.
My dad was a US Navy veteran, and he received extraordinary health care from the Veterans Administration health care system up the street here on Foothills. My understanding from general public information is that had he received comparable care outside the VA system, it would have been much more costly, even if he had it covered from other insurance and Medicare that he had. How can we replicate that for those of us who did not serve our country in the military?
Medicare covers millions of people over 62 or 65, although some of the town meeting speakers in August apparently did not know that Medicare was a government program. From a care standpoint, it gets good marks. No death panels, no compromises on services provided. But, it is going broke. I actually am surprised this has not come up more in the disucssion around a "public option" alternative. A big concern I and I believe others should have is how can we be assured that a "public option" won't get caught in same snare that Medicare is in? Perhaps some experts and policy makers have offered some useful information around that question, and if any of you know of it, please add to this posting.
As for co-operatives, my experience with them have been with 2 long standing insurance companies--USAA and State Farm. Both have been excellent. Neither firm is involved in health care, which is a different business, but there are such things as best practices that can migrate from related industries. How much discussion is going on in DC around this model? Senator Susan Collins (R-Maine, member of "Gang of Six," is promoting this model. Is she on to something?
I write this about 24 hours before our President speaks to a joint session of Congress. Perhaps more will be known after his address.
One thing for sure, we must get something done. The status quo may work for many, but not for all. I feel screwed as a small business owner in trying to provide coverage to the people that work for me as my rates go up willy nilly with no clear explanation.
This is a time when we can take the "first do no harm" approach in protecting those who have satisfactory coverage, but not at the expense of those who are truly feeling the harm.
I just wish the rhetoric were helping us understand that we all are in this together, instead of how it has come across, which is more of a zero sum game. I blame the pros in both parties in DC, and I fault our President for allowing Capitol Hill to own this issue. Let's hope that changes tomorrow night, whatever options become the game plan for the Administration.
Posted by Walter_E_Wallis, a resident of the Midtown neighborhood, on Sep 9, 2009 at 4:59 am Walter_E_Wallis is a member (registered user) of Palo Alto Online
Replace the unfunded mandate that hospitals serve all whether they can pay or not, which forces hospitals to "tax" all the payers, with a system where the government pays for non-payers and then determines whether the guy can pay or not. Hospitals will then base fees on cost plus.
Remove the ability of judges to graft new coverage onto existing policies. Imagine some judge deciding that car insurance covered gas.
Tax punitive damages at 90% and apply to coverage of deserving uninsured.
Posted by Anon., a resident of the Crescent Park neighborhood, on Sep 9, 2009 at 12:21 pm
Bill H. - yes, the debt is staggering. What do we do about it? Enslave and deprive our people, let our country fall to ruin?
Do we have to solve the debt before we do anything else, because if we do we will never be able to do anything, and we are broke from spending money on things that we probably should not have done that most people did not have a say in or benefit from.
While some benefit hugely from this catastrophe a growing number get run down every day. What do we do? Keep mowing them down in all kinds of ways. This is what we decided we were not going to let happen to people in the early 1900's and have been moving away from.
How do we re-settle the debt with the world is what I'm wondering?
Posted by observer, a resident of another community, on Sep 12, 2009 at 1:50 am
In answer to this and another healthcare post you made recently--
I have read T.R. Reid and find it fascinating. The one place he gets it wrong is by categorizing insured people in this country as having care under the Bismarckian model -- which is wrong. We are only promised care essentially under that model, insurance companies make a profit by making sure we don't get that coverage if they can get away with it.
He points out that no other system uses for-profit insurance as their main healthcare financing, but then doesn't connect the dots.
We spend $450 billion annually on paperwork, largely due to private for-profit insurance. According to Dr. Claudia Chaufan at UCSF, we now have nearly one paper pusher in the system for every healthcare worker.
Here's how it works: insurance companies individually use paperwork to delay and deny care. They overwhelm, confuse, make "mistakes, call things not medically necessary and let people fight until they give up, etc. The insurers gamble that the paperwork will cost less than paying the claim. Sometimes they will do things where the paperwork costs more, but they make the money back and more on a percentage of cases where they get away with it. Sometimes they like to just harass individuals and doctors that cost them money in other areas.
The total paperwork costs are not just on the insurers side: medical centers, hospitals, doctors groups, patients, even the government, have to maintain a huge paperwork structure to deal with this in order to collect from insurance. There's an enormous burden on our citizenry and legal system that isn't even counted in those statistics.
Ponder for a moment how much money that is: $450 billion versus $500-600 billion which is the budget for the entire Department of Defense (all branches of the military, bases around the world, operations, armed forced, overhead, etc.etc)
The trouble with the proposals is they are naive about why we have this waste. It's only waste from our perspective; for insurers, it's their investment in their profits. Other types of insurance do exactly the same with paperwork, you just don't hear about it as much because fewer people have claims.
Countries like Japan and Switzerland have lots of insurers, they just don't make a profit for healthcare financing. As long as they do, they have an incentive NOT to do their job, and we're all suffering for it.
This is where the huge savings is to be found in reform, simply getting rid of insurance profiteering. I don't see how the public option alone will save any of these costs, it seems poised only to add to the paperwork structure. And insurers will only redouble their efforts to regain their advantage.
It's time we looked at what this industry is costing us, and what it is delivering (a lot of negatives, and little of value that I can see). It is utterly failing at what it was chartered as an industry to do, which is save people from financial ruin in the event of large medical expenses. As you know, nearly 2/3 of personal bankruptcies are due to medical expenses and most have health insurance.
We know longer have the luxury of propping up this ridiculously expensive and deleterious industry at the expense of our business and citizenry.
Posted by observer, a resident of another community, on Sep 12, 2009 at 6:19 pm
Oops, I meant:
We NO longer have the luxury of propping up this ridiculously expensive and deleterious industry at the expense of our business and citizenry.
Our business sector and doctors should really be hopping mad about this and demand this one insurance reform.
If the Congress were wise, it would take on this one issue separate from healthcare reform, and call it "insurance reform". Then they could lay out just the arguments for it, and appeal to our business community, medical profession, and the public directly against the insurance industry's shakedown. More importantly, they could get insurance reform through far more quickly and it would begin to help our economy right away -- and wouldn't be hampered by all the emotionally loaded aspects of healthCARE reform.
Posted by Get back to what works., a resident of the Meadow Park neighborhood, on Jan 9, 2010 at 7:18 am
Stunning..big name MIT "academic" pusher of "health reform" was on payroll of ..the government HHS while pushing govt option.Wow, shocking..his pocketbook would greatly benefit from consulting with HHS to get 'er done.
Stunning..as people like me say all the time, follow the money and the power.
I prefer to keep my freedom to choose my coverage amongst many many "greedy" individuals trying to earn my trust than to simply hand it over to a couple folks in DC...with no power to drive them out of business from lack of enrollees, since we would all be forced onto their plan.
I don't believe for one moment the 'govt option" is dead, as is being touted, I believe they are going to go Alinsky and Clowen Pivens on us, and just trying to break the private system so we are screaming for "govt" to step in.
The increased taxes on private insurances - result? -- more expensive insurance, fewer people to afford it.
The push to willy-nilly regulate "no prior conditions refusal"..more expensive private insurance for those of us who actually think ahead responsibly and buy our insurance while we are healthy- result? Fewer healthy folks will buy the private plans because they are more expensive, and be forced into "govt save me" when they fall ill...or better yet, simply wait till they are ill then "buy insurance" at the guaranteed, subsidized by the rest of us level.
Every "new rule" I have read so far will only have the effect of driving up private insurance costs, with the ClowenPivens goal of breaking the system, so that the ignorant masses are begging for relief from "govt".
Which brings us back to the original line..where DC will pick and choose the winners, like this MIT bozo, who benefit from your taxes, leaving you worse off than you are now.
Remember that the scariest sentence in the English language is "Hi, I am here from the government and i am going to help you" ( to paraphrase Reagan and, basically, Thatcher)
Don't take all your info from one source..like Reid. Read each source with a jaundiced eye, and think "what will the end results be in 20 years". Think like the American Indian tribe (I forget which one, but it has always stuck with me) "7 generations from now". Think how much we have changed in the last 140 years, what we have encouraged with our 'good intentions" and ask yourself what else wrong we are going to do by moving ever more away from the founding principles of our country.
I recommend reading any and all by Sowell, and Heritage Foundation, and Pacific Research Institute, for principles that work. Our insurance worked until Govt started regulating what "must" be covered, and started "protecting" consumers, and lawsuits went insane.
Let's get back to those basics and do what works again.
Posted by Get back to what works, a resident of the Meadow Park neighborhood, on Jan 10, 2010 at 9:53 am
I work in health care, and overheard a great exchange in the lunch room a couple days ago.
Every single one of the CNAs, not one of whom was born and raised here, and therefore are working the least paid and hardest jobs we have in health care, were complaining about getting a "raise" which made them all pay more in taxes....so that they brought nothing more home.
What were they talking about? Finding jobs outside of health care where the work wasn't as hard but paid as well. These guys work hourse around the clock, weekends, holidays..and figure it just isn't worth it any more. Going to be fun trying to keep delivering "quality care" as more and more of us leave health fields and leave those remaining with more and more patients to care for as the boomers age out....
keep up the good work, socialist policy makers.
Good story now running around about a teacher with an economics class that insisted that "Obama's economic recovery plan is good"..so he said fine, let's put it into action in this class with grades. and they all agreed. Everyone would get the average of the grades of all of them on each test to "keep it fair".
The first test averaged B..the hard working ones were mad, the others happy.
The second test averaged D..the hard working ones said "why bother" and the others thought the hard working ones would pull them along.
The last test was an F..big surprise.
this is the inevitable result of taking away the benefits of working hard, be it for "health care" , housing, food..anything.