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Health Care Reform
It appears that today might be the end of a very long road to health care reform. There's been a lot of debate on the subject really leading back before the election. The mainstream sounds like an echo chamber, so I'm hoping you guys have better insight. Will this bill do what the administration claims to do, or is it as bad for the future of America as Fox says?
Is there anything that the government runs that really functions correctly/efficiently?
Is there anything about the proposed act that is government-run? If there is, I'd missed it. It mandates a bunch of things that private insurance companies are required to do, but it doesn't set up a public option (aka government-run health care).
PenguiNet: the (shareware) Windows SSH client
Full bill: http://www.scribd.com/doc/28572002/Reconciliation-HR-4872-Full-Text
CBO report: http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf
Get to reading!
Living With a Nerd
The US spends more money in percent of GDP in health care than any other country in the world. The Greece debacle is more about a government that increased wages and welfare to a point that the economy could not sustain, but it has nothing to do about health care specifically.
Study after study has completely debunked the myth that high malpractice insurance is due to frivolous lawsuits. High malpractice insurance is for the same reason their is high medical insurance. The insurance companies made bad investments and lost their shirts now they're raking everyone over the coals while still pulling down 20 to 40% profits.
Over-the-top Response Guy! Giving "Over-the-Top Responses" since 1970.
>>>Republicans had years in which they could have pushed through health care reform
They did.
Or have you forgotten the new Prescription Medicine Reform where people can get "free" medicine? Or the Tort Reform to help reduce expenses?
"I disapprove of what you say, but I will defend to the death your right to say it." - historian Evelyn Beatrice Hall
This is not a 'health care reform'.
This is not even an 'insurance reform'.
What is going to pass is a few regulations that are supposedly going to make it not possible for an insurance company to drop coverage, to do rescission and a few more items. - This is good.
Here is what you are not going to get:
1. No optional public insurance against private insurance, the prices will not go down. Worse than that, what is happening is private insurance is raising prices to offset any of the new changes that will be coming with this 'reform'. Does not look good.
2. You probably are going to get a mandate, which is unfortunate given that you will have no public option. You will be forced to buy into expensive private insurance, there will be no choice or it looks like you will get some sort of a fine. Does not look good.
3. No cheaper drugs imported from other countries. The bill was introduced earlier this fall, but Obama actually killed it very very personally because he signed a deal with the manufacturers to do this: no competition from cheaper imported drugs AND the patents are to be extended from 5 years to something like 12 years. Does not look good.
4. Looks like US is one of the backwards countries that will try to limit women's access to health care they need. You going to get the 'reform' that will prevent any private insurance coverage for women that includes abortion. This is no joke, even for those who have coverage today, looks like they will actually lose it with this 'reform'. Does not look good.
The other part of it, the cost of it, that's a moot point. It was calculated that if Medicare was provided as a buy in for anyone at all, at cost (at cost - means whatever it costs, but no money is made for profit), or if there was a public option, then the reform could even save money. The way it is going to happen with no public negotiations with hospitals, no public negotiations with drug manufacturers, no import of cheaper drugs, no generics because the patents will be extended, well, I don't know if this will be cost neutral. It does not matter really, if US just cut its WAR cost, it's defense contractors costs they could probably fund the entire reform in health insurance and there would be enough money for the public education reform. Of-course that's not going to happen.
Anyway, Pelosi and Obama and the rest of them are lying sacks of shit. They do not want to take a vote on the public option, they will not take a vote on Grayson's proposal to just allow anyone to buy into Medicare at cost. This is not a health reform, this is just a little chunk of 'change' you were promised. Take it and be happy, cause you are not going to get anything better at all.
You can't handle the truth.
In 1999, administration cost $1,059 per capita in the US, versus $307 per capita in Canada, per New England Journal of Medicine. So much for private businesses being better than the government. I've lived in Cyprus, UK, Canada, USA, Australia and China, and my experience, the UK has the most encompassing system, and Canada (Ontario at least) the most proactive and efficient. I totally hated the American system, and I can't say I'm much of a fan of what I saw in Melbourne. China was great as an expat because it was so bloody affordable, but that's not what we're discussing here.
Not entirely true. The legislative actions (ending recissions, forcing insurance companies to cover everyone, etc) take effect immediately. Only the benefits that cost money have been delayed. There will be a big, positive effect right away.
Genocide Man -- Life is funny. Death is funnier. Mass murder can be hilarious.
There are a lot of drug companies doing research in other countries than Europe. ;)
Maybe you should do a bit of research
If you look at this list you can see that some of the biggest pharmaceuticals are based outside of the US. There is a lot of research going on in medicine in the universities around here as well.
Another wikipedia article states:
"In terms of pharmaceutical R&D spending, Europe spends a little less that the United States (22.50bn compared to 27.05bn in 2006) and there is less growth in European R&D spending."
So the research argument doesn't really bite.
Regarding your first point "When our government *starts* taking away our liberties...", are you new to the party? Federal, State and Local governments long forced people to buy this or that, and eminent domain has been exercised since the days of the railroad barons. You may have some valid points, but you taint them when you pretend that this administration is doing anything to us that past administrations did not.
To err is human. To arr is pirate.
(forcing people to buy health care, taking away private property to give to another private party are just two examples)
I'm not a fan of the bill -- the lack of a public option creates, as you say, a major problem by forcing people to give money to insurance companies that have little incentive not to gouge their captive market. A mandate *is* necessary, though, for insurance-based health reform to work. (That's why single-payer was the way to go...)
As for the other, that's inevitably always going to happen. Unless the government carries out its necessary functions entirely itself (which wouldn't be a bad thing, but would probably be considered "socialist" or something), there will always be government contractors and the like. But redistributing income is a core part of every government, ever. Taxing the serfs to keep your warriors in meat and mead fits that description just as well as does Social Security, the Space Program, and the local fire department.
When it continues to spend us into either runaway iflation or economic ruin, I'd say that's bad for America.
We are nowhere near runaway inflation. In fact, there is a substantial risk of a very bad deflationary spiral at present. (see e.g. graph here). Deflation is bad; it means wages decrease, consumer spending drops, and job losses keep mounting. I mean, deflation is wonderful if most of your assets are dollars. If you own anything of value though, like say a gold stockpile, or a house, or if you like jobs, deflation is very very bad. And there is approximately zero chance of Zimbabwe-style inflation in any imaginable non-post-apocalyptic America over the next fifty years.
Freedom isn't free; its price is the well-being of others.
This thread, and news coverage at large, are incredibly sparse on what the plan actually is! So here it is:
INSURANCE MARKET REFORM
COVERAGE MANDATES, SUBSIDIES AND MEDICAID
FINANCING
MEDICARE
This bill is the minimum that can be done to remove recission and pre-existing condition clauses without destroying the system.
The economic logic is as follows: We want to regulate the insurers such that they don't exclude people based on pre-existing conditions. This makes sense.
However, once you try to apply that in practice, it gets hairier: if you cease to enable insurers to do that, then you get what's called an "adverse selection death spiral", wherein some healthy people drop coverage (since they know they can get it back as soon as they get sick) which worsens the risk pool. Because it's worse, those remaining members left in this new risk pool get charged higher premiums. These higher premiums cause more healthy people to drop coverage (since they're getting less for their money) which causes a repeat of the same cycle. As this goes on, the price of insurance gets so astronomical that only the sickest have it and nobody can afford it because the cost approaches the cost of the procedure you're supposed to be insured for.
The way we work around this is the unpopular part. We put a mandate on everybody that says "alright, since they can't kick you out anymore, you can't game the system: everyone has to be insured". Whether it's better to do this by putting the mandate on individuals or on employers is debatable, but what's on the table is an individual one.
Now that we're mandating everyone have insurance, we need to address its affordability, since mandates to buy things that people can't afford don't really work. This is where the subsidies (ie, costs) come in. This package is basically $900bn in subsidies for people who have trouble affording comprehensive insurance--including everyone from the average joe to a reasonable percentage of the slashdot crowd. The latest bill has caps on premiums set as follows: "[f]or people who buy insurance on the exchanges, a family of four making $88,000 would have a cap of 9.5 percent of their income." The penalty for not buying insurance is $695/person/year with exemptions for financial hardship, etc.
The $900bn comes by way of medicaid as well as direct subsidies.
The rest, once those things are in place, are to cut costs/cut the deficit and regulate insurers. But the above is by far the bulk of the bill. While I personally wouldn't mind killing the insurance companies so we can institute a single-payer system, if you want pre-existing conditions gone, this is what you get.
Actually, there are provisions in place to keep them from just charging whatever they want: they have to pay out at least 85% of revenues on actual medical care. Given that insurance companies have their own staff that they have to pay, this puts pretty strict limits on how much they can actually profit.
In fact, per the bill, insurers have to pay out 85% of their revenues in actual medical care, which means it's more or less impossible for them to just charge whatever they want. Yes, a public option would be better, and single-payer would be better still... but this bill is still a huge improvement on the status quo.
The case of Texas is instructive - they strictly limited damage payouts for medical malpractice cases... and their medical malpractice insurance premiums continued to escalate at exactly the same rate as the rest of the country. Nor was there any particular change in overall health-care cost escalation. So I think we can safely ignore this particular line of argument.
Concessions haven't been made simply to appease republicans. They've been made to try and get more of the citizens aboard, and to try and get more support within the democratic party. Things like the taxes on expensive plans have been relaxed to ease the union opposition. Sweet-heart deals have been made to buy reluctant Senators like the Louisiana or Nebraska deals, etc. Removal of the public option from the House bill was an attempt to get Senators on board. Finally, there are a lot of people in the United States, to whom congressmen have to answer in a few months who aren't fond of either the whole bill, or certain provisions. Trust me, with the filibuster proof majority in the Senate, if they didn't have to fight within the Democratic party, we'd already have a bill completed and out the door (They had this majority long enough before they lost Ted Kennedy's seat).
Cost more, yes. Gets less, I don't think so.
Overall cost of health care is up because the tests, treatments, and medications that are now mainstream are all dramatically better than they were not all that long ago, when they were prohibitively expensive and rarely employed. They are used more widely now because they are less expensive (economies of scale), and, after all, nobody wants sub-standard treatment.
Absolutely provably false.
Harvard Business Review published a piece on this recently. It uses raw data to compare the US health care system to other developed nations. It's conclusions:
Americans realize amongst the poorest health outcomes of developed nations. Americans have the lowest life expectancy amongst developed nations -- 78.1 years, compared to 81 in the UK, and 82 in Switzerland. [...] And America has the highest infant mortality rate -- 6.9 deaths per 1000 live births, compared to 5.4 in Canada, or 4.7 in Belgium.
The numbers are preliminary, but suggest a visible trend. Where survival rates have increased in other countries -- sometimes significantly -- in the US, cancer survival rates have dropped over the last two decades.
Americans pay more for healthcare because they trade more expensive products for less service, realizing poorer outcomes. Why? Because that is what maximizes near-term profits along the value chain. [...] Healthcare in America is a textbook example of thin value. The healthcare industry maintains significantly supernormal profitability -- yet, those profits are divorced from people being relatively better off. An American healthcare industry that "creates value" by limiting how much better off people are is simply transferring value from society to shareholders.
(emphasis theirs)
The article also goes on to state that most pharmaceutical companies spend over TWICE as much on marketing as they do on R and that the gap between R&D and marketing continues to grow. By moving to a government single payer health insurance system, the pharmaceutical industries would have to forego their ~20% annual profit margins and live with profit margins in line with the state of the economy.
The outraged opposition from "Real Americans" to public health care is entirely a manufactured product, supported by those who have interests in the insurance and pharmaceutical industries.
On a personal note, I talk with some friends from Europe on a regular basis about this, and they don't really understand the fuss, or the need for insurance to be involved. One friend from Denmark summed it up by saying "If you're a citizen, you pay taxes and get health care. If you're sick, you go to the doctor, you get treated, the doctor sends the bill to the government. The end".
As opposed to my current situation, where the Family Practitioner that my family has been going to since my son was born (the OB/GYN that delivered him works there) is now suddenly not covered by my insurance company - EVEN THOUGH the insurance company's own website says that certain doctors at the practice participate, and EVEN THOUGH we have previously had coverage for things performed at the doc's place. We got a bill for over $500 for a STATE MANDATED health checkup for my son that was required before he could enroll in Kindergarten - not a drop of it was covered. My employer stepped in and reimbursed me for a portion of it, but told me sadly that they couldn't fight the insurance company and that I'd have to change doctors.
We need health care reform. The Right Wing in Washington opposes it. They will fight it at any cost, because it cuts into their backing funds from the insurance and
sig?
Mass here. Self-employed, using the state mandated marketplace. - Costs were up 38% last year, year over year (not to mention the obvious, but on top of already having the highest cost in the nation...)
socialized heath care is everything but good heath care.
Canadian here.
I've been following this all pretty closely. And as soon as the public option is off the table, I just have to sit back and laugh. Conservatives/Libertarians/name-your-right-wing-group-member just don't get it, and never will. I almost understand. It's baked into the fabric of America. Take advantage by any means necessary to gain wealth no matter what the ramifications. Case in point - insurance-based healthcare.
What is good health care and what is bad heath care? Go ask these four people: A poor American, a poor Canadian, a rich American, and a rich Canadian.
And for all those who think socialized medicine is evil, well I guess the rest of the world is just evil and America is, as it always was, the epitome of "good".
Oh, and BTW, since you already have socialized postal, fire, school and police services, you should return those. They are evil.
Just imagine a society where someone's house is burning down and the fire dept. checked to see if you had insurance before dispatching a truck. It boggles the mind.