We have passionate views on both sides of the issue.

Lets see what kind of reform our group would be able to come up with.

 

RULE 1: LEAVE ROOTING FOR YOUR POLITICAL PARTY AT THE DOOR

RULE 2: LEAVE GRUDGES AGAINGST YOUR POLITICAL FOES AT THE DOOR

RULE 3: LEAVE THE (NON) ISSUE OF THE DAY AT THE DOOR (i.e. Death Panels, Astroturf, etc)

RULE 3: CONSTUCTIVE CRITICISM ONLY

 

I happen to feel that most people who contribute to this board are intelligent, bright people who are able to work with others who do not share their ideas. 

If we can't work out a plan without lobbyists and constituents, who can?

 

 

I'll start by saying I think we can reform the system to reduce waste.  We spend more per capita on health care, but not everyone has access to adequate medical resources.  Many people are denied coverage for a pre-existing condition, and others loose benefits because they have hit a cap on spending for their policy.

 

Here are some of the things I am for:

• Cover people with preexisting conditions under the Americans with Disabilities Act, which requires businesses to make "reasonable accommodations" to make sure they are not discriminated against.  Make an outright denial of service a form of discrimination.  Basically make it illegal to use "preexisting condition" as a way to deny service.  People with HIV are currently covered under ADA
  
• Open up insurance company competition across state lines, this would also make them regulated by the Federal Gov't via the interstate commerce clause
  
• Use the tax code as a carrot and a stick for hospitals and doctors to adopt the Cleveland Clinic, salary based, not procedure based compensation
  
• Set a hard dollar amount that employers can use to expense employee health care, like what is used for mileage, with minimum standards for coverage. 
  
• Let small businesses get back dollar for dollar in tax credits the amount they spend on healthcare  to the amount above
  
• (Just thought of this one) Let individuals go into the marketplace and purchase the policy they want, and be able to turn it into their company for reimbursement like mileage.  That will stimulate competition
  
• For the unemployed, have COBRA be tied into unemployment insurance,
  
• Use tax code to incentivize "minute clinics" in drug stores, especially in poor areas, and near hospitals that have there ER used for general medicine
  

 

 

In short, I don't mind government paying a big chunk of health care.  I just don't want them running health care. 

 

Critiques, any other ideas?

Great topic. I can't disagree with any of the mandates listed above, though I think short of a full-blown, from-scratch public option, we would need to look at expanding access to Medicare benefits.

As far as i'm concerned the biggest needs are 1) making sure those with pre-existing conditions can not be denied; 2) making sure that everyone has access to preventative medicine; and 3) profits aren't a driving force behind medical decisions.

The last one is going to be tricky; ideas such as increasing cross-border competition and HSAs function on a model where the market is seen as a solution for controlling the cost of health care. Until we regard health care as an intrinsic function of society (such as fire departments, power companies, water and police), I think there's going to be tension. Human beings are not rational decision-makers when it comes to their health--we'll tend to pay whatever it takes to get better, and doctors are peculiar in how they decide which course of action to take from patient to patient. Harnessing all those variables is impossible; what is needed is a system robust enough to offset the costly decisions with more robust wealth of cost-effective solutions (minute-clinics, streamlining of medical records; preventive care and wellness incentives, ect.)

 

Again: I like all the ideas on Punch's list. But with the present market-centric mindset, coming between a health care provider and his profits is asking for trouble, politically speaking.

Compared to some hospital systems and especially pharmaceutical companies, insurance companies make much lower percent profit.

I think it is because they are selling a commodity, and the fact that there is competition.

 

If you want to get after waste and greed in health care, lets look at the companies that make the largest percent profit, and go after them, then down the line.

 

Lets try to measure the difference between profiting and profiteering.  I also understand the political necessity to boil down a complex issue to a good vs. bad.  While I don't like insurance industry bashing, I don't think it is sinister.

 

While we are talking about profiteering, lets throw ambulance chasing lawyers, the kind of ones who have commercial testimonials saying "Lawyer Joe got me $100,000"

 

 

I appreciate the sober conversation so far on this thread.  Thank you

I agree that there needs to be some discussion about law suits, that also needs to be waded into lightly.  The insurance rates for doctors are insane.  But, we can't put up too many barriers for people that are legitimately injured by a doctor's negligence (not a mistake, necessarily, but honest to god negligence) and their ability to sue for compensation.

 

in the interest of keeping this apolitical, one big issue that we'll have in any reform is the size of the industry itself.  I believe we've allowed it to become so big that we'll have difficulty dismantling it if we so choose.  Another major hurtle is removing politics and religion from the health care debate; and what i mean by this is health insurance companies covering a 75 year old man getting viagra but not a 20 year old woman getting birth control.

Great topic. I can't disagree with any of the mandates listed above, though I think short of a full-blown, from-scratch public option, we would need to look at expanding access to Medicare benefits.

 

+1.  I like all the ideas so far as well.

 

I wonder if a compromise can be reached so that, let's say, a program akin to medicare can be created to create coverage for children in the U.S.?  So, in the end, the governement would end up paying for the elderly, the disabled and minors.  All able bodied adults are on their own short of some entitlement to welfare.  It would take the stress off employers and the working class so that such coverage does not have to be included in employee benefit packages and/or purchased privately.

 

Would anybody on either side of the aisle be agreeable to that compromise if it was included in a reform plan that contained means to achieve the other goals outlined in previous posts? 

The insurance rates for doctors are insane. But, we can't put up too many barriers for people that are legitimately injured by a doctor's negligence (not a mistake, necessarily, but honest to god negligence) and their ability to sue for compensation.

 

Negigence is just that - a mistake or an accident.  I think the terms you are looking for are "gross" negligence or "recklessness"

I wonder if a compromise can be reached so that, let's say, a program akin to medicare can be created to create coverage for children in the U.S.? So, in the end, the governement would end up paying for the elderly, the disabled and minors. All able bodied adults are on their own short of some entitlement to welfare. It would take the stress off employers and the working class so that such coverage does not have to be included in employee benefit packages and/or purchased privately.

 

Would anybody on either side of the aisle be agreeable to that compromise if it was included in a reform plan that contained means to achieve the other goals outlined in previous posts?

How would that work for the working poor adults? they wouldn't be covered by the govt program for the young or old, right?

Educate me, how does S-CHIP work.

 

I am actually for a universal type health insurance for children.

 

Like this debate, the devil is in the details

How would that work for the working poor adults?

 

It wouldn't, short of (like I said) some entitlement to welfare.  It sure would not be my first choice.... I am just curious as to what a consensus can agree to.

It wouldn't, short of (like I said) some entitlement to welfare. It sure would not be my first choice.... I am just curious as to what a consensus can agree to.

I think that would probably get more agreement from the right side (protecting the kids) than the left (leaving out the poor).  Interesting idea, though.

One thing that gets left out of this discussion is the public health aspect of our decisions regarding who gets what individual care.  For example, if a waiter gets sick they probably don't have health care or get sick leave.  So they go to work if they can still walk.  They have no choice.  Guess what- they're handling your salad.  Plus many other people's, too.  How many other people have to get sick before it would have made sense to have handled the first person's illness?  Waiters, bartenders, cooks, cashiers, and other people working with the public make up a good portion of the working poor, who are the people who are without health care.  To poor to have insurance, not poor enough for charity.

 

For the same reason I hate the idea of high deductible, "catastrophic" plans.  They discourage exactly the kind of preventative care and "public health responsibility" care that I'm talking about above.

For the same reason I hate the idea of high deductible, "catastrophic" plans. They discourage exactly the kind of preventative care and "public health responsibility" care that I'm talking about above.

 

Agreed.  I would firmly oppose any such proposal.

1)  Tort reform is essential.  Damages should be determined by judges, not juries, as criminal sentences are.  "Punitive damages", when warranted, should not be paid to plaintiffs or their attorneys.  In malpractice cases, I'd recommend a fund that reimburses providers of indigent care.

2)  Allow insurance companies, HMOs, etc to be sued for denying care.  (Without tort reform, this does more harm than good).

3)  Allow organizations to provide insurance for their members using pre-tax dollars.

4) Ban insurance companies from providing discounts to employers that only offer their plans.

I wonder if a compromise can be reached so that, let's say, a program akin to medicare can be created to create coverage for children in the U.S.? So, in the end, the governement would end up paying for the elderly, the disabled and minors. All able bodied adults are on their own short of some entitlement to welfare. It would take the stress off employers and the working class so that such coverage does not have to be included in employee benefit packages and/or purchased privately.

 

The whole point of insurance is to spread the risk.  If we put all the high-risk people (elderly and poor) into a public insurance pool, along with children (who also wouldn't be able to pay into the system), the rest of us are going to have to be taxed more heavily than we are now to cover them.  It seems to me that if you're going to increase my medicare tax to cover more people, adding a healthy me to the insurance coverage is going to save me from having to pay for private insurance but isn't going to put much added burden on the public insurance.  I'm healthy and don't use much healthcare. 

 

I work for a small business.  Our insurer threatens to raise rates 20% almost every year.  So every year we shop around for cheaper insurance, and lucky us our insurance only goes up 15%.  And we change insurers almost every year, and slowly keep reducing the coverage and increasing our deductible.  It's crazy. Competition in the marketplace is not working for our small business, something has to change. 

 

I don't think tort reform is going to make that much of a difference.  Despite the occasional big headline I think the damages actually paid out are far lower than what a jury awards.  First a judge generally will reduce those outrageous amounts, then there will be an appeal or a settlement for a far lower amount.  Those things aren't very exciting and don't get reported. 

 

So how would you reform the legal system?  What if we hired more judges to handle medical malpractice cases and insurance denial cases and set a "rocket docket" to  push cases through the system more quickly so that baseless claims can be thrown out sooner before the lawyers' fees can add up too much? 

I might be wrong, but I think the UK has a system where the losing party in any civil lawsuit must pay the legal fees and court costs of the winning party. I think such a system would reduce the number of frivolous lawsuits (fewer ambulance chasers willing to take their chances at winning a huge jackpot) as well as reduce the temptation settle legitimate cases out of court (big companies less able to buy off aggrieved parties simply by dangling a settlement check in front of them). It would help ensure that the legal system is only used for legitimate cases, rather than as a casino or a means of extortion.

^^Suing one's insurance company for benefits is no picnic, either. It drags on for years with lawyers from both sides cashing in on fishing trips, and usually ends either 1) A low ball settlement, 2) Slightly less low ball arbitration settlement or 3) No award and costly legal bills for the plaintiff. The only winners here are the lawyers. Torte reform is a lovely sentiment, but abuse of the legal process is not a matter of spectacular jury awards; it's death by a thousand papercuts. Flat out barring insurance companies from denying benefits is the only torte reform we need (as it applies to medical costs).

I would think it's possible to lose a case even though it wasn't frivolous.  Such a system would make it too risky for middle class and lower people to bring any lawsuit that isn't a slam dunk.

 

I work for a small business. Our insurer threatens to raise rates 20% almost every year. So every year we shop around for cheaper insurance, and lucky us our insurance only goes up 15%. And we change insurers almost every year, and slowly keep reducing the coverage and increasing our deductible. It's crazy. Competition in the marketplace is not working for our small business, something has to change.

 

I think that it's essential for our small business to remove this burden from them.  Rather than forcing them to provide coverage on a private plan, wouldn't a public one make a lot more sense?

I would think it's possible to lose a case even though it wasn't frivolous.  Such a system would make it too risky for middle class and lower people to bring any lawsuit that isn't a slam dunk.

 

Exactly.  And that is the flaw in the UK's system (as appealing as it is at first glance) - only rich people can afford to sue.

 

Besides, if the goal is to make people who bring frivolous suits pay the defendants' attorney fees, we already have that mechanism.  If the suit is baseless in law or fact, then  a judge can award attorney fees.

 

The whole point of insurance is to spread the risk.  If we put all the high-risk people (elderly and poor) into a public insurance pool, along with children (who also wouldn't be able to pay into the system), the rest of us are going to have to be taxed more heavily than we are now to cover them.  It seems to me that if you're going to increase my medicare tax to cover more people, adding a healthy me to the insurance coverage is going to save me from having to pay for private insurance but isn't going to put much added burden on the public insurance.  I'm healthy and don't use much healthcare. 

 

But we already pay for the elderly and the indigent (those that present at the ER).... and our veterans.... and the disabled.  All this would do is add children to that list.  I mean, say what you want about some lazy, willfully unemployed adult who can't afford insurance, but no child should have to live that way.  We share the costs of education by presenting a public education option to all children, both the wealthy and the poor.  Why not health care?

 

I realize it is not ideal.  It is just an idea tossed out there to see if anyone would outright reject to a reform plan that carried a public "option" for all children and those already covered under currently available public options (elderly, veterans, disabled), but did not contain a public option for the rest.

 

Of course, other details (many of which discussed in previous posts) could be negotiated in, such as electronic record keeping, tort reform, interstate commerce, etc.

 

I think the Repubs could sell this to their constituents because of the benefit it provides to the American family

 

 

Not to take this on a tangent, but even a model that spreads risk can fail its participants; the insurance on my house in Detroit just doubled without a single claim. Since it's in an area with many vulnerable structures, I pay the price. Bringing it back to point, there will always be catastrophic market fluctuations. If there were a public plan (ostensibly immune, or at least girded against ups and downs), wouldn't the whole market benefit from greater stability?

Here's some research on what costs medical malpractice adds to our health insurance premiums (not much). 

 

From the summary:

    • Medical malpractice premiums, inflation-adjusted, are nearly the lowest they have been in 30 years.

 

    • Medical malpractice claims, inflation-adjusted, are dropping significantly, down 45 percent since 2000.

 

    • Medical malpractice premiums are less than one-half of one percent of the country’s overall health care costs; medical malpractice claims are a mere one-fifth of one percent of health care costs. In over 30 years, premiums and claims have never been greater than 1% of our nation’s health care costs.

 

    • Medical malpractice insurer profits are higher than the rest of the property casualty industry, which has been remarkably profitable over the last five years.

 

    • The periodic premium spikes that doctors experience, as they did from 2002 until 2005, are not related to claims but to the economic cycle of insurers and to drops in investment income.

 

    • Many states that have resisted enacting severe restrictions on injured patients’ legal rights experienced rate changes (i.e., premium increases or decreases for doctors) similar to those in states that enacted severe restrictions on patients’ rights, i.e., there is no correlation between "tort reform" and insurance rates for doctors.

 

Full report (PDF)

http://www.insurance-reform.org/TrueRiskF.pdf

 

The Medical Malpractice field of law could use some tweaking, but it several hurdles are already built in to safeguard the healthcare system - 1 yr. statute of limitations, requirement of an affidavit of merit from another physician, no shifting burdens of proof, etc.

 

I still have not had any outright rejections to the idea of universal coverage for all children in the U.S.  Is it safe to assume that is a measure that is agreeable to all sides of this debate? (regardless of what ELSE you might or might not want in the reform package).

I still have not had any outright rejections to the idea of universal coverage for all children in the U.S. Is it safe to assume that is a measure that is agreeable to all sides of this debate? (regardless of what ELSE you might or might not want in the reform package).

 

Well, I cringe at the buzzword "universal coverage," but yes, I'm one of the more strident free-marketeers out there, and I'm still OK with at least some basic publicly-funded coverage for minors.  (My problem with the term "universal" is that some people mean "covers everyone" and some people mean "covers everything for everyone."  Both are fair meanings of "universal" but they definitely have different practical implications ... including the price tag.)

I still have not had any outright rejections to the idea of universal coverage for all children in the U.S. Is it safe to assume that is a measure that is agreeable to all sides of this debate? (regardless of what ELSE you might or might not want in the reform package).

 

Well, I cringe at the buzzword "universal coverage," but yes, I'm one of the more strident free-marketeers out there, and I'm still OK with at least some basic publicly-funded coverage for minors. (My problem with the term "universal" is that some people mean "covers everyone" and some people mean "covers everything for everyone." Both are fair meanings of "universal" but they definitely have different practical implications ... including the price tag.)

 

Well, let's just forget about catch phrases that have been used for tactical purposes in this debate.

 

The idea I propose would be akin to the public school system.  Available to all (regardless of class), with the cost shared by all, but not forced on those who can afford a private plan.  Thoughts?

The idea I propose would be akin to the public school system. Available to all (regardless of class), with the cost shared by all, but not forced on those who can afford a private plan. Thoughts?

 

Sounds good to me... Such a model works successfully in a number of countries, including the US. A single-payer plan would provide a basic minimum of coverage, and if people wish to supplement that coverage out of their own pockets with a private insurance plan, they're welcome to do so. That's pretty much how Medicare works.

I think my health care plan would basically be identical to the one John Mackey proposed in his now-infamous WSJ article, so I'll just copy and paste the part of that with the substantive proposals, sans the one that I'm not as keen on:

 

http://online.wsj.com/article/SB20001424052970204251404574342170072865070.html

 

Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees’ Personal Wellness Accounts to spend as they choose on their own health and wellness.

 

Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan’s costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

 

• Equalize the tax laws so that that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

 

• Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

 

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

 

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

 

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

 

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren’t covered by Medicare, Medicaid or the State Children’s Health Insurance Program.

^ I think that most conservatives are in favor of those changes.  However, the point of this thread is to see where the "MIDDLE-GROUND" lies.  Meaning, what "concessions" would you be willing to make to create a "bipartisan" plan. 

 

Putting aside the fact that the current political power landscape is left of center, in order to create a bipartisan plan, conservatives will have to make some concessions from their hard line stance and liberals are going to have to back off some of their demands.  That is why I think that a public plan for children might be agreeable.  Conservatives would have to agree to some form of public option and liberals would have to give up their idea of universal coverage for all citizens.  So.... what say you? 

Sounds good to me... Such a model works successfully in a number of countries, including the US. A single-payer plan would provide a basic minimum of coverage, and if people wish to supplement that coverage out of their own pockets with a private insurance plan, they're welcome to do so. That's pretty much how Medicare works.

 

Isn't that basically how Single-payer works everywhere? basic levels for everyone and then add ons for the people that want them?

The universal plan for children is certainly something I'd be willing to consider.  However, I'm less a conservative ideologue than a budget hawk.  I have no moral objection to government-provided healthcare--even universal care.  The worldwide, government-led campaign against polio was a triumph for humanity.

 

The difference I have with both ideological conservatives and ideological liberals is that both of the latter tend to start with what they want to do and only then start talking about what we can afford (after they've already shaped in their minds certain things that "we just have to have," "we can't compromise," etc. etc. etc.).  To me, that's like walking into a restaurant fully intent on ordering something that's not on the menu and then getting sullen and defensive when someone tells you what you actually can have.  It's also the same kind of thinking that leads people to bury themselves in debt for cars, houses, even computers, furniture, and jewelry.

 

I support those policy points from the article I quoted above because I think they'd lead to both public and private cost-savings, and that they wouldn't sacrifice much in terms of quality of care.  I should also add some other policies that I favor for the same reason, ones which weren't in Mackey's editorial:

 

(1) Increase the number of procedures that can be performed by nurse practitioners and others without med school degrees.  There are some things that assigning an M.D. to treat is overkill, and expensive overkill, at that.  (I will also add that I've seen some experienced nurse practitioners that I'd actually prefer to have treat me for minor ailments than some rookie M.D. fresh out of residency.)

 

(2) Buy out the loans of all med school graduates who stay in the field for at least 10 years after completing their residency.  This would allow more of them to actually consider taking jobs in family medicine and less highly paid specialties--and to charge less for services in those specialties.

 

(3) Decrease the period of patent protection on "me-too" drugs to make it more profitable (in relative terms) to do new things than to follow trails already blazed.

Here are a couple of things that I think. I work in the utility field so I am going with what I know.

 

I think there should be a minimum level of of coverage for everone regulated but not supplied by the government.

There are two options for this both would probably require some sort of socialized tax rate, money distributed to the insurance companies by a governing agency.

      1.Regulated monopoly, insurance companies would cover everyone one in a segment (state, region, some other grouping) in return for a regulated level of profit (return) and reimbursement of prudently incurred expenses. The cost savings would come when the regulators would review the expenses when approving the new rates.

      2.Market Based Auction where the entire eligible population would be divide into traunches composed of a cross section of similar demographics (ie theroretically same amount risk) and would bid into auction to provide insurance coverage for 3-5 years at a time. After the 3-5 years the traunches would be rebalanced and the auction repeated. This should provide lower costs and stability to costs by forcing the Insurance Companies to bid low enough to win.

 

Both of those methods require arbitrary hurdles to healthcare to be eliminated, your insurance should work at any doctor or hospital in the US. Unless they are entirely private and opt out of the Insurance system.

 

I have been trying to find this online, but with little luck.  My basic question is how will I be affected if one of the House bills pass?

I currently have a high deductable ($2500) and a heath savings account.  My company kicked in about $500 to start the account, and I put in $35 a week.  The $35 is the only out of pocket I pay, but it is basically my money.

 

By the end of the year, I should have just about enough money to cover the deductable.  Next year, I can actually start saving beyond the deductable(got willing I don't need medical care). 

 

Will the "mininmum" coverage floor require me to pay for a policy with a lower deductable, when I really don't need it?

 

If you do have an answer to this or a similar situation, please cite the source.  Thank you!

 

 

I have a question I don't know if anyone around here can answer. I come from a family of seven kids, and growing up I only played one sport: Soccer. I never needed major surgery growing up. My younger brothers played soccer, football, basketball and lacrosse. They broke their feet, broke their noses, and one of them has had extensive shoulder surgery. This was all covered by my parent's insurance. Yet I know that we all had the same premiums. What's THAT all about?

 

 

I have a question I don't know if anyone around here can answer. I come from a family of seven kids, and growing up I only played one sport: Soccer. I never needed major surgery growing up. My younger brothers played soccer, football, basketball and lacrosse. They broke their feet, broke their noses, and one of them has had extensive shoulder surgery. This was all covered by my parent's insurance. Yet I know that we all had the same premiums. What's THAT all about?

 

 

 

We don't pay a seperate premium for each of our kids, we simply pay a premium for family plan. 

I have a question I don't know if anyone around here can answer. I come from a family of seven kids, and growing up I only played one sport: Soccer. I never needed major surgery growing up. My younger brothers played soccer, football, basketball and lacrosse. They broke their feet, broke their noses, and one of them has had extensive shoulder surgery. This was all covered by my parent's insurance. Yet I know that we all had the same premiums. What's THAT all about?

 

 

 

We don't pay a seperate premium for each of our kids, we simply pay a premium for family plan.

 

Well...yeah. Therein lies the curiosity of not being able to leverage actuarial data for kids who engage in higher-risk activities.