This one will be short and sweet as I just want to post a quick reaction to Obama’s speech on healthcare. Personally, I’m thrilled that he is making a serious commitment to a revamped healthcare policy. I am 100% for universal healthcare, and the plan he laid out today makes a heck of a lot of sense to me. I was keeping a rough tab on the spending cuts he wants to make in order to realize his bold plan. Isn’t this the very thing conservatives have been saying all along, that Medicare and Medicaid were crippling our healthcare system? Aren’t these the kind of cuts the exact kind of thing they wanted all along? Isn’t the conservative plan to create a system to end the inefficiencies in our current healthcare plan? Obama addressed these things in the speech and Republicans are still shaking their fists.
The problem here has nothing to do with the practicality of Obama’s plan and everything to do with conservative ideology. It doesn’t matter how useful or important a government program is, if Uncle Sam’s face is on the logo, they don’t want it. What most people fail to realize is the government programs is not the failure, it is the practitioners. Our schools don’t suck because it is a government program; they suck because the nation by and large is using an obsolete educational model. There are great teachers and great schools, but the great results are localized. The truth is the free market school system isn’t much better. Sure the quality of education may be better, but in terms of retention and comprehension, the numbers are about the same as public school education.
I’m personally sick and tired of the free market crapping all over people. If you are uninsured, going to the doctor for a simple checkup costs more than taking a college course, more than round trip airfare from New York to London, more than nice dress suit, and many other things. How is this right? Pre-existing conditions? Even if you are insured, you may not get the coverage you need because the insurance won’t cover it. I know of a few people who filed for bankruptcy because they had a major emergency surgery. Even an ambulance will hit you for a few grand. I like the framework, and I’m excited to see how it shapes up in the coming months after rigorous debate. So I will submit to you dear reader my thesis for the upcoming post on healthcare (probably Episode 66 or so): A nation’s wealth is not only determined by its GDP, but also by its standard of living, their health, their educated workforce and the gap between the richest and poorest. Healthcare in many ways ties all of the aforementioned elements together. Those are my thoughts… more to come soon.
21 comments: on "Episode 64: Preliminary Thoughts on Healthcare"
tL,
So...who determines the ciriculumn that is outdated and why??? Could the answers be government and...politics? Why is it that school administration remains ineffective and unreformed?
My problem tL, is that once government enters the scene in an industry in the US, then progress in that industry grinds to a hault. You pointed to Social Security and Medicare/Medicaid. Those trains have been headed for a cliff for years and still are not solved. You seem to think that making the train bigger and faster is the answer. Meanwhile, we see politicians doing what they always do with the systems they control; the general public has to live within the boundries created and special interest cronies get special treatment.
My question is...if government can do all this cost cutting and the cost cutting has nothing to do with Obama's health plan. Why not just impliment the cost cutting plans and leave the government health plans out of it? I'm not actually advicating this, just pointing to the obvious why question.
In truth, the government is a huge reason why heath care is so expensive at the moment. Obama's suggested cost cutting has already been implemented. Medicare/Medicaid already sets the price they are going to pay and it is always under the market value. They also slow down the rate at which they pay. They may be billed in one month, but health care providers need to wait several months before getting paid by the government. The solution is not to make small payment over even greater periods.
In order to stay in business health care providers they need to raise costs to everyone else who will pay right away. As a result, uninsured pay much higher prices. What will happen on a larger scale? Maybe the government plan will be cheaper, but anyone else in the private market will be higher. Private health care is going to subsidize government health care. That is until there is no private health care...and what will we do with no one to shift the costs to??? Doesn't this all sound a little like SS?
In truth, a simple visit to a Doctor is not goign to send you to the poor house so long as you go to a private doctor as opposed to an emergency room. I recall you once told a story about someone you knew who went to the emergency room and spent $600 to be told they were fine. The truth is I can call my doctor, give him the symptoms, ask if it sounds like a problem, be told it is nothing, and all of it is at no cost :)
I spent a couple of years with no health insurance, but then I realized I could afford health insurance on my own. It cost me $200/month and did not cover simple visits, but it did cover major medical procedures (by the way...I've seen cheaper since). In truth, paying for the small stuff in healthcare is no different than owning a car. I have car insurance and should I get into an accident, I'm covered. Should my car break down and needs to be fixed, I'll pay the mechanic around $500-$1,000. This seems to occur a couple of times every year. It's a pain when the unexpected happens, but I don't see how health insurance is any different.
I could go on and on, but I was trying to specifically address your point :)
I'm not sure I could disagree more with pretty much everything you're opining, L, but I'll try to lay out some reasons for reference. I should also point out that I don't consider myself a "conservative" per-se, and I also don't think a public plan is necessarily a de-facto bad thing; however, I do think Obama's plan, or at least as much as has been expressed or implied about it, would be horrible for the country. But on to specific points...
Yes, conservatives have been clamoring for reducing health care costs: for example, reducing the massive expense of nuisance litigation born by medical professionals. Adopting socialized medicine would do nothing to address this. Yes, Medicare and Medicate are crippling long-term monetary obligations which could drain our national financial resources to the point of exhaustion; socialized medicine makes that problem worse.
Government programs are not universally failures, but they do usually come with increased costs, inefficiencies, waste, and marginal results (as would be expected from any socialized industries, as theory and experience would indicate). It's not that people don't try to get the systems to work, it's that the system itself is fundamentally flawed. In the public school example, the system is so full of waste, inefficiency, bureaucracy, and lack of accountability that we can throw massive amounts of money into the system and still get dismal returns. But even more asinine is that practically everyone knows exactly what the problems are; ask any teacher who cares about students, and they can tell you how the system just seems designed for failure, and how resources just do not go where they are needed to get the desired effects.
Yes, medical procedures are expensive, and ludicrously so. My understanding is that the reason medical practitioners do this is to make the payments from patients/insurance (which are fractions of the nominal cost) in line with the actual costs (so that they can continue to stay in business), and to compensate for risk and collection cost if the person seeking treatment doesn't pay. The industry could certainly use some large changes in that respect; for example, I would create a rule to limit the cost when the bill is paid by a credit card or other "guaranteed payment" mechanism to a reasonable amount, eg: max 150% of the lowest negotiated rate the practitioner or facility accepts. However, all of the meaningful and worthwhile changes, new rules, cost cutting, etc. could be enacted without, and completely independent from, a socialized medicine program.
My fear, and likely the fear shared by most people opposed to socialized medicine, is that if you had such a "public plan", it would undercut the actual cost to the practitioners for services (a la Medicare), and/or force providers to accept the government plan coverage. This would cause some facilities to shut down, and medicine to be much less profitable for the people who remain working in the industry. This, in turn, will lower the quality and availability of care, as well as the profit potential for medical research (and thus the quantity and quality of such research). If you get "free" health care, but you have to wait six months to get care which was less competent than you could provide yourself with an internet connection and online cross-border pharmacy orders, did you really improve health care in America?
Teachers who care are who determine this. Read any education journal and you see some great ideas out there. So why can't everybody do it if we're all reading the same journal... well first and foremost, it comes to teacher ability. Some teachers are incredibly innovative. Others need to follow a teachers workbook. This is why I constantly stress that we need better teacher training. Next, different school districts have different resources. My district I graduated from didn't have too much money for resources, and the school the next town over had significantly more. Certain things like nature hikes to bride a science lesson with a real world experience is difficult if not impossible. Third, administration sucks. Lack of accountability leads to squandering of funds. Finally, reform means that the days of easy street is over. People who are profiting at the expense of others fear regulation and reform because they will a) get caught doing illegal transactions or b) they can't take advantage of a situation anymore.
Regarding healthcare, I like your car insurance analogy. That is by far the best analogy to explain opposition to healthcare yet. And you're right, if my appendicitis costs say $5000, I think that is something I could work out over the span of a few years. But we are not cars. My surgery cost as much as a brand new Mercedes Benz. And there was no way I could have predicted it. And if I didn't have healthcare, I probably would've passed it off as the worst flu I've ever had, and died at the end of the week (keep in mind I was about 12 hours from biting the dust because it was caught late).
I also seriously doubt that we are going to lose private health. I brought up education because it would work the same way... everyone has the basic right to an education, but you can go to a private school with better resources and get top notch education and the best teachers. It'll cost more, but you have the choice. And if you lose your job, you don't have to worry about your kids not learning how to read because they can still go to public school. I really don't see how its different.
In order to stay in business health care providers they need to raise costs to everyone else who will pay right away.
If everyone is covered, why would this happen? they wouldn't have to worry about flighters because everyone is covered. This should lower the price.
Maybe the government plan will be cheaper, but anyone else in the private market will be higher
This is to be expected. You get what you pay for. I don't expect free healthcare to compete with government plans, by which I mean government insurance would not be as comprehensive. Personally, I can't afford even a $50/mo insurance. So I could get coverage from Uncle Sam. As soon as I'm able to afford better, I would definitely do that. I think that’s what most people would do. Didn't you start with your pops old Buick POS when you were in high school? When you had enough cash to buy a new car did you go to the junk yard to save money, or did you buy the very best car you could afford?
Meanwhile, we see politicians doing what they always do with the systems
Your distrust for the government is equal to my distrust for big business. I think the highr up the ladder you go, the more power and money you want to horde.
I think your fears are grounded in the government is bad stereotype that it has rightly earned in many respects. However, I will bet my entire fortune that if you were uninsured, and you had... I dunno, some kind of cancer that was 100% treatable and you could live a normal healthy life after, but you needed a few surgeries, follow ups, medicine, and therapy for a grand total of $90,000, you'd be singing a very different song right now. I would never ever wish anything like that upon you. But I also would never ever want to see that scenario play out on you or anyone else, especially when we had the power to do something about it.
Hey Nick, thanks for stopping by again! Here is my response to your comment:
Yes, conservatives have been clamoring for reducing health care costs: for example, reducing the massive expense of nuisance litigation born by medical professionals.
Obama did address this in his speech, calling for reform in malpractice lawsuits by using evidence based criteria. I'm not a doctor, so I don't know how it works, but from what I read, that statement was received well in the medical community.
Government programs are not universally failures, but they do usually come with increased costs, inefficiencies, waste, and marginal results
Again I argue that private enterprise is not much better. They are more concerned with making money than making sure you are in good health, getting the appropriate amount of money for the coverage you need. If they can find a way to shave of as much money as they can, even if it is to your detriment, they will. If they were doing thir jobs right, then the idea of universl ahealthcare would seem silly.
In order to stay in business health care providers they need to raise costs to everyone else who will pay right away.
Just incase you didn't read my response to Cgen, how will this be a problem under universal health care? everyone would be covered so there should be no worry about people who don't pay.
In the public school example, the system is so full of waste, inefficiency, bureaucracy, and lack of accountability that we can throw massive amounts of money into the system and still get dismal returns.
I feel it is necessary to hammer this one home everytime I hear it. The institution of public school is not flawed. In fact when it works, it is unparalleled to any educational system in the world. But teachers work for 30+ years... many of the journeymen teachers are not failiar enough with the new technology and education trends to be effective. I have argued for serious teacher union reform to get rid of or completely revamp the tenure system (and I have my degree in education), and push for national educational standards. With the right people in play, the education system can be fixed within 5-8 years.
Our healthcare system is being approached with the 21 cetnruy in mind. Private enterprise is vying for the top spot in medical record digitzation and datbase creation. The competition is especially fierce between google and microsoft.The process is being designed to be streamlined.
tL,
As I said, insurance should cover the big things. If they did, you'd see cheaper prices. People don't want to pay for anything and so insurance is expensive.
Just a thought though...my education cost more than my house. I think a lifesaving procedure for far less $ sounds reasonable.
tL,
Just a couple of follow ups.
Actually, there is a poll showing that conservatives distrust government as much as libs distrust big business. I guess we prove the poll :)
I don't feel the gov't stereotype here is wrong. Even Roemer on Obama's economic council has written papers on government waste. There is government waste when it taxes and when it spends. It costs $30 billion in waste to spend $100 billion, which would have $0 waste in the private sector.
As I stated above. I think everyone should have insurance and I beleive everyone can afford insurance at the moment. As I've mentioned, I have done it. I think we could make insurance even cheaper if we make insurance more like insurance. By offering plans that do not cover simple visits or have high deductibles like $5-10k.
However, what people really want is top notch health care for/or close to free. It a myth. The same level of health care is not attainable for close to nothing or free. In fact, government is going to make things worse. Either with deficits or taxes.
To your $90k scenario. I'm not saying I'd be happy to get the bill, but I would not be wishing for government health care. I have been through all kinds of hardships and turmoil in my life and I have always understood that it is my responsibility to deal with the ups and downs in life. I don't expect the entire nation to subsidize my bad times. Health care is just like any number of things that can go wrong in life. I could lose everything in the stock market, my spouse could die without life insurance, I could lose my job, I could get sick, my house could burn down, my cars could crash, I could be attached by aliens. These could happen to anyone. It's life. It is my responsibility to be responsible for me.
Government waste may be high in many cases, but the true difference is we have the ability to make them accountable for it. Especially in today's times, with bloggers, and twitter, and incessant scouring for new stories by cable news, politicians who are doing questionable things lose votes. Sarah Palin bombed for numerous reasons, but when she was the subject of an ethics violation, she lost votes. When Obama had the Jerimiah Wright thing, he lost votes. And look how the two respnoded. Palin instead of fiercely defending her position which would have been a great opportunity to show if she has grace under fire, told reporters she had been acquitted when she really wasn't (actually, she was only acquitted a couple of weeks ago!) How did Obama handle The Wright fiasco? By delivering one of the most important speeches on race relations in this country that will undoubtedly be dissected for generations to come in textbooks. I'm not talking about orartorical skills here, I'm talking about strength of character. I'm not going to presume Palin lacks character, but I'm also going to say Obama is chock full of it. He has a track record of defending the little guy and the disenfranchised. That's who I voted for, they guy who gives a hoot about his neighbor even if the neighbor spits in his face.
So my good friend, to an issue as important as healthcare, tough luck, it's life is not good enough for me. If the government was trying to make government assisted car insurance, I'd be strongly against that, since car insurance will never cost the average guy more than a few grand a year. And even after debate and study, I'm not happy about GM.
In the debates, Tom Brokaw asked "is healthcare a privilege, a right, or a responsiility?" John McCain, all the reasons you pointed out say it is a responsibility. Obama said it is a right. So the debate in the end I think has little to do with the numbers, and everything to do with philosophy.
We have a right to live... to have the fighting chance to pursue some kind of happiness in this crazy world. The peace of mind knowing you're not going to die of something really stupid like I almost did is worth more than any amount of money can buy.
tL,
The Palin situation is an excellent example of how the government is not being accurately watched. Palin was acquitted for troopergate back in November 2008, right after the election, but you know nothing of it, because no one is covering her side of the issue.
During the election, she was independently investigated and determined not to have committed an ethics violation. This happens to be the exact same thing Obama did regarding Blagogate during the transition (exactly the same).
We heard nothing but troopergate during the election and the Republican culture of corruption before that in the news. Yet, Rangel, Burris, Fienstein, Murtha, and Conyers are all under criminal investigation at this moment and no one hears anything about it.
Finally, I do not believe someone's poise in front of the camera has anything to do with their integrity or ethical character.
Just wondering here. Have you looked at paying for your own health care insurance?
I think this debate needs to be about reducing costs and not having the government jump in, committing tax payers to promises that we don't know we can keep in the long term (SS, medicare, medicaid, post office). What is the point of paying huge amounts for everyone to have insurance, but not everyone will be able to actually get access to healthcare?
Here are some fixes that would do a lot to cut costs. I beleive we need tort reform to keep medical malpractice insurance low. We need to offer a large variety of insurance plans with different limits of coverage. There should be a number of plans where people can get coverage for huge expensive procedures, but pay out of pocket for the cheaper, small general visits and preventative procedures. I believe that they should also allow people to choose higher deductibles for lower premiums. They should end employer assisted insurance, which is hampering competition amongst insurance companies. Instead, employers should be able to get a tax break to put an annual amount into an FSA account so employees can pay for their own selected insurance. FSA accounts should be able to roll over year to year. Premium rates should use some health characteristics such as smoker/overweight to help determine costs.
I know this is a personnal issue for you, but it is for me as well. My family is in the private health care business and I know that they are not out there gouging people. I also know that they are constantly at odds with medicaid and medicare, aka government, who does not pay in a reasonable amount of time, they set their own prices under the market value of the service, they require ridiculous billing procedures that costs a lot, and they often do not pay when they should. My family run business has no choice as far as whether they can turn away medicaid/medicare patients, they must take everyone regardless of their ability to pay.
The government's hands are dirty with respect to health care costs. There is nothing to justify giving them the keys to health care. If you want health care for all, the government is about the worst entity to trust in that regard.
this is a great debate, which is funny because I haven't gotten to the meat and potatoes yet!
To tell you the truth, having been in the healthcare industry as a part time job in college, I still am not quite sure how medicaid and medicare works. I know the veterans (I worked at a veterans home) complained about it, and a few days later thanked the heavens it exsists.
I think government assited healthcare would work like college loans. It is one of the most efficient government programs I've experienced at least... always got that check on time. This is because the government and the schools have a highly tuned system... fill out the paperwork, enter it into the computer, sign off on it, and get your school loan. Now, government loans 9 of 10 times won't cover all of your expenses, but at least in a state school, it will almost always cover the semester's tuition
I don't envision a government plan being the be all and end off of health insurance. It would probably cover little things like simple doctors visits, follows, and medicine. For big medium things like delivering babies and simple operations like appendecatmies it would absorb the costs. And for larger procedures, it would work like a stafford college loan. they would absorb some of the cost, and set up a long term payment plan and subsidize hal f the interest.
What this does is allow people to get treatment for small things, and puts more emphasis on dealing with preventative diseases so bad situations don't escalate to worse ones.
Overall, I think it is far more likely that costs will go down becauseultimately, fewer people would be sick. Hosptials would have more beds to deal with real problems. We're going to need more doctors and facilities. So now there is a way to build more clinics and train more doctors.
No system is perfect, but I'd prefer a system where I can vote in good people and petition against bad people, instead of the pharmaceutical industry that creates illnesses to sell more drugs.
This is to be expected. You get what you pay for. I don't expect free healthcare to compete with government plans, by which I mean government insurance would not be as comprehensive. Personally, I can't afford even a $50/mo insurance. So I could get coverage from Uncle Sam. As soon as I'm able to afford better, I would definitely do that.
This is an interesting side-note that I'll expound further on, since it relates to a couple of ridiculous statements made by the Obamanation and their supporters in relation to the benefits of socialized health care. About that "free" coverage: who do you think pays for it?
Say the country was going to adopt socialized health care, and for this they took an extra $200/month from every single person in the entire country (the average cost per person for the "free" program, which, due to a lack of exclusions, covers the most risky people in the entire country). Could you more afford to pay $200/month to the government for their program than $50/month for minimal private insurance? Of course not, that's absurd; yet that's exactly the situation you just advocated.
Or, alternatively, perhaps you're advocating some sort of "progressive" graduated scale for determining who pays for the costs, so that the people who make the most money are taxed to pay for the health insurance for people who don't work, have high premiums due to unhealthy habits, and/or are the most expensive to insure. In that case, why not just have the government purchase private insurance for those people out of general tax revenue? It would be cheaper, you don't need to change the system, and you don't need an entirely new bureaucracy to manage the new program; you just need to convince a majority of the voters that the "rich" people should pay for health insurance for everyone in the country. Of course, that wouldn't fix any of the real problems, but at least it wouldn't be making most of them worse.
The related Obamanation comment was in regards to making the auto industry more competitive by removing the burden of paying for health care from the employees, which is absurd per the previous discussion of where the money actually comes from to pay for the "free" health care.
Overall, I think it is far more likely that costs will go down because ultimately, fewer people would be sick. Hosptials would have more beds to deal with real problems. We're going to need more doctors and facilities. So now there is a way to build more clinics and train more doctors.
I'm sorry, this is just kinda a naive statement. The only way a public plan could be cheaper, overall (because of government waste) would be to force medical facilities to accept lower payments for services, as it readily obvious looking at Medicare. If/when that happens, facilities close, and smart people look to other careers. The overall effect would be (predictably) fewer doctors and facilities, longer waits, and a lower quality of care. That's the trade-off for socialized health care, as most countries which have done it have figured out, and accepted.
There are a lot of problems with the medical system, and a lot of things which could be done a lot better, both for people receiving care, and for lowering costs in general. Perhaps the most unfortunate aspect of the health-care "debate" (as it is) is that by having it crafted and pushed in such a partisan manner, the people will ultimately need to choose between two bad options: doing nothing, and socialized health care. I think that's a shame, because although I think lots of things could be improved, and I'd love to see actual improvements, and I personally have had nightmares with billings in the current system, I'd rather have the current system ($90,000 treatments and all) than the alternative crafted by socialists to destroy effective health care in America.
A loan program...now you are speaking my language. On first thought, I don't see a problem with loaning money for major surgery. Something like that doesn't really exist and would be hard to abuse.
Say the country was going to adopt socialized health care, and for this they took an extra $200/month from every single person in the entire country
This is not how the plan would work. The money is coming from cutting the fat out of medicare and medicaid, repealing th ebush tax cuts, and other budegtary trims. So the money to cover it would not be coming out of my paycheck... as you noted, that would completely defeat the purpose.
Also, I don't think the notion that Americans who are in better health because they don't have to worry about having the ability to see a doctor is naive at all. Take my appendicitis I've mentioned. If it was caught earlier, it would have been a routine procedure that would've been about $15,000. Because it burst, I had to have a more complicated procedure, spent a good deal of time in the ICU (which was awesome to have 24/7 attention I must admit haha) and the multiple follow up visits and recovery procedure wound up hitting me for $42,000. Preventitive medicine in my case would've been nearly off the bill I didn't have to pay because I was insured. IN FACT! since I've been recalling this memory a lot for the past few days, I didn't initially go to the hosptial (day 4 of the "flu") because I didn't know I had insurance at the time.
But there has to be middle ground in this debate. I'd be in favor of a loan program for expensive procedures. I mean if the gov't had to pay for every single major surgery, the coffer would probably exhaust very quickly. The things that are cheap anyways, why not have guaranteed basic coverage for that?
I can't afford health insurance, there is just no way. If I were to get seriously injured or sick I might decide to travel to Mexico or Canada rather than lose all my savings.
This isn't a welfare case, I work and pay plenty of taxes. People like me in a country with such a high standard of living shouldn't have these concerns.
I mean if we can't do healthcare better than Mexico or Cuba...
If the government ran healthcare like with the efficiency of the army I think things would be alright.
Anyway if a free healthcare program becomes available maybe I can go get a checkup, it's been a while
tL & Grog,
Have you honestly looked at purchasing health insurance on your own. I'm just wondering here, because I have done it and it did not cost much more than my car insurance. In fact, I was listening on the radio and they were advertising health care insurance for $100/month for single payers and $200/month for families. I do not except the premise that people can't afford health care insurance if their work does not cover the costs.
The CBO has already shown that repealing Bush tax cuts is not enough. Hence, why I am mostly against the program.
* Accept not except
Without putting my financial situation on full blast on the internet, I really can't afford it. I think I have earned a little benefit of the doubt because I have never had a problem with saying I was wrong about something on this blog before. I can't afford 100 bucks a month, 50, 25, or even 5 bucks right now. I even looked into plans I can get once my situation turns around. Until then, I have to hope and pray nothins happens to me, or I have a serious problem on my hands...
CG,
if you were to look into the $100 a month plans you would see they are like the $20 a month car insurance. The deductibles, doctors etc. are absurd. You get what you pay for and those health plans on the radio are basically a scam for people who can't read fine print.
So technically you are right and in states like Mass it is mandatory to have health insurance.
So I have tons of friends who all have the cheap health insurance and the care is no better than a free clinic in LA
I think we can have national healthcare. And for people who don't want it, they can get private insurance.
One thing I never understood is how people complain that universal healthcare would mean you have no choices as to your hospital or doctor...well that's exactly how HMO plans work already. The insurance company chooses for you, and if you don't like it, you can go elsewhere and pay the whole bill yourself.
To me this issue is basically about compassion and human rights. Every person has a right to education, to food, to housing, AND to health care. Why? Because no person deserves to lose their home because of some unexpected medical emergency.
Grog,
Do you really believe you get what you pay for, because you would like the government to provide free health care.
haha I am not oblivious to the irony here but strictly based on a concern for friends who can barely pay the rent let alone get health insurance, we need something better than the free clinic
The part that you do not understand is that the entire reason that healthcare costs so much is BECAUSE of the Govt. If it was truly free market the costs would go down. The failure of your logic to get to the root cause of the issue is astounding.
I may have to do a thorough post on this issue, but I am frankly flabbergasted by anyone who can take this position seriously...
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