Possible Health Care solution?

[soulcougher73]

Just noticed the bold part.

Your proposed solution does nothing to ensure universal coverage.

Those not working, or working but whose wages are too low to cover withholding for HI will not covered under your plan.

One of the primary aims of Obamacare is to achieve universal coverage. It doesn't actually do it, but it gets closer. I don't see how your plan does even that.

Fern

Well i meant that the people working and paying taxes would be covering everyone in the US. Its a cycle. When i'm too young to work or of retirement age then i wouldn't be paying into the system, but i could still use it. Basically the working class no matter the generation would be taking care of the others. But it comes back once you are too old to work but still require health care. The current working class would pay for you. Sort of like SS was originally set up.

I know most of these ideas are not new but i've been trying to formulate anything that resembles a compromise both sides could agree on. Because if we don't all we will do is bicker back and forth and achieve nothing. "When all is said and done, more is said than done". We don't want that.

 

[woolfe9999]

I'd suggest a combination of tax incentives such as making premiums fully deductible.

Making premiums deductible won't do anything for the people who can't by insurance because they're already sick, or were sick in the past. Furthermore, those who do not pay federal taxes because they make less than, what, 40K, will get no benefit from this. It's similar to the subsidy under Obamacare but still allows insurance companies to not sell insurance to sick people and your form of subsidy is a deduction so the benefit is top loaded instead of bottom loaded.

Then look at practitioner habits and allowing a standard of practice not based defensive medicine. Redundant tests are made just to reduce chances of malpractice suits which reach 100 percent for internal medicine specialists over their career. If we insist in on limiting costs then practitioners need protection. I believe that other nations do this. Provide incentives for cost saving measures. Devise a secure national database to provide accurate and timely information to providers. The immediate savings and treatment benefits are huge. The value of knowing what was done and when, along with current and past disease states and therapies cannot be overstated. That's a start.

Studies show that disallowing or severely limiting malpractice suits will not save a lot. Not only that, it's arbitrary to say that someone victimized by medical incompetence gets no compensation whereas people victimized by any other form of incompetence can be made whole.

Over-testing isn't only caused by the fear of liability. Over testing results in more fees collected. There is a pilot program included in Obamacare to base compensation on outcomes rather than volume of services. No idea how effective that program will be, but it strikes me as a good concept.

I agree with a national database. Isn't part of Obamacare moving to electronic records?

In any event, if the government is restricted to not really doing much more than they are now, we'd better figure out how to implement major systemic changes fast. Health care costs have been increasing way out of pace with inflation and are showing no sign of letting up.

- wolf

 

[Moonbeam]

I like the military. They are disciplined. They execute missions. Because health is national security I would put the military in charge of medicine, establish military medicine schools with good football teams and a service commitment of say 20 years for doctors on down for nurses, and a draft for 2 years service in hospitals for all citizens. The mission 'to care for the medical needs of the American people like they were combat veterans'. The government would also run research hospitals and drug research, and the production of all medical tools and equipment. The greater the specialization and skill and record of outcome the higher the pay, but not pay that makes a person rich, just well off. The need folk have for healthcare should not be allowed to be manipulated to for the profit motive. It should be reserved for folk who are willing to serve and have a decent if extravagant life.

 

[Bird222]

At first blush we still have the same/original problem.

I.e., you still have a mandate that people must purchase HI. The problem, as in the current SCOTUS case, is under what Constitutional provision can Congress claim this power?

I.e., you are setting up a national HI program which mandates people must participate, (however you provide an exception for those purchasing HI from a private insurer). But what is the basis for Congress's power to (1) set up a national HI program and (2) force participation?

It does not seem to me the power of taxation, because the tax return is only used as a vehicle to return govt premium payments to those (legally) not participating. And purchasing or not purchasing does not affect the amount of income taxes you pay.

Fern

OP your idea sounds like the 'public option' with a twist. I don't really have a problem with it but it might evolve into single payer if private insurance companies can't compete. It also may be kind of difficult for people who are paying the 'extra tax' during the year and also trying to pay for private insurance. I know they'll get the refund at year-end but it could be tough in the interim. We still haven't dealt with the cost of health care here though.

Fern - Why would this not work? The government is taxing you and then giving you a credit if you have insurance. I thought this was the very thing you said in the other thread.

 

[Hayabusa Rider]

Making premiums deductible won't do anything for the people who can't by insurance because they're already sick, or were sick in the past. Furthermore, those who do not pay federal taxes because they make less than, what, 40K, will get no benefit from this. It's similar to the subsidy under Obamacare but still allows insurance companies to not sell insurance to sick people and your form of subsidy is a deduction so the benefit is top loaded instead of bottom loaded.



Studies show that disallowing or severely limiting malpractice suits will not save a lot. Not only that, it's arbitrary to say that someone victimized by medical incompetence gets no compensation whereas people victimized by any other form of incompetence can be made whole.

Over-testing isn't only caused by the fear of liability. Over testing results in more fees collected. There is a pilot program included in Obamacare to base compensation on outcomes rather than volume of services. No idea how effective that program will be, but it strikes me as a good concept.

I agree with a national database. Isn't part of Obamacare moving to electronic records?

In any event, if the government is restricted to not really doing much more than they are now, we'd better figure out how to implement major systemic changes fast. Health care costs have been increasing way out of pace with inflation and are showing no sign of letting up.

- wolf

Regarding the first comment, I'm not talking about settlements but risk adverse practices themselves.

As far as the escalation of health costs two points. The overhead associated with providing care is ignored. While the dollars charged are increasing, reimbursements aren't. Margins are down and staffing is cut. Taking a simplistic view that cutting payments to providers is a solution is wrongheaded. An understanding of the financial underpinnings is needed first.

Second, it is fundamentally impossible to reduce increases in costs below inflation due to demographically unavoidable increases in utilization and that these will be time and cost intensive. The estimated cost of treating senile dementia is reasonably estimated to be 300 billion before 2040. Having attended a conference dealing with this issue I can say that no one believes any known possible government intervention will significantly change that. I can assure you that these people are far more in tune than either Congress or Obama. Thats one concrete example why we need better minds and planning than we've yet seen.

 

[Fern]

-snip-
Fern - Why would this not work? The government is taxing you and then giving you a credit if you have insurance. I thought this was the very thing you said in the other thread.

His is different from mine.

He's creating a social security type program. SS taxes are not income taxes. I question whether in this day and age we could create an SS type program for HI, that is otherwise readily available.

The only time his program ever even touches an income tax return is if the person wants to opt of the govt HI program and instead buy private HI. It is not an income tax credit, just a refund of unnecessary HI premiums (unnecessary because you purchased elsewhere.)

In my plan everyone's income tax goes up due to an increase in the rates. Clearly, Congress can raise income tax rates anytime they want; nothing in the Constitution stops that.

Then I give you a tax credit if you purchased HI. The credit brings your income tax back down to what it was originally (before the rate increase). Clearly, Congress can give you a tax credit for purchasing any product they want. (E.g., electric cars, green windows etc.). The Constitution doesn't prevent tax credits either.

Somewhat similar plans, however, and as usual, 'the Devil is in the detail's'. His plan is not an income tax based plan, so is significantly different in Constitutional terms than mine.

Fern

 

[Zebo]

I like the military. They are disciplined. They execute missions. Because health is national security I would put the military in charge of medicine, establish military medicine schools with good football teams and a service commitment of say 20 years for doctors on down for nurses, and a draft for 2 years service in hospitals for all citizens. The mission 'to care for the medical needs of the American people like they were combat veterans'. The government would also run research hospitals and drug research, and the production of all medical tools and equipment. The greater the specialization and skill and record of outcome the higher the pay, but not pay that makes a person rich, just well off. The need folk have for healthcare should not be allowed to be manipulated to for the profit motive. It should be reserved for folk who are willing to serve and have a decent if extravagant life.

Ahh I see. That's basically what UHC countries do. You're typically always a govt employee whether a nurse, orderly, doctor or pharmacist and school is paid for by govt (to those highly qualified) and they do make more than average but not walking corporations like some specialists here. There are no businesses to skim off the care or incintivized not to give care such as insurance, paperwork companies, etc.

 

[Zebo]

OP your system is fine from a liberty aspect. Issuance companies could still have biggest buildings in town and hundred million dollar salaries. Anyone could work where they wanted and go with system they wanted but does nothing to address costs which are crippling us. HC doesnt make us richer in any way just sustains us like any other service and pumping 14% of GDP into it is wasteful (comparatively to other nations). And bringing 40 million online costs will just go up even more because of simple supply and demand curves.

 

[woolfe9999]

Regarding the first comment, I'm not talking about settlements but risk adverse practices themselves.

As far as the escalation of health costs two points. The overhead associated with providing care is ignored. While the dollars charged are increasing, reimbursements aren't. Margins are down and staffing is cut. Taking a simplistic view that cutting payments to providers is a solution is wrongheaded. An understanding of the financial underpinnings is needed first.

Second, it is fundamentally impossible to reduce increases in costs below inflation due to demographically unavoidable increases in utilization and that these will be time and cost intensive. The estimated cost of treating senile dementia is reasonably estimated to be 300 billion before 2040. Having attended a conference dealing with this issue I can say that no one believes any known possible government intervention will significantly change that. I can assure you that these people are far more in tune than either Congress or Obama. Thats one concrete example why we need better minds and planning than we've yet seen.

With respect to the overhead, we of course pay more for medical equipment and drugs than do countries with government backed UHC because they put caps on those prices. We're essentially getting the shaft because we sponsor innovation in those areas and the rest of the world pays a lot less for it.

If we can't control the cost of the services, we will not be able to keep trending toward higher utilization. Until we can cure these chronic diseases that we spend so much money treating, rationing of care is inevitable. It's only a question of how it is rationed. In our system, the wealthy will get the lion's share of it.

 

[theeedude]

I am fine with Medicare being available to all, and if Obama embracing individual mandate is enough to make his opponents embrace that, than he should embrace more conservative ideas

 

[shira]

Obamacare could easily have been set up as a "tax and tax-credit" system rather than as a "mandate" system, but it would have required to Democrats to dramatically increase income taxes to do so, even though the "net" income tax would have been identical to what it now is. The way the system would have worked - which would have been 100% Constitutional would be:

1. Increase income taxes by exactly the amount that individuals/families/families-with-dependents would need for their insurance premiums.

2. Provide an income-tax credit equal to the increase, above, which would be available to anyone who obtained health insurance the previous year.

3. For people/families below a certain income threshold, the size of the credit would be greater than the size of the income tax increase, but the credit would always be approximately the amount the individual/family would need to pay for their insurance premiums for the year.

Notice that there would be no mandate. People would be free to NOT get health insurance, but they would forgo the tax credit if they did so. So there would be no question of Constitutionality. Tax credits are currently provided to encourage all sorts of activities (for example, engaging in oil drilling or installing energy-efficient heating systems), so adding a tax credit to encourage people to purchase health insurance would be equally valid.

But as I wrote earlier, the above tax-credit system could have been put in place only if a concomitant tax increase was also implemented. And I doubt very much enough votes could have been mustered to do so.

 

[cubby1223]

1. Insurance companies. These guys are not interested in your health as primary. They are interested in how much money they can get off of insuring your health. That is not a, well, HEALTHY way of doing this. They will take a slice of a pie that really should not have anyone's private parts in.

But first and foremost, they must operate in the black. They cannot print money to cover debt like the government does. It is also important to scrutinize the level of care people receive, so long as other people are paying the bill via the insurance pool. Someone out there needs to help manage fraud & abuse to a minimum, and question unnecessary care. Care devoted to one person is always care taken away from another person, regardless of who is controlling the money.

99% of the people that oppose this "mandatory" program would NOT refuse health care in a situation more pressing than breaking a finger, and I would bet more than half would even take it for that.

People are self serving greedy insecure individuals that will take what they can get and somehow be insulted when asked to pay for it (siting that they haven't taken it YET).

I oppose the mandate, I also have health insurance I pay for every month.

I feel health insurance should be optional, and then that person is responsible for 100% of any hospital bills. Give hospitals more legal authority to reclaim payment from such individuals.

The main problem we have in the wash now is that we STILL have insurance companies in the mix ($$) and we have some convoluted "must pay" system that needed to be invented because of the Republicans Tax moratorium they have signed in (that oddly does not endeavor for them to CUT THEIR OWN SPENDING OR REPEAL PREVIOUS "TEMPORARY" CUTS). that moratorium forced the funding out of the term "taxes" when it is actually a better way to get the payment....

I disagree with your analysis.

You would not get a system that would be in trouble because a road cost too much, or a war was being fought.

That will never be the situation. Same with the social security "lock box," all money going to the government is indistinguishable from the general fund. I mean you can create a "system" to help you sleep at night, but it doesn't actually ever do anything useful.

 

[Ninjahedge]

No, the SS was a lock box, as were pension funds.

That box was broken "for the greater good" and look what good it got us.

As for "in the black", I agree, except there is a difference between keeping your head above water and walking on it.

 

[xj0hnx]

The opt out only works if private health insurance is abolished. They could then allow doctors to opt out of the system and only take fee for service patients. Anyone could then go and pay fee for service for those doctors if they didn't want service from providers who are in the system. The opt out would have to be permanent or for a long time so that they couldn't switch back and forth at will.

Even if that happened, and prices were reduced dramatically to where basic care, and emergency services were almost, to affordable, there would still be the issue of long term care, and treatment that are truly expensive that private individuals couldn't pay, there would still be a need for some type of insurance, but at least it would be how insurance was originally intended.

 

[cybrsage]

Bottom line if we had single payer Big insurance would die! This will never happen because Big Insurance has paid off our Lawmakers. Also I forgot to add our Politicians get FREE healthcare for life so basically they don't give a rat's ass about anyone who doesn't pad their pockets.

I assume you want everyone involved to be forced to join unions, right?

 

[cybrsage]

I would rather see 50 (51 if DC, PR, etc were put in a Fed God plan) state run healthcare systems than one monolithic, expensive, and doomed to fail fed gov run system. Each state can then compete with each other on creating the best system AND state govs are far easier to hold accountable than the fed gov is.

The Fed Gov can only harm us with a UHC system.

 

[cybrsage]

Obamacare could easily have been set up as a "tax and tax-credit" system rather than as a "mandate" system, but it would have required to Democrats to dramatically increase income taxes to do so, even though the "net" income tax would have been identical to what it now is. The way the system would have worked - which would have been 100% Constitutional would be:

1. Increase income taxes by exactly the amount that individuals/families/families-with-dependents would need for their insurance premiums.

2. Provide an income-tax credit equal to the increase, above, which would be available to anyone who obtained health insurance the previous year.

3. For people/families below a certain income threshold, the size of the credit would be greater than the size of the income tax increase, but the credit would always be approximately the amount the individual/family would need to pay for their insurance premiums for the year.

Notice that there would be no mandate. People would be free to NOT get health insurance, but they would forgo the tax credit if they did so. So there would be no question of Constitutionality. Tax credits are currently provided to encourage all sorts of activities (for example, engaging in oil drilling or installing energy-efficient heating systems), so adding a tax credit to encourage people to purchase health insurance would be equally valid.

But as I wrote earlier, the above tax-credit system could have been put in place only if a concomitant tax increase was also implemented. And I doubt very much enough votes could have been mustered to do so.

I agree, such a system would have been constitutional. The dems could not do it because McCain had proposed taxing health care benefits and then giving a tax credit to people. Obama and the other dems could not do what they had just villified...

 

[cybrsage]

I am fine with Medicare being available to all, and if Obama embracing individual mandate is enough to make his opponents embrace that, than he should embrace more conservative ideas

Violating the Constitution is not a conservative idea.

 

[Juddog]

To be perfectly honest, I wouldn't mind paying a bit more taxes if it was set aside explicitly for healthcare coverage for everybody. I already pay a big chunk at work ($300/ month for two people both healthy, me and my wife).

If this $300 went straight to the overall healthcare fund instead of to a private insurance agency, I would have zero problems with that. The money is being spent either way.

The only main problem that I can see is that the government would have to take over the spot currently occupied by insurance companies - and there is some serious BIG MONEY at stake if they do that. That's political suicide for a politician unless they have an extreme amount of support from the base population, because as soon as the various health insurance agencies found out that they were going to be relegated to a "opt-in if you want to pay extra, or get the base coverage for free", then they would unleash billions of dollars into attack ads and campaigns against the government idea.

The fact of the matter is that the way congress is right now, this is simply impossible, even if say %80 of the population wanted it.

So the other way of instituting national coverage would be for the government to buy the coverage from the insurance agencies, which would cause a whole separate problem, because if they knew that the government was going to pay regardless, they would soak the government for all the cash they could.

 

[Ausm]

I assume you want everyone involved to be forced to join unions, right?

LOL...I have to admit I am enjoying your hard on for my posts....

 

[Ausm]

I am fine with Medicare being available to all, and if Obama embracing individual mandate is enough to make his opponents embrace that, than he should embrace more conservative ideas

You forget everything he embraces whether it is "Conservative" or not they still make lame excuses to do a complete 180 on ANYTHING.

 

[cybrsage]

LOL...I have to admit I am enjoying your hard on for my posts....

I hear that a lot. :sneaky:

 

[Ausm]

I hear that a lot. :sneaky:

Then you woke up?

 

[cybrsage]

Then you woke up?

Yes, in your loving embrace. <3