So come give her songs a listen and catch some of the background behind them as well as her own fascinating personal story!
Who IS this guy?!
Political Talk Show Host and Internet Radio Personality. My show, In My Humble Opinion, aired on RainbowRadio from 2015-2017, and has returned for 2021! Feel free to contact me at niceguy9418@usa.com. You can also friend me on Facebook.
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Showing posts with label single. Show all posts
Showing posts with label single. Show all posts
Sunday, August 22, 2021
IMHO 2021 07 31 with Roxanne McDaniel
In case you missed it on my You Tube Channel... And if you DID, why haven't you SUBSCRIBED yet?! But IF YOU DID... You missed a real treat as I was joined by the amazingly talented Country Music Singer and Songwriter, Roxanne McDaniel!
Wednesday, March 24, 2010
One more post on health care, then I'm done.
Unlike most Conservatives these days, there is no one on earth that I let do my thinking for me. Granted there are some people that I AGREE WITH about 99% of the time: Professor Bob Carroll, Keith Olbermann, Rachael Maddow, Lewis Black, Eric Alterman, Jameson Foser, Eric Bohlert and Karl Frisch all come to mind. But even in those cases, if I listen or read long enough, I’m bound to come across something that causes me to raise an eyebrow or shake my head. Since I have no desire to be a cult leader myself, I certainly hope that while my “followers” enjoy reading most of what I have to say, they don’t end up agreeing with everything I post. Aside from that just being really creepy, it’s no fun for me if I never get to debate anything with anyone, and I don’t get any wisdom out it myself. We can only be made better by engaging in civilized discourse with the educated few who can really challenge our point of view. In short: I really appreciate and cheerish the disagreements that inevitably come along.
That being said, I’d like to put up what I plan to be the last post in my ongoing back-and-forth with ClassicLiberal (and Left Hook) regarding the health care bill. [Classy, if you want the last word, I’ll gladly let you have it. ;) ] And I’m going to borrow from one of those people above to do so – namely, Rachael Maddow. She gave what I felt was a phenomenal run-down on her show Tuesday night that I think hammers home that which drives my judgment on this issue and on the bill that was just signed into law. The following is from the transcript of her 3/22 show:
And that’s far from everything – it IS a 2700 page bill after all – but given the points above, there is no doubt in my mind that this IS real, meaningful reform. To say that doing away with the most egregious abuses of the system is not reform is to clearly put ideology ahead of pragmatism, to let the perfect get in the way of the good. As liberals, I’m sure we’d all like a different system. Most of us would like single payer. I still believe it will happen eventually, but it was never on the table this time around, and is just not feasible or practical in the near future for many reasons, some of which, granted, have to do with the money and corruption that drives our current political system. That’s sad, but that's the world we live in and THIS BILL, in any of its forms, was never going to change that. All the same, the REFORMS listed above are HUGE. They will save lives. They will make this system work BETTER, and if they are in fact just a starting point, can go a long way towards making the system WORK.
Saying that it won’t, just because you want a different system, to me sounds no different than the conservatives’ refusal to acknowledge the good that’s happened, and the economic progress that been made under Obama, simply because they want to do things their way, and can’t bring themselves to acknowledge that our way works too. (Works BETTER, in fact!) To say this bill is bad because it makes a system you don’t like WORK BETTER, is routing against the system every bit as much as the Right has been rooting against America since 20 January, 2009. In my opinion the liberal opposition to this bill amounts to no more than: If you make the for profit system work, we’ll never get a ‘single payer’ system. But from my own POV: If the for-profit system can be made to work, WHO CARES? The biggest problems with the for profit system – namely that those profits came from DENYING care, rather than providing it – have been swept away. (OK, fine, will be swept away by 2014.) In the mean time, there will inevitably be other issues that come up. We’ll simply deal with them.
I am not so liberal as to believe that a company making a profit, and even more of a profit, and even coming from government spending, is in and of itself a bad thing. Not when that profit is derived from providing an essential service and doing so in a way that delivers what everyone needs. I’ve heard it called “corporate welfare.” But it’s NOT; at least no more than almost ALL Government spending is. Anytime the government contracts out a service, they are doing what they’re doing here: Paying a private, for-profit corporation to provide a service for the American Public. Sometimes this is done well, sometimes this is done poorly (Blackwater, Haliburton, etc…) And we, as liberals, all know that if left to their own devices, these for-profit companies will do whatever they can to maximize their revenue and minimize there costs. To this end, insurance companies started shirking their duties in a BIG WAY by refusing to give medical coverage to those who need medical coverage! (Which was their raison d'être.) So that’s absurd! In fact, it’s indefensible. It’s EXACTLY what was wrong with our system. And, as liberals, we know that it is up to the government to create industry regulations to force these companies to behave, and compete, in a responsible fashion and in a functional environment for their customers and for society. We’ve seen how well this worked (relative to what existed before) in the Airlines, the automotive industry, regulated power and water utilities and many other industries. And the extent that companies pollute, exploit, and otherwise “externalize costs” is directly proportional to the ability of Libertarians (Conservatives) to prevent the Government from serving in this regulatory role. The regulations passed in this bill have been a long time in coming, and address the worst aspects of that previously irresponsible behavior in the pursuit of profit.
It saves lives, provides increased and protected coverage, and makes things better. It is not ‘bad’ just because it makes the less preferred system work, and you cannot claim it is not ‘real reform’ simply because the only reform you accept as real would be a complete scrapping of the system in order to bring about one that better fits your ideology. I DO believe that liberal ideology is better than conservative ideology, but I DO NOT believe in its inherent goodness or perfection. I will not judge this bill, or the system that results from it, only against liberal ideology. I will judge against what we had, what we have now, and what we still have to do. This bill goes a long way towards getting from where we are to where we need to be. That someone in the private sector will make some money off it, or because it will keep a private system in place instead of going towards a public system, in and of themselves do not make it “bad.”
I am simply not THAT liberal (or that kind of Liberal.) This can work. And if it doesn’t? Well… polls show that the American Public will support MORE reforms. So we’ll just keep going until it does, or until we have single payer. In any case, I am glad this has passed. I am glad President Obama signed it. And I hope Harry Reid grows a set, forces the reconciliation vote as soon as possible, and ass-whips any Democrat who proposes any amendments, or slows down the passage of this package in any way. The books must be closed on this.
There is so much more work to be done.
That being said, I’d like to put up what I plan to be the last post in my ongoing back-and-forth with ClassicLiberal (and Left Hook) regarding the health care bill. [Classy, if you want the last word, I’ll gladly let you have it. ;) ] And I’m going to borrow from one of those people above to do so – namely, Rachael Maddow. She gave what I felt was a phenomenal run-down on her show Tuesday night that I think hammers home that which drives my judgment on this issue and on the bill that was just signed into law. The following is from the transcript of her 3/22 show:
The minute President Obama signs health reform into law tomorrow:
• Small businesses will begin to get relief from what has been an unpredictable and yet ever-increasing financial burden of providing coverage to their employees. Small businesses can start applying for tax credits to buy health insurance for their employees.
• Are you a senior citizen? Well, the minute President Obama signs that bill tomorrow, you will start getting help paying for your prescription drugs. That dreaded donut hole that forces way too many seniors to pay way too high out-of-pocket costs for their prescriptions — that dreaded donut hole will finally begin to close. For seniors who already hit the donut hole in their drug coverage in 2010, $250 rebate checks will be on the way to you.
As of June 21st, 90 days after the bill is signed, those high-risk pools will be up and running.
• Americans who have been deemed uninsurable because of preexisting conditions, they will finally start getting a path toward health coverage. High-risk pools will be set up for them to purchase the insurance they could never get before.
The next date to mark down on your calendar -- 90 days after that— is September 23rd.
• As of September 23rd, it will no longer be legal in this country for insurance companies to deny kids coverage because of a preexisting condition.
• As of September 23rd, insurance companies will be prohibited from dropping you when you get sick. No more rescissions.
• As of September 23rd, insurance companies can no longer impose life-time limits on your benefits.
• And if you have children, they can stay on your insurance until the age of 26.
All of that will happen in just six months. But wait, there‘s more. As of the next calendar year, as of this forthcoming January 1st:
• Insurance companies will be required to spend 80 percent to 85 percent of what they take in from you on premiums on actual medical care. If they don‘t, they will owe you the difference in the form of a rebate.
• That same day, Medicare patients will start receiving free preventive care services, no co-payments, free preventive care.
Then, after all that, in 2014,
• It will no longer be legal for insurance companies in this country to deny anyone coverage based on preexisting conditions. Those who don‘t have coverage can buy some in the health insurance exchanges that will be fully operational.
• With lifetime limits on benefits already a thing of the past, in 2014, insurance companies will not be able to impose annual limits on your benefits, either.
And that’s far from everything – it IS a 2700 page bill after all – but given the points above, there is no doubt in my mind that this IS real, meaningful reform. To say that doing away with the most egregious abuses of the system is not reform is to clearly put ideology ahead of pragmatism, to let the perfect get in the way of the good. As liberals, I’m sure we’d all like a different system. Most of us would like single payer. I still believe it will happen eventually, but it was never on the table this time around, and is just not feasible or practical in the near future for many reasons, some of which, granted, have to do with the money and corruption that drives our current political system. That’s sad, but that's the world we live in and THIS BILL, in any of its forms, was never going to change that. All the same, the REFORMS listed above are HUGE. They will save lives. They will make this system work BETTER, and if they are in fact just a starting point, can go a long way towards making the system WORK.
Saying that it won’t, just because you want a different system, to me sounds no different than the conservatives’ refusal to acknowledge the good that’s happened, and the economic progress that been made under Obama, simply because they want to do things their way, and can’t bring themselves to acknowledge that our way works too. (Works BETTER, in fact!) To say this bill is bad because it makes a system you don’t like WORK BETTER, is routing against the system every bit as much as the Right has been rooting against America since 20 January, 2009. In my opinion the liberal opposition to this bill amounts to no more than: If you make the for profit system work, we’ll never get a ‘single payer’ system. But from my own POV: If the for-profit system can be made to work, WHO CARES? The biggest problems with the for profit system – namely that those profits came from DENYING care, rather than providing it – have been swept away. (OK, fine, will be swept away by 2014.) In the mean time, there will inevitably be other issues that come up. We’ll simply deal with them.
I am not so liberal as to believe that a company making a profit, and even more of a profit, and even coming from government spending, is in and of itself a bad thing. Not when that profit is derived from providing an essential service and doing so in a way that delivers what everyone needs. I’ve heard it called “corporate welfare.” But it’s NOT; at least no more than almost ALL Government spending is. Anytime the government contracts out a service, they are doing what they’re doing here: Paying a private, for-profit corporation to provide a service for the American Public. Sometimes this is done well, sometimes this is done poorly (Blackwater, Haliburton, etc…) And we, as liberals, all know that if left to their own devices, these for-profit companies will do whatever they can to maximize their revenue and minimize there costs. To this end, insurance companies started shirking their duties in a BIG WAY by refusing to give medical coverage to those who need medical coverage! (Which was their raison d'être.) So that’s absurd! In fact, it’s indefensible. It’s EXACTLY what was wrong with our system. And, as liberals, we know that it is up to the government to create industry regulations to force these companies to behave, and compete, in a responsible fashion and in a functional environment for their customers and for society. We’ve seen how well this worked (relative to what existed before) in the Airlines, the automotive industry, regulated power and water utilities and many other industries. And the extent that companies pollute, exploit, and otherwise “externalize costs” is directly proportional to the ability of Libertarians (Conservatives) to prevent the Government from serving in this regulatory role. The regulations passed in this bill have been a long time in coming, and address the worst aspects of that previously irresponsible behavior in the pursuit of profit.
It saves lives, provides increased and protected coverage, and makes things better. It is not ‘bad’ just because it makes the less preferred system work, and you cannot claim it is not ‘real reform’ simply because the only reform you accept as real would be a complete scrapping of the system in order to bring about one that better fits your ideology. I DO believe that liberal ideology is better than conservative ideology, but I DO NOT believe in its inherent goodness or perfection. I will not judge this bill, or the system that results from it, only against liberal ideology. I will judge against what we had, what we have now, and what we still have to do. This bill goes a long way towards getting from where we are to where we need to be. That someone in the private sector will make some money off it, or because it will keep a private system in place instead of going towards a public system, in and of themselves do not make it “bad.”
I am simply not THAT liberal (or that kind of Liberal.) This can work. And if it doesn’t? Well… polls show that the American Public will support MORE reforms. So we’ll just keep going until it does, or until we have single payer. In any case, I am glad this has passed. I am glad President Obama signed it. And I hope Harry Reid grows a set, forces the reconciliation vote as soon as possible, and ass-whips any Democrat who proposes any amendments, or slows down the passage of this package in any way. The books must be closed on this.
There is so much more work to be done.
Tuesday, March 16, 2010
The Health Care Bill
Things have been busy at work the past couple weeks (the car makers must be making up for last year!) and I've hardly had any time to put my two-cents in over of MMFA lately. (Which is a good thing: in this economy, and in Michigan of all places, I'd rather have too little time on my hands than too much! LOL) So I was really rushed in this thread, so I wanted to come back and put my piece on the table regarding the pending health care legislation...
...and I don't suppose too many people, on either side of the issue, will like what I have to say about it. So let put a few "givens" out there, right up front.
1) I HATE insurance companies. We all know the multitude of ways that they screw people over, and I'm no different. My story? My two sons have autism. The insurance company paid for the diagnosis, but the minute they "autism" label was stuck on them, they wouldn't pay for shit in terms of therapy. (I came across THIS once, and it really hit home.) You know... Cause they don't get any better. (1) First of all: tell that to Temple Grandin. (2) Second of all, neither do AIDS patients or Diabetics or Schizophrenics or Transplant Patients or a million other patients who are on medication or medical therapy for life. But we all know that they'll throw any bullshit they can at you just to get out of paying. It doesn't have to be logical, scientifically correct or even make sense. They hold all the cards, so you're at their mercy.
So if anyone things I'm in the pocket of the insurance industry, I dare you to say it my face. (And I'd then advise you to them DUCK.) I HATE. HATE. HATE. those scum-sucking bastards. They turned their backs on my kids. So fuck 'em.
2) The Right, the Conservatives, The Republicans, the Insurance Lobby and Fox have all told so many lies about this whole issue, that I really don't even care what they have to say anymore. (I never really did, but it's less than background noise now.) They're so far out in Right Field it's not even funny anymore. It's pathetic and sad. Death Panels? Lie of the year. Deficits? Lie of the day, just depends on the issue you're discussing. Government Takeover? I only WISH. And I swear I'm going to punch the next person I hear crying about "socialism." So this in not, in any way, intended to argue with the idiots on the Right. 90% of them have no fucking idea what they're talking about, and the other 10% are lying for their paychecks. And even if every concession was given to them (and it basically has) they'd oppose it even if their own mother's life depended on it, just to see Obama and the Democrats "lose." They're despicable bastards without heart, soul or brains. So I'm done with them.
I want to take issue with the LIBERALS, who at this point are ready to jump ship on it.
Now... don't get me wrong. IMHO, the only PRINCIPLED, EDUCATED opposition to this bill, and anything in it has come from the Left. And I've laid out my own plan, which is about as close as you can get to single-payer, and yet not have the gov't run it, and still use market forces to keep costs DOWN, rather than UP as they do now. So you know I'm no libertarian when it comes to this issue. All that being said, in my humble opinion...
THIS IS IMPORTANT LEGISLATION. THIS IS GOOD LEGISLATION. AND THIS COUNTRY NEEDS IT TO PASS. NOW.
I can't remember where I read it (and it may have been in this blog, so please forgive me if it was you and I forgot) but I recently read where someone call Health Care Reform the "New Deal" of our generation, and went on to call Gay Rights the "Civil Rights Movement" of our generation. I absolutely agree, 100% with that analogy, and that is exactly what drives my thinking here: The New Deal was not a single piece of legislation. Neither was 'Civil Rights.' Both represented sweeping changes in HOW WE THINK. They represented paradigm shifts in out whole legal, economic, political and social philosophy. They both occurred over MANY bills, MANY laws, and even MANY court cases, both in support of and in opposition to. And there was no point at which ANY single piece of legislation SOLVED THE PROBLEM. (We still have both economic instability and racial issues today, after all, and we probably will 100 years from now.) So you could take ANY piece of legislation, in either of those two cases - the first, the last or any in between - and find some fault with it. It doesn't go far enough. It makes too many concessions. It makes things worse. But just as well, in each case, each step had to be taken, as it was, because at each stage they had to take what they could get and keep moving forward.
And that's where I part with the idealists on the Left: I'm a pragmatist. Do I agree with Michael Moore, and Keith Olbermann and Dennis Kuccinich? In principal? Yes. But in practice, I do not accept the conclusion that this bill makes things worse.
Will the insurance companies profit from this? Yes, I'm sure they'll find a way to. They always do.
(I don't mind that they make a profit. What bothers me is that the currently profit more by denying care. That's the dysfunctional incentive.)
Will some people remain uncovered? Yep. A good 20 Million as I understand it.
(That's still half what it is now, however.)
Do I like the individual mandate? Not without a public option I don't.
(But whether or not it's constitutional, is a matter for the courts to decide, not a reason to oppose it.)
BUT... I also see this bill as a NECESSARY first step. We'd all like single-payer. Wasn't going to happen. Personally, I prefer MY PLAN. Not going to happen. (Wasn't even on the table. LOL) Public Option? Might have happened, if Harry Reid had any balls, Nancy Pelosi was worth a damn and President Obama wasn't the pragmatist that I figured him for when I voted for him, despite the Right's attempts to brand his as the most moon-bat liberal homo-sapient of all time. And while I'd certainly have have liked it, maybe even participated in it, I can live without it, even with the individual mandate.
Why?
Pre-existing conditions. If you want to force them to cover pre-exsisting conditions, (and we need to, with everyone switching jobs, getting laid off, etc...) and not let them totally jack up the premiums to cover them, and you DON'T want your costs to skyrocket, the only way to achieve that is to have EVERYONE pay-in. You need healthy people who right now, whether by choice or by circumstance, aren't putting in to ante up and get covered. And to all you wanna-be micro-economics majors out there, this is yet another instance where market forces work in strange ways. You see... It doesn't cost more to COVER more people. COVERING PEOPLE is a source of REVENUE. The increased demand for coverage does not necessarily lead to higher costs. What increases costs is more (and more expensive) CLAIMS being filed. Does universal coverage lead to more, and more expensive, claims? On average, per person, not really.
Remember - this gets a lot of currently HEALTHY people on board. That will only LOWER the [insurance company's] cost, on a per person basis. And all those uninsured SICK people? As I laid out in my earlier health care posts, right now they wait until their on death's door and then show up in the ER. And they then run up HUGE bills, that then don't get paid. Well, first of all: Guess who pays them? WE DO, though higher premiums, as hospitals try to recoup unpaid bills by soaking insurance companies! They don't just write it off, and even if they do officially, they still try to recoup it from US - the insured. Second of all, if these same people were covered, they'd go to the doctor EARLY ON, when [whatever it is that they have] can be fixed CHEAPLY and EASILY, with FEWER COMPLICATIONS and better PATIENT OUTCOMES. Which is exactly what we WANT THEM TO DO because it COST LESS THAT WAY! It's ALWAYS costs more, not to mention has more negative outcomes, to treat a disease in the later stages. It's ALWAYS better, and cheaper, to catch it and treat it EARLY. So the idea that we'll be paying for something that we're not already is misguided, no matter what model you're looking at.
Is this bill perfect? No. No way. Is it even good? Debatable, certainly. But is it NECESSARY?
Yes. I firmly believe it is.
And to some extent the details don't matter. (And I realize there are some doozies.) This will not solve all of our problems, but neither would a public option and neither would even single payer. But about the only idea I've heard that would make it WORSE was John McCain's '08 campaign idea to let people buy across state lines. THAT, and some of the more "free market" solutions I've heard, would make it WORSE. Much worse. And I just don't believe this bill does. Not in any BIG PICTURE kind of way. It has it's warts, but at this point, and really at any point, we need to take what we can get, celebrate the victory, and move on to the NEXT STEP. Because whoever succeeds Obama, and whenever that happens, will STILL be dealing with health care. No matter WHAT happens, or even might have happened with this bill.
I actually, honestly believe that we'll get to single payer eventually (though still I prefer my own model.) But we're not going to get there in one bill. (Shit, we might not get there in my lifetime!) This will be, and has to be a gradual process. And the necessary FIRST STEP, really the first two steps, has/have to be:
1) Everyone needs to put it / Nobody is allowed to opt out. (And help the ones who truly can't afford it.)
2) The insurance companies can't be allowed to refuse anyone, and can't be allowed to gouge anyone.
Now... we're not there yet. But this bill brings us closer. And we can't get on with the REAL reforms until we've achieved those first two steps. And come November? It's likely the Republicans will make some gains, and the already uphill climb will only get steeper. We need to take what we can. We need to start moving in the right direction. We need to get the ball rolling. And we need to do this as soon as we can.
We NEED this legislation, warts and all. I don't LIKE it... but I do believe it's necessary.
...and I don't suppose too many people, on either side of the issue, will like what I have to say about it. So let put a few "givens" out there, right up front.
1) I HATE insurance companies. We all know the multitude of ways that they screw people over, and I'm no different. My story? My two sons have autism. The insurance company paid for the diagnosis, but the minute they "autism" label was stuck on them, they wouldn't pay for shit in terms of therapy. (I came across THIS once, and it really hit home.) You know... Cause they don't get any better. (1) First of all: tell that to Temple Grandin. (2) Second of all, neither do AIDS patients or Diabetics or Schizophrenics or Transplant Patients or a million other patients who are on medication or medical therapy for life. But we all know that they'll throw any bullshit they can at you just to get out of paying. It doesn't have to be logical, scientifically correct or even make sense. They hold all the cards, so you're at their mercy.
So if anyone things I'm in the pocket of the insurance industry, I dare you to say it my face. (And I'd then advise you to them DUCK.) I HATE. HATE. HATE. those scum-sucking bastards. They turned their backs on my kids. So fuck 'em.
2) The Right, the Conservatives, The Republicans, the Insurance Lobby and Fox have all told so many lies about this whole issue, that I really don't even care what they have to say anymore. (I never really did, but it's less than background noise now.) They're so far out in Right Field it's not even funny anymore. It's pathetic and sad. Death Panels? Lie of the year. Deficits? Lie of the day, just depends on the issue you're discussing. Government Takeover? I only WISH. And I swear I'm going to punch the next person I hear crying about "socialism." So this in not, in any way, intended to argue with the idiots on the Right. 90% of them have no fucking idea what they're talking about, and the other 10% are lying for their paychecks. And even if every concession was given to them (and it basically has) they'd oppose it even if their own mother's life depended on it, just to see Obama and the Democrats "lose." They're despicable bastards without heart, soul or brains. So I'm done with them.
I want to take issue with the LIBERALS, who at this point are ready to jump ship on it.
Now... don't get me wrong. IMHO, the only PRINCIPLED, EDUCATED opposition to this bill, and anything in it has come from the Left. And I've laid out my own plan, which is about as close as you can get to single-payer, and yet not have the gov't run it, and still use market forces to keep costs DOWN, rather than UP as they do now. So you know I'm no libertarian when it comes to this issue. All that being said, in my humble opinion...
THIS IS IMPORTANT LEGISLATION. THIS IS GOOD LEGISLATION. AND THIS COUNTRY NEEDS IT TO PASS. NOW.
I can't remember where I read it (and it may have been in this blog, so please forgive me if it was you and I forgot) but I recently read where someone call Health Care Reform the "New Deal" of our generation, and went on to call Gay Rights the "Civil Rights Movement" of our generation. I absolutely agree, 100% with that analogy, and that is exactly what drives my thinking here: The New Deal was not a single piece of legislation. Neither was 'Civil Rights.' Both represented sweeping changes in HOW WE THINK. They represented paradigm shifts in out whole legal, economic, political and social philosophy. They both occurred over MANY bills, MANY laws, and even MANY court cases, both in support of and in opposition to. And there was no point at which ANY single piece of legislation SOLVED THE PROBLEM. (We still have both economic instability and racial issues today, after all, and we probably will 100 years from now.) So you could take ANY piece of legislation, in either of those two cases - the first, the last or any in between - and find some fault with it. It doesn't go far enough. It makes too many concessions. It makes things worse. But just as well, in each case, each step had to be taken, as it was, because at each stage they had to take what they could get and keep moving forward.
And that's where I part with the idealists on the Left: I'm a pragmatist. Do I agree with Michael Moore, and Keith Olbermann and Dennis Kuccinich? In principal? Yes. But in practice, I do not accept the conclusion that this bill makes things worse.
Will the insurance companies profit from this? Yes, I'm sure they'll find a way to. They always do.
(I don't mind that they make a profit. What bothers me is that the currently profit more by denying care. That's the dysfunctional incentive.)
Will some people remain uncovered? Yep. A good 20 Million as I understand it.
(That's still half what it is now, however.)
Do I like the individual mandate? Not without a public option I don't.
(But whether or not it's constitutional, is a matter for the courts to decide, not a reason to oppose it.)
BUT... I also see this bill as a NECESSARY first step. We'd all like single-payer. Wasn't going to happen. Personally, I prefer MY PLAN. Not going to happen. (Wasn't even on the table. LOL) Public Option? Might have happened, if Harry Reid had any balls, Nancy Pelosi was worth a damn and President Obama wasn't the pragmatist that I figured him for when I voted for him, despite the Right's attempts to brand his as the most moon-bat liberal homo-sapient of all time. And while I'd certainly have have liked it, maybe even participated in it, I can live without it, even with the individual mandate.
Why?
Pre-existing conditions. If you want to force them to cover pre-exsisting conditions, (and we need to, with everyone switching jobs, getting laid off, etc...) and not let them totally jack up the premiums to cover them, and you DON'T want your costs to skyrocket, the only way to achieve that is to have EVERYONE pay-in. You need healthy people who right now, whether by choice or by circumstance, aren't putting in to ante up and get covered. And to all you wanna-be micro-economics majors out there, this is yet another instance where market forces work in strange ways. You see... It doesn't cost more to COVER more people. COVERING PEOPLE is a source of REVENUE. The increased demand for coverage does not necessarily lead to higher costs. What increases costs is more (and more expensive) CLAIMS being filed. Does universal coverage lead to more, and more expensive, claims? On average, per person, not really.
Remember - this gets a lot of currently HEALTHY people on board. That will only LOWER the [insurance company's] cost, on a per person basis. And all those uninsured SICK people? As I laid out in my earlier health care posts, right now they wait until their on death's door and then show up in the ER. And they then run up HUGE bills, that then don't get paid. Well, first of all: Guess who pays them? WE DO, though higher premiums, as hospitals try to recoup unpaid bills by soaking insurance companies! They don't just write it off, and even if they do officially, they still try to recoup it from US - the insured. Second of all, if these same people were covered, they'd go to the doctor EARLY ON, when [whatever it is that they have] can be fixed CHEAPLY and EASILY, with FEWER COMPLICATIONS and better PATIENT OUTCOMES. Which is exactly what we WANT THEM TO DO because it COST LESS THAT WAY! It's ALWAYS costs more, not to mention has more negative outcomes, to treat a disease in the later stages. It's ALWAYS better, and cheaper, to catch it and treat it EARLY. So the idea that we'll be paying for something that we're not already is misguided, no matter what model you're looking at.
Is this bill perfect? No. No way. Is it even good? Debatable, certainly. But is it NECESSARY?
Yes. I firmly believe it is.
And to some extent the details don't matter. (And I realize there are some doozies.) This will not solve all of our problems, but neither would a public option and neither would even single payer. But about the only idea I've heard that would make it WORSE was John McCain's '08 campaign idea to let people buy across state lines. THAT, and some of the more "free market" solutions I've heard, would make it WORSE. Much worse. And I just don't believe this bill does. Not in any BIG PICTURE kind of way. It has it's warts, but at this point, and really at any point, we need to take what we can get, celebrate the victory, and move on to the NEXT STEP. Because whoever succeeds Obama, and whenever that happens, will STILL be dealing with health care. No matter WHAT happens, or even might have happened with this bill.
I actually, honestly believe that we'll get to single payer eventually (though still I prefer my own model.) But we're not going to get there in one bill. (Shit, we might not get there in my lifetime!) This will be, and has to be a gradual process. And the necessary FIRST STEP, really the first two steps, has/have to be:
1) Everyone needs to put it / Nobody is allowed to opt out. (And help the ones who truly can't afford it.)
2) The insurance companies can't be allowed to refuse anyone, and can't be allowed to gouge anyone.
Now... we're not there yet. But this bill brings us closer. And we can't get on with the REAL reforms until we've achieved those first two steps. And come November? It's likely the Republicans will make some gains, and the already uphill climb will only get steeper. We need to take what we can. We need to start moving in the right direction. We need to get the ball rolling. And we need to do this as soon as we can.
We NEED this legislation, warts and all. I don't LIKE it... but I do believe it's necessary.
Monday, February 8, 2010
Revisiting Healthcare
Awhile back I agrued the there was some wisdom in philosophical conservatism. Of course, I went on to demostrate how most of this wisodm is missing from the modern American Conservative movement... But I also think that there are exceptions to the darwinian idea that wheatever we have now must be good, since it has withstood all competing ideas and mdoels and has emerged though a process of competition and survival of the fittest. The most glaring example of this, IMHO, is our health care system.
Rather than something that has competed whole cloth against alternative models, our current health care system is a band-aided-all-to-hell version of a system that was inherently flawed form the start, but which conservatives have not let us meaingfully reform. So over the years, rather than evolve, our system has instead mutated sprouting arms and legs as needed to fill one more role until, in the end, we're left with an ungangly mess of appendages that NO ONE would have concieved naturally, if they just sat down one day to design a health care system with the laudable goal of providing universal care.
If someone had presented me with the following, as their initial proposal for a system, I'd ask them if they joking, and have them fired on the spot if the said, "No." This is my interpretation of what that might have looked like, given how our system has ended up looking like:
Just LOOK at this mess! FYI: The Blue Arrow represents CARE. My Doctor provides me with care. Green Arrows represent PAYMENT: I currenltly pay out to (1) my doctor, (2) my insurance comapny, (3) my employer and (4) the government, who is also paid by my employer. Doctors recieve payments from three different sources: Me, the Insurace Companies and the Governement. Insurance companies are also paid from three sources: Me, my employer and the Government. Then you have the Red Arrows. These represent RED TAPE or DA RULZ. Governement tells (in far too few cases, I might add) the insurance companies how to operate as well as any doctors, who collect medicare/medicaid payments. (And this is not even considering standards of care, regulating safety, the FDA, etc... I'm only considering the PAYMENT side of things here!) Insurance companies make the doctors jump through hoops to get paid, and also create all kinds of red tape for their customers, just to justify not paying out or not covering them in the first place. In addition, because of their involvement, my company gets to dictate all kinds of stuff to me. A couple of gems that my company madnates: We have to declare our non-use of any tobacco products or else face a $50.00 insurance surcharge. And don't think for a minute that the insurance company's are giving us non-smokers a break. (Yeah right!) Even if they were, I'm not sure the $2 a month I'm saving is worth the invasion of privacy. (And lying on this form is grounds for termination!) What's more, if you have a working spouse that qualifies for benefits under her employer's health care plan, the s/he MUST be insured with them, otherwise you'll pay an additional premium to inusre your spouse under our plan. Yes, it's already more to insure a spouse, so why the hell should it be EVEN MORE just be she'sotehrwise insurable?! Insuring a spouse ALREADY costs more! WTF?
Bottom line, you shouldn't have to pay out to (or get paid by) three or more different entities and you shouldn't have red-tape going in every direction. None of this complexity is necessary or has anything to do with providing health care. And it doesn't even WORK! We're the wealthiest nation in the world, with health care RESOURCES to spare, and yet tens thousands die (or declare bankrupcy?!) every year from lack of coverage! And even putting that aside, NO ONE, if tasked to design a health care system form the gound up, would have come up with anything like this monstrosity right form the start. No way. It's like... if you asked someone to design the perfect household pet, chances are they come up with something simple, like a dog or a cat. There's basicaly no way they'd invision something resembling some sort of land-based octopus with five mouths.
By comparison, here is the same chart, based on what I proposed with my own health care plan:
See how simple this is? The Gov't creates the policy. A UNIVERSAL health insurance policy with little or ideally no out-of-pocket expense to me. Everyone is covered the same way: Completely. They pay for it with increased taxes (from me and my employer), but the increase in taxes is offset by none of us having to pay insurance premiums or other health care costs out of pocket. They then contract and pay the insurance companies to manage it, negotiate prices with doctors, etc... Insurance companies pay the doctors and the doctors give me care. There. Done. Simple. And if you read my original post, and the few follow-up posts I think you'll see that market forces are harnessed in functional ways that keeps costs low, using good old fashioned competion, in a way that guarentees universal care, rather than promising more profit the more people get refused coverage.
Now... I'm not saying this MUST be the BEST plan EVER, but thus far I have not seen one that's really made me think, "Yeah, that could work too!" Not even truly single payer. (The laws of Microeconomic[supply and demand] guarentee that true single payer will always either have shortages or cost more than it needs to.) Based on what we have as far as resources, THIS is how I'd have it work. And depending on your POV, it's both more conservtive than single payer, or even medicare/medicaid and yet more radical that anything being proposed by congress. And it's sustainable.
But it would never pass. It just make too much sense!
Rather than something that has competed whole cloth against alternative models, our current health care system is a band-aided-all-to-hell version of a system that was inherently flawed form the start, but which conservatives have not let us meaingfully reform. So over the years, rather than evolve, our system has instead mutated sprouting arms and legs as needed to fill one more role until, in the end, we're left with an ungangly mess of appendages that NO ONE would have concieved naturally, if they just sat down one day to design a health care system with the laudable goal of providing universal care.
If someone had presented me with the following, as their initial proposal for a system, I'd ask them if they joking, and have them fired on the spot if the said, "No." This is my interpretation of what that might have looked like, given how our system has ended up looking like:
Just LOOK at this mess! FYI: The Blue Arrow represents CARE. My Doctor provides me with care. Green Arrows represent PAYMENT: I currenltly pay out to (1) my doctor, (2) my insurance comapny, (3) my employer and (4) the government, who is also paid by my employer. Doctors recieve payments from three different sources: Me, the Insurace Companies and the Governement. Insurance companies are also paid from three sources: Me, my employer and the Government. Then you have the Red Arrows. These represent RED TAPE or DA RULZ. Governement tells (in far too few cases, I might add) the insurance companies how to operate as well as any doctors, who collect medicare/medicaid payments. (And this is not even considering standards of care, regulating safety, the FDA, etc... I'm only considering the PAYMENT side of things here!) Insurance companies make the doctors jump through hoops to get paid, and also create all kinds of red tape for their customers, just to justify not paying out or not covering them in the first place. In addition, because of their involvement, my company gets to dictate all kinds of stuff to me. A couple of gems that my company madnates: We have to declare our non-use of any tobacco products or else face a $50.00 insurance surcharge. And don't think for a minute that the insurance company's are giving us non-smokers a break. (Yeah right!) Even if they were, I'm not sure the $2 a month I'm saving is worth the invasion of privacy. (And lying on this form is grounds for termination!) What's more, if you have a working spouse that qualifies for benefits under her employer's health care plan, the s/he MUST be insured with them, otherwise you'll pay an additional premium to inusre your spouse under our plan. Yes, it's already more to insure a spouse, so why the hell should it be EVEN MORE just be she'sotehrwise insurable?! Insuring a spouse ALREADY costs more! WTF?
Bottom line, you shouldn't have to pay out to (or get paid by) three or more different entities and you shouldn't have red-tape going in every direction. None of this complexity is necessary or has anything to do with providing health care. And it doesn't even WORK! We're the wealthiest nation in the world, with health care RESOURCES to spare, and yet tens thousands die (or declare bankrupcy?!) every year from lack of coverage! And even putting that aside, NO ONE, if tasked to design a health care system form the gound up, would have come up with anything like this monstrosity right form the start. No way. It's like... if you asked someone to design the perfect household pet, chances are they come up with something simple, like a dog or a cat. There's basicaly no way they'd invision something resembling some sort of land-based octopus with five mouths.
By comparison, here is the same chart, based on what I proposed with my own health care plan:
See how simple this is? The Gov't creates the policy. A UNIVERSAL health insurance policy with little or ideally no out-of-pocket expense to me. Everyone is covered the same way: Completely. They pay for it with increased taxes (from me and my employer), but the increase in taxes is offset by none of us having to pay insurance premiums or other health care costs out of pocket. They then contract and pay the insurance companies to manage it, negotiate prices with doctors, etc... Insurance companies pay the doctors and the doctors give me care. There. Done. Simple. And if you read my original post, and the few follow-up posts I think you'll see that market forces are harnessed in functional ways that keeps costs low, using good old fashioned competion, in a way that guarentees universal care, rather than promising more profit the more people get refused coverage.
Now... I'm not saying this MUST be the BEST plan EVER, but thus far I have not seen one that's really made me think, "Yeah, that could work too!" Not even truly single payer. (The laws of Microeconomic[supply and demand] guarentee that true single payer will always either have shortages or cost more than it needs to.) Based on what we have as far as resources, THIS is how I'd have it work. And depending on your POV, it's both more conservtive than single payer, or even medicare/medicaid and yet more radical that anything being proposed by congress. And it's sustainable.
But it would never pass. It just make too much sense!
Saturday, September 12, 2009
A little more on the free market, and health care...
I just realized that I'd forgotten a few things about why free market theories don't really apply to health. I mentioned the flat demand curve, and relatively static supply, but there are two other equally, if not more, important points that I forgot.
FIRST...
For a free market to really work, I need to KNOW what something costs and be able to compare, or shop around. Now in SOME CASES you might be able to do this, but consider this: You've cut yourself. You're bleeding. You need stitches. There's a hospital a block away, so you go there. Do you know it's going to cost? At best, you might know what % your insurance is supposed to cover, but % of what?! Chances are, none of the doctors you see will even be able to give you an estimate of the cost. And even if they did, that doesn't mean they know what price the hospital negotiated with the insurance company. Bottom line: You have NO IDEA what a trip to the hospital will cost until you get the bill. You. Have. No. Idea.
And if you did, what would you do? SHOP around?! Do you have time for that? Would you drive and hour to save $100? You might if you were buying a sofa, but YOU'RE BLEEDING! (Or having a stroke, heart attack, seizure, etc...) And even if you could shop around, do you have any objective way of determining quality? Not really. Anecdotal evidence, if you're lucky. (Or go online.) And that's about it. Is Dr. Smith better than Dr. Jones? There is basically no way to find that out! None!
So you can't compare quality and you have no idea what it costs. Some efficient market that will make!
SECOND...
A free and efficient market CAN be a beautiful thing. But we don't have one when it comes to health care, and we really never had. Putting aside that many of us have our choice of doctor narrowed down by our insurance company or HMO, most people DO NOT CHOOSE their insurance company. THEIR EMPLOYER DOES! To get a better plan, you have to change jobs.
And that's not the same as saying, "Get a better job." If I want a Mercedes, I very well might need a better job - one that pays MORE. But to get a given health care plan, it's not a function of the money I make, because I'M NOT BUYING IT! I can't buy it! Employers pick up about 80% of the cost of premiums, so THEY are the ones that choose the plan. To get a given plan, I might have to go to a worse job that pays LESS, just because that company might be the only one that offers the plan I want!
There is no other 'market' that operates that way. None. So it's NOT a market. Not for individuals anyway. And getting back to the idea of risk pooling, the only way to get the best care for the lowest price is to get as many people as possible into one plan. That's why even if I could afford what some other company pays for their employees' coverage, I won't be able to get the same price. Insuring one person is extremely expensive. But insuring a whole bunch of people is cheap, at least on a per person basis. So there's no benefit to everyone going around and negotiating their own plan. Risk pooling will always, automatically get you a lower cost than you'll ever be able to find (or negotiate) for yourself. Better coverage too. So a market just won't work, and really doesn't exsist anyway.
If you're still not convinced, I offer this: The micro economic factors that I've already mentioned here and in previous posts worked to make health care so expensive in the first place that being sick became something that we need to insure against. Market forces made that insurance so expensive that the only way to sell it way with employers paying for most of it. NOW insurance is so expensive that HUGE, BILLION DOLLAR corporations can no longer afford it. (GM? Chrysler? Yeah, pretty much killed by health care costs.) And it is not despite market forces, but precisely BECAUSE OF THEM that we have the situation that we do. And this trend is thirty years in teh making. I little deregulation isn't going to reverse it.
The 'free market' just won't work in this case. There are many areas where it will (almost all, in fact) but Health Care is one of the rare exceptions.
Oh yeah...
I also want to deal with a common talking point: That since medicare is going broke, that means that gov't health care 'doesn't work.' Here's the thing: Everyone's health care costs are going up. There's no denying that. Private companies just raised their rates. And yours went up too, I guarantee it! But what are you going top do? It's not like you had a choice, remember? But for MediCare's budget to go it means MORE TAXES. So while there costs have gone up, they haven't been able to increase their revenue the way insurance companies can. And THAT'S why it's failing. But with my plan, costs can fluctuate. And if, in future, the taxes you pay for gov't health care go up, this is in lieu of your premiums going up: so your still no worse off!
As for the whole government efficiency remember: Insurance companies run it; like contractors. But they won't have the same dysfunctional profit motives that they have now. They can still make money, but it won't be like before. No more huge salaries for CEO's, not generated by health care premiums anyway! They'll want as many new babies as they can get, since that lowers their average cost, and increases their revenue, so they won't risk losing those to their competition by over bidding.
FINALLY...
I want to, once and all, eviscerate the idea that Senator McCain (R) proposed on the 2008 campaign trail that we could benefit by eliminating state boundaries. Now... this COULD work, in the short term. I live in Michigan. I have two autistic sons. At the moment, speech theraphy is not covered for Autistics in Michigan. So I could, say, buy from Florida, where it IS covered. Sounds great right? Two problems.
First of all: I'M NOT BUYING IT! It's still going to be up to my employer to buy it. And THEY are likely to choose the cheapest plan, which is likely in the state with the leats regulation and least mandated coverage. So there goes my coverage! What's more, in the long term, if anyone can buy form any state, then the insirance companies will all move their plans to the one state with the least regulations. (So Autism reform, for example, won't happen for ANYONE unless ALL FIFTY states pass it! And when was the last time Alabama and Massachusetts agreed to do anything together?!)
So, Mr McCain, all your plan will do is make it IMPOSSIBLE for a given State to regulate it's insurance industry. And here I thought Republican's were all about states rights. Ha!
FIRST...
For a free market to really work, I need to KNOW what something costs and be able to compare, or shop around. Now in SOME CASES you might be able to do this, but consider this: You've cut yourself. You're bleeding. You need stitches. There's a hospital a block away, so you go there. Do you know it's going to cost? At best, you might know what % your insurance is supposed to cover, but % of what?! Chances are, none of the doctors you see will even be able to give you an estimate of the cost. And even if they did, that doesn't mean they know what price the hospital negotiated with the insurance company. Bottom line: You have NO IDEA what a trip to the hospital will cost until you get the bill. You. Have. No. Idea.
And if you did, what would you do? SHOP around?! Do you have time for that? Would you drive and hour to save $100? You might if you were buying a sofa, but YOU'RE BLEEDING! (Or having a stroke, heart attack, seizure, etc...) And even if you could shop around, do you have any objective way of determining quality? Not really. Anecdotal evidence, if you're lucky. (Or go online.) And that's about it. Is Dr. Smith better than Dr. Jones? There is basically no way to find that out! None!
So you can't compare quality and you have no idea what it costs. Some efficient market that will make!
SECOND...
A free and efficient market CAN be a beautiful thing. But we don't have one when it comes to health care, and we really never had. Putting aside that many of us have our choice of doctor narrowed down by our insurance company or HMO, most people DO NOT CHOOSE their insurance company. THEIR EMPLOYER DOES! To get a better plan, you have to change jobs.
And that's not the same as saying, "Get a better job." If I want a Mercedes, I very well might need a better job - one that pays MORE. But to get a given health care plan, it's not a function of the money I make, because I'M NOT BUYING IT! I can't buy it! Employers pick up about 80% of the cost of premiums, so THEY are the ones that choose the plan. To get a given plan, I might have to go to a worse job that pays LESS, just because that company might be the only one that offers the plan I want!
There is no other 'market' that operates that way. None. So it's NOT a market. Not for individuals anyway. And getting back to the idea of risk pooling, the only way to get the best care for the lowest price is to get as many people as possible into one plan. That's why even if I could afford what some other company pays for their employees' coverage, I won't be able to get the same price. Insuring one person is extremely expensive. But insuring a whole bunch of people is cheap, at least on a per person basis. So there's no benefit to everyone going around and negotiating their own plan. Risk pooling will always, automatically get you a lower cost than you'll ever be able to find (or negotiate) for yourself. Better coverage too. So a market just won't work, and really doesn't exsist anyway.
If you're still not convinced, I offer this: The micro economic factors that I've already mentioned here and in previous posts worked to make health care so expensive in the first place that being sick became something that we need to insure against. Market forces made that insurance so expensive that the only way to sell it way with employers paying for most of it. NOW insurance is so expensive that HUGE, BILLION DOLLAR corporations can no longer afford it. (GM? Chrysler? Yeah, pretty much killed by health care costs.) And it is not despite market forces, but precisely BECAUSE OF THEM that we have the situation that we do. And this trend is thirty years in teh making. I little deregulation isn't going to reverse it.
The 'free market' just won't work in this case. There are many areas where it will (almost all, in fact) but Health Care is one of the rare exceptions.
Oh yeah...
I also want to deal with a common talking point: That since medicare is going broke, that means that gov't health care 'doesn't work.' Here's the thing: Everyone's health care costs are going up. There's no denying that. Private companies just raised their rates. And yours went up too, I guarantee it! But what are you going top do? It's not like you had a choice, remember? But for MediCare's budget to go it means MORE TAXES. So while there costs have gone up, they haven't been able to increase their revenue the way insurance companies can. And THAT'S why it's failing. But with my plan, costs can fluctuate. And if, in future, the taxes you pay for gov't health care go up, this is in lieu of your premiums going up: so your still no worse off!
As for the whole government efficiency remember: Insurance companies run it; like contractors. But they won't have the same dysfunctional profit motives that they have now. They can still make money, but it won't be like before. No more huge salaries for CEO's, not generated by health care premiums anyway! They'll want as many new babies as they can get, since that lowers their average cost, and increases their revenue, so they won't risk losing those to their competition by over bidding.
FINALLY...
I want to, once and all, eviscerate the idea that Senator McCain (R) proposed on the 2008 campaign trail that we could benefit by eliminating state boundaries. Now... this COULD work, in the short term. I live in Michigan. I have two autistic sons. At the moment, speech theraphy is not covered for Autistics in Michigan. So I could, say, buy from Florida, where it IS covered. Sounds great right? Two problems.
First of all: I'M NOT BUYING IT! It's still going to be up to my employer to buy it. And THEY are likely to choose the cheapest plan, which is likely in the state with the leats regulation and least mandated coverage. So there goes my coverage! What's more, in the long term, if anyone can buy form any state, then the insirance companies will all move their plans to the one state with the least regulations. (So Autism reform, for example, won't happen for ANYONE unless ALL FIFTY states pass it! And when was the last time Alabama and Massachusetts agreed to do anything together?!)
So, Mr McCain, all your plan will do is make it IMPOSSIBLE for a given State to regulate it's insurance industry. And here I thought Republican's were all about states rights. Ha!
Some of the more sticky questions about my health care plan...
Ok. Many of you probably think that MediaMatters is nothing but a bunch of pinko, commie, liberal, lefties. Well, they are a lot of them over there, and I fit right in with 'em! But they also have more than a couple regular posters who lean sharply conservative. I've locked horns with many of them over the past couple years, and some of them have posed some very reasonable questions that deserve answers.
So here goes.
Why should abortion be covered? You say you don't cover other voluntary procedures, why cover abortion? Isn't abortion a 'voluntary procedure'?
First off, let me say that if you feel abortion is IMMORAL, I'm with you! The thing is... so are most liberals and pro-lifers! MORALITY isn't the really key issue here, it's LEGALITY. And the difference between a liberal (like me) and a pro-lifer is that while I BELIEVE (meaning, IN MY OPINION) that abortion is immoral, I DO NOT feel the need to infect my opinion onto anyone else. If you don't like abortions? DON'T HAVE ONE. No one will ever force you to and whatever anyone else does is none of your business to tell them one way or the other.
Second... There is more to excluding voluntary procedures than just the fact that they're voluntary. It's also because they're EXPENSIVE and there's no reason anyone else should have pay for them! The alternative to having a boob-job is NOT having one: Which costs nothing. The alternative to abortion is BIRTH, which always costs MORE. I'm not begrudging those who wish to have children (another voluntary decision, mind you!) BIRTH will always be fully covered, but if a person wants to ASK LESS of the system by terminating the pregnancy early, as long as the procedure remains legal there is no rational reason not to do this! (Fair enough: If you managed to OUTLAW it, it won't be covered. Of course, in theory, it won't be PERFORMED either, so the question of coverage is moot either way.
Which brings me to the next part of the question:
What if I don't want to subsidize someone else getting one?
This is just stupid for many reasons. First of all, if you currently buy private insurance, chances are you're already doing this. You are not paying for anything other than YOUR COVERAGE and YOUR FAMILY'S. So mind your own business and stop worrying about the choices other people make with theirs! And again, we can't have individuals deciding what they do and don't want to cover for themselves, or you lose all the benefits of risk pooling - which is how our CURRENT SYSTEM works! I'm sure 90% of AIDS patients didn't think they'd ever get AIDS, and thus may have been tempted to exclude AIDS coverage if they could save a few bucks a months. And while SOME may have changed their behaviors, most would still eventually get the disease. (And where would THAT leave them now?)You can't have people estimating their own chances of getting something. That's what insurance companies are for and they have thousands of experts crunching reams of data all day long to figure it out. So let THEM figure that out. Just take you gold-star, universal coverage and stop whining about it!
This same line of reasoning, BTW, applies to pharmacists who refuse to fill prescriptions for birth-control pills (for example) for religious reasons. This is BULLSHIT. Anyone pharmacist who refuse to fill a doctors prescription for moral reason should lose their license and business. PERIOD. Why, you ask? What about respecting people's beliefs, you ask? Again, BULLSHIT. If you're Catholic (for example) and you believe the use of birth control is a sin, then YOU can't use, and YOU can't be partners with someone else who does! The Catholic Church's prohibition of contraception DOES NOT (and by the First Ammendment to the Constitution, CAN NOT) APPLY to non-Catholics, and isn't observed by 99% of practicing Catholics anyway! A pharmacist refusing to let SOMEONE ELSE use contraception is nothing more than him or her forcing their religious beliefs onto another person. Someone else's sin is not theirs and don't give me any hogwash about enabling it, either. What's next? Holding gun manufacturer's responsible for every murder that's committed? Not THIS liberal!
Why do we even need this? What wrong with the FREE MARKET setting the price? Wont this lead to RATIONING?
First things last. The 'free market' IS a system of rationing. That what market forces DO. They give resources to those willing (and able) to pay the marker price for a given good or service. Those that aren't willing (or able) to pay DON'T GET the good or service. And the volume available (supply) is only a function of the market price. It is not a function of actual need - the opposite in fact, the more something is needed, the HIGHER the price. In this way the free market serves to ration EVERYTHING.
And that is EXACTLY why it's a lousy way to manage HEALTH CARE: Because the demand curve for health care is essentially flat. Here's what that means in English: Let's say a bag of Doritos cost $100. What would happen? First of all, a WHOLE LOT of people would start making Doritos! But who would pay that much when POTATO CHIPS still cost $1? You see? There a diminished demand for certain goods at higher prices because I have COMPETING CHOICES. And thus the price is kept low, to compete with those alternatives. If I can't afford a Mercedes, I can buy a Chevy. If I can't afford a house, I can rent an apartment. If I can't afford fillet, I can buy chuck.
But if I can't afford chemo... (and I'll give you a clue: nobody can)... then I DIE.
Now, death may be the low-cost alternative to most health care procedures, but it's not one I'm ever likely to choose, is it? It's basically not an acceptable alternative for anyone. So HOW MUCH will your triple-bypass cost? Well... How much do you have?! Since I know that you won't go without, and I know that there's no competing alternatives, there's nothing to reign in my cost. 'Give me all you got and more!' is therefore the only answer one can expect from a free market. (Thankfully, most hospitals are non-profits entities!)
AND not only is the demand curve FLAT, but the SUPPLY curve is unique as well. You see, the supply of oil, potato chips, cars or beef can fluctuate. If demand for something goes UP, we can usually just make more. But the number of DOCTORS we have at any time doesn't really go up with demand, because doctors come from MEDICAL SCHOOLS and med schools take only a very small percentage of applicants. And medical fellowhips (needed for specialties) only take a small percentage of applicants from that pool! And they're not about to lower their standards just because doctors salaries have gone up and more people want to be doctors. So we can't really allow the supply to fluctuate like a regular commodity does, because it takes to long to increase the supply!
What about the unemployed? Or illegals aliens? Why should I pay for them?
First off, you already are. The unemployed already get coverage: Medicaid. And you already pay for that. You still will, but in a less dysfunctional system. You also already subsidize the UNINSURED (which includes illegal aliens) in exactly the way I've already described. SO get over it. Better they get GOOD TREATMENT that costs everyone LESS than get lousy treatment that costs everyone more.
And we REALLY don't want hospitals to put off treatment until they verify legal status, do we? Imagine you've had a stroke or heart attack. Every second counts. Do you really want there to be ANY possibility that your treatment is delayed? That could be fatal! So, just as they are now, hospitals will treat their patients according to medical need, NO QUESTIONS ASKED. They don't have to worry: THEY'LL GET PAID. And is there really any benefit to saying, "Sorry, that guy was an illegal, so we won't pay you for treating him?" NO! Now we're right back to the hospitals baking in unreimbursed expenses, just as they do now, and WE END UP PAYING ANYWAY!!! So get over it. There's no way to avoid it without screwing everything up with red tape and you won't save a single penny anyway!
JUST TAKE YOUR UNIVERSAL COVERAGE AND STOP WHINING!!!
BTW, this is one of my pet peeves with conservatives on a lot of things... They're always more concerned about making sure that the WRONG PEOPLE (whoever they are) don't benefit, than they are are making sure that the RIGHT PEOPLE (whoever they are) don't get hurt. In this case, they'd create a whole system of gov't bureaucracy that will end up killing someone who was entitled to care just to stop someone who isn't from receiving it. Not only is this a senseless trade off, going against the very conservative Principal of limited gov't and making the conservative's fear of a gov't bureaucrat getting between you and your health care a reality, but WHAT IS SO WRONG with saving a life?! Why should the HOSPITAL get punished, by not being paid for services rendered (and costs incurred,) just because they saved the wrong person's life. That's just... psychotic. So get over your xenophobia, conservatives. And besides, there's no reason that the Mexicans would flood over our borders just to get free health care... THEY ALREADY GET PUBLIC HEALTH IN MEXICO!
SO let me knwo if you have any other questions. I'll do my best to satisfy you. I've spent a lot of time thinking about this from many different angles, and I'm confident it's the best way to go. So I'll take all comers!
Now let me have it!
LOL
So here goes.
Why should abortion be covered? You say you don't cover other voluntary procedures, why cover abortion? Isn't abortion a 'voluntary procedure'?
First off, let me say that if you feel abortion is IMMORAL, I'm with you! The thing is... so are most liberals and pro-lifers! MORALITY isn't the really key issue here, it's LEGALITY. And the difference between a liberal (like me) and a pro-lifer is that while I BELIEVE (meaning, IN MY OPINION) that abortion is immoral, I DO NOT feel the need to infect my opinion onto anyone else. If you don't like abortions? DON'T HAVE ONE. No one will ever force you to and whatever anyone else does is none of your business to tell them one way or the other.
Second... There is more to excluding voluntary procedures than just the fact that they're voluntary. It's also because they're EXPENSIVE and there's no reason anyone else should have pay for them! The alternative to having a boob-job is NOT having one: Which costs nothing. The alternative to abortion is BIRTH, which always costs MORE. I'm not begrudging those who wish to have children (another voluntary decision, mind you!) BIRTH will always be fully covered, but if a person wants to ASK LESS of the system by terminating the pregnancy early, as long as the procedure remains legal there is no rational reason not to do this! (Fair enough: If you managed to OUTLAW it, it won't be covered. Of course, in theory, it won't be PERFORMED either, so the question of coverage is moot either way.
Which brings me to the next part of the question:
What if I don't want to subsidize someone else getting one?
This is just stupid for many reasons. First of all, if you currently buy private insurance, chances are you're already doing this. You are not paying for anything other than YOUR COVERAGE and YOUR FAMILY'S. So mind your own business and stop worrying about the choices other people make with theirs! And again, we can't have individuals deciding what they do and don't want to cover for themselves, or you lose all the benefits of risk pooling - which is how our CURRENT SYSTEM works! I'm sure 90% of AIDS patients didn't think they'd ever get AIDS, and thus may have been tempted to exclude AIDS coverage if they could save a few bucks a months. And while SOME may have changed their behaviors, most would still eventually get the disease. (And where would THAT leave them now?)You can't have people estimating their own chances of getting something. That's what insurance companies are for and they have thousands of experts crunching reams of data all day long to figure it out. So let THEM figure that out. Just take you gold-star, universal coverage and stop whining about it!
This same line of reasoning, BTW, applies to pharmacists who refuse to fill prescriptions for birth-control pills (for example) for religious reasons. This is BULLSHIT. Anyone pharmacist who refuse to fill a doctors prescription for moral reason should lose their license and business. PERIOD. Why, you ask? What about respecting people's beliefs, you ask? Again, BULLSHIT. If you're Catholic (for example) and you believe the use of birth control is a sin, then YOU can't use, and YOU can't be partners with someone else who does! The Catholic Church's prohibition of contraception DOES NOT (and by the First Ammendment to the Constitution, CAN NOT) APPLY to non-Catholics, and isn't observed by 99% of practicing Catholics anyway! A pharmacist refusing to let SOMEONE ELSE use contraception is nothing more than him or her forcing their religious beliefs onto another person. Someone else's sin is not theirs and don't give me any hogwash about enabling it, either. What's next? Holding gun manufacturer's responsible for every murder that's committed? Not THIS liberal!
Why do we even need this? What wrong with the FREE MARKET setting the price? Wont this lead to RATIONING?
First things last. The 'free market' IS a system of rationing. That what market forces DO. They give resources to those willing (and able) to pay the marker price for a given good or service. Those that aren't willing (or able) to pay DON'T GET the good or service. And the volume available (supply) is only a function of the market price. It is not a function of actual need - the opposite in fact, the more something is needed, the HIGHER the price. In this way the free market serves to ration EVERYTHING.
And that is EXACTLY why it's a lousy way to manage HEALTH CARE: Because the demand curve for health care is essentially flat. Here's what that means in English: Let's say a bag of Doritos cost $100. What would happen? First of all, a WHOLE LOT of people would start making Doritos! But who would pay that much when POTATO CHIPS still cost $1? You see? There a diminished demand for certain goods at higher prices because I have COMPETING CHOICES. And thus the price is kept low, to compete with those alternatives. If I can't afford a Mercedes, I can buy a Chevy. If I can't afford a house, I can rent an apartment. If I can't afford fillet, I can buy chuck.
But if I can't afford chemo... (and I'll give you a clue: nobody can)... then I DIE.
Now, death may be the low-cost alternative to most health care procedures, but it's not one I'm ever likely to choose, is it? It's basically not an acceptable alternative for anyone. So HOW MUCH will your triple-bypass cost? Well... How much do you have?! Since I know that you won't go without, and I know that there's no competing alternatives, there's nothing to reign in my cost. 'Give me all you got and more!' is therefore the only answer one can expect from a free market. (Thankfully, most hospitals are non-profits entities!)
AND not only is the demand curve FLAT, but the SUPPLY curve is unique as well. You see, the supply of oil, potato chips, cars or beef can fluctuate. If demand for something goes UP, we can usually just make more. But the number of DOCTORS we have at any time doesn't really go up with demand, because doctors come from MEDICAL SCHOOLS and med schools take only a very small percentage of applicants. And medical fellowhips (needed for specialties) only take a small percentage of applicants from that pool! And they're not about to lower their standards just because doctors salaries have gone up and more people want to be doctors. So we can't really allow the supply to fluctuate like a regular commodity does, because it takes to long to increase the supply!
What about the unemployed? Or illegals aliens? Why should I pay for them?
First off, you already are. The unemployed already get coverage: Medicaid. And you already pay for that. You still will, but in a less dysfunctional system. You also already subsidize the UNINSURED (which includes illegal aliens) in exactly the way I've already described. SO get over it. Better they get GOOD TREATMENT that costs everyone LESS than get lousy treatment that costs everyone more.
And we REALLY don't want hospitals to put off treatment until they verify legal status, do we? Imagine you've had a stroke or heart attack. Every second counts. Do you really want there to be ANY possibility that your treatment is delayed? That could be fatal! So, just as they are now, hospitals will treat their patients according to medical need, NO QUESTIONS ASKED. They don't have to worry: THEY'LL GET PAID. And is there really any benefit to saying, "Sorry, that guy was an illegal, so we won't pay you for treating him?" NO! Now we're right back to the hospitals baking in unreimbursed expenses, just as they do now, and WE END UP PAYING ANYWAY!!! So get over it. There's no way to avoid it without screwing everything up with red tape and you won't save a single penny anyway!
JUST TAKE YOUR UNIVERSAL COVERAGE AND STOP WHINING!!!
BTW, this is one of my pet peeves with conservatives on a lot of things... They're always more concerned about making sure that the WRONG PEOPLE (whoever they are) don't benefit, than they are are making sure that the RIGHT PEOPLE (whoever they are) don't get hurt. In this case, they'd create a whole system of gov't bureaucracy that will end up killing someone who was entitled to care just to stop someone who isn't from receiving it. Not only is this a senseless trade off, going against the very conservative Principal of limited gov't and making the conservative's fear of a gov't bureaucrat getting between you and your health care a reality, but WHAT IS SO WRONG with saving a life?! Why should the HOSPITAL get punished, by not being paid for services rendered (and costs incurred,) just because they saved the wrong person's life. That's just... psychotic. So get over your xenophobia, conservatives. And besides, there's no reason that the Mexicans would flood over our borders just to get free health care... THEY ALREADY GET PUBLIC HEALTH IN MEXICO!
SO let me knwo if you have any other questions. I'll do my best to satisfy you. I've spent a lot of time thinking about this from many different angles, and I'm confident it's the best way to go. So I'll take all comers!
Now let me have it!
LOL
Some Strengths & Benefits of my health care plan
Question: How does giving everyone everything LOWER costs?!
A big way that the cost of any given procedure will be result from the hospital KNOWING that when they treat someone, they WILL get paid. So they won't have to bake-in extra costs assuming a certain percent loss, based on a bunch of patients NOT paying. (Why do YOU think it costs $10 dollars to get an aspirin in the hospital?) Also, the Hospital won't get low-balled anymore for medicaid patients. Since EVERYONE will be in the same plan, the hospital will get paid the same for any given petient they take. Again, this reduces the unreimbursed costs that they currently pass onto everyone else. (And why should it matter WHO the hospital is treating? From their perspective, does a triple bypass cost less to give a poor person than a rich person? They should get paid for the SERVICE not the PATIENT!)
Another way costs are lowered is by providing people with incentives (or at worst removing the disincentives) to make the kinds of decisions that benefit the system, namely: GET TREATMENT EARLY! For example: Right now, if someone gets an earache, and they don't have insurance, they don't go to the doctor; not today, not tomorrow not next week, even when the pain gets worse. A month later, after the infection has spread, they show up in the ER; unconscious and on death's door with 105 degree fever. After spending the night in the ER, they're moved to the ICU. Then they're there for a week, getting exotic, aggressive anti-biotics intravenously, after which they either DIE (and likely don't pay) or LIVE, but declare bankrupcy because they can't pay. Ten's, maybe Hundreds of thousands of dollars worth of unreimbursed costs (and possibly a patient death) now get s passed onto everyone else over something that could have been solved with a single course of simple $10 anti-biotics if it had been treated early.
Because, with health care, sometimes giving MORE in the right place at the right time cost a LOT LESS. This also frees up the ER, ICU and Specialized resources that would otherwise be consumed, thus lowering the cost for THOSE resources. (See? My plan just keeps WORKING!)
Getting people to go to their primary care providers at the first sign of trouble lowers the overall cost of treating any given condition AND improves the likelyhood of a positive outcome. Putting of treatment for lack of coverage ALWAYS costs more, can only INCREASE to chance of a negative outcome, thus leading to more costs being passed onto to those who CAN and DO pay. This is also the answer to the concern (of many Conservatives) that the RICH will SUBSIDIZE the POOR. Well... they may, but no more than they already are, for the very reason I've just laid out. The thing is, under my plan, they'll do a LOT LESS of this. The theory here is NOT to have the RICH subsidize the POOR, but rather to have the HEALTHY subsidize the SICK.
This is the one part of our current system that actually works very well, and it works better the more people you have in a given risk pool. So how about... ALL OF AMERICA?! That should make the cost per person as low as possible.
Question: SO... who pays more and who pays less?
An individual who currently buys insurance, though an employer's benefit program, will pay almost the same as he does now, but get better coverage. Someone who buys insurance ON THEIR OWN will pay a LOT less.
Someone with NO INSURANCE? Yeah, they'll pay more... But they'll get coverage. Let's say your in this group and making OVER median income (about $50,ooo for an individual) but you work for a small company and they don't offer health care. What you'd pay in increased taxes is roughly what your share of the premium would be if your employer DID offer health insurance. If you make LESS than median income, we can cut you some slack. Since you're probably paying NOTHING now (and we're subsidizing you anyway, as I've explained above) ANYTHING would be better than NOTHING. So you'll pay some greatly reduced amount. Below the poverty line? (for example) You'll pay nothing, just as you do today, but you'll get better coverage than medicaid currently offers.
You might ask: Why shouldn't healthy people be allowed to opt out if they choose?
Simple: It doesn't work. First of all: How do you how long you;ll be 'healthy'? Young people all think they'll live forever and we (adults) all know that just ain't true. And besides: a lot of 'healthy' exercise. Which means they can be still be INJURED. So what if they're not sick? If they blow out their knee or rupture a tendon, their will still be COSTS, and that will be more than they can afford. And if they don't pay, THE REST OF US END UP PAYING! So no: EVERYONE puts in who can. Period. It compulsory. Same goes for the whole lower premium / higher deductible argument. It doesn't work our form most in the long run, and if you can't pay the difference, WE end up paying. NO. EVERYONE puts in. DONE. That's the only way it works for EVERYONE.
What about those small companies that can't afford insurance?
Well, if they make a PROFIT, they can always afford a 2% or 3% tax increase. If you make a dollar, after all your employees and other costs are paid, you can afford 3 cents. If you make $100 you can afford $3 and if you make a $Million you can afford $30,000. You see? If you small and don't make enough to afford the HUGE FIXED cost of health insurance, you'll pay a much smaller amount. And if you do make scads of money, then you have no excuse. And below a certain amount (and amount that most all small companies will never meet) you'll still be paying less. But employers pick up about 80% of the tab now, and they'll need to continue to do so. But if it's a TAX, they'll get a break exactly when they need it. (Unlike with private companies who'll want to be paid whether you made a profit or not!)
The other benefit is that the cost of retaining an employee is less, so companies can afford to hire more people, since their health care tab will be a function of the money (profit now, not revenue) they make rather than the number of employees they have. This will increase the number of decent paying jobs, and thus also increase the number of people paying into the system!
SO IT'S SUSTAINABLE! The more you look at it the more you realize that all the right incentives are there!
In my next post I will take on some of the more controversial questions about my Health Care Plan.
A big way that the cost of any given procedure will be result from the hospital KNOWING that when they treat someone, they WILL get paid. So they won't have to bake-in extra costs assuming a certain percent loss, based on a bunch of patients NOT paying. (Why do YOU think it costs $10 dollars to get an aspirin in the hospital?) Also, the Hospital won't get low-balled anymore for medicaid patients. Since EVERYONE will be in the same plan, the hospital will get paid the same for any given petient they take. Again, this reduces the unreimbursed costs that they currently pass onto everyone else. (And why should it matter WHO the hospital is treating? From their perspective, does a triple bypass cost less to give a poor person than a rich person? They should get paid for the SERVICE not the PATIENT!)
Another way costs are lowered is by providing people with incentives (or at worst removing the disincentives) to make the kinds of decisions that benefit the system, namely: GET TREATMENT EARLY! For example: Right now, if someone gets an earache, and they don't have insurance, they don't go to the doctor; not today, not tomorrow not next week, even when the pain gets worse. A month later, after the infection has spread, they show up in the ER; unconscious and on death's door with 105 degree fever. After spending the night in the ER, they're moved to the ICU. Then they're there for a week, getting exotic, aggressive anti-biotics intravenously, after which they either DIE (and likely don't pay) or LIVE, but declare bankrupcy because they can't pay. Ten's, maybe Hundreds of thousands of dollars worth of unreimbursed costs (and possibly a patient death) now get s passed onto everyone else over something that could have been solved with a single course of simple $10 anti-biotics if it had been treated early.
Because, with health care, sometimes giving MORE in the right place at the right time cost a LOT LESS. This also frees up the ER, ICU and Specialized resources that would otherwise be consumed, thus lowering the cost for THOSE resources. (See? My plan just keeps WORKING!)
Getting people to go to their primary care providers at the first sign of trouble lowers the overall cost of treating any given condition AND improves the likelyhood of a positive outcome. Putting of treatment for lack of coverage ALWAYS costs more, can only INCREASE to chance of a negative outcome, thus leading to more costs being passed onto to those who CAN and DO pay. This is also the answer to the concern (of many Conservatives) that the RICH will SUBSIDIZE the POOR. Well... they may, but no more than they already are, for the very reason I've just laid out. The thing is, under my plan, they'll do a LOT LESS of this. The theory here is NOT to have the RICH subsidize the POOR, but rather to have the HEALTHY subsidize the SICK.
This is the one part of our current system that actually works very well, and it works better the more people you have in a given risk pool. So how about... ALL OF AMERICA?! That should make the cost per person as low as possible.
Question: SO... who pays more and who pays less?
An individual who currently buys insurance, though an employer's benefit program, will pay almost the same as he does now, but get better coverage. Someone who buys insurance ON THEIR OWN will pay a LOT less.
Someone with NO INSURANCE? Yeah, they'll pay more... But they'll get coverage. Let's say your in this group and making OVER median income (about $50,ooo for an individual) but you work for a small company and they don't offer health care. What you'd pay in increased taxes is roughly what your share of the premium would be if your employer DID offer health insurance. If you make LESS than median income, we can cut you some slack. Since you're probably paying NOTHING now (and we're subsidizing you anyway, as I've explained above) ANYTHING would be better than NOTHING. So you'll pay some greatly reduced amount. Below the poverty line? (for example) You'll pay nothing, just as you do today, but you'll get better coverage than medicaid currently offers.
You might ask: Why shouldn't healthy people be allowed to opt out if they choose?
Simple: It doesn't work. First of all: How do you how long you;ll be 'healthy'? Young people all think they'll live forever and we (adults) all know that just ain't true. And besides: a lot of 'healthy' exercise. Which means they can be still be INJURED. So what if they're not sick? If they blow out their knee or rupture a tendon, their will still be COSTS, and that will be more than they can afford. And if they don't pay, THE REST OF US END UP PAYING! So no: EVERYONE puts in who can. Period. It compulsory. Same goes for the whole lower premium / higher deductible argument. It doesn't work our form most in the long run, and if you can't pay the difference, WE end up paying. NO. EVERYONE puts in. DONE. That's the only way it works for EVERYONE.
What about those small companies that can't afford insurance?
Well, if they make a PROFIT, they can always afford a 2% or 3% tax increase. If you make a dollar, after all your employees and other costs are paid, you can afford 3 cents. If you make $100 you can afford $3 and if you make a $Million you can afford $30,000. You see? If you small and don't make enough to afford the HUGE FIXED cost of health insurance, you'll pay a much smaller amount. And if you do make scads of money, then you have no excuse. And below a certain amount (and amount that most all small companies will never meet) you'll still be paying less. But employers pick up about 80% of the tab now, and they'll need to continue to do so. But if it's a TAX, they'll get a break exactly when they need it. (Unlike with private companies who'll want to be paid whether you made a profit or not!)
The other benefit is that the cost of retaining an employee is less, so companies can afford to hire more people, since their health care tab will be a function of the money (profit now, not revenue) they make rather than the number of employees they have. This will increase the number of decent paying jobs, and thus also increase the number of people paying into the system!
SO IT'S SUSTAINABLE! The more you look at it the more you realize that all the right incentives are there!
In my next post I will take on some of the more controversial questions about my Health Care Plan.
The Solution to the Health Care Problem
The health care debate rages on. President Obama took yet another opportunity to make his case, and yet all the media can focus on was Representative Wilson's outburst, "YOU LIE!" (Never getting around to letting there audience know that Rep. Wilson (R) was, in fact, LYING.) So Democrats keep trying to compromise, the Republicans keep trying to obstruct and the media remains complicit with the RIGHT WING but still refusing to inform people about the ACTUAL BILL, in favor of repeating RIGHT WING LIES... like those death panels on page 425? Yeah: THEY AIN'T THERE! But you won't get that form the media who would rather report on a fight than actually INFORM people.
So once against the media's forfeiture of credibility, the Republican's lack of brains and the Democrat's lack of balls have doomed us all. And that's not even to say that I LIKE Obama's bill, it's just better than anything ELSE I've seen so far...
Except for MY SOLUTION. Which would solve everything, and satisfy everyone. Over on MediaMatters, even the conservative posters had to concede to it's quality. So here's MY PLAN:
PART ONE: The Government's Role
The primary role of the GOVERNMENT, meaning the LEGISLATURE is to DEFINE the COVERAGE. Put in the simplest terms: Everyone & everything is covered. You could make this 100%, with NO out of pocket expense or could have a SMALL (~$20) co-pay, just to deter some idiot going to the ER for a hangnail.
Now... Just some common sense details: No, I wouldn't cover elective/non-reconstructive cosmetic surgery. I wouldn't cover any 'alternative medicine' (which is all BS anyway!); and I'd also be sorely tempted to exclude lifestyle drugs (Cyalis/Viagra/Levitra?) but I guess I could be persuaded to include those. Abortion would be covered. If you don't like that? Grow up. Seriously. (I'll address why this is the case in another post, "Questions Answered about My Plan, because people have asked.) And mental health would get the same level of coverage as everything else. There's no reason to treat the brain any differently from any other organ that has something go wrong with it. (Currently most Ins.Co shaft mental health drugs big time.) Many things not currently covered, like Speech therapy to treat Autism, would also be covered.
The exact details on every little things can be worked out later, but the GUIDING PRINCIPLE is: If you're sick, and we can heal you, your healed. No fuss, no muss and little to no out of pocket expense! No one dies of anything we can fix, and no one EVER goes bankrupt for getting sick. Period.
PART TWO: So who actually RUNS it?!
Utilizing the enormous network of health care cast negotiators that already exists, the program will be managed by the insurance companies, much in the way they do now. The big difference is that they can't refuse coverage. Everyone gets treated, and the hospital (doctor, etc...) gets paid for everyone they see. DONE.
They will adjust their premiums to figure out what it would cost and then bill the government for that service. What stops them from just GOUGING the government? Simple: COMPETITION. They will have to bid to cover people. And once they get someone they have them for LIFE. SO: Every time a baby is born, they will want to snatch up as many babies as they can since, once born and vaccinated, most babies represent about 30 years of little to no cost. Since they'll be paid to cover them ANYWAY, they'll want as many of those babies as they can get. If their price is to high, their competitors will snatch them up and their current case load just gets older. (Which in the health care world is a disaster! If you can get paid the same for babies as for the over 65's, YOU WANT THEM!)
So they will negotiate prices. The difference between what they negotiate and what the government pays - THEY KEEP. So there's still a profit motive and opportunity. (But for PROVIDING care, not DENYING it!) Going back to PART ONE, to maintain "universal coverage" and to avoid both rationing and robbing people of control over their own care, they will be required to reimburse doctors/hospitals/etc... at a level that (for example) insures that any given person will have a choice of at least three doctors within 50 miles of their home (100 miles in rural areas) that will perform a given test or procedure at no additional cost to the patient. (Save for ~$20 co-pay, if applicable.) Some Doctors can still charge more, if they think the market will bear it, but the difference will have to be paid by the patient. But the standard payment will have to be enough to make sure I have at least three Doctors to choose from with no additional expense. This gives doctors an incentive not to gouge insurance companies because there will be great pressure for them to be among the "free" providers - or at least very close to "free."
Now - I've also thought about how to reimburse at a higher level for specialists. First off, we'll need some way of identifying who the specialists are. It could be years of service, education, experience... whatever. The HOW isn't really important. It would likely been done however it's done now. So let's say someone has a complicated case and needs a specialist. Teh specialist won't be working for the regular rate. So does that mean that the patient now has to pay? NO. Here's how it would work: Specialists get reimbursed at a higher rate, to the point where the "choice of three" doctrine is maintained. So who decides is you get to see the specialist? Not the government (as you may be suspecting, but) YOUR DOCTOR. That's right. You see the regular doctor. When he sees your complicated case, assuming he's not a specialist himself, he'll think "No way am I dealing with THAT, for what they're paying me!" (Since he's only getting the base rate) and he'll refer you to a specialist or three. If a doctor is willing to give up the chance to make a little money (because he judges that what's really needed is beyond what he's getting paid, and thus he'll be at a loss) that's good enough for me. Off to see the specialist!
PART THREE: So how do we PAY for it?
OK, you guessed it: The government will pay the insurance bills with increased taxes. But stay with me now! It's not nearly as bad as you think. In fact, YOU MAY NOT EVEN NOTICE. And corporations may even prefer it!
The increased taxes will be offset by the fact that you're no longer paying premiums. This new tax would be structured such that most people's take home pay would not be affected + or -. This tax would be partially based on income (to give a break to anyone making under median income) but would also vary with martial status and number of children, much the way your premium does now. But the guiding principle here is that your take home pay will be as close as possible, to what you're taking home now.
Corporate taxes increase will increase to, such that the revenue generated will be the same as what is currently being paid in premiums - this is meant to be revenue-neutral. The benefit of this is that in the form of a tax, it will not have to be paid by struggling firms, who would otherwise still have huge, fixed health care costs, and more of the bill will be footed by companies doing really well. Who could just as easily have a tough year next year, and be in the other boat themselves. (Don't believe me? As late as the 1990's it was UNTHINKABLE that GM, still the worlds largest and richest corporation at the time, would EVER declare bankruptcy.) So while ExxonMobil might not like the increased taxes now, 5 years from now (let's say) when they're approaching red ink, rather than BIG FIXED COSTS for health care, their cost will be... NOTHING! And that can easily be the difference between making a profit and taking a loss!
PART FOUR: So what controls costs?
Cost are controlled automatically, through market forces in a more functional manner than they are today: Doctors will charge what the market bears, but will have an incentive to be among those that are "free" to the patient. Insurance companies will be in competition with each other to bid for new babies to cover. Free market principals apply, but will be used to insure coverage, as well as control cost. But rather than let supply and demand drive price, we'll use price to drive supply, and competition to keep Price down.
YOU see a DOCTOR. The DOCTORS deal with the INSURERS. The INSURERS deal with the GOVERNMENT. And the GOVERNMENT bill YOU (and your EMPLOYER.)
That's the basic structure. I'm going to do a separate post on strengths and benefits and also for any questions I get here, and for questions I've gotten from the MediaMatters posters.
So once against the media's forfeiture of credibility, the Republican's lack of brains and the Democrat's lack of balls have doomed us all. And that's not even to say that I LIKE Obama's bill, it's just better than anything ELSE I've seen so far...
Except for MY SOLUTION. Which would solve everything, and satisfy everyone. Over on MediaMatters, even the conservative posters had to concede to it's quality. So here's MY PLAN:
PART ONE: The Government's Role
The primary role of the GOVERNMENT, meaning the LEGISLATURE is to DEFINE the COVERAGE. Put in the simplest terms: Everyone & everything is covered. You could make this 100%, with NO out of pocket expense or could have a SMALL (~$20) co-pay, just to deter some idiot going to the ER for a hangnail.
Now... Just some common sense details: No, I wouldn't cover elective/non-reconstructive cosmetic surgery. I wouldn't cover any 'alternative medicine' (which is all BS anyway!); and I'd also be sorely tempted to exclude lifestyle drugs (Cyalis/Viagra/Levitra?) but I guess I could be persuaded to include those. Abortion would be covered. If you don't like that? Grow up. Seriously. (I'll address why this is the case in another post, "Questions Answered about My Plan, because people have asked.) And mental health would get the same level of coverage as everything else. There's no reason to treat the brain any differently from any other organ that has something go wrong with it. (Currently most Ins.Co shaft mental health drugs big time.) Many things not currently covered, like Speech therapy to treat Autism, would also be covered.
The exact details on every little things can be worked out later, but the GUIDING PRINCIPLE is: If you're sick, and we can heal you, your healed. No fuss, no muss and little to no out of pocket expense! No one dies of anything we can fix, and no one EVER goes bankrupt for getting sick. Period.
PART TWO: So who actually RUNS it?!
Utilizing the enormous network of health care cast negotiators that already exists, the program will be managed by the insurance companies, much in the way they do now. The big difference is that they can't refuse coverage. Everyone gets treated, and the hospital (doctor, etc...) gets paid for everyone they see. DONE.
They will adjust their premiums to figure out what it would cost and then bill the government for that service. What stops them from just GOUGING the government? Simple: COMPETITION. They will have to bid to cover people. And once they get someone they have them for LIFE. SO: Every time a baby is born, they will want to snatch up as many babies as they can since, once born and vaccinated, most babies represent about 30 years of little to no cost. Since they'll be paid to cover them ANYWAY, they'll want as many of those babies as they can get. If their price is to high, their competitors will snatch them up and their current case load just gets older. (Which in the health care world is a disaster! If you can get paid the same for babies as for the over 65's, YOU WANT THEM!)
So they will negotiate prices. The difference between what they negotiate and what the government pays - THEY KEEP. So there's still a profit motive and opportunity. (But for PROVIDING care, not DENYING it!) Going back to PART ONE, to maintain "universal coverage" and to avoid both rationing and robbing people of control over their own care, they will be required to reimburse doctors/hospitals/etc... at a level that (for example) insures that any given person will have a choice of at least three doctors within 50 miles of their home (100 miles in rural areas) that will perform a given test or procedure at no additional cost to the patient. (Save for ~$20 co-pay, if applicable.) Some Doctors can still charge more, if they think the market will bear it, but the difference will have to be paid by the patient. But the standard payment will have to be enough to make sure I have at least three Doctors to choose from with no additional expense. This gives doctors an incentive not to gouge insurance companies because there will be great pressure for them to be among the "free" providers - or at least very close to "free."
Now - I've also thought about how to reimburse at a higher level for specialists. First off, we'll need some way of identifying who the specialists are. It could be years of service, education, experience... whatever. The HOW isn't really important. It would likely been done however it's done now. So let's say someone has a complicated case and needs a specialist. Teh specialist won't be working for the regular rate. So does that mean that the patient now has to pay? NO. Here's how it would work: Specialists get reimbursed at a higher rate, to the point where the "choice of three" doctrine is maintained. So who decides is you get to see the specialist? Not the government (as you may be suspecting, but) YOUR DOCTOR. That's right. You see the regular doctor. When he sees your complicated case, assuming he's not a specialist himself, he'll think "No way am I dealing with THAT, for what they're paying me!" (Since he's only getting the base rate) and he'll refer you to a specialist or three. If a doctor is willing to give up the chance to make a little money (because he judges that what's really needed is beyond what he's getting paid, and thus he'll be at a loss) that's good enough for me. Off to see the specialist!
PART THREE: So how do we PAY for it?
OK, you guessed it: The government will pay the insurance bills with increased taxes. But stay with me now! It's not nearly as bad as you think. In fact, YOU MAY NOT EVEN NOTICE. And corporations may even prefer it!
The increased taxes will be offset by the fact that you're no longer paying premiums. This new tax would be structured such that most people's take home pay would not be affected + or -. This tax would be partially based on income (to give a break to anyone making under median income) but would also vary with martial status and number of children, much the way your premium does now. But the guiding principle here is that your take home pay will be as close as possible, to what you're taking home now.
Corporate taxes increase will increase to, such that the revenue generated will be the same as what is currently being paid in premiums - this is meant to be revenue-neutral. The benefit of this is that in the form of a tax, it will not have to be paid by struggling firms, who would otherwise still have huge, fixed health care costs, and more of the bill will be footed by companies doing really well. Who could just as easily have a tough year next year, and be in the other boat themselves. (Don't believe me? As late as the 1990's it was UNTHINKABLE that GM, still the worlds largest and richest corporation at the time, would EVER declare bankruptcy.) So while ExxonMobil might not like the increased taxes now, 5 years from now (let's say) when they're approaching red ink, rather than BIG FIXED COSTS for health care, their cost will be... NOTHING! And that can easily be the difference between making a profit and taking a loss!
PART FOUR: So what controls costs?
Cost are controlled automatically, through market forces in a more functional manner than they are today: Doctors will charge what the market bears, but will have an incentive to be among those that are "free" to the patient. Insurance companies will be in competition with each other to bid for new babies to cover. Free market principals apply, but will be used to insure coverage, as well as control cost. But rather than let supply and demand drive price, we'll use price to drive supply, and competition to keep Price down.
YOU see a DOCTOR. The DOCTORS deal with the INSURERS. The INSURERS deal with the GOVERNMENT. And the GOVERNMENT bill YOU (and your EMPLOYER.)
That's the basic structure. I'm going to do a separate post on strengths and benefits and also for any questions I get here, and for questions I've gotten from the MediaMatters posters.
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