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  1. KAM1138
    KAM1138's Avatar
    #1  
    Hello Everyone,

    I know this is a fresh thread on a topic that is well, worn, but I think this may be an appropriate break point.

    I have no idea what's going to happen, and various "nuclear" options have been bandied about, and the range of opinion goes from "We must pass something at any cost" to "its dead."

    So, I ask...what do you think we should do from here, or rather, what should be done.

    Here's what I would like to see. Republicans seem to have gained an advantage (no matter how small), so I think they have an opportunity to make a positive step forward. Since, I am an advocate of actual reform (not whatever mangled mess they can force through), I suggest a positive approach to this--in order to maximize benefits to the American people.

    I would like to see Republicans present a list of ideas that they believe there can be broad agreement--and thus pass. I think a few areas to hit immediately are: Reform of Medicare and Medicaid to track, eliminate, and reallocate funds lost to fraud. I'd suggest creating a "blue ribbon" commission (temporary) to review how funds are being spend, and distributed, and if there are areas where savings can be found. I also suggest that they look at the medicaid system as a whole (existing money being spent--around 300 billion annually) and ask the simple question--why isn't that enough to provide Health insurance to those 12-47 million uninsured. Personally, I think this is the key to the entire problem of the uninsured--spending money WISELY would go a long way.

    Second: Preexisting conditions and cancellation of policies. I think this is an area where a close eye needs to be kept on insurers. I think an efficient system to deal with claims of insurer wrongdoing might help. Simply stated--I think that we need to decouple employment from insurance. A policy should be attached to a person, not an employer.
    I think an equitable system that doesn't punish someone with pre-existing conditions for what MAY happen (and may never happen), should be established, and my view is that this should be an additional Co-Pay ONLY applicable to narrow areas--directly related to the Preexisting condition. The pipe-dream of simply ignoring preexisting conditions isn't realistic, or financially sound.

    Third: ALL healthcare costs, including insurance premiums for all Americans should be tax deductible. That is instant savings for the American Taxpayer.

    Fourth: Tort Reform. Clean up the mess, before adding additional complications.

    Fifth: Begin to extricate Insurance companies from common medical care needs. There is no reason we should be trying to insure for every sniffle or bruise. Medical Insurance should be for an unexpected major medical problem, not a common ailment. This will help alleviate the burden both of volume (overhead) and overall payout--which will allow for lower costs for the really important unknowns--the whole purpose of insurance.

    Sixth: Stop the end-run between Health care Providers and Insurers. The only way to control costs is to have the consumer of the Services aware of and sensitive to the cost issues. When someone says that 2 Tylenol in a hospital cost $28 (or whatever) the consumer has to be able to say "no" and have the motivation of their own pocketbook as a reason.

    Now, of course, there are people who can't afford this...right, the same as now, which is why we need to reform Medicaid and use those MASSIVE amounts of money wisely.

    Let's start clean, and do what should have been done in the first place (regardless of whether my ideas are accepted or not)--deal with the common ground and get beneficial things done, rather than reaching for the sky, and then cutting dirty deals one after the other to prop up a shameful mess and calling it reform.

    KAM
  2. Habious's Avatar
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    #2  
    I couldn't agree more with all of your points.

    For your Fifth point...what's wrong with having insurance deductables, just like our car insurance has now?

    You can get a policy for your car that doesn't kick in until the damage is over $1,000. If you want, you can get a policy that kicks in when the damage is only over $250.00...but that policy will cost you more per month than the $1,000-deductable policy.

    This system works great. You buy as much coverage as you want/need.
  3. #3  
    on point 5, my wife had a plan though her previous employer where she paid 30 bucks every 2 weeks. However the deductable was 5000. In addition to that they paid 100% of preventive and 100% after the deductable was met.

    And while this is not related, her company used to match 3:1 every dollar she put in a HSA (not FSA). So far that has been the best plan we have seen. It met our needs and that covered her and both kids.

    Now for how much that plan costs on cobra... about 1k a month. These are some of the things that i hope change for the better. There is no reason that insurance should cost more than rent (which differs by region). And if it becomes illegal to not have insurance.... well this will put more of a burden on the tax payer as more people we be going to jail as out unemployment continues to rise.

    For the rest of the info, i like it, but am still not in favor of our gov getting involved in more aspects of our life.
  4. KAM1138
    KAM1138's Avatar
    #4  
    Quote Originally Posted by Habious View Post
    I couldn't agree more with all of your points.

    For your Fifth point...what's wrong with having insurance deductables, just like our car insurance has now?
    Well, a high deductible parallels what I suggest fairly well. I prefer just eliminating it, to remove the paperwork burden--which does cost money.

    Quote Originally Posted by Habious View Post
    You can get a policy for your car that doesn't kick in until the damage is over $1,000. If you want, you can get a policy that kicks in when the damage is only over $250.00...but that policy will cost you more per month than the $1,000-deductable policy.

    This system works great. You buy as much coverage as you want/need.
    Theoretically, I don't have a problem with it, but practically speaking, I think it ends up contributing to rising costs if we try to cover common things.

    I used the Analogy of trying to include Gasoline insurance as part of auto-insurance. Even if nothing else, at least the overhead would lead to higher costs. Meaning--you can't have an insurance model for something that you know is going to happen for sure, on a regular basis--like buying fuel, or common medical needs (which almost everyone needs at some point).

    KAM
  5. KAM1138
    KAM1138's Avatar
    #5  
    Quote Originally Posted by scoobdude View Post
    on point 5, my wife had a plan though her previous employer where she paid 30 bucks every 2 weeks. However the deductable was 5000. In addition to that they paid 100% of preventive and 100% after the deductable was met.

    And while this is not related, her company used to match 3:1 every dollar she put in a HSA (not FSA). So far that has been the best plan we have seen. It met our needs and that covered her and both kids.

    Now for how much that plan costs on cobra... about 1k a month. These are some of the things that i hope change for the better. There is no reason that insurance should cost more than rent (which differs by region). And if it becomes illegal to not have insurance.... well this will put more of a burden on the tax payer as more people we be going to jail as out unemployment continues to rise.

    For the rest of the info, i like it, but am still not in favor of our gov getting involved in more aspects of our life.
    I am not aware of anywhere the US Government has been empowered by the people of this country to require anyone to buy health insurance as a consequences of being a citizen. No way should that be tolerated.

    As far as HSA...I think under our current system this is a great option. Matching funds...that is really great. It helps to accomplish my third point--although with limitations.

    KAM
  6. #6  
    Health coverage as described in both versions would not stand a court test unless the courts were packed.
  7. #7  
    You really nailed alot of great points!

    Here's my 2 cents:

    Once we get this whole employer sponsored group health insurance idea out of people's heads and replace it with a tax deduction on the purchase of their own portable INDIVIDUAL plan the closer we will be to fixing this mess. As it stands employers who buy insurance do so at the expense of allowing individuals to purchase it on their own....and what you allow someone else to do for you, can also be taken away from you.

    Nobody can take your car insurance away from you. That's because you buy it with your own money. Same should be the case with health insurance.
    Last edited by foosball; 01/21/2010 at 12:40 AM.
  8. #8  
    Quote Originally Posted by KAM1138 View Post
    deal with the common ground and get beneficial things done, rather than reaching for the sky, and then cutting dirty deals one after the other to prop up a shameful mess and calling it reform.

    KAM
    What bill did you propose?

    How long did you spend in office?

    Dirty deals???

    All "good ideas" start much like yours... very innocent... very popular... very nice... easy and simple.

    Then reality sets in and you realize that your ideas don't fly when you have all "sponsors" sitting at the table.

    Of course, talking and making things work, is called "dirty deals".

    With your path, you would never get anything accomplished.

    I highly recommend you read some negotiation books... lol
    01000010 01100001 01101110 00100000 01010100 01101000 01110010 01100101 01100001 01100100 00100000 01000011 01110010 01100001 01110000 01110000 01100101 01110010 01110011 00100001
  9. KAM1138
    KAM1138's Avatar
    #9  
    Quote Originally Posted by theog View Post
    What bill did you propose?

    How long did you spend in office?

    Dirty deals???

    All "good ideas" start much like yours... very innocent... very popular... very nice... easy and simple.

    Then reality sets in and you realize that your ideas don't fly when you have all "sponsors" sitting at the table.

    Of course, talking and making things work, is called "dirty deals".

    With your path, you would never get anything accomplished.

    I highly recommend you read some negotiation books... lol
    Are you under the impression that I was talking about negotiation? I wasn't--I was talking about ideas--as a Citizen. Asking what bills I introduced is just silliness--you are presumably aware that I'm not a member of Congress. So, were you just making some sort of meaningless backhanded jab, or is there a point?

    No--dirty deals are just that. It is selling out the American public to buy off your union pals for example. I know that talking about this exposes the people you support as the exact same politicians that they railed against, not agents of "hope and change" or whatever other meaningless drivel they used to get elected.

    What I want to hear for example is why our politicians would reject simple solutions--which may include things I mention (may include others). I want an actual honest debate, and have them go on record in a straightforward way...you know, so they are accountable to the American People.

    Oh I know--for such sophisticated folks as yourself, that sort of notion is just so archaic, so unrealistic. I guess I'm just a silly idealistic fool that way, thinking that my government should be accountable to its citizens, instead of serving special interests who pour money into campaigns, and then expect (and get) their payoffs.

    Perhaps you are satisfied with such blatant corruption, but don't expect others to be.

    KAM
  10. #10  
    Kam, good points but here is what I've posted in here before, and I know you will not like # 2:

    1) Get rid of pre-existing conditions
    2) Require participation. I hate this step, but step 1 only works if you do step 2. You can't have people coming onboard with no pre-ex only when they have an illness or accident. Plus, this helps keep premium costs down as the healthy and youngsters are paying into the system.
    3) Step 1 helps the person who can afford the coverage but can't get the coverage, but does nothing for the person who simply can't afford it. So, the states must help fund those that can't afford it. This can be done by some type of gas tax (.05/gallon?) or sales tax. These funds must be allocated for health premium assistance. The amount (%) you qualify for depends on your income.
    4) Open up coverage across state lines.
    5) Aggressively attack Medicare fraud.
    6) Tort reform.

    Unfortunately, you can't get rid of pre-ex without requiring everyone to enroll. I hate # 2, but to get costs down you must have everyone covered, especially the healthy folks who would be paying premiums but getting nothing back until they have an accident or get sick. To not require 100% participation means that health providers will end up taking care of them basically for free (as they do now) and passing these costs on to those of us with health insurance. But if the insurance companies have these younger members paying in, it will help offset the costs of those with a much higher outflow of expenses.
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  11. #11  
    Quote Originally Posted by scoobdude View Post
    Now for how much that plan costs on cobra... about 1k a month.
    COBRA is not some plan that has higher costs, it is the same premium that the employer was being billed. But while you work for the employer the biz pays a portion of the premium and therefore many people don't see the entire premium. The only additional costs for COBRA is 2% which is allowed by law to be charged for administrating the COBRA. Other than that 2%, COBRA premium = Employer billed premium.
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  12. #12  
    My proposal....

    • Government runs healthcare as a public service and provides this service to all citizens and legal residents.
    • Everyone receives the same level of service and that same level of service is available everywhere.
    • There are no worries about bills or coverage denials because these issues do not exist.
    • The "less fortunate" have full and complete accsess to health care and therefor are now practicing preventative medicine, this saves the tax payers billions every year.


    I lived with such a system for nearly 30 years in Canada. Worked very well. Perfect? No. Better than here? Yes. The USA already spends more tax payer money per capita every year on healthcare than Canada (or many other nations that have public medicine), so the money is already there....just need to spend it smartly.
  13. #13  
    Quote Originally Posted by ryleyinstl View Post
    My proposal....

    • Government runs healthcare as a public service and provides this service to all citizens and legal residents.
    • Everyone receives the same level of service and that same level of service is available everywhere.
    • There are no worries about bills or coverage denials because these issues do not exist.
    • The "less fortunate" have full and complete accsess to health care and therefor are now practicing preventative medicine, this saves the tax payers billions every year.


    I lived with such a system for nearly 30 years in Canada. Worked very well. Perfect? No. Better than here? Yes. The USA already spends more tax payer money per capita every year on healthcare than Canada (or many other nations that have public medicine), so the money is already there....just need to spend it smartly.
    WOW....free coverage....sign me up! What? It isn't free? Wait, how much do I have to pay? It depends on my income? Well why should that matter if it is the same for everyone? So how is this paid for? Will the amount paid into this system actually keep the program solvent or will it be like most government programs and run in the black until it just goes bankrupt?
    PalmPilot, PalmIIIc, Treo 650, Pre, Pre 3, Nokia 1020, Lumia 950

    "It's good to be the King" - Mel Brooks, History of the World, Part 1

    "I would rather have a German division in front of me than a French one behind me." General George S. Patton
  14. #14  
    There is no such thing as "free" healthcare.

    Like I said, the US taxpayer is already paying enough money to cover a public medical system.

    Your income level is not a factor in determining the level of service you receive as everyone receives the same level of service.

    Public medicine isn't designed to run as a profitable business (at least not in Canada). It's a public service funded completely by taxpayer dollars. Healthcare is administered at the provincial level just like any other ministry such as Transportation or Education. Budgets are set yearly and the various health regions within a Province have to operate within the budget set by the Government.

    Solvency and bankruptcy aren't factors.

    Quote Originally Posted by clemgrad85 View Post
    WOW....free coverage....sign me up! What? It isn't free? Wait, how much do I have to pay? It depends on my income? Well why should that matter if it is the same for everyone? So how is this paid for? Will the amount paid into this system actually keep the program solvent or will it be like most government programs and run in the black until it just goes bankrupt?
  15. #15  
    Quote Originally Posted by ryleyinstl View Post
    There is no such thing as "free" healthcare.

    Like I said, the US taxpayer is already paying enough money to cover a public medical system.

    Your income level is not a factor in determining the level of service you receive as everyone receives the same level of service.

    Public medicine isn't designed to run as a profitable business (at least not in Canada). It's a public service funded completely by taxpayer dollars. Healthcare is administered at the provincial level just like any other ministry such as Transportation or Education. Budgets are set yearly and the various health regions within a Province have to operate within the budget set by the Government.

    Solvency and bankruptcy aren't factors.
    Do you live in the US now, or still in Canada? I think the biggest difference between your thinking and my thinking is regarding whether "solvency and bankruptcy" are factors. I believe those are quite important for it to remain a viable long term solution and not put our country further in debt. I can't speak for the level of debt in Canada, but here in the US we are in deep dodo. We simply cannot keep funding programs and say "solvency and bankruptcy aren't factors."
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  16. #16  
    I live in the USA at the moment.

    Canada does have public debt like most other western governments, around 520 billion, and spends 30 to 40 billion each year paying it off. Since the 80's the trend has been to run the federal government deficit free (in the black) but I think the world financial issues of late have caused a slight bump in that road temporarily.

    Provincially many governments run deficit free and some don't. In Alberta (where I'm from) the public debt was fully paid off a number of years ago.

    Considering the US taxpayer is already spending more tax dollars per capita then Canadian taxpayers, public healthcare could work here without increasing taxes (theoretically). Naturally this would require a cataclysmic change in policy as well as a gigantic change in how American's view healthcare.

    There would also need to be an ideology shift about providing the same level of care to all individuals regardless of there ability to contribute to the public purse (via income taxes). Most Canadians are comfortable with it but I don't think American's would be.

    Quote Originally Posted by clemgrad85 View Post
    Do you live in the US now, or still in Canada? I think the biggest difference between your thinking and my thinking is regarding whether "solvency and bankruptcy" are factors. I believe those are quite important for it to remain a viable long term solution and not put our country further in debt. I can't speak for the level of debt in Canada, but here in the US we are in deep dodo. We simply cannot keep funding programs and say "solvency and bankruptcy aren't factors."
    Last edited by ryleyinstl; 01/21/2010 at 10:20 AM.
  17. KAM1138
    KAM1138's Avatar
    #17  
    Quote Originally Posted by clemgrad85 View Post
    Kam, good points but here is what I've posted in here before, and I know you will not like # 2:

    1) Get rid of pre-existing conditions
    2) Require participation. I hate this step, but step 1 only works if you do step 2. You can't have people coming onboard with no pre-ex only when they have an illness or accident. Plus, this helps keep premium costs down as the healthy and youngsters are paying into the system.
    3) Step 1 helps the person who can afford the coverage but can't get the coverage, but does nothing for the person who simply can't afford it. So, the states must help fund those that can't afford it. This can be done by some type of gas tax (.05/gallon?) or sales tax. These funds must be allocated for health premium assistance. The amount (%) you qualify for depends on your income.
    4) Open up coverage across state lines.
    5) Aggressively attack Medicare fraud.
    6) Tort reform.

    Unfortunately, you can't get rid of pre-ex without requiring everyone to enroll. I hate # 2, but to get costs down you must have everyone covered, especially the healthy folks who would be paying premiums but getting nothing back until they have an accident or get sick. To not require 100% participation means that health providers will end up taking care of them basically for free (as they do now) and passing these costs on to those of us with health insurance. But if the insurance companies have these younger members paying in, it will help offset the costs of those with a much higher outflow of expenses.
    Well, what do you think of my alternate idea for Pre-existing conditions--simply create an exception for that narrowly focused problem--making the customer pay ONLY for that issue--if it ever comes up again. That would allow people with pre-existing conditions to get coverage and not be penalized for what may never happen again. Its a shared risk, and there would be an additional co-pay IF it ever occurs. I think something like this is necessary, because simply eliminating Pre-existing conditions will not work.

    Here's the thing about 100% enrollment--its not Constitutional. We cannot force people to buy insurance. The problem is that we aren't willing to make people be responsible for themselves.

    Now, obviously some people cannot pay, but with $300 billion a year on Medicaid, I think we can cover those people--that money just needs to be spent wisely. If we do this (I know--its still a government subsidy, but I can't change everything all at once), we will have everyone covered.

    We don't need massive new programs--we need to reform the ones we have, and use the money we already spend wisely.

    KAM
  18. KAM1138
    KAM1138's Avatar
    #18  
    Quote Originally Posted by ryleyinstl View Post
    My proposal....

    • Government runs healthcare as a public service and provides this service to all citizens and legal residents.
    • Everyone receives the same level of service and that same level of service is available everywhere.
    • There are no worries about bills or coverage denials because these issues do not exist.
    • The "less fortunate" have full and complete accsess to health care and therefor are now practicing preventative medicine, this saves the tax payers billions every year.


    I lived with such a system for nearly 30 years in Canada. Worked very well. Perfect? No. Better than here? Yes. The USA already spends more tax payer money per capita every year on healthcare than Canada (or many other nations that have public medicine), so the money is already there....just need to spend it smartly.
    Fair enough, but here are a few points.

    1) If I want a Canadian system, why wouldn't I move to Canada--its nice, and they speak English even, and have a culture that most Americans could likely easily adapt to.

    2) You say that you have the same level of service. Ok--what level is that?

    3) We do need to spend that money "smartly"--the government who is the single largest payer of medical costs in the country and a significant amount of the total isn't spending it wisely--which is part of the problem. If they were, then perhaps our per-capita spending would be more favorable.

    KAM
  19. #19  
    My guess is that most Americans want to stay and "fix" healthcare. It's "the best nation in the world" after all.

    Level of service is an interesting question (quality is equal). Based on my experience so far I'd say it's the same. There are differences but for me it's been a "6 of one half dozen of another" type situation.

    For example. Say I need an elective surgery to fix a deviated septum or cosmetic work after a car crash. Here in St. Louis I would make an appointment with a surgeon for a consultation and could likely schedule the procedure for the following week, if not sooner (after checking with my health insurance provider first to see what is covered and what isn't and how much I might need to pay, blah, blah, blah). Back in Canada you would likely need to wait 1 to 3 months. That said, in the Canadian system all citizens and legal residents, regardless of age or income, are entitled to that service and will be treated equally during the whole process.

    Which system is better is largely a matter of opinion and/or values.

    In my experience American's generally feel that they have worked hard for their money and the benefits of that work should (as it pertains to covering the costs of healthcare) go to them directly....each person reaps the rewards they make for themselves. Canadian's put that same money into a "pot" and use it to cover everyone's needs. 2 different ideologies.


    Quote Originally Posted by KAM1138 View Post
    Fair enough, but here are a few points.

    1) If I want a Canadian system, why wouldn't I move to Canada--its nice, and they speak English even, and have a culture that most Americans could likely easily adapt to.

    2) You say that you have the same level of service. Ok--what level is that?

    3) We do need to spend that money "smartly"--the government who is the single largest payer of medical costs in the country and a significant amount of the total isn't spending it wisely--which is part of the problem. If they were, then perhaps our per-capita spending would be more favorable.

    KAM
    Last edited by ryleyinstl; 01/21/2010 at 11:11 AM.
  20. #20  
    Quote Originally Posted by KAM1138 View Post
    Well, what do you think of my alternate idea for Pre-existing conditions--simply create an exception for that narrowly focused problem--making the customer pay ONLY for that issue--if it ever comes up again. That would allow people with pre-existing conditions to get coverage and not be penalized for what may never happen again. Its a shared risk, and there would be an additional co-pay IF it ever occurs. I think something like this is necessary, because simply eliminating Pre-existing conditions will not work.
    Not sure I understand your option. Let's say someone is terminated from employment, and whether they have state continutation (less than 20 employees) or COBRA their coverage is about to run out and they have come down with cancer and are receiving treatments. Explain how your option would help them. On another example, say a self employed individual is looking for coverage and he had back surgery 6 months ago, how would your plan work for him?

    Quote Originally Posted by KAM1138 View Post
    Here's the thing about 100% enrollment--its not Constitutional. We cannot force people to buy insurance. The problem is that we aren't willing to make people be responsible for themselves.
    I agree with you on this, but I also don't believe Social Security is Constitutional and yet we have that, correct? Oh sure, the Supreme Court ruled it was Constitutional back in 1937 (Helvering v Davis), but if you have a chance read up on why. Here is one side of that story: Is Social Security Constitutional? by John Attarian But I figure if they can force you and I to contribute to Social Security, they can force us to buy health insurance.

    Quote Originally Posted by KAM1138 View Post
    Now, obviously some people cannot pay, but with $300 billion a year on Medicaid, I think we can cover those people--that money just needs to be spent wisely. If we do this (I know--its still a government subsidy, but I can't change everything all at once), we will have everyone covered.

    We don't need massive new programs--we need to reform the ones we have, and use the money we already spend wisely.

    KAM
    I agree about not needing more massive programs. That is why I like my plan as it keeps the government out, for the most part. Hard to keep the gov totally out (grrrrr).
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