Seriously: what is the Republican plan to fix healthcare? They claim they'll get rid of Ocare....and do what?

stupid is wrote:

as stupid does wrote:

The government has been saddling companies with the cost of healthcare (and making individuals unduly dependent on their employers) for 70 years.

yes, and that has hurt our companies' competitiveness. that's the point. Some poster said that government should not have a role in healthcare - I was mocking that, since that would mean companies would most likely have to take on even more health care costs.

Your reasoning is entirely backward.

The reason that companies take on health care costs at all is because that cost to them is tax deductible whereas health care premiums paid by individuals are not. Getting the government entirely out of having a role in healthcare would necessarily include eliminating the corporate tax break for health insurance premiums.

As a result, eliminating a government role in health care would most likely yield a system where most companies would have no health care costs at all.

I am not saying that this would be a good or bad thing. Just pointing out that your logic is entirely backwards.

truckdriver wrote:

as stupid does wrote:

The government has been saddling companies with the cost of healthcare (and making individuals unduly dependent on their employers) for 70 years.

That's not accurate. Employers first offered health care as a benefit to attract workers.

Actually, it was entirely accurate.

Very, very few people were covered by any company health care plans until WWII when the government stepped in and created the single largest tax break in existence today - the write-off of employee health insurance premiums - thereby making it inevitable that companies would end up taking on health insurance rather than individuals (who do not get the same tax break on health insurance premiums).

Now please try informing yourself before posting. It will save everyone a bit of time.

The entire issue is that employers got involved with offering healthcare to employees to attract and retain workers in the first place.

The healthcare issue that this country subsequently faces is how to get healthcare coverage to all of the Americans that do not receive employer subsidized healthcare.

Part time workers, those that work for small businesses, contractors, freelancers, etc.

I've posted this before in other threads. I think a bigger picture needs to be covered for this topic. We have to learn to think beyond ourselves to truly understand health insurance and health care. Here it goes:

In order to understand why we have our current health insurance (not healthcare) system, we have to take a little history lesson. The whole system was an outgrowth of government implemented price controls during WWII. That's right, our current for-profit system was unplanned and not sought. The US was deeply concerned at the beginning of WWII that it would not be able to afford the full cost of conducting war. Most able bodied men were fighting and there was a serious shortage of labor to produce war material. The government implemented sweeping price controls to ensure that the price of a bullet in 1942 was the same as the price of a bullet in 1945. Simple economics meant that a shortage of labor meant that wages should rise, but companies were not allowed to do so. To attract labor companies instead started offering benefits including health insurance.

After the war, we were the obvious victors and the system was never dismantled because at the time there was no political drive to do so. We had the only remaining industrial base and thus had a ready made market where the whole world was forced to purchase U.S. goods. Economically, we won huge and were able to continue this higher costing and complex health insurance system. More importantly, every other nation had sweeping political changes or entirely new political regimes because the populace was sick of war and/or the losers of the conflict. This paved the way for every other post-WWII nation to choose their own form of health insurance. Effectively, every other nation had a politically blank canvas whereby policy makers and the populace could choose their preferred system. Interestingly, despite having the US as a stand out example of excellence, they chose something different where everyone was covered despite employment status.

What has happened in the ensuing 70 years? The world recovered economically and restored their ability to manufacture. The U.S. no longer enjoys a monopoly on our goods abroad. Our companies large and small are put at a significant disadvantage compared to international competition because they are throttled with the burden of this patchwork of health insurance systems. This is one of the major reasons why businesses have actively chosen to sell or move abroad. All you have to do is look to the thread yesterday where a small business owner is drowning under the administrative burden of insuring his 25 employees let alone the cost of dealing with it.

We need to collectively realize that our health insurance system was never chosen by us, it is the inherited child no one thought they would have to deal with. This system was never expected to be contorted into the fragmented mess it is today let alone survive past the War. Honestly, nothing short of a revolution will change this system because a select few powerful people / companies profit well at the majority's expense.

If we as a people could see through the fog, the answer is clear. Our current system puts our companies at a significant disadvantage from their international counterparts. Also, each employee or entrepreneur is handicapped. Employees are saddled with our employer until we can find another employer with decent health insurance. This is a problem because people's employment choices should be based upon work, not insurance. When the economy tanks, millions of people lose insurance overnight as they lose jobs. Finally, it becomes that much harder to start a company because to do so means that you may forgo having health insurance and thus are at risk of losing your company to unforeseen health problems. Ultimately, by decoupling health insurance from employment means a more flexible and more adaptable workforce.

There, I did it. I framed the argument in a way you neocons can understand.

I've seen a few people ponder what decoupling health insurance from employment would mean and I felt the need to opine.

The fundamental problem with US health insurance is that it has two entirely juxtaposed goals. The first goal is to provide financial coverage for those insured within the plan based upon the medical needs of those within the plan. The second goal is to maximize profit of the company and therefore shareholder value. In order to fulfill the needs of one side, the other loses ground and it is a constant battle. Unfortunately, the shareholder wins more battles than the medical consumer.

The reason for this is simple. The insurance company must negotiate with three separate entities. First, the provider. Most providers are very large companies as well that make it their business to provide care and push hard to get paid for it. Second, is the company which purchases the insurance plan (employer). They too have a bottom line they need to protect. They can negotiate, but at the end of the day, there is a minimum profit the insurance company is willing to earn. This drives employers to cheaper and cheaper plans or shouldering less of the premium. Any 30 year employee has seen this drifting of benefits over their lifetime. Third, are the employees / plan holders. They have virtually no negotiating power. By the time the choice comes to an individual, you will have a small handful of plans to pick from and the open marketplace is guaranteed to be worse unless you have income below poverty. This is why the burden of expense has drifted towards the individual and the ACA does little to affect this balance. In all actuality the ACA was a boon to the insurance industry in disguise. In addition, the consumer has no negotiating power on the cost of any drug or the cost of any care.

Arguments are often made by insurers that these new plans "put you more in control" or that it "allows you to understand the cost of care". The problem with this statement is it ignores the way unique way people consume healthcare. Healthcare in general is highly inelastic meaning it is not price sensitive regardless of the cost. If you have a heart attack, you don't wait to get a preauthorization and then instruct the ambulance to send you the cheapest hospital while you shop around. If your kid has leukemia, you don't find the cheapest solution. You search for the best solution to save someone that you love more than money.

To further obfuscate the problem is the cost of everything is highly fungible based upon who is paying / the source of funds. What I mean is that providers can rarely have the same price for the same service for two separate buyers. They do this to maximize revenue and thus maximize their own profit. They often have to do this because the insurance companies make it their job to whittle that bill down as much as possible.

Okay, so I just stated a whole lot about the current situation without providing solutions. I have my own strong opinions, which is why I withheld them until now. The following is why I say change from the current situation requires nothing short of a revolution. The solution requires trade offs, different freedoms, and several huge puzzle pieces to be aligned.

First: decouple employment from health insurance. Statistically speaking, those recently unemployed or under employed are most likely to require healthcare. People need access to care regardless of their current ability to work. A healthier population ultimately works more; earns more; and thus pays more taxes.

Second: eliminate the profit motive from the health insurance companies. This one is huge and nearly impossible. One possible example for guidance is Germany. Germany does not have a single payer system yet has universal coverage. They have many different insurers. However, German insurers are not permitted to make a profit. If premiums are too much, they must return those to the policy holders in the form of lower premiums the next year. What is to motivate the insurance companies then? Their right to exist. They compete for customers / policy holders rather than shareholder value. If they charge too much, customers seek other insurers. This system does work. The Germans have used the framework set down by Bismarck for decades.

Third: end political intervention that favors the pharmaceutical industry / providers. A great example of this abuse is Medicare Part D (prescription drug coverage). Medicare is not permitted to negotiate with the drug companies for drugs provided to seniors. That means that the taxpayers are on the hook for the full retail price of the drugs. This is a huge failing and a public disservice because Medicare is being barred from pursuing one of its primary purposes which is to negotiate for the collective welfare of our senior citizens. A nationwide single payer / multi payer system must be empowered to negotiate aggressively with multinational drug companies.

Fourth: we have to overhaul the tort system so doctors, hospitals, and the medical establishment can't be sued into oblivion. A significant portion of our healthcare costs come from high medical malpractice insurance premiums as well as the collateral damage from expensive unnecessary suits. What we lose by doing this is the ability to enrich a few based upon the mistake of a medical professional. If a doctor screws up, they should lose their job and license, not put another attorney in the Hamptons. This reduces the expenses doctors pay and thus doctors can be paid less and still keep a high standard of living.

Fifth: End the obfuscation of the costs of all services. When you buy anything else in this world, the price can always be quoted upfront prior to the transaction. Only in America is the cost disclosed after the service has been performed. This system makes it impossible for any consumer to make an informed decision even if they had the time to research their needs. In an emergency, this is even worse as the provider knows no shopping can be done. Japan does the exact opposite by conducting an annual study, publishing the results, and then dictating the price of every single good or service they charge. Until recently, it was literally in a huge book like a dictionary. Anybody, could go to this book and see exactly what you would be charged for anything. Taiwan also implements their own market studies and cost controls. The key is that they revisit these items annually and adjust accordingly to ensure that the system continues to function and that care continues to be delivered to the population.

Sixth: End the for profit university system. Another significant contributor to the expense of healthcare is that medical professionals can graduate up to a quarter of a million dollars in debt before they even start working. They are in-turn compensated with high salaries (theoretically). If college education was based upon academic ability rather than how much money you have / can borrow, we would not have the same costs in healthcare. Voila, everyone gets paid less, but they can still maintain their high standard of living without being burdened with huge debt loads. Again, Germany does this through their taxpayer funded college system which provides free higher education to its citizens. Their doctors earn on average one half to one third their American counterparts, but they don’t have the same debtload they must overcome to achieve their high income.

Finally, I am deeply disturbed by the growing sentiment I am reading about a complete free market system. While it may sound nice at first, I’m not sure that thought has been followed to its ultimate conclusion. While you may have some negotiating power now, good luck getting any in that system. One of two paths show up in that situation, both of which are ugly and morally disturbing. One, insurance companies cease to exist and everything is out of pocket and a la carte. For someone young and healthy, that may be feasible. Once age and chronic illnesses kick in, this could prevent people from getting care and ultimately curtail their worklife and actual life by years or decades. In the other path, insurance companies exist, but you buy what you can afford. Again, the young do fine, but the older and parents of sick children will lose big. Those people will either be uninsurable or the premiums so exorbitant that few will be able to pay. Half of the population will get cancer at some point in their life (healthy runner’s included). In a free market, you will either become uninsurable due to advanced age or prior conditions and likely will get no coverage prior to having cancer or certainly following it. Again, it comes down to negotiating power. None of us have the ability on an individual basis to negotiate effectively with insurance companies or providers so don’t plan on doing well in this system. In the free market, you can guarantee lower life expectancies and a lower quality of life for all but the richest Americans.

The trade offs with what I am proposing can be varying. We as a nation would be accepting that we can no longer individually choose to believe we will always be healthy and therefore pocket a couple bucks that year in reduced premiums. We also lose the ability to get rich off a doctor’s mistake. However, if it is done correctly, it can benefit nearly every American by providing them with more health care security, greater employment flexibility, and equal or greater care at potentially lower costs.

I am not saying that moving away from our current insurance model will make the world perfect. Far from it. To those that say the transition cannot be done, look to Switzerland. They switched from our model to universal coverage in the 90s and there isn't a hint of that population demanding the old system back.

L L wrote:

The entire issue is that employers got involved with offering healthcare to employees to attract and retain workers in the first place.

The healthcare issue that this country subsequently faces is how to get healthcare coverage to all of the Americans that do not receive employer subsidized healthcare.

Part time workers, those that work for small businesses, contractors, freelancers, etc.

Having employers involved in the health care of their employees is a fundamental problem. One way or another this should be eliminated.

I think you don't understand 'tax deductibility'

tax deductibility does not make things free. It makes them less expensive. Point being that if IBM didn't have to pay for healthcare, it would save billions. Even tho the premiums are deductible.

and yeah - companies started offering health care as a benefit to attract workers - not for some tax benefit.

Why not just increase taxes on rich, white men?

Paper wrote:

There is no way for the government to "fix" healthcare other than to stop breaking it by being involved at all. The only governmenr policy on healthcare should be a Constitutional amendment making it illegal for the government to subisidize or regulate it in any way whatsoever.

It's already illegal for the federal government to get involved in health in any way. It's not listed as a responsibility delegated to the federal government in article 1, section 8, so it falls through the 10th amendment to States or to the people.

If we had a Supreme court that actually ruled according to the written law, and if our government obeyed it's own laws, then one single person should be able to sue the federal government and put an end to ALL federal government involvement in health care in one shot.

Adding new rules to the rule book makes no sense when our judges and elected officials simply ignore the law.

We used to have a Constitutional Republic, where the people elected representatives who had to govern within Constitutional limitations no matter what the majority wanted.

Now, all we have left is a Republic, where the majority can do whatever it wants, and that aint good. It's called the tyranny of the majority.

And you are wrong. Try saying things that are not wrong.

More stupidity. Sorry, I have been trying to be nice but your lack of understanding is quite extraordinary.

Of course companies offer any and all benefits that they offer to attract workers. Why in the world would they offer benefits if they did not attract workers.

BUT, and this you seem to be having a hard time understanding, as soon as you make health insurance costs tax deductible for companies (but not for individuals) it is a 100% certainty that companies will offer health insurance as a benefit. An alternative "benefit" would simply be to offer higher salaries. Why don't employers just give their employees the money that they spend in health insurance premiums? You guessed it, it is because there is greater benefit in spending this money on health care premiums rather than higher pay. And why is this? Oh, because it is tax deductible for the company (but not for the individual).

Now please, please educate yourself. It is not hard. Go ahead and look up the history of the tax break on health insurance costs for companies. It won't take you very long to find out that, oops, companies did NOT offer health insurance prior to this tax break and that, what do you know, suddenly they started to offer health insurance once this tax break was put into place.

Seriously, educate yourself. It doesn't hurt. I promise.

Honestly you guys, nothing does more to paint a picture of the US as a mean, selfish, uncaring, "if my neighbor is doing well for himself then i must be doing worse" nation than reading some of this horse$hit about healthcare.

The provision of healthcare should be based on someone's medical need not their ability to pay, is utterly barbaric.

You go, girl!

Radical fixes for OblunderCare

-Credit all taxpayers the amount of premium increase in tax credits

-Mandate all insurance companies that must offer a policy in every state or else they are not allowed to be in business

- Mandate max 5% profit for insurance companies, if they don't like it, quit or leave

- Mandate all drug companies to get max 5% price increase/year, they don't like it, quit or leave

- Mandate all hospitals, they get max 5% profit, they don't like it, quit or close

- Reduce all 535 Congressional member salaries to $1 dollar until insurance resolved or

- Congress keeps their salaries but charge them $1,000 per day until a new insurance program is approved by the president (gives them plenty of incentive to get the job done)

Wow you guys are dumb

And that education should start with "the law of unintended consequences".

All this started in WWII when the government tried to freeze everyone in place so that the war effort wouldn't get disrupted by people moving around, so they put freezes on wages so that companies couldn't steal employees away from other places. This forced the companies to offer benefits instead of salary, and that's how company sponsored health care plans started.

As usual, the government created the mess in the first place and now we're supposed to think that they can fix it... again.

Get the government out of all of it, and it will get better.

L L wrote:

It's easy for you to say that you have no problem killing it and replacing it.

But millions will lose coverage for care that they currently have.

I am not sure why you have no problem with other people having problems.

Maybe you are just selfish.

I'm sorry, but that's just silly.

Again, we're broke as a country. So, what you're saying that you're morally superior to me because you want to borrow trillions of $ plus interest to give something to people who chose not to pay for it.

I reject that thinking completely.

That thinking is why this country is a mess.

so your idiot argument is that any benefit that is tax deductible would automatically be offered to workers?

so, how's your free car supplied by your company doing? because by your logic we all have nice company cars! because they would be tax deductible to our companies.

vroom vroom, buddy

you good with giving up your medicare?

"Get the government out of all of it, and it will get better."

Hmmmm so when your insurance company drops you when....

you turn 60,

when you are diagnosed with a disease,

when you file a claim,

when you need an ongoing medication,

when you are in a car wreak,

when they find out you have a family history of heart disease/cancer/diabetes...

Who are going to turn to, the free market?

Can YOU pay for your parents to stay in a nursing home, all their medications, transportation to doctor's offices, nursing care?