Well, sure there are companies that, wanting to attract the best people, will keep funding a private healthcare benefit. A lot more companies, especially in difficult economic times, will find the opportunity to add $$$$ to their bottom lines irresistable. This is, again, what happened with TennCare- it nearly bankrupted the program. Tennessee ended up having to disenroll people and cutting the scope of who could participate. I still havn't seen a good argument as to why this won't happen with a national healthcare plan that shares much with the TennCare plan. And, worse, a national plan with universal coverage as it's goal won't be able to disenroll people- which means that when, not if, costs rise above what was expected, what was budgeted, that the only options to try and meet those budget shortfalls will be increased taxes or reduced benefits. Probably both.

I see a number of comments such as, "Gee, why wouldn't you want healthcare for everyone?" It's not that simple.

At some point, America continuing to prosper as a Nation must outweigh what Peggy The Moocher wants.

Obama givin' us money

It can't be that hard, every other civilized nation has health coverage for everyone, if those backwoods countries can do it the great and powerful US of A should be able to handle it no sweat right?

The CBO just crunched the numbers on the House of Representatives' bill which has a public option. CBO says it reduces the deficit and would cost $871 billion over 10 years [works out to about $87 billion a year on average, compare that with our $500 billion annual defense budget] and result in 96% coverage of all Americans (I think currently we have like 83% coverage).

http://www.cnn.com/2009/POLITI.../21/health.care.cbo/

This is the bill I vastly prefer over Baucus's bailout for insurance companies that is in the Senate, though I'm sure the conservative Americans here will complain about it as well as the Baucus bill [seems like all the Americans here are conservative but me, and all the Brits are liberal...lol I'm so lonely ].

The government's estimate for the cost of programs like Medicare is often overly optimistic:



There can be little doubt that the cost of a US NHC will be significantly more than what is being suggested, especially as none of the underlying forces driving prices up are being addressed by the 'reform'.

One of the most powerful forces for driving costs down is giving individuals a stake in selecting lower prices. For example, we recently recieved an itemized bill for our son's school physical. Among the charges was $60 for an eye exam. $60, for, at most, two minutes of a nurse's time and a $5 eyechart. Now, we didn't blink at this outrageous cost, as the insurance was paying for it (ignore for the moment, that I've certainly paid for it through my premiums deducted from my paycheck). If the money was coming directly form my pocket, I sure as heck would be refusing to pay it, because it's crazy to pay that much for that particular service. (Consider, too, that a FAA First Class medical exam costs only $60, includes eye exams, urine analysis, plus the rest of the exam. FAA medicals aren't covered by insurance.) But, our doctor will get that amount because some Byzantine regulation at the insurance company says it makes sense, and I've got to get something out of all the insurance premiums I've paid.

But understand this: Healthcare that is covered by insurance is more expensive than healthcare that isn't. It costs less, and doesn't increase in cost nearly as quickly as healthcare that appears to have someone else footing the bill. (See: LASIK)

So, how to give individuals a stake in their health care decisions while insuring that no one is without care? This recent article in the WSJ (sorry, Sword;-) highlights how the system in Singapore works. A mix of public and personal financing ensures not only that everyone has health care, but also, gives downward pressure on costs by putting decisions about how much to spend in the hands of patients, who are required to use their own money, directly out of an account they own (and are required to have), on their health care. As the article says, not everything that Singapore does would work here, but it goes to show that exposure to real costs, rather than having some third party pay for things with your money, can indeed be a driver for more affordable health care.

Consider, too, that both our current method of health insurance and the proposed national health care must, by nature, interfere in the patient-doctor relationship, despite repeated claims to the contrary. Anytime you have a third party footing the bill, they're going to want to have a say in what you spend (even if they're using your money). You see this now, in both private and state run health care in which decisions are made as to what treatments will be covered, what doctors you can see, etc, by people not directly involved in the medical process. By accountants, and bureaucrats, and elected officials, and CEOs. What must be seen is the overall level of control the health care industry, and by this we must include government healthcare, usurps from the individuals who are most impacted by health decisions.

erco I highly recommend this really excellent article about exactly what you are talking about in regards to costs and incentives in Singapore or in general:

http://www.newyorker.com/repor...90601fa_fact_gawande

There really is no incentive at all in our current private provider system to lower costs. And the interesting thing is that this happens much more in certain regions in the US than in others--McAllen Texas has way higher spending than El Paso, which has similar demographics. And systems like the Mayo Clinic, which doesn't give doctors incentives to see as many patients as possible in a day or order as many tests as possible, cost WAY less than other health care systems but the level of care is the same or better.

quote:

Originally posted by erco415:
Consider, too, that both our current method of health insurance and the proposed national health care must, by nature, interfere in the patient-doctor relationship, despite repeated claims to the contrary. Anytime you have a third party footing the bill, they're going to want to have a say in what you spend (even if they're using your money). You see this now, in both private and state run health care in which decisions are made as to what treatments will be covered, what doctors you can see, etc, by people not directly involved in the medical process. By accountants, and bureaucrats, and elected officials, and CEOs. What must be seen is the overall level of control the health care industry, and by this we must include government healthcare, usurps from the individuals who are most impacted by health decisions.

Complete tosh, I'd like to see any health insurance company cover someone with a known genetic disease.

quote:

Originally posted by Urufu_Shinjiro:
It can't be that hard, every other civilized nation has health coverage for everyone, if those backwoods countries can do it the great and powerful US of A should be able to handle it no sweat right?

Civilized? Perhaps you can answer this question. Just how civilized is it to provide HC, which most of us use infrequently, but don't provide guaranteed food and housing, which we all need everyday? Isn't that barbaric if one had the mindset that HC is a right, yet people starve and are homeless?

Even more bizarre, who would want the US to ape these other HC systems instead of embracing the idea of something even better that maintains US innovation and research which so many people, hospitals and other HC systems benefit from?

That's a great article, Sword, thanks for posting it. The Singapore system also puts emphasis on quality of care, perhaps that is as much the reason for lower costs as is the method of payment. In light of this article, what direction would you take health care reform?

Airmail, maybe I worded my post poorly, but I would think your reply suggests that you agree with my post. That an insurer would want to deny coverage for a person with a genetic condition proves the point that insurance companies, or NHCs interfere in the patient-doctor relationship.

My main goal is to see as many Americans as possible having insurance or access to care that doesn't bankrupt them. I don't care how that happens, but our current system is not doing it. I think costs need to be controlled but we also need some government intervention either in the form of an insurance plan or subsidies and regulation to get private insurers to cover people who can't afford insurance currently.

For a very basic public option, Healthy San Francisco gets the job done. Here is a discussion of it:

http://prescriptions.blogs.nyt...nd-of-public-option/

The Health Care system in the Netherlands is an interesting mix of for-profit private and public systems[any Dutch people here who like it or hate it?]:

http://en.wikipedia.org/wiki/H...e_in_The_Netherlands

The U.S. has at least one similar plan to the one in Singapore.

Before I got laid off earlier this year, the company where I worked didn't have insurance for its employees. My employer was thinking of getting an insurance plan where employees would pay a $2000.00 fee up front with additional membership fees deducted from each employee's paycheck. This insurance plan would supposedly take over after an employee's costs exceeded the $2000.00. My opinion is that this particular insurance plan was betting that members would be reluctant to go to the doctor when they were sick, with either real or imagined illnesses, and as a result would keep company costs down. What I didn't care for was that I would be required to 'top off' the money anytime the, for the lack of a better word, 'deductible' fell below $2,000.00.

My employer decided to not go with the insurance because he said that even though the plan sounded like a good idea, it turned out to not work very well when he researched how the company actually operated. He said that the company would attempt to stall or prevent paying for further treatment when member's costs exceeded their $2000.00 prepaid deductible. I don't know whether or not this behavior was justified with the parties involved, however. Also consider that if there was a law that required people to have an 'insurance account', then there would be all that money to play with coming into private or government hands. Whutta windfall!

Another problem with private insurance is the conundrum of older people who have previous injuries or health problems, aka 'pre existing conditions". In my case, I have had a number of documented and undocumented concussions, and have had a lot of bones broken over the years. Add to this the fact that I am almost 48 years old, and insurance companies either do not want to deal with me, or will, providing that I pay a ridiculously high monthly fee to participate. With the insurance companies that I have conferred with, it doesn't seem to really matter to them that I am in very active, excellent shape, don't smoke, don't drink alcohol, and can do everything that I could do when I was 20. As for now, if I need to see the doctor in the future I will pay cash.

So, if wishes were fishes, then I would like to have 'Single Payer' insurance please because I do subscribe to the concept of 'Personal Responsibility', but without it causing me to have to sell a liver, kidney, or brain to get the hypothetical treatment I need....

quote:

Originally posted by Aimail101:
Complete tosh, I'd like to see any health insurance company cover someone with a known genetic disease.

There are situations where pre-existing conditions, including genetic, are covered. In Texas there are laws that require companies providing group health coverage to cover pre-existing conditions. There are exceptions and eligibility requirements but it's not a simple, "we don't feel like covering you", so we won't situation.

--Outlaw.