universal health care

[disneysteve]

But, one of the proposals I have seen on this board is to move everyone over to Medicare. Would you be willing to pay about $500 per month per person in your household for coverage that does not include prescription drug coverage (that is an additional cost)--and then on top of that, pay for supplemental insurance for coverage that medicare does not cover?

Medicare (in its current form) is a high risk pool of individuals by definition. Everyone is over 65. All are going to die while insured by the plan. And most have one or more chronic conditions like high blood pressure, diabetes, high cholesterol, arthritis, cancer, etc.

If you expand coverage to all, your overall risk level drops dramatically. That's pretty much the basis of insurance to begin with. Spread the risk over as many people as possible. Pool resources so that money from the low risk members helps provide for the high risk members. In doing so, you're able to lower the cost for everyone. If Medicare suddenly had a bunch of kids and teens and 20 and 30 year old members paying into the system, you would no longer need to charge the 70 year olds $500/month.

[Captain Save]

I think until the we change our focus to curing and preventing diseases... Universal healthcare or healthcare in general is doomed .. there has to be an incentive to find real cures as oppposed to treatment... there have to be incentive to do studies for prevention ... and finding the real cause ... right now the incentive is to find drugs and this means people will continue to get sicker and sicker and costs will be way too high and no matter how we pay for healthcare .. it will be too much..

so I'm not for or against any type of healthcare system ... so long as it addresses the real issue of why costs have been skyrocketing

[kork13]

Other factors that might be considered to reduce the cost of UHC would be tort reform & reigning in the profiteering by big pharma/medical device industry. Those items alone could probably reduce healthcare costs nationwide by 20% (at least?). Fear of getting sued for "missing something" probably leads to alot of unnecessary tests, as well as forking out thousands of dollars every year (per doc) in malpractice insurance. DS can surely attest to the ludicrous levels/costs that his medical malpractice insurance has to cover (or that his hospital system provides). And need I remind everyone about the Epi-Pen debacle a couple years ago, where the sole producer jacked the price to $600 per pair or something like that?

ETA: Yes, I'm aware that such changes are pipe dreams. But hey, we're talking about UHC, so why not?

[LivingAlmostLarge]

Yes because I don't think that $500/month is going to be the number. Also if we decouple insurance to employers will they give us the increased salary to pay? Or just take it as payroll tax to medicare? I mean what our employers are paying to cover us either has to come back to us or something.

What people don't know is that employers are self insuring their employees. They have a company which is managing it but they are covering costs. Hence why things keep on getting changed. But yes if you have 0-18 and then down to 50 in the insurance pool AND you force everyone off of employer provided insurance than it becomes a very different pool.

That's why small businesses have trouble with health insurance and big companies take costco for example with all their employees has a big pool with spread risk.

[Like2Plan]

Also if we decouple insurance to employers will they give us the increased salary to pay? Or just take it as payroll tax to medicare? I mean what our employers are paying to cover us either has to come back to us or something.

That is one of the first things I thought about. When DH's company (a few companies ago ) made a decision to freeze their pension plan they did not increase DH's salary. They did make a one time 3% extra match to the 401k. What it represented to us was a reduction in compensation. It was a pretty generous plan so I could see why they did it, but they had been making contributions to the plan all along--what happened to that money?

[disneysteve]

I think until the we change our focus to curing and preventing diseases... Universal healthcare or healthcare in general is doomed .. there has to be an incentive to find real cures as opposed to treatment... there have to be incentive to do studies for prevention ... and finding the real cause ... right now the incentive is to find drugs and this means people will continue to get sicker and sicker

Can you explain what you mean here? Why are people going to get "sicker and sicker" despite us finding better and better treatments?

Not all conditions can be cured, at least not currently. Diabetes, hypertension, psychiatric disorders, Crohn's Disease, you name it. We're getting better at treating those things but can't cure them. That's a big part of longer life spans. Conditions that used to be fatal can now be managed effectively and people can live a normal lifespan. Many cancers are now considered chronic diseases rather than terminal ones. HIV is a shining example. I know patients who have been HIV positive for 25+ years at this point. When the virus first emerged, it was considered a death sentence. Now we have excellent treatments.

I agree that much needs to be done with prevention, but that's more of a societal issue than strictly a healthcare one.

[LivingAlmostLarge]

That is one of the first things I thought about. When DH's company (a few companies ago ) made a decision to freeze their pension plan they did not increase DH's salary. They did make a one time 3% extra match to the 401k. What it represented to us was a reduction in compensation. It was a pretty generous plan so I could see why they did it, but they had been making contributions to the plan all along--what happened to that money?

Like2plan, are they still giving him a pension? That's where the contributions went. I am going to guess they froze contributions and payouts. But they weren't able to get out of liability completely.

[Like2Plan]

Like2plan, are they still giving him a pension? That's where the contributions went. I am going to guess they froze contributions and payouts. But they weren't able to get out of liability completely.

I was referring to the time after they froze the pension. They were no longer making the contributions to the pension and they didn't raise DH's salary. So, DH was no longer getting that delayed compensation--it really amounted to a pay cut because DH had to make up for the retirement savings by increasing his savings rate. I suspect that is what would happen if the health care was decoupled from the employer. Right now, (for those who receive health insurance through the employer) the employer pitches in a certain amount of money towards health care.

[cypher1]

I guess the question is how do you get both parties to cooperate on something - anything really, not just this - when one party is fundamentally opposed to what the other party is trying to accomplish?

Wait for a pandemic. But even with that it's still pulling teeth getting both parties to agree on a bill without getting the last say on it. Otherwise, the other real answer is you don't get them to cooperate. That's the joke with both sides thinking they're better than the other. That's all I'll say on the political side.


While I don't know which is truly the best model; Out of Pocket, Bismark, Beveridge, or Universal, IMO no one should have to worry going into debt to get treated for health care.

Add to the fact that our country is ranked 27th for health and education metrics, we spend the most on healthcare (almost 17% of our GDP while the avg 9% for other countries), and yet we have the highest rates of chronic diseases, obesity, and suicides. Outside of genetics, about 80% of chronic diseases can be avoided based on good diet, sleep, and exercise. But that is a whole other discussion about accountability and lifestyle choices.

While I'm grateful for my HDHP option through my employer, maintaining being relatively healthy is a personal and financial investment to myself. Ultimately I believe in smaller, efficient government, but this is one topic I think the government does need to step in, as well as regulating big pharma pricing.

I don't know what the answer is, but at this point I'm not opposed to a type of single payer system, or updated hybrid option. I just know our current system out of pocket options still leaves almost 30 million Americans uninsured which is inexcusable.

I think anything is better than what we have right now for a health system. So if anyone has a better solution besides replying with "xyz health model sucks", I'm all ears.

[disneysteve]

Otherwise, the other real answer is you don't get them to cooperate. That's the joke with both sides thinking they're better than the other.

I really don't think it's necessarily a "better than the other" thing. It's just that the two parties have VERY different points of view and priorities. They approach pretty much any problem from completely opposite directions. What they are each trying to accomplish and where their focus lies is radically different. It makes compromise exceedingly difficult.

Add to the fact that our country is ranked 27th for health and education metrics, we spend the most on healthcare (almost 17% of our GDP while the avg 9% for other countries), and yet we have the highest rates of chronic diseases, obesity, and suicides. Outside of genetics, about 80% of chronic diseases can be avoided based on good diet, sleep, and exercise. But that is a whole other discussion about accountability and lifestyle choices.

I don't think the accountability and lifestyle choices is a separate discussion at all. The reason we are ranked so low and spend so much isn't because we don't deliver good care. Our care is fantastic. We just spend so very much of our time and money treating self-induced or at least self-aggravated issues. There's no way to effectively lower healthcare costs without doing something about that. If we continue to have 70% of the population obese, for example, we're going to have to continue to spend a fortune to treat hypertension, diabetes, heart disease, arthritis, acid reflux, sleep apnea, cancer, strokes, joint replacements, weight loss surgery, and so many other things that could have been prevented.

I don't have the answer either but having tens of millions of Americans with no insurance at all and tens of millions more still unable to afford care even with insurance just isn't a workable system.

[Captain Save]

Can you explain what you mean here? Why are people going to get "sicker and sicker" despite us finding better and better treatments?

Not all conditions can be cured, at least not currently. Diabetes, hypertension, psychiatric disorders, Crohn's Disease, you name it. We're getting better at treating those things but can't cure them. That's a big part of longer life spans. Conditions that used to be fatal can now be managed effectively and people can live a normal lifespan. Many cancers are now considered chronic diseases rather than terminal ones. HIV is a shining example. I know patients who have been HIV positive for 25+ years at this point. When the virus first emerged, it was considered a death sentence. Now we have excellent treatments.

I agree that much needs to be done with prevention, but that's more of a societal issue than strictly a healthcare one.

because the treatments are geared to help folks live with the disease rather than eradicate it. There is no incentive to cure the disease. If I'm a drug company why would I devote my research dollars to something that might get rid of the disease... I need to have a way to recuperate those dollars. If I come up with a treatment that delays the progression of the disease, I recoup what I invested in research and then some. Frankly that's the only way to stay in business.

So I'm not saying that the treatments are not getting better .. there's money to be made in improving the treatments but there's no money to b3e made in getting rid of it.

[disneysteve]

there's money to be made in improving the treatments but there's no money to b3e made in getting rid of it.

Sorry, I'm not a conspiracy theorist so I don't buy that crap.

We now have treatments that are 96% effective at eradicating Hepatitis C, for example.

Many, many types of cancer are now curable that were fatal just a couple of decades ago.

We've eradicated multiple diseases with vaccines. Smallpox and polio are two stellar examples.

If a cure hasn't been found for a disease yet, it isn't due to lack of trying. It's just not that easy a thing to do. Hundreds of billions of dollars are spent seeking those cures, though.

[LivingAlmostLarge]

I was referring to the time after they froze the pension. They were no longer making the contributions to the pension and they didn't raise DH's salary. So, DH was no longer getting that delayed compensation--it really amounted to a pay cut because DH had to make up for the retirement savings by increasing his savings rate. I suspect that is what would happen if the health care was decoupled from the employer. Right now, (for those who receive health insurance through the employer) the employer pitches in a certain amount of money towards health care.

I agree but then it's an across the board paycut to everyone with employer provided coverage. That number will decline steeply if we keep losing jobs and insurance with it. And companies may also drop coverage if times are tough for an extended period. Small businesses might not cover families but just the employee. So if we started by covering those without jobs, above 50, below 18, then natural attrition I think full universal coverage might occur before then. Also if we are talking about instituting extra coverage bought through work that may be how business incentive keep people. Benefit to buy extra or premium coverage.

[Smallsteps]

because the treatments are geared to help folks live with the disease rather than eradicate it. There is no incentive to cure the disease. If I'm a drug company why would I devote my research dollars to something that might get rid of the disease... I need to have a way to recuperate those dollars. If I come up with a treatment that delays the progression of the disease, I recoup what I invested in research and then some. Frankly that's the only way to stay in business.

So I'm not saying that the treatments are not getting better .. there's money to be made in improving the treatments but there's no money to b3e made in getting rid of it.

I agree and at the moment I work for a bio science firm that has had a few approvals of new drugs since I started only able to may slow this or that nothing to cure items.
I can attest to the huge money involved.

In this discussion there has been talk of employers ....talk of government.... talk of inability to run systems without huge waste / fraud..... one mention of TORT reform but I have NOT seen talk about the Patient.... what is their part?

Treatments can only be effective if taken correctly and other advice followed.

This is not being done ... and so we have the getting sicker repeat customer. We have people wanting an easy answer or a pill to make it all go away

Tests (in the current system) are being ordered and done in excess to cover all bases to cover any malpractice. This really shoots up the costs.
On the flip side the medical version of let's wait and see ( repeat visits) or better yet refer to someone else perhaps a specialist $$$.
Many a doctor knows what patient is NOT going to follow thru that wants a cure-all without any effort on their part.

[Scallywag]

I don't know how UHC works! Do we still go through the same health insurance companies like Aetna / Cigns / Kaiser etc except the govt pays the premium or we share premium costs (based on income) with the govt?

My son is disabled and will likely have Medicare for life, as ws would after we turn a certain age? I think we'll likely have our daughter on our plan for as long aa we can unless she gets access to a better one through her work or action. I do agree that we shouldn't keep health insurance tied to work - we should be able to purchase it like any other commodity or service as long as we have the ability to pay the premium.