Enough to make you sick: Take a look at McCain/Obama's health care plans
 

A rundown of key issues

Also, those Harry and Louise ads are back, except on the other side this time. Although they're keeping the statements strictly non-partisan.


What really boggles my mind is the continuing onslaught against S-CHIP. To listen to McCain and Bush, you'd think children were evil communists.

"Bring everyone to the table and make it happen." Nice.

Problem is, we're broke, and there are deeply entrenched special interests with massive amounts of money on the line for the status quo.

I'm pretty resigned about any meaningful healthcare reform in the next decade or so.

There will be no Clinton style plan, but S-CHIP would take just a little money to make huge difference. Children are very easy to insure as their health care costs generally pale in comparison to the population 40+. By doing so, in 35 years or so, those 40+ won't need health care nearly as much as they do now.

The overwhelming majority of congress voted for this, but chimpy boy vetoed it. It failed to override narrowly.

If congress is substantially unchanged after November, the difference between President Obama or McCain will be the diffence between America's children having decent health care as a whole, or not. The current count stands at 9 million uninsured children.

well... of course these comparisons are intentionally misleading.

familiesusa.org is a 501(c)(4) advocacy group that favors the Obama plan. There's nothing wrong with that because 501(c)(4)' s can engage in political campaign activity, so long as this is consistent with the organization’s purpose and is not the organization’s primary activity. Wouldn't it be less biased if we simply visit each candidates website to review their detailed health plans instead of digesting 3rd party advertising? It may not change your opinions, but at least you can draw your own conclusions.

John McCain's health plan summary from his "issues" website: JohnMcCain.com - McCain-Palin 2008

Barack Obama's health plan summary from his "issues" website: Barack Obama and Joe Biden: The Change We Need | Health Care

The foundation of McCain's health care plan is to give more "choice" to individuals ...through $2500 individual $5000 family tax credit....but he does so by taking tax incentives away from employers. SO you are left with employers paying more and passing the cost on to employees....or having the "choice" to find you own plan....for $5000/year when the average cost is about $12,000/year.

The foundation of Obama's plan, at least in the short term, is to strengthen employer-based plans with tax`incentives to control premium costs passed on to employees and to create pools for employers currently not providing coverage to their employees....and to cover more kids through SCHIP.

Yep...decide for yourself which makes more sense.

McCain's plan will end up with even more adults in this country having not enough healthcare insurance or none at all.

:shakehead:

Its the free market, baby!

Another way to look at the fundamental approaches to the problem.

When people have ownership of something, are in control and aware of the costs they will more actively participate in controlling those costs. So, if I shop and select my health insurance, pay for my health insurance premiums, pay deductibles and co-payments, see the bills, understand the coverage, I will be part of the overall solution in driving costs down.

On the other hand, if someone else "owns" my health care coverage (employer plans or government plans) they will manage my health care to their priorities. If I am unaware of heath care options and the real costs I have no incentive to keep the costs down. The third party may or may not do what is in my best interest.

McCain's plans has the intent of getting Americans more involved in their health care. Obama's plan is more of the same. McCain's plan will help reduce overall costs, Obama's plan is more of the same. If you really want "change" or some new ideas, perhaps the McCain plan is worth consideration.

ace...I am not opposed at all to "getting more Americans" involved in their health care.

My question is where you can find comprehensive family coverage for $5000/year.

Let's get real. How many people without coverage don't have it because they made that choice? It happens every day. The twenty year-old on his first job after college who could buy an individual plan or participate in a group plan, says I would rather spend the money on other things. People can buy individual coverage for a couple of hundred dollars a month. Some spend that on cell phones.

The average cost of a fairly comprehensive family plan is about $12,000/yr. For many, it is not a choice if you are a family w/o employer based coverage.

Depends on the deductible or co-pay, and of course age. Those who shop can find coverage for that or less. A young couple, in their twenties, non-smokers, in good health can easily find coverage for major medical. Also, if they choose a high deductible plan they could open an HSA. Assuming relative good health they can accumulate a large amount in an HSA.
-----Added 30/9/2008 at 11 : 20 : 20-----
A myth. If you ever get bored, spend 30 minutes and look into it, you may be surprised.

Assuming "relatively good health" ignores accidents, unanticipated serious and/or long term medical emergencies, pre-existing conditions, chronic conditions.......

For the most part, employer-based plans have served the public (150+ million) well, in terms of the level and quality of service...the issue for me is containing the costs of that employer-based system..not abandoning it.
-----Added 30/9/2008 at 11 : 30 : 44-----
ace....I have come to accept that anything you dont agree with is a "myth" or "smoke and mirrors" or a "scam"

First here is a website where you can put in information and get some quick quotes, I just tried it and found some policies for 30 year old couples for $200 or less per month.

https://www.ehealthinsurance.com/ehi...25151&sid=CORE


Second, people with pre-existing conditions can still get coverage. In some situations that pre-existing condition is excluded for a period, or there is an up-charge for it. Again, the consumer has to put in some effort to get the best deal.

There are flaws in the employer based model and currently fewer and fewer employers actually want to be in the business of providing health care for their employees. And in our current economy, as opposed to the Industrial period, most people don't start and retire with the same employer. Most people in today's world will have several employers, and may spend time as an independent contractor. People need consistent coverage, not needing to change every time they change employers.
-----Added 30/9/2008 at 11 : 39 : 35-----
Another myth. I back up my positions or I can back them up. Perhaps immediately dismissing something from a conservative is unproductive.

I think it's strange that my health coverage is a function of my job. I don't have a particular opinion on whether it works or not--I'm not well enough informed to really have much of an opinion. But, you know, why is it my employer's job to supply my health insurance? Why not my city government, or my neighborhood watch committee, or my church? Those would make about as much sense, it seems to me.

ace...I will offer this, based on a GAO report:
ace...my comment was not meant as any kind of personal attack....but whenever I offer research that "backs of my position" and contradicts your position, be it health care, minimum wage, tuition assistance, tax policy...you dismiss it as myths, smoke and mirrors, scams....

There are two sides (or more) to most public policy issues.

What is your point? People don't have to use an HSA with a high deductable plan, it is an option. The reason the "rich" people use them is because they understand them and are smart enough to use them. If a person is 22 and without coverage, they can buy a low premium - high deducible plan (let's say $10,000 deducable - less than the cost of a car), and then over time put $10,000 into an HSA, but after taxes the real cost will be less than $10,000. Then they have coverage with a low cost plan and they have an account with $10k earning interest or investment returns. If they go 10 years without needing to tap into the money what happens? Perhaps, you can contact the GAO and find out.
-----Added 30/9/2008 at 11 : 54 : 24-----
I gave you a website to check regarding what I called a myth. It appears you have not looked at it but continue to argue your point, o.k. I get it. It is my problem, right?

In so-called "right to work" states, there are people who are fired because their insurance company deems them a risk. So yes, that sucks. Right now, my wife has something called an "insurance nurse" deciding how she should behave during her pregnancy.

We have good insurance. We have the same insurance as John McCain.

On the other hand, Ace, you keep equating non-insured people as 20 year olds with fancy cell phones. The vast majority of the uninsured population are people on government support programs.

But of course, that was their choice to buy into the whole "cycle of poverty" thing.

to the other rb: why should it surprise you that your insurance in amurica is tied to your job? the decision that explains that is simple enough: your health is only a system concern to the extent that it impacts upon your status as wage laborer. period. so it's not your health, it's your health insofar as it is of interest to capital. beyond that, you don't matter.

it's a lovely system that the free marketeers defend.
of course, rather than face the facts of the matter, it's easier to blame the uninsured for being uninsured.
personal responsibility applies to other people, and not at all to political choices.
capitalism is nature, like a rock, a firehydrant or a tv set.

Yeah, I know. Dog eat dog. Wolf eat sheep.

So you have 700 billion to give to the banks in crony capitalism but don't have a two dimes to rub together when it comes to health care... I don't get it.

Another perspective...

Is health coverage a function of your job because there is liability and potential for injury? Or is your health coverage a component of your benefits package? A general rule of thumb (in some industries) is your cost of employment to your employer is approximately twice your income. Whether you are a salaried, hourly, and/or union worker, it's all part of your compensation package.

General and optional costs to a company to employ someone:
Base pay
FICA (their portion)
Health care
Unemployment Insurance
Liability Insurance / Worker Comp
Professional Insurance
Life/AD&D
Long term disability
Short term disability
Vacation
Sick leave
Admin cost.
Facilities
Equipment
Other insurance
Training
Licenses and certification
etc.

It's not your employers job to supply health insurance, but it is smart in a competitive market. Why should healthcare be managed by an incompetent government? But we should care for those who absolutely cannot care for themselves. Those who struggle with the price of health care outside of employers or government assistance should have reasonable access. They should also prioritize their expenses within their own means... as should the government, as should all of us.

i would think that an adapted version of the french model (free access to basic health care, manditory insurance for more intensive care with price controls on insurance companies) would fit with your position quite nicely, otto.
the problem with debate in the states is that the alternative model is typically the english, which isn't anywhere near as good or as flexible as the french model.

free access to basic health care creates an incentive to be proactive---it pays for the system to keep folk out of the system--so the system is far more geared around proactive health care than is the american system.

if there's a moral question in this, it is at the level of how a society wants to be in general: i would think it far better to provide health care as a citizenship right than what we currently have---it provides some idea that capitalism produces something beyond commodities and infrstructure and profits and wage labor...something more like an advanced civilization.

From what I have read, the French system is quite good (and this from a Canadian).

No one does....


Opinion or fact?

I've had maybe ONE excellent coverage provided by an employer.
We shop around for life insurance, car insurance, home insurance...we should be able to shop around for health insurance. At $5700 a year, ours basically sucks and we are allowed two choices-take it or leave it. Those choices apply anywhere, too.
I'm not saying either "plan" is better, but someone sure needs to bring back reasonably affordable coverage and give US options, not the government, not employers.
If one is poor enough, one can get pretty good medical care and not pay a dime; we pay over $100 a week and get crap. I'm still paying off medical bills from 2006 that my insurance wouldn't cover either because, even with an HMO, we had a deductable or the doctor didn't file his claim in "a timely manner".

I have an HRA plan through work. It differs from an HSA that I had before my employer created this plan in two ways.

1. The money is mine only while I work for the company.
2. No interest is earned on the money. (maybe a little, but it is insignificant)

Now, HSAs aren't perfect either. The few banks that have them charge monthly maintenance fees of $3 if you aren't putting money into it, they don't earn very much interest (1/4th of a savings account), and while I am healthy and it does promote staying healthy, it also promotes not wanting to spend your money if you are sick.

Oh yeah, and good luck trying to figure out what things will cost you before you go to the doctor. The first year of allergy shots I had to pay for out of pocket (using a flexible savings account because I knew that I needed them and had to wait 3 months before I could start putting money into it). So, I had to pay close to the $2500 deducible the first year because I needed allergy shots. Luckily something unplanned didn't happen, because I don't want to be laying on the pavement trying to decide which hospital I want to go to because it will cost less.

And honestly, I'm tired of dealing with changing insurance and having to deal with it. I don't want to deal with bills, statement updates, whatever. If my doctor doesn't get paid, then I will look into it when they tell me.

And i'm sure that a universal system could be setup and work, but it might not cover things like allergy shots and non-emergency medicine. And I'm ok with that.

This assumes a few things, one being a one plan fits all approach. If an employers workforce is homogeneous they may be able to find a plan the fits and at a group rate the coverage and cost may be competitive. In some other cases, perhaps the employer and employee would be better off if the employer passed on the cost of the coverage to the employee in increased wages. If I get an offer from company A that is $100,000 salary with no health care coverage and I can get an A++ PPO type plan perfect for my family for $6,000 a year, compared to a company that is offering $95,000 and an HMO plan that excludes the doctors and specialists my family has been using, perhaps I would be better served with the higher salary with no company coverage.
-----Added 1/10/2008 at 11 : 57 : 15-----
True they are not perfect. The intent is to provide a means for people to save enough to cover high deductible plans, not really for investment growth. Even with initial low interests rates paid the biggest benefit is the tax deductability of the contributions. similar to an IRA or a 401(K) a dollar contributed may on cost $.66 depending on the person's tax bracket.

There are some HSA's that allow investments in mutual funds after a certain amount is invested in the HSA.

I don't think I understand your point about not wanting to spend the money if you need too. If you are saying you would spend it on your health if it were someone else's money but would not spend it if it were your money, I think that is an interesting question, and perhaps part of the problem with our system. Perhaps we need a balance between the two extremes.

Yes, the nature of insurance is managing risk. It is not easy. some people will come out ahead others don't. If you buy a life insurance policy, pay one months premium and die, you sort of win. If you buy a life insurance policy, pay so much premium that you could have put the money in an investment and got a better return, you sort of loose. But, if you look at it based on the peace of mind having insurance gives, you win in either case.

We agree. Not only do I get tired of staying on top of my health care issues, I get tired of washing the dishes and taking out the garbage. I keep hoping I am the newly found illegitimate son of Warren Buffet or some other billionaire (maybe not Buffet, he is giving his money to charity) so I can have other people take care of my personal business.

just for fun, Health Insurance, Medical Insurance, Individual Health Insurance Quotes

most arein the 200-400/month range on a family of four in my area (near charlotte, nc) with 3000-10,000 deductibles...

seriously....

From polls and surveys I have seen.

Here is a Gallup poll from last year. While it is not limited to employer based plans, since such plans represent about 70% of the market, IMO, it is reasonable to draw conclusions from the results.

I know that polls are only opinions, not fact, but they offer a better snapshot than single anecdotal experiences.

Eighty-three percent of Americans rate the quality of healthcare they receive as excellent or good.

http://media.gallup.com/poll/graphs/...2907Graph3.gif

Majority of Americans Satisfied With Their Healthcare Plans

-----Added 1/10/2008 at 06 : 20 : 33-----
This also assumes most employers offer only one plan. That may be the case for small business employers...and even in those cases, it would likely be a bit more affordable or a bit more comprehensive than their employees could find on the opne market....even more so if small business could create and join pools as Obama's plan proposes.

My organization, with about 100 employees, and probably typical of many companies/organizations of similar size (or larger) offers a choice of 4 plans with different types/levels (HMO, PPO...) of coverage and cost.


rb..I agree. That would be my ultimate goal as well.

But with more than 150 million currently served by employer based plans, I dont think we can get there from here in the short term without major disruption.

roachboy and dc ... I'm seeing signs that some evolution in this direction as well. It will take a while to "get there", at least getting to what works best here. I want accessibility, accountability, equity, responsibility, and charity. Finding the right balance will be the struggle, but it's inevitable.

Does this view surprise you?

Why, oh why, are US-ians still debating what has been proven for OVER 50 YEARS.

Universal, free at the point of delivery health care is more efficient, better for the majority and only denigrated when the wealthy are allowed to abdicate from it.

If you believe people are born equal, they should have equal access to healthcare, education and opportunity in the workforce.

Anything less is oligarchy.

We might be created equal, but there is definitely a class system here. Now, people can freely move up and down, but the rich don't want to bring the poor up to their level if they haven't don't anything in their lives. What's the point in becoming rich if there is no improvement in your life?

There is also still underlinings of racism, ageism, sexism, and a bunch of other differences that complicate things.

I'm not saying it can't be done, but it will be a really tough sell. I think there will be a bunch of people that would say, even though this is better for me, since it is better for other people, I don't want it. We are very competitive here going after limited resources of money, material items, and attractive girls. Things that might make it easier for the next guy aren't supported sometimes.

Existing within a system, arguing it cannot be changed, despite alternative systems existing and flourishing in the world.

The only way people have EVER forced up standards for the majority in education, healthcare and living standards is by FORCING those who exist in a social or economic strata 'above' them to share in common services.

Hence, almost 100% public healthcare is good. 70-80% is bad (the middle and upper classes are allowed to abdicate)

Same for education. (Finland versus the UK for example) Same for all services.

When the wealthy share the services of the poor, they are well funded and deliver excellence. when the wealthy are allowed to opt out of the services offered to the poor, those services for the poor become poorly funded and deliver sub-excellence.

Yes. The wealthy should deliver excellence in education, healthcare and social provision to all, just as they do for their own.

On the subject of technical/economic viability. You'll be amazed what is possible once outright greed, oligarchy and gradient are eliminated.

What a fascinating way of putting it. Thank you!


I was a bit disappointed with the link the OP provided. Unfortunately it does not really compare and contrast - only mentioning what McCain is lacking that Obama has included. Here is a link to a thought-provoking comparison of the healthcare stance of Obama vs. McCain (vs. Clinton,written in April 2008). Link: Where Clinton, Obama, and McCain Stand on Healthcare - US News and World Report
Note that none of the proposed plans come close to the complete coverage offered to EU citizens.

What has been proven? I think I understand and appreciate your pride in ideology, but you tend to paint with a very broad brush.

Regarding equality: Born equal under the law is different than physical, mental, and economic equality. In a so-called utopian society, classes will still evolve... it's human nature. What form of equality are you referring?

Every US citizen has access to immediate or emergency care. However, there have been cases where some have unfortunately fallen through the cracks. I believe we can find casualties of "the system" in any country's form of healthcare. The question here in the U.S. is how do we reduce the cost of healthcare delivery, encourage the continuance of world-class leadership in the innovation of medical technology and clinical technique, and provide reasonable access for those challenged by medical costs.

Our current Medicare and Medicaid system is so poorly managed by the U.S. government that it has been seriously running in the red for several administrations. Our Social Security Insurance (aka SSI) program is not a pension plan, but has been allowed to be perceived as such. The government has made a shambles of managing this as well. Universal healthcare would be a wonderful idea if we could trust our government to manage anything responsibly.

Apparently universal systems have some serious issues too. Why do so many come to the U.S. in large numbers for advanced or specialized healthcare procedures unavailable to them in countries where UH has been "proven for over 50 years"? There is a balance to be found, we'll get there eventually.

One would think that getting people to buy health care like other consumer services in a competitive environment would be a good thing and result in choices that result in better service at lower prices. The problem is that for much of health care there seems to be little or no competition and it is almost impossible to get bids and compare service for many illness/accident situations. We seem to be at the mercy of whatever hospitals/doctors/dentists choose to charge with little recourse to lower our costs by shopping around. I have yet to have a serious illness or injury but shopping around for even basic care has resulted in little or no competitive pricing.

Most hospitals/doctors/dentists are not prepared to give bids or prices for their services and many don't want to be bothered when you try. Also if you have an emergency condition it is usually impossible to get competitive pricing even if you are in good enough condition to try.

Also shopping around for insurance, we have not found much difference in their prices either. The best we have been able to do is find a company that offers large deductible ($10,000) in order to keep our cost under $400 a month and we have no preconditions. I don't really blame insurance companies for charging so much due to the out of control underlying costs which I believe will eventually be out of reach for many more people. That is why I have come to believe that like national defense which is also very expensive and necessary that perhaps it is time for the government to provide it. There are too many people (even with insurance) at risk of losing everything they have worked for due to medical costs.

Currently our system is in an area that is not "free market" and is not "third party" provided. It is sort of in the middle a combination and not really working effectively for either. As a nation we need to decide which direction we want to take our system and commit to it.

One problem with health care insurance is that it is regulated state by state rather than nationally. Availability, costs and choice vary widely depending on the state you live in. In my view real reform would include allowing health care insurance companies to have national policies and common federal regulation if we move in the "free market" direction.

I have no proof for or against this, but do you think there is a cost reason why health insurance is more expensive in one state compared to another? Do you really think Health insurance companies will lower their rates for people who live in the cheap states now? Or will they raise my rate to offset lowering it in the expensive states?

There are a lot of problems with the current system. I'm sure there is a solution somewhere. But I'm not sure that a universal health care system would be fair to everyone. Small business owners and the rich would have to be taxed too much to pay for healthcare coverage that will be abused if it's free. (It's free in the military too, but they are more responsible and healthier than most average Americans)

If they want to change it, they will need to phase it is slowly. Start with emergency and accident coverage for everyone. This takes care of most large bills and won't be abused. It will lower the risk of insurance companies having to pay out or fight paying out big money. It will take away a lot of worry that comes when you don't have insurance and get seriously injured.

I like this idea, it is the large almost unsurmountable bill for a serious injury or accident that worries me most. Those who have saved and acquired some small amount of prosperity have the most to loose. I know several people who thought they had good coverage who lost almost everything trying to keep up with the bills.

The argument many use against this kind of catastropic coverage is that it won't encourage people to visit the doctor for the small things which can become chronic if not treated. From what I can tell talking with family and friends, there seems to be way too many prescription drugs being consumed which of course requires visits to the doctor for more. I think the statistics will back this up and something should be done to eliminate or reduce the costs if we go with a national plan. Many of these drugs are becoming almost recreational.

Out of curiosity, how does one 'abuse' healthcare?

If I'm sick, I go to the doctor. If I go to the doctor and I'm not sick, he kicks me out. Pretty straightforward.

Maybe I'm naive. My pinko commie socialist healthcare system has probably blinded me.

I don't understand how anyone can reasonably argue against the idea of universal healthcare. When a society is healthy and educated as a whole, that society does better than the ones who do not provide these basic necessities.