okay, did Will hack ace's account or something?

I think your plan's a damnsite better than the status quo, ace. I'd go farther, myself, toward providing a basic level of care for every citizen regardless of their age, but if we're not going to do that, at LEAST we should break down the walls to real competition among insurance providers.

It's that #1 I have the most questions about: "Make insurance mandatory". Can you expand on that a little? What about the guy who lives under the bridge?

Check my posts on SCHIP. I was clear in my position then as I am now. With SCHIP I think it was a bad bill for a number of reasons, one being its failure to insure every child and the complexities involved in 50 different state programs all with different qulification standards. They need to write a simple law: Every child born in this country is covered, period. Every child in this country gets treated and we will sort everything out later (i.e. sending a bill to the country the child came from).

just busting your balls, ace

The best way to keep premiums low is to make the pool as large as possible. Currently a young healthy person has an incentive not to purchase insurance and the people most likely to purchase it are those who need it. Also, just like every auto on the road needs to be insured, every human should be insured. I think people need to understand that the cost of health insurance is one of their first priorities, then buy the fun stuff - no free rides when it comes to health insurance. But then just like Medicare we could require some type of basic plan and allow for supplemental plans that allow for more/better coverage. A fair classification system could be something like all males born in 1985 be put in a class together and charged a premium based on the experience of the entire class, so everyone pays the same basic premium for the required plan.

...and that number is going to decrease when the federal government gets involved?

The belief is that if you don't have insurance companies involved anymore there won't be a need for a billing department, or atleast a smaller staffed one.

Just look at Medicare (and every other country in the world to use public health care). They're all substantially cheaper and a lot of it has to do with a significantly lower administrative cost.

despite the fact that Republicans have been ringing the "government is expensive and inefficient" bell for years, there are many very effective govt. agencies.

To quote Bill Maher: "I can send a letter from L.A. on Monday and it's in my sister's hand in New Jersey on Wednesday, and it cost me 42 cents. I can only hope government health care is that inefficient"

Ok, now that we have discussed some of the problems what are the solutions? How can we increase coverage and lower costs of health care?

Medicare? You mean the program that is bankrupt in less than 5 years? That is the model we should use? I have a lot of life left and I won't see one benefit from medicare (although I pay 7.5% on my pay into it.)

The only people saying it's going to be bankrupt in 5 years are conservative think tanks. The same ones, undoubtedly, that said the same thing in the 1980s.

2% administrative cost. Compare that to the 25% administrative costs of the private sector.

Will, you really don't see the diff btw national defense and health care without having someone explain it? or are you asking just for devil's advocate reasons?

---------- Post added at 09:02 PM ---------- Previous post was at 09:01 PM ----------

Actually, let me flip this around on you, Will: if the govt runs health care, why not go all in and have it handle food, clothing and shelter, too? Those are absolute necessities, right?

You're assuming my argument was based on "absolute necessities". It wasn't.

What happens when the military is private? One, it's a hell of a lot more expensive (like health care). The individuals employed are paid substantially higher than their public counterparts would be (like health care) despite not having any better training, but also have to worry about legal problems (like health care) because they like to screw people over in order to make a quick buck (like health care) or because some employees are allowed to act unethically (like health care). They often are vertically integrated in the political structure (like health care), and have powerful lobbyists (like health care) that can help to shield the private industry from the regulation it needs (like health care). They use media outlets to trumpet the benefits of their private services (like health care), but actively prevent dissent from reaching the public (like health care).

I could go on and on and on.

Tort reform:

1) Trial lawyers do not get a cent out of punitive damages. They are compensated a set rate for hours worked. Time records will be audited against their entire office to ensure they aren't double-dipping the rates.
2) The plantiff does not receive one cent of punitive damages. Punitive damages should go to a comparable charity. ie - McDonald's who paid $20M to Stella for the coffee burn should have paid the $20M to St. Judes Children's hospital burn unit.
3) If a plantiff brings suit and loses then the trial is reviewed by a legal panel of judges. If the suit is determined to be a "frivilous suit", the plantiff must pay the legal fees of the defendant. Obviously, this standard for "frivilous" needs to be vetted, but I think you understand the intent.

Graduated rates:

1) 70% of healthcare bills are related to heart disease, cancer, and obesity related issues. A vast majorities of these cases are preventable through the person just taking care of themselves. In short, if you are 200 lbs overweight, you are high risk and your rates should reflect that. The same as auto insurance - if you have 4 tickets, 2 at-fault accidents, and a DUI, you pay a lot for insurance. If you are a good driver, the rates are dirt cheap. Don't like your rate? Quit smoking and lose 200 lbs. If you are 22, in good shape, and a non-smoker: your rate should be about $30/mo.
2) Open the industry to allow the consumer to shop across the country. It's all electronic anyway. Who cares if my insurance company is in Montana, as long as it is the most competitive rate.
3) Take colds/flu out of health insurance. If the diagnosis is something like that - the customer pays for the entire visit. Auto insurance doesn't cover oil changes.
4) Build cold/flu centers in adjacent buildings in hospitals with reduced rates to keep these people out of the ER.

The tough pill to swallow:

Illegal aliens who show up in the healthcare system will be given care and then placed on a plane and placed in a tent jail to serve a 6-month sentence. After which, they will be deported. All illegal aliens who are caught anywhere are taken to the tent jail to serve their 6-month time. The risk of losing 6 months of income will serve as a deterent. I know this will offend many, but we are denying care to U.S. citizens so that we can give it to illegal aliens.

Psst. PUB DISCUSSION. :thumbsup:

What about people who have chronic conditions (and in particular conditions that prevent them from making money)? Will we raise their rates even though they can't afford the increased rates?

Wouldn't this lead to people not seeing a doctor because they think it might be a cold or flu even though it is something much more serious?

If we are going to jail them we better give them a trial first (our constitution requires it). Also if we are going to deport them we are also constitutionally required to give them due process. In the end that would likely cost more money than just helping them in the first place.

have I mentioned I hate Pub Discussions?

Yeah, they tend to die off because people can't post articles to back up their claims.

You've just described virtually every single private business in the counrty. Is the answer to have government take it all over?

I kinda doubt that the massive tentacles of the lemonade industry are slithering their ways through the halls of congress, or that ultra-powerful lobbyists working on behalf of the dog food industrial complex are intimidating the media into silence about the horrifying truth behind snausages.

Well yeah, there's no getting around that the term "health care reform" needs to be a code-word for radical re-structuring and regulation of the insurance industry.

I was listening to the last This American Life episode on podcast this evening, and they did a piece on the recent house committee hearing on insurance recision. You know, where a person's expensive medical need triggers a review of their policy for any little reason the company can find to revoke their policy? Including their own clerical errors, their own agents' errors on the application, in some cases. It happened to over a hundred thousand Americans in 2008. Can you imagine dealing with a diagnosis of a serious illness, plus suddenly being uninsured? The three insurance companies whose CEOs were at the hearing made over $100 million on revoked policies.

This is just exactly the thinking that has made the insurance industry so powerful. I've made the analogy elsewhere on this thread, but... An insurance company CEO would be completely at home running a casino. Breaking the knees of anybody who wins big, running them out of town. Hope they have insurance for those knees, too...

"Chronic conditions" are wiggle words. If you are Type 2 diabetic because you are 200 lbs overweight, your rates are high. If you were born with MS, then your rates would be comparable to the average demographic you fit in(age,weight,smoking) excluding your condition. I won't "punish" anyone for a condition they could not avoid.

The point is that the rates would be lower due to tort reform. It's a $60 doctor visit, sorry it costs money to treat you.

Yes, they get a trial: "Show me your H1B. What? You don't have one? Guilty." It doesn't require Perry Mason.

---------- Post added at 12:00 PM ---------- Previous post was at 11:56 AM ----------

You know, let me go back to this. Why do we have to help them in lieu of helping our own citizens? This notion that we owe illegal aliens something is absurd.

I have a serious question to ask.

In the state of Ohio Workers Compensation is mandatory for all businesses to provide for employees. The same for West Virginia. Ohio is Single Payer by the state. Wv is private. Both are very efficient. If someone is hurt at work and files a comp claim they immediatly must take a drug test to be eligible. In other words if you are doing somethng detrimental to your health and get hurt at work your claim will be denied. This is for both single payer and private. Would something like this be acceptable in whatever form the healthcare reforms will take? Should drug related health problems or obesity related problems be punished?

Please don't bash me on this, I'm genuinely curious. Especially since this is the case already with Workers comp in both sectors.

EDIT: OOPS, I forgot this was a pub discussion and put an awesome quote by James Madison (one of your precious Founding Fathers, Cimaron) who scorned the notion that Constitutional rights should be withheld from aliens inside the US. He said that by the same logic our laws don't apply to them either, which is obviously even more absurd than extending them Constitutional protections. But since this is a Pub Discussion, I can't cite that quote. So the closest I can come is to say "neener neener".

---------- Post added at 07:55 AM ---------- Previous post was at 07:46 AM ----------

I don't know about "punished" exactly, but I think it should inform the range of treatment that person is given. If somebody's messed up on drugs at work and drops something on themself and breaks their leg, I'm not going to just let them limp around. Gotta fix the leg. But at some point, drug rehab needs to be part of their treatment plan.

You get into some weird privacy stuff when you start doing tox-screens and Chem-7 tests as part of general trauma intake. But if you made it policy to do that to everyone, you can't be accused of prejudice. Especially if what comes next is treatment (versus punishment).

Punished was a bad choice of word, what I meant was charge very high premiums for these people until they are off drugs, or living a healthier lifestyle. This is already the case with life insurance for example. Smokers pay a higher premium than non smokers for the same amount of coverage. Depending on the amount of health insurance you have to take a complete physical before hand. I'm not suggesting we go that far with health insurance but the government likes to tax bad behavior as a deterent I assume, so why not do the same with healthcare.

1) aliens <> illegal aliens - and I didn't say "don't treat them". I said "treat them, then arrest them."
2) the Constitution does not provide healthcare. (Go ahead and quote the liberals' favorite comeback to this, "General Welfare".)

If you want to remove the general welfare clause then we better remove fire departments, police departments, schools, highways, national parks, student loans, research grants, medicare, medicare, social security, welfare, food stamps, income tax, etc.

Let's face it some of these programs have been challenged on constitutional grounds all the way to the supreme court and in every case the supreme court came back and said that the programs are constitutional. There is nothing in the constitution that prevents the government from providing health care and the general welfare clause would seem to allow it (especially given the precedence set by other programs). The unconstitutional argument is a non-starter.

Wow, I would eliminate virtually every thing on your list. I would keep highways and income tax (flat tax). fire/police/schools/parks/healthcare/retirement/welfare/food stamps would all go to state (as the state chose to vote it in). Loans and grants would be private.

It would be for the general welfare of the people that we all have a pony. Ponies are cute and cut your grass while you work. I think the federal government should give everyone a pony.

I still don't get why States would/could run things better than the feds. This is the great Libertarian fallacy.

At one point it was only 13, but now I get 50 different ways to pick and choose how to live my life. Don't like the government policies of California? Move to another state... I can tell you I've lived in 3 different states and own property in one I don't live in, but pay attention to all the rights and differences. There's lots of differences, but those differences get narrower and narrower over the past 10 years.

oh don't like the policies that the US Government is forcing upon all 50 states? you don't get much choice.

i don't see the distinction in this debate between saying "i like state-level control" and "i like peanut butter"

it's an aesthetic preference that has fuck all to do with the topic at hand.
if you are a libertarian and oppose the present debate because in some magical other universe you'd imagine that the same problems would thereby devolve onto the states--as if the states had the resources to cope with it---then it seems to me that what you're opting for really is the present system. because this in-between "idea" isn't an idea at all. it's a fantasy.

so all this stuff about how great the states are and how nice it is to shop around for your favorite flavor of state, being it smooth or chunky, salted or not, amounts to a non-sequitor. an evasion. nothing else.

You don't get it because you don't want to. You prefer a large central government. We prefer a smaller, decentralized government. It isn't a matter of that the states would or could run it better - it's the fact that some states will have the common sense to know that the government should not be involved in social programs. Those states would have low taxation, and the citizens would be free to enjoy the fruits of their own labor, and to manage their own affairs. Those states would be attractive to us. States that would control all areas of your life would be attactive to you. At least there would be a choice. What are YOU afraid of if you turn it over to the states?

you may think that rb, but I enjoy the idea and belief from the history and understanding that I have of the US Constitution that the Federal government's duties are specifically enumerated, those that weren't were left for the states.

For example, people didn't flock to MA once they got universal health care.... there's other cons to that choice, mainly having to move and live in MA.

i don't find anything about strict construction arguments to be relevant here.
seriously--for them to have any meaning except as (again) an aesthetic matter (peanut butter again)--there would have to have already been a basic change in how the existing constitutional system actually operates. and there hasn't been.

but it's nice that you have some nostalgic take on the constitution as you imagine it was written and functioned in some 18th century world that's long disappeared, and it's your privelege to indulge that nostalgia, just as it's mine to listen to the sons of the pioneers to hear that manly man cowpoke roy rogers yodel. yippee yi kai yay.

I don't think a single state would dump social programs in favor of lower taxes. Not a one.

Question for rahl or whoever:

If health insurance through one's employer is cheaper because you're "spreading the risk around", why can't I, as a healthy, non-smoking male with no family history of diabetes, etc. negotiate a cheaper rate on my own? Among all the workers at the company, I would fall on the lowest risk end of the spectrum, so aren't the unhealthy people in the pool actually pulling my rate up?

Yes. Did you read my solution above? (Post #136)

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What are you talking about? They do it right now! If you think, for example, North Carolina has the same social programs as, for example, California - you are delusional. Why do you think California has a $126B deficit this year? Because of their out of control social programs!

I didn't say NC and CA were the same. I thought you were implying that in your Utopian Libertarian world, certain states would drop social programs completely