Obama's Health Care Plan

[Prestan]

Video I made. Be sure to watch the end of it as well.

www.youtube.com/watch?v=9XfojExYOZE

[clericjay]

Nice satire... though having a health care system run by the state is still far far away from Socialism.
My parents lived in the former GDR and experienced real Socialism. Though it means poorness for all, the healthcare system was something, which worked very well. A more actual example is Cuba, where the government runs a high quality healthcare system and even exports their well educated doctors. These people there may be poor, but they are healthy. I read about this on the internet, but a friend of mine, who's coming from Cuba, confirmed it.

I've been watching CNN recently by accident and I was surprised that everyone is talking about Obamas healthcare plans and though I don't have any good overview about how far Obamas plans are going I want to say something to this issue.
Well, I'm not an expert with these things, but we do have a healthcare system run by the state in Germany since the era of Bismarck.
_{I think Germany was the first country to do that worldwide...}

In the Federal Republic they splitted it into different companies, who are responsible for health care and insurances, strictly controlled by several laws and the observation of the state. So everyone in Germany needs to decide for one of the possible companies and pays a monthly fee, which is shared between you and your employer equally.
In the case of a treatment by doctors, in hospitals or for therapies the company you pay takes these costs and you don't have to pay your therapy costs directly.
There are some private corporations who deal with healthcare now, which is a possible alternative, but there's no one without an healthcare insurance and no one will annoy you with any bills after your treatment, which seems to be different to most of the countries on this planet.
The disadvantage may be that you pay regularly even if you'll never need any service from your healthcare corporation and you are forced to have an insurance.
On the other hand all these things dealing with healthcare are less complicated for you and the high standard of medications and technical equiptment as well as the doctors salary is secured by the state and the money everyone pays.

I cannot clearly say if this is better than the system in the USA, because I haven't dealt with it yet, but it's an alternative you could think about. ;D

[Mirabilis]

And living in the UK I have to say that our own National Health Service, flawed as it is, still beats the hell out of having to take out a bank loan or re-mortgage the house in order to pay the medical bills!

ETA: I will add that people who indulge in cigarette and/or alcohol consumption (like myself) ...or drug abuse or over-eating to the point of obesity, deserve NO sympathy and should expect to pay for their vices personally, with no support from the state. I take full responsibility for my bad habits and don't expect anyone else to pay for them...I shall put a bullet through my brain when the time comes...so a health care plan should ONLY be available to those who develop illnesses through no fault of their own.

[Prestan]

I have cystic fibrosis.

I have a very seclusive special program for people with "CF" that pays 100% of all of my medicines. People like me who depend on several different medicines and special equipment and annual hospital visits all their life need these programs. Universal Healthcare would shut my insurance down.

The threat of losing my doctors, losing my quality of care (such as medicine delivered to my door without me even having to order it) and having to pay huge amounts because I require so much is frightening to me.

Maybe universal healthcare could work for the average healthy citizen, but for people with diseases like me, its a nightmare.

[Aedh]

My heart goes out to you my friend ... it is very hard. I have my own opinions on health care ... shaped by my own experiences with chronic disease--which treatments under our current healthcare system did not improve but made worse. It was only when I fled the doctors and developed my own treatment regimen that I improved. But that is me and not anyone else.

I think that what the majority of basically healthy people need is to be treated like basically healthy people and not given a lot a crap they don't need simply to satisfy rules designed to enrich health insurance companies and protect the arses of politically-connected bureaucrats. That being said, those who are NOT basically healthy need treatment which can at need be blind to cost.

How we do this, I can't outline. But I can't believe we can't take the ingredients of the system we have now, and reforge them into something more effective somehow.

[clericjay]

I can understand the concerns of both positions, though there are many really ridicules things going on in the US these days...

But did Obama say that all the old insurances would be forbidden or that there won't be any private alternatives to the governmental healthcare? Couldn't it be that you would still keep your old insurance?

Mira's thoughts are very interesting I think. I totally agree with her position and I think it could be useful in Germany to think about this. These days the government here is thinking about making the people more healthy by special sport- and education-campaigns and acts like forbidding smoking in public places and pubs. These things do not really work and the reason for that could be that those deseases caused by smoking, obesity and alcoholism are still paid by the public healthcare.
Otherwise the people would probably think about their health before every cigarette or beer...
Or maybe not...

[Mirabilis]

Aug 12, 2009 6:14:04 GMT -5 clericjay said:

I can understand the concerns of both positions, though there are many really ridicules things going on in the US these days...

But did Obama say that all the old insurances would be forbidden or that there won't be any private alternatives to the governmental healthcare? Couldn't it be that you would still keep your old insurance?

Mira's thoughts are very interesting I think. I totally agree with her position and I think it could be useful in Germany to think about this. These days the government here is thinking about making the people more healthy by special sport- and education-campaigns and acts like forbidding smoking in public places and pubs. These things do not really work and the reason for that could be that those deseases caused by smoking, obesity and alcoholism are still paid by the public healthcare.
Otherwise the people would probably think about their health before every cigarette or beer...
Or maybe not...

There are plenty of private medical alternatives to the NHS in the UK, if you're prepared to pay for them...in that respect we are no different to the USA. And I agree that if people had to pay for their own health care as a result of a bad habit then yes, they might think twice...certainly banning smoking in all public buildings including pubs and bars hasn't deterred a lot of people here since it was introduced.

[Aedh]

I don't know a lot about what to do. It seems unfair to tax (they won't call it that but that is what it is) healthy people for care they don't need or want. On the other hand, putting off adequate care when you are younger WILL lead to need for more care when you get older if you neglected yourself.

On the other hand, that assumes that adequate care is available. I haven't had access to adequate health care for 20 years. I've had access to CRAPPY Third World-style health care, of the sort where you come to them with torn back muscles or rotator cuff injuries to your shoulders, and they give you some aspirin and tell you to take it easy for a few days, after which time your employer fires you because you can no longer do your job.

I could design a health care plan for an ideal USA. Unfortunately we don't live in an ideal USA. We live in a USA where 90% of people either need care they can't pay for, or don't need care THEY CAN pay for; and a world where many people who need adequate care have access only to poor care, administered by people whose top priority is satisfying the accountants and directors rather than helping patients.

I think we got into this mess because we refused to acknowledge that there are limits. If current trends continue, in another thirty years--assuming we don't bail out on our commitments--the entire Federal budget will have to be devoted to funding health care, and 75% of people's income will have to go on taxes to pay for it. Well, obviously something's going to have to give way somewhere.

Personally I think the main problem in the health care sector is that too many people are paid fat salaries to occupy comfy seats in plush offices and say "No" all day.

[Vespertilio]

Aug 13, 2009 9:02:00 GMT -5 Aedh said:

Personally I think the main problem in the health care sector is that too many people are paid fat salaries to occupy comfy seats in plush offices and say "No" all day.

BINGO!!! and we have a winnah!!! ;D

I hear more horror stories about claims being denied at the last minute to stop the insurance companies from losing a few pennies of profit... I have the opportunity to get some sort of basic health insurance through my job but it doesn't cover eye care or dental and I'm kind of unclear on exactly what I would be covered for, how much I would have to pay, etc. *sigh*

I have a friend whose mother was hopitalised with a severe stroke, contracted a mystery staph infection and ultimately died. When my friends got her hospital bills (much of which was covered by medicare), they found charges for treatments which neither of them had authorised or been informed of. They reported this to the medicare administration and were thanked and told if more people reported things like that the administration could save millions. Of course, anyone who's looked at a hospital bill can tell you it's one of the most arcane documents on earth.

In the meantime, I'll pass this along and hope it assuages some of the concerns over the health care bill (which is still being written and finalised as I type)...

8 WAYS HEALTH INSURANCE REFORM PROVIDES SECURITY AND STABILITY TO ALL AMERICANS

1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.

6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

Learn more and get details:
tinyurl.com/nbn5fg


8 COMMON MYTHS ABOUT HEALTH INSURANCE REFORM

1. It's a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.

2. It's a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.

3. It's a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.

4. It's a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.

5. It's a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.

6. It's myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.

7. It's myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.

8. It is an absurd myth that government will be in charge of your bank accounts. Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose. Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you - and the same rules of privacy will apply as they do for all other electronic payments that people make.

Learn more and get details:
tinyurl.com/lyxel4

[Aedh]

Well, to understand why claims get denied so often is to understand the very nature of bureaucracy. Whether it's health care bureaucracy, government bureaucracy, corporate bureaucracy, etc. Bureaucracy is always the same. But we must understand just what it is and where it came from and why.

Bureaucrats existed in the ancient world and in the Orient, but bureaucracy as we know it in the West to-day had its origin in France--to be precise, in the Frankish empire of Charlemagne in the early ninth century AD.

Prior to Charlemagne's time, lords and kings were accustomed to hold court and deal with requests, grievances, petitions, business, etc., personally. Some were more energetic and willing to do longer hours, and some less, but they all did it. There was, essentially, no such thing as bureaucracy.

But Charles the Great conquered such a huge empire that his Courts became chaos. People from a huge area jammed his palace at Aachen, waiting months or even years to be heard--often over trivial matters like who stole a cow. Well, this wasn't good, and frankly (haha) the ruler of Europe's time was too valuable to listen to arguments about stolen cows.

So, Charlemagne instituted a layer of paid functionaries below him whose job was to examine all the people who wanted to come to his Court and sort them out. If it was a matter that dealt with a boundary dispute, a large inheritance, etc., they were to be allowed in. If it was about a cow or some spoilt cheese, they were to be sent away. It worked, and the Emperor was able to get on with business that was significant to him, while things he didn't care about were sent packing.

This was the beginning of bureaucracy as we know it. The modern bureaucrat does just what Charlemagne's people did ... sit behind a desk and collect a paycheque to say NO to a lot of people and YES to a few, and the beauty of it is that their paycheque depends on whether they give satisfaction to their masters and not to the customers who walk in.

Naturally it is much easier to say NO than to say YES, because the minute you say YES you have a problem on your desk. When you say NO it simply goes away. Well, what is the temptation there?

It all went downhill from there.

[Aedh]

As I understand it, much the opposition to the reform is due not so much to the reform's details itself, but the way in which it is scheduled to be implemented.

The centrepiece of the proposal, I'm told, is a 'premium subsidy programme' by which people with private or employer-based insurance would have the Government cover part of the cost of their premiums.

For example, a family of four with an income at twice the poverty line--that is, an income of $44,000 per year--would pay no more than 5% of their total income for insurance; the Government would cover the rest. It would cost an enormous amount of money to offer that to ALL such families with such an income. The Census Bureau counts 102 million people under age 65 in households between 150% and 400% of poverty level, so we are talking about a lot of families here. How to reduce that?

The answer is to make the Government subsidy come through 'exchanges,' which would be public health-insurance pools set up in each State to parallel private- or employer-based pools which already exist. To begin with, persons employed full-time and having access to employer-provided health insurance would be barred from entering the 'exchanges,' so they would not have access to the subsidy.

The effect of this is that two households, who could conceivably be neighbours, in similar houses, with similar incomes, could be treated very differently depending on whether they got insurance through their employer, or qualified for coverage through their 'exchange.'

Our family which makes $44,000 a year, if they lacked employer-provided health insurance and were insured through an exchange, would pay no more than $2,200 a year for a policy that might cost $12,000 ... so they would be receiving a Government benefit worth nearly $10,000. At the same time, the next door family, identical in income and situation but deriving health care via an employer, would receive a tax break for paying for their $12,000 plan, but the tax break would be worth $3,600. Therefore the household in the exchange would be about $6,000 ahead of the other.

The financial advantage for the family in the exchange is obvious. It would be natural for many families to wish to abandon employer-provided health insurance and go to the exchanges, and if that were the case, employers' pools would shrink to the point where it would no longer be worthwhile for them to offer an insurance benefit at all. This is where the fear of many people comes in. They fear losing their employer-based health coverage, with which many of them are happy, in exchange for--well, they know not what.

As far as commissions to rationalise health-care costs go, it's worth a bash. But we've had a bash before. In 1989 a commission was appointed to rationalise Medicare--that is, health care for senior citizens--by adjusting fees and creating incentives for more doctors to become general practitioners and fewer to be specialists, thus increasing the amount of general low-level health care available, increasing preventative medicine, promoting healthy lifestyles, etc.

In fact, the 1989 scheme achieved the opposite effect. General practitioners who accept Medicare patients have now almost completely vanished, and there are very few even for younger than senior citizens. The complicated fee schedule requires billing-specialist employees devoted to nothing but figuring it out, and costs have risen. Most doctors entered medicine because they wanted to work in an individual style with individual patients, but with so many things that Medicare--and private insurers, who tend to imitate Medicare--won't pay for, many became discouraged and simply stopped offering services.

This highlights the greatest potential problem in critics' eyes, which is, trying to maintain a semblance of private healthcare for everyone while effectively undercutting it with Government subsidies. Many people see this as somewhat hypocritical. I don't say that it is, but anyone in Government who proposed a scheme that said, "No more private insurance ... it's all single-payer now," would be hooted down by Americans who like their private insurance--who are a solid majority. At the same time, the number of Americans who can't GET private insurance, such as yours truly, are left by the wayside, and their numbers are growing, and have a loud political voice. The current proposed scheme is the way the most politicians agree offers something to both sides; however, the private-insurance side are increasingly not buying the idea.

Universally-accessible private health care insurance through the market is a chimaera. It was not available before World War Two, and BECAME available during the War only because employers existed on massive Government War subsidies, and were able to carry on for another twenty years after while US industry dominated the world. After that time, it became more and more expensive and more and more restricted, and it's been obvious for twenty years that it's no longer a realistic dream.

Before that, Americans simply paid for their own damn health care unless they worked for the Government or had an in-house benefit at work. No one believes we ought to return to those days; in 1918 my aunt died of yellow jaundice--an easily curable condition--because my grandparents couldn't afford a doctor for her. We don't want to go back to that ... of people dying of pneumonia because they can't afford to buy antibiotics.

The alternative--always understanding that there may be small groups of workers, professionals, or wealthy persons who can set up their own 'in-house' plans--is a single-payer plan backed by the Government ... if we want universal health care access, and don't wish to have to step over dying beggars in the street or try to ring up Grandma to find that she caught the common cold and died of it. Call it socialism ... call it communism .. call it Evil-Genius-ism ... call it whatever.

How the Government is to pay for this is--well, really, unknown. Cutting waste, fraud, and abuse may cover some of it but it won't come close to covering all of it. Taxes will have to go up, and unlimited treatments for every and any condition will have to end. No more MRI for someone who wanders in with the sniffles. There are limits.

In America we had a system that worked well for fifty years or so. That is meant to be a tribute. Few human contrivances work so well, so long, for so many. But the day has come when it no longer works well, and may well soon cease to work at all. Something must be found to replace it, and we are listening to a loud and ugly debate over what is to be done. That is really what is going on ... no hype, no spin. Just reality, however unpleasant it might sound.