Universal Health Care

[robin]

Significant tort reform (limit non-economical damages)

Fewer state and federal mandates

Allow for purchase of health care over state boarders - Oregon residents should be able to buy insurance from Companies outside our own state.

True cost transparency

Eliminate PPO's and reimburse based on UCR (Usual customary and reasonable)
Increase Medicare reimbursement - There is a significant cost shift from Medicare and Medicaid to the private market

Greater tax incentives for both employers and individuals

None of these are included in the current bills being negotiated.

[krhagan19]

Robin, why would you eliminate PPO networks? That is where they negotiate a reasonable rate then there is a predictable charge for the patient and a predictable expense for the patient. UCR is a meaningless term, check this website www.emoryhealthcare.org/patient-guide/insurance.html it states in part "Your insurance carrier may claim that your bill exceeds the usual and customary rates for a specific type of service. Please understand there are no usual and customary rates. Each insurance company determines how much it will reimburse for different medical services, and those rates vary widely." This would not lower the cost of healthcare for the consumer, it would simply lower what an insurance company would pay and leave the consumer with the lions share of the bill. PPO networks are useful because it allows the patient to seek care and have a predictable rate. For example if I see a Doctor in an office visit and they are in network (In Atlanta almost all Doctors are in network for my insurance) I pay $15. That is reasonable. If on the other hand There were no networks, and my insurance company was willing to pay lets say 150 for an office visit, I would have to check with many many many doctors to figure out who was the best one for the best price. Network pricing gives me a range of Doctors to choose from and I can choose them based on their merits because my Insurance company has negotiated the prices. Your proposal would also lead to even further stratification of the healthcare system as even people who have the same insurance would now have different rates for different doctors. One practice that many insurance companies have already done away with that I believe should be done away with by law is networking ERs. Why? Because unlike a scheduled appointment, Emergency treatment should be done in all cases at the nearest facility that is highly capable of dealing with the Emergency, it is absurd to have someone penalized because their in network hospital is across town and they need to be seen ASAP for an true emergency. As for the idea of Cost Transparency I agree with you wholeheartedly. As for the issue being able to purchase insurance across statelines, again I agree with you. Tort reform needs to happen as well but I am not sure limiting non-economic damages is the best thing in all cases. There are many cases where truly substantial sums of money that are non economic would be and appropriate penalty. For example, if the negligence caused massive pain and suffering that deserves major recompense. A good example of this would be when an incompetent anesthesiologist manages to paralyze the body so that it cannot move or react, yet not get the pain portion quite right so a person is conscious and able to feel pain during a major invasive operation, and also has memory of the event. This actually occurs, but is exceedingly rare. I think that level of pain and suffering, along with psychological damage that it would cause should allow for substantial non economic damages, even if the person is able to return to work and his income is not affected in a major way.

[robin]

First of all you should be aware of the fact that I have worked in the health care insurance industry for 10 years. My family owns a Group health insurance brokerage firm in Portland and I constantly communicate with employers, employees, and insurance companies, so I know a little bit about this topic.

Let me ask you this. How much have dental premiums increased in the last 10 years on average? If you look into it you will find out that on average rates have increased about 2-4% annually. Guess what. Most dentists do not participate in PPOs. Most dental insurance companies provide benefits based on UCR. UCR is meaningful. An insurance company can establish plans at a percentage of UCR (generally 80-95%). UCR's are established on a area specific bases. In the Portland area reimbursement is higher in Lake Oswego and lower in Gresham, and they are only about 20 miles apart. If a provider charges more than the UCR and patients are being balance billed, the consumer can choose to pay the extra expenses to see that doctor or they can choose one who's rate are more reasonable.

When doctors are competing for business with other doctors real competition starts to take place. As it stands now there is no competition. You pay you 15.00 co-pay regardless of what the true costs are. There is no incentive for you to see a doctor who has a reimbursement of $100 for an office visit as opposed to one who receives $110 per visits.

You also have this mistaken notion that insurance companies are negotiating lower rates on our behalf, where in fact most cash payers will pay less then the negotiates fees arranged by the insurance company.

Hopefully I've been able to explain myself clearly.

[krhagan19]

I agree with you on dental insurance, but I have several ER visits in the last year. One of them was with my old insurance at a hospital that was not in network. The Bill was 1600 dollars, and the UCR from my insurance was 700, I got stuck with the rest. PPO's are not perfect but if need expensive care, PPO is better than UCR because it keeps prices lower for the consumer.

[robin]

The term UCR can have two definitions. UCR on your plan may very well have stood for Usual Contracted Rate, and not Usual Customary and Reasonable. Meaning that the insurance companied will reimburse out-of-network services base on what the would pay for an in-network provider.

PPO's are not perfect but if need expensive care, PPO is better than UCR because it keeps prices lower for the consumer.

Under the current system, I would agree. However if the system were to change as I suggested, I believe that rates and the cost of care would be reduced.

[robin]

Is anyone else watching what is happening in DC regarding health care? Watching the sausage get made is absolutely disgusting. The Democrats in Congress are well aware of the fact that this legislation is very unpopular with the public, and they are having a difficult time coming up with the votes to pass their overhaul of the health care system. Pelosi and Obama are looking at using a procedure called "Deeming", where by the vote on changes to the Senate bill, and then without a up or down vote on the bill simply deem it to have passed the house. This is outrageous! This new sign of desperation from the liberals is astonishing. Whether you agree with the legislation or not, every American should be outraged at this abuse of the Constitution by our President and leaders in Congress.

As a new sign of desperation the President went on Fox News yesterday and embarrassed himself by displaying both his lack of knowledge and multiple contradictions. It is interesting to see how the President performs when he is truley challenged by the press, and not reading from a telepromter. Perhaps this is why his approval rating are at a staggering 43%.

I'm curious to know if those of you who voted for Obama are getting the "Change" that you hoped for?

November cannot come fast enough.

[rbbailey]

There is some room for socialistic programs in the United States. Programs, for instance, to take care of those people who really, actually, have no choice -- children, the old, the crippled, and the mentally retarded. But I believe even those programs should be temporary. They should be there as transitional help till those people can be cared for by private organizations.

Why should the government not get involved more than that? Because otherwise you are inherently taking away the free will of the people who don't want to help others. However selfish these people are, however bad it may be for some people in the times when they are not being properly cared for, it is not as bad as taking free will from a human being.

As Christians, we must understand that Christ came specifically to give us true free will. That's what his death and resurrection were all about. To allow us to have a choice. If we build a government that takes away free will, and call it benevolent, we are only fooling ourselves. Benevolence is not gained by paying higher taxes, it is not gained through an unwilling, cop-out sacrifice of the whole. Socialized medicine is not charity, caring, lovely, benevolent, or free; it is a perversion of these things, an excuse for not properly doing these things, it is sacrifice without purpose, a waste.

As Christians, we should be taking the place of government to provide for our fellow human beings, not allowing for, and even advocating for government to take the place of God. Government is a tool by which our rights are preserved, not the author of our rights. To mix these two roles is to practice idolatry.

[Josh]

But if you're allowing for some mandatory government provision for certain individuals (as in your first paragraph), then aren't you contradicting yourself when you say that it is wrong to take away the free will of people who don't want to help others?

You see, I don't think it's wrong for the government to force people to pay for some things. But I do think it is wrong for the government to prefer it's own benevolent intervention over that of the private citizen.

If the church and other citizens aren't stepping up to the plate to take care of the "least" among us, then by all means I hope the government will. But if the church and other individuals or groups are stepping up to the plate, then by all means let the government get the heck out of it.

[moritz]

Apr 1, 2010 9:20:45 GMT -8 rbbailey said:

(...) However selfish these people are, however bad it may be for some people in the times when they are not being properly cared for, it is not as bad as taking free will from a human being.

As Christians, we must understand that Christ came specifically to give us true free will. That's what his death and resurrection were all about. To allow us to have a choice.

Where do you draw the line? You sure want the government to restrict the free will of people on some things, don't you? Are you pro choice in matters of abortion? Are you pro choice in matters of stealing, murder, the violation of your human rights by others, etc.? Living in a society always implies the restriction of free will (or to be more precise: the restriction of the implementation of free will decisions).

That doesn't mean that UHC is good or not half bad or necessary or as severe an issue as murder. But it illustrates that your point of unlimited free will is problematic.

On a different note: could anyone of you who doesn't belong into either of the two big political camps in the USA explain to me in brevity and simple language what's the matter? I understood so far that UHC collides with libertarian ideals: the state is reaching into yet another aspect of personal life. That's annoying. But other than that? I mean, I've grown up in a country that prides itself in having one of the best health care systems in the world and it so happens that it's universal health care. I also know that Germany is neither a socialist* nor a communist country.
I don't know where I stand on universal health care. I'm warming up more and more for libertarian approaches (despite my distrust of human reason) but I also know that universal health care doesn't harm me at all. Sure, I probably pay more for my insurance than I would have to (especially since I barely ever need a doctor), but I like the idea that my money makes health care affordable for less priviledged people.



*though there might be a transatlantic different understanding of what the term socialist means . When I hear the term I think of former sovjet block countries like East Germany (GDR).

[Josh]

Most Americans would consider most northern/ western European countries as somewhere on the spectrum of "socialism". What this really means to us is that "socialist" policies and programs* have taken hold to a noticeable degree. My general impression is that the Scandinavian countries are the most extremely socialist, followed by Germany and France, and lastly even England to some degree.

This same viewpoint holds that American has been growing ever socialist since the FDR administration/ New Deal policies of the Great Depression.

Americans think of East Germany as having been virtually "communist"- a step further than our idea of "socialist".

*policies and programs by which the state controls aspect of civil life that are in addition to the ancient, historical, more modest roles of government that tends to be limited to national defense, foreign policy, a legal/criminal system, and infastructure.

[moritz]

Apr 1, 2010 11:50:51 GMT -8 Josh said:

Most Americans would consider most northern/ western European countries as somewhere on the spectrum of "socialism".

In that case, there's nothing wrong with socialsm. The high living quality in Scandinavian countries is the envy of the entire European Union. In my book those countries aren't really socialist, though.

[carebear]

I've grown up in a country that prides itself in having one of the best health care systems in the world and it so happens that it's universal health care

I'm not going to say if it is good or bad yet, but I was in Stutgartt in 2005 and I had an urgent situation with my knee swelling from an injury and so my host took me to the local hospital emergency room because it was late. When we got there, it was an empty building (maybe 7pm) and there was a sign to the emergency area. When I got there, there was no window to check in (it was closed) and there were about 7 different injured people there. None serious but one lady who had cut her finger really bad and was holding it together with a cloth.

I just thought it was soo weird that there wasn't at least one employee always ready to see if people were in need. About 20 minutes later a lady came out from behind a door and took someone.

After the doc saw me, I had to wait close to 60 min. in an empty hallway with no one in sight for an xray guy to come.

I guess it just seemed super cold and uncheery and not client oriented. No decor anywhere. Just plain empty walls with no one around.

That was the impression I got of the healthcare there. I wondered how someone with a heart attack gets their attention in the ER if they are not around to see the person?

Am I being too dramatic?

[robin]

There is some room for socialistic programs in the United States. Programs, for instance, to take care of those people who really, actually, have no choice -- children, the old, the crippled, and the mentally retarded. But I believe even those programs should be temporary. They should be there as transitional help till those people can be cared for by private organizations.

So long as we allow the Government to take care of children, the old, the crippled, and mentally ill or retarded, we as Christians will be allowing the Government to replace Jesus and his church as to vehicle of compassion. As a Christian I am not comfortable with the government standing in the place of the church when dealing with those in need. Not only does the government take this vital role from the church but the government fulfills this role by taking money away from individaul by force. This is anti-Christian, and should be rejected. Charity should be given freely and not forced. When Christians give freely the credit goes to Jesus, and when the government gives by stealing from others the government is praised. I don't understand how anyone could feel good about taking money this way.

Peter tells us why we have a government (1 Pet. 2:13—17). Government is there to punish evil, and reward goodness. That is governments God given authority, and I don't see any reason to expand it's power.

Josh,

If the church and other citizens aren't stepping up to the plate to take care of the "least" among us, then by all means I hope the government will. But if the church and other individuals or groups are stepping up to the plate, then by all means let the government get the heck out of it.

In order for the Government to do this they will need to take from others. The government doesn't have it's own money, it can only spend money that belongs to others.

[moritz]

Apr 1, 2010 12:01:18 GMT -8 @carebear said:

Am I being too dramatic?

Depends on the point you are trying to make, I would guess. If you are going to make a conclusion about the German Health Care System based on one single experience, then you are probably being too dramatic, yes.
That's like judging the state of the American society based on a trip to Compton, Ca. ;D

But that doesn't mean that your experience is singular. We only have to make sure not to confuse a structural problem with a systematic problem: With more than 80 million inhabitants, the demand for medical attention is, economically speaking, simply exceeding the capacities the practicing doctors can offer. Especially given the fact that the German society is demogrphically shifting more and more towards large majorities of elderly people, who need more of the doctors attention. That's a problem. But a structural one which has little to do with the health care system.

This leads to the question of whether the quality of the system depends on pretty wall decor and cozy waiting rooms. My guess would be, that when politicians and media celebrate the success and quality of the system they are not quite concerned with such esthetic objections (without wanting to downplay them) but rather looking at pragmatic primary questions such as: is every cititzen getting the medical attention he needs?

It seems that even though you had to wait for a while and didn't feel comfortable in the waiting room, you received your treatment and that seems to be the decisive part of the story for me. The German system might not resemble Utopia but it does work well enough.

However, if millions of people can't afford to get the treatment they need or decide to play risk because an insurance would cost them more than they could comfortably spare, or are simply plain irresponsible, then there's an urgent problem. Does the government have to step in? Hopefully not. If civil organizations such as churches can manage to take care of the needy, that sure seems to be the preferable solution for me. But apparently the churches and individual Christians throughout the United States weren't able to manage the problem. One can still dislike and reject governmental intervention. But to speak of socialism* or even communism because of universal health care seems a bit exaggerated to me.

But probably I simply haven't got the necessary information to understand the panic of the American people. Could an independent fill me in? Josh? From the distance it seems that the core of the objection is selfish greed guised as championing liberty. Let's hear the correction.

*in the European understanding of the term which differentiates between communism (= former Soviet Union) socialism (= former East Germany) and social democracy (= West Europe).

[steve]

Moritz

I think the main objections from the Republicans are

1) Increasing governmental interference in the private lives of citizens

and

2) The fear that a UHC system will eliminate the competition which keeps the medical research and quality of care on the cutting edge.

Having made reference to quality of care, I must also mention that this care is for many people not affordable. It may be good, but it's unattainable financially.

I personally think the state of american health as well as american health care is catastrophic. I don't know if Obama will change it for the better, but I guess at this point I would welcome any attempt. I don't really understand his bill, so I can't say if it's good or not, but I don't think that most of the critics really understand it either. (That's just a hunch)

I agree with you that calling Germany socialist is very over-the-top. Germany is actually, in my view, very conservative. Nonetheless, the issue of health care being universal wasn't hard for them to swallow.

In my personal experience, the health care system in Germany has been fabulous. We pay an extremely agreeable rate and receive better health care then I ever had in my previous country of residence. In addition, treatment which focus on prevention get paid for.

In America, we are fine with paying for roads, libraries and school with public money. I'm not sure why health care is where they draw the line. I guess I think that somebody having to choose which of their fingers should be sewn back on simply shouldn't happen.

I believe in a free market in most regards, but in the case of UHC, I lean more towards socialism. (I never thought I would say that)

[carebear]

Yeah, I think many people think the quality of health care will go down the tubes because people will be seen as a number and not as a person. They fear that yes, everyone will get "care" but it won't be quality and thus might hurt them.

That's like judging the state of the American society based on a trip to Compton, Ca.

I understand your point but this was a nice part of town in Stutgartt, nothing at all like Compton.

[robin]

I don't really understand his bill, so I can't say if it's good or not, but I don't think that most of the critics really understand it either. (That's just a hunch)

The original bill number over 1500 pages. I read over 900 and my wife read nearly the entire document. Many of my business associates have much of the bill, but I cannot say exactly how many. The fact is that much of the public is fairly well informed, and I would say that the public understands more than the politicians who voted on the bill, generally. A week before the bill was passed, president Obama had an interview on Fox News and he himself could not clearly explain what was in the bill and what was not.

The fact is this. Americans want health care reform, but we're not satisfied with just any attempt. This health care bill could very well end up bankrupting our country. Americans agree on many points of reform, and these reforms could have been passed with majority support, but nearly none of the most popular proposals were included (tort reform, purchasing over state boarders, expanded privatization of Medicare). Americans of decidedly against this bill because it is less about make health care more accessible, and more about social engineering.

The CBO (Congressional Budget Office), which is non partisan, puts the price tag at 1.1-1.2 trillion dollars when they include the doctor fix with the bill. Other independent groups have estimated that the bill could cost up to 5 trillion dollars. This bill simply costs too much.