SCOTUS argues Mandate Constitutionality

[stebo0728]

Ok, so I thought Id start up this thread, see how you guys sit regarding this. I thought the proceedings this week were quite astonishing compared to what I expected. It will be June likely before we know the outcome, and historically arguments heard and questions asked aren't always good indicators of outcome for SCOTUS rulings. Still, if they were, this week's proceedings would certainly spell death for either the mandate alone, or the entire bill.

My desire is to see the whole bill shot down. There seems to be a narrative building that this would sack the right with the weight of the healthcare problem in November, furthering campaign heartburn. Im not sure that I agree with that idea, but perhaps. Death of this bill will definitely put the problem in the lap of conservatives, but Im not sure it will place the blame in their laps as well, but public opinion can be a fickle thing. This would most certainly be a do or die moment for conservatives. Although I disagree with the Affordable Healthcare Act as a solution to the problem, the fact remains, there is a problem. We need to see the conservatives step up to the plate and put forth some good solid free market solutions to the problems at hand. Ive spelled alot of these out in previous posts. The ideas are out there, but they have yet to be bundled into a bill of goods to be sold on the Congress floor.

I can tell you, I would have not enjoyed sitting in the chair of the Solicitor General this past week, that was quite a hot seat, and it almost seemed he was a bit ill prepared to argue his points. Perhaps he expected to not have to defend his position as much as he did? I dont know.

So you have a few points to this.

A) The mandate, and its constitutionality.

This is the biggest problem I have with the act, although not the only, but I definitely agree with those who feel this measure is unconstitutional. Arguments going back to wheat farmers were used to help argue the merit of this measure, but that wasn't exactly a clean sale. For one, the justices who had problems with this measure, didn't like the notion of giving the government the power to force the creation of commerce. Additionally, there were concerns about the slippery slope that allowing this measure could potentially create. I understand the reason the mandate was developed, and in all honesty, the arguments for it make a degree of sense, HOWEVER, at the expense of furthering the unenumerated powers of the Federal government, which in my opinion, is not an acceptable exchange.

B) The severability of the mandate from the rest of the bill.

This one could definitely go either way. It seems the justices didnt really want to read the bill in order to figure out what can stay and what goes. Hell most of congress didnt read it, why should the SCOTUS? But then you did have the Ginsburg quote "its like the difference between a salvage job, and a wrecking job" So it seems there is at least some desire to keep the bill instact minus the mandate, if indeed the mandate is struck down. Personally I'd prefer to see the whole bill go, but as far as the constitutionality goes, really only the mandate is in question, so I could see the bill staying without the mandate as well.

Oh and there was the first day, and the question as to whether the penalty was in fact a penalty or a tax. This all boiled down to the ruling decades ago, I think regarding the income tax, that until a tax takes effect, and is imposed, it cannot be challenged. This would mean that any Supreme court challenge would have to be postponed until 2014, when the tax/penalty actually takes effect. Here I think the SG made the wrong choice. He decided to argue that the penalty was in fact a penalty, and not a tax, so that he could get this ordeal out of the way now, rather than put it off. This severely hurt his arguments. Any thread of constitutionality would have to hinge on the penalty in fact being considered a tax. Obviously it was considered a penalty, and arguments resumed. This was quite entertaining I thought.

Something else, as a side note, I really never paid as much attention to SCOTUS proceedings as I did this week. If you stop and consider, SCOTUS is supposed to be our backstop, our last resort against government tyranny, and theres really only ONE MAN who actually thinks for himself on the panel, Justice Kennedy. The four liberally appointed justices pay their homage to their appointers, as do the four conservatives (although Suitor is a flip flop, would have given a 5/4 or 6/3 lock had he stayed conservative). So in some respects, our backstop is ONE MAN. I dont think that's the outcome that was intended. Of course I've oversimlified it to a degree, I dont mean to say the partisan justices are 100% partisan, but I would prefer that the other 8 were more like Kennedy. Imagine the outcome 9 swing votes could produce.

[bigbadberry3]

Strike it down....

Rise up universal healthcare....

[telcoman]

Strike it down....

Rise up universal healthcare....

+1 Single Payer System

Everyone on Medicare.

Existing for profit insurance companies put out of business.

SCOTUS Go strike down Obamacare, I double dare ya

But I don't think they will.

Telcoman

[stebo0728]

Existing for profit insurance companies put out of business.

Is anyone allowed to make profit Telco? Or maybe just not health insurance companies? Those evil profiteers.

Do you even know what their average margin is, or are you just pontificating again?


And single payer system wont work. Its a reverse monopoly. But rather than one supplier to drive prices too high, you have one demander to drive prices too low. Service providers will not be able to stay in business on the cut rate they will receive, and they wont be able to just opt to not service medicare patients. The system will begin to hemmorage doctors. The only doctors left will be those philanthropic enough to keep working for beans.

[telcoman]

Existing for profit insurance companies put out of business.

Is anyone allowed to make profit Telco? Or maybe just not health insurance companies? Those evil profiteers.

Do you even know what their average margin is, or are you just pontificating again?


And single payer system wont work. Its a reverse monopoly. But rather than one supplier to drive prices too high, you have one demander to drive prices too low. Service providers will not be able to stay in business on the cut rate they will receive, and they wont be able to just opt to not service medicare patients. The system will begin to hemmorage doctors. The only doctors left will be those philanthropic enough to keep working for beans.

I do not hear any alternatives to The Affordable Healthcare Act either from you or anyone of the candidates seeking the republican nomination.
In my opinion and in the opinion of many others health care should not be a for profit system beholden to stockholders.
This is what is the cause of run away health care costs.
Prior to the bill being written President Obama invited all interested parties to sit around the table for their thoughts and input. This group included health insurers, drug companies, doctors, hospitals, and others. This is how the bill came to over 2700 pages. It is not perfect but if those on the right were working to represent the interests of the American People instead of working solely to defeat President Obama we most certainly would have had a much better bill with better results.

http://www.nytimes.com/2012/03/31/healt ... ml?_r=1&hp

Its defeat now may not give you the results you are expecting and may very well put existing insurance companies out of business. Who is going to pay for the health care for over 50 million uninsured Americans?

[stebo0728]

I do not hear any alternatives to The Affordable Healthcare Act either from you or anyone of the candidates seeking the republican nomination.

Yes and no. First, me, I have previously posted free market solutions I believe will work. These are also solutions that conservatives in general believe will work. You are right that there is not cogitated bill being put forward to implement these. Many are state level solutions. I think the first step is to get Obamacare back out of the way. Then, as I asked in the OP, will conservatives seize this opportunity to put forth their plan? We shall see.

In my opinion and in the opinion of many others health care should not be a for profit system beholden to stockholders.

I assume you are comfortable with the level of medicinal understanding we have currently? If you make health care non-profit, say goodbye to future breakthroughs, say goodbye to future developments. Keep in mind, we are at a stage of understanding that is increasing our life expectancy, we've discovered ways to reverse ailments that would have killed us a century ago. Thats all due to R&D, which functions on profit centers. People invest and take risks everyday in healthcare R&D. Many lose their investment because of failure, or whatnot. Some have a breakthrough, and their investors, the ones who took the risk, now reap the reward.

This is what is the cause of run away health care costs.

I disagree. Service providers carrying exorbitant amounts of malpractice insurance due to out of control frivolity in our tort system is to blame more than anything. Yes, when a new drug, a drug that was not around last month, comes into market, its usually quite expensive. Its possible that perhaps the pricing is still a bit too high, but keep in mind, the company introducing the drug has a patent, this patent insures that they are able to recoup at least some portion of the R&D overhead that comes with development of the drug. These patents generally only last about 7 years, after which generics begin to flood the market, drugs that do the same thing for fractions of the cost. The generic company has none of the R&D overhead, they take the recipe, make it, and ship it out. Add to that the fact that OTC versions of prescription drugs are on the rise. Pricing due to profit is not the predominant problem.

One problem is closed door pricing structures. Most hospitals have ZERO competition, especially for emergency care. Thats understandable, however, theres not alot of competition for non emergency care. For one, private pay rates compared to brokered insurance rates, are ridiculous. Private pay should be the same as brokered insurance rates. Secondly, rates for non emergency procedures should be published. A person should have the ability to shop this procedure around.

Its defeat now may not give you the results you are expecting and may very well put existing insurance companies out of business. Who is going to pay for the health care for over 50 million uninsured Americans?

First of all, do you have any idea what that 50 million figure becomes when you factor out people who do not wish to have insurance? Why are you convinced that government, AKA, taxpayers, AKA, you and me, should have to pay for these uninsured?

[C-Kwik]

And single payer system wont work. Its a reverse monopoly. But rather than one supplier to drive prices too high, you have one demander to drive prices too low. Service providers will not be able to stay in business on the cut rate they will receive, and they wont be able to just opt to not service medicare patients. The system will begin to hemmorage doctors. The only doctors left will be those philanthropic enough to keep working for beans.

Its not really that simple. Insurance companies already come up with agreed to pricing on services. Insurance companies are not dumb enough to not know that they need to keep doctors in business and keep from driving doctors out of business and keep the interest in the field up. While I can't speak to the inner workings of health insurance carriers, this is something I am familiar with in auto insurance. Direct repair facilities with pricing agreements with insurance companies must remain profitable. I took a class at a local college for writing auto body estimates years ago. The class was taught by a husband and wife team. Both were former body shop owners. Both lost their business when they failed to realize that despite the lower rates they might receive the DRP referrals from the insurance companies both reduced the marketing costs AND provided them enough volume to turn a profit. I'm not saying the dynamics of each are equivalent, only that it is more complicated than you make it sound. One commonality though is there is some level of symbiosis that needs to remain between insurer and provider. Any insurance will fail if there are no providers.

Where the reasoning for the individual mandate and single payer essentially come from is that in order for an insurance company to remain profitable is that they spread their losses. Many people have a hard time obtaining insurance and being able to afford the higher rate due to preexisting conditions. In order for insurance companies to be able to cover these types of insured while keeping rates reasonable, they have to include everyone in the pool. This is something insurers demanded if they were to be asked to provide affordable coverage for people with preexisting conditions. This essentially ties the individual mandate to the pre-existing condition coverage. With respect to the SCOTUS, I prefer that if they scratch the individual mandate, they leave everything else in place. While it wouldn't exactly work, it forces congress to work on the healthcare issue further as they will have to fix what the lack of the mandate will break. If they scratch everything, there is much less motivation to keep this issue off the backburner.

I assume you are comfortable with the level of medicinal understanding we have currently? If you make health care non-profit, say goodbye to future breakthroughs, say goodbye to future developments. Keep in mind, we are at a stage of understanding that is increasing our life expectancy, we've discovered ways to reverse ailments that would have killed us a century ago. Thats all due to R&D, which functions on profit centers. People invest and take risks everyday in healthcare R&D. Many lose their investment because of failure, or whatnot. Some have a breakthrough, and their investors, the ones who took the risk, now reap the reward.

As with above, both insurance companies and a single payer systems must recognize the need to further medicine. So when a new drug hits the market, they know the pricing needs to provide enough profit to continue to promote the desire for research. Our current system tends to push towards the ability to maximize profit by creating temporary monopolies. It does little to try and make it affordable. IIRC, the single payer system in Japan has made allowed some advancement in bringing more affordable procedures to market. I believe smaller MRI's that can fit in smaller offices and are cheaper to purchase made it possible for more people to get MRI's performed more frequently (though with less resolution; which may be more of a screening for bigger issues) at a lower cost. If something particular is found in the first MRI or a doctor is looking for something that is known to require a higher image density (I don't know if such medical conditions exist), they could go straight to the more expensive machine and pay more. What I hear is that in Japan, MRI's are pretty common procedures as they can be as low as under $100 to $200. Business will adapt to what the market dictates to a reasonable degree. And in a case like this, it may be a good thing. Again, I can't say this is going to apply to all scenarios, but its not a simple system as you might describe.

[telcoman]

Existing for profit insurance companies put out of business.

Is anyone allowed to make profit Telco? Or maybe just not health insurance companies? Those evil profiteers.

Do you even know what their average margin is, or are you just pontificating again?


And single payer system wont work. Its a reverse monopoly. But rather than one supplier to drive prices too high, you have one demander to drive prices too low. Service providers will not be able to stay in business on the cut rate they will receive, and they wont be able to just opt to not service medicare patients. The system will begin to hemmorage doctors. The only doctors left will be those philanthropic enough to keep working for beans.

Stebo
Here is an example of what happens when young healthy people either refuse to purchase or do not have health insurance. They fall under the republican solution to just let them die.

http://www.northjersey.com/news/033112_ ... CRASH.html

Telcoman

[telcoman]

I assume you are comfortable with the level of medicinal understanding we have currently? If you make health care non-profit, say goodbye to future breakthroughs, say goodbye to future developments. Keep in mind, we are at a stage of understanding that is increasing our life expectancy, we've discovered ways to reverse ailments that would have killed us a century ago. Thats all due to R&D, which functions on profit centers. People invest and take risks everyday in healthcare R&D. Many lose their investment because of failure, or whatnot. Some have a breakthrough, and their investors, the ones who took the risk, now reap the reward.

No I am not satisfied!

Whether The Affordable Healthcare bill is overturned or not research will continue.

I support both government and private funding of stem cell and organ growth research as it will eventually lead to lower health care costs.
The right wing nuts and bible thumpers oppose stem cell funding. They also oppose woman's healthcare and contraception that will not only lower costs but result in fewer abortions.

[stebo0728]

The problem with the symbiosis is two fold. One, you have the rates. You are correct in seeing that its mutually beneficial to keep rates up high enough that providers can be retained. Here's where you run into a problem: as anything else, healthcare is a limited resource. There are going to be 2 options. Force rates low enough to be able to provide for the most, or set up a means test, or a "death panel" as its been deemed. Option 1 starts a death spiral as the low rates force providers out, thereby requiring further rationing. Id also like to know how rates are determined, whether physicians help determine them or not.

The other problem is beauracracy, red tape, paperwork involved. A system that is too bogged down deters providers as well.

Another question, lets say a doctor decides to start a practice, where he only treats private pay patients. Would this be illegal now? I ask this because rationing is a forgone conclusion of the single payer system, and if someone decides to bypass the rationing to those who can pay, do you want to force them to either help system patients or no one, or will they be free to practice as they see fit?

Why do people think that they should be able to insure their pre existing conditions? Thats like buying home insurance while the fire is raging! Its asinine, and dont give me this "but its healthcare" crap. Be responsible and get insurance while you're healthy, or suffer the consequences.

That sort of leads to my last point. I've been perplexed in this whole national debate regarding healthcare, in that the whole drive is revolving around insurance. Insurance is insurance, at one point no one had ANY insurance for ANYTHING. Eventually the notion got started, and we began insuring things, one after another, but its usually always been for areas where catastrophic losses are possible, and you would insure against those. Health insurance in this nation has not been insurance for a long time. If it were insurance, we'd be out of pocket paying for checkups, sick visits, and CONTRACEPTIVES. And then we'd fall back to insurance for big things, like sudden cancer, or heart attacks, surgeries, and the like. We called this bill the Affordable Healthcare Act, but its a misnomer, it doesnt make healthcare more affordable, it just tries to jerry rig insurance in ways insurance isnt intended to work. Why are we so hung up on the insurance angle, rather than working to actually make health care affordable?

[C-Kwik]

The problem with the symbiosis is two fold. One, you have the rates. You are correct in seeing that its mutually beneficial to keep rates up high enough that providers can be retained. Here's where you run into a problem: as anything else, healthcare is a limited resource. There are going to be 2 options. Force rates low enough to be able to provide for the most, or set up a means test, or a "death panel" as its been deemed. Option 1 starts a death spiral as the low rates force providers out, thereby requiring further rationing. Id also like to know how rates are determined, whether physicians help determine them or not.

Elaborate please. I'm not sure what your basis for these "options" are or the logic behind them.

The other problem is beauracracy, red tape, paperwork involved. A system that is too bogged down deters providers as well.

What specifically are you saying will bog down the system?

Another question, lets say a doctor decides to start a practice, where he only treats private pay patients. Would this be illegal now? I ask this because rationing is a forgone conclusion of the single payer system, and if someone decides to bypass the rationing to those who can pay, do you want to force them to either help system patients or no one, or will they be free to practice as they see fit?

I don't think it could be illegal, but I suspect most doctors outside of those who perform specialized optional services (cosmetic surgery perhaps?) would find it painstakingly difficult to have enough business to be profitable. There is a reason so many body shops try and get on direct repair facility lists for auto insurance companies. Those that don't make it on these lists tend to struggle. The exception tends to be shops that specialize in custom work or low end shops that do shoddy work. A lot of good shops went out of business when DRP's started becoming heavily utilized by insurance companies when they failed to realize this trend.

That said, most doctors accept insurance payments. I don't see much changing on that end. Personally, I have no problem letting doctors decide if they participate in the program. Any that would choose not to are probably catering to a specific niche.

Why do people think that they should be able to insure their pre existing conditions? Thats like buying home insurance while the fire is raging! Its asinine, and dont give me this "but its healthcare" crap. Be responsible and get insurance while you're healthy, or suffer the consequences.

My girlfriend had insurance when she had to go out on disability due to her fibromyalgia. It took more than a year to be diagnosed properly and find treatment that was effective. Her company laid off a bunch of people during that time and that included her. Finding insurance on her own would have been severely expensive for her. What saved her was that COBRA was being subsidized at the time. Unfortunately, the subsidy expired eventually (not long after she was finally cleared to try and work) and her unemployment checks at that point were a joke. She had to forgo insurance until she was able to find a job. The damnable part was without her meds, it made it hard for her to do her job. And in her field, employers require a demo reel (similar to a portfolio) that shows your abilities. So basically she had to try and do her job without her meds because she had no insurance. Had it not been for her pre-existing conditions, we could probably afford insurance. But that wasn't the case. Lucky for her, she was hired by a company late last year. But whose to say this couldn't happen again. Her Fibromyalgia doesn't discriminate as to her employment status. She did everything a "responsible" person would. She still suffered consequences.

That sort of leads to my last point. I've been perplexed in this whole national debate regarding healthcare, in that the whole drive is revolving around insurance. Insurance is insurance, at one point no one had ANY insurance for ANYTHING. Eventually the notion got started, and we began insuring things, one after another, but its usually always been for areas where catastrophic losses are possible, and you would insure against those. Health insurance in this nation has not been insurance for a long time. If it were insurance, we'd be out of pocket paying for checkups, sick visits, and CONTRACEPTIVES. And then we'd fall back to insurance for big things, like sudden cancer, or heart attacks, surgeries, and the like. We called this bill the Affordable Healthcare Act, but its a misnomer, it doesnt make healthcare more affordable, it just tries to jerry rig insurance in ways insurance isnt intended to work. Why are we so hung up on the insurance angle, rather than working to actually make health care affordable?

Different types of policies have their own sets of challenges, goals and constraints. What works for an auto policy doesn't necessarily work for a homeowners policy. Workers comp insurance is an even different ball game than auto or home insurance. But how healthcare insurance differs from other types of insurance is that what is being insured is not a function of some optional activity. Don't own a car? You won't be needing car insurance until you get one. And the car you don't own isn't going to be getting into an accident that will be covered on a policy you intend to get later. Same applies to cars, workers comp, business insurance, etc. The reality is that we do not stop using our bodies. They are constantly at risk for something or another. And unlike other types of insurance, healthcare essentially covers wear and tear. Most types of insurance excludes that type of damage.

Frankly, I doubt insurance companies would want to cover only the big stuff. Its in their interest to try and help people be healthy by encouraging periodic visits to check for problems or before small problems become big ones. Its likely that health insurance to cover only big losses would be disproportionately expensive. Not to mention, if no mandate existed, many would opt out of such coverage and we'd still be paying for the big costs for people who are not insured when they are admitted into the ER.

There is no jerry rigging involved. The mandate was something the insurance companies required in order to go along with removing restrictions for pre-existing conditions. The intent of insurance is to cover risks. More specifically to healthcare, it covers even minor costs to help encourage health. From the insurance company's perspective, the intent is to make money. The hurdles for those with pre-existing conditions exist because of this intent. Given the prior laws it became a necessity to add the hurdle so that the company can remain profitable.

Not saying affordable healthcare is a bad thing, but a lot of medical procedures inherently cost a lot of money. I certainly could not afford the $13,000 my insurance company paid to my surgeon 2 summers ago for my broken clavicle. The original billing was for nearly $30K. The set rates from the insurance made it cheaper but certainly not affordable. Really think you can make such treatment affordable? How about a $100K procedure? How would you make that affordable? Realistically, most medical treatment for most people is made affordable through insurance. But for many, the insurance isn't affordable or even accessible.

[telcoman]

My girlfriend had insurance when she had to go out on disability due to her fibromyalgia. It took more than a year to be diagnosed properly and find treatment that was effective. Her company laid off a bunch of people during that time and that included her. Finding insurance on her own would have been severely expensive for her. What saved her was that COBRA was being subsidized at the time. Unfortunately, the subsidy expired eventually (not long after she was finally cleared to try and work) and her unemployment checks at that point were a joke. She had to forgo insurance until she was able to find a job. The damnable part was without her meds, it made it hard for her to do her job. And in her field, employers require a demo reel (similar to a portfolio) that shows your abilities. So basically she had to try and do her job without her meds because she had no insurance. Had it not been for her pre-existing conditions, we could probably afford insurance. But that wasn't the case. Lucky for her, she was hired by a company late last year. But whose to say this couldn't happen again. Her Fibromyalgia doesn't discriminate as to her employment status. She did everything a "responsible" person would. She still suffered consequences.

......Not saying affordable healthcare is a bad thing, but a lot of medical procedures inherently cost a lot of money. I certainly could not afford the $13,000 my insurance company paid to my surgeon 2 summers ago for my broken clavicle. The original billing was for nearly $30K. The set rates from the insurance made it cheaper but certainly not affordable. Really think you can make such treatment affordable? How about a $100K procedure? How would you make that affordable? Realistically, most medical treatment for most people is made affordable through insurance. But for many, the insurance isn't affordable or even accessible.

Healthcare is a system that needs to be fixed.

By having everyone pay into it those that require expensive care should be able to receive it.
Isn't that individual responsibility which is what the republican party was for before they became against it when President Obama became for it.

Why does government have rules that pay $75k per year for continuing medical care but not $100k to solve the medical problem?

.."a maze of conflicting health care and immigration policies meant that while the government would pay for a lifetime of dialysis, costing $75,000 yearly, it would not pay for a $100,000 transplant that would make dialysis unnecessary."

http://www.nytimes.com/2012/04/07/nyreg ... odayspaper

“It has nothing to do with legal or illegal,” said Dr. Kim-Schluger, whose mother escaped North Korea as a child and brought the family to the United States via South Korea, British Guyana and Jamaica. She went to Catholic school in New York, married a descendant of Eastern European Jewish immigrants and converted to Judaism. She said Angel was on her mind as she prepared Passover Seder"

Telcoman

[stebo0728]

Healthcare is a system that needs to be fixed.

At least there, we are in agreement. No one can doubt that there are flaws in the system. Where we disagree is in way things should be handled, and where the responsibility settles for handling things. In essence, you believe the government, in all its glory, should be our knight in shining armor. I see our government's rusty old squeaking armor, and disagree with you. I see flaws in a government based system, and really, any single payer system, but especially a government controlled single payer system. But the fact that we disagree on solutions does not mean we disagree that the problem exists. I understand your sentiment that the government is the only entity in a position to effect such control, I disagree with it, but I understand it. The things that put the government in such a position also make such a position a precarious one to be in.

CK, the example you give of your girlfriends ordeal, thats a good example of what is broken, again we may disagree on how to fix it. In her situation, here's the fix I see:

* Firstly, the biggest fix I see necessary, is to move responsibility of insuring away from the employer, and into the hands of the individual. The benefit you get from your employer should be converted from insurance to monetary compensation, with which you now have the freedom to search and select your own policy, much as you would your automotive, or homeowners/renters insurance. Note - this does require a good bit of tweaking, I've never claimed the solution set to be an easy one. Theres other things that need to be handled, and honestly, I'm not quite bright enough to figure all the minutae out myself, but the general direction I am heading is FREE MARKET, rather than government control. Things to tackle is getting premium rates affordable at the individual level, maybe pooling unions, brotherhoods, or industries together, again individually handled, but your area of employement COULD possibly help effect the affordablility. For one, if you leave a particular employer but remain in the industry or union or whatever, your still eligable for coverage.

* Secondly, to avoid gaps in coverage when you lose your job or whatever, premium payment can be a portion of unemployment benefits, allowing you to keep your coverage valid, so that any arising conditions are no longer pre existing. You stay on the same private sector policy, the premiums are the same, as its not tied to your employement, and you just get help with the premiums as long as your eligible for unemployment.

* We need to move away from insurance paying for everything healthcare related. Your health is part of your own responsibility, you pay for your own checkups, if you decide its time to extend your family with a child, part of the cost of this is the related hospital costs. If you're raped I understand you didnt ask for it, you sue your attacker for 110% of the cost of whatever choice you make regarding the child, either termination or birthing. Although being a private market policy, IF your insurer and you decide to have a childbirth rider on your own policy, or coverage for anything else for that matter, you can pay those premiums if you choose. As long as your choice to cover these items dont affect and increase the premiums for others, then by all means, insure away. But I dont see the end game solution being "cover everything", instead we need to find ways to make healthcare related things less expensive. Perhaps extending patent life, so that R&D costs can spread over longer times, allowing market price to be lower, keeping patents life indefinite, but allowing generics from day 1, where generic companies pay a royalty to the patent holder. This will make generics a bit more expensive, but will also lower brand costs, and allow R&D to be recouped more effectively without raping consumers for 7 years, then having pennies value generics afterwards. In otherwords balance out the brand/generic divide.

* What gets service provider costs so high is the unmanageably high malpractice insurance required even for the simplest of things. Over the past decade you've had the system leaking OB/GYN's because of the malpractice involved. We need tort reform, like yesterday. we need a complete loser pay system, regardless of circumstance, if you lose, you pay YOURS and YOUR OPPONENTS legal fees, even if your opponent is a fortune 500 company with a 30 man legal team. If you take someone to court, be damn sure you should be, and face the consequences a frivolous suit brings. Will this keep some legitimate victims from bringing suit? Sure, but then maybe they weren't quite as victimized as they thought. We need to address juries awarding damages that were undue, just be cause "well the insurance will be the one paying anyway, may as well help these poor people out a bit".

The problem is large, but the solution is larger, more encompassing than just "let the government get it". We need government for certain parts of the solution, but we need the private sector as well, and we need individual participation in the solution as well.

[stebo0728]

* Secondly, to avoid gaps in coverage when you lose your job or whatever, premium payment can be a portion of unemployment benefits, allowing you to keep your coverage valid, so that any arising conditions are no longer pre existing. You stay on the same private sector policy, the premiums are the same, as its not tied to your employement, and you just get help with the premiums as long as your eligible for unemployment.

Let me clarify that a bit more. The responsibility of coverage is still your own, not the governments in this case. But the lost revenue for your household included revenue meant for coverage, so unemployement, though it may not cover all your loses, should seek to cover your necessities, in which category health coverage should fall. You may have to give up some things, and in fact you COULD drop your coverage, but that's your call, and if a pre-existing condition arises, well then you made the stupid move to drop your coverage yourself. Also this brings into mind another idea I've had, in which, much akin to having liability only type insurance, you could have a multi-tiered insurance policy for healthcare, in which in cases of duress, such as unemployement, you could switch your policy down a notch, making premiums cheaper, but also diluting coverages accordingly. Ideally you would still have catastrophic coverage, but maybe at the low tier you pay for your own doctors visits, for basic colds, infections, herpes flareups and the like, but if cancer or diabetes or whatever pops up, you're still covered. The exact logistics of this are beyond my scope.

[C-Kwik]

* Firstly, the biggest fix I see necessary, is to move responsibility of insuring away from the employer, and into the hands of the individual. The benefit you get from your employer should be converted from insurance to monetary compensation, with which you now have the freedom to search and select your own policy, much as you would your automotive, or homeowners/renters insurance. Note - this does require a good bit of tweaking, I've never claimed the solution set to be an easy one. Theres other things that need to be handled, and honestly, I'm not quite bright enough to figure all the minutae out myself, but the general direction I am heading is FREE MARKET, rather than government control. Things to tackle is getting premium rates affordable at the individual level, maybe pooling unions, brotherhoods, or industries together, again individually handled, but your area of employement COULD possibly help effect the affordablility. For one, if you leave a particular employer but remain in the industry or union or whatever, your still eligable for coverage.

A big problem with that in the absence of a universal HC system is that there are administrative costs benefits that are no longer available. Group plans have some savings built into it because of that alone. Conversely, a universal healthcare system would group everyone's policy into one group and there would be some savings realized there. Pooling removes some of the specific options you describe even if its handled by a union or whatever. And if you think about it, healthcare as a benefit of employment is a free market result. Wouldn't moving away from it be viewed as a move away from a free market system?

* Secondly, to avoid gaps in coverage when you lose your job or whatever, premium payment can be a portion of unemployment benefits, allowing you to keep your coverage valid, so that any arising conditions are no longer pre existing. You stay on the same private sector policy, the premiums are the same, as its not tied to your employement, and you just get help with the premiums as long as your eligible for unemployment.

Problem is unemployment benefits run out...if one runs out of benefits and still doesn't have a job, then what?

* We need to move away from insurance paying for everything healthcare related. Your health is part of your own responsibility, you pay for your own checkups, if you decide its time to extend your family with a child, part of the cost of this is the related hospital costs. If you're raped I understand you didnt ask for it, you sue your attacker for 110% of the cost of whatever choice you make regarding the child, either termination or birthing. Although being a private market policy, IF your insurer and you decide to have a childbirth rider on your own policy, or coverage for anything else for that matter, you can pay those premiums if you choose. As long as your choice to cover these items dont affect and increase the premiums for others, then by all means, insure away. But I dont see the end game solution being "cover everything", instead we need to find ways to make healthcare related things less expensive. Perhaps extending patent life, so that R&D costs can spread over longer times, allowing market price to be lower, keeping patents life indefinite, but allowing generics from day 1, where generic companies pay a royalty to the patent holder. This will make generics a bit more expensive, but will also lower brand costs, and allow R&D to be recouped more effectively without raping consumers for 7 years, then having pennies value generics afterwards. In otherwords balance out the brand/generic divide.

Insurance doesn't cover everything as it is. Most typical treatments are, but think about what you are saying from a cost standpoint. If people are only paying for childbirth related insurance at the time they are planning to have a child, then that additional cost will have to be at least as much as the cost to actually have all the reasonable and necessary prenatal care and the cost of the birth. Why? Because the pool of people contributing to those costs equals the number of people benefiting from it. In other words, there is noone to spread some of those costs onto. Which is the whole point of insurance in the first place.

Increasing patent life won't necessarily have the effect you want. Businesses are in it for the money ultimately. As such, the companies are going to get as much as they can for their drug for as long as they can. Put it this way. If there was some wonder drug that was the only known treatment for a specific illness, would increasing the patent life decrease the immediate demand or supply for the drug? And why would any company try to spread out the R&D costs over the future? First, the future is uncertain, so recouping those costs as quickly as possible is important. So is keeping the profit margins high as shareholders tend to buy or hold stock that show growth. It would be naive to think otherwise.

* What gets service provider costs so high is the unmanageably high malpractice insurance required even for the simplest of things. Over the past decade you've had the system leaking OB/GYN's because of the malpractice involved. We need tort reform, like yesterday. we need a complete loser pay system, regardless of circumstance, if you lose, you pay YOURS and YOUR OPPONENTS legal fees, even if your opponent is a fortune 500 company with a 30 man legal team. If you take someone to court, be damn sure you should be, and face the consequences a frivolous suit brings. Will this keep some legitimate victims from bringing suit? Sure, but then maybe they weren't quite as victimized as they thought. We need to address juries awarding damages that were undue, just be cause "well the insurance will be the one paying anyway, may as well help these poor people out a bit".

Actually its not. Costs of medical torts represent some 1-1.5% of the overall costs.

http://prescriptions.blogs.nytimes.com/ ... are-costs/

The problem is large, but the solution is larger, more encompassing than just "let the government get it". We need government for certain parts of the solution, but we need the private sector as well, and we need individual participation in the solution as well.[/quote]

Its not a matter of just let the government get it. Its a matter of what kind of solution would work for the given set of problems. As I see it, we spend a total aggregate on health as a nation. Insurance probably pays for most of it for most people. But many who are not insured will forgo a lot of preventative care and only see a doctor when things get bad. Many can't pay for this treatment, especially if its serious. Well, they get the treatment anyways and as a nation, we still pay for it. And for argument's sake, lets assume the total cost of the actual services provided doesn't change. So what will probably change? Administrative costs for one. The US has the highest administrative costs for health insurance than any other modern nation. You would think that the free market would have pushed that down, but a significant part of that is the lack of economies of scale. Add to that the "for-profit" nature of the companies and the costs of going through more claims to look for denial opportunities means more resources are needed.

Of course, we can not ignore the fact that some people are going to be unable to pay for their coverage, so individual premiums are likely not going to see all the savings that the reduction in administrative costs suggest. For argument's sake lets assume its a wash. So what we end up with is everyone is covered and no net increase in premiums at the individual level. That said, what I believe will happen is with more access to preventive care, the number of major claims will decline. I suspect the net difference will be lower overall costs. Add to that the lower cost of administration and its likely we can reduce the overall costs and thus the premiums further.

Other benefits:

Small businesses get access to a larger pool of potential employees as employees do not need to base who they work for on health benefits.

Employees get more flexibility to choose to work for a smaller company and take more risks with their employment choices.

Some people may be more inclined to start a business as health insurance is certainly a hurdle for some.

In jobs that don't typically provide health insurance, those employees are likely to see doctors for conditions that may be work related before they escalate into larger workers comp claims. This could also reduce disability claims since earlier access to preventive care may nip it in the bud as well. Generally a healthy population is also a more productive population. Perhaps we'll see a decrease in the number of sick days used. I don't think these are going to be hugely significant, but I do expect to see some indirect benefit from it in the form of lower WC and disability premiums and whatever benefits consumers and shareholders see from reductions in operating costs.

And of course, everyone gets equal access to basic healthcare, regardless of financial standing, or medical history.

While my big push for UH is due to the overall financial implications, the smaller benefits tend solidify my view. And while you may argue the loss of personal freedoms (I certainly understand the argument), I see a lot of freedoms opened up. And as with everything, I try to look at things in the context of finding a solution to a problem. And most solutions will have compromise. The question then becomes which solutions have effective solutions with minimal or acceptable compromise.

[BusyBadger]

The question then becomes which solutions have effective solutions with minimal or acceptable compromise.

Acceptable to whom, the few or the many?