Hmm You want me to pay for what?

Natas wrote:

Annachie wrote:Natas, in essence most healthcare in America is provided by the employer, who seeks a bulk coverage from the insurance companies. A one size fits all emoployees as it were. So the employer has a huge say in what's covered.

So, in my socialist opinion , the US Government (or the state govnerments) gave up responsibility (or never had it) for the health care system and made it a problem of the employer?

They never had it. The employer system is a legacy of WWII. Basically the government put in place wage controls so employers couldn't raise wages to compete for workers and the labor supply was exceptionally low since most working age males were in or working for the military. So to bid for the very few available workers the companies started offering benefits such as health care which didn't count toward the wage controls.

biochem wrote:They never had it. The employer system is a legacy of WWII. Basically the government put in place wage controls so employers couldn't raise wages to compete for workers and the labor supply was exceptionally low since most working age males were in or working for the military. So to bid for the very few available workers the companies started offering benefits such as health care which didn't count toward the wage controls.

Hmm, that answers the question as to why employers in the US have that responsibility.

It never made much sense to me before, certainly in my own experience I wouldn't let any of my employers be responsible for that - I'd get shafted, to use a turn of phrase...

Since Obamacare is "not the best way" of providing universal healthcare, how would the US go about providing such a scheme for all of it's citizens? Assuming Obamacare is scrapped, to start off with.

Drop it down to State level with basic, enforceable guidelines to make sure that basic care is the same nation wide, but at the same time allow each State to tailor such a scheme to it's needs and population? At the same time, to use the UK as an example, allowing private individuals to have their own health insurance? We have "National Insurance" automatically deducted from our wages to help pay for the NHS and the State Pension, but we're also allowed to pay into our own, private, health insurance plans - I do.

I can't see a nation wide, "one size fits all" scheme working. The US is geographically too large and with too uneven a population distribution for that.

Mike.

Drug companies also have to recoup their liability and litigation costs when selling in the US. The US has a plethora of sleazy lawyers who file lawsuits for any failings perceived or imagined of any drugs or medical devices. The same applies to doctors who typically pay a very large fraction of their income for liability insurance.

During the debate about Obamacare, it was suggested that the law should include liability reform and limitations. Ofcourse the trial lawyers opposed this and Obama eagerely supported them.

biochem wrote:

I was a bit puzzled on a response earlier that indicated the problem was related to the price of drugs, as I can't see how that would vary between countries.

That could be a whole new topic anyway, on the ethics of drug company executives charging thousands on drugs that cost tens to produce simply because they can regardless of how many unnecessary deaths such practices incur.

Each new drug costs a billion dollars in R&D and usually takes about 15 years to develop. The US bears the bulk of the burden for worldwide development costs. The socialized medicine countries basically negotiate with the pharmaceutical companies at gunpoint. The CEOs have already spent the billion $ so they take what they can get from them (usually production costs and a small profit, not anywhere near enough to pay for R&D), knowing that they can recoup their cost plus get the profits their investors demand from the US. And for the large number of drugs that fail in phase 3, that money has already been spent and the return on investment is zero. The money people who invest in pharmaceuticals demand a substantial return on their investment commensurate with this risk. And these money people demand to be paid otherwise they'll just invest in the next hot software company instead. It would be nice if there was no need for these people to invest, but as much as I hate them we need them unless the governments of the world want to start spending $200 billion annually on pharmaceutical R&D.

I don't buy the recouping of research costs argument either, as they continue prohibitive pricing long after recouping those costs.

They've got to give those greedy money people the return on investment they demand or they'll invest in something much less risky. And unless you can get $200 billion per year from somewhere else, we're stuck with them.

Since Obamacare is "not the best way" of providing universal healthcare, how would the US go about providing such a scheme for all of it's citizens? Assuming Obamacare is scrapped, to start off with.

Step 1 - Go back to the pre-Obama care healthcare system. Under that scheme about 85% of the population was covered with insurance. Most were reasonably happy with it and don't want the government screwing it up.

1. The poor were covered by Medicaid (about 20% of the population).

2. The elderly are covered by Medicare. The middle and upper class elderly supplement this by private Medigap policies.

3. The majority of the middle class (about 55% of the population) is covered by group private insurance provided by their employers or unions.

4. About 5% of the population purchased private insurance.

Step 2 Deal with the 15 % uninsured and only the 15% uninsured. It's a lot easier (and cheaper!) only to deal with this group than to try to do the universal thing Obamacare is attempting.

People who are not covered by the above include self employed, people who retired early (Medicare starts at 65), people who work in lower middle class jobs (the not quite poor who make too much to qualify for medicaid) etc. The biggest losers under the old system were individuals with chronic health conditions (complicated diabetes, autoimmune disorders, etc) who were uninsurable.

1. Have a government high risk pool for the uninsurable. Model it after Oregon's which namelessfly says works well. Individual states could design their own variations to fit their needs.

2. The one popular part of Obamacare was that the young uninsured are now eligible to stay on their parents' policies until age 26. Reinstate that part as a stand alone law.

3. For the not quite poor (income limits apply), the self employed (proof of self employment required), and early retirees (59 1/2 and above, the same age at which you may start accessing 401Ks).

Part 1 - Make available government subsidized catastrophic insurance to those in these 3 groups. The catastrophic issues are what the people in these categories really worry about. Those are what can cause bankruptcy and destroy lives.

1. Major accidents such as car accidents but not minor accidents such as a broken arm.
2. Treatment of major diseases such as cancer but not cover minor diseases
3. Maternity coverage for women of childbearing age
4. Not cover most medicines, only cover very expensive ones such as those used to treat cancer
5. Not cover most physical therapy, only cover extensive physical therapy such as that following knee surgery
6. Not cover mental illness
7. Not cover preventative care
8. Not cover vision or dental
9. Not cover addiction treatment

Part 2 - Have private insurers provide catastrophic gap policies for those in this group. Similar to Medigap policies, covering the things that the government provided catastrophic insurance doesn't. Individuals could choose to buy the gap policy or not as they so chose.

biochem wrote:1. Major accidents such as car accidents but not minor accidents such as a broken arm.
2. Treatment of major diseases such as cancer but not cover minor diseases
...
4. Not cover most medicines, only cover very expensive ones such as those used to treat cancer
5. Not cover most physical therapy, only cover extensive physical therapy such as that following a stroke
6. Not cover mental illness
7. Not cover preventative care
8. Not cover vision or dental
9. Not cover addiction treatment

This is quite an insane list of things that should not be covered. Let me explain.

Under these rules, people are strongly discouraged from requesting medical aid under any but the most severe circumstances. This will lead to more long-term effects in the population, reducing the amount of people who are able to work at full capacity over long periods of time. In Germany, where everything except for cosmetic surgery is covered by insurance, people are generally healthier and less worried about their health, because they know that they're covered for everything that might go wrong, and thus have a peace of mind that americans, generally speaking, do not enjoy.

A huge part of this is that preventative care is covered, and so seeking such care doesn't carry any particular stigma; It's indeed encouraged by larger employers.

I particularly disagree with your point 6. Mental illness is something that can hit anyone, at any time, and which will have life-changing consequences. Worrying about how to deal with a depression, or burnout, or PTSD is bad enough, having to worry about getting the money to pay for the treatment is just something that doesn't have to be stacked on top of all that.

Icould quibble about certain points, but I generally agree with this.

What some people,especially people fromother countries, fail to understand is that for most of a century employers competed to offer the best insurance to attract valuable workers. Unions also made health insurance a major bargaining issue. The exceptions were industries that used unskilled labor and thus did not need to compete.


One of the big issues aside from preexisting conditions was portability of health insurance. If you were laid off or went to a new job, you could loose your preferred insurance. The COBRA laws allowed you to keep your insurance by paying out of pocket.

I always agreed that the American system was far from perfect. However; I strenulously disagreed with the premis that everyone was entitled to the best possible healthcare with the corollary that no one should be allowed to have better healthcare than others. Obama actually made this point when the ACA was passed!

More importantly, since Obamacare was Obama's signature achievement, he should have implemented it competently. He chose not to and obviously intended to delay implementation repeatedly and would not have implemented it if the TEA party Republicanshad not made delay an issue in the debt limit talks. (IMHO, that was brilliant maneuvering by Senator Cruz andGov Palin). Now that it is revealed as a FUBAR, people are opening their eyes.

biochem wrote:

Since Obamacare is "not the best way" of providing universal healthcare, how would the US go about providing such a scheme for all of it's citizens? Assuming Obamacare is scrapped, to start off with.

Step 1 - Go back to the pre-Obama care healthcare system. Under that scheme about 85% of the population was covered with insurance. Most were reasonably happy with it and don't want the government screwing it up.

1. The poor were covered by Medicaid (about 20% of the population).

2. The elderly are covered by Medicare. The middle and upper class elderly supplement this by private Medigap policies.

3. The majority of the middle class (about 55% of the population) is covered by group private insurance provided by their employers or unions.

4. About 5% of the population purchased private insurance.

Step 2 Deal with the 15 % uninsured and only the 15% uninsured. It's a lot easier (and cheaper!) only to deal with this group than to try to do the universal thing Obamacare is attempting.

People who are not covered by the above include self employed, people who retired early (Medicare starts at 65), people who work in lower middle class jobs (the not quite poor who make too much to qualify for medicaid) etc. The biggest losers under the old system were individuals with chronic health conditions (complicated diabetes, autoimmune disorders, etc) who were uninsurable.

1. Have a government high risk pool for the uninsurable. Model it after Oregon's which namelessfly says works well. Individual states could design their own variations to fit their needs.

2. The one popular part of Obamacare was that the young uninsured are now eligible to stay on their parents' policies until age 26. Reinstate that part as a stand alone law.

3. For the not quite poor (income limits apply), the self employed (proof of self employment required), and early retirees (59 1/2 and above, the same age at which you may start accessing 401Ks).

Part 1 - Make available government subsidized catastrophic insurance to those in these 3 groups. The catastrophic issues are what the people in these categories really worry about. Those are what can cause bankruptcy and destroy lives.

1. Major accidents such as car accidents but not minor accidents such as a broken arm.
2. Treatment of major diseases such as cancer but not cover minor diseases
3. Maternity coverage for women of childbearing age
4. Not cover most medicines, only cover very expensive ones such as those used to treat cancer
5. Not cover most physical therapy, only cover extensive physical therapy such as that following knee surgery
6. Not cover mental illness
7. Not cover preventative care
8. Not cover vision or dental
9. Not cover addiction treatment

Part 2 - Have private insurers provide catastrophic gap policies for those in this group. Similar to Medigap policies, covering the things that the government provided catastrophic insurance doesn't. Individuals could choose to buy the gap policy or not as they so chose.

Perhaps I exaggerated in an earlier post regarding the percentage of the uninsured who are illegal immigrants, but the fact remains that the US has some 10 million to 13 million illegal aliens who simply are not allowed to buy health insurance under US law. If you want to have a conversation about a liberalized work visa program integrated with mandatory or government funded insurance for immigrant laborers whose itinerant employment makes employer based insurance not feasible, I am all for it.

When Obama came to office, surveys showed that about 15% of adults were uninsured. This soared to about 20% as people lost jobs and interim coverage to Obama's recession.

(Note to the uninformed: read ARCHITECTS OF RUIN by Peter Schwitzer. Obama had devoted his career as a community organizer teaching people how to extort NINJA loans from the banks. This inflated home values while creating a $4 trillion pool of loans to unqualified people who would inevitably default)

This means that 45 million people in the US were uninsured of whom about 11 million were illegal aliens. Additionally, there are by my estimate perhaps an additional 5 million minor children of illegal immigrants who are legal citizens by birthright citizenship. Let us call it 15 million total illegal immigrants or children of illegal immigrants.

This leaves about 30 million adult American citizens or legal immigrants who are uninsured.

I don't have a link to a reference handy, but many of these remaining uninsured are young adults who choose to remain uninsured even though insurance was dirt-cheap for them and/or have less reason to be alarmed by their lack of insurance.

IF OBAMA HAD PROPOSED A BARE BONES, NATIONAL CATASTROPHIC INSURANCE FOR THE POOR AND STUPID THAT WOULDHAVE ALLOWED OTHERSTO HAVE MORE COMPREHENSIVE INSURANCE, I WOULD HAVE SERIOUSLY CONSIDERED SUPPORTING IT!


Unfortunately; Obama gave us a law that is intended to impose government control over everyone's healthcare (that tax on "Cadillac insurance plans" and medical devices). Then he implemented it with utter incompetence.

Obama had devoted his career as a community organizer teaching people how to extort NINJA loans from the banks. This inflated home values while creating a $4 trillion pool of loans to unqualified people who would inevitably default)

To translate the acronym for those outside the US. NINJA loans - No INcome No Job, (No) Assets. These were high interest rate subprime loans, no documentation required. They just took your word for it. Also known as liar loans.

There was a problem with a small number of community organizers (most of them well intentioned idiots, but some not) helping poor people lie on these loans. Their thought was that the evil banks were exploiting the poor and that they were helping the poor in their struggles against the system by helping them fake loan docs and that if their clients couldn't pay they could always just sell the property for more than they bought it for and at least make a small profit.

Incidentally, it is a matter of public record that Obama was an assistant attorney in one of the many lawsuits to lower lending standards by accusing the banks of racism (Buycks-Roberson v. Citibank Fed. Sav. Bank). But that one lawsuit wasn't a big deal in and of itself. It was that type of lawsuit in the aggregate which was problematic.

All true.

However; Obama was giving seminars to ACORN chapters to teach them not only how to apply for LIAR LOANS but how to demonstrate and boycott to coerce compliance. He was only one of many culprits in the mortgage meltdown but he was far more at fault than G W Bush.

biochem wrote:

Obama had devoted his career as a community organizer teaching people how to extort NINJA loans from the banks. This inflated home values while creating a $4 trillion pool of loans to unqualified people who would inevitably default)

To translate the acronym for those outside the US. NINJA loans - No INcome No Job, (No) Assets. These were high interest rate subprime loans, no documentation required. They just took your word for it. Also known as liar loans.

There was a problem with a small number of community organizers (most of them well intentioned idiots, but some not) helping poor people lie on these loans. Their thought was that the evil banks were exploiting the poor and that they were helping the poor in their struggles against the system by helping them fake loan docs and that if their clients couldn't pay they could always just sell the property for more than they bought it for and at least make a small profit.

Incidentally, it is a matter of public record that Obama was an assistant attorney in one of the many lawsuits to lower lending standards by accusing the banks of racism (Buycks-Roberson v. Citibank Fed. Sav. Bank). But that one lawsuit wasn't a big deal in and of itself. It was that type of lawsuit in the aggregate which was problematic.

Fix your system basic human rights and care for everyone for everything considered medically necessary for life. Free Emergency and end of life care. Free medically necessary drugs. Ie: Cancer drugs or aids drugs or whatnot drugs. If you die without it it costs you nothing.

Free being paid for by taxes. Free to you at point of admittance and discharge.

Voluntary procedures you pay for or have your private health insurance pay.

Your body quits it is covered. You want a different body you pay.

Unlike Canada having a two tier system option. If you pay you get better service, like in England. Faster service, you pay for everything but that's why you have private insurance.

Free service includes free family / walkin doctors service. Tax paid for. Like what all military people get.

Of course in Canada we don't extend free medical to visitors nor illegals, nor refugees. Basic care for emergencies yes. But if you have MS and you snuck across the border from the USA, too bad. Or the various foreign worker programmes have some restrictions.

Your USA problem is the basics are not covered for everyone which makes the poor hate the rich. In Canada the guy in the next bed isn't paying anything, outside taxes, like you. Your all in the same boat same room same costs. He a millionaire, your a hundred aire. We don't have a 99% 1% problem like you. Also our businesses don't pay most medical insurance, some sometimes but not all.

1. Basic body stops working care paid for.
2. Doctors visits paid for, not feeling well go to the doctor.
3. Necessary to get back to healthy care paid for.
4. Maintainence for health paid for, might have limits.

Extra coverage (may have / pay for extra coverage for this)

You pay for acupuncture
Massage for a stiff neck
Dentist
Plastic surgery
Contraception
Glasses / laser ...
Some drugs.