What the terms "Universal Health Plan" and "covered" imply....

[Bread and Circus]

One of the biggest problems I have with Hillary Clinton and Barack Obama is that they both call their plans "Universal health care" and insinuate that everyone is "covered" under their plan.

The term "universal" means that it applies to everyone and when you couple this with the phrase "my plan covers everyone" (a phrase found in their numerous speeches, debates, and policy papers) it is misleading because it implies that everyone will get some kind of government benefit to "cover" their insurance costs.

That's just not the case.

Most people that are not already on Medicare or Medicaid already have insurance and the government is not going to be underwriting those health insurance premiums by and large. Therefore, their plans really don't provide universal coverage in and of themselves.

In addition to the above, both candidates say they will "reduce expenses" in the overall system while expanding the rolls by 35,000,000 to 46,000,000 individuals. They both go as far to say that there will be no overall increase in expense healthcare expenditure. Well, if you keep the dollar amounts the same and expand the number of people getting care then you will have to "increase efficiency" in the system. That means somehow you have to deliver an equal amount of care to more people without the number of dollars going up. So, I gotta ask, how's that going to be done?

They both say they will offset costs by having better IT in health care and more focus on prevention but I find those to be pithy "feel good" solutions and I say that specifically regarding the latter because they don't discuss how they are actually going to prevent specific diseases. There's the inference that we could cut down on obesity related illnesses (dyslidemia, hypertension, diabetes) but people don't need insurance to get a proper diet and exercise like they should. \

The costs of medical care (as billed) are mainly from these things:

physician visits at the office
physician visits in facilities
ER visits
hospital stays
hospital surgeries and procedures
laboratory tests
imaging tests
home health nursing
physical therapy
special treatments (outpatient chemotherapy)
drugs and medications
durable medical goods

Now, adding 47,000,000 people onto the equation is going to increase demand for all those services and, as far as I know, neither plan actually goes to state that any of the prices of any of those services will go down.

It's like acting as if you could keep the total government candy bar expenditures the same while you gave out subsidies for candy bars for everyone who couldn't afford a candy bar. If you don't reduce the price of a candy bar, you will just end up spending more money no matter what as long as their is a demand for candy bars.

Some will say "but..but...what about the improved efficiency, won't that offset the costs?"

Not if the prices of the services don't go down.

However, if they are right and overall the system cost does not increase then someone is going to have to take a hit on their prices...

Who will it be? The nurses? The doctors? The hospitals? The support staff for facilities and physicians? The insurance companies? The pharmacies? The pharmaceutical companies? Physical therapy outfits?

And with that said, who REALLY thinks the Insurance companies and pharmaceutical companies are going to take the brunt of this increased efficiency?

I agree we need to fix the system, I even agree with a change if it means more societal cost via taxes.

But if you are going to spend all that money why not just do what really needs to be done in providing REAL universal health coverage and go single payer? Then you can actually cut out waste by doing away with the insurance companies. You can dramatically lower physician and hospital overhead by simplify their billing process. You can have an integrated billing and medical record systems that will help them do away with legions of billers, transcriptionists, legalizers, T-crossers, and I-dotters. You will also need to work on an integrated way of reducing the demand of diagnostics and treatments which are over-ordered due to defensive medicine practices or "consumer driven demand".

The vast majority of the healthcare dollar is spent at the tip of a physician's pen, and there's got to be an intelligent way for them to "order less" while getting the same health outcomes. However, I can tell you that most physicians' feet are usually held to the fire if they don't order a test, med, or referral and a lot less if they order something that really didn't need to be done. There's legal and economic incentive for doctors to order more and more and that has to change. Perhaps an integrated single payer system would be able to better address that through public education and published treatment guidelines.

In addition, a national single payer plan will allow everyone to be on the same playing field in collectively negotiating for the best drug prices. I could go on an on.

My point is that adding "more patches" to a patchwork broken system is not going to fix the system. It's great that a lot of people will get health insurance and as a primary care physician I will benefit more than most. However, it's still going to be a broken system.

The best system would be Single Payer Universal Health Coverage that provides for preventative, chronic, and episodic care from conception until the grave that's built in a way so that hospitals, nursing homes, home nursing agencies, and the like can render the same care for less cost.

It bothers me that both candidates take credit for the benefits of a single payer plan but don't actually offer one. They don't actually "cover" everybody because a lot of people won't really derive any governmental benefit as they are already paying for insurance and will continue to do so. Nor do they simplify the system that would allow true increased efficiency. They should call their plans what they are, piecemeal systems that subsidize and expand coverage for the currently uninsured.

[gateley]

1. When they use that term -- universal health care -- I initially assumed it to

mean on par with Dennis's plan. Yeah, right.

I'm so uninspired by both of their plans and don't see much hope for those who really really really need help.

[Rosemary2205]

2. Recommended

I agree with everything you posted, but I'll add, even those newly 'insured' under either of these plans will not necessary recieve much in actual healthcare. They will be 'insured', and therefore the Democrats will be able to claim they got so many millions more insured. But neither are talking about getting actual access to healthcare improved.

[K Gardner]

3. You are right. Neither even remotely offers "universal health care". The

best that can be said for the plans are that they are a means to obtain Universal Health Insurance.

Hillary is absolutely deceptive to try to frame her proposal, which lines the pockets of big insurance, as UHC and a "core democratic ideal." Her supporters are equally as disingenuous, or uninformed, to repeat the big lie.

Obama offers voluntary insurance coverage for everyone..i.e., optional.

I'm not crazy about either plan, but particularly incensed at Hillary's deliberate deception.

[DJ13]

4. I look at it this way

While I agree 100% that "universal" is NOT the same as "single payer" (nationalized), the difference between the two candidates comes down to which is more likely to be willing to modify their plan more towards our goal of a true nationalized health care, Hillary or Obama?

Hillary has a history of being rigid and inflexible in her past policy decisions, while Obama seems more than capable of moving past prior stated goals on towards even higher goals.

Neither candidate has a plan I truly want, but between them I think our best chance lies with Obama.

[RaleighNCDUer]

14. Not only that, but I don't see how it is possible to enforce Hillary's

mandate without the creation of a huge bureaucracy to track 300 million insured covered by hundreds of separate private insurers, and provide for punative measures for those who are not in compliance. And once that bureaucracy is in place, won't it get in the way of any meaningful move toward single-payer? It's very existance is predicated on there being hundreds of private insurers - single-payer would cut their workload, thus their personnel, thus their federal budget, and what federal bureaucracy has EVER worked to reduce its own budget?

At least Obama's plan wouldn't deliberately obstruct reform.

[sandnsea]

5. Yes, private insurance premiums will be subsidized

Oregon already has a program where private insurance premiums can be subidized up to 95%. We can do that very quickly. If we open up the federal plan to everyone, and offer a generous subsidy based on income, than we have a plan that covers everyone who makes the effort to sign up. Obama has been very clear to say that. I imagine people in every country that has a govt plan has to at least sign up for it. You have to sign up to get a social security check and your medicare, even.

What I object to with Hillary's mandates is that she is acting as if she's offering a guaranteed benefit when she is only requiring people pay for insurance they might not even be able to use. It's very misleading.

[Bread and Circus]

6. They "can" be subsidized of course, but they are not going to be for the most part.

Most will get no subsidies at all.

[sandnsea]

8. I'm not sure why you would say that

Here's a chart with the break down for 300% of poverty. That's $30,000 for one person, the median income for one person is $26,000. Over half the country would get premium assistance if we used this measure, which is what many states already offer to children and families.

http://www.taxfoundation.org/news/show/22471.html

[Bread and Circus]

17. Here's the basic math

300,000,000 people
-47,000,000 uninsured
-94,000,000 already on medicare and/or medicaid (alot of these comprise your under 300% of poverty number mind you)
------------------------------------------------
159,000,000 insured

Obama says his plan will cost 50 to 60 billion additionally without any proof that he can actually lower the prices of services. I don't see how he is going to add 47,000,000 uninsured and a significant % of the 159,000,000 insured to the government dole without adding a lot of cost to the bottom line.

[sandnsea]

23. Nobody can prove they would lower anything

I guess I don't get your point. Any plan that the government is involved in is going to cost money. Everybody, even Kucinich, bases big parts of their plan on cost savings. I don't believe streamlined paperwork is going to save all that Kucinich says it would. Modern technology is expensive and that's the bottom line.

[dkf]

7. Yes, I wish they would admit all this would get us is health insurance, not

actual health care.

Then we are all stuck with our sucky insurers making our medical decisions for us and ripping us off.

Great.

[sandnsea]

9. And then we can all decide to go single payer

But until we get everybody in and take away the insurance companies and hospitals' excuses, we aren't going to get anywhere.

Also, I know Obama's plan regulates insurance companies as well. It limits the amount that can be paid out in dividends, requires a base set of benefits, requires everyone be accepted, etc.

[dkf]

10. Yeah but you and I agree that having everyone on health insurance

isn't the end solution.

I think we are being sold a bill of goods and I don't like it.

[sandnsea]

11. Maybe yes, maybe no

But as someone who has subsidized insurance and can see the doctor because of it, I have to tell you that from my perspective, it's a godsend.

[dkf]

15. I can see that. I just think prices are rising so fast that

the system is going to collapse anyway. Look at what is happening in Massachusetts for instance.

Also, if we have 47 million more people using our health care system, how is our system going to accomodate all these extra needs?

[sandnsea]

19. And with aging boomers

Our health care system, totally, is kind of a looming disaster I think. What's really annoying is how bad our medical schools are. My duaghter tried to go to nursing school and it was just a nightmare. There isn't enough room. And they're bringing in people from all over the world when our own people want to get degrees and can't.

But that's why I kind of take the 'fuck it' approach. If the idiotic top 10% would rather subsidize everybody's health insurance than make the kinds of changes we need, then just go ahead and get everybody health insurance. Whatever it takes to get folks to the doctor, that's all I care about at this point.

[dkf]

25. Yeah I have that attitude too.

Its the same attitude I had about Iraq. I thought we would go in there and muck it up, and would be fighting all sides and would lose, all the while thinking that they were no threat to us as they were.

A waste of lives, time and money.

I guess this health insurance fight will do some people good for a little while before we realize how totally screwed everything is. I'm wondering if that is worth the political capital to spend everything on a failing system. Then we Dems will be held accountable for what was originally a Republican idea.

[Bread and Circus]

21. I can't find anywhere if there will be guidelines on copays and deductibles, which is huge...

If I am an insurance company and offer a plan for you with a $5,000 dollar deductible, I'm not really offering much in terms of preventative care, am I?

All your physicals, basic tests, and day to day prescription drugs for your chronic diseases will not be covered...

Is this the kind of care Obama and Clinton are going to subsidize?

[sandnsea]

24. Read the plan

The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers' premiums.

Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure. Obama will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information and lower costs.

Coordinate and integrate care. Over 133 million Americans have at least one chronic disease and these chronic conditions cost a staggering $1.7 trillion yearly. Obama will support implementation of programs and encourage team care that will improve coordination and integration of care of those with chronic conditions.

Require full transparency about quality and costs. Obama will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.

http://www.barackobama.com/issues/healthcare/

[Bread and Circus]

27. I didn't see any direct mention of deductibles in what you linked and I have read

those passages before.

If it's true it should be simply stated what the allowable deductibles, if any, will be. The only thing I can glean from the passage is this "The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency." I think a discussion of deductibles should be made more clear as this is where those with insurance are effectively "underinsured".

I couldn't find a discussion of deductibles on the Clinton website.

Just as an FYI, I'm a firm Obama supporter on his overall candidacy. Healthcare is important, but it's just one of many issues.

[sandnsea]

28. Do you think a public plan would have unreasonable deductibles?

I guess I kind of thought that would be part of what we would be doing when we took part in putting this health plan together. Making sure it was useful. In addition, for subsidized insurance, there would be a choice of deductibles and co-pays anyway. I don't think it's possible to get into every nitty gritty detail. I do think Hillary ought to have to give us an idea of what kind of income cap she's considering though.

[DefenseLawyer]

12. Right on the money

Nothing really changes.

[juno jones]

13. One issue that I have not seen addressed

(beyond a couple of posts I made earlier) is whether providers will in their turn be mandated to accept government insurance. I'm uninsured, cannot afford insurance and make more than the current medicaid cap. I just spent most of my Tuesday off sitting in line, waiting for an emergency slot at the only low-cost/medicare clinic in the county. The waiting list to become a regular patient is years long and a poster on the wall basically states that you will be accepted as an emergency only if you are in considerable pain and even then will have to wait for cancellations and no-shows to be seen. It made me think: Are we simply going to create/expand a double tier system where the government insured are still not allowed to access the same system that the wealthier, those with 'name brand' insurance, enjoy? If the mainstream of hospitals and doctors continue to not accept govt insurance we will be in the same place, and probably worse, because of the increased demands on an already overburdened system.

I have asked this question a few times now and all I get are vague replies, that 'Hil will take care of that' and 'don't worry, you'll be taken care of.'

At least Obama won't take money out of my check to pay for such a system.

Another thing I question is who exactly is going to make the determinations that someone is eligible for this and that program. Sounds like another layer of bureaucracy and not exactly welcome to someone who has actually had to jump through hoops on a monthly basis to prove income to case workers and social workers in the past.

Don't get me wrong. I'll gladly pay for real single-payer. We are all deserving of the same time and care. Accept no substitutes.

edit to add: Sandnsea, first time I'd heard of Oregon's program. Thanks for offering some definitive numbers on the subject. I was beginning to think it was all illusion.

[sandnsea]

16. That's a serious question

I think private doctors should be allowed to do whatever they want. But if a hospital or doctor accepts ANY federal or state funds, they should have to accept it ALL.

On a side note, you can't look at my BC/BS card and tell that I get any assistance for it. It's the same card anybody who has that policy would get and the local people have no way of knowing how much I pay for it. That is one benefit of having subsidized insurance. It eliminates some of that two-tier health care stuff.

At the same time, Oregon has some other policies that have limited health care and I've had trouble with a few of them. Most recently I had to get permission to switch doctors at the only clinic in town, and I really didn't like that at all. So I worry about some of these proposals too.

[juno jones]

20. Thank you, best info I've gotten in weeks!

(just in case you didn't see my edit above!) :)

[sandnsea]

26. Oregon FHIAP

http://www.oregon.gov/OPHP/FHIAP/

This is why I actually supported the Mass plan, even the mandates. I expected them to do as good a job implementing their plan as Oregon did. Unfortunately, no they didn't. Oregon's doesn't have enough money so there's a waiting list to get on the plan. And I'm sure there are people who don't qualify or qualify at a rate they still can't afford. After seeing what has happened in Mass, we need to go slow with mandates I think.

[juno jones]

29. Once again thanx.

I have lived on either side of Oregon (currently Bellingham, WA) and Oregon has always been a sort of mystery. Some really progressive policies there and some really backwards ones too. It's definitely different from either CA or WA, but I suppose it could be argued that we left coasters all have our own flavor and it tends to not be vanilla... :) I'll check this out, once again thanks.

[juno jones]

30. PS

I love that pic of Obama and Michelle. They are in love and seem so secure about it. That is the kind of secure personality we need to be looking for in a leader rather than someone who has to re-enforce his power through political marriages and outside relationships. It's not the cheating per say, and if any of these people would admit to an open relationship, I would gain respect, but mostly it's about conquest and if you need to 'conquest' you are insecure and immature. Obama seems to be neither.

I heard about Obama a while back from my sister who lives in his former state district. (I grew up in IL) She was amazed at how much people on all sides of the fence liked him. This was a number of years ago, so I've been watching him rise. The dems should count themselves lucky they have someone so charismatic and popular on their side.

[Bread and Circus]

18. Great question, as a matter of principle I take Medicare, Medicaid, and the military insurance...

I will also accept the gov't care provided in either of their plans.

However, I don't have to take any of those plans and I can even opt out of medicare if I wanted to.

[juno jones]

22. Thank you

There needs to be more like you out there. :)