Mandatory Insurance would be a REPEAT of the PxDrug fiasco (higher drug prices, corporate welfare...

[Faryn Balyncd]

......paid for by looting the taxpayers, and very little, if any benefit to the health care patient.)

Would patients have been better off if we had just enacted RE-IMPORTATION OF CANADIAN DRUGS (like Bush promised in the 2000 campaign, and promised to "look at" again in the 2004 campaign, and then promptly killed it both times, claiming that "patient safety" was the issue), and never passed the industry give-away that was billed the "Medicare Prescription Drug Benefit"????????

Re-importation of Canadian drugs would have cost the U. S. taxpayer, and Treasury nothing, and would have benefited not only Medicare patients but ALL patients. Instead, we got a prescription drug program that allowed the drug companies to go on a pricing-jacking spree, which raised the prices for everyone, & was one of the most egregious examples of corporate welfare in US history.

But a piecemeal health-care reform would have at its heart Mandatory Insurance, which would make the corporate welfare to the drug companies look like small potatoes.

(And, again like the Prescription Drug debacle, Mandatory Insurance would financially STRENGTHEN the insurance companies whose lobbyists corrupt Congress and influence, sometimes even writing, legislation. These financially strengthened insurance companies {whose 31% cut is more than double anyplace else in the world} would then be MORE FINANCIALLY ENTRENCHED, and even more motivated to continue their control of healthcare policy. That a piecemeal plan based on Mandatory Insurance would eventually evolve into a sound Single Payer plan is flawed wishful thinking. Mandatory Insurance would DOOM eventual Single Payer.)



Can we learn from the mistakes made in the prescription drug debacle?




Perhaps we should not only re-import drugs from Canada, but some of the Canadian judgement that went into forming a banking system, and a healthcare system.




:kick:

[Hello_Kitty]

1. I oppose any health plan that includes mandatory insurance

It is not only corporate welfare, it's a form of taxation without representation. We have no say over the operations of the private insurance companies who will collect these premiums and have no ability to vote them out if we don't like what they're doing.

[earthboundmisfit]

2. Insurance is the problem -

not the solution.

[Ilsa]

10. That is the issue, in only 7 words. Thanks! nt

[customerserviceguy]

18. Agreed

but I didn't see anyone protesting the issue when COBRA continuation was made part of the stimulus bill. Even with the fairly high subsidies, the part that the families have to pay out of an unemployment check is still very great.

[earthboundmisfit]

22. Yup. For me and thousands of others, it's a foregone conclusion

that we can't afford COBRA - it's so out of reach that, to us, the option does not exist. So we do without. It can have a continuation for friggin' YEARS, but who the hell can afford it? I wonder how many people actually DO take advantage of it (or is it more like COBRA takes advantage of THEM...)?

[MercutioATC]

3. "Taxation without representation"???

How so?

By your measure, ALL taxes fall into that category.


I don't get to vote on whether I have to pay property taxes, but I DO get to vote for the people who make that decision. Am I being taxed without representation?

[Hello_Kitty]

4. Do you get to vote out the CEO of Humana?

[MercutioATC]

6. No, but neither do I get to vote out the owner of the company that resurfaces the roads.

My tax dollars pay his company, just as my tax dollars would pay Humana.

It's still not "taxation without representation".

[Hello_Kitty]

9. The road company is bound by a gov't contract.

Health insurance companies would not be. I saw nothing in Hillary's plan that stipulated they'd be under contract.

[MercutioATC]

13. Who's talking about HRC's plan???

Expanding the FEHBP or something similar, as Obama has suggested, would most certainly involve government contracts.

You actually have a fear that the government will mandate health insurance without providing a program? Yes, there has been talk of "mandatory insurance", but in conjunction with a defined program that would place health insurance providers under contract.

[Hello_Kitty]

16. HRC's plan was considered the model for mandates, so why shouldn't I reference it?

The Federal employees' health plan is just a menu of private insurance providers offered to federal employees. If we're going to mandate coverage, why not just extend Medicare to everyone? And do you have a link to something that shows that private insurance companies would be under contract in a mandate scheme? I'm not saying there isn't any but I haven't seen one and I looked. I mean, other than the contract that American citizens would be forced into with insurance companies.

[MercutioATC]

17. The notion that health insurance without a program would be mandated is just ludicrous.

..and, as far as I know, it's never even been suggested.

You're talking about HRC's plan from more than a decade ago, right?

[Hello_Kitty]

19. I don't understand what "program" you're talking about.

FEHBP is a "program" that works for federal employees because every one of those employees gets his/her coverage heavily subsidized by their employer, the U.S. government. If it is extended to all, will the U.S. government pay the same portion of the premiums for all people, as it does for fed'l employees? Not from what I understand. I keep reading about "subsidies" but those will only go to some people. What's going to happen is that either you'll be paying a substantially higher premium than a fed'l employee or you will get substantially less coverage.

[MercutioATC]

23. The idea is to provide health insurance to everybody.

Premiums would be on a sliding scale, based on income, and would follow the person...not the job.

Insurers wishing to be part of the plan (and the plan will be the only game in town) would have to comply with set standards (what they cover, no disqualifying for pre-existing conditions, etc.).

People would have the option to choose from a range of individual PPOs, PPVs, and HMOs and could decide which best fit their needs. I'm an FEHBP member and I have the choice of over a dozen plans. The costs and coverages differ (within the requirements) and I base my decision on my current medical needs.

[Hello_Kitty]

24. If your first statement is true then it's not an extension of FEHBP

"Premiums would be on a sliding scale, based on income, and would follow the person...not the job." That would be a mandatory individual insurance plan with subsidies based on income. What you have, as a member of FEHBP, is employer-sponsored coverage.

To further clarify (edit): Say the total premium for whatever plan you have under FEHBP is $500. Your part of it may be something like $100 a month, with your employer (the U.S. gov't) picking up the rest. Now say I'm an uninsured person who is now under a mandate to get health insurance. I may decide that the plan you have is right for me but because I make "too much" to qualify for subsidies. Therefore, I either get stuck with a $500 premium or I get a cheaper one with less coverage.

[MercutioATC]

25. Yes, I realize that. That's why it would be an EXPANSION of FEHBP.

Use the same program, expand it to cover all Americans.

[Hello_Kitty]

26. I'll repeat the clarifying remarks I made in my previous post:

Say the total premium for whatever plan you have under FEHBP is $500. Your part of it may be something like $100 a month, with your employer (the U.S. gov't) picking up the rest. Now say I'm an uninsured person who is now under a mandate to get health insurance. I may decide that the plan you have is right for me but, because I make "too much", I don't qualify for subsidies. Therefore, I either get stuck with a $500 premium or I get a cheaper one with much less coverage. Simply expanding the FEHBP program to all Americans, without a corresponding extension of the exact same premium offset that ALL federal employees get from their employer is not fair or reasonable.

[MercutioATC]

27. The premium offset would be the same.

The plans (within the contract) differ in price and coverage, however, so not everybody would pay the exact same amount or have the exact same coverage. That's one of the benefits of this approach...the consumer gets to choose the plan that best fits them.

[Hello_Kitty]

28. You are still not getting my point

Regardless of what type or level of plan you, as a federal employee, choose within the FEHBP you get a substantial part of your premium picked up by your employer. Individual mandates with "subsidies on a sliding scale based on your income" are not the same thing. Again, if I make "too much money" I get no subsidies. Which means I'll be able to exercise that consumer choice you refer to by picking a cheaper plan with far less coverage.

[MercutioATC]

32. Correct, but how would that differ from now?

...unless you chose to forgo health insurance altogether, in which case if you get sick or injured you're a burden to the system.

Going without health insurance doesn't only affect the individual, it's a huge drain on the system as a whole...it harms all of us.

[Hello_Kitty]

34. And if they don't get the same premium offset you get?

I guess you are arguing that (many) currently uninsured people should be forced to buy insurance at a much higher premium than the heavily subsidized one you are paying. Where are they supposed to get that money? Do you honestly believe that the self-employed and service job people who are currently uninsured have gobs of money laying around to pay big health insurance premiums?

[MercutioATC]

35. No, we'd ALL be under the same program.

The subsidy would be scaled to income, but it'd apply to everybody...me included.

[Hello_Kitty]

36. If it were truly "scaled to income" you'd be unpleasantly surprised.

Right now, your federal plan covers 76% of your premium. If they introduced a means test, you'd probably be paying a LOT more.

[MercutioATC]

37. ...and at my salary, VERY unpleasantly surprised...

Employers would have the option, I suppose, of offering additional subsidies as part of their compensation package but yes, I'd pay a lot more.

[Hello_Kitty]

38. And those who make much less than you would be screwed.

So how about not calling for them to be mandated to buy private health insurance that they'll never be able to afford? If you want everyone to be covered, universal single payer is the best way to go.

[MercutioATC]

39. How would they be "screwed"?

They'd have affordable (free, if they were unemployed) health insurance. How does that equate to "screwed"?

...and I've expressed my issues with single-payer...

[Hello_Kitty]

40. Define "affordable"

[MercutioATC]

45. Free for those with zero income.

I don't know exactly where they'd set the premium subsidies, but the whole point is to make it available to everybody.

[Hello_Kitty]

48. You trust the same government that you don't trust to run single payer to determine that?

Amazing.

What I predict would happen is that young, single people with crap jobs would get stuck with full premiums and no subsidy.

[MercutioATC]

50. If the subsidies are based on income, how would that happen?

That aside, you are criticizing the plan based not on its fundamentals, but what you think might happen. I could just as easily criticize single-payer because I think they might dig up the remains of Josef Mengele, clone him, and put him in charge of the program. Single-payer wouldn't really be a health plan, it would be a covert means of carrying out human experimentation.

Since we don't have any definite numbers yet, we're debating concept. The CONCEPT is to use FEHBP as a model to provide affordable health insurance to everybody. Premiums would be subsidized based on income.

Aside from your created scenario in which the government abandons the concept entirely and simply mandates unaffordable health insurance, what are your issues with it?

[Hello_Kitty]

42. And how much are you willing to have your own premiums go up?

Since, by your own admission, you make a good income.

[MercutioATC]

46. As much as it takes. I'm also for lifting the FICA cap...

...which means my paychecks would stop getting bigger every August. It'd cost me thousands, but it's the most equitable way to help stabilize Social Security.

Sorry, you're not going to score any points trying to appeal to my greed.

[Hello_Kitty]

49. I'm not trying to appeal to your greed and stop making assumptions about my motives

I asked how much more you'd be willing to pay for health insurance and you gave a non-answer. Then you made some comment about FICA, which is beside the point.

[MercutioATC]

51. I would be willing to pay the full premium with no subsidy.

Is that a precise enough answer for you?

[Skidmore]

5. Insurance is the original ponzi scheme.

[Lars39]

7. How would people that have no insurance right now, yet have $12,000

and only $23,000 in income be able to afford mandatory insurance? Are their medical bills going to be forgiven? Will the medical insurance that they have to pay for magically pay 100% so that no more medical bills will accrue?

[Hello_Kitty]

11. Young, single people would be SCREWED by it.

They would not qualify for any subsidies or credits, since they're all "rich" from their jobs waiting tables and don't have dependents.

[Warren Stupidity]

12. Insurance would be sliding scale subsidized.

Such a system can be made to work, but it requires extensive regulation and a lot of detail work to get it right and keep it right. It would be far simpler to extend our existing medicare system to everyone, plus re-doing the prescription plan to make it work.

[MercutioATC]

14. ...or we COULD just extend FEHBP....

It's an existing plan that works pretty well.

[Warren Stupidity]

15. That was basically Edward's 'back door' approach.

And it seemed like an interesting way to get this done way back then.

[area51]

29. You might find this of interest

regarding PNHP on extending FEHBP to everyone.

[MercutioATC]

33. Interesting, but I take issue with a couple of their premises.

1) Yes, insurers would offer the same plans at the same price to the general public. If the FEHBP was the only game in town...for everybody...they'd have no choice.

2) The article you linked to makes the "gatekeeper" issue seem like a problem. I've been an FEHBP member for 18 years and I've never had the slightest problem. I've even gotten them to cover a procedure by an out-of-plan doctor simply by blustering.

3) The "pay now or pay later" claim assumes that we all have the same health issues. We don't. Historically, I have very few dental problems and I take ONE prescription drug. I can choose a plan that doesn't offer as comprehensive dental and drug benefits, but costs less...and I can change plans during open season every year if my needs change.

The benefits? It's an existing plan. It'd require some tweaking to expand it, but not a ground-up build. It would completely one of the biggest insurance issue for many, the exemption for pre-existing conditions. It would follow the individual, not the job, so people wouldn't lose their coverage if they lost their job.

Single-payer is a completely different way of approaching the healthcare situation, and it's not without its own pitfalls. There would be gatekeepers. There would be less ability to subscribe to a plan that fit one's individual needs. ...and the big issue...it'd be administered by a government that is barely capable of doing anything competently. The VA is administered by these same people and service is, at best, spotty.

No program will be without drawbacks, but I think this choice would work...and work better than single-payer.

[Hello_Kitty]

41. Of course you don't have any problems with your FEHBP

Your employer covers 3/4 of your premium!

[MercutioATC]

47. 72%, actually...but that has nothing to do with what I said.

Regardless of cost, there could still exist the "gatekeeper" issues that the link suggests. In 18 years, I've not encountered that.

[Hello_Kitty]

43. BTW. the VA is a very well run system

It's only problem is that it's underfunded. So is health care for active duty military. Tri-Care (for military retirees) is about the best system there is.

[Warren Stupidity]

8. Other nations have mandatory insurance systems that work.

Not all universal systems are the single payer model. France and Germany both have rather complicated mixed systems, and Japan has a functional mandatory insurance system. The problem is the regulation of such a system. If in fact it is put together with little or no regulation of insurance providers, or where regulation is deliberately crippled as it was for the medicare prescription plan, such a system will fail. I tend to agree with you that we will not successfully regulate such a system, we will not set strict standards for insurance coverage and cost and for fees charged, and that healthco will be writing the legislation for their benefit, not ours. We are at a point in our system where the corruption is so complete that nothing is being done that is not at the direction of and the benefit for the kleptocracy entrenched in Washington.

[earthboundmisfit]

20. See this related DU thread from yesterday

from Girl Gone Mad:
Massachusetts doctors say single-payer or bust
citing Sarah Arnquist Feb. 18 article in The Health Care Blog, about the Massachusetts experiment with mandatory health insurance.

[Faryn Balyncd]

21. Here's the Single Payer plan proposed by Physicians for a National Health Program..............

http://www.pnhp.org/


and Doctors Steffie Woodhandler and David Himmelstein (founders of PNHP) have been leading proponents of Single Payer (as have the California Nurse's Association).

Woodhandler and Himmelstein, as practicing physicians in Massachusetts, have been strong critics of any health "reform" based upon Mandatory Insurance (a la Massachusetts):

http://www.pnhp.org/news/2007/september/health_reform_failur.php

[SoCalDem]

30. "re-importation" of drugs is not a solution

Removing the INSURANCE COMPANIES from the mix ENTIRELY, is part of the solution.. one leg of the stool..

Another leg is the REGULATION of the pharma industry. They are a VITAL part of the national health care, and should NOT be a "for profit" industry, to start with.. I have NO problem with the scientists being well-compensated for their efforts. But MUCH of the success they have is bought & paid for by tax dollars invested in university labs, where a lot of their research is done, and by federal grants.. Without the neverending patent merry-go-round, and the inane advertising, and the excessive "profits", drugs would cost a lot less..

The third leg of the stool is the REGULATION of hospitals, and restoring them to not-for-profit status as well..

[defendandprotect]

31. Drug plan is a fiasco doing more for drug companies and insurance companies . . .

than for recipients --- !!!

End privatization of Medicare ---

and let's negotiate the price of drugs -- or are we going to remain stupid?

[Kansas Wyatt]

44. Anything less than expanding Medicare into any of the European or Canadian models...

Means that there are parasitic Corporations denying health care, while hi-jacking the money for it. That is the bottom line to the whole health care mess in the United States, that Washington refuses to acknowledge.

The Insurance Industry can go straight to fucking Hell and roast into a pile of ashes. Insurance Companies serve no purpose in health care, other than robbing people of everything as they facilitate and hasten their death.

Next on the 'go to Hell' list, is the pharmaceutical companies, who make obscene "profits" off of sick people, like a bunch of fucking vultures. There is no way in Hell they will ever allow a cure to be known, if they cannot make an enormous profit off of it. It doesn't matter how dedicated their employees are to finding a cure, the pharmaceuticals will always tilt the balance to not finding a cure. There is no profit in curing people.