Thursday, January 26, 2006

Health

Post and discuss

54 comments:

J. Small said...

Hi Marilyn,

Thanks for setting this up. Perhaps this should be called health care, and you would sure get more posts, judging from the amount of healthcare ideas on ssb.

Here is my very simple idea. It does not neccesarily create jobs but it would be very helpful to the average working family:

http://www.sinceslicedbread.com/idea/14150
LinkOur Health Care to politicians
Submitted by anonymous in Massachusetts
Universal basic health care at the same level as legislators. Whatever the plan is, the universal plan must be the same one as the legislators have available that is paid for by their constituents.

These ought to be linked together by law, we pay for their governmental health care, and we elect them. Legislators are less likely to address the average person's concerns for their families, if they are insulated from these worries. There should be no exceptions to this.

Since when do employees have better benefits than their employers? This is what we have going on, when you boil it down. It is outrageous.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There was a later idea submitted, that was very similar, but included other benefits. I thought that my version would keep it simple and unalterable, although, you can imagine legislators giving themselves compensating benefits on the sly, so perhaps it would be useful to include other govt. benes.

Judy B. said...

John A. and I have been having a lenghty discussion on Universal Health Care on the Changing the World thread over at SSB. And now Art has joined in with some concrete ideas..
Without their permission, I will copy the last 3/4 comments to get the idea moving here. for full details you will need to go over there and see the unfolding of a complicated plan.

Judy B. said...

The following discussion of Universal Health Care comes from the last page of the "Changing the World" thread at SSB. To get a more comprehensive idea of plans discussed go there and read the last three pages... Judy

"John A., my idea would be to give working people the option of putting their (6.2%) ss contribution into health care, continuing to put the employer's part into ssi, in exchange for reduced retirement benefits or a higher retirement age (which could be made up at a later date with additional contributions).
I would allow several related and/or married individuals to "pool" contributions into a "family" plan, and non-salaried people to contribute to the plan, which would have a basic level of coverage, including catastrophic illness insurance.
With individuals contributing more towards medical costs, employers -especially small businesses- could afford to pay more for (tax-deductible) supplementary health insurance (dental, eye care, Prescriptions?) without dramatically increasing wages, remaining competitive.
Also, there would be less of an obstacle to raising the cap on ss contributions, since all taxpayers would benefit by being able to apply a yet to be determined amount of their ss contribution towards health care.
- Art N. in New York on January 28, 2006 - 11:39pm"

"Art, the way you are approaching the idea makes some sense to me. Do you have a full blown plan, or is this in the idea stage??
- Judy B. in Washington on January 29, 2006 - 5:16am"

"It would certainly be an interesting compromise with what I'm suggesting, which is to say, has similar elements, but it less "extreme"....
- John A. in New Mexico on January 29, 2006 - 12:13pm"

"Judy B.
I'm not an economist, but I was a government budget analyst for 30 years. I think there is a point at which interests intersect-The "tipping point," to coin a cliche, an equilibrium that workers, employers and government can "live with," that would be necessary and sufficient to support universal health care. I visualize a chart where several lines intesect; however, that intersection moves as we speak. For example, Governor Ahnald recently suggested allowing people to buy drugs from Canada. As a representative Republican Governor from a state with a large elderly population-Florida, New York and Texas are similar-with the burden that Medicaid and Medicare places on state budgets, I'm just waiting for the rest of them to "get it!" Let's make it an issue in the next election, since, as I (easily) predicted, the Medicare Part "D" Rx plan is an unmitigated disaster that costs about $30 bilion more than it should, has already put people unnecessarily into the hospital (or worse!) and is so arcane most pharmacists, let alone ordinary people can't follow it. (I read the VA, for example, has a mere $7 "co-pay" on prescriptions. Sounds pretty simple to me. Run by the government. What's wrong with this picture?)
- Art N. in New York on January 30, 2006 - 2:16am"

"I certainly agree with what you say, Art. I sense that the tipping point is near. The number of UHC ideas in this "contest" makes it clear that the people are in favor... Since our representative respond most to hand written letters from their own district, (not emails/phone calls), I believe that the tipping point can be manufactured sooner than waiting for the system to completely break down. It is time to start a letter writing campaign... each in our own way, but united, I believe we can put pressure on our representatives/senators and make a difference. Another way is to get a third party candidate to run with this as their agenda item.. Give it more publicity."
Judy B. in Washington

deb said...

People are so afraid that some poor person is going to get something for nothing...what about the megarich corportaions getting something for nothing?

"a couple weeks ago the Republicans stuck in a $22 billion tax money giveaway to HMOs. Nobody knew anything about it. That's the problem with corruption. It's not just dishonesty. It costs the American taxpayers billions and billions of dollars. That is the shame of this scandal."


From a Howard Dean speech yesterday.

Marilynn M said...

I'd like to see Medicare improved and expanded. It works very well for Seniors. Let's look at the health care plans in Europe and Canada. What they have works. Then make the legislators sign on too. Their pensions and benefits are way too generous. GWB is going to come up with some lame screw the people idea in his State of The Union speech. Anything to stop a decent plan from evolving.

Cheryl V said...

With the debate over we should extend Medicare to everyone, or go to some sort of private coverage, I did a search on Medicare & efficiency. I tried to find some reasonably non-biased reports. Here's what I found:

The Inspector General of the U.S. Department of Health and Human Services has found that far from being more efficient, private plans are actually less efficient than traditional Medicare. Private plans have average administrative costs of 15 percent, much higher than the 2 percent administrative cost of the traditional Medicare program. And because private plans attract more healthy beneficiaries who are cheaper to care for

----------------------------------
http://www.hopkinsmedicine.org/about/Crossroads/06_13_03.html

Moon argues somewhat convincingly that Medicare has been a success. While not necessarily denying that certain reforms might be needed, she stresses the importance of preserving three essential tenets of the program:
1. Its universal coverage nature creates the ability to redistribute benefits to those who are neediest.
2. It pools risk in order to share the burdens of health care among the healthy and the sick.
3. Through Medicare, the government protects the rights of all beneficiaries to essential health care.

It has been argued that, in part, Medicare's cost effectiveness arises from the fact that it does not need to expend funds on marketing and sales-functions that are obligatory for the success of competitive, private-sector health plans. Moreover, some argue that the competitive model for health insurance has not been successful. In a market-driven economy, the healthy can and will change health plans for savings of only a few dollars a month, while the sick must remain in their existing plan in order to retain their physicians. Such behaviors lead to asymmetric risk pools and cost inequities.
-------------------------------
http://desmoinesregister.com/opinion/stories/c2125555/23362064.html

With the passage of Medicare legislation late last year, the Bush administration and Congress have managed to take a generally well-run, efficient system of delivering health care to 40 million American seniors and turn it into a money-wasting, inefficient program that will mimic the wasteful, private health-care sector. Here's how:

Several years ago, Medicare instituted a Medicare+Choice option intended to entice private insurance companies to take over managing the health care of seniors who gave up traditional Medicare. It was a dismal failure. More than 2 million seniors lost coverage when insurance companies couldn't make enough money and dropped the plans. It's estimated the government spent $5.2 billion more on these private plans than it would have paid to cover those seniors in traditional Medicare.

Art N. said...

Thanks for putting my uhc idea here , Judy B.

Art N. said...

Let's get the word out on the Canadian Rx plan from Ca. AARP owes us BIG TIME for pushing Medicare Part D in the first place. I'm writing them asap.

Judy B. said...

I wonder if we can agree on a few points?
1. Universal health care is needed.
2. The Medicare model of providing coverage works well for those one it.
3. Using this model (or variations of it) we can extend health care to everyone.

What then are the variations to be considered? Dental care? Long term/nursing home care? RX coverage?

And the really big question,how do we pay for it?? this seems to be the sticking point.

If we could address these questions (and the ones you add to the mix)point by point we might come up with a solution.

Cheryl V said...

Judy,
I agree on your points.

We might also want to consider vision care as another variation.

john Ashman said...

Cheryl, you have to admit, my MRSA plan essentially eliminates overhead, removes the advertising/marketing aspect, and is even more efficient than anything else currently available. The one thing about Medicare that they typically don't factor in is the greater waste/fraud/abuse thing. They may be efficient at throwing around money, but less efficient as to how that money is used.

The MRSA program has the advantages of essentially zero overhead and essentially 100% efficiency.

Cheryl V said...

Your MRSA plan does have overhead. It has a review process.

Your plan also mentions insurance policies. Overhead & advertising.

j. Small said...

Marilyn 8:48AM Comment

I had an idea 'copy foreign health care that works"
but I forgot to copy it before the user pages were taken down. Exactly my thoughts.

john Ashman said...

"Your MRSA plan does have overhead. It has a review process. "

What review process? Said "overhead" is *substantially* lower than the current system due to the flat tax and shifting the accounting to banks who will gladly do it in order to have your money to put into their loan pool.

"Your plan also mentions insurance policies. Overhead & advertising."

The insurance policies have a $5K+ deductible. The amount of "overhead & advertising" is vanishingly small because it will come down to price rather than using image ads. And people could use the government as their insurer if they like. The overhead is *dramatically* reduced - essentially zero by comparison to today's system.

Let me ask you, Cheryl, do you have a plan that would cut medical *expenses* in half? MRSAs will do that. Any overhead pales in comparison that amount of savings.

Cheryl V said...

A number of other countries have good health care systems that cost much less than ours.

I agree with Marilynn, find good ideas from what already works.

Marilynn M said...

We already have a plan in place that works well. It just needs updated to serve the entire country. Investigate other countries Universal health care and use any ideas that are good. Raise the cap on FICA and it will be funded. If necessary raise FICA a bit. It will still be cheaper than the price gouging private insurance. Plus everyone will be covered. You don't have a "savings" but that would be more than wiped out with one hospitalization. This is what several Senators are starting to talk about. GWB of the screwed up prescription plan is going to advocate a savings plan. Another attempt to destroy Social Security.

john Ashman said...

Social Security needs to be destroyed and something better put in its place. The returns are dreadful and your money is stolen by the government and given to someone else if you die.

Dan/Mich said...

John, Take a look at the social security thread for an option that preserves the program in what I think is a sensible way.

Marilynn M said...

john Ashman said...
"Social Security needs to be destroyed and something better put in its place. The returns are dreadful and your money is stolen by the government and given to someone else if you die."

John, you don't have to live very long to get every dime you paid in back out.

Plus if you die before you raise your family they get your benefits to live on.

If you become disabled you get benefits. It is insurance to protect people from poverty.

john Ashman said...

dan/mich, I'm all for anything that *improves* SS, but I'd rather see it be razed and replaced. It costs something like $80B to administer, it is losing money, most of the money has been borrowed and spent, the returns are pathetic. I just don't see much about it worth saving. That's just me though.

john Ashman said...

"John, you don't have to live very long to get every dime you paid in back out. "

Doesn't that make my point about the lousy return on investment? You pay in all those years and then it gets used up right away because you got 2% interest instead of 5-10%?

"Plus if you die before you raise your family they get your benefits to live on. "

As they would if you had an MRSA.

"If you become disabled you get benefits. It is insurance to protect people from poverty."

And, yet, we have a whole lot of poverty. I guess it's not working so well. There are simply better, more efficient ways of doing it.

Marilynn M said...

I hate to tell you that your idea is about the same as Bush's. His was not well recieved.

Social Security is as safe as our government. If the government fails so will everything else.

If you can't afford to take the same amount each payday as you pay into FICA and invest that in whatever, you can't afford to not have Social Security when you retire.

Dan/Mi said...

Wonder why heath care costs are rising so rapidly? An editorial in this mornings NY Times points out some of the problem.

February 2, 2006
Editorial
Seducing the Medical Profession
New evidence keeps emerging that the medical profession has sold its soul in exchange for what can only be described as bribes from the manufacturers of drugs and medical devices. It is long past time for leading medical institutions and professional societies to adopt stronger ground rules to control the noxious influence of industry money on what doctors prescribe for their patients.

Last week two new cases came to light that reveal the lengths to which companies will go to buy influence with doctors, pharmacists and other medical professionals. Reed Abelson reported in The Times on Jan. 24 about a whistle-blower's lawsuit alleging that Medtronic had paid tens of millions of dollars in recent years to surgeons in a position to use and recommend its medical devices. In one particularly egregious example, a prominent Wisconsin surgeon received $400,000 for just eight days of consulting.

In last Saturday's Times, Gardiner Harris and Robert Pear revealed that a Danish company paid a pharmacist, doctors' assistants and a drug store chain to switch diabetic patients to the company's high-priced insulin products.

In the wake of past reports of industry's influence over prescribing practices, medical and industry groups have issued guidelines defining appropriate behavior. But as an article in The Journal of the American Medical Association made clear last week, these guidelines are far too weak.

The influential authors called for a complete ban on all gifts, free meals and payments for attending meetings. They urged doctors to reject free drug samples because they are a powerful incentive to use medicines that are expensive but not more effective. And they called for a ban on consulting arrangements that entail no specific scientific duties.

These proposals are hardly onerous. Kaiser Permanente, a California-based managed care group, has adopted nearly all of the recommendations. Its doctors prescribe heavily marketed medicines far less frequently than most other doctors.

The critical issue is that doctors must have the best interests of their patients at heart in prescribing drugs or recommending medical devices. Their judgment must not be clouded by financial self-interest or the desire to please industrial benefactors.

Judy B. said...

dan...I was going to post that article... you beat me to the punch.. It is really a sad state of affairsabout how the rich seduce the not so rich into doing their bidding..

john Ashman said...

Dan - MSRPs. Solves the whole problem.

Judy B. said...

Probably not John... The drug companies would still use whatever means possible to pro,mte their drug as the best "cure". If that means paying off doctors that would still happen..

Judy B. said...

I have been thinking long and hard about the Health Care dilema. The very best SSB finalist idea, "Don't tie Healthe Care to Employment" is probably doable at the state level with some modifications.

Marilyn, think about this for a moment... one of the biggest complaints about government is waste. One of areas that is perceived as having the most waste is the welfare system.. This system includes a huge number of people who are there because of medical needs.

If we were to come up with a state model of UHC funded by a sales tax, I am betting the welfare rolls would decline dramatically, cutting back on a state budget item that has no source of revenue except the general fund.

The arguement againt this (UHC) is the unions, the no-new-tax people, and the medical profession.

I think a plan might be evolved that would bring them into the fold...

Help me out with the arguements to show the doctors how they would benefit...
also the unions...
and the no new tax people...

Cheryl V said...

I stumbled across this group a while back. They seem to be doing some good work.

Physicians for a National Health Program,

http://www.pnhp.org/

deb said...

Cheryl: Thanks for the address. These doctors have a page that dispels the myths about a national health system.

I also noted a quote from the site:)

"Our current national health care system is simple: don't get sick." - Anonymous

Cheryl V said...

Another good quote from the site:

"Some services are too important to leave to the marketplace." - Cardinal Joseph Bernardin

Judy B. said...

Thanks for the website Cheryl... lots of good information there..I just had a discusion about this with my mother's doctor yesterday.. I just emailed him the web address...

My conceern is about waiting for the feds to do something. it looks like a state could start up a similar plan... I am going to talk to some more people about it...

deb said...

Judy: It would have to be national because people move.

Dan/Mi said...

Judy,
I know the UAW has championed national healh care for at least 30 years. I was unaware that other unions were against it.

A state plan is probably better than nothing, but I think having one national plan offers the best opportunity for efficiency and cost savings.

Anonymous said...

For many Americans, affordable health care is simply not available. Only 60% of the population has employer-based health insurance, while 27% has government-based coverage, primarily Medicaid. The rest are uninsured. (source: US Census Bureau) However, the statistics are misleading, since many people with coverage are under-insured, do not have coverage for medications, or have high deductibles and co-pays.

http://www2.sinceslicedbread.com/idea/5343

Marilynn M said...

Judy, People can't get welfare just because they need health care. If they are truely disabled they can get SSI. It isn't that easy to get welfare. Plus I believe there is a time limit on recieving it. I don't think health care plays a big part in welfare.

I can't believe labor unions are against UHC. Why would they be? They have to fight tooth and nail to get health care paid for, for their members. I think they would be happy if that headache were replaced with UHC. They have other things they could be working on if that were gone.

Marilynn M said...

Medicare is already in place and it works. Raise FICA and the caps it will be paid for. It will still be cheaper and more efficient than private health care.

The States wouldn't willingly give up their sales tax revenues.

Judy B. said...

I agree that Medicare works, and would like for everyone to have access to it..It seems that the politics of the times make that impossible, and a GW plan probably would not be one we would like anyway.

State health care plans could be more easily brought to fruition because people have more access to their state representatives.

And if a state is primarily red or blue, the state plan could address the positions of the party in power, giving us some options for a national plan down the line.

City and county governments, school districts, state agencies, etc., all have to figure health care in their budgets. This money is already coming from the taxpayer in some form or another. It would simply be figured differently.

Small businesses to large corporation who pay for health care have to figure it in to the bottom line in their budget. If they didn't have to take that into consideration, they could give their employees raises(??) which would stimualte the economy with more disposable income which would in turn be taxed as it is spent. The biggest upside of this for the first few states that develop a plan and implement it, is the economic development that would occur. Businesses that don't have to figure health care as a cost of being in business will thrive in these states.

Granted, i do not have all my dicks in a row yet, but I think when I do it will be an easier sell than a national plan...

Judy B. said...

The states already allot a big share of tax revenue to health care..

This might be the one area that people would get behind a sales tax increase as everyone benefits.

As for welfare,.." People can't get welfare just because they need health care. If they are truely disabled they can get SSI."

I don't know how many "welfare" offices you have been in lately, but I know that here in Washington state a lot of people recieving aid are doing so because they are unemployable because of hewalth reasons...and they do not qualify for SSI.

Anonymous said...

Wish I could figure how this works. Heh Judy and Deb. Glad to see you are still debating issues you believe in. Keep up the good work. John G. in Georgia.

Judy B. said...

John G.
welcome aboard...
We missed on the winner...
we will tackle more issue here..
the website is fairly easy once you become accustomed to it..

Marilynn M said...

John G., Happy to see you. Please join in. We didn't do well with our America fixing on SSB, but we are going to work together here and do what they said they would do.

Anonymous said...

I do not know who runs this site...I will make a suggestion if I may. How about a consumer topic/blog? We can debate back and forth about which products provide the most value for the money. IE: healthcare plans, cars, etc. (which ones are American made)
Also maybe a futuristic, before it's time, Idea submission topic/blog category. IE: flex motors,plug in cars, te-he LBT.:-)
I read somewhere the other day FORD is going green! Maybe they read your postings in SSB?!(did not win, Judy b.??? Please keep posting...you guys/gals are winning/winners!) What is folksonomy? take care.
John G. in Georgia

Richard Yarnell said...

I don't understand why business isn't behind health care reform.

They're not going to be rid of some expense in the form of taxes devoted to health care, but it would seem to me they'd be glad to get rid of the crippling status quo.

It wouldn't be skin off their noses to support a plan that didn't strip a worker or his family just because of a job change.

Anyone got a clue?

ryarnell@iwon.com

Judy B. said...

I actually think small businesses are ready for reform... Small and medium sized businesses can't afford the insurance for their employees, which causes them to hire part timers (who leave when a job with benefits comes along, this results in continually training new hires or temporary workers, using up valuable time og management...

In larger corporations that have good health care coverage I think it is more likely that it is the worker who doesn't want to change..
And the unions play a part here too.. By championing health care in the work place they have a trump card in their recruitment deck... Not that that is bad, but it is time for a change, as more and more unions are losing members and the Walmarts of the world are not offering health benefits...

There needs to be a big education program addredded to the Chamber of Commerces of the nation about how UHC would be of benefit to them..

And the same thing for the unions and the workers...

Judy B. said...

Here you will find a proposal for UHC pro[osed by physicians:
http://www.physiciansproposal.org/embargoed/angell.html

Cheryl V said...

Another reason I hate insurance companies.
My husband & I both work. The entire family's health insurance is through my employment. At least once a year, we get asked to verify that we have no other health insurance. What a waste of time for all involved.

Anonymous said...

Thank-You for the link Judy.
It will be reviewed by my governor.
Promise. Keep posting, It's working.
Your friend,
John G. in Georgia

Judy B. said...

I am on a blog at the local level. The issue is health care. i am trying to get people to quit blaming and find areas of agreement. I am starting with the following; please add your "arguement" to mine.

While there is apparent disagreement about the personal responsibility issue with regards to health care, I sense that there might be areas where most parties might agree on some fundamental concerns.
1. It is hard for corporations to remain socially and environmentally responsible when one third of their labor costs are benefits (health care, vacation, retirement). This puts them in an unfair position in the world market. A car built by GM or Ford has to add those health care benefits to the cost of the car. Americans then proceed to buy foreign cars that are cheaper, and our factories have massive lay -offs. I am not speaking of third world countries here, but of European and Canadian countries that have labor and environmental standards.

2. All of us pay for health care for the uninsured in some way or form. Hospitals are forced to supply health care to the medically indigent. That cost is passed on in the form of higher rates to those of us who have insurance; or passed on to the government in the form of Medicade; or foundation support picks up some of the cost.

3. Small businesses that can't compete in local markets when/if they pay their employees a decent wage plus health care benefits. To get around this they have opted to hire part time and temporary workers, effectively putting those employees on notice that each pay check may be their last; a stress inducing condition that sends more people to the doctor.

4. Physican and hospital costs are multiplied by the bookkeeping and billing proceedures that are associated with hundreds of different insurance companies. This is effectively forcing small medical practices out of business and into HMO's or other unbrella organizations (like Peace Health).

These are just a few areas in the market economy that demonstrate that we do have a health care crisis. These points do not even start to address the human element that the uninsured face day in and day out.

If we can stop arguing about who is to blame and think of solutions, I believe that we can perhaps come to the conclusion that we MUST do something about our national health care problem.
The next step is "What to do!"

Richard Yarnell said...

If we agree that it is inhumane for anyone to be without medical treatment (therefore, health insurance), then it behooves us to organize delivery of that health care to everyone in the most efficient way we can. That is not happening now and it's costing us plenty.

Those without health insurance most frequently obtain their care from emergency rooms, the most expensive operation center in any hospital. On top of that, they don't receive prophylactic care, regular exams, or even advice on how to avoid diseases that, by the time they are discovered are often advanced and expensive to treat.

Having a minimum standard of health care which is provided to everyone, does not mean that some elective procedures can't be left in the for profit centers. Oregon, under a terrific Governor Kitzhaber, an Emergency Room physician, developed the Oregon Health Plan which prioritized common medical procedures an the basis of which were most effective and touched the lives of the most people. Dollars were applied to those procedures. When the dollars ran out, the procedures below that line were not covered. Flu shots and pap smears were covered: heart/lung transplants weren't.

ryarnell@iwon.com

Anonymous said...

THE FACTS from http://www.umich.edu/%7Eeriu/highlight-chernew.html

Premiums went up, and coverage went down. During the 1990’s, the average cost of a health insurance premium rose by about 53 percent, or over $800 inflation-adjusted dollars. Spending on health care increased even more, by 57 percent. Over this same decade, the number of uninsured Americans rose from 34.7 million to 42.6 million, a 23-percent increase.
Uninsured rates increased even in economic boom times. The nation’s gross domestic product increased by between 3 and 5 percent each year during the 1990’s, while unemployment continually hit new lows and real wages jumped 20 percent. Despite this growth, the number of uninsured Americans increased by nearly 8 million during the decade, with the percentage uninsured increasing from 13.9 to 15.4 percent.
Gains from strong economy are offset by demographic shifts. The vibrant economy of the 1990s increased coverage, but growth in the number of female-headed and non-white households counteracted these gains. The decade saw larger population gains for groups more likely to lack coverage, including workers earning low wages, those with low education levels, blacks, Hispanics, and the unmarried.

Judy B. said...

Heard it on the news this morning. The Amish are going to Mexico for their health care.. What will we out-source next??

Judy B. said...

GAO Report Amplifies the Need for Assured Funding of VA Health Care

INDIANAPOLIS, February 03, 2006 - Veterans have been shortchanged out of more than $4 billion in VA health care through deceptive accounting practices over the past four years, the Government Accountability Office revealed this week.

See the rest of the story at:
http://www.legion.org/?section=pub_relations&subsection=pr_listreleases&content=pr_press_release&id=335

Richard Yarnell said...

If we had a single payer system, funded by both industry and individual taxes, we could put the VA out of business.

It's expertise wouldn't disappear, I'm sure, but there would no longer need to be two separate systems.

Just imagine, vets with acute care requirements would no longer have to wait between 100 and 467 days for an appointment!

ryarnell@iwon.com

Judy B. said...

Nor woould they have to go hundreds of miles for medical care...