From www.economist.com

Quote :

"From July 2007 every [Massachusetts] resident must have health insurance, or face a $1,000 fine. People with incomes up to three times the federal poverty threshold (almost $60,000 for a family of four) will get subsidies to buy insurance. Firms with more than ten workers must offer employees a health plan or pay the state a “contribution” of up to $295 per employee."

So the question is, other than, "is this even remotely Constitutional", could universal health care be a lever by which the government can impact the decisions you make on a daily basis; ie. diet, recreational habits, activities, mandating universal mandatory drug testing, etc? Since one’s health care costs are roughly determined by a statistical analysis of one’s activities, will prohibitively high (but mandatory) health care costs force people out of activities they currently enjoy or will those activities simply be prohibited to those for whom the government covers the cost, even if it is against their will?

Discuss

1/19/2007 10:55:00 AM

Quote :

"Since one’s health care costs are roughly determined by a statistical analysis of one’s activities"

the reason health care costs are so high for people with higher risk is because statistically the people that are looking for health insurance are the people who need it the most. there is a great deal of risk to the health insurance program, they have to protect themselves. by requiring everyone to have healthcare you greatly reduce the risk to the insurance companies so the prohibitive prices for these at risk activities will drop.

1/19/2007 11:03:24 AM

I don't understand what you are asking. Of course it is constitutional, unless there is a provision in the Massachusetts Constitution I am unaware of.

I find it very unusual to me that no state has tried to adopt universal health care before now. I guess those that believe we should adopt universal health care also believe everything should be done at the federal level and those that believe it would only be constitutional to do it at the state level don't want universal health care. Any other ideas?

As for the "mandatory insurance" line, I don't think it is a good idea. It doesn't fix the innate incentive problem. All decisions about treatment are being made by patients and doctors, so both decision makers benefit from any treatments (one gets paid the other gets treated) and neither pays the costs. At least with state run health care the doctor's boss would be worrying about costs.

1/19/2007 11:08:10 AM

Could you post a link to the actual article?

Reading just this little bit is hurting my head.

1/19/2007 11:20:02 AM

http://www.economist.com I believe has paid subscription.

1/19/2007 11:23:06 AM

^ it does, and I apologize for not being able to post the whole thing. If you want to pay the fee, or have a subscription the link is here: http://tinyurl.com/2p95pe My question was based less on the article as a whole and more on that specific blub, I was just crediting the Economist for its article.

Anyway to rephrase with an example. Everyone knows that there is no nation-wide drinking age, yet the universal drinking age is 21 because the Federal Government demands that each state set it as such or lose federal funding. Universal health care could possibly make this more expansive. For the right, it could use (IMO flawed) statistical analysis showing that there is a correlation between guns in homes and crime, thus demanding an extra premium for gun ownership. For the left, it could point to the perception (accurate or not) that gay men are notoriously promiscuous and thus demand an extra premium for homosexuality. These are both hyperbole, but I use them to illustrate my point and my question, could the governtment use this as a lever? Or, more accurately, could special interest groups use this as a lever through legislation?

Quote :

"by requiring everyone to have healthcare you greatly reduce the risk to the insurance companies so the prohibitive prices for these at risk activities will drop."

True to a point, (for example the auto insurance industry), but by making it mandatory you skew market forces. The auto insurance comparison also loses some traction due to its relatively narrow scope compared to "health".

Anyway, I'm less posing a specific question than picking TWW's collective brain. I don't personally have my own mind made up on this.

/words

1/19/2007 11:47:24 AM

Gee, it sounds like a wonderful idea. Give the government more power, they're doing such a wonderful job as it stands. Personal responsibility, freedom, individuality, forget that I want to be part of the hive.

1/19/2007 5:24:30 PM

Good point.

This should be an issue of the states, a moral issue dealing with the well-being of the population. This proposal should not be seen as "single-provider" and instead "single-payer" with regards to insurance. From a proposal for single-payer insurance made by an advocacy group in Connecticut:

Quote :

" 5. Myth Four: Universal Health Care Would Result In Government Control And Intrusion Into Health Care Resulting In Loss Of Freedom Of Choice * Fact One: There would be free choice of health care providers under a single payer universal health care system, unlike our current managed care system in which people are forced to see providers on the insurer’s panel to obtain medical benefits * Fact Two: There would be no management of care under a single payer, universal health care system unlike the current managed care system which mandates insurer preapproval for services thus undercutting patient confidentiality and taking health care decisions away from the health care provider and consumer * Fact Three: Although health care providers fees would be set as they are currently in 90% of cases, providers would have a means of negotiating fees unlike the current managed care system in which they are set in corporate board rooms with profits, not patient care, in mind * Fact Four: Taxes, fees and benefits would be decided by the insurer which would be under the control of a diverse board representing consumers, providers, business and government. It would not be a government controlled system, although the government would have to approve the taxes. The system would be run by a public trust, not the government."

http://cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm

Locally administered urgent care, or the creation of a greater number of preventative care centers, particularly ones either funded by local tax dollars (approved by local voters) or driven by tax incentives to private centers are another option I've toyed with the idea of.

[Edited on January 20, 2007 at 12:40 AM. Reason : .]

1/20/2007 12:37:02 AM

single payer systems are something different

and bad

1/20/2007 12:39:20 AM

If a two-tier system is still allowed (unlike in Canada, well, de jure anyway), and the hospitals remain private (unlike the NHS in Britain), then I suppose you could be objecting to the idea of your taxes going to pay for other's insurance....

tough, that's how i roll.

I suggest reading up on the systems in Asia (Japan, Taiwan), for one, and if you really want to bite the bullet, France (WHO ranked #1)

http://www.photius.com/rankings/healthranks.html

We do have a very responsive system, but you'll notice it's ranked similarly with the other industrial nations. This is more due to availability of resources than anything.

[Edited on January 20, 2007 at 12:50 AM. Reason : .]

1/20/2007 12:45:05 AM

Government run healthcare... good idea. Did wonders during Katrina, now invite the govt to control your healthcare. Health care is an easy fix, you simply make health ins companies non-profit, so every dollar you pay a large portion goes towards healthcare, not real estate investment. The problem is lobbying bodies control govt. You can get everyone in NC to sign a petition to do just that, it takes one drug company to sign a check to mute us all out.

I have a unique perspective of seeing our reimbursement from ins. companies/medicare decrease 3%, while our premiums for our employees rose 13%. You want to know who is getting rich in healthcare..its the ins companies.

There are two canadian doctors that moved down and work in our local hospital. They talk about the nightmare. You will be told what drugs to use and put on a waitlist for alot of elective surgeries. They cannot get doctors in canada and thier tech. is pretty poor. In addition they have a 60% tax bracket. Yes, this all sounds wonderful to me. We already have a doctor shortage in this country due from limiting your income with increased liabilities. Dont believe me, grab a phone book, esp for a rural area and look at the names, and compare it to 10 years ago. Its americas dirty little secret.

There are people today who work just to get healthcare benefits. I see them all the time. There are people who work whose small company simply cannot provide healthcare or some shit plan for emergencies. This is the problem. Meanwhile we have millions of americans who CHOOSE to do nothing getting the greatest plan on earth..medicaid. pay nothing, eligible for everything, well most things. Take care of our workers first, then the trash. IF we provide "free" healthcare for all, you will take away the only incentive some people have to work. Look at the unemployment rates that have universal healthcare.

1/24/2007 9:20:11 PM

Quote :

"Government run healthcare... good idea. Did wonders during Katrina, now invite the govt to control your healthcare. Health care is an easy fix, you simply make health ins companies non-profit"

haha, you must not know anything about large non-profits

1/24/2007 9:25:09 PM

Of course money is always lost in large "administration costs". However, BC/BS of NC cant raise my premiums, cut remeimbursement citing they are losing money, then post a 34 Million dollar quarterly profit if they are a non-profit organization. Wow, longest run-on sentence in history.

1/24/2007 9:28:39 PM

so if those things were the magic bullet, you could legislate that much easier than a complete industry restructuring and non-profit bureaucracy

[Edited on January 24, 2007 at 9:32 PM. Reason : and insurance companies probably only have a few percent profit margins]

1/24/2007 9:30:34 PM

They are not a magic bullet because the small semblance of competition that we have right now would disappear.

1/24/2007 9:32:59 PM

I agree guth.

Competition? Medicare sets the bar, the insurance companies start cutting there. There is no competition.

What happens with a middle man? well try 10 middle men. THe cost goes up. In my short time working, I have seen Ins companies practicing law without a license, directly and indirectly. The insurance company has a drug panel of covered drugs, and they are ALL different. So the drug that the doctor prescribes is simply not covered, but the drug with 90% resistance is covered bc it only cost 2 bucks to them, but its in your 15 dollar tier. I get called 3 times a day from a patient at the pharmacy asking if there is anything else I can perscribe because the first drug isnt covered. Works best for the ins. company, is a pain in my ass, but the patient suffers most. Directly, I have seen my patients and my family get a letter from an INSURANCE company telling them that THEY are concerned about dependancy with the drug the DOCTOR as perscribed and that they will only cover HALF the amount of the PRESCRIBED dosage, and then RECOMMEND something OTC(over the counter) to take instead. Im sorry this shit pisses me off. Let me worry about what I prescribed, not some accountant in new hampshire making those decisions.

The real problem with healthcare is people. People hate to pay for things they need, but expect the best and quickly. People complian about a 40 dollar drug that keeps them from stroking, but will gladly spend 400 dollars to keep thier teeth white. Its amazing. There is a growing idea that healthcare is a right. Well I ask where does it end? Our office is no different than a hardware store. We have rent, overhead, staff, and goods. Yes we provide a service, but we have expenses. Someone has to pay to keep those doors open.

I enjoy the discussion on here. Feel free to ask some questions. I know I was very naive about alot of things when I was younger. Im not here to try to change your mind, just give you a different perspective.

1/24/2007 9:46:45 PM

1. Single payer doesnt mean single provider. The gov. doesnt have to own all the hospitals like the NHS does.
2.

Quote :

". IF we provide "free" healthcare for all, you will take away the only incentive some people have to work. Look at the unemployment rates that have universal healthcare."

You mean like Australia (4.9%), Canada (6.4%, much higher than it has been in the past decades under the same system), Denmark (4.5%), Ireland (4.3%), Japan (4.1%, and an economic powerhouse), The Netherlands (5.5%), Norway (3.5%), South Korea (3.6%), Sweden (5.6%), Taiwan (3.6%), and the UK (5.4%)?

Quality of care under universal systems, as I already stated, is quite high according to the WHO.

Why do other countries with universal plans, like Germany, Italy, and France have higher unemployment rates? Restrictive labor laws, it's impossible to fire someone, for one.

A high degree of individual economic freedom can surely exist alongside these programs, check out Ireland, the UK, Australia, the Scandinavian countries, Germany, Japan, South Korea, and Taiwan:
http://www.heritage.org/research/features/index/countries.cfm

Now, many of these countries have much smaller populations and are thus more able to be responsive to the needs of their populations. This is why it would be best for any program to be implemented at the most local level possible. I guess I'm one of those few LoneSnark is talking about that want to see it as a local/state initiative, and preferably as single-payer to ensure better localized, private control of facilities. National welfare programs typically become unresponsive. Universal healthcare should be the minimum of welfare we should be providing to people, not blank checks like we have been doing. Without health, what is the point of having anything else in your life?

There are, of course, other options to ensure some sort of health coverage for all. Say, free preventative care at urgent-care style clinics. Perhaps tax incentives to private urgent care preventative cos. to ensure that costs remain low.

[Edited on January 24, 2007 at 9:50 PM. Reason : .]

1/24/2007 9:46:50 PM

prawn, I agree. The best thing would be to keep the govt as far away from healthcare as possible. Name one thing the govt manages well? NASA?

1/24/2007 9:48:02 PM

Quote :

"I agree guth. "

you agree to the situation of legislating those things, and then say this:

Quote :

"prawn, I agree. The best thing would be to keep the govt as far away from healthcare as possible."

1/24/2007 9:54:31 PM

guth, the govt will never get out of healthcare. Once it starts something it cant take it away. The medicare drug plan is another bad idea. However, I feel, that simply making health ins. companies non-profit, it will result in more money being actually spent on healthcare. Think about it. The financial plan of an ins. company is to take your money in, and pay out as little as possible. Just like homeowners in NO. Yes your house is gone, but you have flood ins. I estimate that 80% of your home was damaged by wind.. or vice versa.

This is a very good link, showing the positives and negatives of the system. Forgive me I dont know how to link

http://www.balancedpolitics.org/universal_health_care.htm

1/24/2007 10:04:37 PM

you could legislate regulations much easier than making the industry non-profit
when i said this you agreed with that situation, then said the government should get involved, then said something about non-profit again. I am thinking that maybe you arent understanding me.

1/24/2007 10:07:16 PM

Link about the Canadian govt being out of touch with healthcare needs, and needing find find doctors.

http://www.cbc.ca/news/story/2000/12/08/mb_clinic120800.html

Here is why there is a doctor shortage. Surprise doctors arent making money so there is a shortage.

http://www.caribbeanmedicine.com/article9.htm

And the solution? Foreign doctors and streamline med school. (which will be offered at community colleges?)

http://www.caribbeanmedicine.com/article26.htm

1/24/2007 10:14:04 PM

of course, that all has to do with single-provider systems, which i've said a few times now is not necessary.

[Edited on January 24, 2007 at 10:18 PM. Reason : .]

1/24/2007 10:17:39 PM

I might not be guth. Arnold recently proposed a healthcare system for Cali. The only thing I agree with is mandating that 85% of ins money has to be spent on heathcare. But I really disagree with taxing providers to pay for it. Once you take profit out of something, its dries up and gets worse.

Hillary did this already with flu vaccines, now we depend on foreign vaccines and face shortages. I just dont see this being a good idea. We are already forcing people away from medicine, this will all but close the door.

1/24/2007 10:17:50 PM

none of those say anything about how non-profit status would help, and the last example is in a country where the government is involved

and really none of this addresses my confusion, which was about agreeing with me and then saying the government shouldnt get involved.

Quote :

"Once you take profit out of something, its dries up and gets worse."

wait... what? didnt you just propose making it non-profit? im so confused

[Edited on January 24, 2007 at 10:19 PM. Reason : .]

1/24/2007 10:18:17 PM

guth, I feel non-profits are the key, but you dont hear much talk about them. Some companies offer these plans.

My point about profit, which you pointed out and looks bad, is you NEED your doctor not your health ins company. The way it is now, the insurance company is making the most profits and squeezing out physicians. Doctors, researchers, and even, gasp, drug companies are needed and need to be compensated to encourage people to enter such fields. Did that clarify it or are we still missing eachother?

Here is a link from a doctor at harvard. I disagree with some of he said, but its a different opinion.
http://www.medonline.com.br/med_ed/med10/profits.htm

1/24/2007 10:44:13 PM

provide some information about health inurance profit margins. i bet none of them are more than a few percent.

1/24/2007 10:48:11 PM

http://www.weissratings.com/News/Ins_HMO/20051024hmo.htm

2005 best I could do quickly

1/24/2007 10:53:11 PM

jumped 52% in 9months in 2004

http://www.marketwatch.com/News/Story/Story.aspx?guid=%7B04A2FC4E-12BE-4E77-B497-72D80479CDB8%7D&siteid=google&dist=google

I dont know if 2006 data will be out yet.

1/24/2007 10:56:12 PM

so it is just a few percent and the rate of increase is tapering off. and you think this is the cause of all of the problems? healthcare costs were still expensive in 2001 when profit margins waveraged 1.1%. how exactly is cutting profit going to help things?

1/24/2007 11:14:06 PM

haha, i think you misread it. Oh and per quarter. Yes, I do feel this is a problem. Bc that is basically showing you the shift of people paying their doctor to now paying thier insurance company and showing how much PROFIT they keep.

WellCare of New York -- profit up 32,575 percent to $3.89 million, up from $11,900.
Aetna Healthcare of Texas -- a 9,724 percent jump to $46 million, up from $468,792.
Kaiser Foundation Health Plan of Ohio -- an increase of 3,467 percent to $25 million, up from $701,392.
Health Plus of Michigan -- a jump of 2,434 percent to $5.5 million, up from $220,235.
HMO Health Plans of Colorado -- profit rose 2,295 percent to $828,974, up from $34,600

"The nation's HMOs1 reported a $3.6 billion profit for the first three months"

Billion with a B. Meaning they took in 3.6 BILLION dollars more than they spent..in oh 3 months. To me thats a problem. Meanwhile I get a fee reduction due to lack of funds. Its laughable.

Good discussion. Ill have to continue it tommorrow.

1/24/2007 11:20:42 PM

i dont think i misread anything:

Quote :

"The industry profit margin registered only a slight improvement with a rise to 4.6 percent in the first quarter 2005 compared to 4.2 percent in the first quarter 2004. Profit margins in the first quarter of previous years were 3.5 in 2003, 2.4 in 2002, and 1.1 in 2001 The slowdown of both profit margins and net income is illustrated in the following graph:"

http://www.weissratings.com/News/Ins_HMO/20051024hmo.htm

Quote :

"Oh and per quarter"

haha do you think you have to multiply the quarterly profit margin by 4 to get the annual? unless something drastic changes in the year its going to be about the same.

1/24/2007 11:25:21 PM

what i see is 3.6 Billion dollars in 3 months that arent being spent on healthcare. I also see rising cost of healthcare with rising profits for these ins. companies.

What do you feel is a solution goth? To me, prices only increase with the middle man, and I think this case is no different.

1/24/2007 11:31:16 PM

$3.6B is less than 5%
even if you consider health care a commodity thats not high

1/24/2007 11:40:59 PM

Quote :

"Locally administered urgent care, or the creation of a greater number of preventative care centers, particularly ones either funded by local tax dollars (approved by local voters) or driven by tax incentives to private centers are another option I've toyed with the idea of."

the major cost of health insurance is not urgent care. It arrives from people not having general care physicians. If people could go to a general practioner for preventative care the burden on emergency rooms and urgent care places would diminish and the costs would decrease.

1/25/2007 1:10:38 AM

well, primarily what i was getting at was that we should promote preventative public health and healthy lifestyles through incentives. i have no idea what the best way to do that would be.

1/25/2007 1:58:00 AM

have different helath problmes then alot of those coutnires you list, and frankly we have LOTS more people and Lots more poor.

1/25/2007 6:35:28 AM

I guess you missed the part where I said our system will have to be unique in that it exists primarily at the state level.

And are we supposed to just accept the fact that we have health problems here and not work together and as individuals to fix them?

I assume you were drunk when you typed that sentence? It's sorta...out there.

[Edited on January 25, 2007 at 10:21 AM. Reason : .]

1/25/2007 10:20:20 AM

making health insurance companies non-profit isn't the answer - as has been shown here, the margin isn't so enormous that we're all just throwing money into their pockets. the solution is single payer (not single provider)... the reason: administrative costs...

now i know we all have the notion that the fed. gov. is a huge beauracracy that wastes money on shuffling paper, but at least in the case of healthcare coverage, they seem to have it down. Administrative/overhead costs of Medicare consume about 2% of the overall budget. By comparison, these administrative costs for the private health insurance industry averages around 17% .. ... so our healthcare costs as a nation could be as much as 15% lower under single payer.
(Clemmitt, Marcia. "Rising Health Costs". The CQ Researcher. April 7 2006, vol 16, number 13... need subscription or library access )

by the way - bush's comments on incentives for health insurance are ridiculous.. if the gov't is going to be (essentially) subsidizing private health insurance companies with tax incentives for people to buy in the insurance, then the gov't should just take over... the free market is not at work, and can not work in this industry.

1/25/2007 2:03:10 PM

Administrative costs of Medicare / Medicaid belong to the hospital systems. Medicare/aid just send money to the hospital once a week based on patient load. As far as I know (I work for a hospital, not in the hospital) the system does not function at all like a private insurer.

That being said, I wish that I could say that the market will determine who buys insurance and keep prices reined in naturally, but I guess insurance is pretty inelastic. I still do not want to see the government running healthcare.

1/26/2007 12:37:32 PM

The best thing would be let the govt sit this one out. In away we already have universal healthcare. If you are poor or old the govt pays for your healthcare. If you are working and dont have insurance and need a procedure you go to the hospital...never pay your bill, and taxpayers help cover that cost. So basically, in a Universal system, whoever is paying for healthcare now, will simply pay more, mostly in taxes.

If we could do away with govt issurance doctors would not have the NEED to raise prices across the board. The only competition for most doctors is with insurance companies. Doctors that specialize in elective procedures do face competition from other doctors, thats why you have seen the prices for some procedures to fall...like LASIK, mainly bc insurance doesnt cover it. Technology, standard of care, and lawsuits/defensive medicine are also great factors for the increases.

I pay close to 2k a year in medicare taxes and 500 a month for insurance for my wife and I. So that roughly 8k a year towards "health ins.". If I could put that amount in a HSA and draw interest I would have roughly(starting around age 25) 2.2 Million dollars at age 65. Of course the catch is, you are screwed if you get into an accident at age 27.

Oh and I wont argue over a percentage, but amazingly our corporation shows around a 1% profit most years on paper. You have to look at the numbers, not a percentage.

1/26/2007 10:01:31 PM

The best way to lower costs in healthcare is to force insurance companies to open up their books and justify their prices and policies.

But good luck with that.

As someone alluded to before, they'd rather keep investing in Indonesian junk bonds.

1/27/2007 2:58:09 PM

bttt by request

3/17/2008 2:56:33 PM

if you want your health care run like the DMV, vote Obama or Hillary 08.

3/17/2008 7:49:02 PM

Quote :

""is this even remotely Constitutional""

I don't think so.

Health care is not a right.

The rights set out by our forefathers are rights to actions like the pursuit of happiness. I don't think the original concept of "rights" included rewards from other people, nor do I think this is morally correct.

"But nobody has the right to the services of any professional individual or group simply because he wants them and desperately needs them. The very fact that he needs these services so desperately is the proof that he had better respect the freedom, the integrity, and the rights of the people who provide them.

You have a right to work, not to rob others of the fruits of their work, not to turn others into sacrificial, rightless animals laboring to fulfill your needs. "

3/17/2008 8:39:49 PM

Quote :

"life, liberty, and the pursuit of happiness"

3/17/2008 9:02:50 PM

Everyone who wants Teddy Kennedy, John Kerry, and Nancy Pelosi making decisions on your health-care..raise your hands!

3/17/2008 9:08:07 PM

you're sort of screwed either way on this one. but i tend to think that a company looking for profit and any way to get out of treating me is worse than a gov't that is not profit-driven. sure both are trying to reduce costs. but there would naturally have to be more transparency and culpability if there were a single payer system.

[Edited on March 17, 2008 at 9:14 PM. Reason : .]

3/17/2008 9:13:46 PM

I think Former 1972 Democratic Presidential Candidate George McGovern has some prudent concerns:

Quote :

"Health-care paternalism creates another problem that's rarely mentioned: Many people can't afford the gold-plated health plans that are the only options available in their states. Buying health insurance on the Internet and across state lines, where less expensive plans may be available, is prohibited by many state insurance commissions. Despite being able to buy car or home insurance with a mouse click, some state governments require their approved plans for purchase or none at all. It's as if states dictated that you had to buy a Mercedes or no car at all."

http://online.wsj.com/article/SB120485275086518279.html?mod=opinion_main_commentaries

That being said, I'm no libertarian. I think the government should play an active role in getting health care to our poorest Americans. However, I'm still unsure on what the precise role should be.

3/17/2008 9:46:19 PM

Yeah.

I'm stumped, too.

I've studied Medicare and Medicaid for insurance licenses. I've worked in the financial industry. And I've got family that work in medicine. I wish all that counted for something in the solutions department.

While stumped and sickened at the very words, I'm reasonably sure more government is involved the solution. Why? Because they're the only ones who can be forced into it.

The system we have now is the result of a failure of duty on the part of both institutions: government and corporate.

The fact is that nobody wants to pay for medical expenses.

1) Not you. That's why you buy insurance...
2) Not your doctor. That's why he bills you and your insurance...
3) Not your insurance company. That's why they stiff you as much as they can as often as they can, resulting in foreclosures and other loan defaults when you can't pay for it yourself, leaving you on Medicaid....
4) Not the government. Because why?

Well...because then we're back to (1), making you pay for it again.

That's why I'm constantly forced into playing both sides of this issue.

Free marketers a simple question: What incentives do health insurance companies have to expand into the too-rich-for-Medicaid (i.e. $2000< in total assets) but too-poor-for-private insurance market? It's gotta be low margin and a claim-heavy market.

Lefties, another: Within the present financial order, how do you propose to pay for any system expanding the role of the federal government to cover everyone?

[Edited on March 17, 2008 at 10:41 PM. Reason : ...]

3/17/2008 10:23:26 PM