Health Insurance Discussion

[SweetGeorgia]

From way back - DownNotOut, I'm not criticizing you for voluntarily self-insuring. Might be the smartest thing to do; we pay for the insurance but still don't have peace of mind. I guess I don't feel very oppressed by the government. It's the corporations that have their boot on MY neck.

As for taxes, I rather like the Fair Tax even though I loathe Neal Boortz. It would be about as progressive as the current system (way better for the people at the very tiptop, but whatever) and MUCH less expensive to administer. I like single-payer for the exact same reason.

Next time you go to the doctor, pay attention to how many women behind the desk have phones to their ears, sitting on hold. There's one to verify coverage, one to get referrals, one to appeal denials, and so on....

[JRScott]

I think voter apathy has more to do with having a First-Past-The-Post (FPTP)/Winner-Take-All system plus wild gerrymandering of districts. A candidate wins with 50.1% of the vote and the other 49.9% feel alienated, especially if there is strong polarization. In a district where say 70% affiliates with one party, the remaining 30% don't feel they ever have a shot winning so why vote at all.

Instant Runoff voting, Single Transferable vote, and MMP (Multi-member Proportional or something like that) moves that debate to the legislative body which actually makes the decisions.

The way it would work would be say Georgia had 9 districts. Ideally you'd use Instant Run-off for those elections but you could use FPTP. If using IR, you would rank the candidates you wanted to win. If you didn't care for any particular candidates, you'd leave them out of the ranking. So if you have 3 candidates running, During the 1st round, the candidate with the fewest votes is eliminated and those ballot's 2nd choice is entered. The winner would then be the one that had the most votes. You could technically get rid of primaries this way. You just have one election. Or the primaries could use this method to pick their 1 candidate then have 1 candidate per party in the general election today.

With MMP this is where it gets interesting. Say you double the seats available to each state. So GA would now have 18. 9 would be elected by district. The remaining 9 would be awarded by party (which you would vote for in addition to the candidate - it doesn't have to be the same as the candidates party though). Lets say the republican candidate won all in all 9 districts. The democrats and libertarians and greens feel pretty left out. If the total of all the votes showed 55% voted for republican and 35% democrat 8% libertarian and 2% Green. Those new 9 seats would come into play. The winners of the districts have guaranteed seats, but the system "tops up" to come closer to the actual party makeup of the vote. So we'd take 55% of 18 which is 10. The Republicans already had 9 seats, so they will get 1 additional. The Democrats get 35% of 18 - which is 6. The Libertarians get 1 (8% of 35). The Greens get none because a party would have to get more than 3% of the vote to be eligible for "topping up". (However, any party that actually won a district seat would be able to keep it). That leaves 1 open seat. It can either be left vacant or filled by the party with the greatest remainder.
Under the current system 100% of the Georgia delegation would be republican. Under MMP, the delegation from Georgia would be 55% republican, 33% democrat and 5% Libertarian. So pretty much everyone partywise is now represented.

Then it's up to those in the house to form coalitions to form majorities. And those coalitions might shift given different topics being discussed.

This would allow everyone to be represented in actually making policy.

Of course that doubles the size of the House of Representatives :-)

Other changes I would also add:

The Reps should not make more than twice the median of their homestate with additional compensation for the difference in housing prices in DC vs their home state and travel expenses.

I'd also want a "Single Subject" rule implemented so that pork barrel stuff can't be tacked on to bills that originally had nothing to o with the original purpose. Possibly, add to that a line item veto for the president.

If there is a public healthcare option, congress and all gov't employees would have to participate.

Any pension benefits would be tied to the number of years served in Congress.

Any travel, especially foreign, would need to be approved by their home state's legislature and/or governor.

While what you cite is part of the problem the majority of the problem is really hand outs from the government such that almost a third of the nation does not pay any income tax and indeed gets what amounts to free money. In order for democracy to work everyone has to feel the pain of taxes, because when we feel pain is the only time we pay attention. That 1/3rd which also has a very poor voting record over the last 3 decades is more than enough to swing any election.

What you suggest actually isn't new.

"Article the first... After the first enumeration required by the first article of the Constitution, there shall be one Representative for every thirty thousand, until the number shall amount to one hundred, after which the proportion shall be so regulated by Congress, that there shall be not less than one hundred Representatives, nor less than one Representative for every forty thousand persons, until the number of Representatives shall amount to two hundred; after which the proportion shall be so regulated by Congress, that there shall not be less than two hundred Representatives, nor more than one Representative for every fifty thousand persons."

That's actually the 1st proposed Amendment to the Constitution, see the bill of rights started out as 12 Amendments not 10, only 10 were ratified at that time. Techinically this Amendment is still pending before the states. 11 States have ratified it (Including the one I live in). If you could get 17 more states to ratify it then it would become law. Unlike modern amendment proposals it never had an expiration date (and this was established by the Supreme Court in 1939)

(The original 2nd Amendment of the Bill of Rights was later ratified and is currently the 27th Amendment).

If passed today you could see a House of Representatives as large as 6000 if you accepted the 1 per 50000 as a minimum. That was the original intent of it, and yes that would make a far better system than we have today.

Another thing that hurts voters is large states. Ideally they should be broken up into smaller states, Texas could do it at anytime they decided to as it was part of the agreement of them joining the Union that they could subdivide into 5 states at any time their Legislature agreed to do so. Other states would be harder to break up, it would require their legislatures as well as the US Congress to approve. But in essence beyond 10-15 electoral votes per state is hurting the voters as you point out because the minority is drowned out by the majority thus skewering things like today where we have uber liberal congress when most americans are just right of center.

How districts are drawn is a matter of problem to. Originally Jefferson envisioned 7 sq mile districts, this was later dropped while the framers were drafting the Constitution in light of the population method. We have districts now that run like snakes over the ground. They were never intended either and are made to solely keep certain members of congress in power.

[OhioFiler]

My thoughts in all this, and how I dragged it out... You eitehr go all the way to socialized medicine, or you leave it as a market-based (cost-per procedure) model (while maybe doing some tort reform).

The problem is, you can't have a semi-public system. We are already seeing the waste, fraud and abuse of the Medicaid and Medicare systems, through overcharging, double billing, and outright fraud. The reason for the abuse of those programs are squarely because of the reimbursement rates as well as the ease of actually doing it.

And it's easy because we have career bureaucrats minding the store. There is nothing more inefficient nor more wasteful than a government operation.

[justbroke]

We live in a free market economy. The market sets the wages. Interference by the government always makes the situation worse. Always.

My thoughts in all this, and how I dragged it out... You eitehr go all the way to socialized medicine, or you leave it as a market-based (cost-per procedure) model (while maybe doing some tort reform).

The problem is, you can't have a semi-public system. We are already seeing the waste, fraud and abuse of the Medicaid and Medicare systems, through overcharging, double billing, and outright fraud. The reason for the abuse of those programs are squarely because of the reimbursement rates as well as the ease of actually doing it.

[OhioFiler]

]I don't know that they deserve to be paid that low[/B]. (Or mechanics make alot more than I think!). European doctors make about 1/2 what US doctors do, but they also don't have that college loan burden as their medical school are paid for by the government. From what I have read that's still in excess of $100K a year. Maybe have some loan forgiveness in exchange for working a certain number of years in rural or less desireable areas would be one of the answers.

We live in a free market economy. The market sets the wages. Interference by the government always makes the situation worse. Always.

[FLBK7]

I don't know that they deserve to be paid that low. (Or mechanics make alot more than I think!). European doctors make about 1/2 what US doctors do, but they also don't have that college loan burden as their medical school are paid for by the government. From what I have read that's still in excess of $100K a year. Maybe have some loan forgiveness in exchange for working a certain number of years in rural or less desireable areas would be one of the answers.

I agree completely. Another option would be to offer full or partial loan forgiveness for those who go into Family Practice, Pediatrics, or Internal Medicine. There's far too much specialization these days and because of the very "system" we have and the fear of litigation, primary care doctors end up referring us to specialists when they could have treated our ills themselves.

[momisery]

The facts are from factcheck.org where they do tell both sides of the issue. We will not be giving healthcare to illegals, but we are right now. They go to the ER's and get their care on our backs. So, that arguments does not float at all. Medicare and works, and it would continue to work if they would not have taken the funds for a war, and give tax breaks to the wealthy. A public option is the only way to get around the profits. Does anyone realize that healthcare costs have risen 50% in a decade, has your income? And over the next year it will go up again 10%. The reasons are more than just costly test, CEO's for BCBS and companies like them keep competition out of their states and the CEO"S are making huge profits doing just that. They deny coverage and the employee who did it makes a bonus. CEO income now are 450 times more than ours, they use to be only 47 times more. We do have corruption in government but for gosh sakes big business is far worse. One look at wall street and the banks, is there any doubt? Medical debt causes more BK's than anything else, it certainly pushed us over the edge. How can an average earner pay in 250.00 per month for coverage and manage to pay at least 4000.00 out of pocket for ONE PERSON< or 9,000.00 for both??? That is 3000.00 plus my 4000.00 or 12000.00 if we are both sick. Of course if your both sick you will miss time and your income will come down even more. Then add on to that my BCBS wonderful MEDCO plan that covers rat tur+s basically. We are paying 120.00 for one medication right now.. crazy. We need watch dogs, and believe me the hospitals can't watch themselves let alone costs, and the insurance companies have no reason to watch a thing. The last time we tried for reform under Clinton healthcare and insurance told us they would be the watchdog, we don't need reform. They did not do that, and they never will. Public option is the best way to circumvent the huge profits needed to provide BCBS with the huge fancy buildings they so richly deserve on the backs of the dying public. 400 people die a day without coverage, and 14,000.00 Americans lose their coverage everyday. IT is coming your way, just a matter of time before you lose yours.

[TooMuchCredit]

I feel that the current system is the main reason we have such voter apathy, to many are being paid to maintain a status quo, everyone needs to feel the pain I feel, even the poor and the rich alike. Only then do we all pay sufficient attention to our government to avoid the slip into tyranny.

I think voter apathy has more to do with having a First-Past-The-Post (FPTP)/Winner-Take-All system plus wild gerrymandering of districts. A candidate wins with 50.1% of the vote and the other 49.9% feel alienated, especially if there is strong polarization. In a district where say 70% affiliates with one party, the remaining 30% don't feel they ever have a shot winning so why vote at all.

Instant Runoff voting, Single Transferable vote, and MMP (Multi-member Proportional or something like that) moves that debate to the legislative body which actually makes the decisions.

The way it would work would be say Georgia had 9 districts. Ideally you'd use Instant Run-off for those elections but you could use FPTP. If using IR, you would rank the candidates you wanted to win. If you didn't care for any particular candidates, you'd leave them out of the ranking. So if you have 3 candidates running, During the 1st round, the candidate with the fewest votes is eliminated and those ballot's 2nd choice is entered. The winner would then be the one that had the most votes. You could technically get rid of primaries this way. You just have one election. Or the primaries could use this method to pick their 1 candidate then have 1 candidate per party in the general election today.

With MMP this is where it gets interesting. Say you double the seats available to each state. So GA would now have 18. 9 would be elected by district. The remaining 9 would be awarded by party (which you would vote for in addition to the candidate - it doesn't have to be the same as the candidates party though). Lets say the republican candidate won all in all 9 districts. The democrats and libertarians and greens feel pretty left out. If the total of all the votes showed 55% voted for republican and 35% democrat 8% libertarian and 2% Green. Those new 9 seats would come into play. The winners of the districts have guaranteed seats, but the system "tops up" to come closer to the actual party makeup of the vote. So we'd take 55% of 18 which is 10. The Republicans already had 9 seats, so they will get 1 additional. The Democrats get 35% of 18 - which is 6. The Libertarians get 1 (8% of 35). The Greens get none because a party would have to get more than 3% of the vote to be eligible for "topping up". (However, any party that actually won a district seat would be able to keep it). That leaves 1 open seat. It can either be left vacant or filled by the party with the greatest remainder.
Under the current system 100% of the Georgia delegation would be republican. Under MMP, the delegation from Georgia would be 55% republican, 33% democrat and 5% Libertarian. So pretty much everyone partywise is now represented.

Then it's up to those in the house to form coalitions to form majorities. And those coalitions might shift given different topics being discussed.

This would allow everyone to be represented in actually making policy.

Of course that doubles the size of the House of Representatives :-)

Other changes I would also add:

The Reps should not make more than twice the median of their homestate with additional compensation for the difference in housing prices in DC vs their home state and travel expenses.

I'd also want a "Single Subject" rule implemented so that pork barrel stuff can't be tacked on to bills that originally had nothing to o with the original purpose. Possibly, add to that a line item veto for the president.

If there is a public healthcare option, congress and all gov't employees would have to participate.

Any pension benefits would be tied to the number of years served in Congress.

Any travel, especially foreign, would need to be approved by their home state's legislature and/or governor.

[TooMuchCredit]

It's easy. Federalize the hospitals and have doctors on salary making what an average mechanic makes. That's how you solve that. But first, you'd have to reduce the costs of premium medical degrees from places like Harvard, Brown, Yale... because you can't get out of medical school and have $400K in debt (like TeacherMomma), working for $20-30 an hour. Just won't work.

The issue I have is, this new plan is not socialized medicine, doesn't address the root cause of costs (litigation, cost-per-procedure, insurance, overhead), and doesn't go far enough. It will be another Medicare Prescription Drug Benefit program.

They just want to slam something in, that would, in and of itself, need a major overhaul in 5-10 years.

I don't know that they deserve to be paid that low. (Or mechanics make alot more than I think!). European doctors make about 1/2 what US doctors do, but they also don't have that college loan burden as their medical school are paid for by the government. From what I have read that's still in excess of $100K a year. Maybe have some loan forgiveness in exchange for working a certain number of years in rural or less desireable areas would be one of the answers.

[justbroke]

I don't get these cost estimates that it will cost us more than what we are paying now. We already pay 50% more than the next highest country (Switzerland), yet every other country manages to cover everyone for less per capita.

It's easy. Federalize the hospitals and have doctors on salary making what an average mechanic makes. That's how you solve that. But first, you'd have to reduce the costs of premium medical degrees from places like Harvard, Brown, Yale... because you can't get out of medical school and have $400K in debt (like TeacherMomma), working for $20-30 an hour. Just won't work.

The issue I have is, this new plan is not socialized medicine, doesn't address the root cause of costs (litigation, cost-per-procedure, insurance, overhead), and doesn't go far enough. It will be another Medicare Prescription Drug Benefit program.

They just want to slam something in, that would, in and of itself, need a major overhaul in 5-10 years.

[TooMuchCredit]

I don't get these cost estimates that it will cost us more than what we are paying now. We already pay 50% more than the next highest country (Switzerland), yet every other country manages to cover everyone for less per capita.

We certainly are wasting something significant somewhere if we can't cover everyone at what we are paying per capita today. And before one goes and says it's all medicare waste, their overhead is 3% whereas insurance companies is 17-20%. So is all that extra money we pay per person going into the pockets of insurance companies, hospital companies, etc? Are they not taking into account the folks that do go to the public option would SHIFT their contributions from private insurance to public essentially negating that added cost?

If we expanded medicare to all, yes medicare's budget would grow significantly, but there would be nothing going to insurance companies so it would just shift money, not be an added cost.

[JRScott]

I feel that the current system is the main reason we have such voter apathy, to many are being paid to maintain a status quo, everyone needs to feel the pain I feel, even the poor and the rich alike. Only then do we all pay sufficient attention to our government to avoid the slip into tyranny.

[justbroke]

Instead institute a 6% national sales tax that applies to all goods and services including stocks, dividends, etc. You'd in essence make about oh around 7-8 trillion a year. (Twice the current proposed budget).

I didn't go directly there, but I am absolutely for a consumption-based tax system. If you have no money, you don't spend, so you don't get taxed. You have lots of money, you spend alot, you pay lots of tax.

However Congress isn't willing to do that even though it would provide tax relief to all Americans, would shift the burden to the rich who spend more money, force wall street to repay the loans we gave them, etc.

Some of the costs saved just by reducing the size of Revenue departments in the Federal and State governments alone, would be enormous. The problem is, that the perception will be that the Rich only pay the 6% VAT. Unfortunately, most people who complain that they are overtaxed, have no idea how the tax system works (and yes, I said most, not all). Especially those in the lower tax brackets (and the negative tax brackets). The lower 50% have been taught that they are entitled to receive money they didn't earn. While it's commendable to spread wealth, in the end, this is all about getting re-elected and building that war chest.

The reason is because it's easy to create class-warfare by telling everyone that the Rich only pay 35% of their income in taxes, and have all these wonderful deductions available. What they don't say, is that the top 5% pays more than 60% of all taxes. The bottom 50% pays 2% of all taxes but make up 1/7th or about 14% of all income earned.

Yet, it's all the rich people's fault. (Okay, maybe I take this too much to heart, as I've been in the top 2% of earners for over 10 years... but I'm filing bankruptcy too! And it's not because I have jet skis, a powerboat, a Lexus, a Hummer, or even multiple SUVs in the driveway.)

[JRScott]

Well justbroke we don't have the money to pay current expenses more less a National Health Care. Also the CBO numbers being used are low. Total cost to cover everyone in the United States in a Medicare style system would top 3 trillion a year. They are hoping that companies don't dump their health care programs if this passes, but in truth many probably will especially if the 8% tax is cheaper than their current health care.

So worst case scenario about 3 trillion a year. Best case scenario about 1 trillion over 10 years (lol).

Tax Reform is what they really needed to have tackled first.

The current corporate and personal income taxes are a convuluted mess. They are that way because of lobbyist and congressman looking out for war chests more than the people. You see I could tell you how to really afford it for everyone even though I oppose it because I feel National Health Care is beyond the mandate of the Congress (I am not opposed to Congress attempting to amend the Constitution to give themselves the right if the states approve incidentally).

Remove the current taxes. Everything. Income (personal and corporate), estate, gasoline, all federal taxes.

Instead institute a 6% national sales tax that applies to all goods and services including stocks, dividends, etc. You'd in essence make about oh around 7-8 trillion a year. (Twice the current proposed budget).

However Congress isn't willing to do that even though it would provide tax relief to all Americans, would shift the burden to the rich who spend more money, force wall street to repay the loans we gave them, etc. They won't do it because you can't manipulate such a system, you can't have all those discriminatory exceptions the current code has that really should be against the anti-discrimination laws of the nation.

[justbroke]

There was actually a really good and unbiased report on the Czech medical system. It's single-payer and everyone has it. They go to the doctor 10-15 times a year on AVERAGE. (In the U.S., we go less than 5 times a year.) The reason their healthcare system has been okay, is that they actually had reserves from when the economy was good. The system is 75% paid for through taxes and 25% through employers. This was one of the "model" systems that we keep using as a benchmark for how we should do it...

Now their system is about to collapse. They don't have the revenues to pay for it. The reserves have kept them running, but that's running out (sound familiar? medicare/medicaid?).

Seems like we are basing our new system on that model. The hospitals are all government owned, but there are private physicians (with offices). The hospitals are staffed with government salaried medical staff that are underpaid. The incentive was that the more staff a hospital had (and more beds), the more money the hospital itself got. So they grew and grew and grew and have too much staff now.

The other problem is that private insurance providers exits, and get to bill the government, but they are not for profit. They can only make 3-5% profit to cover overhead.

Did I mention that the system is collapsing?

I just don't have the answer. The reason I don't have the answer is because I think what's about to happen is exactly what happened with the Prescription Drug Benefit Program for Medicare. While it was the right thing, it wasn't thought through. In the end, that program is costing way too much because it was rushed through.

The change is necessary. I still don't see where the actual costs are being addressed at all by any bill in the Pelosi's, the Senate's, or the President's version. They are in for a serious uncontrolled costs problems. Only the collective they, won't be around when it comes crashing down.