Comments

Submitted by Anonymous N : November 9, 4:22pm

What people don't realize is that we are ALREADY paying for universal healthcare, we're just paying for it through the most expensive and inefficient delivery channels.

No one is turned away from an emergency room, legal citizen or illegal alien. That's where uninsured patients with a cut or a fever or some other problem that could have been handled through an office visit, end up going. Often the problems are more severe because the uninsured do not get preventative care, and wait to see a doctor when an insured patient would have gone in immediately. Those costs then get baked back into the hospital's cost base that's charged to insured patients. Insured patients pay for that care and those writeoffs.

It doesn't bother me at all that we are an advanced enough society that we don't withhold health care when someone is in an extreme need. Compassion is the surest measure of a country's advancement.

It does bother me that we somehow don't have a citizenry savvy enough to realize that the proposals out there will not be creating new demand, they're re-channeling it to more efficient and lower cost channels, with more timely care and therefore better overall costs. To be personal about it - I know that I already pay for universal health care. Since I'm having to pay anyhow, I want to be paying for a better outcome, at a lower cost, through a more appropriate channel. My taxes may go up, but without the same rate of chargeoffs, my healthcare costs should go down.

Submitted by Jonathon Z : September 28, 4:49pm

Looking at the census figures presented by FactZ, above, the present Baucus bill in the Senate is sheer madness; it is going to please no one.

Peeling away the non-useful numbers it is plain to see that of the 45M uninsured, millions have no interest in insurance even if it is free.

Then you get down to the core group that "wants" insurance; I want many things I don't have because I am not willing or able to pay for them.

How many of these millions who "want" the insurance want a government mandate that they now spend $1,000 per month on premiums because of their wanting? Do they still want now? I bet not.

Then you have the 87.7% (or whatever it is), including me, that have insurance (not Cadillac insurance) and are positive that this "reform" will result, for us, in a serious decline in the quality of care and success of outcomes from the present situation.

This Baucus health care bill is patently feeble from the ground up.

What about the unemployed? The latest "Employment Situation Summary" from the Bureau of Labor Statistics says 14.9M unemployed as of 8/31, plus 9.1M part time for economic reasons, plus 2.3M marginally attached (unemployed, but not included in the unemployment figures because they did not look for work in the last four weeks).

That's around, what, 25M people and all the business journals and even the Fed Chairman Bernanke say this is a jobless recovery and it may be years before most of these people find adequate employment and many may never.

How about if the government helps the private sector (tax cuts, anyone?) get these people back to work and cleans up it's own act before sticking it's nose into the 17% of the economy that remains viable?

Submitted by Nelson T : September 28, 6:22am

All the persons providing comments herein seem to want a health care system that is "perfect" in every way for every individual in the country without regard to citizenship, age, health status, employment status, ethics, morality, etc. There is no health care system in any country that can provide this at a cost that pleases everyone!

Some things that would help:

1. Allow private industry to work - it has done well for over 200 years in the US. Government has not done well. Government has no profit incentive, so cost reduction is an unknown concept there. This has lead to an over bloated organization that is BANKRUPT!

2. More than 40 % of the health care cost in the US is paid by taxpayers through government programs such as Medicare, Medicaid, VA, etc. and the delivery system is grosly inefficient.

3. Stop paying individuals to sit home and not work! Our current welfare system provides more financial benefit to an individual who choses not to work than he/she could earn by working a minimum wage job. The excuse "there are no jobs available" is not valid,otherwise we would not have more than 12 million illegals crossing the border to take the jobs our citizens won't accept.

4. Stop the frivilouos law suits with multi-million settlements. All of this cash payout is charged back in the price of the services provided. The provider; doctor, hospital, drug manufacturer, etc. must buy insurance to protect themselves from the frivilous law suits. To recup the cost, the price of the office call or other service is raised.
Place a cap on settlement to the actual loss.

5. Stop using tax payer dollars to support those who are in the country illegally. Giving food, clothing, shelter, education, transportation, heathcare, language accomodation, etc. is a burden taxpayers should not be required to pay. These illegals are in violation of law and should be treated as such. That would include children born in the US to illegals.

6. Make substantial reductions in the size of government. Taxpayers are paying trillions for government programs which provide no benefit to anyone. Our president proposes some method of evaluating health care and refusing to pay for services deemed non beneficial. Why not start with the government?

Enforce laws or enact laws to prohibit "price fixing". It is illegal for companies to conspire to set prices for products or services. Enforcement is something the government should do - if they are capable.

Submitted by Fact Z : August 11, 8:56pm

45M is the number in 2007 who had no insurance at any time in the previous year.

35.8M were citizens, native or naturalized. 87.3% of citizens had health insurance - 12.7% did not.

9.7M of the 45M were non-citizens. 44% of non-citizens had no coverage in the previous year. (Interestingly, 3.6M (16%) of non-citizens, were covered by a government program.)

8.15M children aged 18 and under had no insurance coverage for the year previous. Perhaps 20% of those were non-citizens, if the overall fraction of non-citizens is used. Leaving at least 6.4M citizen children not covered.

If we assume practically everyone aged 35-44 (7.7M without insurance) would like insurance if they could get it, perhaps 3M of the 10.3M aged 25-34 may not have cared that they had no insurance, leaving about 33.3M US citizens who would have liked to have had insurance but could not get it.
Source: http://www.census.gov/hhes/www/macro/032008/health/h01_001.htm

Submitted by Anonymous a : July 22, 6:52pm

Let's look at the other side of the equation. Say, for example, a family practice physician generates a revenue of 450/hour and in a community clinic, operational cost is $350/hour. Reimbursement is low if the clinic serves a population of medicaid/medicare and uninsured. However, loss is compensated by federal grants so that earnings becomes at par with private practice. Can you imagine if the operational cost goes down and reimbursement goes to the healthcare providers as a just compensation? Remember, most of the jobs, from CEO to COO and associate directors of every imaginable position is generated and surrounds a practicing physician because it is essential at this moment when it comes to billing issues, proper coding and obtaining grants. With President Obama's plan, when this red tapes are abolished and reimbursements are simplified, pay per performance are implemented, jobs that were forged to work with the existing healthcare system will be gone, billing department will shrink,administrative cost goes down, subsequently, the operational cost coses down, hence, healthcare delivery becomes affordable and healthcare provision goes back to the doctor or midlevel healthcare providers. HMO dies and everything become accessible and affordable.

Submitted by Jane F : July 22, 4:11pm

Why have we not asked "How many of these 47MM uninsured persons are ILLEGAL TRESPASSERS" whom taxpayers are being asked to support and pay for with their hard earned taxes.
Are we not letting the WORLD know that this present Government intends to let anyone who can find their way here from Europe, The Far East, Africa, Asia or anywhere else, to benefit from FREE health care, social security, Medicare, Medicaid, education, housing, even abortion, food stamps etc if they cannot afford it themselves?........WHAT A COUNTRY !!!
Our borders are wide wide open for anyone who wishes to enter the USA.
via Mexico, Canada, by land or sea or air, and we will pick up the tab for their living costs, for now and evermore.
We must stop this stupidity at once, or forever Let us take care of ouy own poor first.

Submitted by Brian S : July 21, 6:51pm

While I can understand the need for more time, I really hope that republicans will not use the delay to further minimize the problem and kill any chance at reform, as they have continuosly done over the last 30 years. The trend is dis-heartening.
The usual method behind these delays is the hope that a more immediate problem will come along to capture the imagination of America while health-care continues to destroy lives. I am afraid that this is exactly what republicans are doing. Health care IS a big issue and it needs to be done as best we can but doing nothing is worse.
I can almost predict that healthcare reform will die again and that the cost will continue to sky-rocket, insurance will continue to monopolize the lives of Americans.
I cannot trust Republicans to do anything, I am starting to lose faith in democrats for being ruled by the fear spread by republicans. The only thing that seems certain is that insurance will win against the government and we will all suffer in indentured servitude to insurance simply because our legislature lacks the moral fiber to actually protect the American Public.
There are a lot of posts about greed lately, mine included, and it was said that who's greed is worse. It isn't a matter of my not wanting to pay my way, it IS about my not wanting to live a slave's existance to the greed, not of hospitals, but of insurance.
This isn't about denying a doctor from making a living to support his family, this IS about denying insurance the ability to decide my fate, my wealth, my health, my job, where I live, who I talk or associate with. This is about being able to make decisions with my doctor without outside interferance. This IS about buying a service and actuallyu recieving the service for which I paid.
Illegal immigrants? So what. They pay taxes through work just like I and every working American does. People do not want to admit that immigrants provide many services that Americans refuse to provide. They work at jobs for pay that Americans refuse. They pay taxes just like American citizens do. So what if they recieve health benefits? If they weren't working the jobs that Americans refuse to do, food would be more expensive and many other things would also be more expensive. This is a nation of immigrants, (unless you are native American). Immigrants, legal or not, are what have made this nation the best nation in the world today. Healthcare should be extended to EVERYONE! If you cannot get healthcare for sickness then you can, and often do, die. If we have the right to life under the constitution, then so does every human alive. Go to Canada and get sick, you are treated without cost. Go to England and get sick, you are treated without cost. Come to America and healthcare is only for the wealthy. It is a shame when other countries better exemplify the very values America was founded on. The constitution says "ALL MEN", not just Americans. Healthcare should be available and affordable and quality for everyone regardless ofnationality because it is a human rights issue rather than a national rights issue.

Submitted by Anonymous M : July 17, 1:12pm

This insurance is supposed to cover every AMERICAN. What do you propose to do with the 11 million illegals you acknowledge living here and the probably more than 15 million you choose to ignore? Is government funding for their insurance another of the many rewards they will enjoy for breaking the law?

If this plan goes through I feel that since we are already paying for the insurance for all Congressmen(and women), Senators, and the President & Vice President, they should be required to use this same insurance and abide by all of the same rules. Either that or cover all AMERICANS with the same policy they have.

Submitted by Anonymous a : July 12, 4:42pm

When a pregnant illegal alien crosses the border or when she manages to hide here with an expired tourist visa status, She goes to a safety net health clinic and gets a presumptive medical. The newborn then becomes an anchor baby with full benefits. The mother will continue to stay and be on welfare, and can absolutely sustain herself until she has another one. Multiply this cases in the land of opportunity and you will see why there is a sudden shift of ideals that immigrants and non-immigrants are imposing. There is no more shame/guilt attached to this "welfare abuse". I will not argue about the humanitarian act of Americans,however, the absolute way to stop this insane pattern is that a newborn should assume the legal status of the parent until such a time that they both can pledge allegiance to the AMERICAN FLAG, ASSIMILATE into the bigger society- not the cultural social nucleus that they so manage to seclude from you and the IRS.They should be able to speak the common language (ENLISH), obtain a tax ID number and register, subsequently apply for legal status at the time when they fully embrace american ideals. Now, this is a conditional situation. When all of them are subjected to such regulations, only the deserving ones who understand their obligation to the society will stay. The opporunistic parasitic relationship will end if things do not come easy. Now, let us go back to the issue of 9 million children- those majority who do not have child health insurance- they are the children of the middle class hardworking americans, and,on the extreme side, the children of non-tax payers or perhaps, they were not born here at all. Imagine if everybody is socially obligated to put a coin in the pot- will this numbers go down?

Submitted by william w : July 11, 11:50pm

Years ago I completed a questionnaire about health with recommendations for how to live longer.

It boiled down to wear your seatbelt, don't smoke, eat healthy, exercise, and have good genes from you parents.

Doctors, hospitals, and healthcare were not part of the solution.

People want doctors to fix the effects of obesity, smoking, risk-seeking behaviors, and just plain old age.

It can't be done, for any amount of money.

So if you think I want my taxes raised to subsidize people with a death wish, or quest for eternal life, forget it.

I just learned of a person who had already suffered two serious recreational injuries in the past year, that just got a new motorcycle because their old one wasn't fast enough. They have already had some minor motorcycle wipeouts.

At some point you just have to accept people are where they want to be. And no amount of social engineering do-gooding is going to change that.

Submitted by deb e : July 10, 6:41pm

I'm a widowed working mom. I work for $9.61hr...salary for 50 hrs per week...plus monthly bonuses that range $200.00 to $500.00. I work for a very well known company. After I pay for rent..car payment..renters and car insurance...utilities...cell (requiremnet for my job as a store manager on call 24/7)...household needs (i.e. toliet paper, dishsoap, etc.)...my daughters basic needs like shoes or tampons...groceries.. I CAN NOT afford the health/dental insurance my company offers. I did purchase it at $297.00 every 2 weeks, for my daughter and I, for over a year...and every time I tried to use it they denied any use. I needed a blood transfusion due to extremely low hemoglobin..and my body not producing the right blood cells...$17,000. and they paid nothing...I was finacially gone...I had to go to the hospitail, who sent me to the state of michigan...who then helped me pay it. I tried to use the dental care for a visit because I had lost a filling that had been in place since I was a teenager and was causing me pain due to the exposed nerve...well even then they claimed it was pre-exsiting and denied the $36.00 office visit. They will barely pay for any routine care for my child. I had faithfully paid my premiums but every time I tried to use my "ASSURANT" or "DELTA DENTAL" they refused me. Everything is pre-esisiting to them, and at 44yrs old how can anything NOT be pre-exsiting (LOL)...And even when you are actually ok'd for something the $1000. annual deductable per person you must pay atop the bi-weekly premiums...the co-pays and so forth make the insurance unaffordable to working people like me. I'am not on a welfare ticket...I do not get food stamps...I work 8-12 days because it is my responsiblity to take care of my daughter...but if I become really ill what will happen to us...to her...what about the medications the doctors said I must take daily for the rest of my life but cost so much that I haven't had them in over 7 months and I can feel my body getting tired again....they said I may need future blood tranfusions...well what am I to do???? I just keep doing my best...working everyday, even though I'm so physically tired and my body hurts constantly...because that's what a mom is suppose to do...take care of her kids...take care of their home...teach their kids manners...and give them the best example she can...and I pray that soon someone will see the needs of "the working poor"...I don't want a free ride...just a decent priced insurance that I can use when I need to. If I made less money I could ride the "FREE TRAIN' on medicaid...or I could quit my job and get a "FREE RIDE" for everything...rent and utilities (HUD)...food stamps...you name it the government gives it ALL away to those who DON"T really deserve it or need it...I"ve seen the abuse of this often in my life...yes help those who are truely disabled and need it ...but so very many take when they don't need...that leaves me asking what about the folks like me??? I honestly try my best everyday...and I want to keep doing so...but without the medications and affordable..and useable insurance...I'm only left to ponder ...for how long will "I" last...my daughter is 14 and lost her dad last christmas...all we have left is each other...I hope insurance reform will help and not put more $$ in pockets that are already too heavy...lawyers suing docs for just about anything and the insurance comany's are making $$ 2 ways here..from us for premiums..and the docs for malpractice insurance..it all adds up to everyone who doesn't matter that pushes a pencil around...all that should matter is my health and how it should be treated as my doctor sees fit...too many $$$ are wasted on "PROPER CODING" and even forged coding just for the docs to get paid...we need to go back to the day of small town docs who lived around, knew, and cared emotionally and physically for their patients...we need change...but when politicans...(who can pay for any treatment out of their personal checking account)...are making the choices will they even think of persons in situations like mine????

Submitted by David W : July 10, 12:18pm

I am a physical therapist in our healthcare system for 30 years. I take great pride in what I can do for a patient. However, any system, even in Europe or Canada has flaws. I do not think we can afford "major" reforms of our system, but I also do not think we need to if we do what we can now, that won't cost much. First, the 45 Million number was adequately explained earlier (ie, it is really much smaller), but it is true more and more people are lacking good health care by virtue of employers or cost. Second, all of our providers and hospitals make way more than the "other" countries (US averge 150K, Europe 60K for MD's), so unless you are going to cut their pay down by 2/3's you better find another way. The right way is to solve the problems at the root level, the level of medical care. Those problems dont necessarily create cost, they improve quality and decrease cost. For example, cosmetic surgery or dental cosmetics are cash paid by patients, not covered by insurance. Both of these practices have grown hugely over the last 30 years. Both cost less for each procedure they do now, and the quality has gone up. In short, when you publish your results, people will pay for quality. So, how to make our system extend these types of improvements to our entire system?
1. Patience, it will take quite a while to add outcome data to our system, but that is what we so need. In New York when they made hospitals publish their data about coronary artery bypass, deaths reduced over three years time, just by telling the world how bad some of the hospitals were doing. And the question begs that why do all hospitals have to do heart surgery, it should be done by whomever does it the best. I want to know how many CABG surgeries are done at what hospital and how many people died. I am not going to a hospital that only does a few a month. Outcome studies will pay improve healthcare, and bring down the costs by publishing who is the best at any particular care. I know that not all Physical therapists are the same quality, but Medicare pays the same for the same procedures without caring about whether the patient got better. I know there are providers who harm patients, but they get paid just the same. While it isnt easy to sort it all out, mandating that outcome studies are designed and used in all of medicine, will eventually sort out the bogus billing, unneeded procedures, and bad policies.
2. Mandate insurance companies use the same medical policies as MEDICARE. While Medicare is not the best example of government run healthcare, they do publish their medical policies. If all insurers had to use the same policies, providers and hospitals would need far less administration to comply with medical necessity questions.
3. Mandate that all providers of healthcare use Electronic Medical Records.
4. Mandate that all insurers must supply a bare-bones policy that covers basic catastrophic health care with no limit.
5. Mandate that all insurers cannot deny coverage for pre-existing conditions.
6. Mandate that all insurers provide wellness checks in primary medicine and that patients who do not take care of themselves by reducing weight, improving health will be required to pay more for their care. Smokers should pay more for their healthcare is as sound a rationale as everyone should have healthcare. Those people who work hard at their health should benefit, not pay for those that dont.
7. Mandate that hospitals and physicians cannot refer to themselves. There is so much overutilization going on that Medicare has tried to outlaw this but the physicians and hospitals have opposed anti-trust and Stark rules to the point that there is no way to stop them. Every hospital knows how much they make their employees (read MD's) send care to the system that is not needed (they have to pay for all those new toys and buildings). MD's who own PHYSICAL THERAPISTS as employees refer far more physical therapy than those that don't own other health services. If we just cut out the over utilization and fraud, we can have a better system that wont cost more.
8. If we have outcome studies, the call for reforming the defensive practice of medicine and lawsuits will be reduced. Hospitals and physicians do make mistakes, but the insurers, hospitals and lawyers have neat method of settling before anything goes to trial. Patients have no defense in any of this. We have to have lawsuits because too many mistakes are made and swept under the rug. Let's air that data and see how many patients want to visit that hospital or physician.
9. Require living wills and end of life treaties for every patient that has health insurance.
10. Have government require Medicaid and Medicare to improve their efficiency and waste.

Dont get more government care, require government to mandate proper ethics to the system. We can do all of these things without increasing costs, if we only do one thing. Require all providers of healthcare to publish how well they do what they do. AS LONG AS THE OUTCOME DATA IS VALID, MEDICAL CARE AT THE LEVEL OF THE PATIENT, WILL IMPROVE AND COSTS WILL GO DOWN.

Here's hoping those darn politians try to do small things to improve the greatest healthcare providers in the world, not give us more government and administration over our heads.
7.

Submitted by J M : July 9, 11:52am

As an individual who has grow up in healthcare and now works in the field. The belief that universal healthcare will work is dreaming. Whether you are a democratic or republican the numbers don't add up. Yes there is lets says 50 million people in the United States without health insurance. But lets break it down. There are roughly ten million illegal aliens living here within the 50 million. There is another eight million that make over 75,000 a year and choose not have insurance. And lastly there is roughly ten million that are on welfare and another government aide that refuse to change the way they live. I understand how some may say that some people can't help being poor or the decision they make. But as a son of two immigrants who had a father working two fulltime job and one part time along with a mother that also work two fulltime jobs, I have feel no pity anyone saying that they make it. . You make what life gives you. I understand that sometimes people need a hand and that is fine but giving things away is not the way our country was founded on. The backbone of our country was by hard work and fighting for justice and freedom not handouts and IOU. So by giving healthcare away, banks money, and carmakers bailout what are you saying for the future? China, along with other countries own a good portion of US bonds. So we are selling our souls to benefit the politicians and no one else. The taxes that coming for all American is scary. Not because of Obama or Busch, it is reality you can’t spend as much as we are and hope that everything will be okay. That is what as lead us to this point. The rich will be taxed but the middle class will get screwed, by the way I not tin the middle class as a point of interest. The middle class is the largest and no matter how much the rich get taxed it will be passed down to the middle class. Think about it, if the wealthy are making less they will not spend in the stores that make up a good portion of the middleclass or give to charities that make sense. Very Sad!!!!!!! I love this country because of all the great things it represents I hope for any who reads this will understand that we have the right to question our government and our peers. Don’t stop believing that because that is how other countries have fallen.
Solutions are not easy but here are some thoughts. First a flat tax will help to make everything equal for all classes. Healthcare is not easy but the one way I would handle is by giving healthcare tax credits to those Americans who don’t have healthcare but they must prove that they citizens and have insurance to receive the money each year. Then I would make hospitals transition to electronic files so they can monitor patient’s records and reduce errors. And the most difficult is reducing malpractice insurance for doctors and surgeons enabling cost savings in Medicare and Medicaid reimbursement, which will help in paying for the tax credits. The last one is lawsuits. Doctor and surgeons make mistakes. They are no different then anyone else, that being said the government should reduce the amount an individual can sue for based on what there current income is. For example if someone gets a spine operation and is making a hundred thousand a year and the operation is not a success or causes this individual to lose there job they should be covered for the amount of money they would made and cover all future medical bills. Then I would provide a certain amount of money to the lawyers for representing the client. If the lawyers are making a standard rate bases on fair practices this will reduce the false suits and cover those who have been harmed by doctor and hospital errors. These are some of my thoughts thank you

Submitted by Jay H : July 8, 4:40pm

It is simply not feasible to have a system where "everyone pays in". There will always be those that can not afford health care or insurance for it. Everyone else will pay for those. The government has no money, other than what we give it (primarily). So, government paid coverage is still coverage paid for by us.
As soon as you require "insurance" to everyone, you have just increased the cost of health care. Insurance companies are in business to make a PROFIT. If they don't they go out of business, or get bailed out by your and my tax dollars. But profit is what they are about. Insurance companies will not operate at a loss. Hospitals will not operate at a loss. Their money ultimately comes from us.
The 45MM figure is inflated. That number includes non-US citizens, people temporarily between jobs (had and will likely again have insurance), and a significant number of people that do actually have access to already available government programs, but do not avail themselves to it. The increase in unemployment does increase the number, but more than the number that are not qualified, or have chosen to not access available programs that are included in the census.
There are ways of doing it, and Insurance companies will play a part. One option is by educating people on how to use health care accounts supplemented with umbrella policies. The extent of government involvement could be giving a tax refund to individuals to personally finance it (not more tax and spend on our behalf).
Bottom line, no one approach is going to work for everyone. Some will have more options than others (our economy requires options to grow). And people have to be responsible for themselves and stop asking the government to run their lives for them.

Submitted by Anonymous T : July 1, 4:54pm

I believe there are already current structures in place to provide healthcare for the 45 million uninsured Americans without retooling the entire system. For example, why can't the majority of hospitals -- which are not-for-profit and largely tax exempt -- be required to serve the uninsured in their market areas for free, or lose their tax exempt status? Secondly, let us not turn our noses up at the fact that healthcare was (until recently, I do not have the lost current data) one of just two sectors of the economy that is/was still generating new jobs. Some 50,000 healthcare jobs were added in December 2008 alone. And lastly, the majority of Americans actually like the healthcare they receive. So in closing, let me say that we need to look for ways to make the current delivery system work more effectively without creating a governmental competitor to the private insurance system. Ask yourself: when was the last time the government actually did a better job of providing a consumer service than the private sector did?

Submitted by Jason H : July 1, 1:07pm

The administration cites 45.6 million "people" are uninsured, or simply "46 million uninsured", not 46 million "Americans". This is because 21%, or 9.7 million of that 45.6 million, were not US citizens in 2007. Further, a large proportion of the uninsured Americans (a) can afford health insurance but choose not to purchase it, (b) are young (18-34) and healthy and choose not to purchase insurance, and (c) are in transition, and only without insurance for a brief period. Only 19 million go without insurance for a full year (i.e., 6% of the US population). From IBD, "The Phantom Uninsured" http://www.investors.com/NewsAndAnalysis/Article.aspx?id=479724

Not all of the uninsured would be covered anyway by the $1.6 trillion plan(i.e., $1,600 billion), and House Democrats will not yet share how we are to pay for this. From the AP http://news.yahoo.com/s/ap/20090619/ap_on_go_co/us_health_overhaul (I think the House bill is now over 1,000 pages).

We already have a solution for poor Americans who want insurance but cannot afford it: it's called Medicaid. It's a failure of Medicaid that such people remain uninsured. Perhaps we should first focus on "reforming" Medicaid. We should also demand more "transparency" from elected officials before they move to vote on such sweeping policy.

Submitted by Anonymous L : June 30, 12:24pm

It's very, very important to this discussion to bear in mind that the $45 million figure includes people who HAVE ACCESS to health insurance and DON'T WANT IT. Many people do have access to coverage through employers and waive coverage, because they do not feel they need it. I am an insurance broker and I see this all the time. Employers in professions that hire a high percentange of young, healthy people, especially males (construction, landscaping, iron-working companies) often cannot meet participation requirements because so many of their employees waive coverage, even though the employer is covering 65% to 99% of the cost. Until these people are removed from the figures, we don't have an accurate idea of what the "problem" looks like.

Submitted by annie s : June 28, 11:37am

After 20 years as a medical practice administrator, I have seen the for profit insurers delay, deny and diminish care at every turn. I have seen hard working people who earned too little to afford private insurance lose everything they own to an unexpected illness. I've seen cancer patients reach the maximum payouts on their insurance plans and have to decide between continuing treatments that may save their lives and financially destroying their families. I know how difficult it is to find a private insurer for the self employed, those over 55 or those with pre-existing conditions to find an insurer at any cost. I've lived in Europe and applaud the countries that understand that equal access to health care is the right of all of their citizens, and I'm saddened that this great nation thinks corporate profits are more important than American's lives. Although I am in favor of nationalized single payer care, I know that isn't feasible in this nation that resists change so firmly, so a public health option is the best we can hope for to make health care more affordable and more accessible. It will create competition for the for-profit insurers and drive down costs.

Submitted by Bill B : June 26, 9:29am

This Reinhardt fella is pretty smart for a Professor at Princeton...

http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-pub...
April 17, 2009, 7:02 am
Health Reform Without a Public Plan: The German Model
By Uwe E. Reinhardt

Uwe E. Reinhardt is an economics professor at Princeton.

In the previous two posts, I sought to explain why the public health insurance plan that Barack Obama had firmly promised during the presidential campaign appears to have become a deal-breaker in President Obama’s quest to sign a genuinely bipartisan health reform bill later this year.

What if that plan were sacrificed on the altar of bipartisanship? Would it be the end of meaningful health reform?

Not necessarily, if the health systems of the Netherlands, Germany and Switzerland are any guide.

None of these countries uses a government-run, Medicare-like health insurance plan. They all rely on purely private, nonprofit or for-profit insurers that are goaded by tight regulation to work toward socially desired ends. And they do so at average per-capita health-care costs far below those of the United States — costs in Germany and the Netherlands are less than half of those here.

To see how this can work, think of the basic functions that any health system must perform. To wit:

* 1. the financing of health care, that is, the extraction of the required funds from individuals and households who ultimately pay for 100 percent of all health care
* 2. the pooling of individual risks with the aim of protecting individuals and households from the high costs of medical care in case of illness
* 3. the purchasing of health care from its providers (doctors, hospitals, drug companies, etc.)
* 4. the production of health care goods and services
* 5. the regulation of the entire system so that it operates towards socially desired ends.

Who should perform these functions is powerfully driven by the distributive social ethic that nations wish to impose upon their health systems.

In Europe, as in Canada, that social ethic is based on the principle of social solidarity. It means that health care should be financed by individuals on the basis of their ability to pay, but should be available to all who need it on roughly equal terms. The regulations imposed on health care in these countries are rooted in this overarching principle.

First, these countries all mandate the individual to be insured for a basic package of health care benefits.

Many Americans oppose such a mandate as an infringement of their personal rights, all the while believing that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it. This immature, asocial mentality is rare in the rest of the world. An insurance sector that must insure all comers at premiums that are not contingent on the insured’s health status — a feature President Obama has promised — cannot function for long if people can go without insurance when they are healthy, but are entitled to premiums unrelated to their health status when they fall ill.

Second, these nations try to tailor the individual’s contribution to the financing of health care closely to the individual’s ability to pay — almost perfectly so in Germany, albeit less perfectly in the other two countries.

In Germany, statutory health insurance, which covers 90 percent of the population, is financed by a payroll tax. The individual’s premium is not a per-capita levy, as it is in the United States. It is purely income-based. Ostensibly, about 45 percent of the premium is contributed by employers, although economists are persuaded that ultimately all of it comes out of the employee’s take-home pay (See this and this).

An employee’s non-working spouse is automatically covered by the employee’s premium.

Unemployment insurance pays the premiums for unemployed individuals, and pension funds share with the elderly in financing their premiums, which are set below actuarial costs for the elderly.

Finally, premiums for children are covered by government out of general revenues, on the theory that children are not the human analogue of pets whose health care should be their owners’ (parents’) fiscal responsibility. Instead, children are viewed as national treasures whose health care should be the entire nation’s fiscal responsibility.

The health insurance premiums paid by Germans are collected in a national, government-run central fund that effectively performs the risk-pooling function for the entire system. This fund redistributes the collected premiums to some 200 independent, nongovernmental, competing, nonprofit “sickness funds” among which Germans can choose.

For example, if individual A chooses sickness fund X, then the central fund will give to fund X a capitation payment that uses over 80 variables to identify individual A’s actuarial risk. The same payment would be made for this individual to any other fund.

Thus, the sickness funds in Germany only perform the third function mentioned above — acting as purchasing agents on behalf of the central fund and patients.

Space does not permit a detailed description of the Dutch and Swiss systems. But these countries, too, have married the financing and risk-pooling systems, which try to own up to the principle of social solidarity, with a delegation of the purchasing function to competing, private insurance carriers. In the Netherlands, the latter may be for profit or not for profit. In Switzerland, they are basically nonprofit, except for supplementary coverage for items not in the basic package.

All three countries offer their citizens reliable, portable health insurance based on the principle of social solidarity, but without a government-run health insurance plan like Medicare. The $64,000 question is whether America’s private health insurers would be willing to countenance the tight regulation required for that approach.

Submitted by Tom P : June 22, 12:50pm

I keep seeing this 45 million number or the 15% of population figure as those without health care.
I am somewhat skeptical of this number because I have yet to see a more detailed breakdown of its components.
For example are illegal aliens counted in this number?
How many of these people are already on medicaid or are able to be treated by free clinics etc.?
How many of those counted in this number are temporarily without health care as opposed to how long these people have been without care?
There are probably other questions that could be asked. But the point is that before statistics are bandied about so easily as one of the reasons we need health care reform, we should attempt to understand the reliability of this number. Knowing the sub-components of this population would also help identify where to direct reforms target at this population.

Submitted by Leo C : June 19, 4:41pm

My friend, Rick is 65 years of age. His wife is 60. Rick's healthcare is handled through medicare and a supplemental. His wife, Cindy has to pay over $700.00 monthly for health insurance. By the time Cindy gets to be 65 they will have paid $42,000 in premimums just for her. Isn't this a nice way to enjoy your retirement years?
Canada has a national health care system I think we should try. If you don't care for the service, you can buy health care. At least every american could have a better chance of staying out of debt.
How else can healthcare costs be constrained in the USA? Look at the reduced cost of prescriptions in Canada? This is the United States of America. There should be a way for americans to afford healthcare at a reasonable cost. God Bless this land.

Submitted by Dave F : June 18, 11:02am

I am a physician and I want my bias to be up front. I think the health care system needs fixing but the heart of this sticky debate is "Are we responsible for those who do not or cannot take responsibility for themselves?" I see many patients who work hard and do not make enough money to cover all of their medical expenses; they usually find some way (charitable organizations, medicare/medicaid, hospital "free care") to get the care they need. I have never personally turned away a patient nor have I seen the hospital I work for turn away a patient because of inability to pay, and I am proud of that. HOWEVER, I cannot tell you how many people I see abuse the system. Patients coming in on medicaid (you and I pay for their treatment) with clothes, cars, and cell phones nicer than mine. I also see well-to-do suburban yuppies driving BMWs who do not have health insurance because "they don't need it." Until something happens, but when they DO need healhtcare a public cry goes up that "It's too expensive!"

There ARE places to trim the fat in healthcare. Defensive medicine due to malpractice concerns would be my number one choice (again, I admit my bias). Second would be aggressively promoting living wills/advanced directives so that those who do not desire to have their lives prolonged with desparate measures are saved the suffering and indignity in the intensive care unit. Third would be REDUCING (not INCREASING) the administrative costs of healthcare. Every year, more and more government regulations on healthcare delivery require more and more documentation. The hospital I work for has nurses who are hired to do nothing but check charts. They look at the progress notes I write every day to correct them. And when I say correct I do not mean correct a medical error, but an administrative one. If I say a patient has a low hematocrit and I am ordering a unit of blood for transfusion, they flag it and ask me to correct it to say the patient has "anemia." You see, medicare reimburses for blood transfused for "anemia" but not for "low hematocrit." (They're different words for the same thing.) So, when you complain how expensive healthcare is realize that part of your healthcare dollar (insurance premium, taxes, etc) goes to pay these administrators WHO HAVE NOTHING TO DO WITH HELPING PATIENTS. The ONLY thing they do is help the hospital and doctors jump through the hoops medicare sets up to get paid. Realize this: Universal healthcare = more hoops = more money spent on healthcare NOT ACTUALLY RELATED TO PATIENT CARE.

A solution is needed but I am not convinced that a single payer system is it. My two cents.

Submitted by Barb R : June 16, 2:48pm

15% doesn't sound like much but 45 million people does? When you put that into perspective: if you are sitting in an elementary class with thirty 7 yr old children, and then you realize that 4 - 5 of them may not get immunized, or dental work, or glasses...then multiply that by every person in the USA? It's 45 million people.

And that's WITHOUT insurance. That's not counting all the people on Medicare and Medicaid. So we're paying for 15% of the population to use an Emergency room at the hospital to treat a case of tonsillitis or the flu. Plus, the insurance coverage needs to be taken into consideration of the population that is covered by PRIVATE health coverage.

For a modest income family with 3 children and one employed parent at a $15/hr job, full coverage will run him over $700/month. Sometimes more than a housing payment. So the gamble? Pay the $300/month plan where I have a $10,000 deductible. But that deductible isn't just for heart surgery or other things that could go wrong: it's for routine medical care that prevents many illnesses in children and adults. So what happens? You pay the lower rates, pray you never need long term treatment, and do everything you can to NOT take your child to the ER or to a family physician.

The numbers are deceiving. It's not just 15% you pay for in ER care through tax dollars. It's everyone on Medicaid and Medicare as well (no income, low income, seniors)

Submitted by Emma A : June 12, 2:51pm

While I agree with the poster who states that 15% of the population sounds like much much less than 45 million. I challenge all of us to realize that having so many among us who are uninsured contributes directly to the cost burden that we all must share. I am a family nurse practitioner working in rural primary care. I had a patient who was without insurance for many years and we "made do" in the short run. By the time he was old enough to take part in the medicare system his chronic health problems (diabetes, hypertension, hyperlipidemia) were far more advanced than they would have been with more comprehensive management earlier in his life. Now the medicare system will cover much of his medical costs however they will be more expensive as his multiple co-morbidities are more progressed. The referral person in the office made a joke about sending this guy to every specialist in the area...we were waiting until he had coverage. This doesn't even acknowledge the physical and emotional cost to this person.

Submitted by Anonymous C : June 11, 2:11pm

I think people like to use the number $45M because it actually represents a small percentage. People wouldn't respond as emotionally if they used the percentage, which I think it about 15%. This number is also misleading as it counts anyone who did not have health insurance at some time during the year, as opposed to the perennially uninsured.

Submitted by Jerry J : June 10, 6:53pm

That's a lot of people. Children don't vote. What if on this one issue we gave them the option.

Submitted by Tarun S : June 10, 3:55pm

The problem isn't entirely greed, we have to remember that we are investing a lot in diseases that are not common and therefore cost a lot to treat and it seems to me that that is a tough thing to be against - perhaps dismantling the pharmacy lobby or the medical lobby would help but it is not a simple solution

Submitted by Logan P : June 10, 3:41pm

There is no such thing as "free" health care. If you are getting free care, it's because someone else has paid taxes through the nose to make that possible. The problem with universal health care is it requires the government to get into the business of decided what care will, and will not, being provided to various patients. It takes medical judgment out of the hands of physicians and puts it in the hands of federal regulatory agencies.

Submitted by Rob M : June 10, 3:03pm

Seriously! Whats so wrong with saying everyone in America deserves Health Care!

An interesting story about health care: My wife and I had our 1st child before we were married, so my wife didn't have any insurance. Medicaid paid for everything. Perscriptions were under $5 if not free. Hospital stay was free.

Our second child was born in the same hospital, with the same group of doctors. It cost us more then $1,500. It took us 6 months to pay off.

I think greed is the only reason we haven't switched to a privatized health care system. Why provide for free what you can charge thru the nose for?

Submitted by Anonymous M : June 10, 10:23am

I don't know what the solution to this would be- universal health care, possibly- but it needs to be fixed! Medical bills are too high for any individual to carry sole responsibility for their payment. I have insurance, and the bills are still sometimes difficult to meet, often taking months of a payment plan in order to be rid of. This should be one of the primary concerns our government addresses in order to better medical care in our great country.

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