Healthcare Part II

[Paladin of Ice]

A question for those who say private and public insurance cannot exist together without putting the private insurance out of business: putting aside for a moment the examples of multiple other countries that do exactly this, if the private world cannot compete with the public world, then why hasn't public education eliminated all private schools?

[Aemon Stark]

I attended a talk last night by the president-elect of the CMA - it was about myths and realities about the Canadian healthcare system. It occurred to me during the talk that there's a significant structural difference between Canadian and American insurance. Setting aside the public/private question, we have separate insurers for comprehensive medically-necessary care (excluding dental, vision, and many drugs to varying extents) and for "extended" care - dental, vision, drugs, some physio, and the like. In short, for matters of life, death, and to a significant extent quality of life, we have single-payer public insurance. Everything else is generally private, with some public coverage available for certain groups. But the key is that for-profit insurance is not available or else banned (and certainly crowded out) for medically-necessary care, something replicated in most other countries regardless of whether such comprehensive (but not extended) insurance is paid for publicly or privately.

Implementing that kind of reform would be a positive development.

[Swordfish]

Jeffrey Toobin? Is that you?

I have heard one theory from Michael Tanner of the libertarian Cato Institute. He said that the government in this case would use its leverage and tax revenue to price all private insurers out of the market. I doubt he's right, but it's an idea that is out there.

Just out of curiosity, what makes you doubt it?

[Paladin of Ice]

Jeffrey Toobin? Is that you?

:lol:

Nope, I can assure you that I'm not him. However, I am curious what people have to say. Because if they're going to disregard the cases of other countries which have both private and government insurance, then lets look at an area in our own country where we have both government and the private sector in the same business.

And lo and behold, public schools, state universities and such haven't wiped out the various different private interests ranging from tutoring/mentoring to private boarding schools all the way up to Ivy League schools. So even when people have the option of sending their kids to an excellent state university for $3,000 a semester or a community college with a good reputation for about $100 a credit + some fees for using their gym and computer rooms, (both first hand experiences of mine, by the way) people who have the means or grades still choose to go/send their kids to acclaimed private institutions for specialized fields, extra development beyond what is seen as "necessary", in order to go to the place with the best reputation, etc.

Y'know, that even sounds like some nation's health care system as has been described many times over now, the exact name slips my mind... ;)

And, just because some wiseass is going to make a crack about the state of public education in the US: yes, public education runs the gamut from excellent to piss poor for any number of reasons, some of which presumably wouldn't apply to healthcare. (Like backward policies such as punishing schools that don't score well by withholding money. That works out real well when it gets to the point, as any number of schools have, that they're using textbooks from the 60s and can't attract a single decent teacher to work there. I understand not wanting to make a place a money pit, but there are far more constructive ways to respond and improve things).

Unless you feel that the only schooling should be private and anybody who can't afford to go should kindly fuck off and die (and so what if that means that a large portion of the country never attends anything beyond the rudimentary basics and thus is consistently less educated than all but 3rd world nations) I assume you believe that, whatever its faults, there should be a public school system in place. Why not a public health system then?

[ztemhead]

I need to rant for a bit, so I'm sorry if my spelling and formatting which are usually questionable anyway are even more awful in this post.

What a steaming load of horseshit the "Baucus bill" is. It's the same load of crap Bush did with the prescription drug benefit under medicare- a cherry for big business at the expense of the taxpayers. If you're a neoconservative Bush-era Republican, you should be all over this like flies on the turd of a bill that it is. If you're a democrat, you should be looking at it like WTF? It further decimates the middle class!!! You remember, the people who built the country up in the first place, not to mention the ones who buy all that made in China crap they don't need, and all those McMansions that are in foreclosure... So if you're poor, you get a subsidy (as if you pay any tax anyway), but if you're middle income and struggling, what? Pay a penalty or else get forced into an expensive insurance plan?

Point is, this is what the insurance companies wanted all along, 40 million new members. This is why they threw all that money at the blue dog douchebags, so that they could turn the conversation their way, which will have the effect of adding billions in net new sales over the next decade. All the other stuff is not even substantive enough to be called window dressing, it's just airtime filler to take away from the main point that the American people were sold out by the politicians elected to represent their interests. Worst of all is the GOP who oppose this bill not on any reasonable policy grounds, but simply for the fact that the dems want it.

Obama fucked up when he tried to fix the whole thing at once. He should have gone at it piece by piece, changing public perception about healthcare, whittling away at that 40-and some million uninsured number until the rest of the population was so horrified the plight of the remaining uninsured that we voted in single payer.

[Forderz!]

I just find it ethically/morally unbelievable that some people think others shouldn't get medical treatment if they have to help pay for it. You can't put a price tag on saving ANYONE'S life, no matter how many Republicans think you can. Besides, eventually that person will get better (hopefully) and pay it forward to some other poor sap who had the audacity to be struck ill.

Also, lower medical bills means more money to spend on, say, anything else, thus benefiting the economy more than giving a insurance company that produces nothing tangible more.

[Aemon Stark]

I trust you're not suggesting that "government" is making arbitrary decisions about coverage on a daily basis. About the only time the "non-coverage" thing comes into play is with new, largely unproven drugs that so far appear to convey marginal benefit. Almost all hospital and physician services are otherwise covered and that really doesn't change.

The administrative costs for insurance in Canada are about 15% of total spending, but the component for public insurance is about 1.5%, or about one twentieth of administrative costs in the US system as a whole. All those actuaries are pretty expensive.

[TrackerNeil]

I assume you believe that, whatever its faults, there should be a public school system in place. Why not a public health system then?

I think Paladin of Ice has made a very shrewd insight here. We would never accept the educational equivalent of recission, exclusion of preexisting conditions, and lifetime caps, yet there are those among us who blithely nod to these things in our health care system. Every single child in the US is entitled to a public school education, of some quality, but adults are left to go hang in terms of health care.

[Annelise]

Obama fucked up when he tried to fix the whole thing at once. He should have gone at it piece by piece, changing public perception about healthcare, whittling away at that 40-and some million uninsured number until the rest of the population was so horrified the plight of the remaining uninsured that we voted in single payer.

Then again, there's an election every 2 years that stands to affect passing legislation. And single payer the GOP is going to try to shoot that down at any time, same w/ Blue Dogs are still going to have a problem with, etc. I am quite dubious of winning such overwhelming public support that the GOP just gives in.

[TrackerNeil]

Then again, there's an election every 2 years that stands to affect passing legislation. And single payer the GOP is going to try to shoot that down at any time, same w/ Blue Dogs are still going to have a problem with, etc. I am quite dubious of winning such overwhelming public support that the GOP just gives in.

I agree. Because of the regularity of elections, there is often a very narrow window in which any president can reasonably expect Congress to act. I don't think any senator or rep is going to want to be seen monkeying around with health insurance reform two months before an election. Clinton made that mistake. The time to act is now, while elections are a year off and the political will, to some extent, is there.

[Swordfish]

I’d like to get some of your guy’s thoughts on an aspect of the health care mess: prevention.

It is no secret that we are an increasingly obese nation. Chronic diseases like heart disease and Type II Diabetes are strongly associated with obesity and lifestyle choices. A huge % of our expenditures go towards treatment of chronic diseases.

So it is undeniable that huge potential saving exist in the area of prevention, in theory. But a lot of the stuff I’ve seen has suggested that prevention a) is really not very easy to impose and b) is simply not the system we have. We treat disease after it occurs, not before.

Now I would love to largely reverse that if possible. But how? There are some proposals in the reform bill to link payment to providers to the health outcomes of patients but this is probably just an incremental step at this point.

What other ideas are there to make our society more healthy and less prone to things like Type II Diabetes which is very preventable?

More information on food?

More taxes?

A nationwide media blitz to make obesity as socially unacceptable as possible?

A fat tax (this is not a joke, Alabama will start taxing obese state employees soon)?

impossible.

Holding people accountable for making those kinds of healthy choices is just not politically viable for conservatives OR liberals.

Conservatives don't want that level of federal involvement in our lives.

liberals don't want the government discriminating against the obese.

no one is going to touch handling obesity in any meaningful way.

[Week]

Free gym memberships? Tax breaks if you go 3+ times a week for longer than 30 minutes?

Get paid and lose weight!

[Annelise]

Obesity is tough, I think, because there's a few different areas that encourage it. We are a spaced out nation.. we don't exercise much in the pursuit of our daily tasks, like work, shopping, taking the kids to this place or that. We have a 40 or more hour work week, so people cut corners in both exercise and meals.

I don't really think more education about food is worthwhile.

A couple small, quick ideas come to mind.. perhaps a tax credit for companies who install gym equipment on site? Perhaps they could bargain for reduced rates at a local gym, if they get x people to sign up? Offer membership as a benefit.

[Swordfish]

Obesity is tough, I think, because there's a few different areas that encourage it. We are a spaced out nation.. we don't exercise much in the pursuit of our daily tasks, like work, shopping, taking the kids to this place or that. We have a 40 or more hour work week, so people cut corners in both exercise and meals.

I don't really think more education about food is worthwhile.

A couple small, quick ideas come to mind.. perhaps a tax credit for companies who install gym equipment on site? Perhaps they could bargain for reduced rates at a local gym, if they get x people to sign up? Offer membership as a benefit.

Don't those already exist?

Or maybe companies just do this on their own. i know my company does, and i know a lot of others do as well.

of course, access to a gym is not the issue for most people who are obese, so I'm not sure it would help, but I like the idea.

[BloodRider]

I don't really think more education about food is worthwhile.

A couple small, quick ideas come to mind.. perhaps a tax credit for companies who install gym equipment on site? Perhaps they could bargain for reduced rates at a local gym, if they get x people to sign up? Offer membership as a benefit.

How about a sin tax on high fructose corn syrup, processed grains, starches and bad fats. And stop subsidizing corn fer cryin' out loud. Subsidize flax seed and leafy greens and shit like that. And limit the subsidies to growers who sell their foods within a certain radius of their production.

[Swordfish]

OK but Alabama (who must have one of the more conservative governments) is about to start taxing employees.

I'm not at all familiar with what is happening in Al, so I can't comment on this.

And if liberals really do want to get government involved in everyone's lives, wouldn't obesity just be another logical place? I mean, if you look at cigarette taxes or banning trans fats in New York, why not things that relate to obesity?

If you want to regulate peoples weight/eating/whatever then you must, in essence, say 'You're obese because of your lifestyle'.

The war on cigarettes and the war on trans fats was the exact opposite of this, namely:

'You're obese/unhealthy because these vile products are available, and you need to be protected from them so that they don't make you unhealthy through no fault of your own'.

I suppose there is a possibility the message could be packaged correctly when it comes to holding people accountable for their weight, but I can't imagine what that would look like. Do you have any links on the AL stuff? how did they sell it?

My guess is that future responses in this thread will demonstrate the problem for the liberals in addressing obesity quite well, but we'll see.

[TerraPrime]

Positive reinforcement and incentives will probably work better if you want to encourage people to make choices that are better for their health. And that should be the issue, not fat, or weight. It's health.

At any rate, I think the role of the government in this is to regulate the industries appropriately and to educate the public. I can easily support that soft drinks with over X amount of sugar (HFCS or otherwise) should be slapped with a warning label, much like we do with cigarettes. And I'm sad to say that the general public still are not as educated about nutritional values as they should be, imo. Still, I'd leave the money aspect off, until the government because the single-payer insurer. At that point, then the government can start offering incentives to promote healthier lifestyle choices.

[Annelise]

Don't those already exist?

Or maybe companies just do this on their own. i know my company does, and i know a lot of others do as well.

of course, access to a gym is not the issue for most people who are obese, so I'm not sure it would help, but I like the idea.

I don't know if there is a tax credit available or not for that. Maybe there is.. I know a lot of companies do it already, my old one did too. If not thought it might help encourage whoever hasn't done so. Access to a gym likely isn't an issue in at least non-rural areas, but thought saving a bit of money the company either by lowering the fee or picking up all of it as a benefit might help a little.

Have to read up on Alabama when I get back.

[Swordfish]

It was in my post that you responded to (although with little information). Alabama will soon tax overweight employees of the state. So it's only starting with the state's employees and not some sweeping thing across all employers. But it's a move in a new direction. It's actually referred to as a "fat tax" by many. Here's a link.

That article lays out quite well the problems this kind of effort has, and what i presume to be the position of the left.

"I worked for a state institution and I'd hate to see something monetarily taken away from me," says, Shultz, who was employed at two Alabama colleges. "We have to be healthy, but I don't think you should penalize people for being heavy."

"Do I have any privacy interests in my body weight?" Creighton says. "I'm just glad my firm doesn't require me to hop on a scale."

"I don't think we can arbitrarily pick out one specific set of people with health risks," San Francisco internist Ann Haiden, MD, tells WebMD. "There is evidence that fit people with a little excess weight can actually be healthier than unhealthy normal-weight people. What we don't need is for a policy like this to turn into yet another reason to exclude as many people as possible from the insurance pool."

The Alabama requirements, Levi tells WebMD, could be interpreted as a genetic penalty for those who are predisposed to having extra weight or high cholesterol. Some people also require a variety of treatments or medications before finding one that is effective. Making those who fail pay from their pockets also places more economic pressure on them, he says, which could lead them to turn to cheaper, calorie-dense food..

Politically, it seems untouchable to me. What politician is going to risk this?

I'd be surprised if we don't see a reversal in AL.

I don't know if there is a tax credit available or not for that. Maybe there is.. I know a lot of companies do it already, my old one did too. If not thought it might help encourage whoever hasn't done so. Access to a gym likely isn't an issue in at least non-rural areas, but thought saving a bit of money the company either by lowering the fee or picking up all of it as a benefit might help a little.

Absolutely. I think it's a great benefit. in more ways than just saving people a few bucks.

[The Progressive]

I would say that there is a positive correlation between obesity rates and the availability of public parks and outdoor recreational areas.

I used to think that areas with highly efficient public transportation systems would have lower rates of obesity compared to areas that doesn't. But my fiance correctly pointed out that sedentary lifestyles encompassed more than just availability of public transportation, but also the availability of public parks and outdoor recreational areas. For examples, New York arguably has a much better public transportation system than Colorado, but the latter has much more public lands dedicated to parks and the use of outdoor activities ........... and by comparison, the rate of obesity in CO is substantially less than NY.

http://www.msnbc.msn.com/id/31672178/ns/he...t_and_nutrition