The Insured Poor

[pundit999]

People talk about insurance reforms and single payer, but a very important part is the supply side. There was a study last year from Harvard which came to the conclusion that health care is so expensive in the US mainly because we pay too much to doctors and other healthcare professionals. We need to make it easier to become a doctor and we have to make it quicker and a lot simpler for quality doctors to come from aboard.

There is going to be a shortage of 100s of thousands of doctors in a few short years. Our education system cannot produce so many doctors. We need to make major changes in how doctors are educated and licensed.

[Spiral]

Just a clarification- my understanding is that individual states can't experiment with implementing single payer until 2017, and only then if they get a waiver under the ACA.

I don't believe that the federal government could prevent a state from providing universal health care to its constituents. I don't believe that it would hold up in the federal courts. In fact, I doubt the federal government would try to use any legal maneuvering to prevent a state government from spending money to provide either health care or health insurance to its population.

Could they withhold federal Medicaid funds from a state? Perhaps.

The population is not the point. Then point is that looking at the problem as 50x (states) one at a time in a country of extremely mobile people is both undoable and unappetizing—a non-starter. There is no juice behind it for reasons I've already mentioned. People will not invest money and energy in a solution that is unworkable and impractical because it tackles a state at a time. Portability across states is a fundamental aspect of any plan and that can only be handled federally.

If the California legislature were to pass and the governor of California were to sign a single payer universal health care plan, similar to the one existing in Canada or Great Britain, advocates of single payer would be celebrating.

It would show that the most populous state in the United States, a state with a population larger than that of Canada's, had adopted the single payer world view.

But . . . . California has not passed any such legislation.

In Vermont there was a serious effort to pass single payer, despite that state's small population. But Vermont eventually gave up the effort because they found that they had no way of financing a single payer health care plan.

Why was there trouble with financing? Because the taxes that would have been required to pay for everyone's health care expenses would have been extremely high. Vermont already is a relatively high tax state. But to finance a single payer plan would have required large tax increases.

So, this argument that people who advocate for single payer are not interested in experimenting at the state level is incorrect. It is just that there are some very significant disadvantages to single payer and when a state is confronted with these disadvantages, they don't pull the trigger and enact single payer.

A similar situation happens when there is any attempt at enacting single payer on the federal level.

People who already have health care coverage that they wish to retain get nervous and ask, "If I like my current plan, will I be able to keep it? If I like my current physician, will I be able to continue to see her?"

Every action must start with a positive thought. Mine is that we can provide a basic level of healthcare for every single American. That this is important (nay vital) to our country's ills and it will be done of we apply ourselves to it.

I think that every action must start with a sober assessment of the advantages and disadvantages of taking a given action. We should not enact a healthcare plan because some politician makes it sound good.

Yours is defeatist, no can do, and same old same old.

I am not a defeatist. I simply believe that single payer health care is something that sounds much better in theory than works out in practice. And this explains why no deep blue state like California, Massachusetts, Maryland or Vermont will enact it on their own. It also explains why wealthy Canadians often come to the United States for health care.

Heck, in the city of Baltimore the Democrats outnumber the Republicans by an 8 to 1 ratio. You would think that due to this fact Baltimore would be a great place to live. All would be peace, love and understanding.

Things that sound good in theory don't always work well in practice.

[dailycarbs]

Spiral, I'm glad you're ejoying repeating the same old same old but it's not doing much for me. I will close with some practical realities:

What we do know is that:
- The health care system was (and possibly still is) coming apart at the seams.
- Obama got elected on a mandate to reform it.
- Accordong to many polls the single payer option was favored by many of Americans (and possibly still is). http://thehill.com/policy/healthcare/22 ... poll-finds
You'd think this sort of groundswell of public support would be justification for consideration and debate in any reform but it was never put on the table. Instead, the republicans with a coalition with blue dogs still birthed it. I'll leave you to wonder why.
- Cherry picked examples to the contrary, Canadians are not swarming the border and overrunning our country looking for health care. Every Canadian I've ever talked to (including several survivors of serious cancers) are very pleased with their health care system.


Edit: let's agree to disagree. At least we can agree on potatoes.

[dstewart]

What is the point of having these massive government structures if they don't provide things like roads, schools, airports and services like health care? What else should they be doing? Just saying.

To not leave the question as rhetorical: None of these things should a government be doing. A government should be doing nothing more than police, national defense, and courts. There should be no massive government structures; your question assumes that there should just be massive government, and then we'll find things for it to do--and you like roads, schools, airports and medical care as (some of) the things. None of those are legitimate government purposes.

[ETeSelle]

Trying to get Americans to accept the quality and quantity of health care that the British or the French accept would be very, very difficult to do. Sure, many people in other nations live longer, but that has more to do with things other than their health care system. Americans eat more meat than almost any other nation in the world. Our homicide rate is higher too.

The notion that other countries (Britain, France, Canada) have healthcare that is inferior to that of the US is a popular notion, but it is inaccurate.

http://www.commonwealthfund.org/publica ... ror-mirror

We are way down the list. Britain is first.

[ETeSelle]

Cherry picked examples to the contrary, Canadians are not swarming the border and overrunning our country looking for health care. Every Canadian I've ever talked to (including several survivors of serious cancers) are very pleased with their health care system.

My mom and her partner live in Vancouver and love the health care system up there. Do they sometimes have to wait a bit? Yup. But they feel it's fair. If something is truly urgent, it is treated as urgent. If it is not urgent, it is not.

[dailycarbs]

None of these things should a government be doing. A government should be doing nothing more than police, national defense, and courts. There should be no massive government structures; your question assumes that there should just be massive government, and then we'll find things for it to do--and you like roads, schools, airports and medical care as (some of) the things. None of those are legitimate government purposes.

This an extreme libertarian ideology not supported by Americans on the left or right. In presidential election after presidential election, libertarian candidates like Ron Paul can barely muster 1% of the popular vote. Nader, by comparison, got almost 3% in 2000, so progressives can claim everything should be socialied and be more in the right than libertarians. You're welcome to your opinion but it is supported only by internet noise and schoolboys in love with Ayn Rand's blatherings. The people have spoken again and again and they want federal government involvement well beyond what you describe here.

[f1jim]

Hmmm...Those "extreme" numbers sound like the counts for those that eat like us!
f1jim

[dailycarbs]

Hmmm...Those "extreme" numbers sound like the counts for those that eat like us!
f1jim

We're talking about governance. Although I agree it's the best woe, I would not agree that we have the right to mandate it on the other 99%. It would be unamerican.

[petero]

I can't wait until we privatize the roads! I'm saving up for a mile of Interstate 40 right now, for a retirement investment. It'll be gravel with a manned toll shack at both ends, so I'll be a job creator, a maker not a taker. I'll put up a yellow sign with a picture of tire treads crushing a rattlesnake and the text, "Don't tread on me... until you pay the fee!"

[petero]

supported only by internet noise and schoolboys in love with Ayn Rand's blatherings. The people have spoken again and again and they want federal government involvement well beyond what you describe here.

That's exactly right, in a democracy the business of the government is anything the people want it to be, not more or less.

[Spiral]

Switzerland rejected the single payer approach to health care. A Washington Post story.....

Switzerland rejects single-payer, will keep its own version of Obamacare.

Besides our own health-care system, Switzerland's may be the one that gets the most attention in America because of its similarities to the Affordable Care Act's new coverage scheme. So it seems worth noting that 64 percent of Swiss voters rejected a ballot measure on Sunday that would have scrapped its own system in favor of single-payer health care.

If that vote had gone through, it would have replaced more than 60 insurers with a government-run system, something that a fair number of liberals and others would like to see here, too. Instead, voters in Switzerland opted to keep their current system, which has key similarities to Obamacare. For nearly 20 years, Swiss residents have been required to purchase coverage from private health plans who compete for their business; those health plans have to offer a minimum level of benefits and can't reject people based on pre-existing conditions; and the government provides subsidies to help low-income people afford coverage. That's essentially how the ACA's expansion of private coverage is structured.

In the United States, Obamacare is far from the final word on health reform. There are plenty of liberals who would like this country to move to a single-payer system and see Obamacare as that stepping stone. There are some more local efforts — Vermont is trying to set up its own single-payer system, and former Medicare administrator Don Berwick campaigned on a single-payer platform in his unsuccessful gubernatorial bid in Massachusetts this year.

[Spiral]

So much for the "affordable" part of the Affordable Care Act. Looks like ObamaCare premiums will rocket next year while sky-high deductibles make it too costly for many to see the doctor.

Big insurers in six states "are seeking to raise rates an average 18.6% next year."

BlueCross BlueShield of Tennessee — which currently accounts for 70% of the ObamaCare enrollees in that state — is looking to increase premiums a whopping 36.3%.

CareFirst — which has 80% of the ObamaCare enrollees in Maryland — is pushing for a 30% increase.
Oregon's Moda Health wants a 25.6% increase, on average, for the roughly half of ObamaCare enrollees it covers in the state.

New Mexico's market leader, Health Care Service, wants an average 51.6% boost in premiums.

A couple of reasons for these huge spikes:

First, insurers now have claims experience on which to base premiums, and what these market leaders are finding is that enrollees are older, sicker and more expensive to cover than they'd anticipated.

Second, federal bailout programs meant to cushion insurance industry profits in ObamaCare's first couple years are starting to end.

This is part of the reason the Congressional Budget Office predicts ObamaCare premiums will climb 8.5% next year.

Then there's this — namely, a market distortion created by ObamaCare's premium subsidies. These big insurers know that most consumers won't even notice these higher premiums, because ObamaCare caps what they have to pay as a share of income.

Taxpayers, however, will notice when they are forced to cough up larger subsidy payments. So, too, will anyone who is ineligible for ObamaCare's subsidies because their incomes are above 400% of the poverty line.

To be sure, some of the proposed premium increases are relatively small, and state insurance commissioners will no doubt try to push down the double-digit hikes before they go into effect. But as Graham notes, because these latest premiums are based on ObamaCare claims data, regulators may not be able to push them down much.

Things aren't looking much better for ObamaCare enrollees at the other end of the spectrum, where even high-cost plans can come with substantial deductibles.

Families USA, a strong backer of ObamaCare, finds that a quarter of those in the individual market went without some needed care "because they could not afford the cost." That includes follow-up treatments, prescription drugs and primary care visits.

[dailycarbs]

In other news, health insurance companies are looking to increase insurance premiums (unlike before aca). Oh wait. My super high deductible insurance was averaging roughly the same 17-18% per year increase prior to this. Meet the new boss. Same as the old boss.

[Spiral]

In other news, health insurance companies are looking to increase insurance premiums (unlike before aca). Oh wait. My super high deductible insurance was averaging roughly the same 17-18% per year increase prior to this. Meet the new boss. Same as the old boss.

What did you think about the Washington Post article reporting on how the people of Switzerland voted down a single payer health care plan?

Is this just another case of cherry-picking? Or are their some disadvantages (along with some advantages) to single payer?