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1. Brian Shields says:

   March 5, 2009 at 9:06 pm

   How?

2. mike g says:

   March 5, 2009 at 9:32 pm

   For one, companies would be relieved of the burden of having to pay exorbitant health insurance premiums on behalf of their workers. That capital could go into reinvestment and/or expansion.

3. Unstable Isotope says:

   March 5, 2009 at 9:59 pm

   I also think that having universal healthcare would encourage more small businesses to start. Right now people are terrified of losing their jobs and their healthcare.

   The U.S. is also the only developed country that has medical bankruptcy. This is a huge problem.

4. Brian Shields says:

   March 5, 2009 at 10:34 pm

   The cost isn’t going to go down, it’ll just be replaced by taxes.

5. Brian Shields says:

   March 5, 2009 at 10:38 pm

   You seriously can’t look at nationwide universal healthcare until you fix the system in place: Medicare.

   There are abuses and cost overruns that are rampant, and rising year over year nearly exponentially.

6. anon says:

   March 5, 2009 at 10:49 pm

   86.7 million is one hell of a voting bloc.

7. cassandra_m says:

   March 5, 2009 at 10:50 pm

   Abuses and cost control issues are in Medicare and in Medicaid and in the VA system — the abuses are a question of management control, which can be done. The cost control issues are the same issues that private insurance has — the cost of care is rising much faster than inflation, care is driven by services rather than by outcomes, and those with insurance are paying for those without it.

   The cost of care is a worldwide challenge, but we may be the only industrialized nation that is paying for our uninsured in the most inefficient way possible. Which is part of the reason why for all of the money we spend, we have mediocre health outcomes.

   You can see the car companies’ issues with health care commitments that made to their workers as very emblematic of the problem. When the current group of retirees’ were making cars back in the day no one could have predicted how fast health care expenses could rise. These companies’ did little to prepare for these retirements, but they’d be stuck whether they did or not. Just a question of degree.

8. Unstable Isotope says:

   March 6, 2009 at 5:42 am

   The private system is extremely expensive, much more expensive than Medicare. We have to pay a whole bunch of middlemen in the private system and its delivery is extremely inefficient.

9. Dana says:

   March 6, 2009 at 7:18 am

   Y’all write as though universal health care would somehow be free, or at least not fall on corporations as an expense. The last atte,pt, the awful Clinton plan of 1993, would have put the burden on corporations, and at least what President Obama talked about during the campaign would put the burden on employers.

   Regardless of how such a plan is structured, someone is going to have to pay for it. And there is no particular reason to think it would be any cheaper.

   One of my drivers, who very foolishly voted for Barack Hussein Obama, keeps talking about “if they’ll just fix health care,” he could retire early. But regardless of what is done, he’d still have to pay, in taxes if nothing else. The thing is, he is an Air Force veteran; he’s seen, first hand, how having the government run something does not make it any less expensive.

10. pandora says:

    March 6, 2009 at 7:27 am

    If he’s a veteran, Dana, then why isn’t he using the VA?

    (And what’s with all the y’alls?)

11. Brian Shields says:

    March 6, 2009 at 7:32 am

    I really don’t like using the VA unless I have to. I like to think that the vets injured while on duty deserve the treatment more than I do. I am sure there are other Veterans who feel the same way.

12. Brian Shields says:

    March 6, 2009 at 7:33 am

    If cost savings and management issues and cost controls “can be done,” then why aren’t they?

13. anon says:

    March 6, 2009 at 7:42 am

    Regardless of how such a plan is structured, someone is going to have to pay for it.

    Exactly. Right now we are cutting costs by letting 87 million people go uninsured. Except that the costs for the uninsured pop up in other areas of society.

    And there is no particular reason to think it would be any cheaper.

    And no reason to think it will be more expensive (that is, cost per person, once you bring in all the uninsured).

    If cost savings and management issues and cost controls “can be done,” then why aren’t they?

    Because management is spread acruss thousands of private companies alliwth their own agendas, none of which are in the interest of either the patient or the taxpayer.

14. pandora says:

    March 6, 2009 at 7:45 am

    Because, Brian, up until now, they haven’t had to control a thing. This is the fantasy about capitalism. It isn’t about competition and survival of the fittest. It’s about businesses raising their prices together in the name of mutual survival.

15. Dana says:

    March 6, 2009 at 7:46 am

    Y’all is the plural of you, which is a singular. 🙂

    Tyhe guy to whom I refer is constantly combitching about the $61 a week he’s paying for his health insurance, a family plan which covers his wife and younger son. I’ve pointed out that if an employer-based coverage system is passed, he’d still have to pay, but then so would his wife.

    I don’t know what kind of coverage he can get through the VA, but he spent four years in the Air Force, twenty years ago. There’s no VA hospital close to us, and that would still leave the issue of his wife and son.

16. Dana says:

    March 6, 2009 at 7:50 am

    Mr Shields asked:

    If cost savings and management issues and cost controls “can be done,” then why aren’t they?

    Oh, they are, they really are!

    But if you’re counting on the government for cost contrls, you’re counting on the government that’s going to spend $20,000 for tattoo removal machines for gang areas of LA, and $1.7 million for pig odor research in Iowa. Good luck with that!

17. Truth Teller says:

    March 6, 2009 at 7:55 am

    Look in order to find out what system works. Let’s look at the system our Senators and Congressman have.
    Several of them have had serious Health problems and what i would like to know is how much out of pocket cost they had on their recent Health care.
    Biden and Spector come to mine along with others.

18. anonone says:

    March 6, 2009 at 8:07 am

    Brian Shields wrote:

    There are abuses and cost overruns that are rampant, and rising year over year nearly exponentially.

    Please cite a credible source, statistics, and time period for a “nearly” exponential rise in “abuses and cost overruns,” otherwise, please don’t just make stuff up or cite facts that are unsupportable in reality.

    Thank you.

19. Dorian Gray says:

    March 6, 2009 at 8:28 am

    This is a big red herring. The fact is the every western/industrialized (aka non-third world) nation has some type of universal health care, socialized medicine whatever. Actually some third word nations have it as well. It’s a moral imperative. Someone’s health isn’t and shouldn’t be a for-profit enterprise.

20. pandora says:

    March 6, 2009 at 8:43 am

    Some people consider health care a privilege .

21. Brian Shields says:

    March 6, 2009 at 8:43 am

    I don’t need to cite facts in this case, I see it every day.

    My FIL is my case study. Why, after his leg amputation, did he get a “temporary” prosthesis, and than six months later, get a second? Why is he required to have a “Life Alert” type system in his home, even though he will never use it. Why does a home health aide have to visit his home in order to qualify for the care he needs, even though he is quite capable of taking care of himself, with the family living with him?

    These are all required for him to receive either Medicaid or Medicare, and it’s a constant waste of taxpayer money. He should be able to opt out of it without fear of losing his eligibility.

22. Donhusseinsquishviti says:

    March 6, 2009 at 8:45 am

    fyi:

    Dana doesn’t think the Chimp Cartoon was racist. So, take any facts he presents with a grain of salt.

23. david anderson says:

    March 6, 2009 at 8:57 am

    The answer is maybe. It depends how it is designed. It could become a massive drag or it could be a boost. I will grant you that for long run prosperity we need better policies in the areas of energy, healthcare, and fiscal management.

    Remember health care is an industry and we have the most vibrant in the world in developing medicines and equipment.

24. cassandra m says:

    March 6, 2009 at 9:10 am

    Vibrant in developing technologies, but not so vibrant in keeping us all healthy.

    Brian, I think you are being rolled on the Medicare stuff. I’m watching over my Great Aunt and Uncle (he has altzheimer’s), and neither of them are being required to take services or meds that they don’t want. There is a home health person who comes by periodically who checks in with my aunt that she still wants to take care of my uncle at home, but that is it. Both of my grandmothers were on this and neither of them were forced into stuff they didn’t want, either. But A1, has a point — an ancedote is not data.

    My original point was that abuses could be managed — but that controlling costs was a much larger problem that even private insurance has issues with. And as long as the price of services includes paying for folks who don’t have insurance you won’t ever even make a dent in controlling those costs.

25. anonone says:

    March 6, 2009 at 9:21 am

    I don’t need to cite facts in this case, I see it every day.

    Right, Brian. Do yourself and everyone else a favor and don’t make up stuff like “abuses and cost overruns that are rampant, and rising year over year nearly exponentially” because you’re just spouting utter lies and nonsense.

    Writing stuff like “I don’t need to cite facts in this case, I see it every day” to support your meaningless wingnut generalizations and lies destroys your credibility and puts you on the same level as Duminique and her fact-free drivel.

    You’re a decent blogger, Brian. Check for paper (facts) before you flush your credibility down the toilet.

26. cassandra m says:

    March 6, 2009 at 9:25 am

    I’ll also add for Brian’s FIL situation — that kind of stuff (which does happen, certainly) argues for changing the payments for medical services for outcomes instead of services. Payments for services always provides an incentive to sell more of them.

27. anonone says:

    March 6, 2009 at 9:27 am

    cassandra_m,

    You’re right on.

    Medicare is, in fact, a blessing to millions of Americans like my Mom and your Uncle and Aunt. The system works, and should be used as a model for universal healthcare.

    Are there abuses? Yes, but they aren’t “rising year over year nearly exponentially” and people that abuse it are getting caught and prosecuted.

    There will be abuse in any system. Some doctors will rip-off patients directly, Medicare or not.

28. Unstable Isotope says:

    March 6, 2009 at 9:28 am

    We don’t control costs very well because we have a lot of different people to pay, and they don’t work together. The cost control in Medicare is actually much better than private insurance.

    For-profit medical insurance may be a very profitable business (as long as they keep kicking out sick people), but it does a poor job actually keeping people healthy. The U.S. measures of health (like infant mortality) are on par with developing countries, and are the lowest in the developed world.

29. Truth Teller says:

    March 6, 2009 at 10:44 am

    Of course it would.

    Look the Big Three Auto companies assemble cars in Canada because Canada has Universal Health care and the workers there are covered by the state unlike in Detroit or the USA.

    This little fact saves the Big Three $1500 per car

30. Brian Shields says:

    March 6, 2009 at 11:43 am

    Ok, ok, I may have gone overboard with that phrase.

    My FIL isn’t the best source, either. He says “I have to or they will take away my coverage.” I have to take it at face value. I remember one instance when he tried to tell his Home health Aide to never come back and wasn’t needed, and the Division of Aging told him he had to have it for some reason or another. It’s probably tied to his Medicaid top up for his disability.

    He is required to have it, though, from what I have been told. Of course, he is also a lying bastard who does things just to piss off his wife, so who knows. My home situation is screwed up.

    That all being said, I was out of line and over exaggerating.

    I do think there are abuses in the system, doctors milking Medicare and Medicaid, ordering extra services and extra tests they wouldn’t have if there was someone without insurance.

    Heck, my doctor does the same thing. Before she would prescribe medicine, she would ask what my medication premiums are to look out for me. If it is covered, why go for the generic? Why use the antibiotic that covers my ear infection when she can prescribe a mega antibiotic that may be more pricey, but covered by the insurance and covers more than a simple infection, and covers her butt if the infection was something beyond what we thought it was?

    See what I mean, it’s simple choices that are inherent in the system that nickel and dime the insurance companies and Medicare/Medicaid that raise these costs overall.

    For instance: I go in to get an annual blood sugar test, because I have a family history with diabetes. While I am there, and since it was covered, she ordered a full blood workup. I didn’t care, no extra cost to me.

    Now that I am uninsured, I just buy a blood glucose meter and the strips to test myself once a year, and actually save money compared to the doctor’s visit and the blood test costs.

    It is the psychology of “FREE to me.” You take the cost control out of the patient, and you take away the only cost control you have.

31. Brian Shields says:

    March 6, 2009 at 11:46 am

    Now, if Universal Healthcare was a high premium system set up like HSA’s, I may be on board with it.

    Matter of fact, HSA savings accounts are tied to retirement too, might be a way to work on a fix for Social Security.

32. anonone says:

    March 6, 2009 at 12:07 pm

    Brian,

    Thanks for stepping up – it says a lot of good things about your character.

    In regards to the full-blood work: it may have seemed unnecessary to you but it may detect something early when it is cheaper to treat. So the benefit-to-cost ratio of performing diagnostic tests can be really high. For example, it is a lot cheaper to treat high blood pressure or high cholesterol over a lifetime then it is to treat a single heart attack or stroke.

    And cancer research is moving big-time to try to develop super early detection tests because many cancers can be totally eliminated if detected early enough. The challenge is to learn to detect what very subtle changes occur in the body when cancer just starts.

    anonone

33. Sharon says:

    March 6, 2009 at 12:17 pm

    This 86 million number is a red herring. The fact that *some* people at *some point*in 2 years don’t have health insurance does not make them unable to get care. That number includes a lot of people (specifically young people) who don’t want to pay for insurance because they don’t expect to use it.

    The fact is that people with insurance use it a lot more than people without. Why not? They don’t think it’s costing them anything. And these consumers don’t bother comparison shopping for care or supplies, or making informed decisions about their care.

    How do I know? I’ve used nearly every form of health care available (or had experience with it) in my lifetime. As a military brat, I saw up close what that system looks like (and you don’t really want that unless you enjoy waiting 12 hours for a doctor to tell you to go take Tylenol, or wait 18 months for a routine physical). I’ve had a catastrophic health plan when I was just out of college, which cost me 20 bucks a month, but I paid my own doctor’s visits (that’s ok, since you don’t go to a doctor much at 23). I’ve had an HMO and a PPO, which wasn’t too bad for having children, but doesn’t work well for the health problems of aging. I’ve bought a policy for myself and my children, but that didn’t work well because insurance companies don’t really want those policies because they can’t make money on it. And I now have terrific insurance through a large corporation.

    And guess what? Once we got insurance through Big Corp, I had an elective surgery done that probably cost $10k or so. Did I need it? Nope, but I wanted it done. Wouldn’t have paid $10k out of my own pocket for it, but I’m happy I did it. And I bet all of you have or will have some sort of experience similar, where you had procedures done because “the insurance” paid for it.

    Under socialized medicine, I don’t really think the government would have been willing to do my procedure. If they did ok it, they probably would have tried to do it on the cheap, maybe with a less effective medicine or something. Because that’s how socialized medicine can cover everybody.

    My guess is that most of the bloggers here are (at least) under 50, which is when life isn’t too expensive (barring childbirth, of course). Telling the old folks to walk with a cane, instead of having that knee replacement, seems logical to you now. Maybe you don’t mind people with cancer being told to go home and die, but I’ll bet your attitude will change when it is you or a loved one being told this news.

34. cassandra_m says:

    March 6, 2009 at 12:26 pm

    The other reason that doctors over-order tests is for CYA reasons. It shouldn’t be that way — and I hope that electronic medical records (easily shared among practitioners) will reduce this practice.

35. cassandra_m says:

    March 6, 2009 at 12:29 pm

    Nominated for the Stupidest Comment of the Year:

    The fact is that people with insurance use it a lot more than people without.

    Hello? This is news? And as for it being free — the last time I was covered by insurance that paid for everything, I was living in my father’s house. Most people pay for some part of their treatments these days via copays and so on.

    Medicare isn’t turning away folks who need knee replacements now. So take your scare stories back to your friends who actually believe this stupidity.

36. Sharon says:

    March 6, 2009 at 12:31 pm

    Cassandra, are you really as idiotic as your writing makes you out to be? Yes, people with insurance pay copays or premiums, but that hardly covers the costs of expensive procedures including angioplastys, hip and knee replacements, life-prolonging cancer drugs and so on.

    If we get socialized medicine, you’ll be bitching in a few years that the government won’t pay for your life- or quality of life-prolonging procedure.

37. Sharon says:

    March 6, 2009 at 12:32 pm

    Yeah, Cassandra, we wouldn’t tell people they have a duty to die here.

38. anon says:

    March 6, 2009 at 12:36 pm

    The fairest way to distribute health care is to give it to everybody. The fairest way to pay for health care is via progressive taxes.

39. Sharon says:

    March 6, 2009 at 12:40 pm

    Health care is available to everyone, via your tax dollars now. That’s what county hospitals and health clinics do.

40. pandora says:

    March 6, 2009 at 12:45 pm

    You do realize, Sharon, that cancer patients in this country are sent home every day to die. All sorts of care in this country is already rationed, just not by the government.

41. cassandra_m says:

    March 6, 2009 at 12:46 pm

    Come on, Sharon — don’t keep upping the stupid ante:

    es, people with insurance pay copays or premiums, but that hardly covers the costs of expensive procedures including angioplastys, hip and knee replacements, life-prolonging cancer drugs and so on.

    Do you really not know how insurance is supposed to function? Grow up, will you — your life really will be easier.

    And provide some data that says that we are bullying people into dying here because it is cheaper and you may have a point. Otherwise you have your usual fear mongering masquerading as an argument.

42. a. price says:

    March 6, 2009 at 12:51 pm

    Sharon, come home from planet “emergency room”. accidently chopping off your arm and needing help isn’t the issue. OF COURSE people can go to a hospital for that….. they will have to pay later but the wont be denied care.
    the issue is people who get sick, cancer, heart problems, diabetes, high blood pressure…. whatever. conditions that require continued care that cost a lot of money. those are the people who …. why not …. WE are the people who need access to care. I dont want you to pay for my blood pressure medicine, I’d like US ALL to take care of US ALL.

43. Sharon says:

    March 6, 2009 at 12:51 pm

    Pandora,
    You do realize that everyone is sent home to die eventually, right? The argument that some cancer patients aren’t given drugs till the end doesn’t negate the fact that, at least in Oregon, they are telling people they have no option but to go die.

    Cassandra, you already upped the stupid ante from your first comment. I realize that providing links doesn’t qualify as evidence backing up statements for you, but I’m not gonna come hold your gnarly little hand and click the mouse for you.

    If you want to have a grown-up discussion about why socialized medicine is problematic, I can do that. But if you want to act like a petulant 2-year-old, forget it.

    Ok, now return to your regularly scheduled echo chamber.

44. a. price says:

    March 6, 2009 at 12:54 pm

    aaaaaaand sharon goes off the deep end.
    everyone goes home to die eventually? …..republican.

45. cassandra_m says:

    March 6, 2009 at 1:00 pm

    Thank you for going away.

    There is no socialized medicine even on the legislative agenda. That is some bullshit that your radio is lying to you over — again. Whatever comes out of Congress is going to look like Medicare or perhaps the Massachusetts insurance plan.

    Oregon is not forcing people to die. Which is probably another lie your radio tells you.

    If you want to have a grown up discussion about the real issues over health care you are welcome back as long as you get a clue about how insurance works, drop the bullshit over socialized medicine, and stop lying about people in Oregon being made to die. Because I’m hopeful that you know that you cannot have a conversation with someone who just insists on lying. And when you stop lying (or at least get better data) you’ll know that you are ready for the adult’s table.

46. pandora says:

    March 6, 2009 at 1:12 pm

    You go, Cassandra! Sharon has a need to subscribe to the “We’re #1” mentality. And her comment about everyone eventually being sent home to die is deliberately simplistic and purposefully misses the point.

47. Brian Shields says:

    March 6, 2009 at 1:49 pm

    The more I am thinking about it, the more I am thinking that a governmental form of HSA would be the middle ground here.

    It would eliminate the medical bankruptcy problem. It would eliminate the costs incurred with typical over ordering of procedures in a CYA fashion by putting those on the patient up to a certain limit. It would allow for a tax deduction for medical expenses and supplies. It would encourage savings and retirement.

    Last but not least it would provide for emergency coverage at an affordable cost to governments… and you can make the copay a certain limit for certain income levels.

    it will also keep the competition of regular health coverage, giving employers options and citizens options for better care, but providing for basic care at a basic cost.

48. anon says:

    March 6, 2009 at 3:27 pm

    Oh yeah, that’s what unemployed people need – increase the amount they may contribute to an HSA. And more tax deductions.

49. cassandra_m says:

    March 6, 2009 at 3:37 pm

    HSAs always look like a responsible option until you realize that this basically eliminates the basic function of insurance, which is risk pooling. Some HSA schemes require that you get catastrophic insurance, but it isn’t clear to me that the line is between routine procedures that you pay for and when the insurance kicks in.

    Controlling your own health care costs definitely works when you are in a position to clearly make those decisions. If you (or a kid) are dealing with a burst appendix or a heart attack or a dislocated shoulder I’m not so sure you’ll be able to control the purse strings nearly as well.

    But the bottom line on these accounts is that basically you can have the health care you can afford, which strikes me as many steps backward.

50. Rebuild the Delaware GOP says:

    March 6, 2009 at 4:05 pm

    I did not read all the comments but yes we could accomplish many things with universal care – things like Wellness, Productivity and Security.

    Include choice, competition and personal responsibility and you have a winner. We proposed DELACARE last year to do all of these things.

    I have some self interest here, my oldest son is a Medical Doctor and I want him to have a great career taking care of his patients not serving insurance companies.