Affordable Healthcare

Jul 2015
2,691
1,605
Maryland USA
understand. thank you. I made a proposal in post# 168. a comment or correction would be appreciated.
As requested, I read your proposal in post # 168. My initial comment is that I think it does form a basis for the development of a private sector/government partnership in order to secure access and coverage for all without an undue burden on taxpayers. I agree that any system must assure that all citizens (and I would include legal residents) have the capacity or resources to access and pay for their healthcare. That does not mean totally based on a form of insurance, it could include an HSA, for example. I'm not sure that I would change much regarding Medicare and Medicaid. Medicare beneficiaries have made payments to secure coverage in their senior years and Medicaid recipients do not have the ability to pay premiums or taxes. I might suggest an increase in the eligibility age for Medicare to make it more consistent to its initial intent. I would also leave the VA alone. Military service is sufficient payment for coverage, in my opinion. I would also develop incentives for employers to provide and share the cost of healthcare coverage, unlike the disincentives of the ACA.

I would also agree that a public option should be in the mix, for those that do not have the access, means or desire to secure commercial coverage. If one cannot document their ability to pay for healthcare services via commercial insurance, employer coverage or other means, use of the public option is mandated. However, the public option would not be a solely tax based program, but rather a government operated insurance program financed through premium payments. Premium payments based on age, the level of deductibles and coinsurance assumed and, importantly, the ability to pay. Any tax support would be to subsidize the premiums of those without the ability to pay in part or in full, much like the ACA attempted to do. I might even suggest a separate category of the public option to cover pre-existing conditions, giving many the opportunity to purchase commercial insurance for all other conditions and incidents. Such a program could reduce the price of commercial insurance for everyone.

From my perspective, as taxpayers, we have no obligation to finance the healthcare of those with the resources to provide for themselves, but we do have the responsibility to assist those that cannot.
 
Sep 2013
41,642
33,080
On a hill
Again, I must disclose that I have spent most of my professional life in the hospital industry, so accept or reject my comments with that understanding. Watching the debate regarding the payment, the delivery and cost of our health care, to me, is rather frustrating. It is frustrating because many if not most of the points used in that debate are generally accepted assumptions regarding those topics, not the reality of those topics. For example, most of the hospitals in this country are governmental or "not-for-profit", so there are no stockholder pockets to be filled with excessive profits. Even in the for profit sector, for which I was a part, the same mandates and regulations apply, the only difference is that they must pay taxes. In both sectors, profits are needed to provide the working capital to access new technologies and respond to the changes in delivery, such as the transfer of services from inpatient to ambulatory or outpatient. Funds are needed to comply with the ever increasing government mandates, for example, hospitals had to spend significant sums to accommodate the privacy requirements of the HIPAA as well as the standard billing requirements.

It is agreed that many specialty physicians make significant incomes, but I think the public perceives that the average primary care physician is making far more than actual. The last time I looked the primary care physician was not making multiple hundreds of dollars, their average income approximated $175,000 to $200,000. An income I don't see as excessive due to the responsibilities they assume in our litigious society, the cost of their training and the fact that they were in training when others were advancing their careers.

When some like to suggest that we replicate the systems of other countries, they do so as if they are comparing apples to apples, but they are not. Our population and geographical demographic are significantly different. The total population of many are the same as or less than our uninsured population. In every major USA city there are multiple facilities providing the extensive care for which only a handful are available in other countries. With a governmental single payer system financed exclusively by taxpayers, such duplication of services will become an issue. So the coverage of services not only will need even tighter controls but those allowed to deliver such services as well potentially reducing immediate availability.

It should be remembered that the payment for healthcare is being debated, not the cost of healthcare. There are numerous factors impacting the cost of care specific to our nation. For example, our education system, the better educated a population, the better use of available healthcare resources. Some like to use life expectancy statistics. If accidental deaths and deaths via violence are removed, the USA rises to the top of the list.

I'm quite sure that many do not understand that the payments from commercial payers are subsidizing the payment short falls of the current government programs. Medicare pays what the program perceives to be cost, not actual costs. The Medicaid program does not even pay those costs. Without the commercial subsidization, many hospitals, especially rural hospitals, could not remain financially viable. Without that subsidization, the burden will be placed on taxpayers, all taxpayers.

While I thought the ACA needed some major improvements, I liked the concept of it. Specifically, it sought a form of private sector, government partnership. In my opinion, the best means to finance healthcare in this nation is a workable private/public partnership. It represented a means by which not to place the burden totally on taxpayers. Additionally, I would suggest that the system used in Maryland be examined. In Maryland, hospital rates are controlled by a Commission, much akin to a public service commission. Governmental and commercial payers are subject to those approved rates.
This plan was created by health care providers

Single Payer FAQ | Physicians for a National Health Program

Next, insurance is, in part responsible for some of the crazy rates we see charged. Health care providers raise rates that insurance providers negotiate down. Therefore if doctor wants $1,000 for a particular service, he charges, say $1,700 knowing that insurance will pay $1,000 negotiated fee.

A pre existing condition made the individual purchase of health insurance un-affordable. For several years I paid out of pocket. What was interesting, was health care providers offered a 50% discount for immediately payment (which, fortunately I could do). The poor guy who really gets screwed is the one without insurance who has to make payments over time.

(BTW, an uninsured colonoscopy with single, uncomplicated, polyp removal [changes the procedure to abdominal surgery] can cost in the neighborhood of $20,000.)

IMHO, our system is so broken, no one knows what the true cost of health care is.
 
Sep 2013
41,642
33,080
On a hill
Incorrect. Your healthcare is not my responsibility, and my healthcare is not your responsibility.
That is an extremely short sighted attitude that costs everyone in a long run.

Think about it the next time some one shows up without insurance at an er with ebola. Do you really think treatment is just for him?
 
Last edited:
Jan 2014
16,162
6,165
south
As requested, I read your proposal in post # 168. My initial comment is that I think it does form a basis for the development of a private sector/government partnership in order to secure access and coverage for all without an undue burden on taxpayers. I agree that any system must assure that all citizens (and I would include legal residents) have the capacity or resources to access and pay for their healthcare. That does not mean totally based on a form of insurance, it could include an HSA, for example. I'm not sure that I would change much regarding Medicare and Medicaid. Medicare beneficiaries have made payments to secure coverage in their senior years and Medicaid recipients do not have the ability to pay premiums or taxes. I might suggest an increase in the eligibility age for Medicare to make it more consistent to its initial intent. I would also leave the VA alone. Military service is sufficient payment for coverage, in my opinion. I would also develop incentives for employers to provide and share the cost of healthcare coverage, unlike the disincentives of the ACA.

I would also agree that a public option should be in the mix, for those that do not have the access, means or desire to secure commercial coverage. If one cannot document their ability to pay for healthcare services via commercial insurance, employer coverage or other means, use of the public option is mandated. However, the public option would not be a solely tax based program, but rather a government operated insurance program financed through premium payments. Premium payments based on age, the level of deductibles and coinsurance assumed and, importantly, the ability to pay. Any tax support would be to subsidize the premiums of those without the ability to pay in part or in full, much like the ACA attempted to do. I might even suggest a separate category of the public option to cover pre-existing conditions, giving many the opportunity to purchase commercial insurance for all other conditions and incidents. Such a program could reduce the price of commercial insurance for everyone.

From my perspective, as taxpayers, we have no obligation to finance the healthcare of those with the resources to provide for themselves, but we do have the responsibility to assist those that cannot.
thank you for commenting - and yes, it is an attempt to form a partnership between business, citizens and government. I have found this works best for all, as it relies on an equal share of use and costs. as to Medicare, I feel the cost stated would, for 90%, end up being a reduction in premium cost based on the current monthly premium versus the modest 5% tax. Medicare, as you may know, is not free if you include doctor/specialist visits and prescription drug costs. and, with Medicare, there is no annual limit of your costs when the system doesn't cover all costs for some services. if we want a universal system for those who wish it, then it needs to supplant all existing systems and have it that way. otherwise, for those who can easily afford any healthcare available, they can have whatever they wish with the exception of paying the 5% tax on their SSA when they get to that age - it's pretty much chump change for them.