As can be seen throughout the media and on a growing number of blogs, the Democratic candidates' health plans is drawing a lot of attention. There is, however, one word that is drawing this attention more than anything else - "Universal". The meaning of the word, in this usage, is to mean that everyone will be covered. However, both candidates miss that mark and instead redefine it in significantly different ways.
Going back over the basics of their plans they are very similar: Both want to offer plans similar to the Congressional insurance plan (no specific information found about the coverages). Both want to expand Medicaid and SCHIP. They will both give subsidies and tax credits to help people afford the premiums. And both will force the removal of "pre-existing condition" clauses. These plans are an attempt to make insurance coverage more affordable and available to everyone.
Unfortunately, because insurance companies are for-profit and beholden to their stock holders to keep increasing those profits, these plans will never push the citizen payout to zero (at least not without bankrupting the government [further] and making it a short lived program). This means that there will be those who: can't afford one more bill, don't believe that the insurance companies that have screwed so many people over time and time again deserve their hard earned money, or are healthy and never see a doctor anyway who don't think they need to pay for health care when they can buy something they want/need. These people will not automatically be covered under the cores of these candidates' plans.
This is where Barack Obama has chosen to redefine "universal" to mean "universally available". He has said that he will make it affordable enough that anyone who wants insurance can get it easily. To make it even easier, he intends to set up a national institution to allow people to compare coverage side by side and get the plan that best suits their needs, if any. But he does not provide insurance to everyone. He has said in debates, speeches, and interviews that he doesn't want to fine people who can't afford it. And when someone uninsured does show up at a hospital or doctor's office needing care, they will likely face fines or have to pay back premiums - to keep everyone else's premiums down.
Hillary Clinton, however, does go another step. She believes that in order for her plan to be "universal", everyone has to pay for an insurance plan. This is how she changes "universal" to "universally enforced". She as yet has not explained how this will be enforced, but if her interview with George Stephanopoulos is any indication, if someone doesn't choose their own plan, one that matches the premium the government believes they can afford will be chosen for them and they will have to pay for it (either through garnished wages as former Senator Edwards proposed or fines/taxes - again, a very vague, dodgy answer).
Unfortunately, both candidates miss the real problem - although Obama comes closer in some of his related proposals (see the Providers heading on my previously linked chart). The problem isn't just getting insurance. I have insurance, and half the time I feel I would be better off without it. The problem is quality of insurance. It's all well and good for me to be able to say I have insurance, but if my deductible is $2,000+, I'm still bankrupt at my first medical emergency.
Just to throw some real numbers in here, lets say my premium is $200 per month (lower than what I expect the lowest rate they will get for middle income earners) and the limit of my health care needs is going to see a doctor once a year for an annual physical. I just wrote a check for $2,400 to an insurance provider (plus $20 to my doctor, who gets maybe $50-$100 more from the insurance company). Now, taking the long view, that $2,300+ is supposed to go to help Joe down the street when he is diagnosed with cancer and has to get treatment, but 1) there are, roughly 250 more "me"s than there are Joes (otherwise this would be an idiotic business model), and 2) Joe's coverage has an upper limit of (for the sake of argument) $500,000, even though his treatment is going to cost $1,000,000.
No matter which candidate wins the debate over this, who do you think is the real winner?
P.S. Don't even get me started on the Republicans' "plans"
7 comments:
john j, you are overlooking the two chief obstacles to Universal Government Healthcare:
Lawsuits and eligibility.
The single largest expense faced by Medicaid is liability payments in malpractice suits. The taxpayer is an easy target, and the taxpayer has deep pockets.
The government needs better lawyers and/or better doctors. However, as long as people like John Edwards can earn personal fortunes of $50 million by suing medical insurance companies, the cost of government healthcare will always run higher than private coverage.
Second is eligibility. Citizenship. Every person born on US soil is an American citizen. That means every person born on US soil will be eligible for Universal Government Healthcare. Hence, illegal aliens will have even more incentive to sneak into the US.
That means even the poorest person in the US is better off than millions and millions of Mexican citizens because there are no medical services available to so many in Mexico. And other countries.
If this country intends to offer Universal Government Healthcare, then changes in citizenship laws must occur.
It has been shown time and again that restricting malpractice lawsuits has no effect what-so-ever on premiums charged to doctors for malpractice insurance. From a Texas department of Insurance filing - "Non-economic damages are a small percentage of total losses paid. ... loss savings of 0.1%" I do believe that there needs to be tort reform, but not to cap payouts to the injured/family. I believe that the lawyers should have their fees capped. They payouts of $1 million to a 20 something that lost his/her legs because some doctor screwed up and now the person can't get a decent job is fine (imo), but the $1 million payout to a lawyer when the client gets $10k is an issue.
As for your immigration argument, it is false. Illegal immigrants are not covered under either of their plans. Their children, if born in the US, are US citizens with all the rights they deserve. It is not for us to punish the innocent for the acts of the guilty. This is something that needs better attention and should be addressed, but it is not the cause of our health care problem; it is merely a convenient scape-goat.
john j, you wrote:
"It has been shown time and again that restricting malpractice lawsuits has no effect what-so-ever on premiums charged to doctors for malpractice insurance."
There have never been any restrictions on malpractice lawsuits. Hence, your claim is out the window. I gather you don't understand that most cases are "settled" out of court, and that the settlements, in total, add up to a big number.
You argued:
"I do believe that there needs to be tort reform, but not to cap payouts to the injured/family. I believe that the lawyers should have their fees capped."
Parties in the US are free to make any agreement they wish with respect to payment for services.
You wrote:
"They payouts of $1 million to a 20 something that lost his/her legs because some doctor screwed up..."
Have you got even ONE example of such a misfortune?
and:
"...but the $1 million payout to a lawyer when the client gets $10k is an issue."
Again. Have you got even ONE example of this imbalance occurring? Medical malpractice lawyers typically work on contingency -- they get a piece of the settlement or jury award, like John Edwards. No settlement, no paycheck.
You claimed:
"As for your immigration argument, it is false."
First, my position reflects what WILL happen in the FUTURE. Thus, my argument cannot be false today.
Second, emergency medical services are provided to everyone in the US who needs them. Thus, an illegal alien who is injured in an accident can go to any emergency room for medical treatment. He will be billed, but nothing will happen to him when he does not pay the bill.
Meanwhile, sometimes illegal aliens are involved in violent crimes. They are shot or knifed and they are taken to emergency rooms. Sometimes they live for a while before dying. They receive extensive life-saving services. But they do not pay their bills if they die. That's how it is today.
You said:
"Illegal immigrants are not covered under either of their plans."
The cost of treating uninsured non-paying patients is buried in the bills of all those who pay, a group that includes both taxpayers and those who are privately insured.
You wrote:
"Their children, if born in the US, are US citizens with all the rights they deserve. It is not for us to punish the innocent for the acts of the guilty."
Millions of people sneak into the US because life here is better than life where they were. If we offer universal government healthcare to every person on US soil, we will add another inducement for the poor of the world to sneak into the US.
I am a big supporter of immigration and I support a guest-worker program that would permit easy entry for millions into the US labor force. However, many Americans disapprove of this idea. Therefore, illegal immigration will continue and illegal immigrants will continue to receive health benefits to which they are not entitled and US taxpayers will pay the bill.
The bottom line is this: if we give people more incentives to come to the US, they will come. Free healthcare for life is a huge inducement. Once illegal aliens are here and give birth to US citizens, there is no way to throw them out. Hence the citizenship laws must change or you can forget about Universal Healthcare.
You calimed:
"This is something that needs better attention and should be addressed, but it is not the cause of our health care problem;"
Cause? I didn't say it was the "cause" of our healthcare problems. I'm stating that expanding the pool of eligible beneficiaries will increase the burden on taxpayers. This is so obvious it's astounding anyone questions it. Our healthcare is expensive because it's good.
The "cause" of high healthcare costs is rooted in another obvious set of facts. People in the healthcare industry are well paid. Hospitals cost a lot of money. Medical insurance is expensive because it's easy to sue and obtain settlements. Drug development is expensive.
Moreover, lots of people suffer from diseases that are wholly preventable. Ailments stemming from smoking and drinking consume a huge portion of our healthcare dollars.
If you want to see a decrease in healthcare costs, or, at least a slowing rate of increase, then convince all Americans to quit smoking and reduce their drinking. While you're at it, get everyone to eat sensibly too. Add in a little regular exercise and you'll see extraordinary improvements.
There's also the option of limiting healthcare. That's what happens in the countries offering universal healthcare. They limit it. Limiting the availability of expensive services caps costs.
Nobody goes to Cuba to obtain healthcare. Just ask Fidel. He's going to die soon because Cuban doctors and Cuban healthcare are poor.
"most cases are "settled" out of court ... Parties in the US are free to make any agreement they wish with respect to payment for services"
Well, I guess we don't need any sort of tort reform at all by that logic. It is after all just an agreement on payment for (failed) services.
Of a doctor performing surgery on the wrong limb/side of the body? Yes - http://abcnews.go.com/Health/story?id=3789868&page=1 apparently, three times at this hospital.
Of lawyers getting millions of dollars while their clients get next to nothing? Yes - http://www.stltoday.com/stltoday/news/columnists.nsf/billmcclellan/story/70A129626AD8A9B4862573E2001621B0?OpenDocument (although this is a class action suit for a non-medical law suit, it is a prime example of the sort of bs that is allowed.
"First, my position reflects what WILL happen in the FUTURE. Thus, my argument cannot be false today." In other words, straw man.
As for your second argument, would you rather the hospital made you wait to get treatment until you proved you could pay in advance? From an ethical standpoint this is an indefensible statement. Also, this is currently an issue, both with American citizens that can't pay and illegal immigrants. It is already worked into the cost of a hospital. It will become less of an issue when more (or all, depending on the plan) people are covered. Thus costs across the board will go down because more people are paying.
"If we offer universal government healthcare to every person on US soil" - Straw man: they are planning on offering bought insurance to all citizens. Right now Medicaid and SCHIP covers the same people you are claiming will come running for our borders for health care.
john j, it's obvious you are deeply troubled by direct attacks on your viewpoints. You should toughen up.
Like I've said, deleting my posts won't change the outcome of any political race. But you might learn something if you can understand that a lot of people see the same things I see.
If I were troubled by attacks on my view point, none of your posts would still be on my site. I welcome opposing view points, but they must be backed up with facts. I will not accept lies, misleading statements, or racism, as has been reflected in many of your recent posts. I also will not allow my blog to degrade into a series of "Nuh uhs" and "Uh huhs", so if you do not add any new facts to the conversation your posts will be deleted. I would direct you back to one of my original posts for an overview of my commenting policy.
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