Universal Healthcare Affordable?

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EvilGenius
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Post by EvilGenius »

Ok. These are my preferences, in order of impossibility. :)

1) The end of the world happens sometime in 2012 as many many ancient prophesies have predicted. Problems solved. :p

2) We invent StarTrek replicators and no one really wants for anything.

3) We outlaw all insurance as being a form of legalized protection racket. Doctors charge what people can pay, true market forces come to play which drives costs down for most care. Medical research and advancement grinds to a halt because there are no multi-billion dollar insurance companies subsidizing an astronomical cost structure which includes costs for R&D.

4) We negotiate for insurance companies to lower premiums and then for employers to stop paying insurance benefits. In a Good capitalist system, employers take the money they save (by many estimates, 50% of your total salary cost) and give it back to the employees. This gives people more $ in pocket. Inflation takes off as most working Americans get a 50% raise. People go out and buy their own primary health insurance the same way they do car insurance.

5) We institute national healthcare coverage that covers routine medical care and you can purchase supplementary care (ala AFLACK) to cover more.
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Lars Porsenna
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Post by Lars Porsenna »

NukeHavoc wrote: I'm not sure what you mean by "settling". Insurance companies weaseling out of their contracts is always an issue (and its certainly happened to folks I know), but under rationed health care, the government could simply have prevented you from getting the care in the first place.
Sounds like you've never had any credit card problems (which is a good thing of course).

"Settling" is where a debtor goes back to the creditor and says "I can't pay the full bill. But I'd be more than willing to settle and pay half, and we'll call the debt done." For average schmucks such as you and I this usually results in a black mark on our credit reports. For insurance providers, they just don't care.

I think if we were to go with your system, legislation would have to be passed to prevent that. Either the insurance providers would have to BY LAW pay the full bill submitted (except of course for resonable disputes), or the burden would have to be placed back on the end-consumer (i.e. bill reverts to them unpaid, and allow market forces of disgust adjust). The latter would stick a lot of customers with bills they might not be able to pay, and force them to go through litigation to recover damages. There'd be a real problem of growing pains (and I think it would be unfair to force custmers through that...)

Lars Porsenna wrote:I would also say that if you think T-mobile or ANY other corporation are going to "give" me back the $300 or $400 they pay in health insurance...
They are already "paying" you that money as part of your salary and benefits package; it's not a question of "getting it back" as much as it is moving from column A to column B. It's arguably something you'd need to work out with your employer, but people who've advocated such a plan usually include some stipulation about the money that had been going to paying for your benefits going into your salary.
I understand that. I'm being cynical in that I think most corporations will find a way of saying that is not part of our pay.

Damon.
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NukeHavoc
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Post by NukeHavoc »

Lars Porsenna wrote:"Settling" is where a debtor goes back to the creditor and says "I can't pay the full bill. But I'd be more than willing to settle and pay half, and we'll call the debt done." For average schmucks such as you and I this usually results in a black mark on our credit reports. For insurance providers, they just don't care.
But we have insurance (and legal systems) in place to handle this with other forms of insurance (car insurance, house insurance, etc.) which cover equally large sums. Is it possible for a company to go bankrupt because it wrote too many policies it couldn't cover? Yes ... but that's true of every other type of insurance that exists.

The weasel factor is always there (witness the after effects of Katrina) but this is not new ground.
"Oh, I'm so sorry. Forgive me. I'll try and be a tad more quiet as I desperately struggle to break free -- and save all creation!" -- Doctor Strange
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erilar
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Post by erilar »

It doesn't help that pharmaceutical companies are doing everything in their power to sell drugs at completely retarded prices.

Yes, people expect to have their "maintenance" prescriptions partially paid for by insurance, but that's because they are not affordable as-is. Again, "bad" capitalism.
"This enemy you cannot kill. You can only drive it back damaged into the depths, and teach your children to watch the waves for its return." - Quellcrist Falconer
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Jonkga
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Post by Jonkga »

I just want to throw out there that I wasn't really talking about national or socialistic healthcare (although, unlike others here, I am not opposed to such concepts). I was talking about a society not based upon income and/or money at all, where services such as helathcare no longer needed to be "paid for". I know, I know, it's a fantasy, but that's what I was envisioning.

As for this discussion, I don't really care much how healthcare goes. In my lifetime, I will either get healthcare or I will not, based upon what some sort of amalgam of my money and an insurance companies money can afford. Any of the proposals being touted all boil down to variations on a theme, and frankly, my eyes glaze over too early in these discussions for me to really have an opinion on any of the proposals.
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NukeHavoc
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Post by NukeHavoc »

erilar wrote:It doesn't help that pharmaceutical companies are doing everything in their power to sell drugs at completely retarded prices.
Yes, people expect to have their "maintenance" prescriptions partially paid for by insurance, but that's because they are not affordable as-is. Again, "bad" capitalism.
But again, we circle back to why are the prices so ridiculous in the first place? Sure, companies are going to charge as much as they can; that's the nature of the market. But the cost to bring a drug to market is ridiculously high, in large part because of a huge number of government regulations AND the fact that in many foreign governments set price caps. There aren't caps here, so our prices are even higher.

Of course, you could implement caps here as well, allowing the government to set the price for the various drugs, but price caps *always* produce scarcity; it's the nature of the economics, and it will simultaneously ensure that no one goes out on a limb to make the next wonder drug, because the chances they'll ever make their money back are slim to none.
"Oh, I'm so sorry. Forgive me. I'll try and be a tad more quiet as I desperately struggle to break free -- and save all creation!" -- Doctor Strange
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erilar
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Post by erilar »

NukeHavoc wrote: But the cost to bring a drug to market is ridiculously high, in large part because of a huge number of government regulations AND the fact that in many foreign governments set price caps. There aren't caps here, so our prices are even higher.
True, but drug companies are also enjoying tremendous profits compared to many industries. Again, "bad" capitalism if you will. (Although I don't like that term - it's either capitalism (i.e. a free market) or it isn't.)

In the end, any discussions on this problem boil down to "whining" in a sense, IMO, because it is unsolvable. Our government is too bloated, quagmired and corrupt to solve a problem of this magnitude, and corporate greed is too powerful an opposing force. I know that may sound defeatist to some, but I prefer the word "realistic" instead.
"This enemy you cannot kill. You can only drive it back damaged into the depths, and teach your children to watch the waves for its return." - Quellcrist Falconer
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EvilGenius
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Post by EvilGenius »

erilar wrote:True, but drug companies are also enjoying tremendous profits compared to many industries. Again, "bad" capitalism if you will. (Although I don't like that term - it's either capitalism (i.e. a free market) or it isn't.)

In the end, any discussions on this problem boil down to "whining" in a sense, IMO, because it is unsolvable. Our government is too bloated, quagmired and corrupt to solve a problem of this magnitude, and corporate greed is too powerful an opposing force. I know that may sound defeatist to some, but I prefer the word "realistic" instead.
I don't think that you sound defeatist at all. I think that's a perfectly rational analysis of where we are and the obstacles to moving forward.

Re: Bad/Good Capitalism - I agree that a system is either free market or not, however, as with logic, capitalism is only a system. It is neither good nor bad. The underlying moral principles of the users (precepts) are usually what causes the effect to be judged as good or bad.

Our economy today can best be described as "not a free market", IMO. We still have some aspects of a free market society and pay lip service to some of the ideas, but after the Great Depression the government decided to step in and 'guide' the economy so they could prevent another G.D.
setanta14
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Post by setanta14 »

Exactly... when you look at your paystub, what you pay for benefits is shown as a pre-tax deduction from your gross pay, just like 401K contributions. Then SSA, FICA, State, Local, etc. is taken out, and what is left is your net. You are already being paid the funds, as well as not having to pay taxes on them as income. This is the biggest reason why I support personal medical expense accounts. I haven't been to the doctor for anything besides physicals (2 of them) and the dentist since 1998, when I went for a severe sinus infection... think of how much money would be in my personal medical expense account since I haven't really used it for anything other than the routine?
NukeHavoc wrote:They are already "paying" you that money as part of your salary and benefits package; it's not a question of "getting it back" as much as it is moving from column A to column B. It's arguably something you'd need to work out with your employer, but people who've advocated such a plan usually include some stipulation about the money that had been going to paying for your benefits going into your salary.
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EvilGenius
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Post by EvilGenius »

I understand perfectly that medical benefits are part of an employee's salary and I think Damon does also.

What he and I are saying is that we find it extremely likely that if healthcare became independant like, say, car insurance, most corporations will 'adjust' your salary or hourly rate so that they're not paying you much (if any) more than you're making now. And yes, employers certainly can 'renegotiate' your contract and salary.
setanta14 wrote:Exactly... when you look at your paystub, what you pay for benefits is shown as a pre-tax deduction from your gross pay, just like 401K contributions. Then SSA, FICA, State, Local, etc. is taken out, and what is left is your net. You are already being paid the funds, as well as not having to pay taxes on them as income. This is the biggest reason why I support personal medical expense accounts. I haven't been to the doctor for anything besides physicals (2 of them) and the dentist since 1998, when I went for a severe sinus infection... think of how much money would be in my personal medical expense account since I haven't really used it for anything other than the routine?
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Lars Porsenna
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Post by Lars Porsenna »

Bob's got it in one.

I get paid hourly. I pay @$100 for my health coverage (covering Clare, Kaylee and me...Clare AFTER taxes). T-mobile ponies up another approx $3-400 or so (I don't recall the exact figures). So we switch to a free market insurance model. I get my $100 back to spend on insurance and that $300...? THat's what I'm talking about; maybe the company will chalk that up as a "benefit" or "extra income" (i.e. above and beyond what they are entitled to compensate me for) and say "sorry, your rate is $x." While salaried employees have more negotiating room, hourly employees have less. This is of course speculation, but that's sort of what this thread is about.

Damon.
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setanta14
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Post by setanta14 »

Yes, your pay is always negotiable if you don't have a contract, and when your contract is up, you are in the same boat... but what makes a company competitive in the market place in terms of attracting talented employees are the salary/benefits they provide. If you could get paid more somewhere else, then why wouldn't you go work somewhere else? It shouldn't be the responsibility of the company you work for, nor the governments to provide you with healthcare, nor any other social service... it is your own. Their only responsibility as an employer is to compensate you for the work you do based on an agreed upon arrangement for salary, hours, job duties, etc. It is your choice to continue working for them or not... it is also their choice whether they keep you as an employee or not. You aren't "entitled" to anything, nor should you expect to be. And believe me... you have just as much "negotiating" room as an hourly employee as you do as a salaried one... if they want you bad enough, they will pay you what you ask.

Lars Porsenna wrote:Bob's got it in one.

I get paid hourly. I pay @$100 for my health coverage (covering Clare, Kaylee and me...Clare AFTER taxes). T-mobile ponies up another approx $3-400 or so (I don't recall the exact figures). So we switch to a free market insurance model. I get my $100 back to spend on insurance and that $300...? THat's what I'm talking about; maybe the company will chalk that up as a "benefit" or "extra income" (i.e. above and beyond what they are entitled to compensate me for) and say "sorry, your rate is $x." While salaried employees have more negotiating room, hourly employees have less. This is of course speculation, but that's sort of what this thread is about.

Damon.
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NukeHavoc
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Post by NukeHavoc »

EvilGenius wrote:I understand perfectly that medical benefits are part of an employee's salary and I think Damon does also.

What he and I are saying is that we find it extremely likely that if healthcare became independant like, say, car insurance, most corporations will 'adjust' your salary or hourly rate so that they're not paying you much (if any) more than you're making now. And yes, employers certainly can 'renegotiate' your contract and salary.
Yep, they could do that. And lose their employees, since medical benefits are just another form of compensation, who would promptly move on to companies that did not do something so foolish.

But since the government screwed it up in the first place, a transition plan seems necessary -- even just allowing corporations to offer a yearly lump sum as an alternative to the standard health plan would be a beginning.

If it makes the liberals sleep better at night, then mandate that people have to spend some of that money on buying into a bare-bones government sponsored non-profit health plan, and then pocket the rest.

My primary point is that there are alternative, market-based solutions to this problem that *are* possible, and I wish we saw at least one Democrat (or hell, one Republican) would would stand up for them.
"Oh, I'm so sorry. Forgive me. I'll try and be a tad more quiet as I desperately struggle to break free -- and save all creation!" -- Doctor Strange
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EvilGenius
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Post by EvilGenius »

NukeHavoc wrote:Yep, they could do that. And lose their employees, since medical benefits are just another form of compensation, who would promptly move on to companies that did not do something so foolish.
While I do believe that this sort of change would cause many people to seek different jobs, the modern practice of 'market adjustment' is actually counter to the theory of competition.

When I was at Ford I talked to a lot of the branch management and a few corporate executives (I was only beginning to become angry at that point, so I was much more personable, and they let me talk to everyone. :) ). Several times during the three years I worked there, our benefits were reduced. Each time, the managers explained it as a move to 'stay competetive'.

What happens today is that large corporations, say company A, hires a consulting company who is able to provide Company A with a survey of what other companies in their 'direct competetor' list in their area are paying in salary and benefits, and even details what's covered under those benefits and costs associated. And most importantly, the consulting company provides an average of salary and benefits for an industry and a geographic location.

Then Company A looks at the list and says, "hmm. The average salary/benefit is X. We're paying X+5%. So we can reduce benefits by 5% in order to 'stay competetive'."

Now why doesn't the company that's paying X minus 5% increase their salary and benefits? Two main reasons.

First, the reason they're paying lower is because they found people who will accept that rate, and then the company built their cost and profit structures around it. Simply giving everyone a 5% raise would completely throw off profit margins and product pricing. You can't just pass on the huge cost increase to the consumer if your direct competetor is already priced about the same as you are.

Second, management knows that the largest operating cost is employee salary and benefits, not just for their company but for EVERY company. So the managers of all of their direct competitors (who went to the same schools and got the same MBAs) are always looking for ways to cut operating costs in order to increase profitability.

So if Company A is paying 5% less in salary/benefits than Company B and their product price is the same, Company B is going to be feeling internal and external pressure to reduce costs, and looking to emulate Company A's model; ie. Company B is going to come to the conclusion that their direct competitor, Company A, spends less money on salary/benefits and charges the same for a similar product. Therefore Company A is the 'stronger' company. Competition dictates that Company B will try to reduce their own operating costs, most likely salary/benefits, in order to match Company A's profit margin.

If Company B does NOT reduce operating costs in order to 'stay competetive', Company A will eventually make much more $ than Company B and Company B may go out of business.

This is not speculation or accusation on my part. This is how the mid-level executives of a Fortune 500 company explained their operating model to me.

What that means though, is that instead of companies competing to attract or keep 'line employees', they quasi-collude to keep salary and benefits down. Where they actually compete for employees is more at the executive level, although some similar cost balancing must occur at all orgainizational levels.

What this means to the general 'bottom of the totem pole' employees is that most of the employers in their field pay roughly the same, with very similar benefits.

So the prospect of 'go get a different job' is more of an option on paper than in the real world.
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erilar
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Post by erilar »

setanta14 wrote: It shouldn't be the responsibility of the company you work for, nor the governments to provide you with healthcare, nor any other social service... it is your own.
I agree completely, and would also elect to "take care of my own" given some option to do so. Unfortunately, one of the aspects of our US of A is our fervent proclivity to protect the stupid.

"That won't work!" say the movers and shakers. "If we just give everyone all their pay and expect them to take care of themselves, they will end up starving to death in a pile of their own excrement!" I don't necessarily disagree. I've witnessed people I work with doing extremely retarded things with their benefits - withdrawing and squandering their 401K, etc.

There is something to be said for the "golden days" (perhaps only perceived) where the company took care of their workers - insurance, pensions, etc., because these folks didn't have the opportunity to screw them up.

I'm sure that if we freed the system up for everyone to self-manage, most of them would use the extra income to buy a bass boat or whatever. It doesn't make me agree with Nate any less though. Given the choice, I will choose free will (as Peart says). :)
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