We got universal health care!

[Nurse Ben]

But states can opt out.

So now what?

[maestro8]

We grow the federal deficit even larger?

[Nurse Ben]

We grow the federal deficit even larger?

or maybe our premiums go down because we don't have to pay for the health care needs of the uninsured?

I wonder if health care will be triaged, and if so, then can you "jump" the helath care gatekeeper by buying a premium insurance or some gap insurance...

It is about time the United States joined the rest of the developed world in providing health care to all.

I also like that my kids will be covered under our insurace until age 26, very smart, now they won't have to struggle with that cost as they try to make it after graduating college.

Other than the possibility of increased taxation or changes in insurance premiums, what do we get from this package?

Anyone have thoughts on states being able to opt out? Any disadvantages?

[maestro8]

Originally Posted by Nurse Ben

or maybe our premiums go down because we don't have to pay for the health care needs of the uninsured?

Ohh that's funny!

We don't have to pay... because the money will magically shoot out of a unicorn's posterior?

Mmm hmm. Go on.

[nick]

Can someone explain to me what the downside of this particular plan is?

Also, what would be the downside of single payer (socialized) healthcare? I really hate that there is an entire industry out there that gets between me and my healthcare. As far as I can tell, all insurance does is add cost; the insurance industry doesn't provide a product, or a service of any real value.

Serious questions. Thanks for answering.

[Gilby]

Originally Posted by nick

As far as I can tell, all insurance does is add cost; the insurance industry doesn't provide a product, or a service of any real value.

Insurance is a good thing. What we have in the US is not really typical insurance anymore. Government destroyed it long ago which caused the problems that made people request government to do more of the same thinking it would fix the problems. If it were really insurance, people would buy it to cover the unforeseen higher cost cases, and pay out of pocket for the routine care, but now it is mostly expensive all-inclusive health care plans that people have. If people paid out of pocket, they would price shop around and cause downward price pressure on health care costs, and they would question if certain tests or medications are really needed.

So now we have people who have an unhealthy diet (probably since they follow the upside down food pyramid) that go to their doctor for that quick fix (the latest expensive designer medications), instad of looking for the lower cost solution to their ills (eating right and exercising).

Meanwhile, Nurse Ben is excited because his pill pushing industry is being subsidized.

[unibabyguy]

Originally Posted by nick

Can someone explain to me what the downside of this particular plan is?

The downside is that you'll be forced to pay for health insurance to help pay for the health care costs of all the unhealthy people. You know those grossly obese people you see in the grocery store driving around in the electric carts with their cart filled with stacks of red meat and junk food? Those people.

[maestro8]

Originally Posted by Gilby

If people paid out of pocket, they would price shop around and cause downward price pressure on health care costs, and they would question if certain tests or medications are really needed.

While I agree with most of what you say, here is where I have trouble: where the rubber meets the road if you will. Where theory meets practice.

When one is quite ill, time is of the essence. Heck even when he isn't quite ill... time lost from work costs money. Who would have the time to shop around? Especially given the fact that a call to a doctor's office rarely gets one in touch with a doctor or nurse?

How would one even shop around if they don't know their diagnosis? You're wasting a lot of time by going to the doc just to get diagnosed, then going to another doc to get treated... that second doc would likely want to re-diagnose you first to be sure you're getting the right treatment. This could be more expensive than if you just got treated at the first visit.

And who has sufficient knowledge to override a doctor's decision to question if a test or medicine is needed? Here is one place where insurance companies sometimes benefit patients... they can take statistical looks at remission / survival rates given particular diagnoses and treatments and sometimes make better decisions than doctors.

Yes, in theory, shopping around benefits the consumer. But I can't see how it plays out in practice in this situation. Sure, for elective procedures, in cases where treatment can be delayed, etc. But I don't think this will encompass enough of the medical market to make a big enough impact on pricing...

Edit: Food for thought: would you REALLY want a surgery done by "the lowest bidder?" At some point, price competition creates bottom-of-the-barrel providers. Mobile tonsillectomies? No thanks...

[harper]

Originally Posted by Nurse Ben

So now what?

The number of people in the US with health insurance will decrease.

[unibabyguy]

Originally Posted by maestro8

When one is quite ill, time is of the essence. Heck even when he isn't quite ill... time lost from work costs money. Who would have the time to shop around? Especially given the fact that a call to a doctor's office rarely gets one in touch with a doctor or nurse?

When your car breaks down, you often need a repair done on the car ASAP if it's your daily driver. You will often go to a mechanic whom you trust and have had prior experience with. Why should it be much different with doctors and hospitals? You go to a doctor or hospital whom you like where they have not charged you exorbitant fees in the past.

[Gilby]

Originally Posted by maestro8

And who has sufficient knowledge to override a doctor's decision to question if a test or medicine is needed?

A lot of times you can just ask the doctor. They may give you a recommendation, and if you then tell you are paying out of pocket they will tell you a test is not necessary, or that there is a cheaper medicine that is just as good.

When one is quite ill, time is of the essence. Heck even when he isn't quite ill... time lost from work costs money. Who would have the time to shop around?

Even if you do not have the time to shop around, you have the benefit of downward price pressure caused by those who do and can shop around. If you have an insurance policy, one of the benefits they may provide is to limit your out of pocket costs, even if you are under the deductible amount, to equal their predefined pricelist assuming you meet the conditions they lay out (ie. you are incapable of decision making, and/or they are notified asap to manage your care).

[tomblackwood]

Originally Posted by harper

The number of people in the US with health insurance will decrease.

Explain please...

[wobbling bear]

Originally Posted by maestro8

Edit: Food for thought: would you REALLY want a surgery done by "the lowest bidder?" At some point, price competition creates bottom-of-the-barrel providers. Mobile tonsillectomies? No thanks...

Hey Maestro we agree on that one!
Globally the economics of health care is something extremely complex and not understood even by economics spin doctors.
Every country where universal Health care is provided has to fight money leaks and fixing that depends much on local conditions. Two important (cultural?) points:
- one is social solidarity: yes I pay for those who may have poor health compared to mine. So where is the problem? For sure you can pinpoint problems with some people with irresponsible behaviours but do people that have big health problems suffer because some are irresponsible? no way!
- the other is personnal responsiblity from persons delivering health cares.
(I don't mean hunting doctors with lawyers!)

Oops yes I forgot the personnal responsibiliy of insurance companies when they prefer to fleece their customeers instead of offering a service (that merits a just retribution).

[harper]

Originally Posted by tomblackwood

Explain please...

Given a choice between a health care plan paid for out of pocket that is more expensive than the penalty (tax) charged for the uninsured, people will abandon their private insurance programs and let the state care for them instead. Maybe I was unclear; the number of people on out-of-pocket health care programs will decrease as they move into the inferior state-supported program. Health care as a whole will necessarily deteriorate.

I have $10K left from the bet that nobody took about the impeachment date of Bush that I am willing to wager on this. This is another sure-thing bet. Charles Murray's book, Losing Ground, from the 1980s describes the historical record of government programs like this, what they try to accomplish, and how and why they always produce exactly the opposite of what was intended. There was a weak apology written to this book that Billy or Raphael will chime in with eventually. What they won't chime in with is the $10K to cover the wager.

[wobbling bear]

Originally Posted by harper

This is another sure-thing bet. Charles Murray's book, Losing Ground, from the 1980s describes the historical record of government programs like this, what they try to accomplish, and how and why they always produce exactly the opposite of what was intended.

by "governement" you mean just the US governement ... or just any "government" ?