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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Katelew who wrote (4043)	1/19/2008 1:30:38 PM
From: John Koligman	Read Replies (1) \| Respond to of 42652

There was an article in the NY Times the other day about many Nevada voters viewing lack of healthcare as their defining issue. Some interesting stats were in it in regard to the percentage of people lacking insurance in each state. I found Michigan interesting, it's got one of the highest unemployment rates in the nation, but a much lower 'uninsured' rate than other states. Must be due to those 'dastardly SOCIALIST auto unions'!! <ggg> Regards, John Texas - 24.1% New Mexico - 21.0% Florida - 20.3% Arizona - 19.0% Oklahoma - 18.7% Louisiana - 18.5% California - 18.5% Nevada - 18.3% US average - 15.3% Wyoming - 14.0% Michigan - 10.6% New Hampshire - 10.4% Iowa - 9.3%

To: Katelew who wrote (4043)	1/19/2008 3:08:12 PM
From: Road Walker	Respond to of 42652

I don't see why some of that couldn't be retained in a single-payer system in the US. The government could offer a few different plans that have different levels of benefits with differents levels of cost attached. This might appeal to businesses who could then offer fancier plans to their most valuable employees. Or more likely, the government could administer a basic plain vanilla plan, and private insurers could pick up the rest, i.e. coverage for less critical expenses such as cosmetic surgery, extensive physical therapy, cosmetic dentistry, etc. Or the government could provide a plain vanilla plan, and the public could just learn how to SAVE UP for the other stuff, LOL. Or, as discussed here previously, the current private insurance companies could sell "gold plated" supplemental insurance.

To: Katelew who wrote (4043)	1/19/2008 4:33:08 PM
From: Lane3	Read Replies (2) \| Respond to of 42652

The government could offer a few different plans that have different levels of benefits with differents levels of cost attached. Yes, but as a practical matter, I wonder. Let's say we offer three different levels of service. Now, we have half of the population not paying any income tax. Presumably these people would get their coverage free. The rest would choose among the three tiers and pay insurance designed to cover that service lever. Which service level do we provide without cost to half the population? The basic coverage? Or do we flinch at treating them as second class citizens? We would surely end up making the free tier more than just basic, which means that those stuck paying taxes plus paying for their coverage would resent their treatment. My bet is that we'd end up with just one level of service from the public system and those who want more would get additional private insurance just like in France. So we still have insurance companies and we still have multi-payer and have accomplished what? We've given taxpayer-paid coverage to most those without adequate insurance, that's what. Which is effectively like just putting the not quite poor who are uninsured on Medicaid. Which would be so much easier to do.

To: Katelew who wrote (4043)	1/19/2008 7:28:41 PM
From: TimF	Respond to of 42652

In a single-payer system, the production and delivery of health care stays in the private sector. Doctors, nurses, pharmas, clinics, etc. stay just as they are now. But insurance processing, service, and payment doesn't stay the same as it is now. That, not the doctors, nurses, pharmas, clinics, etc. was what I was talking about when I said - "Others would replace the health insurance companies with government insurance, but then you lose on choice, and possibly lose on efficiency. (You benefit from greater economy of scale, and lowered marketing expenses, but you lose the positive effects of the drive to profit, and you lose labor flexibility)" So I don't see how labor flexibility would be changed. If the people working to provide insurance are civil service employees than providing insurance, processing claims, etc. becomes an area with less labor flexibility. The loss of choice was loss of choice over the type of coverage, and the administrators of the coverage. Even if you think government coverage would generally be better, it obviously won't be better in every way for every person. If the government becomes the entity that pays the bills, it more or less becomes the entity that sets the prices. If it sets the price of services, than it does have an impact on the doctors, nurses, pharmas, clinics etc. Just as with Medicare. Medicare seems to rely on the prevailing rates, then aim for the low end and adjust slower than the non-Medicare reimbursement does. Sometimes this means overpayment as rates have gone down but Medicare hasn't adjusted to the new lower prevailing rates. More often it means low, perhaps underpayment, which keeps some doctors from accepting Medicare patients. (I understand its even worse with Medicaid). If you have no prevailing market rates at all, than what will Medicare use? Rates arbitrarily chosen by some government bureaucrats? Previous rates whether or not they are still reasonable? The government could offer a few different plans that have different levels of benefits with differents levels of cost attached. So you have the choice of a few plans with the same administrators instead of many plans with many different administrators. You still have reduced choice. This might appeal to businesses who could then offer fancier plans to their most valuable employees. Than you don't have single payer any more. You increase the size of the biggest payer (the government) but keep other payers around. Or the government could provide a plain vanilla plan, and the public could just learn how to SAVE UP for the other stuff That actually would tend to keep prices down (and would if the basic plain vanilla plans where provided by the private sector). But many customers want extensive coverage, and also various political groups push for extensive (and expensive) coverage mandates.