Let's stick with broad strokes here... I realize the devil is in the details, but what I'm TRYING to get is a blueprint that both sides could go along with... not a final solution. FTR, France Switzerland and others do something similar.

Medicaid and the VA serve a vital purpose, but I don't know ANYONE that would PREFER VA or medicaid to private insurance... even most HMOs. They only choose it because of costs or coverages.

Between public and private monies, we currently spend about $7000 PER PERSON on healthcare... with just over $3,000 of that being public.... That is $260/month for public monies only for EVERY person.

$260 per person per month buys a pretty decent private insurance policy in todays market. While we may have to adjust that number for pre-existing conditions and other issues... we could also adjust it by excluding people at the top of the income structure.

Rather than having a "public" option, which serves no purpose I can see other than to put the government into the insurance and healthcare businesses... Why don't we simply establish a "baseline" policy... much like our existing HMOs. Drs visits, wellcare etc all free... prescriptions free or very low cost... basic care free... major medical covered with limitations. SORT of like we do with mandated auto liability insurance.

Existing insurance companies could compete within this sector by offering more limited doctors choices with greater benefits... like you can only use this smaller group of doctors, but we cover Chiropractic or some dermatology for the same money. As long as they offer the mandated care for the mandated price, people can choose. They would also compete for suppliments... like greater access to doctors for a higher fee... or some elective procedures etc...

What are insurance companies good at?
Managing contracts and revenue vs expense.
What do they do poorly?
Deny coverage when they shouldn't.
BUT... if there is a sopecific government proscribed list of what they MUST cover... and what they will be paid for it... and WHO is eligible... Then all we need the government to do is collect the taxes and verify that there are actually 50,632,845 people on the rolls of company XYZ... and company XYZ covered all of the bills for those people they are required to cover.

Pretty simple if you ask me... and a good task for the government... rather than having the government operate its own insurance company.

I mean, if an insurance company does a poor job of managing their costs, then they go out of business and you move to another offering the identical coverage for the identical price. You might have to change doctors, but you wouldn't lose care. If they do a GREAT job, then didn't they earn it??

If the GOVERNMENT does a poor job of managing costs, they just increase taxes. Because they aren't really audited, could anyone TELL if the government were doing a good OR POOR job? If you didn't like the doctors on cheap plan A, you could switch to cheap plan b with identical coverage. If you didn't like the government doctors, what would you do? All of the private plans would be more expensive.

I've made broad strokes here... but I'd REALLY like to know why the government has to replicate something the insurance companies are already doing well. Instead, they should simply mandate cost and coverage... and monitor compliance.

I mean if Joe says he was denied coverage for an Ulcer... it should be easy to determine a) if it was on the covered list b) if he was eligible and c) if he was actually denied.

Hambone,

Where you have to be careful is to limit what's covered or else costs go nuts. That's our problem right now, one way or the other (with charity cases at the emergency roon being the last resort) we are trying to cover everybody for everything.

The beauty of the French/German/Swiss approach is they they know there will be quotas and queues and rationing in the free system. That's intentional, to keep a lid on costs. You don't want to wait, you pay to get to the front of the line. Some people pay, some can't, some can but don't. Since almost everyone has insurance, there are very few in the "can't" category. So instead of always trying to provide everything to everybody like ours does, they control costs up front. The marginal capacity between what the French do and what we do is incredibly expensive to maintain, and that's why our costs are so much higher than theirs.

You can approach it three ways:
1. You can provide everything to everyone all the time. That's what we try to do now, including the uninsured who get treated for free and their costs passed along to everyone. You can't control costs in this approach.
2. You can provide everything, but not in enough quantity to meet everyone's needs immediately, so you have quotas and queues and long waits and, yes, ultimately "death panels" to allocate resources.. This is what UK and Canada do (though both are backing off from it a bit now).
3. You can provide some things, but not everything, to everybody, and leave it up to the individuals to cover the gaps out of pocket or with private insurance. This is basically the French/German/Swiss approach.

I posted an article on mandates earlier today.

http://www.theweeklystandard.com/Content...z.asp?pg=1

Fixed link.

The reason I look at HMOs as the model is for that very reason...

They offer coverage for MANY, but not all services... and not all places or at all times... and while they might pay PA or RN but not MD rates to administer basic healthcare... the healthcare would be administered. Rationing would be a function (as far as I can tell) of the bartering for mandated coverage... and/or a measurable to help people decide between company a and company b.

Nice find Paul... Wisconson's plan with 34 mandates would fit within what we currently pay... and by adding tens of millions of subscribers, I suspect we could drop it more... not to mention any savings from avoiding ER charges.

If people and/or states want to buy more then fine. I'm wondering about NY... They have 52 mandates at a cost 4 times Wisconson's 34 mandates... IF you have coverage, but no way to mandate that you HAVE coverage. Seems pretty stupid to me.

The state could STILL say if you want something other than the Federal 34 mandates (or whatever it ends up being) you HAVE to offer 54 mandates. Many of those that currently purchase it probably would... and those that are uninsured would be better off

(09-30-2009 11:03 PM)Paul M Wrote:  I posted an article on mandates earlier today.

http://www.theweeklystandard.com/Content...z.asp?pg=1

Fixed link.

It's a good article.

One of the things that Owl69 alludes to is that the US has the "everything for everybody" mindset. Our news media encourage this, b/c every event that goes wrong is treated like a crime against nature. "Someone has to pay, and we are obliged never to let it happen again!"

I'm all for continuous improvement, but all of those approaches recognize the need for ROI, metrics and reasonable expectations.

buying coverage accross state lines is a common sense thing to implement, however why stop there? Why not let Lloyds of london write health polocies?

I would like to see a Medicorp. Roving bands of doctors and nurses treating the uninsured, especially in poor rural areas. Once your Medicorp commitment is up (5-7-10 yrs) you have your federal medical school loans forgiven. And just think of the experience on would gain in the general practice! Instead of 10 surgeons for every one GP, maybe we would see a resurgences in GP / family doctors which would help to keep costs down as they practice preventive medicine..

I also advocate for open borders and open visas for foreign doctors and nurses. If you graduate from an accredited foreign medical program and can pass a rigourous medical entrance exam, you get a free pass to the good ol' USA. Before you scoff, my neighbor was a dentist in Mexico City, but could not pass US boards with her Mexican certifications and could only qualify as a hygenist. There would be fraud of course, but a program like this would attract a hell of a lot of new medical blood......

Watch how many Cuban doctors float over to Florida.......

What is the #1 reform Doctors need to save billions annually in Defensive Medical Costs?

(you have 15 seconds) dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum, dum Ding

May we have your answer please?

I believe Owl69 has the right idea. The problem is we are trying to provide everything to everybody. I like the idea of providing minimum coverage and then you pay extra benefits that you can afford.

Summy,

I will agree that it seems that we definitely need tort reform. I have a question for you. Do you think "Free People Own Guns" pic would carry the same message if the hand holding that gun was black?

Tort reform is a panacea.

CERTAINLY there are frivolous lawsuits... but there are also bad doctors, or doctors who make mistakes. There is no group to protect MY assets when I accidentally rear-end someone... but they aren't hurt... yet they sue me for "soft tissue" injury and my insurance company pays them $20,000 rather than fight... which raises my premiums. Why should doctors be exempt or have their liability limited if they screw up?

What we NEED is guidelines for recovery. Tort reform was put in place because juries were awarding multi-million dollar awards for mistakes by doctors they think are "gods".

Perfect example... Doctor left a rag in a woman... simple mistake... rather than admit it, he covered it up... stole the x-ray showing the towel (or at least it disappeared)... The woman had UNIMAGINABLE symptoms and almost died because he didn't take it out and insisted it was a side-effect of the surgery... foul stuff oozing from every orafice on her... finally, the rag worked itself out of her body in an extremely gross and almost unbelievable manner... the attending threw it away. No notes about the rags in the surgery notes... no comment about the count by the nurses... ONE line about seeing the radiographic tag by the x-ray tech, but the x-ray was missing so no evidence... the hospital said nothing, the doctors and nurses said nothing... she suffered immensely, but ultimately recovered.... and for their negligence... the TOTAL she was awarded by all 5 doctors, 2 hospitals and 7 nurses was $250,000... $150,000 of which went to the doctors defense (he had a "wasting" policy... and 25k in legal expenses and another 25k went to HER attorney.... She got 50k because he tried to kill her... and she only got that because ONE nurse was willing to testify that she saw them take out the rag.

True story... not "I heard of this guy"... and don't talk about criminal charges... they destroyed the only evidence, and you have to prove intent.

besides... you don't get compensated for criminal acts.

I support tort reform... but it has gone too far already.

(10-01-2009 05:51 PM)uhmump95 Wrote:  I will agree that it seems that we definitely need tort reform. I have a question for you. Do you think "Free People Own Guns" pic would carry the same message if the hand holding that gun was black?

We white conservatives don't believe all black people are the same, so yes, I think it would carry the same message. It's white liberals who are the ones that call conservatives racists because we sometimes denounce the black "gangsta" culture, ....as if ALL black people act like that. With me, it's about culture, race be damned. Do you agree with the black gangsta culture? The one that's killing inner cities across the nation? If not, what makes you different than me? Except color?

As for the "basic" needs, what is basic? Checkups? Preventative shots? Isn't that like me expecting my auto insurance company to pay for my gas, tune ups, and oil changes? Why can't we get back to what insurance was initially set up to be for, medical catastrophes/emergencies?

(10-01-2009 05:51 PM)uhmump95 Wrote:  Summy,

I will agree that it seems that we definitely need tort reform. I have a question for you. Do you think "Free People Own Guns" pic would carry the same message if the hand holding that gun was black?

Until you just asked, I had never notice the color of the hand. Truthfully, looking at it now on my laptop, it could be black or white. I believe you when you say it isn't black. I'll have to look on my desktop later.

It is an interesting question. I can only speak for myself, but being as I never noticed, it wouldn't change for me. My guess is the only people it would have dual messages for would be those who see color in everything and believe people of color need special considerations because they are incapable of doing anything on their own *cough* liberals *cough*.

The liberal jab is not directed at you mumps. That was intended just for the dumb*** white ones.

Would the message change for you?

Damn, the more I look at it, the less sure I am that it ain't black.

Baucus Bill specifically prohibits "national marketing" of insurance coverage.

Amendment didn't pass.

I know the trial lawyer types are defensive when it comes to tort reform. It's expected. But until that little gravy train is run off the tracks there can BE NO MEANINGFUL Health Care REFORM. It's not just jury awards, It's defendants, lawyers, judges and insurance companies. It's a ClusterF'ck and you know it, if your are honest you can see it. I know its a tough nut to crack. Judges MUST push cases along, sanctions for the ones that delay. Insurance Companies must make meaningful attempts to settle putting cash up front equal to their legal costs or face penalty when they lose. Defendants must be truthful about their injuries or be pored out of any settlement. Lawyers need to take cases regardless of the value of the injury so people are not denied access to the court because their case is not worth enough money. Its a Sh!t sandwich and everyone is gonna have to take a bite. That why the Sh!t Sandwich is OFF THE TABLE.

It's a Black Mans hand. It does not make a difference to me. There are slaves of every color. Get over it.

Looking on my desktop now and it still appears to be a black mans hand. Still no difference in meaning to me. It's sums picture. If he say it's black, that's good enough for me.

(10-01-2009 07:06 PM)Rebel Wrote:  As for the "basic" needs, what is basic? Checkups? Preventative shots? Isn't that like me expecting my auto insurance company to pay for my gas, tune ups, and oil changes? Why can't we get back to what insurance was initially set up to be for, medical catastrophes/emergencies?

Swine flu is a perfect example... we want people to have vaccines and stay home from school as much so that they don't infect us as anything else.

The comparison to auto insurance is not bad... but only liability is mandated... and like swine flu... that is so you don't hurt ME... not to protect you. Though there will certainly be a debate, I don't think the MANDITORY healthcare should be everything...

We don't/shouldn't let people die in the streets because they can't afford antibiotics.

(10-01-2009 08:47 PM)SumOfAllFears Wrote:  I know the trial lawyer types are defensive when it comes to tort reform. It's expected. But until that little gravy train is run off the tracks there can BE NO MEANINGFUL Health Care REFORM. It's not just jury awards, It's defendants, lawyers, judges and insurance companies. It's a ClusterF'ck and you know it, if your are honest you can see it. I know its a tough nut to crack. Judges MUST push cases along, sanctions for the ones that delay. Insurance Companies must make meaningful attempts to settle putting cash up front equal to their legal costs or face penalty when they lose. Defendants must be truthful about their injuries or be pored out of any settlement. Lawyers need to take cases regardless of the value of the injury so people are not denied access to the court because their case is not worth enough money. Its a Sh!t sandwich and everyone is gonna have to take a bite. That why the Sh!t Sandwich is OFF THE TABLE.

I fully agree... but the response in Texas to "Tort Reform" was to require a statement by a sitting physician saying the other physician did something that violated the standard of care. In the specific case i mentioned... with no proof (because the doctor didn't note the chart and the x-ray disappeared) no doctor could say for a fact that the Dr was negligent... add on top of that the wasting policy (which actually encouraged the defense to run up expenses) and the policy limitations (250k TOTAL for all involved) it almost wasn't worth suing a doctor for trying to kill a patient.

Your proposal makes INFINITELY more sense... but it is a far cry from what we get when we ask for tort reform

(10-01-2009 09:27 PM)Paul M Wrote:  Looking on my desktop now and it still appears to be a black mans hand. Still no difference in meaning to me. It's sums picture. If he say it's black, that's good enough for me.

Dude, you need to replace your laptop and monitor.

(10-01-2009 09:36 PM)Rebel Wrote:  

(10-01-2009 09:27 PM)Paul M Wrote:  Looking on my desktop now and it still appears to be a black mans hand. Still no difference in meaning to me. It's sums picture. If he say it's black, that's good enough for me.

Dude, you need to replace your laptop and monitor.

I am long over due for an eye exam too!