(09-30-2009 08:39 PM)Hambone10 Wrote:  I think the reason we don't see republicans OR democrats wanting this is that they lose control of THE MANAGEMENT of $1trillion dollars. Instead, they'd only collect payments and dole them out based upon some very simple and transparent rules... you know, like $5,000 per enrolled person. As opposed to the current accounting fiasco that creates opportunities for "pet" projects

I mean, I understand why Dems don't want insurance companies running the show, and I understand why republicans don't want the government running the show... but if the only part of the show the government ran was the IMPORTANT part, you know, ensuring that the insurance companies paid for covered services for covered people (pretty easy to figure out... either they paid it or they didn't... either they are covered or they aren't)... then BOTH should be saitisfied... but neither side can hide anything in that system. You can't collect more in taxes than you pay out in premiums without people knowing you've got a $100byn beauracracy.

I think you're onto something.

What does the U.S. health insurance industry think of the French model?

(09-30-2009 09:40 PM)S.A. Owl Wrote:  What does the U.S. health insurance industry think of the French model?

Haven't seen much on that, but I can say that the French health insurance industry loves it. The "free" plan gives them exactly what they want--a steady stream of cash to manage. They make a nice profit off the float. This is how plan proponents got them onboard in the first place. Plus they have the latitude to get pretty creative with the "pay" policies they offer.

And they got the docs onboard with a combination of helping with med school costs and malpractice, and putting the doc-patient relationship back in the driver's seat on health care decisions.

There's nothing there we couldn't do.

I wonder about the overhead/management challenges that having 51 (or is it more with the territories?) different states plus DC and their individual insurance regimes. That's a huge challenge to overcome in any solution that might be closer to the French/Swiss/German models, don't you think? I know many here think it's a problem (I do to), but how does one get around that one?

(09-30-2009 10:31 PM)gsloth Wrote:  I wonder about the overhead/management challenges that having 51 (or is it more with the territories?) different states plus DC and their individual insurance regimes. That's a huge challenge to overcome in any solution that might be closer to the French/Swiss/German models, don't you think? I know many here think it's a problem (I do to), but how does one get around that one?

It's 57, don't you remember, and Obama's been to all of them.

Seriously, there's an easy remedy, define health care as interstate commerce and the state differences go away. Not sure that's a good answer, but it is a quick one.

I'd rather see it handled another way, and I think it can be. If we had the two-tier plan, exempt the first tier from state regulation, and allow the states to do what they will with the elective tier.

69, not only a steady stream of cash, but an even wider pool of applicants to spread the risks... and let's face it... over time, if people become healthier... it is possible that their earnings could increase by having lower payouts and longer lifespans for their life insurance subs...

Educate me here sloth,...

If the federal government decided that "these" items were mandated to be covered at a cost of "x"... with certain requirements (I'm sure there would be plenty of lobbying for what those items were and what the cost was) What (at least broad strokes) would some of the issues be??

Personally, I'm closer to 69's thought where we simply mandate coverage and administration and let the states and feds oversee. Even as a Republican who believes in local decisions, I don't know that the people in one state want LESS coverage than people in other states. I mean if certain states want to add additional coverage mandates, that would be okay under this plan... you just can't offer LESS.

Not sure I can educate anyone on this topic, but I posed it for anyone who might be more familiar with the reasons for the divisions into state regulation. I'm sure there's tons of case law and/or formal laws around this one. You can be sure that the insurance commissioners (not an insignificant lobby, from my understanding in political power circles) would fight this one tooth and nail, breaking down those barriers. However, at the level that I think you’re getting at, Hambone, the states do get occasional mandates from the federal government that they then need their own laws to implement it within the confines that are managed/monitored/etc. by the state insurance commission.

In concept, I'm all for breaking down the barriers. And maybe 69's suggestion about a federal level for the base coverage, with the states still regulating the elective procedures, is the right model. However, I'm not sure you're getting the best efficiences by leaving the elective side in the states regulatory hands, as you'll still probably not have the diversity of participation (as noted in the column I linked to, there are currently only 18 carriers in the state of Virginia, with 2 owning 60% of the market) that could drive true cost savings. This scenario really doesn’t seem any different than what we have now. If anything, it might be worse for them, as the carriers have lost the more regular, consistent part of their business (the preventative consultations and simple procedures). Not sure where the competition is going to come from to get more participation unless the state barriers are broken down.

Hoping someone smarter in this stuff can add insight.

(09-30-2009 10:38 PM)Owl 69/70/75 Wrote:  It's 57, don't you remember, and Obama's been to all of them.

It was "57, no, 58...one to go".

(10-01-2009 02:21 PM)OptimisticOwl Wrote:  

(09-30-2009 10:38 PM)Owl 69/70/75 Wrote:  It's 57, don't you remember, and Obama's been to all of them.

It was "57, no, 58...one to go".

My bad

(10-01-2009 02:58 PM)Owl 69/70/75 Wrote:  

(10-01-2009 02:21 PM)OptimisticOwl Wrote:  

(09-30-2009 10:38 PM)Owl 69/70/75 Wrote:  It's 57, don't you remember, and Obama's been to all of them.

It was "57, no, 58...one to go".

My bad

Not YOUR bad.

Let me say that, coming perhaps from more to the left than most of the posters on here, I am totally on board that Congress should be required to follow the laws they pass. They should all get Medicare and any new health care plan enacted.

One thing I found interesting in listening to Pacifica Radio the other day is that some on the left believe the public option as it is being proposed now is being set up to fail. If I understood the argument, they say more sick people will sign up than healthy ones, and a few years down the road the costs will be such that it will be declared a failure and we will never get "real" single payer.


Frankly, I don't know a lot about this, but the French system sounds good to me. Anyone know why something like that is not on the table? Too much of a change to the current system, I guess?

(10-01-2009 04:14 PM)Owl75 Wrote:  Let me say that, coming perhaps from more to the left than most of the posters on here, I am totally on board that Congress should be required to follow the laws they pass. They should all get Medicare and any new health care plan enacted.
One thing I found interesting in listening to Pacifica Radio the other day is that some on the left believe the public option as it is being proposed now is being set up to fail. If I understood the argument, they say more sick people will sign up than healthy ones, and a few years down the road the costs will be such that it will be declared a failure and we will never get "real" single payer.
Frankly, I don't know a lot about this, but the French system sounds good to me. Anyone know why something like that is not on the table? Too much of a change to the current system, I guess?

I will probably offend your liberal sensitivities in saying this, but the reason I believe the French option is not on the table is because I don't think any of the principals involved in health care reform really give a damn about improving health care. It's a power grab, pure and simple. And the Obama democrats are just as intent on pulling economic power away from the people as the Shrub republicans were intent on pulling personal liberties away from the people. Either way, we get screwed. That's my opinion, at least.

If this were about improving health care, the French/German/Swiss approach would be front and center. But those plans don't give government bureaucrats the kind of life and death power that they enjoy in single-payer/single-provider systems. Yes, "death panels" are real, although oddly enough it's not the part of the house bill that was removed after those protests that gives rise to the concept. There simply is no way to run a single-payer or single-provider system without either skyrocketing costs or agencies with "death panel" powers to ration care (or, what usually happens, both).

Just one more iteration of the standard left-wing mantra, "This is a terrible crisis, and if you just turn it over to the government, we will solve it." Except that the bureaucracy created to solve the problem quickly realizes that once the problem is solved they aren't needed any more, so the first thing they do is make sure that the problem gets worse (so they get more money to solve it) rather than better.

Meanwhile the republicans are asleep at the wheel. I think they have proposals, but they can't explain them to me in ways that cause me to think that they have a clue what they're talking about.

I have little use for either major party.

I appreciate the perspective sloth...

18 providers with 2 having 60% of the market certainly implies that you can break even with pretty small market-share. In MY world, the costs and risks to the insurance companies would be spread across state lines, just as they generally are now... Medicaid contracts would be administered by BCBS, UHC, Cigna etc. I mean, from a practical standpoint, they're all doing the same thing anyway. The doctor lists and payment amounts might be different, but its the same idea.

75, see... THIS is where I believe the public is being lied to. Those we seek to insure (the poor) are already getting medical coverage... but it is usually in the emergency room (which is expensive) or at the "free" clinic (which isn't really free) or shows up in other parts of the economy like lost productivity, welfare and other checks we're already writing. People don't get paid when they have to spend the day at the clinic, or lose their jobs... The're getting bad, innefficient and expensive care. If they could go to the Walgreens clinic when they had an upper respiratory infection instead of waiting until it was pneumonia and going to the emergency room, we'd ALL be better off... and the costs wouldn't be any more...

My PROOF (honestly its just a theory) is that we currently spend $3100 PER PERSON on healthcare in this country... and that is just the PUBLIC portion of funds... not to mention the $3800 per person in private funds... The state of Michigan (iirc) mandates an insurance policy with 34 MANDATED coverages and it costs $3100/yr. That is, IF you offer insurance, you MUST cover these 34 areas... If Michigan can do it for that amount, then "the country" should be able to do it for even less.

See, to ME... the beauty of the system we are talking about is this...
Who determines how much the policy can cost? The government... but since the money isn't going into THEIR coffers to do something with, but into the coffers of corporations.. they have no reason to have that number be high... in fact, it is politically expedient for them to have it be as low as possible. NOW there comes a tug of war between doctors and insurance companies with the government being the arbiter... and the check they decide to write being the prize... I mean, ultimately... if the doctors or insurance companies want more money, they have to ask congress to increase taxes.

The argument would be simple... and the numbers should be easy and transparent. Sure, we could argue about corporate policies on bonuses and things... and PERHAPS you reach a point where insurers refuse to do it... but I REALLY like the idea that politicians are ONLY motivated to provide me with the MOST care for the LEAST cost... The left mandates 50 areas of coverage, the right wants 25... we settle on 35.... Congress decides it can be done for $2500pp, Industry says it can be done for $3500pp. Arbiters put the figure at $2800 and we roll along. It would REALLY be that simple from our perspective because it would be on everyoned 1040 form... How much are we talking PER PERSON or PER POLICY... not some masive figure of $3 trillion divided by some round figure of 250mm people... but we covered Joe and Mary and Steve etc... at income of $2800 per person and expense of 2790 per person.

69 it would take a lot more than that to offend me. I think our current system works well if you have money or work for a big company (or Congress). So I would like to see an improvement to the system, not for "power" but to have a better result for most people. Maybe others in Washington are about power but its hard to know. I imagine if anyone introduced the French ssytem it would be attacked very much as the worst kind of socialism. By the way, I don't identify with either major party much, but more with the Ds, at least in Texas. If I lived in Mass. maybe I would find the Rs better.

The french system isn't really socialism any more than "the public option" is.

By that I mean, the public option is billed as a way to convert the hodge-podge delivery of emergency type services into a system of care that will be more effective and less expensive. Unfortunately, the model for this care is Medicaid and the VA. Notorious for poor care and fraud. The PRIVATE version of this is an HMO... notorious for denying coverage.

The difference is, while the government doesn't WANT fraud, they really aren't incentivized to stop it... and if you don't like the quality of your care, they don't really care. You can complain to your congressman, but what can they do about it short of "overhauling Medicaid."

At least if the care were private, you could choose between BCBS, UHC or others and address your complaints to Congress who could threaten to kick one or more of them out of the "pool"... and if the care were mandated, denial of coverage wouldn't be an issue.

(10-01-2009 09:09 PM)Owl75 Wrote:  69 it would take a lot more than that to offend me. I think our current system works well if you have money or work for a big company (or Congress). So I would like to see an improvement to the system, not for "power" but to have a better result for most people. Maybe others in Washington are about power but its hard to know. I imagine if anyone introduced the French ssytem it would be attacked very much as the worst kind of socialism. By the way, I don't identify with either major party much, but more with the Ds, at least in Texas. If I lived in Mass. maybe I would find the Rs better.

Actually the French system is very much less socialism than the public option or the two models that the democrats seem to like so much--Canada and UK. And I see many reasons to believe that the public option is intended as nothing but a step on the way to NHS or Canadacare, and no reasons to believe otherwise.

The French have a very derisive term for the UK NHS--they call it "socialized medicine" and want nothing to do with it.

I would say that attacking the French system as socialism is completely misunderstanding it. That's what I find ironic about Michael Moore's movie--he praises French health care at the same time it's obvious that he does not understand how it works. I heard him say in an interview, "We need a single-payer system like France." Only problem, France is NOT a single-payer system (nor is it a single-provider system).

Calling the French system socialized medicine dovetails neatly with the bait-and-switch tactics of some leading democrats--I've heard several of them say, "France has great health care; therefore we need to copy UK (or Canada)." Worse yet, people are falling for it.

I would like to believe that our nation's leaders really want what is best for the USA and American citizens. It's been far too long since we have had a leader that I believed that about.