The health care debate thread.

[LA Ute]

This is sort of a cherry pick of ideas from different systems, with misleading information tossed in. Example: the piece mostly criticizes the Canadian model, but points out 42% of German hospitals are private and can therefore access private capital. Well, in Canada, 100% of the hospitals can access private capital, as the Canadian model is single *payer*, with the provision of healthcare being private. The UK model is actually the one this point needs to attack.

Germany, Switzerland, the Netherlands and Europe in general is much more likely to regulate a major cost component in our system: the horrific effects of fast food and soda. In other words, the US could never achieve the results of these nations, regardless of the healthcare systems they have. Some Americans would be brandishing their AR-15s if anyone suggested the Super Size offering of Diet Coke should be regulated.

Ironically, the main idea this article represents - using private insurance and mandates - is EXACTLY the approach the Heritage Foundation / RomneyCare / ObamaCare takes, but mandates are under a frontal assault, here. Step One here should be to fix the problems with Obamacare and work from there.

The Heritage Foundation plan is a long ways from Romneycare in Mass., and even farther away from the ACÁ. Here’s how it is supposed to work. Stuart Butler, a Heritage healthcare guy, proposed a voucher system. Employers would give their employees a voucher to spend on whatever health plan they wanted. Plans would compete each year to be the employees’ choice. Employees could spend more than their voucher’s amount, or less and keep the difference. There was a healthcare savings account, a provision for self-employed people and something like a generous version of Medicaid for the lowest incomes; they could get a voucher too, if they wanted one. (I’ve forgotten those details.)

This is where the mandate came in, because that system wouldn’t work without one. The Heritage concept would never fly politically (unless a single party controlled the government with a filibuster-proof majority and rammed it through, which we have seen recently and which predictably produced deeply flawed and controversial policy). But it did have some interesting ideas.

I actually support an individual mandate. It’s apparently unconstitutional, however, unless the Supreme Court finds it is a tax.

I like the Swiss model a lot, but Switzerland a small country, geographically and in terms of population, and the Swiss people are culturally much more inclined to follow rules then we rambunctious Americans are. I am not sure it would work here. Politically, the Swiss system constrains personal liberty, which the right would oppose; and it does not provide free healthcare on a broad basis, which is sacred to the left.

[Ma'ake]

The Heritage Foundation plan is a long ways from Romneycare in Mass., and even farther away from the ACÁ. Here’s how it is supposed to work. Stuart Butler, a Heritage healthcare guy, proposed a voucher system. Employers would give their employees a voucher to spend on whatever health plan they wanted. Plans would compete each year to be the employees’ choice. Employees could spend more than their voucher’s amount, or less and keep the difference. There was a healthcare savings account, a provision for self-employed people and something like a generous version of Medicaid for the lowest incomes; they could get a voucher too, if they wanted one. (I’ve forgotten those details.)

This is where the mandate came in, because that system wouldn’t work without one. The Heritage concept would never fly politically (unless a single party controlled the government with a filibuster-proof majority and rammed it through, which we have seen recently and which predictably produced deeply flawed and controversial policy). But it did have some interesting ideas.

I actually support an individual mandate. It’s apparently unconstitutional, however, unless the Supreme Court finds it is a tax.

I like the Swiss model a lot, but Switzerland a small country, geographically and in terms of population, and the Swiss people are culturally much more inclined to follow rules then we rambunctious Americans are. I am not sure it would work here. Politically, the Swiss system constrains personal liberty, which the right would oppose; and it does not provide free healthcare on a broad basis, which is sacred to the left.

Thanks for the insight into the Heritage proposal (circa HillaryCare, right?) Presumably the vouchers would be based on a community rating? Insurers compete for the healthiest customers?

When I worked in health insurance - in IT, granted - the individual market was seen as being highly desirable, because the premiums/margins were pretty high. (No way to establish a group rate based on track record of the employee group.)

With the Senate inching toward no filibuster, the barrier to sweeping change looks to get lower. If a moderate Dem got elected POTUS, with strong leadership in the Congress, a reasonable course toward a hybrid model could occur. If Sanders wins and the far left gets stronger, it could be highly disruptive. There's enough lobbyist money swirling around DC to head that off, I think, not to mention it would be an electoral kamikaze mission.

Until we can get a handle on diet & lifestyle (and Pharma, and defensive medicine, and the expansive costs prevalent throughout the system), any attempt at reform will struggle against reality.

[Rocker Ute]

Until we can get a handle on diet & lifestyle (and Pharma, and defensive medicine, and the expansive costs prevalent throughout the system), any attempt at reform will struggle against reality.

This is core to any true healthcare reform. Anything that doesn't lower risk and improve utilization we are spinning our wheels. Then it is just a choice of being buried by taxes or private health insurance premiums.

This is actually why I am for high deductible plans with HSAs because people need to have an incentive to reduce their healthcare costs and that is only going to come with some skin in the game.

"Is there a generic equivalent to this drug?"

"If I choose between two procedures and the core difference is it takes me a week longer to recover but I save $30k let's do the cheaper..."

"If I drop 20lbs I can come off this blood pressure medication that is costing me $200/mo?"

There are soooooooo many instances of healthcare decisions that can make a difference in your care but save tens of thousands. Better personal health being at the top.

If you read Freakanomics you may remember the part about how realtors don't really act in your best interest and will persuade you to lower your asking price by tens of thousands of dollars because it only means a few hundred for them and they just want a quick commission. We have something similar in healthcare in that if the difference of certain types of treatment may be tens of thousands but only costs you hundreds if anything, we also don't make the best decisions.


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[U-Ute]

The Heritage Foundation plan is a long ways from Romneycare in Mass., and even farther away from the ACÁ. Here’s how it is supposed to work. Stuart Butler, a Heritage healthcare guy, proposed a voucher system. Employers would give their employees a voucher to spend on whatever health plan they wanted. Plans would compete each year to be the employees’ choice. Employees could spend more than their voucher’s amount, or less and keep the difference. There was a healthcare savings account, a provision for self-employed people and something like a generous version of Medicaid for the lowest incomes; they could get a voucher too, if they wanted one. (I’ve forgotten those details.)

This doesn't change anything. If anything it makes it worse. Currently, companies can aggressively negotiate terms based on group rates. That goes away with shifting the choice to employees. Plus, the illusion of "choice" is just that: an illusion. In reality, there isn't much choice in the insurance market.

[LA Ute]

This doesn't change anything. If anything it makes it worse. Currently, companies can aggressively negotiate terms based on group rates. That goes away with shifting the choice to employees. Plus, the illusion of "choice" is just that: an illusion. In reality, there isn't much choice in the insurance market.

Under that old Heritage plan individuals would be free to take their voucher to whatever plan they liked best. The idea was to make the plans compete for each person's business. Interesting idea, on paper.