House Democrat Health Plan

[jamaesi]

The main reason, not the only reason, but the main reason your premiums are going up is that every year the insurance company has to pay out more to providers. Don't confuse this with me being an apologist for the insurance industry. I'm not. But we should temper our liberal demonization of the industry with what is real, not imagined. Where does this leave Jamaesi if we follow your lead?

Jackytar

I am perfectly capable of speaking for myself, you don't need to use me as a talking point in post after post.

 

[Copernicus]

The main reason, not the only reason, but the main reason your premiums are going up is that every year the insurance company has to pay out more to providers. Don't confuse this with me being an apologist for the insurance industry. I'm not. But we should temper our liberal demonization of the industry with what is real, not imagined. Where does this leave Jamaesi if we follow your lead?

It is true that the providers and the insurance companies play endless games with each other. The providers send us the bills, along with the amount allowed by the insurance company--as if the insurance company were somehow cheating them. But they negotiate contracts well in advance of that little game. The bills are sufficiently noisy so that inattentive or elderly folks might think that they had to pay. Providers also routinely tell us that we must make co-pays that we do not owe them under our policy, and then they claim not to know all the details of every insurance policy when we point it out to them. (They can easily see the details by asking to see our insurance cards, but there are a lot of different policies with arcane details that few people can retain.) I assume that they keep the co-pays from less well-informed patients. I am not holding the providers blameless by any means. But the providers tend to be more on the side of health care reform lately, since it would simplify their businesses immensely. The insurance companies are the ones asking us to guess which shell the pea is hidden under. The government needs to step in on the side of the citizen-consumer.

 

[Jackytar]

The government needs to step in on the side of the citizen-consumer.

And how is it that they're not attempting to do exactly that?

Jackytar

 

[Jackytar]

Not to mention "death panels", which you haven't yet gotten around to justifying, although I don't doubt that you would if pressed on the subject.

Alceste a propagandist? What a silly notion.

Jackytar

 

[Jackytar]

I am perfectly capable of speaking for myself, you don't need to use me as a talking point in post after post.

I was parroting others who invoked your plight as a an example of the problems we face. I'll refrain from using your name in future posts.

Jackytar

 

[Alceste]

Alceste a propagandist? What a silly notion.

Jackytar

Jacky, voicing an opinion is not "propaganda".

propaganda
noun
information, ideas, opinions or images, often only giving one part of an argument, which are broadcast, published or in some other way spread with the intention of influencing people's opinions

 

[Copernicus]

And how is it that they're not attempting to do exactly that?

By formulating a bill that gives advantages to the insurance industry at the expense of ordinary citizens. Surely you understand why the Senate, which is the real roadblock in this issue, would be predisposed to do that, don't you? Why would you constantly refer to the Finance Committee bill as the only one under consideration? Why would the national news media encourage that perception? Why isn't the US Senate Committee on Health, Education, Labor, and Pensions considered the main architect of this legislation? They passed a bill out on July 15 that contained a strong public option. Nevertheless, it is the Finance Committee, with its idiotic "bipartisan" ad hoc panel of 6 Senators--evenly split between Republicans and Democrats--that is considered the chief architect of health care reform in this country. They are the only legislative committee that does NOT have a public option. Do you know why?

 

[Jackytar]

By formulating a bill that gives advantages to the insurance industry at the expense of ordinary citizens.

How so?

Jackytar

 

[Copernicus]

How so?

My remarks were clear enough. Mandatory insurance guarantees income to the insurance companies. Without a public option, there appears to be no effective means of controlling the content of policies, the premiums, or the fee schedules. The "free market" does not actually work to control costs, which is why health care in the US costs substantially more than elsewhere. The bill coming out of the Finance Committee, whose chair has a clear conflict of interest caused by heavy industry campaign contributions, is essentially an industry-crafted bill.

 

[Jackytar]

My remarks were clear enough.

Enough with the acrimony, okay?

Mandatory insurance guarantees income to the insurance companies. Without a public option, there appears to be no effective means of controlling the content of policies, the premiums, or the fee schedules. The "free market" does not actually work to control costs, which is why health care in the US costs substantially more than elsewhere. The bill coming out of the Finance Committee, whose chair has a clear conflict of interest caused by heavy industry campaign contributions, is essentially an industry-crafted bill.

Mandatory insurance is essential if we are going to have guaranteed issue and community rating. Otherwise an individual can forgo getting insured and obtain a policy at a community-adjusted rate when they get sick - even very sick. It will also help to bring down costs because a large segment of the uninsured are healthy people who are taking their chances - even when low cost insurance is offered by their employer (we have seen this in our business). I share your disgust with the insurance companies, especially the practices of rescission and automatic claims denial, but those countries who follow the Bismarck model expressly forbid these practices and we will too. This will also bring down costs by cutting down on the ridiculous overhead on both sides of the provider - insurance relationship. And while I agree that some (not all) of the health insurance companies will get away with what they can, the industry lobbyists, powerful as they are, can no longer defend or deny these practices on capital hill. This is not a Trojan horse. They are ready to deal. Who cares if there is a benefit in it for them?

What is a Trojan horse is the public option. You as much as admit this - that it will lead, almost inevitably, to single payer. And whether this is real or imagined does not matter. It simply won't fly - we will never have the votes. What's the point in decrying the reasons you believe this to be the case? What are we to achieve campaign finance reform first? Even if we could you will still have to overcome the ideological differences. And you also made the point that Obama himself does not want to dismantle the employer-based private insurance model altogether. Not only because this is politically impossible, which is reason enough in itself, but it is largely unnecessary. The Bismarck model of universal health care is working very well in several countries. As well as or ( I would argue) better than single payer. And it represents a evolution, not a revolution. A faster, smoother transition that actually has a chance of occurring.

Jackytar

 

[Copernicus]

Enough with the acrimony, okay?

There was no acrimony in pointing out that I felt my remarks were clear enough. Just the same, I went on to paraphrase them. I have found myself having to say the same things repeatedly in order to get through. For example:

Mandatory insurance is essential if we are going to have guaranteed issue and community rating. Otherwise an individual can forgo getting insured and obtain a policy at a community-adjusted rate when they get sick - even very sick...

I'm not opposed to mandatory insurance with community rating when there is some government control over fees, rates, and premiums. You should have responded to my point, so I have to repeat it. Again.

It will also help to bring down costs because a large segment of the uninsured are healthy people who are taking their chances - even when low cost insurance is offered by their employer (we have seen this in our business). I share your disgust with the insurance companies, especially the practices of rescission and automatic claims denial, but those countries who follow the Bismarck model expressly forbid these practices and we will too...

Is that what you think the Baucus bill does? I don't. That bill will do for health care what the Republican prescription bill did in the last administration--a huge giveaway to the industry that it purports to regulate. There are plenty of loopholes in it, and why wouldn't there be? Health industry lobbyists have bought "access" to all of the central players on the Finance Committee. It is their bill.

This will also bring down costs by cutting down on the ridiculous overhead on both sides of the provider - insurance relationship. And while I agree that some (not all) of the health insurance companies will get away with what they can, the industry lobbyists, powerful as they are, can no longer defend or deny these practices on capital hill. This is not a Trojan horse. They are ready to deal. Who cares if there is a benefit in it for them?

They can do with no bill at all. Infinitely preferable would be a bill that fattens their coffers at public expense. They own the Finance Committee. The 3 Republican "negotiators" have all but admitted that they never had any intention of voting for the bill. This entire exercise has been a sham engineered by Max Baucus, who is essentially in the pocket of industry. (I hope that you at least looked at the link to an article on his top 10 campaign contributors.)

What is a Trojan horse is the public option. You as much as admit this - that it will lead, almost inevitably, to single payer...

Wrong. I pointed out why Obama preferred single payer over the public option. I preferred single-payer from the start and lamented that he chose to go that route. I did so precisely because I consider the public option, while better than nothing, still to be something of a boondoggle. Health insurers can still find a way to make the "public option" so weak that it would be useless in holding down costs.

...And whether this is real or imagined does not matter. It simply won't fly - we will never have the votes...

What do you mean "we"? You are singing out of harmony with those favoring the public option, let alone single-payer. Take a lesson from the Republicans. They have the votes precisely because they know how to work together to pass or block legislation. Democrats are in power, but they behave like the minority party. And they may soon regain that status if they don't shape up.

 

[Smoke]

I preferred single-payer from the start and lamented that he chose to go that route. I did so precisely because I consider the public option, while better than nothing, still to be something of a boondoggle. Health insurers can still find a way to make the "public option" so weak that it would be useless in holding down costs.

Exactly. A public option is not a fix; it's just not as badly broken as what we have now.

Take a lesson from the Republicans. They have the votes precisely because they know how to work together to pass or block legislation. Democrats are in power, but they behave like the minority party. And they may soon regain that status if they don't shape up.

I really hope they prove me wrong, but they seem determined to squander their opportunity.

 

[Jackytar]

There is very little competition in the insurance industry, and that is why they have been able to jack up prices to the point where we are paying twice what other industrialized nations pay.

Please show me the evidence to support your belief that the high cost of health care in this country is because of insurance industry greed.

Jackytar

 

[Copernicus]

There is very little competition in the insurance industry, and that is why they have been able to jack up prices to the point where we are paying twice what other industrialized nations pay.

Please show me the evidence to support your belief that the high cost of health care in this country is because of insurance industry greed.

Jackytar, please read what I actually wrote, not your extrapolation of what I must believe based on your impression of the reasoning behind what I wrote. I did not use the word "greed", so I would ask you not to spin what I say in a direction that you find easier to attack. We both seem to think that health care in this country ought to cost less. Do you think that prices have not been "jacked up" by the system? What else could account for the fact that we pay so much more than other industrialized nations for poorer results? Whether it is caused by "industry greed" or some other factor associated with corporate behavior is another matter. I attributed it to lack of competition, not "greed".

 

[Jackytar]

The runaway inflation--caused mainly by insurance industry greed--is the first thing that needs to be brought under control.

You wrote this, Copernicus, in the other thread and you did not defend it there, either. link

Despite your declarations to the contrary, I AM paying attention.

Jackyter

 

[Copernicus]

You wrote this, Copernicus, in the other thread and you did not defend it there, either. link

Despite your declarations to the contrary, I AM paying attention.

I did say that earlier in this thread, and I'll admit that it was an oversimplification and shouldn't always be used to describe cases where the desire for profit drives motivation. What I meant to suggest by that word was that the health care industry has shown rather excessive behavior in its pursuit of profit. I believe that you agree with me that health care is too expensive, but you would probably not characterize it as "greed", a very subjective judgment. (Since there is no objective criterion for labels such as "greedy", "thrifty", "stingy", etc., there is no way to "prove" them. They are always subjective labels.)

But that earlier remark is out of context here. I had attributed the inflation here to lack of real competition. You did not address that remark, but you gave the impression that you were addressing it. Pulling a quote from another context and attributing it to this one in order to make me sound inconsistent is not advancing the discussion.

 

[Jackytar]

Methinks this thread needs to die...

Look - if I've taken you out of context that was not my intent. You have said repeatedly that I'm not making an attempt to understand you, or worse, that I'm intentionally obfuscating, so I went back and re-read your posts. In doing so it occurred to me that you seem to blame the high cost of health care in America on the insurance industry - if not by greed then by lack of competition, or maybe something else - it doesn't really matter. As I see insurance reform as a way forward, and you don't, addressing this point *is* an attempt by me to advance the discussion.

Here's my understanding - every year the insurance companies pay out somewhere in the order of 80% of our premiums in benefits. Their profit margins are all less than 5% according to investment research firms like Morningstar. The rest is overhead - to include, of course, high executive salaries - but mostly underwriting, sales and marketing, and claims processing. There are a lot of people employed in this industry. Our premiums are not rising every year because of increased profits. In fact, insurance companies have been having a harder and harder time turning a profit. They are rising every year because of increased payouts to providers. Americans gorge on everything from gasoline to swimming pools. We gorge on health care too. And the health care providers are lining up to get folks to consume whatever they are offering, which is all too easy when a third party is paying. Insurance companies aren't happy about this. They have tried, and continue to try, to bring down costs with HMOs, provider networks, deductibles and co-pays and the like. American consumers have, for the most part, resisted any such attempts. So the insurance companies have no choice but to raise premiums.

Bringing down the cost of health care in America will, in one form or another, mean ridding Americans of this "blank check" mentality. Which means, of course, that we will have to ration care based on need and effectiveness and, to some extent, cost. This will be the case if we go single payer or if we stick with employer-based insurance. And it will be equally as difficult, politically.

So what I want to see first is universal coverage and a spreading out or a flattening of the burden so the working poor don't live with the fear of illness and the rest of us don't live with the fear of financial ruin. To instill in the psyche of every American that this society cares about their well being and that no matter what we will come to their aid when they are suffering and not kick them when they are down. And I want this to happen ASAP. Sure we pay twice as much for heath care as other industrialized countries but as a percentage of GDP it's more like an extra 50%. We are a wealthy country, after all. And we do get something for this money. If you have good insurance it is still the best place in the world to get sick. The problem of cost, real as it is, is the lessor of the two, IMO, and not an exclusive feature of any one strategy on the road to universal health care.

If we can achieve UHC with employer based insurance - then great. If we can achieve it with single payer - that's great as well. I'm not opposed to the public option. If you are right - that it's simply a matter of political will - I may disagree but I will cheer you on nonetheless. What I won't abide is the notion that it has to be this way or no way at all.

Jackytar

 

[Mr Spinkles]

I think the criticism of the Democrats has missed something. The Dems didn't have much of a problem passing the stimulus, despite the hysterical lies and objections of the Republicans, did they?

The reason the Dems "can't get their act together", so to speak, on health insurance reform may have little to do with deficiencies of the Democratic party per se. It may have more to do with the enormous, anti-democratic influence of the health industry and its corporate and media allies. We have to remember that's the root of the problem, that is the overwhelming opponent to reform. As an analogy: if the mafia bribes police officers we don't stop supporting "the police" we try to get rid of the bribed officers and then keep going after the mafia. (Obviously I'm exaggerating a little.)

 

[Jackytar]

The reason the Dems "can't get their act together", so to speak, on health insurance reform may have little to do with deficiencies of the Democratic party per se. It may have more to do with the enormous, anti-democratic influence of the health industry and its corporate and media allies. We have to remember that's the root of the problem, that is the overwhelming opponent to reform.

If you look at the history of universal health care in other countries you will find that there was politically powerful opposition by the providers and the ideologues in those countries as well. The difference for most of them is that it was at a time when access to quality health care was available to a much smaller segment of the population than we have here in the US. So public support was much stronger and politicians were able to overpower the opposition. For those voters it was largely a matter of self-interest. For us it is largely a matter of altruism. Seniors, military vets, the very poor and the very wealthy, and those who believe their insurance plans are serving them well are happy with the status quo from an individual perspective and together they make up a substantial majority of voters in the US. And, of course, the folks who provide the services that they enjoy are much more powerful. And the ideologues of all stripe have the very real issue of rising public debt to keep them legitimately suspicious of a giant public program that makes sweeping financial promises written into law.

But with rising costs and insurance industry shenanigans it is slowly becoming a matter of self-interest here as well, especially for the middle class and for business owners. A very powerful push in the other direction. And we have the rising numbers of uninsured and medicaid cuts for the poor. And, of course we have the ideologues who feel the moral obligations of health care trumps all.

We may be at a point where the forces are evening out. As a commentator on NBC news said yesterday - the 80/20 issues have all been resolved in this country (80% in favor, 20% opposed). It's the 45/45/10 (where 10% are undecided or "in play") that are the toughest to resolve and remain outstanding. That is why I believe it serves no practical purpose to oppose compromise, and to seek incremental change. Obama is a smart guy who realizes this as well. All politicians over-promise during election campaigns. What else is new? I'm still behind him.

I'm looking forward to his speech next Wednesday, like a football fan with the home team in the Superbowl. I'm such a dork.

Jackytar

 

[Copernicus]

Methinks this thread needs to die...

Is somebody forcing you to reply to posts?

...As I see insurance reform as a way forward, and you don't, addressing this point *is* an attempt by me to advance the discussion.

I am not opposed to "insurance reform" in principle. I am opposed to what you are calling "insurance reform", which does not deliver improved "health care reform". The Finance Committee version of the bill seems likely to be another gift to industry in the guise of health care reform. It is the insurance industry bill.

Here's my understanding - every year the insurance companies pay out somewhere in the order of 80% of our premiums in benefits. Their profit margins are all less than 5% according to investment research firms like Morningstar. The rest is overhead - to include, of course, high executive salaries - but mostly underwriting, sales and marketing, and claims processing...

I do not know anything about Morningstar and have no opinion as to the objectivity or accuracy of their reports. From their web site, it does not appear that they are an independent source of information on the insurance industry. The issue here is not just profitability but the tremendous OVERHEAD that goes into propping up a broken system. And, oh yes, overhead does include high executive salaries, often at tremendous expense to ordinary stockholders. Please do not shove that fact under the rug as you try to make a case for this dysfunctional system.

...There are a lot of people employed in this industry. Our premiums are not rising every year because of increased profits...

Did you forget the overhead invested in employing all of those people to help deny claims, cancel policies, and, oh yes, pay high executive salaries?

...In fact, insurance companies have been having a harder and harder time turning a profit. They are rising every year because of increased payouts to providers...

Have they been cutting executive salaries to be able to afford those payments? I hadn't realized that. :sarcastic Look, you are making a gallent effort to defend the insurance companies by shifting blame to providers, but nobody is entirely free of guilt in the marketplace mess we've created. Drug companies manipulate health care professionals and patients (through TV ads for prescription drugs--a practice that ought to be illegal). Providers try to gouge consumers and insurers. And all of the big orgnanizations are able to mount propaganda and disinformation campaigns to protect and grow their piece of the pie.

...Americans gorge on everything from gasoline to swimming pools. We gorge on health care too. And the health care providers are lining up to get folks to consume whatever they are offering, which is all too easy when a third party is paying...

Oh, let's not forget to blame the public. A lot of them deserve to get sick and die until they put pressure on themselves to just voluntarily stop abusing the system. Some day, Americans will be as well-behaved as Europeans and Canadians. Then we can implement a single-payer system.

Insurance companies aren't happy about this. They have tried, and continue to try, to bring down costs with HMOs, provider networks, deductibles and co-pays and the like. American consumers have, for the most part, resisted any such attempts. So the insurance companies have no choice but to raise premiums.

Poor little self-sacrificing insurance companies. Everyone else's fault, is it? :thud:

Bringing down the cost of health care in America will, in one form or another, mean ridding Americans of this "blank check" mentality. Which means, of course, that we will have to ration care based on need and effectiveness and, to some extent, cost. This will be the case if we go single payer or if we stick with employer-based insurance. And it will be equally as difficult, politically.

Employers will still pay some of the cost in a single-payer system. That is the way it works in other countries. And insurance companies will still exist, as will health care providers and drug companies. They just won't be getting as much money for screwing up health care delivery so badly.

...We are a wealthy country, after all. And we do get something for this money. If you have good insurance it is still the best place in the world to get sick...

First of all, beware of that blank check mentality. We really cannot afford to pay that much more for our health care than countries that have a comparable or better standard of living. Secondly, "good insurance" is in decline now. Even those of us with good employee benefits are watching it diminish, and we are no longer at the forefront of scientific and medical advances. Some of the real innovation is going on in countries like India, not here.

If we can achieve UHC with employer based insurance - then great...

How could that work without universal employement? I don't think that you really mean this the way it comes off.

If we can achieve it with single payer - that's great as well. I'm not opposed to the public option. If you are right - that it's simply a matter of political will - I may disagree but I will cheer you on nonetheless. What I won't abide is the notion that it has to be this way or no way at all.

I'm not saying that. I have been arguing against the way it is shaping up to be--a giveaway to insurance companies without any substantial reduction in the amount paid for it. Indeed, it looks like we are getting ready to shovel even more money out of our pockets for a system that fails to deliver adequate health care.