Governement Healthcare...

[GrayMatterWife]

The dems are just as in bed with the industry as the republicans. This is not the change that I think people wanted to believe in.

Kris: Man, you hit that one on the head. Both parties are in bed with people whose interests are not necessarily vectored toward improvement, but only in self-protection...!

[PrincessFiona]

I personally don't think it is an entitlement or a human right. Just because we can provide it doesn't mean that everyone gets to have it. I believe healthcare is a service and a business, and that we should keep it that way, because capitalist competition produces the highest quality of that service. It's why people don't travel to England for cutting edge procedures--they travel here, because our system promotes competition and allows us to push the envelope of improvement. But, that being said, I also believe that we have a moral obligation to care for the less fortunate and that we as a society should use our resources (which are byproduct of living in our capitalist society) to provide care for the less fortunate. But I don't think the solution lies in forcing everyone into the same system--essentially "dumbing down" the system.

I disagree with this as well. I don't believe health care is the same kind of a commodity as a say...big screen TV. Also, I would argue that without the ability to claim some corporate socialism...on the way down...capitalism has shown itself to be a rather inept tool for progress.

[PrincessFiona]

sigh....death of the commymommy....

[oceanchild]

I think... that at this point, it's a mistake to conflate the House plan with the Senate plan with an Obama plan. And I've kind of lost sight of what Obama's plan is. He's apparently doing a round table with providers at DH's former hospital today, and I'm curious to see what he says.

Like Jenn, I mostly want to see *something* change, because what we have isn't sustainable. I'm willing to give everyone the benefit of the doubt while they negotiate the fine points.

I'd rather tax benefits than add an extra surtax (Senate plan vs. House plan, at this point). But I still find these tax arguments preposterous. They ignore the fact that these are marginal rates (ie, when you jump to a higher bracket, the tax is only on the income in that bracket), they ignore the caps on FICA, and they ignore all the deductions that most people take. So no one's 58% tax rate is a flat 58% tax rate.

I've never consumed health care abroad, but in the experience I do have, it seems to me that my relatives in the "socialist" Netherlands are pretty happy there. And that the non-existant Brazilian social safety net is not the way to go.

I think arguing about rationing care is silly, because we already ration care. It's just that we currently ration based on ability to pay.

And I find it ridiculous that ER care is considered a right but everything else is a privilege.

I don't want to go point by point through a plan that doesn't really exist yet. But I do want to give people a chance to make it exist.

[PrincessFiona]

OK...and here's another question.

We already have govt. healthcrare in the form of both medicaid and medicare. Why create another cog in the wheel? Why can't medicaid become the new public plan. Call it USCares or USHS or whatever. Mandate anyone who has no coverage through work etc to opt in? Revamp medicaid if necessary over the next couple of years, but it is already there. Funding could also be through our current tax system with every single american seeing a slight increase in taxes.

[PrincessFiona]

I don't want to go point by point through a plan that doesn't really exist yet. But I do want to give people a chance to make it exist.

Except that they are trying to pass this by ..what? August 7th? Don't we get time to read the plan first? Why the rush?

I want a chance for change to happen too.

[GrayMatterWife]

I think... that at this point, it's a mistake to conflate the House plan with the Senate plan with an Obama plan. And I've kind of lost sight of what Obama's plan is. He's apparently doing a round table with providers at DH's former hospital today, and I'm curious to see what he says.

I think that's a great point. It all is getting conflated and Obama is losing his marketing edge here. And the original marketing focus--we need to change healthcare to improve the economy--has not proven to be a very convincing message, especially since it won't go into effect for a couple of years. It is hard to criticize effectively, and hard to know what may be good ideas within plans, because it is all such a mess. And he needs a new, less grating and irritating, messenger. Pelosi makes my skin crawl. Find a more appealing House Dem.

Pelosi makes my skin crawl. Find a more appealing House Dem.

I'll actually agree with you there. Pelosi and Reid both make me crazy.

[MrsC]

I didn't mean to turn this into an America v.s UK debate. Firstly, I'm not from the UK so that's not what I was talking about. Secondly, from what I've heard, the NHS in the UK is certainly not the best universal healthcare system so it's not a good comparison or anything you'd want to mirror.

My point about the social healthcare system is that people think it's soo horrendous but they have absolutely no experience of it. Does that make sense?? It's really not something you can judge until you have experienced it, and I mean really experienced it, not living there for 2 years. It's easy to pull up statistics to prove a point, but there's no way you can say that all cancer related deaths are based on timely access to healthcare. That just doesn't make sense. That's like saying that there are more automobile deaths in one country than another and it's because the roads are worse, not taking into account drinking/speeding/driving skills/weather conditions...the list goes on.

I'm just hearing a whole lot of; "We want everyone to have healthcare but we don't want to pay for it." Who do you think should pay for it?

Everyone wants change but nobody has a solution. It's too little too late, the billions of dollars that have been spent on a war that was unnecessary and people can't afford to go to the freakin doctor. Talk about priorities being out of whack. Can anyone disagree with me on that one? Healthcare changes should have been made years and years ago.

Doctors are always going to have to pay, that's what happens when you're in the higher end of the pay scale. That's life! So, we'll be paid 150K instead of 300K. Most people could only dream of having that kind of money. Live within your means and you'll be fine. We have just as much debt as anyone else but DH chose to go down this road, nobody forced him. Docs are always going to be earning more than the average Joe. In my "socialist" country doctors get paid up to $340K for public hospital positions.

I would love if there could be healthcare available to everyone and no impact made on our lives but that's not how life works!

BTW, I'm a U.S permenent resident and taxpayer and soon to become a U.S citizen, I have just as much a right to comment on these issues as everyone else......for anyone who thinks otherwise Hell if I had my citizenship a year ago I would have voted for Obama, cause at least he's trying.

[ladymoreta]

IDoctors are always going to have to pay, that's what happens when you're in the higher end of the pay scale. That's life! So, we'll be paid 150K instead of 300K.

I think you've nailed my main concern. I believe that if we cut doctors' net income by half (or probably less, but still a significant cut), we will have a shortage of doctors. Those who are still in training will still finish and enter the workforce. Newer attendings will still practice because they'll still have loads of debt to pay off. But what about those in their 50s and 60s? What will keep them from retiring? What will motivate college students to sign up for 8 years (minimum) of training and over $100,000 of debt, just to make the same salary they could by going through an MBA program for a couple of years? Yes, it's unfortunate that it comes down to money, but while I'd really like to see everyone have health care, I certainly don't think it would be worth it for anyone to go through all this crap to make 150K a year. (And I know that there are plenty of doctors out there making significantly less than that now. How much will they be making after health care reform, and will it be worth it for them to continue?)

My wish list for health care reform would be:
- Don't create a new government agency. We have enough of those already. Expand Medicaid to cover unemployed people for the duration of their unemployment. Allow people to "buy" Medicaid coverage if their workplace does not provide insurance or if they meet certain income levels. (And base the price on their current income.)
- Get rid of COBRA - it is ridiculously expensive for people who have lost their jobs, and it causes many people to dip into their savings or retirement funds to pay for it.
- Do not allow insurance companies to refuse coverage based on preexisting conditions or lapse in coverage.
- Do not allow insurance companies to deny coverage of children, especially for genetic disorders.
- Tort reform. Excessive testing has more to do with CYA than lining doctors' pockets.
- Do not go to a pay-for-performance system. This will be devastating to non-compliant or terminally ill patients.
- Do not tax employers on the insurance they provide for their employees. Do not tax employees on income spent for health insurance.
- Increase funding to the VA. Those men and women have made more sacrifices than most of us can imagine. I WANT them to have better health care than I could possibly afford.

This would still be an expensive program, but it wouldn't have all the fluff that a new health care "system" would have. It would need to work within the boundaries that we already can't afford, but it wouldn't be adding a bunch of new overhead.

I also think that taxes should be raised across all income levels to pay for it. I believe that if everyone had a stake in this reform, they would be much more likely to want to keep costs down. Congress/Obama are grossly underestimating how much this will cost, and I really don't think that "the rich" make enough to pay for it all. Whether it is a right or a privelege doesn't matter if the Chinese are footing the bill. They've already warned us that we're not such a good investment anymore.

[alison]

- Get rid of COBRA - it is ridiculously expensive for people who have lost their jobs, and it causes many people to dip into their savings or retirement funds to pay for it.

COBRA is insane!!! We've decided to pay for medical expenses out of pocket for the month that my dh isn't working. And I'm pregnant! This actually turns out to be the cheaper option.

There isn't some super-expensive special COBRA policy out there -- it is what employees had through the employers but the former employee foots all the monthly premium plus a small administrative fee. I can't remember if it is the former employer or insurer who can charge that fee but I believe it is not to exceed 2%.

[alison]

There isn't some super-expensive special COBRA policy out there -- it is what employees had through the employers but the former employee foots all the monthly premium plus a small administrative fee. I can't remember if it is the former employer or insurer who can charge that fee but I believe it is not to exceed 2%.

I *think* it's the employer, but I'm not absolutely certain.

Don't get me wrong, I'm glad that something like COBRA exists. It makes me nervous that we're gambling on my health until the end of this month though.

I know it is really expensive. We have used it twice. One time my former employer picked up the tab for 9 months when I was laid off. Another time we were able to do coverage by the week for the two weeks DH was off between residencies.

It is out of reach most of the time but I don't think I would do away with it completely.

[ladymoreta]

COBRA is a system where you purchase the same coverage that your former employer provided before your employment was terminated. When you opt for COBRA, you pay the full amount, not the discounted amount you were paying (your employer usually pays for the majority of your coverage). But my problem with COBRA is that because it's there, you pretty much have to have it. If you don't get it while you're between jobs, even if it's just for a few weeks, you can get hit with a "lapse in coverage" denial from your new insurance if they can reasonable claim that whatever it was happened in that few weeks.

If Medicaid kicked in immediately when your employment was terminated, COBRA wouldn't have to exist. People who lose their jobs often cash out their 401k (incurring huge penalties) to continue to pay for their COBRA health insurance. While it is nice that they can continue to have health insurance in the interim, they are really hurting themselves (and the economy) in the long run.