Originally Posted by TBell
Not sure what you mean by Medicare being in Bad shape. If you ask most people who are on Medicare they will tell you that they prefer it over private insurance. The reality, however, is many people don't understand the government runs Medicare. The above example of not using cheaper technology just because it has other benefits if true, however, is plain outrageous. I suspect this has more to do with a certain companies lobbying efforts then anything. If true, that really is the problem: private and political greed.
I also do not see how the government can ruin the heath care system much more then it already is. In the very least, all insurance companies should be required to be made non profit. It is outrageous that CEO are raking in billions, while many people are going without insurance.
Most people can't afford private insurance nowadays. It used to be employers would pay for it. That more an more is becoming not the case as employers look there first to cut costs.
A single payer system is the way to go. People shouldn't have to worry about health care. It should be a right. Society would be much better off.
Its clear that you have not worked with Medicare on the provider side - I have. It is in very bad shape. On the consumer side, at the moment, it can indeed be a very good program. On the consumer side, one reason it works is that it is basically an 80/20 system which insures that the users have a reason to try and control costs. Those you love it have a co-plan (which are in danger of being eliminate in current proposals) which pick up the 20 %. Please note that most people today won't put up with an 80/20 plan from their employer, they want very small co-pays which eliminated an market control on prices and use of the system.
Getting back to the provider side, the reason Medicare seems to work is that they dictate prices on a cost+ basis (and due to gaming of the system on both sides its actually cost-). At its basic level the formula for setting the price Medicare is based on cost numbers provided to CMS (Center for Medicare and Medicaid Services) by providers (hospital, physicians, etc.) CMS then takes geographic averages, multiplies by some factor around 1.0 and the says this is what the official price for this service will be. Medicare administrators, like Blue Cross, Aetna, etc. (yes Medicare at the consumer level is usually administered by private contractors) then negotiate a reduced payment (typically 80% of this number) to providers.
You might say 'Wow this should control costs' and you would be hideously wrong. If this system actually worked this way the providers would go out of business as their costs would end up being larger than their payments. What do they do - they artificially raise their costs estimates to survive, or they simply overcharge medicare and then accept a reduced payment, which is more than the official prices. Take any physician that will be honest with you and ask them how consistent their charges are to different patient groups. Usually, if you go in without insurance they will charge you significantly less - why? Because they're nice guys? Hardly, they know you will pay 100% of what they charge while insurers will only pay in part.
Now, look at the future of Medicare. President Obama himself, in the same speech in which he held up Medicare as a shining example on one hand, called Medicare the biggest stone around our neck with over $30 Trillion (yes trillion) in unfunded future liabilities. Why is this? because the 'insurance' your paying in your paycheck (which, by the way lowers your ability to get better insurance for yourself as it is funded by the Company by lowering your take home) is being used to pay for today's care for others which is unsustainable in the long run. It is, in any other venue, a ponzie scheme
As to a single payer system, even if the most extreme version of this legislation is passed, it will never exist in the US (nor does it in any other country). The wealthy, powerful, elite, politicians of any system will always (and do always) have access to private care. Congress has already provided for this as Congress' healthcare had been made basically exempt from this legislation. This private care will be even more accessible to those that can afford it once the rest of the population is taken care of by the more restrictive single payer. This now exists is Spain, where everyone one of the high net-work individuals I worked with always went to the system of private clinics when they needed care. Also consider that most of the good physicians in Spain consider it essential to work at least part time in the private system as that is where the physicians actually make money. This same duality exists in the UK as well ( at a higher level) and I suspect elsewhere as well.
Are there solutions, of course. The first is to get the right cart before the right horse. All current proposal follow this pattern - get everyone insured (by force if necessary) and lower costs will follow. The right order is - get costs lowered and the number of insured will increase. It will take longer and is therefore less politically acceptable but is will end up with a better, sustainable system.
How to lower costs - 1) Tort reform. It is agreed by all parties that this action will significantly lower costs ($65 - $200 billion/year) but congress (Both Sides) will not take on the the Tort lobby, as was admitted to by Howard Dean in one of his town hall meetings. This is simply shameful conflict of interest on the part of lawyers in congress. 2) Allow cross-state competition for health insurance. This is an artificial barrier to competition. 3) eliminate co-pays and go back to an 80/20 (or whatever percentage you want to pay for) system. In reality your costs of health care won't go up as you will have more disposable income to pay your 20% as insurance costs go down and the actually consumer of the product will have incentive to control the costs. 4) Eliminate the tax differential between employer provided and self provided insurance. Either tax it all or none of it, I wouldn't care.
Even if you support the current approach being debated (and realize that at this point the majority of American don't) you should be lobbying heavily to have the above provisions added. The current legislation has no real solutions to lower costs. Getting 'Industry' to commit to lowering costs is a red-herring unless there are specifics provided as to method, of which there are none.