Healthcare Discussion on CNN

[oec2000]

Caught this quite by accident as I do not normally watch Lou Dobbs (He comes across as a bitter, angry old man. He was much better as a business anchor.)

 

http://transcripts.cnn.com/TRANSCRIPTS/0910/29/ldt.01.html

 

However, I found this discussion on healthcare reform to be thoughtful and sensible and a nice change from the senseless partisan commentary that we normally get. I don't follow the healthcare situation in the US that closely so found the discussion really enlightening.

 

Some comments that resonated:

 

"Medical practices spend 20-30% on billings and collections; if the paperwork were done elctronically, these could be reduced to 2-3%."

 

"40-50% of healthcare dollars per capita are spent during the last 6 months of a person's life."

 

"One of the sadnesses about medicine these days is that doctors don't have time to talk to their patients when they find out they have cancer."

 

"I'm a nonpartisan, an independent. I would hope at some point that we would grow up and stop acting like 3rd graders. I appeal particularly to the representatives." (And, the House democrats just came out with a 2,000 page bill to be read in 3 days!)

 

Lee Kuan Yew (a topic of discussion on another post) spoke highly on Charlie Rose of America's unique ability to respond to challenges which made him confident that America would remain an economic power for years to come. The panel discussion on Lou Dobbs demonstrated this point - that the healthcare problem was a solvable problem in the hands of the right people, if only the politicians would get out of the way.

 

Would like to hear what our US friends think.

[Packer16]

I agree that something must be done but the crew running the show (primarily liberal democrats) are wed to a big government solution (trying to relive the 60s I guess) and have an aversion to markets.  This combination has never led to lower prices except via rationing which clearly no one wants and markets are the only way to keep prices in check without rationing.  From my perspective, markets can lead to lower costs but the anti-trust laws need to be enforced for health insurers.  What we end up with is the worst of both worlds (little competition because of lack of anti-trust enforcement) and a costly government run and gamed program - much like Medicaid and Medicare is today.  My concern is what has been created is a large new entitlement for which there is no money to pay for it.  This will lead to higher taxes and more borrowing and may eventually lead the US to Japan-type fiscal deficits with no internal savings to pay for it (as Japan has). 

 

The best solution for most folks is a high deductible health insurance plan (to have smaller expenses set by market pricing) with some form of health savings account (to increase the US savings rate).  For those for whom this plan is too expensive (let's say > than a certain % of income), the government can provide some sort of subsidy.  This is the core of the Republican alternative for which the partisan politics in Washington has turned a deaf ear to. 

 

Packer

[bargainman]

What I don't understand is this.  People argue against having government run healthcare because they say it will be too expensive, that government is inefficient, and that capitalistic competitive private insurance works better cause capitalism rules.  But on the other hand these same people argue that having a large government insurance presence will bankrupt the private insurance companies because then the private insurance companies won't be able to compete.

 

To me these seem like totally contradictory statements.  If private insurance competition is the best most efficient way to go, then they are the cheapest, they will lower costs, and then having the big inefficient government compete against them shouldn't matter one iota, since government is supposedly inefficient and the private insurers will be able to compete against big inefficient costly government.  I don't see how someone can rationally argue both statements above, and yet many are doing just that...

 

Any thoughts?

[value-is-what-you-get]

 I don't see how someone can rationally argue both statements above, and yet many are doing just that...

 

Any thoughts?

 

You're right!  

 

But this is CNN - their goal is not to argue effectively - or even reconcile their seemingly disparate arguments.  

 

It would seem that the objective here is to sway public opinion against government healthcare by providing a buffet of arguments - choose whichever one you'd like to embrace Joe the Plumber.

 

[keerthiprasad]

What I don't understand is this.  People argue against having government run healthcare because they say it will be too expensive, that government is inefficient, and that capitalistic competitive private insurance works better cause capitalism rules.  But on the other hand these same people argue that having a large government insurance presence will bankrupt the private insurance companies because then the private insurance companies won't be able to compete.

 

To me these seem like totally contradictory statements.  If private insurance competition is the best most efficient way to go, then they are the cheapest, they will lower costs, and then having the big inefficient government compete against them shouldn't matter one iota, since government is supposedly inefficient and the private insurers will be able to compete against big inefficient costly government.  I don't see how someone can rationally argue both statements above, and yet many are doing just that...

 

Any thoughts?

 

The government has no real "budget."  They can "afford" to lose all the money they want if it means getting what they want. 

[cheapguy]

>People argue against having government run healthcare because they say it will be too expensive, that >government is inefficient, and that capitalistic competitive private insurance works better cause capitalism rules.

 

In theory you are right.

In practice, once there is a govt program the congress will keep giving the govt program lot of subsidies or legislate certain parts of the health care exclusively for them..

Basically rig the game against private insurers.

 

 

[SharperDingaan]

 

Keep in mind that the US is very new to this, & that health-care in most countries in a moving target. The reality is that there will be rationing, but it will be socially vs market driven.

 

Uthanasia & quality of life is going to make itself felt. When you're 80, in constant pain, & your life is 'making it to the next pill' - you're not living, you're a addict in a pharmacy farm. Fundamental changes to laws, how we see age, & how we see life itself. Folks will still get older, but they will not spend their last 6 months in hospital, & they will not linger when they go. Self rationing.

 

Life-style choices are going to bite. You choose to smoke, & you knew the risks; so when you get lung cancer you may get 1 round of chemo & pain killers, & that's it. Fundamental changes to how we see personal/social responsibility, & social compassion. Social rationing.

 

Put bluntly, whatever we might think of it, darwinism works. Coming to terms with it as applied to people, vs animals, is a whole different thing though!

 

Hardly surprizing that it causes such nervousness.

 

SD 

 

     

[ERICOPOLY]

I asked myself how the public option would make health care cheaper.  In order to get an answer, I first had to determine where exactly health insurers get the bulk of their profits.  From my observation, it would seem that they make profit by getting premiums far in advance of claims, and investing this float in government bonds.  Therefore, they are getting premiums essentially directly from taxpayers long before taypayers actually get sick and need to visit a doctor, and these taxpayers effectively are also on the hook for the interest payments on the government bonds.

 

Now, I ask what would happen if a public "option" were simply forced upon America, and the private insurance industry was forced into runoff.  Where does the cost savings come from I ask?  Well, I think there is cost savings in that the government would be paying the claims in real time as they come due, thus eliminating a middle man "float".  So the savings from the public option comes from the time value of money -- interest not paid to insurers on float.

[oec2000]

 I don't see how someone can rationally argue both statements above, and yet many are doing just that...

 

Any thoughts?

 

You're right!  

 

But this is CNN - their goal is not to argue effectively - or even reconcile their seemingly disparate arguments.  

 

It would seem that the objective here is to sway public opinion against government healthcare by providing a buffet of arguments - choose whichever one you'd like to embrace Joe the Plumber.

 

 

It sounds like you have dismissed the discussion without reading/watching it - just because it is CNN! Isn't this precisely the behaviour Dr Carson was criticizing? I find the the degree of partisanship in the US worrying especially when the partisans drown out the voices of reason.

 

The extreme wings of both parties seem intent on breaking the country apart. It's ironic that they do this while proclaiming that they're doing this for the sake of the country. To me they are no different from Wall Street bandits. It's all about personal enrichment - if the system should collapse in the process, so be it, who cares?

 

Limbaugh, Coulter, Hannity, Beck and their counterparts on the left spew dumb rhetoric not because they are dumb and believe everything they say. They do it for ratings and to sell books. Any thinking person can see that they are no voices of reason.

 

At a time when the US is at a critical juncture in its life as a political and economic superpower, this mindlessness is in danger of running the country aground just when it should be doing everything it can to stay ahead of the emerging powers. No one doubts that China will eventually overtake the US. Why make it easier for them?

[keerthiprasad]

 

Keep in mind that the US is very new to this, & that health-care in most countries in a moving target. The reality is that there will be rationing, but it will be socially vs market driven.

 

Uthanasia & quality of life is going to make itself felt. When you're 80, in constant pain, & your life is 'making it to the next pill' - you're not living, you're a addict in a pharmacy farm. Fundamental changes to laws, how we see age, & how we see life itself. Folks will still get older, but they will not spend their last 6 months in hospital, & they will not linger when they go. Self rationing.

 

Life-style choices are going to bite. You choose to smoke, & you knew the risks; so when you get lung cancer you may get 1 round of chemo & pain killers, & that's it. Fundamental changes to how we see personal/social responsibility, & social compassion. Social rationing.

 

Put bluntly, whatever we might think of it, darwinism works. Coming to terms with it as applied to people, vs animals, is a whole different thing though!

 

Hardly surprizing that it causes such nervousness.

 

SD   

 

     

 

I think most people fail to realize that there is no evidence to suggest that this plan will increase our population's longevity (an often cited desire).  However, increased mortality is definitely well correlated with our president's tobacco and junk food habits.

[valuecfa]

What say ye Canadians about your health care system?

 

Personally, I am pro public option (robust) in the U.S.  I wonder if we will ever see the day when politicians can vote with their own minds instead of the special interest groups or party majority votes, and these politicians quit acting like 3rd graders. It would be nice to have respectable debates/rebuttals on the issue, but the media and the politicians always seem to throw in illogical and incredible ideals with little respectable discussion.

 

As an aside, I found a reference to this company on CNN the other day, that is quite an interesting and convenient idea:

http://www.planethospital.com

 

It makes sense that medical tourisim becomes a much larger part of health care in the future, especially for high cost providers like the U.S.

[ERICOPOLY]

>People argue against having government run healthcare because they say it will be too expensive, that >government is inefficient, and that capitalistic competitive private insurance works better cause capitalism rules.

 

In theory you are right.

In practice, once there is a govt program the congress will keep giving the govt program lot of subsidies or legislate certain parts of the health care exclusively for them..

Basically rig the game against private insurers.

 

 

 

I can see that happening.  However, even if that were to happen... where is the harm?  Is the harm only done to the private equity holders of insurers, or do we all lose out somehow?

 

This industry has been private for a long time.  Normally, when we think of free enterprise and private competitiveness we think in terms of it's benefits:  innovation.  It is imperative that our industries remain innovative and competitive on the global stage.  Does that matter for health insurance?  Is there such a thing as innovation here?  This is what I'm at a loss to explain -- why are so many people convinced that any benefit is derived from a private insurer vs a public one?  Don't they just bring in premiums, collect interest on float, and settle claims?  Will we lose any global competitiveness if the govt pushes out private insurers?

 

 

[Myth465]

Im for a public system. But there argument is similar to the post office. They believe that the public option will be subsidized which will give it an unfair advantage. They believe it will basically run at a loss to put the other providers out of business and will have too much bargaining power.

[Myth465]

Thats my problem with it as well. People talk about free markets but, health care isnt one. Most insurers operate as Monopolies or Duopolies. Most of the insurers of scale dominate 1 or 2 regions and are except from laws which are aimed at breaking down Monopolies.

 

I also dont think I want capitalism involved in life and death. It should be similar to education. You should have a respectable option for schooling (arguable in some cases) and have the choice to purchase better options if you are whiling to pay for them.

[rranjan]

I strongly feel that there should be government run basic health insurance plan but government shouldn’t subsidize it rather run it as non-profit. Now due to all the in-efficiencies with government involvement, private insurance plans should be able to provide better value for money and still make decent money. I totally agree that insurance industry is dominated by one or two players in most states so if any innovation is needed it’s the competition for reducing the cost. As Eric pointed out, we are not going to see any innovation in this because there is nothing to innovate.

 

I agree with Myth465 about everyone having basic option at reasonable price. Need for health coverage is almost as basic as education and here people will still pay for it. People still send their kids to private schools but at least free schooling provides basic opportunity for everyone. Same should be true for basic health coverage. Government and private coverage should co-exist and people can choose their plans based on cost and coverage options. If some insurance companies are forced to take less profit or disappear who cares! Taken together they are not adding much value anyway.

 

As long as government doesn’t subsidize it, in my view it’s no brainer decision for greater benefit of society.Even if there is some waste due to little bit subsidy, its worth the price.

 

Fighting all over the world without having any tangible benefit, we can spend so much money but for something as basic as having health covergae for our citizens we can't see government spending any money. Logic seems weird to me. ??? I will still prefer if it is run as non-profit.

 

[txlaw]

Unfortunately, the increased rancor and partisanship in U.S. politics is itself a systemic problem that keeps the U.S. from being the best it can be.  We talk a lot about the systemic issues in the financial system, but there are a lot of systemic problems in the political system as well.  Changing this will be very, very difficult.

 

As I see it, there are three separable problems with healthcare in the U.S.:

 

1.  Not everyone has access.

 

2.  Healthcare costs continue to go up well above the general rate of inflation, and we are using more of it per capita year over year.

 

3.  Quality of healthcare technology has gone up while, paradoxically, quality of the healthcare system itself appears to have gone down (hospital bureaucracy, defensive medicine, increased profit seeking behavior of doctors and hospitals, lack of contact with doctors, gatekeeping, shortage of primary care physicians, etc.)

 

----

 

Access issues will be addressed fairly soon.  We are going to subsidize healthcare for those who cannot afford it, and we are going to require that insurance companies take people who have preexisting conditions.  Furthermore, people who do not currently pay into the system are going to be forced to pay healthcare premiums so that risk is spread across the entire population. 

 

Note that it is not true at all that we are going to have a "big government" system.  A big government system would be an industry where healthcare employees and professionals are employed by the government or where the government is the single payor.  Instead, money paid into government coffers will be redirected to private insurers for the most part.  The public option will be accessible to only a small percentage of the population, which makes it very hard for me to believe that the government will be able to successfully drive down premiums to the point where the healthcare insurers are losing money.

 

The quality of the healthcare system is something that we are becoming increasingly aware of, and based on my contact with patients (friends and family), doctors, med school students, other healthcare professionals, and healthcare consultants, things are slowly but surely beginning to change for the better in terms of making it a more customer friendly industry.  This is definitely a solvable problem, and people are working towards making this a reality.

 

It is keeping the costs down and limiting unnecessary consumption that will be the hard part of healthcare reform, and the government is not doing anything to address these issues.  They better because that's going to be a large part of our fiscal problem going forward.  Everyone knows this is a problem, but it's hard to figure out how to solve it.  If only people would concentrate more on this instead of their partisan bickering. 

[Guest Broxburnboy]

The problem is not whether it should be private or public payers... the problem in the US is that health care is provided for profit by corporate monopolies (as opposed to a competitive free enterprise system). The system is not run to maximize the benefits to its citizens, but to maximize the profits to corporate providers. This is the most expensive and inefficient (to the consumer) way to deliver medical services. It is definitely the most profitable national "system" on the planet for the corporations involved. It is well documented that per capita health care costs in the US are the highest in the world, yet many citizens go without. There is no evidence that Americans are the healthiest on the planet, au contraire, the rates of obesity and diabetes bely any such claim. Simple services such as pre and post natal care are not universally provided as attested by the high birth mortality rate. Extraordinary Health care costs remain the single biggest cause of bankruptcy.

The solution, if you are a consumer in the US ... either introduce a single payer national system with free market providers (this should take the bureaucratic overhead and insurance company profit margin out of the equation) or break the corporate trusts and regulate the food and drug industries... creating the level playing field for competing providers. A combination of single public payer and free enterprise private providers seems to be the best combination in other jurisdictions.

 

 

 

[ERICOPOLY]

Would it be possible to shift the expenses to the balance sheets of the companies that sell the junk food, thereby incentivizing the production of healthier foods?

 

The free market doesn't do a good job of ensuring that producers bear the true costs.  There are these external costs that they aren't responsible for paying.

 

From afar, the food industry may appear to be feeding America profitably, but what if that is only because many of the expenses show up elsewhere?

[cheapguy]

>Would it be possible to shift the expenses to the balance sheets of the companies that sell the junk food, thereby incentivizing the production of healthier foods?

 

It could happen slowly.

 

after the tobacco taxes, politicians need another "source" to tax.

 

Sodas, junk food, candy may fit.

Most likely they will go after soda/junk food.

 

Maybe they should provide incentives for people to keep physically fit (may be gym membership fee, ... )

 

[oec2000]

Unfortunately, the increased rancor and partisanship in U.S. politics is itself a systemic problem that keeps the U.S. from being the best it can be.  We talk a lot about the systemic issues in the financial system, but there are a lot of systemic problems in the political system as well.  Changing this will be very, very difficult.

 

It is keeping the costs down and limiting unnecessary consumption that will be the hard part of healthcare reform, and the government is not doing anything to address these issues.  They better because that's going to be a large part of our fiscal problem going forward.  Everyone knows this is a problem, but it's hard to figure out how to solve it.  If only people would concentrate more on this instead of their partisan bickering.  

 

Txlaw, couldn't agree with you more. Although I live in Canada, I worry about how America's economic well-being could be affected if this problem is not handled well - this can have a huge impact on Canada.

 

I posted the CNN discussion here because I was impressed by how productive conversations can be when it is carried out by non-partisans who genuinely care for the healthcare customer. I am frustrated by how the debate is being carried on in the media and the political arena because the public is influenced by it. It's as though people, once they put on either their conservative or liberal hats, become anchored to only one point of view.

 

The objectives of cutting costs down and improving access can't seem to be discussed without demonising either the govt or the private sector. Why should it matter whether this is achieved with or without a public option or a combination of the two? But no, the politicians just draw the line at their ideological borders which they are not going to cross, come hell or high water.

 

It's a world turned upside down when you have China, once the most ideological of states (during the Mao years), ditching their socialist baggage to go for growth any which way; and the US, arguably the most open of all states, bogged down by ideology. America would do well to take a page from China's book when they embarked on the road to economic reform. Deng Xiaoping, the architect of China's economic miracle, famously said, "It does not matter whether it's a black cat or not, as long as it can catch mice." (Translation: It does not matter whether it is a marxist or capitalist cat, as long as it can catch the mice of economic prosperity.)

 

Why aren't people looking around the world to learn from systems that work (as opposed to looking around to find a system that supports their point of view a la Michael Moore)?

 

I should stop ranting. I'm beginning to sound like grumpy old Lou Dobbs. ;D

 

Oh, I should address the question someone posed about Canada's healthcare system. Well, the system works well if you have a life or death type situation; if not, you learn to be a very very patient patient!  ;D It's not bad but it's not great either.

 

My friends in the heathcare system worry about its sustainability. Doctors are grossly underpaid while other healthcare workers are overpaid (unions). In BC, I believe doctors get paid $28 per patient. So patients get 8 minutes with their doctor - tough if you've just got a diagnosis of cancer!)

 

Btw, the system is not exactly free. A typical family of 4 pays about $1300 a yr in premium to the govt. in BC and many costs -some drugs, physiotherapy, routine check-ups, etc - are not covered by the system. Many people, if they are not covered by their employers, pay several thousand $ more to have supplemental insurance cover.

 

[ERICOPOLY]

I grew up with good healthcare as my father was an HP employee.  Then I had great insurance through UCLA, then hired right out of college by Microsoft (the very best health insurance available).

 

Now, I am not employed and I went on COBRA for my first few months.  Then I didn't know which health insurance to get, so we went with a local business that acts as a broker and she found our insurance for us.  This was an interesting process because I discovered that I can't find insurance to cover prescriptions... anywhere!  Literally, it's just not available.  So if one of us gets cancer, I'm fully on the hook for chemotherapy (which I hear is easily running people into six figure bills annually).

 

So I frankly don't see how the government is going to crowd out the private sector, when the private sector isn't even offering the kind of insurance I want!

 

I can pay for broken bones out of pocket... what I want insurance for is the "supercat" of health coverage... cancer treatment.

 

There is a loophole though that I can exploit... I just have to create some phony corporation (any corporation) and then the insurance companies are required to offer me a plan that has prescriptive coverage (to cover cancer chemotherapy).  How stupid can this be!!!

 

 

[twacowfca]

Gentlemen,  Lets recast the US health insurance "Public Option" into

a different setting : Financial Care Reforn.  Surely we

can all agree that US investors would be better off

with a public option , a giant fund run by illuminatti

on the public payroll like those superior individuals

who now manage our financial institutions taken over

by Uncle Sam.  This fund would cut out all the middlemen

and their unnecessary fees to the great benefit of

the public.  It would have access to low cost government

financing, thus avoiding exorbitant margin interest

charged by private providers.  No one would be refused

the opportunity to purchase shares , and every shareholder

would have an absolute guarantee against suffering a loss!

this will be a huge improvement over the sorry financial

performance of the broken private system.  All this will be

available at no cost to the public. It will be paid for

entirely by cost savings taken out of the inefficient

private system and by a tax(sorry,my bad) a fee on

the most successful fund managers and companies

that took advantage of their less fortunate peers and

those investors who through no fault of their own

suffered large financial losses last year.

    Participation in this Public Option Fund will be entirely

voluntary, but any financial advisor or fund manager

who refuses to provide a similar guarantee against

losses for the accounts they manage will in all fairness

have to pay a fee of 20% of the value of each account

into the Public Option Fund.  However, those very large

private Funds that are first to get on board and support

the Public Option Fund will be exempt from this

requirement.

 

    I hope that all the members of this group will

join me in putting their self interest aside to do the

right thing and support the Public Option Fund. 

If we don't take this bold step to fix the broken

system that has cost the public trillions of dollars

through inefficiencies and losses, we will have only

ourselves to blame, and we will also lose the

opportunity to have a blanket exemption from

financial malpractice lawsuits that is promised if

we follow the government best practice guidelines

for low risk investing.

[Myth465]

Interesting but ineffective analogy.

 

1. Healthcare is a matter of life and death. - Not something you really want to mix with for profit inmo.

2. Healthcare is the leading cause of bankruptcy.

3. You cant really realize the importance of it until you are disconnected from your great job and have to obtain it on your own or until your insurance company denies you vital coverage.

 

[biaggio]

I work in Canadian health care system.

 

Canadian system has many imperfections, mostly leading to much inconveniences in the form of untimely service. However I believe that it provides the “supercat” coverage someone else was talking about. i.e. if you get cancer or need expensive surgery you don t need to worry about payments or going bankrupt.

 

[biaggio]

One of the anxieties in our system is the perception that some of the “new” treatments may not be paid for…however if there is a comparable more cost effective alternative treatment, then the new treatment may not be funded unless there are exceptional circumstances,

 

As well government program will not fund for care that has not been proven. It won t fund care that does not work or is not needed. At least it tries to do that.

 

If services are not available in Canada (which occurs at times either that we don t have the expertise yet, or the wait is too long) then I have seen the system pay for patient to go to the U.S for treatment.