Far fetched fantasy story (1 Viewer)

ColinEssex

Old registered user
Local time
Today, 10:31
Joined
Feb 22, 2002
Messages
9,110
The impression we get in the uk about USA health insurance is that
a) you have to have it and
b) the first question they ask you on arrival at the emergency dept is "are you insured". If yes, then all is ok, if no, you get no treatment.

The caring society?

Col
 

AccessBlaster

Registered User.
Local time
Today, 03:31
Joined
May 22, 2010
Messages
5,823
If you "had to have it", why would it be necessary to ask for it? So silly.
 

The_Doc_Man

Immoderate Moderator
Staff member
Local time
Today, 05:31
Joined
Feb 28, 2001
Messages
26,996
Why do we need a mostly for-profit middle man?

Well.....

Mostly because we don't know enough as individuals on the fine art of negotiating a better price for services of that type, so could easily be bamboozled - AND - that middle man from private industry, self-serving though s/he may be, HAS to be better than ANYTHING run by the government. I've yet to see a U.S. Government program that wasn't fraught with fraud and waste.

Otherwise, Vassago, I agree with you.
 

Steve R.

Retired
Local time
Today, 06:31
Joined
Jul 5, 2006
Messages
4,617
We do not need a health insurance program. Frankly, I would have no problem with a health care system, that many refer to as single payer, provided that the electorate votes for it.

I believe that the whole discussion concerning health care neglects what insurance is really about.

  1. The purpose of insurance is to manage risk. If you have medical risk factors you should pay more for the (health) insurance. Also, the insurance companies should have a right to refuse to enroll a person because of their risk factors.
  2. It is repugnant for the government to require insurance companies to provide service to everyone independent of the risk factors and to provide unnecessary coverage.
  3. It is repugnant for the government to force individuals to buy a product and if they fail to buy the product to fine them. That is anti-capitalistic and is "free" money for the insurance companies.
  4. Insurance companies are not service orientated. Their job is to deny claims. Yet the public is being "sold" the concept that the insurance companies are there to serve you, they are not.
  5. There appears to be a growing mandate from some to promote greater government control over people to "protect them". For example, taxing sugary beverages.

    That may seem innocuous, but think of the progressive implications. Will we eventually be taxed for eating 1,000 calories at a McDonald's in the name of protecting a persons health? Will you be forced to take cholesterol medication, if your cholesterol levels are too high?

    But let's go a radical hypothetical extreme step further. Some individuals voluntarily pursue self destructive behavior, such as drugs. They overdose and require medical intervention. Why should society be forced to pay their medical costs for their irresponsible behavior?

Again, the ACA is an abomination that furthers "BIG" government. If allowed to progressively metastasize we will see the implementation of various "police" (food police as one potential example) or "taxing" agencies forcing compliance. But in saying that, I reiterate (that if the electorate approves) I have no objection to a national healthcare system. A reason, it removes the insurance industry as the "middle man" and it would also restore some semblance of capitalism by eliminating government payments to insurance companies.
 

The_Doc_Man

Immoderate Moderator
Staff member
Local time
Today, 05:31
Joined
Feb 28, 2001
Messages
26,996
Steve R.

I have no objection to a national healthcare system. A reason, it removes the insurance industry as the "middle man" and it would also restore some semblance of capitalism by eliminating government payments to insurance companies.

I'm sorry but somewhere in there I got lost. If the government doesn't pay the insurance companies in a national health care system then the only other way that can happen is that the government pays the hospitals/providers directly, which will instantly lead to either:

(a) non-competitive price controls OR
(b) forcing people to pay extra for some institutions vs. others, even if the cheapie joints have a chop-shop reputation.

Price controls STIFLE competition. See, for example, the Nixon era when that was actually tried. (Yes, I'm old enough to have been an adult during that experiment that didn't even last a full year.) As to paying extra to get into a better institution? ... see below and my responses to your points #1 & #2. Remember also that some people from Canadian socialized medicine will take jaunts into the USA for medical treatment because they can't wait for social medicine to call their number.

Remember, any time the government steps in, their "controls" tend to have loopholes, oversights, and many avenues of waste, fraud, and abuse. Because of course in ANY massive industry, there will be cracks for things to slip through. I recall in the last several years where some doctors perpetrated Medicare fraud to the tune of tens of millions of dollars (per doctor) and billions overall. We can get rid of the middle man and take away some of the compound interest implied therein, but I'm leery of getting the government involved.

So... what did YOU have in mind for a nation healthcare system?

Let's also be clear. Of your numbered points, I agree with #3 completely & #4 mostly. If all the insurance companies ever did was to deny claims, they would have no customers after only a short time - so they have to do SOME good for SOME people SOME of the time. (See also Abe Lincoln's quotes.)

Your points #1 and #2 equate survival with wealth and death with poverty, which is an elitist position. We can talk about equal rights to life, liberty, and the pursuit of happiness in the USA. Taking a medical elitist attitude seems contrary to that concept. There has to be a balance somewhere.

As to #5, that "my brother's keeper" mandate doesn't come from the people directly, given the outcry when New York tried to limit drink sizes. So from where does that perceived mandate originate and (important sub-question) does that originating group actually have the right to tell people how to live?
 

Steve R.

Retired
Local time
Today, 06:31
Joined
Jul 5, 2006
Messages
4,617
Your counter points carry weight. I won't pretend to have "the solution", since some of what I am advocating would not be consistent with Libertarian concepts. In summary, I would like to see a pragmatic medical care solution based on compromise.

Furthermore, my views are biased by my contempt of the insurance industry which exceeds my animosity towards big government.

If the government doesn't pay the insurance companies in a national health care system then the only other way that can happen is that the government pays the hospitals/providers directly, which will instantly lead to either:

(a) non-competitive price controls OR
(b) forcing people to pay extra for some institutions vs. others, even if the cheapie joints have a chop-shop reputation.

Price controls STIFLE competition. See, for example, the Nixon era when that was actually tried. (Yes, I'm old enough to have been an adult during that experiment that didn't even last a full year.) As to paying extra to get into a better institution? ... see below and my responses to your points #1 & #2. Remember also that some people from Canadian socialized medicine will take jaunts into the USA for medical treatment because they can't wait for social medicine to call their number.

Remember, any time the government steps in, their "controls" tend to have loopholes, oversights, and many avenues of waste, fraud, and abuse. Because of course in ANY massive industry, there will be cracks for things to slip through. I recall in the last several years where some doctors perpetrated Medicare fraud to the tune of tens of millions of dollars (per doctor) and billions overall. We can get rid of the middle man and take away some of the compound interest implied therein, but I'm leery of getting the government involved.
Your concern with government waste is correct. But I don't see the insurance companies as being any better at controlling waste.

So... what did YOU have in mind for a nation healthcare system?
It would be funded by taxation. The medical practitioners would be paid directly by the government. The downside is that this could be viewed as a welfare like system along with the unintended side effect of fraud and waste. There is no perfect system. All we can hope for is that the negative effects can be controlled to the maximum extent feasible.

Your points #1 and #2 equate survival with wealth and death with poverty, which is an elitist position. We can talk about equal rights to life, liberty, and the pursuit of happiness in the USA. Taking a medical elitist attitude seems contrary to that concept. There has to be a balance somewhere.
I don't see it that what. What I was trying to express is that insurance companies have certain "rights" in a capitalistic system. Insurance companies have a right to charge you based on your risk factors. For example, a twenty year old should pay less for life insurance than someone who is ninety years old. From the capitalistic viewpoint it is wrong for the government to require that both pay the same premium for the life insurance.

As to #5, that "my brother's keeper" mandate doesn't come from the people directly, given the outcry when New York tried to limit drink sizes. So from where does that perceived mandate originate and (important sub-question) does that originating group actually have the right to tell people how to live?
No they have no right, but it does not stop them from claiming that they do have that right. Given that, I was simply projecting an extreme outcome based on progressive excessive "mission creep".
 

The_Doc_Man

Immoderate Moderator
Staff member
Local time
Today, 05:31
Joined
Feb 28, 2001
Messages
26,996
Insurance companies have a right to charge you based on your risk factors

Since Frothy is probably a bit miffed with me right now, I feel obligated to play Devil's Advocate and reply to this one idea.

If we take the big step towards socialized medicine, that statement might not be entirely true. The current direction of this thread is that in a socialized system taken to an extreme, it would be illegal to deny medical services regardless of the ability to pay because those services would become a "right" not a privilege. In that case, conditions that would deny such services could not be allowed.

The recent headlines about legislation that would allow insurance companies to test your DNA for genetic risk factors is extremely troubling since it would allow denial of service or exorbitant fees for people who had no choice about having those conditions detected in their DNA. They were born that way. (snippets of Lady Gaga singing in the background...) That is the ULTIMATE in denying the concept of "All Men are created equal" and SURELY would be denied in a fully socialized system.

The question would revolve around the role of insurance in a socialized system. Would the health insurance industry cease to exist? Or would they change roles to be the administrators?

As an aside, I will add that given the CRAPPY billing systems I have found in many hospitals and larger clinics, it is clear that SOMEONE needs to tell the hospitals and clinics how to manage their finances. But that's a pet peeve of mine recently exacerbated by my wife getting a notice from an orthopedic practice that UHC denied coverage for a bill sent to them over 18 months after the date of the visit. In that time, my employer changed carriers AND THEN I retired. So that's TWO changes of insurance carriers ago. The person doing that clinic's billing should be fired.
 

AccessBlaster

Registered User.
Local time
Today, 03:31
Joined
May 22, 2010
Messages
5,823
Yes, you are.

You have to have a driving licence but many drivers don't have one.

Col

That was my point, under Obama care several million people were not covered even though it was mandated. BTW if you tried to opt out of the ACA they would sick the IRS on you until you complied. They learned that from tricky dick.
 

Steve R.

Retired
Local time
Today, 06:31
Joined
Jul 5, 2006
Messages
4,617
The question would revolve around the role of insurance in a socialized system. Would the health insurance industry cease to exist?
The role of insurance is to manage risk. The "correct" role of insurance is to provide catastrophic coverage not routine mundane services. Therefore, insurance companies should be removed from providing routine health care.

Given the current trend for socialism and health care as an emerging "right"; I would like to hypothesize that those implementing socialized health care would realize that insurance companies would not be an appropriate health care service provider. That the government should be dealing directly with hospitals and doctor associations.

Or would they change roles to be the administrators?
From the socialized perspective, there would be a government oversight board. The "Consumer Financial Protection Bureau" as being something similar to such an oversight board.

As an aside, I will add that given the CRAPPY billing systems I have found in many hospitals and larger clinics, it is clear that SOMEONE needs to tell the hospitals and clinics how to manage their finances. But that's a pet peeve of mine recently exacerbated by my wife getting a notice from an orthopedic practice that UHC denied coverage for a bill sent to them over 18 months after the date of the visit. In that time, my employer changed carriers AND THEN I retired. So that's TWO changes of insurance carriers ago. The person doing that clinic's billing should be fired.

I fully sympathize. Hospital billing is incompetent as is the insurance processing. I had a case where it took over a year for some surgery to be covered. The hospital kept sending me nasty grams for failing to pay my bill and the insurance company blamed "automated methods" for denying the claim. That is probably one reason, in a strange way, for me to mentally accept a single payer health care system as being a better approach.
 
Last edited:

ColinEssex

Old registered user
Local time
Today, 10:31
Joined
Feb 22, 2002
Messages
9,110
Since Frothy is probably a bit miffed with me right now, . . . . . .

She gets miffed at the slightest thing. when people disagree with her or point out errors, she just sulks for a while.

Col
 

The_Doc_Man

Immoderate Moderator
Staff member
Local time
Today, 05:31
Joined
Feb 28, 2001
Messages
26,996
Yeah, it's called "being human."

It's OK. I've miffed more than my share over the past few decades. Sometimes purposely, sometimes not. But every now and then I let my compassionate side out... usually to take a dump, but still, and outing is an outing!
 

ColinEssex

Old registered user
Local time
Today, 10:31
Joined
Feb 22, 2002
Messages
9,110
What actually does / has Mr Trump done or do?

All we see on the BBC news is him signing a couple of things, which then get vetoed and not implemented. Then he slags off the media, sends a few horrid tweets on Twitter and blames everyone for his non events.
Weird.

Col
 

The_Doc_Man

Immoderate Moderator
Staff member
Local time
Today, 05:31
Joined
Feb 28, 2001
Messages
26,996
It's the things he signs that DON'T get vetoed that sometimes result in some progress. His stated goal was to strip some of the government off our backs. He has signed some quiet legislation regarding reduction of regulations in certain areas. The overhead required to enforce those regulations is what he wanted to reduce.

Now, in case you doubt that we can ever have quiet legislation, we actually can. It happens when the controversy over the OTHER stuff is still reverberating in the corridors. Sort of like, "While the dogs over there are barking, let's bury some bones over here..."
 

AccessBlaster

Registered User.
Local time
Today, 03:31
Joined
May 22, 2010
Messages
5,823
Also a stated goal, "for every new regulation two must be eliminated". That alone would be a huge accomplishment if he can pull if off.
 

The_Doc_Man

Immoderate Moderator
Staff member
Local time
Today, 05:31
Joined
Feb 28, 2001
Messages
26,996
blaster, you are so right. For our friends on the UK/European side of the pond, this concept is crucial to understanding one of the biggest differences between the "conservative" vs. "liberal" viewpoint (or Republican vs. Democrat if you prefer.)

Conservatives want a small central government and then would leave other matters to the individual states to keep localized control. It is the incredible number of federal government regulations that makes government "big" - because to enforce the regulations, you have to have more people in the enforcement side of that regulation.

Liberals are believers in forcing all states to "toe the line" across the country on how they do things. Liberals tend to be "big" government people because they want to enforce your daily actions, frequently in an oppressive way.

For instance, regarding the "Affordable Care Act" (ACA or Obamacare), they won't LET you make the decision that food is more important than insurance. They mandate that you have insurance and make subsidies available - but studies have shown that the subsidies STILL take money away from you. If you have kids to feed, maybe ... just MAYBE ... you might wish to not have to pay the frickin' insurance fees.

Since the idea of removing federal regulations has the effect of leaving things to the discretion of the states, the Republicans are often seen as "states' rights" advocates - and many of them are. The Democrats, with their big central government concepts, are thus opposed to states' rights issues and more in line with federalism.

As one last explanation for our friends on the other side, in the USA a Libertarian is also a small-government advocate but doesn't quite fit into either Republican or Democratic molds. There are crazy Libertarians (Anarchists by some standard) and rational Libertarians. Neither one gets a lot of followers at the moment. (The anarchists invite... well... anarchy and the rationalists are not in power because nobody believes that "rational government" is anything but an oxymoron.)
 

Steve R.

Retired
Local time
Today, 06:31
Joined
Jul 5, 2006
Messages
4,617
Also a stated goal, "for every new regulation two must be eliminated". That alone would be a huge accomplishment if he can pull if off.
As usual, the devil would be in the details. Some regulations are good, others bad. Simply (in a frenzy) issuing wholesale deletions of regulations (because the Obama administration implemented them) without evaluating their "goodness" could be considered premature and in the end would accomplish nothing.

Eliminating regulations related to the ACA would be "good". Eliminating the regulations that allow companies to sell/trade your private information was "bad".
 

The_Doc_Man

Immoderate Moderator
Staff member
Local time
Today, 05:31
Joined
Feb 28, 2001
Messages
26,996
Comment is spot-on, Steve. Not all regulations are bad. We should watch the airline industry in the wake of the "Dr. Dao" incident with United Airlines to see which regulations get modified to protect passengers from the idiocy of incredibly short-sighted airline employees.
 

Users who are viewing this thread

Top Bottom