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What is the basic premise of Nationalized Health Care or Insurance?
Posted by: McQ on Wednesday, September 19, 2007

No matter whose plan we're talking about, when they talk about it on a national level, what is the basic premise?

That the current system is broken and that by dealing with it nationally through government intervention at some level, we can A) include everyone, B) deliver health care more efficiently and C) it will cost less.

Somehow mentions of unicorns and magic rainbows always seems to be left out of the discussion.

The latest to trot our her magic pill is Hillary Clinton.

Her first bogus claim?
This is not government run. There will be no new bureaucracy.
Unless she plans on throwing the 110 billion this is going to cost a year in a big pile and letting everyone take what they want or need, of course it's going to be government run (name the last time the government handed out 110 billion with no strings) and while there may not be a 'new' bureaucracy, there will certainly be a bureaucracy, even if just an expanded one, to administer it.

All the way through her speech she claims the American Health Choices plan will guarantee "affordable" health insurance. But the "how" of the plan, the strategy to both provide "affordable" and all-inclusive coverage is never covered but in vague generalities.

For instance, she never once addresses state mandates on insurance. Those add a lot to the price of basic health insurance products.

And she makes the following claim:
First, you will never be denied coverage because of preexisting conditions or risk factors. Insurance companies will no longer be allowed to discriminate against high risk patients or charge exorbitant premiums to screen them out.
But they will be required to pay the claims. Now the argument is that with a huge pool the "risk" is spread out among thousands, even millions. That doesn't change the fact that the claims must be paid and that payment is going to impact the premiums of those in the pool. It's simply another version of the cost shifting that goes on today with Medicaid and Medicare.

So how "affordable" is affordable?
Second, your coverage will be guaranteed. If you pay your premiums and follow the rules your insurance company will be required to renew your coverage each year at a price you can afford, even if you lose your job, even if you decide to start your own business or stay home with your children for a few years.
What does that mean? If insurance companies must take everyone and must pay all claims, obviously their costs are going to go up. And traditionally, when that happens, those costs are passed on to whom? Yes, their customers.

So you have to ask at this point, what does "affordable" really mean if that mechanism is in place. Or, is she saying something else?

Remember, per Clinton, this isn't a government run system, correct?
Under my plan, the government will provide tax-credits to insure that every single American can afford health insurance. The government will also invest in measures to improve health care quality and cut costs.
Clinton actually says one thing I agree with:
We should do it because in this new economy, when people move jobs more than ever before, their health insurance should move with them.
I absolutely agree with removing health insurance as an employer managed benefit.
I will require insurance companies in the Health Choices Menu to let you take your plan with you as you move from job to job or even state to state.
Yet after this, Clinton spends an inordinate amount of time telling us about a complex tax credit system in which employer management is subsidized. It makes no sense.

But again, this isn't a government run system.

Last, paying for this mess.
Under my plan, large companies will be required to help pay for their employees' health care. Those that do so can simply maintain their current policy that they choose. Those that don't, will need to contribute towards the cost of covering their employees on a sliding scale based on their size and average wages.
But there will be no new bureaucracy to oversee this.
My plan also helps American manufacturers become more competitive by providing a tax credit for those struggling with the high cost of retiree health benefits.
But this isn't a government run system.
Now, under my plan, we won't require small businesses to cover employees. Instead we will provide tax credits to ensure that many of them do. These tax credits will be based on size and average wages, so that small businesses can provide health care without destroying their bottom line. This credit could be as high as 50% of premiums for firms with fewer than 25 employees.
But this isn't a government run system.
Government also needs to do its part to promote shared responsibility. Under my plan, the government will provide tax-credits to insure that every single American can afford health insurance.
But no new bureaucracy will be formed to administer the subsidization of health care insurance or to monitor the product, or to insure they comply with the law.

And finally:
Instead, I'll pay for part of it by implementing the cost saving measures I outlined in May. And I will pay for some of it by rolling back part of President Bush's fiscally irresponsible tax breaks for the highest income Americans.

And I'll pay for some of it by limiting the tax breaks for people making over $250,000 a year to the same level that ordinary, middle class Americans get. Right now, the highest income Americans get some of the most generous health care benefits and the most generous tax deductions to go with them. Well-off Americans should be able to deduct the cost of the same quality health plan that middle-income families can deduct. If they want to receive extra benefits beyond what most middle income families get, they should pay for it themselves, not have tax payers foot the bill for them.
You have to love the irony of that last statement. The "well-off" Americans have been paying for the "extra benefits" they receive all along. This is simply the usual class-warfare rhetoric those like Clinton love to invoke. They don't mind the tax payers footing the bill for their approved constituencies, but not for those nasty rich. It's classic.

But take all of that with a grain of political salt. As James Pethokoukis reminds us:
Blame whomever you want for today's current fiscal mess, but don't cling to any myths about how far rescinding recent tax cuts for the rich would go toward meeting the nation's many budgetary shortfalls. Our elected officials simply cannot get around the most fundamental of political dilemmas. Even if they enact additional taxes on the rich—and that would not be easy—they still must either retract many of the promises made to the middle class, increase its taxes, or both.
All this to say, review the premise above and you find little if anything in this plan, other than the part I pointed too, which is appealing. But if you believe that A) this isn't government run or B) there won't be a new bureaucracy involved then you probably already buy into the premise above anyway.

As John Stossel points out:
One basic problem with nationalized health care is that it makes medical services seem free. That pushes demand beyond supply. Governments deal with that by limiting what's available.
The same holds true with guaranteed health care insurance no matter the risk to the insurer. And with Clinton's "doctors will be calling the shots, you just shut up and pay" mentality, I think 110 billion a year is a woeful underestimation of what this "not government run" system would actually end up costing.
 
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Comments
The government couldn’t run a hot dog stand efficiently, let alone something as complicated as healthcare. I don’t think this will get very far off the ground.
 
Written By: LASunsett
URL: http://poli-yy.blogspot.com
She is such a weasel.

 
Written By: Grimshaw
URL: http://
The reason it makes no sense is beacuase the stated reasons are not why she wants it. What this is about, is governmental control, not healthcare.
Healthcare is a nice sounding excuse for expanding governmental control.

Something, which, I should add, was something the American voter saw quite clearly, when HillaryCare v1.0 was being pushed. That plan, as much as any help from Newt and the gang, was responsible for the Republican takeover of congress, back then.

 
Written By: Bithead
URL: http://bitsblog.florack.us
I agree this is a bloody mess...but we all agree that the current system is broken.

I’ve been trying to find a solution to this and, well...I haven’t found anything that isn’t Marxist.

What would you suggest, McQ?
 
Written By: Joel C.
URL: http://
Riddle me this, Batman.

How do you stop the free-rider problem?

[now, i’m sure all the brave libertarians on this thread will insist on their right to die rather than receive care for which they cannot pay. but remember that such brave libertarians make up less than 1% of the American population.]

or let’s take a different approach:

1. Primary care is cheaper than emergency care.
2. As a society, we have decided that no one should be deprived of emergency care based on inability to pay, but decided not to fund primary care.
3. As a purely theoretical matter, this would suggest that we have stumbled upon an incredibly expensive (not to mention inefficient and needlessly cruel)way of delivering care.
4. Evidence supports the theory.
5. Therefore, we should (a) perpetuate the system or (b) swallow our pride, look at what other first world governments do, and put together a better system that gives everyone access to the primary care system.
 
Written By: Francis
URL: http://
1. Primary care is cheaper than emergency care.
2. As a society, we have decided that no one should be deprived of emergency care based on inability to pay, but decided not to fund primary care.
3. As a purely theoretical matter, this would suggest that we have stumbled upon an incredibly expensive (not to mention inefficient and needlessly cruel)way of delivering care.
Your lack of imagination is astounding. The reason we allow everyone access emergency care regardless of ability to pay is that it’s (often) a life-or-death situation. Certainly more often than primary care. It’s not a matter of having "stumbled upon an incredibly expensive (not to mention inefficient and needlessly cruel) way of delivering care", it’s recognizing that in an emergency, we treat first and ask questions later.

By the way, what is cruel about using an ER? I’ve been in a few over the years...don’t recall any torture going on in them.
 
Written By: Steverino
URL: http://steverino.journalspace.com/
What is the basic premise of Nationalized Health Care or Insurance?
That the people in aggregate want more health care than they can afford, they can’t believe it justly costs what they are asked to pay, and believe the current system is inefficient in caring for the poor and indigent, something they are (in aggregate) willing to pay taxes to do, at least for the young , the aged, and the relatively innocent (never were productive ex-cons who are 60 year smokers at age 80 need not apply for help with lung cancer, in many citizen’s opinion)—and that somehow, without real thought or questions asked, that having the government more involved than it is now, even up to the point of it being the sole provider of it, will make things better.

Seen in every light but the political, it is insanity of course.

Yours, TDP, ml ,msl, & pfpp
 
Written By: Tom Perkins
URL: http://tomdperkins.blogspot.com/
"now, i’m sure all the brave libertarians on this thread will insist on their right to die rather than receive care for which they cannot pay..."

I have no problem receiving "care for which I cannot pay" as long as that care is freely and privately provided, as it used to be by charity hospitals run by NGOs and religious orders.

 
Written By: E. Brown
URL: http://
That it is morally right and constitutionally appropriate for the government, using force if necessary, to take from me that which I have earned and which I can use to provide for myself and my family, and use it to provide for others who have not earned it and whom I have no obligation to support.
 
Written By: DIffus
URL: http://
I agree this is a bloody mess...but we all agree that the current system is broken.

I’ve been trying to find a solution to this and, well...I haven’t found anything that isn’t Marxist.

What would you suggest, McQ?
Well, I’m not McQ, but I suggest phasing out government healthcare (medicare, medical etc.,), removing the requirement that ERs treat everyone, and ending the tax loophole that drives employeer provided health insurance.

I’d even go so far as to ban health insurance for anything except catrostrphic / long term care, at least on a temporary basis until our system starts working properly.

The problems with our system are driven by the insurance companies and the government. Who pays the bills is in charge, hence medical providers work for the government and insurance agencies. And since those who receive services usually are not paying for them, there isn’t a market tendency towards lower costs. So costs go up, and those paying the bills then impose requirements on the health providers to justify their costs, which in turn results in HMOs and the like.

The solution is a free market in medical care.
 
Written By: Don
URL: http://
The reason we allow everyone access emergency care regardless of ability to pay is that it’s (often) a life-or-death situation. Certainly more often than primary care. It’s not a matter of having "stumbled upon an incredibly expensive (not to mention inefficient and needlessly cruel) way of delivering care", it’s recognizing that in an emergency, we treat first and ask questions later.
Forcing ERs to treat everyone regardless of ability to pay is stupid. For one thing, it punishes those providing ERs, and consequently the number of ERs are reduced, as hospitals drop the service. Second, everyone wanting free care shows up to the ER, flooding those that remain.

Hell, the Mexican government even advises wetbacks that our ERs provide care even if you do not pay.
 
Written By: Don
URL: http://
[now, i’m sure all the brave libertarians on this thread will insist on their right to die rather than receive care for which they cannot pay. but remember that such brave libertarians make up less than 1% of the American population.]
Except that most Americans can pay for their healthcare. And, if we ended our current mix of socialist/employeer healthcare, market forces would lower prices.

Riddle me this, Robin: how many people died because they didn’t receive medical care prior to medicare and medicade?


 
Written By: Don
URL: http://
Well, here in the Socialist Republic of New York, I can’t buy a health care policy that covers catastrophic injury/illnesses only. I pay roughly $500-600/month (plus my employer’s share) of my health care coverage, and my wife’s comes out of her pay, and we get to do battle with two insurance companies and my Healthcare reimbursement account then pay the rest ourselves. It’s good we’re all healthy, because dealing with two insurance companies is annoying at best.

Why can’t my wife and I buy what we need with the same tax breaks that private industry gets? Everyone would be a lot more sensitive to prices then. Insurance companies would have to compete on price and service. Right now they make money by not paying benefits that are due to their subscribers.

Oh, and let’s require full disclosure of prices, and complaints against doctors in return for elimination of malpractice awards for other than actual economic damages. That’ll happen as soon as lawyers are a minority in the legislatures.
 
Written By: MarkD
URL: http://
"I can’t buy a health care policy that covers catastrophic injury/illnesses only"
A large part of the problem. My catastrophic policy covers my daughter and I and only costs $120/month. We sock away the difference in an HSA.
 
Written By: Grimshaw
URL: http://
That’ll happen as soon as lawyers are a minority in the legislatures.
Translation: never.
 
Written By: Grimshaw
URL: http://
Forcing ERs to treat everyone regardless of ability to pay is stupid. For one thing, it punishes those providing ERs, and consequently the number of ERs are reduced, as hospitals drop the service. Second, everyone wanting free care shows up to the ER, flooding those that remain.
If ERs were forced to treat everyone regardless of condition, I’d agree with you. But the law says that an ER must treat someone to the point where he’s stable (i.e., not in imminent danger of death). ERs perform triage, the non-urgent cases must wait for those in need of immediate care. An ER can look at someone who’s got the flu, pat him on the tailbone and send him on his merry way. But if someone’s in danger of dying, I’d say this is a case of society wanting to err on the side of life.
 
Written By: Steverino
URL: http://steverino.journalspace.com/
Does anyone know how much of total ER billing is written off because the patient’s inability to pay?
 
Written By: Grimshaw
URL: http://
But the law says that an ER must treat someone to the point where he’s stable (i.e., not in imminent danger of death). ERs perform triage, the non-urgent cases must wait for those in need of immediate care. An ER can look at someone who’s got the flu, pat him on the tailbone and send him on his merry way. But if someone’s in danger of dying, I’d say this is a case of society wanting to err on the side of life.
Well, I found this:
California and federal laws define an "emergency medical condition" similarly as:

a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.3
Here.

If you have the flu and a high temp, that would likely qualify. Even if there is no immediate danger of dying.


 
Written By: Don
URL: http://
There’s a more fundamental (and incorrect) assumption than any of you seem to be making: that the healthcare system has excess capacity.
 
Written By: Dave Schuler
URL: http://www.theglitteringeye.com
There’s a more fundamental (and incorrect) assumption than any of you seem to be making: that the healthcare system has excess capacity.
I disagree. That point was made with the Stossel quote.
 
Written By: McQ
URL: http://qando.net
First, you will never be denied coverage because of preexisting conditions or risk factors. Insurance companies will no longer be allowed to discriminate against high risk patients or charge exorbitant premiums to screen them out .. or I’ll pay for it out of my own pocket.
Now she really didn’t say that.
 
Written By: Neo
URL: http://
What would you suggest, McQ?
1. Make health insurance like any other insurance product. You pay for the small stuff, it pays for the out-of-the-ordinary stuff. You pay for going to the doctor for a cold, it pays for your heart surgery.

2. Take it out from under the employer. That takes care of portability and in most cases preexisting conditions (if you keep your insurance and keep it paid up).

3. Drop the state mandates. Buy what you need and only what you need. If you prefer a catastrophic health insurance policy and an HSA, that should be your choice. If you want a policy with all the bells and whistles and are willing to pay for it, that too should be your choice.

By doing 1 and 3 you put the consumer back in charge of the "buying" decision. That means a) they’re likely to shop around a bit when they have to pay for the visits not covered by insurance, and because of that, b) they’re less likely to stress the system with unnecessary visits to the doctor.

Get a system together like that, keep the government out of the way, and I’d contend the rest will pretty much take care of itself.
 
Written By: McQ
URL: http://qando.net
If you have the flu and a high temp, that would likely qualify. Even if there is no immediate danger of dying.
I didn’t say "flu and a high temp", did I? I would think there’s a temperature range where emergency action must be taken, which is why I didn’t include high temp in my post.

What you posted doesn’t disprove my point: that ERs are not required to treat all patients.
 
Written By: Steverino
URL: http://steverino.journalspace.com/
The basic premises (plural) of "universal" health "coverage" will be eugenic editing of the population at the beginning of life and euthanasia at the end.

In between there will be rationing and mediocre care, standards that once established will never be changed, except for the worse.

You’ll see a lot of good doctors getting out of the profession in despair, and a lot of potentially very good candidates for med school choosing to go into another profession.

As the market forces evaporate, more state bureaucratic intervention will be needed, and the eugenic margin will be expanded to provide post-natal "coverage" and the euthanasia margin will be expanded to provide pre-terminal "care". (Both trends are already fixed in the Netherlands, in case anyone is interested.)

Eventually, a trip to the hospital for anything serious will be a virtual death sentence. And the levels of incompetence and malfeasance and malpractice and even outright homicidal "care" will be folded into bureaucratic fog like raisins into bread dough.
 
Written By: Martin McPhillips
URL: http://mcphillips.blogspot.com/

 
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