Tuesday, November 24, 2009

HEALTH CARE IN AMERICA

First of all, I would like to thank Truth for agreeing to debate health care in an open forum in which all opposing viewpoints will be heard and respected even in disagreement. Also TAO is a worthy, well-informed blogger with a definite plan for health care that is well thought out and well stated. Visit both of these sites for further information on their plans.

I would like to start out with some signposts for effective health care as I see it. I'll lay out several and then flesh them out in later posts. I would like to keep the posts from becoming excessively long.

1) Any plan has to be portable from job to job and must apply in all states. When health plans are restricted to one state, the number of companies offering are so few that they have a virtual monopoly. This lack of competition has a direct effect on driving up the price of the health care plans. This is simple supply and demand.

2) Even the tax laws for those with private health care and employer funded plans. Employer funded plans are tax deductible while private plans are not. I understand wanting to pay off the unions with tax breaks, but this inequity skewers the market in favor of employer funded plans, which are historically "cadillac" plans and are very expensive. Therefore, the health companies have no incentive to lower their premiums because collective bargaining is in their favor. Employers, both government and private, are raked over the coals, financially paying for these plans. I know, I negotiated a few contracts in collective bargaining. If you don't think we knew the value of our health care plans, you should have seen us throwing most of our demands overboard to keep the level of coverage and our level of contributions. Allow competition and prices will drop. (See #1)

3) The Holy Grail of health care reform is the lawyers worst nightmare, tort reform. I've heard some statistics that tort (injury) settlements only account for 2%-3% of health care costs. While the actual awards may account for this amount, the real money is in malpractice insurance costs to medical personnel. This is a very real expense and very real cost that is passed on to the consumer. JC Penney figures the amount of shoplifting it suffers into the price of a sweater and passes it on the the consumer. All overhead is figured into the price of goods and passed onto the consumer or there would be no profit. The spigot should be closed on this profit fountain for lawyers.

Some items to explore later are Medicare reform, tax reform (think Fair Tax), high deductible insurance, HSAs, and others.

What I tried to do here is throw out a first pitch as it were, in this debate. I hope others join in and we have a good old free-for-all. I realize I haven't talked money, but I'll get to that after I frame my position. I look forward to this debate.

Thanks for reading.

19 comments:

TRUTH 101 said...

I don't have a problem with tort reform LaOT. I laid out a plan I thought the right would like on the second health insurance post. You tweaked it a bit and it was a sound idea.

The argument we would end up having is how much of a settlement is too much. It's hard to put a price on a lost life or limb. It's an argument that neither side can win and will just end up as a political football. In the meantime, things will stay as they are and millions will continue to have no health insurance.

Z said...

Truth, why can't we cover the uninsured and not completely revamp all our private insurance plans? My very dear husband died last month and I have to admit that our private insurance was amazingly forthcoming and paid EVERYTHING. Yes, it's not cheap but we managed the premiums and they sure did manage for us in the end.

What bothers me is lies about how we can keep our private insurance if a public option is put in force. Who'd buy private insurance for their employees if they know that public insurance is cheaper? Then, what happens when people find that gov't healthcare is not going well......?? They're already planting stories that doctors like the idea of no mammograms till fifty! NO DOCTOR I've HEARD ON TV LIKES THAT IDEA!
Also, they're upping the age of cervical examination for cancer! WHAT A COINCIDENCE that these stories are out there in the media JUST when we're voting on healthcare..AND there were NO ONCOLOGISTS on these decision making boards! AND, it's already RATIONING of a sort, doesn't the WH see that?

Back to public options, how will the Blue Shields of this world keep open? it's a blatant lie from the WH to not extrapolate what would happen if the plans they want go into effect, you see?

I think we can definitely put a price on life or limb....or at least try to. One who falls at the grocery store and breaks a leg is limited to a certain amount. Period. Covers the surgery and then some down time.. why not?
One who is damaged for life is also covered but not for MILLIONS of dollars!! People get $200 MILLION for asbestos or for smoking related diseases when they knew smoking was bad for them. This has to stop.

And, we simply can't afford to give illegals healthcare.....it's a ridiculous assumption that we have any kind of immigration policy but should cover those breaking our laws!

I hope to be back...I probably haven't sounded too lucid because I"m very tired tonight...sorry about that.
thanks for initiating this, LaOT.

TAO said...

A savings of 2 to 3%....

As an employer who see premiums increases every year of 10 to 14% (and told that I should be THANKFUL that that is all!) then I can expect to one year see increases of only 9% to 12% and then real quick I will be back to the old increases.

Yes, I hear all the talk about how increases in costs are 'passed on' to consumers...

So, logically everyone fires off the retort that any 'savings' are also immediately passed on also...

Let me give you a reality check!

I make tee shirts....the cotton prices change weekly because it is a commodity, UPS fuel charges change weekly, and health insurance premiums go up every year....along with wages...along with minimum wage.

The last time I raised the price of my shirts was in 2001. Thus I have eaten an overall increase of 80% in health insurance premiums and NOT been able to pass those costs to anyone.

I have watched the price of cotton go from .99 to 1.98 a lb due to speculation in the commodity markets and I could not pass those cost increases onto anybody...

Here is more:

In 2001 the retailers in Chicago sold my shirt for 17.99 which they purchased from me for 6.50.

In 2007 the same retailers in Chicago sold my shirt for 15.99 which they purhcased from me for 6.50 (they also began ordering on an as needed basis rather than carrying their own inventory which means I began carrying inventory, shipping them what they had sales for billing them at Net 30 and they banked the profit until they paid me!)

Today the same retailers in Chicago sell my shirts for 13.99 which they purchased for 6.50.

I did away with my sales staff in 2005 and worked direct with retailers and saved 10%.

Insurance salesmen make 12% commission.

In 2010 I can either sell to major department stores and the big box retailers who will get me down to $5.50 a shirt....

Or I can boost internet sales...or I can start a chain of my own retail kiosks in conjunction with another manufactuerer...

But the reality is that the traditional concepts of economics that everyone believes in no longer work...

I could go to India and make shirts, but the cotton is inferior and so is the construction....but it would only cost me $2.50 to make a shirt that I could wholesale for $6.50 (because the wholesale price NEVER GOES DOWN) that the retailers would then retail in Chicago for $13.99.

But the consumer gets an inferior product!

Law and Order Teacher said...

TAO,
Hence the reason I don't want to be a small businessman. It would seem to me that a man in your position would look at a high deductible insurance plan hooked up with an HSA for your employees. I have a friend who owns a chili business that is very successful. The fact that they are forced to file as an individual is deadly to their business. Tax reform would be a good thing, no? What happens to you when the health care plan in congress forces you to pay a fine if you don't offer government mandated health care? Just some questions. I look forward to hearing your answers as your expertise is valuable to the discussion.

Z,
Thanks for stopping by. I'm sure Truth will give a well thought out response.

Truth,
There is a middle way. Caps on awards are necessary and can be negotiated and put in place. Juries are really susceptible to sob stories and junk science.

It will be difficult for sure, but this whole thing is difficult, but has to be done. Thanks for your compliment, you don't know how hard it was to talk about giving government power. Good day sir.

TRUTH 101 said...

Those boards were Bush appointed. Your problem is with him Z. I have close relationships with people experienced in the fields these boards made recommendations on. They all said the boards were nuts.


Can't argue with you about private insurance giving way to public with the option. I don't support this bill anyway so I really can't defend it other than I hope it leads to either single payer or the Swiss system TAO advocates.



I would give priority in hiring to administrate the public option to those already employed by the insurance industry.



Depending on the situation, treatment for illegal aliens could be anywhere from a band aid and send them back to their own country to I don't know what to do. If a guy has an attack of appendicitus do we give him an aspirin and put him on a bus back to his home country knowing he will die an agonizing death on the trip?


I am very happy and relieved you and you husband have good health insurance Z. I am fortunate that I have a good employer and so does my wife. There are millions that don't. I want all of us to have a good health insurance plan and I want all of us to contribute to it's administration.

Bloviating Zeppelin said...

I completely concur with #1 and #3, but, of course, am reticent about #2 because that's about the only perk I get on my job -- tax free.

BZ

Law and Order Teacher said...

BZ,
I think all health care plans should be tax free. If we combine high deductibles with HSAs we can make them tax free and it goes good with all plans. It would encourage people to become insured just like car insurance. Thanks for the visit.

Z said...

Truth...WHY hurt MY insurance with this too-big plan which will economically bring America to her knees? And, do you really think any American gov't will be able to save billions from Medicare fraud and corruption to pay for this as Obama's people think? that's insane! FIX THAT FIRST, THEN address those without insurance, DO NOT HURT MINE, please, that's all I ask. (we were self employed so we paid for our own insurance, by the way)

Law & ORder..thank you for thinking of me on Thanksgiving; that means the world to me.
I'm thinking your Dad was one lucky man to have you for a son and one wonderful man to have merited your amazing affection and respect for him ...I had a great Dad and wonderful husband...We have great memories; MUCH to be thankful for. xxx

Tapline said...

No the government health insurance.....It will bakrupt this nation....it is not sustainable.....We have no money......China owns us......Fire them all and start over with some honest merchants......who work for us....They have forgotten who put them there and for what.......as far as debating Socialized Medicine. It scares the He..out of me. They have already started rationing...I'm 74 currently in good health but my prostate exam will stop this year...I assume forever...I can't get he H1n1 becasuse I am too old cut of is 64 years...I don't want the government deciding when I should die.... The doctors do that to some extent now with the "advanced Directive". What you put in that directive is up for interpretation...I ramble....stay well.....

Z said...

tapline..that's the most sensible, true 'rambling' I've heard in a while.
Excellent comments.

I'm hoping there's sound medical background for my older friends NOT being allowed the vaccine (tho I wouldn't take it, anyway) but I'm wondering if this isn't the death panel already begun? Odd that my Hispanic cleaning woman can get it in the inner city at free clinics but my friends and I can't FIND it at our doctors' offices..and that's the TRUTH.
And, friends with children have had a heck of a time finding it for their kids...but downtown? NO PROBLEM.

Z said...

by the way, I hope you had a wonderful Thanksgiving, L&0...you're a reason I'm very thankful.

PRH....... said...

Hope you and the family had a great Thanksgiving Steve....

pat the fellow sky cop!

Law and Order Teacher said...

Z,
My point exactly. We can adjust things by the free market without killing those of us with insurance that we are satisfied with. I think a good first step would be to make private insurance tax deductible. That would even the playing field and allow for some competition. Make the medical plans portable from job to job. Allow health insurance to bid across state lines. Without this it is a monopoly and that spells high prices.

As for the great men, we were blessed and I always will be. I only wish I could live up to what my dad was. I try everyday. Thanks for stopping by. Happy Advent season!

Tap,
Welcome sir. I agree that the seniors are going to take a beating in any plan for universal health care. Isn't that a bad deal when it is the seniors who built this country? I guess it's thanks for building, but now just go away. Sad.

Pat,
We did and I hope you had the same. Our families are the greatest, huh? That's a blessing.

Z said...

I like all your ideas about insurance, L&0...
And thanks...I can't BELIEVE this is first Advent Sunday already!
Mr Z was, as you know, German, and he liked an Advent wreath with candles.....I may put a tree up this year somehow (his children are coming from Germany) but I can't bring myself to do his wreath. man

Bloviating Zeppelin said...

The other thing is, we should be PAYING for our doctor visits, most of our medicines (excepting the ones of incredibly exorbitant rates), visits to ER, etc. What the bulk of people want, I'm surmising, is coverage for the really catastrophic events, major surgery, etc.

The run of the mill stuff, we should be paying.

BZ

TRUTH 101 said...

We are paying with deductibles and copays.

And if all of you notice, your calls for portability mean a government rule enforcing it.


No offense is intended towards you Tapline but there was not enough H1N1 to go around so it had to go to those most at risk. Not those with the means to pay the most for it. Just like when you go to the emergency room. Those with the most urgent need come first.


And where in this bill, that I oppose because it is a big pander to big insurance. Just as Bush's prescription drug bill was nothing but a boon for big drug makers, does it say it won't be paid for?


And it is republicans who continually call for cuts to Medicare and Medicaid. How come I never hear protests about that?



"Waste" is nothing but a word used by politicos to scare and anger whatever focus group they're focusing on at the time.

Law and Order Teacher said...

Z,
We have our advent wreath up in church and it's beautiful. I hope you feel the spirit to decorate, but your reticence is understandable. I'll post some more here in the next couple of days. Thanks for the visit.

BZ,
I agree that we need to pay up to a high deductible for office visits, co-pays, etc. I too, think that would cut down on the costs immensely. Your point is well taken.

Truth,
I don't like big government. If government fulfills it regulatory function, constitutional by the way, I'm fine with that. But it needs to stop at intervening in business decisions.

I never have said that it won't be paid for. I'm worried about how they will pay for it. Or more accurately who will pay for it. I object to paying for insurance for my family and for someone else's family too. That's always been my objection. Make all health insurance tax deductible, portable and competitive in any state and letting the battle begin. Thanks for the visit.

sheldonhillyer said...

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Z said...

Truth, my Hispanic cleaning lady got her vaccines downtown in the Hispanic neighborhood nobody in Santa MOnica, Beverly Hills or other nice neighborhoods around me can FIND THEM.

You call that "at risk?" The Hispanic poor are more at risk than my upscale pregnant friends or their children? WHAT?

Also, re: Medicare, there are big differences in what the Left wants cut and HOW MUCH, and what the Republicans have ever wanted cut in Medicare, i assure you...and do you really think that if the Republican cuts were as threatening to the elderly as the Leftwing cuts want to be the media wouldn't be ALL OVER THAT?