Until Midterm Elections...

Scott versus Scott

Welcome to our blog. Here we will debate the days most serious topics and allow users the chance to discuss the topics as well. The range of topics will vary, but one thing will remain certain, the debate will rage on. Scott Lesinski is a proud conservative and Scott Jones is a proud liberal. However, the roles will switch on some topics. Stay tuned.

Scott Lesinski is currently an actuarial associate for a large human resources and insurance consulting firm in Saint Louis. He is also an avid student of US history and enjoys following current events, with an eye to their contextual relationship to the past. He is also, in fact, a former student of Mr. Scott Jones. Scott is working toward his FSA credentials, which is akin to earning a PHD in Actuarial Science.

Scott Jones is currently a high school social studies teacher at a high school in suburban St. Louis, MO. He teaches World History, AP American Government and Senior American Foreign Policy. He has a BS. Ed. (Secondary Social Studies) from the University of Missouri - Columbia and a M.A. (History) from Southeast Missouri State University. He is currently working on a dissertation in character education to earn a Ph.D. in Educational Psychology.

Wednesday, May 13, 2009

What's wrong with Healthcare in America? A lack of Capitalism.

I recently promised a discussion on the merits of universal healthcare to my Facebook readers. I intend to make good on that promise. But let me lead into that discussion with this idea.

What, specifically, do I feel that we, as Americans, have a right to? This is essentially the question that was put to me by one of my friends and it kind of shocked me. Why is this even really a question? But I have heard Sean Hannity do “man on the street” interviews and there are quite a few folks out there who seem to think they have all kinds of rights that frankly, just do not exist.

The right to healthcare is one of these.

But I digress. I believe that every human being has the God-given rights to Life, Liberty, and the Pursuit of Happiness. (You know that third one was originally “Property”, but it was changed to slight the slave-owning southern states?)

Perhaps a prudent question to ask is “What IS a ‘right’?” I pose to you that you do not have the “right” to food, shelter, clothing, big screen TVs, healthcare, education or any of these other “things”. The reason we don’t have rights to goods or services is because these products are the result of somebody else exercising one of their true rights, that of the right to pursue one’s own happiness.

Think of it like this. If I work hard all though school and go to medical school, then spend 6-8 years of my life and rack up $300,000 in debt to learn to be a doctor, I am pursuing my happiness to a) help serve my fellow man and b) provide for a comfortable lifestyle for my family. You do not have a right to my services. I worked long and hard to gain these necessary skill sets. Healthcare is a commodity, just as food or shelter are commodities.

You DO have the freedom to choose to spend YOUR money on my services if you need them, or you could also spend your money on insurance programs that have the effect of exchanging a pre-defined, known loss with an unforeseeable, possibly large loss due to high healthcare costs.

I don’t want to get in a long list of each right we all have, but essentially, we have the right to our property, both intellectual and tangible. We can say what we want, so long as it’s not clearly a present danger (yelling fire in a crowded theater is the example most often given). We can even burn the American Flag as protest (something I find repugnant and horribly offensive, but never-the-less, protected). We have all the rights set forth in the Bill of Rights, but not limited to ONLY those.

Now for some touchier issues. I do not believe we have a right to an education. I believe that everyone should get an education, especially regarding the founding of the country, federalism, republicanism, and US history. Clearly, a literate and financially adept public is a large benefit to our society. But we don’t have a right to these things. We can choose to provide them for our citizens by several different methods if we want. We have chosen a publicly funded method for the vast majority of our people at this point. I think as a whole, public education stinks, but it is what it is and we need to try to fix it.

Now then, the point of this discussion was to address healthcare. I want to talk about a couple of things. First, I am going to address why are current healthcare system made up of both private insurance, private providers, and public welfare payments is not working. Next, I want to point out the very obvious problems with socializing healthcare (going to a single-payer system where the government is in charge or providing insurance payments to providers on behalf of consumers). Finally, I will propose a solution to healthcare that I believe will drastically lower costs, increase availability, and improve our healthcare system.

Our current healthcare system is not working. Medical costs increase at rates double the rate of inflation on an annual basis. Insurance rates are ever increasing, both for providers of care and consumers of care. There are quite a few uninsured people, for various reasons. Some truly cannot afford to purchase insurance. Others could but they are young and healthy and choose not to do so. Whether that is an intelligent decision remains to be seen, but those who make it have every right to do so.

Why does our current system have so many problems? The main reason for the increasing costs both in care, drugs, and insurance is the fact that the market-based relationship between the consumer of the care (the patient) and the provider of the care (the doctor/nurse/hospital/pharmacist) has been eliminated. Our current health insurance system, that of HMOs, PPOs, etc, generally do not function as insurance; rather they have become prepaid medical care. The policy holder pays a premium for their insurance and then the insurance picks up (most) of the tab for services rendered. The problem that this causes is abuse of the insurance. Instead of seeking an out-patient facility, people may spend a day or two in the hospital. Instead of buying generic drugs, people may just have the insurance pick up the bill for the name-brand. Basically, since the consumer of care no longer has any vested interest in lowering their health-related expenses, they spend recklessly.

This causes insurance to raise premiums to cover the expanding costs of coverage. You see this abuse from providers as well. How many of you have heard a doctor exclaim, “Oh don’t worry, we’ll just bill your insurance.”? I have, quite often. The main thing we need to do is reconnect the healthcare industry with capitalist principles of freedom of information and competition.

Another problem is skyrocketing medical malpractice insurance costs for doctors and providers of care. While it is the case that malpractice exists, the recent slew of “ambulance chasers” (see John Edwards) has created an environment in which doctors are fearful of giving a diagnosis that may be ever so slightly incomplete. This can result is extraneous and expensive tests being performed when they are truly not needed. Also, just the costs of litigation, whether a legitimate claim is filed or not, causes the insurance costs to go up. A “loser pays” system of tort reform would go a LONG way to reducing the overall cost of healthcare. In this system, only legitimate suits would be filed, because frivolous suits would not payout.

Now then, why is a government fix of healthcare NOT the answer to our woes? Let me begin by asking a question. What task currently under the execution of our federal friends, besides running the military, would you hire them to perform on your behalf? People constantly complain about the services they already perform. Ever been to the DMV? So, there’s the consideration for efficiency and the extreme likelihood of fraud.

But even more than that, it goes back to the first law of economics and the fact that resources are scarce but wants, needs and desires are unlimited. If government is the “single payer” for healthcare needs of this country, they will necessarily be forced to ration that care.

Pay attention to this, I’m going to repeat it. Bureaucrats in Washington will be the decision makers regarding who gets what healthcare. There has already been discussion of “means testing” regarding the cost/benefit analysis of providing care. What this boils down to is this: If you are young and have a long expected remaining lifetime during which you will be earning taxable income, you will be much more likely to receive that organ transplant or cancer treatment. However, if you are older and are nearing the end of your productive years, you are going to be increasingly likely to have treatment withheld, on the basis that it would be a poor investment.

Government healthcare represents the largest loss of individual freedom that we could ever impose on this country, short of going back to a monarchy. Healthcare rationing flies in the face of our rights life, liberty, and the pursuit of happiness.

Obama’s proposals include mandating that everyone pay for government coverage (explicitly or through taxes). However, under this system, you pay in your whole life and take very little during your productive years, then when it comes time to retire and you get on in your age, when you are most likely to need that insurance, the government will “means test” you to decide whether they should pay for the care or not. The system being proposed is very like the Canadian system. Under that system, if you, as a private consumer, pay cash to a doctor to provide care outside the government’s control, you are guilty of committing a crime.

Government healthcare stifles the creation of new and more advanced drugs and treatments. Just compare any socialized system with the US. We are the ones coming up with the newest technologies. Yes, they are expensive, but they are AVAILABLE. In the UK, women are resorting to home-births due to overcrowding, people are pulling their own teeth because the government won’t pay for dental care, and the quality of care is overall, poor. The main point of this discussion is that if we move to socialized medicine, the quality of available healthcare in this country will quickly deteriorate and your healthcare decisions will be left up to one of Obama’s czars in DC.

Now then, if things are so dire, how can we hope to fix them? In the book “Patient Power”, the authors discuss what is known as a high-deductible health plan (HDHP). This is the very type of insurance that I have with my current employer. Let me explain how it works.

With a HDHP, your insurance premiums are VERY low. Mine are $5 per paycheck, coming out to $120 annually. The catch is that you have a very high deductible that you must hit each year before the insurance will cover your expenses. This year, the deductible is $3,000. However, once you hit that limit, you are 100% covered. This way, you are covered in the event of a true emergency, but this restores market economics to healthcare.

Let me give an anecdote to illustrate what I mean. I suffered this past winter from a mild form of eczema on my hands. I went to a dermatologist for treatment. He immediately just prescribed three different drugs to use for my dry skin. The monthly cost of these drugs was well over $500. I balked. He said, “Don’t you have insurance?” Well, yes, I do, but I was required to pay for the first $3,000 of care. This forced me to really consider whether I really needed the expensive drugs or just try other, cheaper alternative forms of treatment. It turns out that a home humidifier and Aveeno lotion worked just fine. But if I would have had the insurance with only a $20 copay, I probably would have just billed the insurance company.

This is the kind free-market capitalism to which I am referring. We need to reduce insurance costs for providers of care; we can do that with tort reform and instituting and “loser pays” system. We need to bring back a free flow of information regarding the quality of care and the true cost of care. We need to eliminate abuse of insurance programs.

Another component of the HDHP is a tax-exempt Health Savings Account (HSA). This is an account that you can fund with pretax dollars and may be used only for healthcare related purchases. This way, instead of “prefunding” your healthcare with expensive insurance premiums, you get to “prefund” your healthcare with tax-exempt dollars that belong to you and will not go away if you don’t use them. If you start funding an HSA out of college, during your healthy years when expenses are typically lower, your account can accrue plenty of funds to cover your deductible should you ever need to. A proposal I could get behind would be to have the government administer HSAs for people in lieu of the medicare and Medicaid spending it currently engages in.

This discussion is meant to point out the flaws with our current system and discuss ways to fix our healthcare problems. I also want to reiterate that government controlled healthcare is an abomination that we cannot afford due to the unsustainable financial costs and the overarching loss of freedom that would ensue. We must return the principles of free-markets and competition to healthcare. To do anything else would be to take a failing system and throw it over the cliff.

38 comments:

  1. Scott, I'm going to try and take this one question at a time. Do you claim that we don't have the right to health care because it isn't explicitly stated in any governing document (Declaration of Independence/Constitution)? Or are you inferring it from some text written in those documents? Or some other source?

    I hate to ask for more writing, but I'm just wondering if you could go into more detail on where we get our "rights" from. The most important thing I hope you'll address is: who decides/decided what rights we have?

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  2. Its simple. We get our rights from God. Providence. The Creator. Nature. Whatever you call it, our rights just are.

    We don't get them from any document nor any man. The Constitution merely serves to protect our rights; it does not grant them. Nor does the government grant any rights. THAT is the point of the founders. If there was one thing they could agree on, it was that Natural Law is what should truly govern man.

    But what of my HDHP proposal?

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  3. Well done Scott! I agree with most everything you presented in this blog. The Constitution could be torn up today and we'd still have our rights.

    As for the healthcare issue, I'll take it a step further. I'm all for HSAs. However these should also remain completely in the realm of the private marketplace. The government having their hand in HSAs can only hamper the benefits they can provide. Tax exemption shouln't even be an issue. The income tax is another blatant violation of our rights and the Constitution. That's a whole new blog topic though.

    Another issue that Scott just briefly mentioned is employer provided healthcare. This also drives up costs. When your employer pays, you want the most/best coverage available. It would be better to for the employer to pay you in increased wages what he pays for your health insurance, then you buy your own health insurance. (See Scott's HDHP proposal above.) Insurance companies would then cater their policies toward the individual as opposed to corportations. The cost of individual health insuance would come down.

    This also eliminates the hassles and costs of losing your health coverage when you lose your job, change jobs, or retire. Think about it like car insurance. You don't lose your car insurance when you change jobs.

    Finally, compliance with government regulations comprises 37% of the total cost of healthcare. Get the government out of the way, and again the cost comes down.

    Scott already mentioned the problems with socialized medicine in the UK and Canada. In the UK there's not only waiting lists for medical procedures, but waiting lists for the waiting lists! If Canada's healthcare is so great, why do so many of them come here for treatment?

    Canada's healthcare is often refered to as "free healthcare". This couldn't be further from the truth. Governemnt controled healthcare still has to be payed for by someone. Guess who that somenone is?....YOU the taxpayer.

    When, in the history of the world, has socialism ever worked in any form?...Never! What has allowed us the progress and the quality of life we enjoy today?... Capitalism.

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  4. I just wonder if any of you have gone in this country without health insurance? Have you ever been in the position to chose feeding yourself (or children) or buying your medication? Have you known anyone with this burden?

    Wait til the day you are asked "Well which is more important for me to take...the cholesterol medication or the blood pressure medication? I can only pay for one so I need to know which I should pick." The day you have to answer that question is the day I will let you think healthcare is not a "right."

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  5. Martha, first of all, that's HARDLY THE POINT 0.o
    because of this plan goes through, we're all going to be faced with no medicine, or not any medicine.


    But second of all, Scott actually just pointed out an example where HE MADE A CHOICE!!! KEYWORD CHOICE to not buy the medicine because it was not necessary.

    Third of all, have you ever been told, WHILE 9 FRICKING MONTHS PREGNANT, "sorry miss, we're out of room. Why don't you try the hospital in THE NEXT TOWN!!"

    Fourth of all, have you ever been told, "yeah, we'll check out that lump when we get a chance. See me in 9 MONTHS"

    Fifth of all, Cholesterol/blood pressure medicine HELP. Not necessary, and besides the point, Marty. In socialized medicine, THERES NOT ENOUGH OF THAT TO GO AROUND ANYWAY >.< something about "rationed" healthcare I don't think you quite grasp.

    Sixth of all, have you ever been told when you go to the ER that there's 78 people in front of you? THE EMERGENCY ROOM HAD A WAITING LIST 78 PEOPLE LONG we have FREE HEALTHCARE and guess what! It sucks! Because they have to treat you and people take advantage of it, causing the real problems to have to wait unless you call for an ambulance.

    Seventh of all, hundreds of years before modern medical knowledge, thousands of years before basic medicine, people lived to extrordinary ages, without medical coverage. Amazing. So what's changed? We can prolong life, with medicine. Problem is, when were talking about INSURANCE v MEDICINE we're arguing about apples and oranges because treatment is available whenever from the ER but INSURANCE is a luxury you must buy.

    Eighth of all, cherry picking one anecdotal example weak. Seriously. 300 +million Americans. About 15% are uninsured. Considering 5-10% is the unemployment force, that leaves 5-10% uninsured, either because they can't afford it or they don't want it. Amazingly, when you're young, like Scott, you only need cheapo insurance because you're young, healthy and in the prime of your life.

    Last of all, I just want to reiterate.
    Healthcare =/= treatment, healthcare =/= insurance and that's not a right. Healthcare =/= life, Life, Liberty, and Happiness. Healthcare which is = insurance is = to something you buy for happiness/security. Happiness = security. Security =/= life.

    For every sob story you have Marty I have 10 of them. Because there is MILLIONS upon MILLIONS of people who CRAVE what we have in America and DESPISE with every inch of their gut, the horrible thing they have in their own country that is "healthcare"

    Sorry to go off, but this is dear to me, because to be honest, if socialized medicine goes through, my family would be in trouble. Want to know why? They want to limit the amount of treatment you can receive. I don't even know what our yearly expense is that gets covered (we have fantastic insurance btw) but we passed that amount up, in MARCH. My family buys and uses so much stuff all the time because we're trying to take care of ourselves, thats OUR RIGHT our DECISION to do so. And if Obama tells me otherwise,,,,, @&^!(*#

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  6. It's interesting how far our society has gotten from what we consider our rights to be. People feel things should be handed to them on a silver platter whether that should be the right to an education, healthcare, the right to marry, etc. The only true "right" that we have under God, Nature, whatever rights that just are, etc. is the right to try and stay alive. Survival of the fittest.

    Now, in a civilized society in an effort to resist government oppression, our constitution lays out some additional rights as they pertain to living in a population. I do not feel those rights are necessarily given by God/Nature/Whomever, but by our Founding Fathers as they thought were necessary. I believe those are the only "rights" that we have.

    Things like healthcare, education, military protection, police, firefighters, etc all these things are nice to have and indeed are practical and important when living in a large population. They are not "rights" however. The first step in fixing many of our problems whether they be healthcare or education is to have people quit considering them their God given right and expecting these things to just be handed to them without thought or consequence. The second is to have the government step out of the way in most instances. You are absolutely right Scott in that most government run programs are inefficient, and many are also corrupt.

    I think your proposal has the potential to work, Scott, though one big assumption is made in regards to it. There is a much bigger issue at hand than just reforming our healthcare policy. The assumption is made that people "need" healthcare in this nation. Now, hear me out. There are cases, of course, that care will be needed. Most often this should be in the case of an emergency. There are some other exceptions, however, healthcare in this country is highly overused and too many interventions, tests, medication prescribing, etc. goes on.

    You touched base on this slightly Scott with your eczema story. Let me ask you then. Why did the physician prescribe medications for your ailment when something much simpler and more natural worked just fine? Why would an "expert" in the field of medicine not know of a much more cost effective and less harmful way to treat your condition? We'll get back to that in a second. Even simpler, why did you decide to go to the doctor for your ailment when the treatment was something easily taken care of at home? Did you really require a physician's care? Perhaps, I am jumping to conclusions in that he maybe gave you the remedy. Would it not have been possible to do some research on ways to cure eczema without medications yourself and forgo a doctor's care altogether?

    I'm getting at a few things. The first is where does personal responsibility come into play in the role of health? I'll answer that. It is no one's responsibility but the individual person to maintain their health. This is one of the major problems with our mentality in our country is that we can do whatever the heck we please because we can always pop a pill later or receive medical care later when we find we have an ailment. And it's not individual people that are at fault for this type of thinking. We are brainwashed to trust our doctor for everything without it ever occurring to most people that if they exercised a little common sense, they may not need the help of a doctor in every circumstance. Don't believe me. Look on almost every ad for anything. Don't start an exercise program without first consulting your doctor. Don't take this harmless herbal remedy without first consulting your doctor. We might as well not eat, sleep, or even breathe without consulting our doctor. Basically, we are being brainwashed to not even think! Doctors are not the authority on everything. People are incredibly out of touch with their bodies and what goes on with their bodies. People freak out for the tiniest of things and go running to their doctor because that is what they have been made to believe is the only thing they can/should possibly do. This is quite especially true with parents in regards to their children. I have seen many times people come into the hospital for the silliest of things- to the emergency room, no less. Really, the only thing they get is reassurance, but not after a battery of tests have been performed that racks up the bill.

    What we need is for this whole "consult your doctor" nonsense to be taken out of mainstream media/publications. We need programs to educate people about when they really "need" to seek medical care. We need to educate people about their bodies. We need people to start trusting themselves. It used to be that information like this was handed down from generation to generation. If your child was sick, you called your mother or grandmother, not your doctor. Most issues resolved themselves, hence the reason our human race is still around. For all of you shaking your heads about the what ifs of people that died that could have been saved by modern medicine. Of course, there will be circumstances that may necessitate care of a physician or hospital, but they are few and far between. We lost this wonderful multigenerational resource and even the original "family doctor" when the medical establishment saw the opportunity to generate ungodly amounts of profits, and they did a darn good job of seizing the opportunity indeed! We spend more on healthcare than any other nation! That's why we're brainwashed with the "consult your doctor" crap and training of individual's to Not take responsibility for their health...because it's making quite a few people (in the government, in the drug companies, in the medical establishment) a killing of earnings!

    This is also where the physician's responsibility comes into play. Some are dishonest and want to drive up the bill, some don't know less expensive remedies, some are scared of malpractice so they order every test under the sun, and some are simply arrogant and just like to do whatever they please. I'd like to ask everyone's opinion. Should there be regulations of physicians to help decrease costs? Should insurance companies be able to refuse to pay for care and the physician be responsible for the bill if he/she ordered unnecessary tests or prescribed unnecessary treatment? How would something like this be implemented? I would say we need some changing and making of new laws. Here's an example. A physician can get sued if he fails to give a woman a Cesarean section when it was medically required. However, it is almost impossible to sue a physician and win if he performed a Cesarean section that was medically unnecessary. Therefore, our nation has a Cesarean rate of 31.1%, in some hospitals around 50%. The World Health Organization states there should be no more than 10% of women requiring Cesarean sections. This was based on very careful research. So, we know 20-40% of Cesarean sections performed are unnecessary. However, the physicians are getting away with it, which drives up healthcare costs and creates complications for women later down the road. Examples like these are abundant. Sure the physician may be trying to cover his own butt, but where is the accountability? So, we definitely need some new regulations before any healthcare system is going to work.

    The second point I am making is the problem with the "care" that is given in our healthcare system. This touches base with my above question in regards to using a simpler treatment. There are many natural treatments out there for almost everything. In fact, we could survive just fine without all the medical intervention that goes on. We don't need prescriptions for everything. The problem is that this information is not readily available, and some conspiracy theorists would have you believe are being intentionally suppressed, in the name of huge profits for large corporate interests. It didn't make the drug company $500.00 on their medications for you to use a humidifier and some lotion. These companies are huge with lots of money, so don't put it past them to try and hide simpler remedies. A humidifier and some lotion can't be patented by the drug company. The drug companies would lose huge profits if people learned easier, cheaper, safer ways to treat most of their ailments. Physicians would lose these revenues as well. Perhaps some are in on the scam. Either way, individual people don't know alternatives exist, and yes, maybe many doctors don't know as well. That's not surprising considering they are taught a very limited scope of things in regards to "health" in medical school. They are taught much about disease and are mainly taught the ways to combat it are with prescription medication. So, to really change the healthcare system, it's going to take a whole lot more than just different insurance propositions. We would need sweeping reforms to the curriculum of medical schools, and we would need to find a way to break the monopoly the drug companies have over our "health". We should have the principle of freedom of information in regards to this so that we may be aware of the alternative treatments that do exist. Also, in regards to the freedom of information, we by law are required to have informed consent for any medical procedure, yet rarely is true informed consent obtained. If people were truly informed about certain risks of drugs, tests, and technology, many of them would decline and opt for a safer treatment. This would decrease healthcare costs too.

    Now, an important word about health. We as a nation are very sick. We are not a healthy nation. In fact, our healthcare would more correctly be termed sick care. We do not seek care unless we are sick. There is no training or responsibility to maintain health, so inevitably most of us get sick. We are so unhealthy that our sickness is going to continue to grow and that will become a large problem in how to treat all of our sickness. This is also why our healthcare costs are so high. the truth is that our nation being sick makes...you guessed it... drug companies, physicians, and the medical establishment lots of money. You have to think about that. Why would we be well unless we took our health into our own hands? Here's a good example. There's always talk of finding a cure for cancer (and by cure what they really mean is some new expensive drug). If we truly "cured" cancer as in made it all go away, huge profits from the treating of cancer would be slashed! So no, an actual cure will not become available unless it is an incredibly expensive toxic drug that makes cancer vanish. However, if you have an understanding of cancer in regards to what causes it and how it works in the body, you would know that a drug or radiation or whatever would not possibly be able to cure cancer. The key to curing cancer is finding out what is causing it. Once you do that, there are cures for cancer out there, they are just not drugs, technology, or expensive therapies, which is exactly why they are not well known. I'll let you ponder that for a moment.

    So, that is a major problem with our healthcare in that it does nothing to maintain health nor does it figure out why someone is not healthy and work to make them healthy. When you went to get your eczema treated, Scott, did your doctor once mention what could possibly being causing it? Did he look for any underlying conditions? I'd be surprised if he did. But, no eczema is not a normal condition of the body, which means that your body was out of balance. Since the body works very hard to maintain its balance (homeostasis), instead of prescribing potentially hazardous drugs to make the body do unnatural things that will, yes, get rid of the eczema, but do absolutely nothing to figure out the underlying cause of the eczema (and no eczema is not caused by the cold weather nor is it something that is normal to happen from time to time), why not actually find out and fix what is causing the eczema? If we practiced this with medicine, our healthcare costs would decrease as people could actually be healthy and not have to come to their doctor frequently for minor ailments. This is why it should be called sick care. We are caring for the sick, and we are keeping them sick. Their ailment may go away, but if a new one comes and then a new one, are they really healthy? No.

    Also, if we want our healthcare costs to decrease, we need huge reforms to what we eat as a nation. The food we eat is not healthy. It is impossible for our bodies to produce health if it is not given the proper nutrients. Would it be too far of a stretch to think that maybe the healthcare industry and the food industry are conspiring together? Hmmm. We eat to obtain nutrients. That is the only reason we feel true hunger. Yet, why are there commercials all over the place advertising some kind of food? Better yet, why are there tons of commercials for prescription medication that are only available by prescription? Why are they being lobbied to us? We cannot be a healthy nation by the way we eat, and our healthcare costs will continue to increase as more people require care for conditions inflicted upon them by their diets. What conditions? Diabetes, heart disease, certain strokes, Alzheimer’s, the list could go on.


    One problem with the loser pays system is the assumption our court system is actually fair. I do not believe that it is in every circumstance. I personally would not want to go up against a large drug company if their medication severely debilitated me because there are many legal protections in place for the drug company as well as tons of money available to fight me on it. It is in the best interest of the drug company to fight me and say their drug could not possibly be responsible for my injuries than to admit wrongdoing on their part. It would be a very hard case to win. But were my rights really protected? I took a medication I trusted was safe and effective and had the proper testing to prove it because I was brainwashed to trust my doctor, but then I sustained injuries, but lost a court case that was destined to be won in favor of the drug company (because it is nearly impossible to "prove" the drug caused problems) and now I have to foot the bill? I could have just said screw it, I'll take my losses and just not sue, but if there really was wrongdoing, should I really have to do that? I guess the definition of a fair trial would have to be evaluated. I think I would definitely not be in favor of a loser pays system. In addition, I think it is important for people to know that there is legislation at present trying to protect drug companies even further and not allow an individual to sue them at all. This is an outrageous infringement on our liberties!

    Another comment I'd like to address is your comment, Scott, of "government healthcare stifles the creation of new and more advanced drugs and treatment". While I agree with you as this is most certainly the case, I have to ask. Why on earth do we really need more drugs and treatment? We come up with lots of new technology that we are brainwashed to believe is wonderful and necessary. We are cutting edge, and we are proud of it. But our healthcare spending will Never be able to be controlled when we must spend so much on this new technology, so we have to ask is it worth it? What if we actually didn't need it (and as I'm certain you can figure out, I don't believe we do)? Personal responsibility to keep yourself healthy and access to cheap alternative treatments are all the "technology" we need. We come out with the latest technology or gadget and it is revered as holier than thou, but come 20 years down the road we find it is responsible for birth defects or cancer, etc. Our medical history is littered with this! Then of course, we need new therapies to remedy the injuries we caused by our technology. Clearly, our technology is not all it is cracked up to be. Simpler can certainly be better.

    One last note in that you went and touched base on homebirth, Scott. I would love to see documentation for my own personal reference, amusement, and curiosity where you got the notion women choose to have babies at home in the UK based on the hospital being full. I would hardly be able to believe it. Women have their babies at home for a host of reasons; mainly being they are dissatisfied with the care they receive in the hospital. Perhaps, they view birth as a natural occurrence instead of a medical event. Perhaps they have reviewed the medical studies that show homebirth to be safer for the 90% of low risk women. I could go on and on. However, I find women do not simply stay home because the hospital is crowded. No, I have seen women deliver in the waiting room or the hallway even when there were no rooms. This is an example of exactly what is wrong with our healthcare in our nation. Women are terrified to give birth at home. Some even give birth in the car on the way to the hospital rushing to get there because if only they set foot in the hospital, everything will be fine. This is not true in any sense, but women are purposefully brainwashed in the name of profits (and profits surrounding birth are huge and actually are what keep many hospitals afloat) to believe that it is unsafe (some don't even believe you can actually have a baby anywhere else- though I assure you the baby will come out) to have the baby anywhere else. This is in direct conflict with the research out there. Where is the personal responsibility for our own birth experiences, for our decision making capabilities, for making sure we have the best outcomes possible? I can tell you that a woman who has her baby at home (planned) is very well informed about birth. It is not a decision taken lightly, nor simply because the hospital was/is full. Women usually don't know it is full beforehand by the way, and most women are brainwashed to be too terrified to stay home on a whim because the hospital is full. Women stay home because they don't want to set foot in the hospital, not because it is full. I hope I made my point clear. Your comment, Scott, just sounded like you thought the hospital is where women should be having their babies, but because of a problematic healthcare system, women can't properly get to the care they need in the UK. This is untrue.

    So, yes, a high deductible health plan would make sense in that hopefully people would not need to run to their doctor for every minor ailment and the coverage reserved could be for larger complicated issues or emergencies. But, I'm not sure it would necessarily decrease healthcare costs based on my reasoning above.

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  7. Scott,

    I don't disagree with your general principles (see, you were right when you said we actually do have a lot in common).

    Two questions:

    How do we educate people on how to make good choices on these health care decision? Please don't say the schools, we are overburdened already.

    How do we guarantee the HSAs will be funded by people? Would you be willing to allow a $3,000 per year tax credit for each individual? The government already gives my school district an ~$6,500 tax credit on my health insurance.

    HSAs are a great idea. I've often thought that I could be more efficient with my own insurance so long as I don't have to have a transplant like my brother. If the government allows for the tax credit, then the $3,000 would be available for all people regardless of income.

    As we got older, then this money would have accumulated. For instance, I'm 37. By the time I am 70, I will have paid in $99,000. Let's say after accumulating interest and using money for various health reasons including physicals, I have etc., I have $50,000 in my account. Therefore, I could purchase major medical with a $47,000 deductible. I'd imagine that wouldn't be too expensive, even at my advanced age.

    We could argue what happends to the account after we passed on, but that would take the debate off topic.

    In general I agree with this idea so long as we make sure ALL benefit from it, including the working poor that might not have the extra money to fund an HSA.

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  8. By the way, the cost per year of allowing the tax credit would be equilavent to the stimulus package (not including the bailouts).

    The overall savings down the road would quickly reach into the trillions of dollars.

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  9. By the way, life is a right. Health care helps us have that life, which is pretty important to happiness.

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  10. Life is a right. However, people lived just fine before healthcare which leads me to believe it's not necessary.

    Healthcare is something you buy so you can lead a better life. ie It's a choice you get to make.

    Im reminded of Gran Torino, where Clint Eastwood's character is a grumpy old veteren who's wife just passed. He's a smoker and is clearly in distress from the smoking because he has these coughing fits where he coughs up blood. Everyone tells him to quit but he doesn't. Why? He made the choice to keep smoking because it's something that made him happy.

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  11. Lski, Do you seriously believe that a life expectancy of 40 years is living just fine?

    Of course, life expectancy in the United States currently is the lowest among the industrialized nations. We must have much less happiness here (we actually do, but it is not because we die earlier. This, however, is another topic).

    All I am asking is for equal access. I think Scott is on to something so long as ALL have access. The tax credit would accomplish this.

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  12. Okay, let me answer some questions.

    "I can only pay for one so I need to know which I should pick." The day you have to answer that question is the day I will let you think healthcare is not a "right."" ~Martha

    Merty, let me answer your point here with another question. Do you really believe that either the status quo system or the government provided, single-payer system would not lead to many people still asking this question? What about the 75 year old grandma who breaks a hip and needs reconstructive surgery, but since the government is funding her healthcare and she isn't expected to live all that much longer anyways, they just don't pay for it? Oh btw, under the system Obama wants to impose, it would literally be a crime for Grandma to pay cash for the procedure to be performed outside the government system.

    The answer is this: There exists NO perfect system. No matter the system we decide to institute, there will be people who have sub-par coverage, or who can't get the medical care to the extent they may need. My point is that under my proposed system, we would be minimizing that number while still maximizing the quality and availability of care. Government rationing, like I said, promotes only the status quo, and leads to poorer overall quality and availability of care.

    SJ,

    This is where the compromise comes in.

    So long as the annual government contribution is in lieu of Medicare coverage and/or medicaid (as in, my system REPLACES the current mess of government provided care already being royally screwed up) then yes. I am willing to compromise that. Because I feel so strongly in returning the health industry to market principles of competition, consumer information sharing, etcetera, this is the exact sort of "safety net" I would be okay with funding.

    Some issues to work out do exist, however. You mentioned what happens when we die. HSAs currently are YOUR MONEY. This should remain. For most taxpaying Americans, we pay over $3,000 in taxes anyways that this represents a refund of tax dollars. For those that don't pay enough in taxes to quite get to that amount, well hell, we already redistribute SO much through crappy programs like Medicare and Medicaid anyways, this would end up being a wash.

    This way, if it is indeed OWNED by the consumer, the tax-payer, then it can be managed by that person. I would absolutely be against a new government run bureaucracy to manage these funds. Edward Jones, Prudential, whoever out there could do the management, choosing very reliable investments that earn a very low risk rate of return would be utilized for these assets. A system of hedging the funds, especially for older participants, would need to be set up to protect people over a certain age from heavy investment losses.

    And Scott, you don't understand the power of interest quite like I do (no fault of your own).

    At a long-term rate of return of 6% (Extremely safe and modest return over the long run), assuming you use half of your $3,000 each year, by the time you reach age 65, you would still have accumulated $108,000. Obviously, for folks like me, the fund would be much higher. Plus, if we establish this HSA as YOUR OWN, then we could also allow you to contribute more to the fund. Plus, some years you won't use all of it, and some you may need more. The bottom line is that the long-term will always bear out investment gains so long as you manage the funds in a responsible way.

    There, enough actuary stuff. Sorry if I bored some of you, but its important to understand investing, even if just a very basic level of knowledge is gained.

    SJ, I would suggest that if there is unhappiness here in America that exceeds other nations, its coming from the liberals who seem to live in a constant state of outrage. I am quite happy. ;)

    Oh yeah, and life is a right. Healthcare is a service that enriches one's life, just as proper nutrition, education, and belief in one's self and having motivation to succeed also enrich one's life. None of these are rights though. We just decided that, as a civilized society, we want these things for our people. But they have to be earned. None of them just spring out of the ground. This is my logic behind arguing against these things as "rights". You cannot claim a right to healthcare or education just as you cannot claim a right to my house or a free lunch. All things have cost that must be borne by somebody.



    Katie, wow, you should have written your own post, lol. It is clear you have done a lot of thinking about this topic. Let me say this, I actually do agree with you that ours is a society that over medicates, with people constantly expecting a "magic pill" to solve all there problems.

    That being said, I do not believe that people who become doctors are in it to keep the population sick and needing their care. Bacteria and viruses do a good enough job of that already to provide our care practitioners with enough patients on their own.

    Are there TONS of things that we can do on our own to stave off the need for antibiotics and other medications as much as possible? Most definitely. I haven't had the flu in close to ten years. I honestly can't remember the last time I had a fever. What do I do? Eat a (moderately) healthy diet, exercise regulary, take vitamins, get plenty of sleep, and live a life with a generally low amount of stress.

    But just because I have been lucky and smart regarding my health does not mean that there aren't some instances where good old amoxicillan works wonders. Penicillan was not discovered by a man wanting to keep the population constantly infirmed. And radiation/chemotherapy do work in many patients. Are cancer treatments perfect? No, but if I have a terminal form of leukemia or mylenoma and the Leukemia and Lymphoma Society funds research that brings about a drug that can enhance my chance of beating the cancer by even 20%, you better belive I'm going to be first in line!

    I would summarize my response to your post like this: Yes, there are many things we can do to keep ourselves healthier than we are. But medicine is not bad, especially if used only when truly needed and in moderation.

    My plan would lend itself to this. If you have to cover the $3,000 deductible with your own money instead of insurance doing so, you are going to be far less likely to run off to the doctor for any little fever, cough, or cold. That being said, if little Billy has had his fever for a week and is vomiting and can't keep anything down, its time to take him to the ER, or at least the doctor.

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  13. Scott, I just don't think I'm getting it. You said: "Its simple. We get our rights from God. Providence. The Creator. Nature. Whatever you call it, our rights just are."

    And I'm simply not understanding how you can claim that a higher power is the one that decides what IS a right and what ISN'T, and that this higher power has communicated what these rights are to you. So maybe this is where you and I fundamentally disagree. I don't believe in a higher power or creationism or anything along those lines (as you can tell, I am anything but religious). I believe that humans are just some random amazing phenomenon that happened to occur after trillions and trillions of years of pure chance and the right things happening at the right time.

    I don't want to start a debate on religion or creationism or higher powers or anything like that, I simply wanted to point out where my opinion comes from. And, like I said, this is probably the fundamental reason for our disagreement.

    We became what we are through the only "natural law" that (to me) exists: evolution. The "fight for survival" is what causes mothers of certain animal species to choose to feed one baby over another, or to even eat their young. So, in my view, humans, just like ANY other living creature or plant on this earth, have NO natural rights. Nothing is "god-given". The ONLY rights that exist are the ones that are granted to us by someone or something else (i.e. a government), but not a higher power. We, as a society, must determine the rights we are willing to grant each other and ensure those rights are protected.

    I think that humans are above the harsh, cruel method of natural selection, in that we are obviously the most intelligent and capable beings to walk the earth. To us, survival of the fittest doesn't apply, because it doesn't have to. We have the intelligence and the resources and the ABILITY to extend and better the lives of those that would normally been deemed by nature as "unfit".

    I don't want to live in a world where those who aren't as "fit" as the rest of us are simply allowed to die off just because they couldn't afford to "buy" the proper treatment. I think that we have the means necessary to ensure that every person has the opportunity to live a long and happy life, and I don't think that a health care system that has a profit motive is the right way to do it.

    Scott, you keep preaching that non-profit organizations are an important and much more efficient way of providing for those in need. With that in mind, I hope that you can admit there are just SOME things out there that ARE NOT PROFITABLE. If this were NOT the case, then why would these non-profit organizations be necessary? You keep recommending that we support these organizations by volunteering and donating, so obviously you MUST see that society has NEEDS that businesses SIMPLY CANNOT (or choose not to) FULFILL. If you disagree with this statement, then PLEASE tell me, WHY do non-profits exist?

    People have NEEDS. And not everyone has the ability to meet their own or their family's needs. Yes, a lot of people do, but there are countless people out there who don't. Health care is a NEED. It may not be a RIGHT (obviously it's not to you, and remember that I don't think that rights really even exist), but it is a NEED and we as a society have the ability to make it easier for everyone to meet that need. Providing health care to the poor is NOT profitable.

    Non-profit organizations certainly provide some assistance. But you CAN'T simply rely on the "goodwill" of others when people's lives are at stake.

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  14. Scott, in your anecdote, you point out that "this forced me to really consider whether I really needed the expensive drugs or just try other, cheaper alternative forms of treatment."

    Well, many people don't even have the opportunity to make THIS choice. For many Americans, the cheaper alternative forms of treatment (if there are any) aren't cheap at all. The only CHOICE they get to make is between feeding themselves and their family or treating an illness.

    Sure, your high deductible plan sounds like it would work in a PERFECT WORLD. But in THIS WORLD, it doesn't.

    You're an actuary, so I'm sure you can help explain this part. With these high-deductible plans, how do you think the insurance company determines the deductible? You think they just pick a random number that seems like it would cover any "emergency" situation? NO. They're for-profit companies that are trying to MAKE MONEY. They're going to set the deductible at a level where the VAST MAJORITY of your medical costs are going to fall below it. If they didn't, they'd be stupid, and they wouldn't make money. Trust me, they've made a lot of money so far, so they ain't stupid.

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  15. Scott, where are you getting this "means test" information from? Where have you been getting your details on Obama's health care reform?

    These are the details I've seen so far:
    "The House plan also includes a government insurance program to compete with private companies. It would be financed by premium payments, not taxpayer dollars."

    And:
    "The summary of the House proposal says one of its main goals is to "minimize disruption" for people who already have coverage by allowing them to keep their coverage. All Americans would be protected by an annual limit on out-of-pocket costs, a safeguard already in the best private plans.

    Individuals would be required to get coverage, either through an employer or government plan, or on their own. Employers would be required to provide coverage or pay the government a percentage of payroll.

    Individual subsidies for health insurance would be offered on a sliding scale to those earning up to four times the federal poverty level, or $88,200 for a family of four, according to the document."

    Where does this means testing come from? Are people just assuming that it will happen?

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  16. Ok let's clear some things up. I have been working in pharmacies for 5 years. I have worked in two VERY poor areas (over 50% of patients on Medicaid poor) for over 4 years. I have seen MANY of people choose between their BP and cholesterol meds, that wasn't a one time question I had to answer. I have to answer more often than I want to think about. It is a fact of life in a pharmacy. It kills me multiple times a day to say "That will cost you $150/month." There are cheaper options for many things. But fact of the matter is the most superior statin for lowering cholesterol is the most expensive. Many people cannot achieve adequate cholesterol levels without Lipitor (no matter how many doughnuts they do not eat).

    I would shock many of you by my answers on who needs some forms of healthcare. I believe if you are a very healthy 75 year old you should get a hip replacement. IF you are not, I'm not sure that is the best option. If you have a 5% chance to survive a surgery...I'm not always sure it is worth the financial burden. If you save 1 life in 500 for something that costs a lot of money, I'm not sure it is worth the cost. This sounds harsh, but seriously we spend a SHIT ton of money on things that are not necessary in healthcare.

    Oh and Todd (I'm assuming you are Lsenski or whatever) I do not consider ezcema something that is life threatening. Sorry you have dry skin, Scott, but that isn't a good of example of a "choice" you made in health care. That is a choice you made on your beauty :). I'm fine with health insurance not covering things such as Viagra, phenteremine, acne medications, and the like. Those are not necessary to your health, if you are in my insurance pool I would rather not pay for it.

    Do I think government run healthcare is what we need? No not really, but the system needs to be fixed. Thinking America has the best damn system in the world is not the idea American's need to have. If you have awesome insurance, good for you. It is probably from a government job ;) (haha I kid I kid, but my bro-in-law has AMAZING insurance as a Senate Aid of a Republican none the less haha).

    I have ideas on cutting costs of Rx meds. I hate drug companies. I think they are the devil. I think they should have the right to be the only one to make that drug for 7 years (after it hits the market) if you are the first drug in the class. I think you should only get 5 years if you are a copy-cat. The drug companies will let you believe they need patents to pay for those drugs that don't ever make it to the shelf. I call bullshit. Pfizer makes so much money on Lipitor alone they could fine hundreds of new drugs a year. So that is just something the CEOs are throwing around. We could also change the process of getting generics. Ever wonder why some come at at $4 a bottle and some still $200? Oh that is when somehow the name brand company then gets the sole rights to make the GENERIC for another year. Generic Lotrel had namebrand Lotrel in the bottle for 1 year. THAT IS RIDICULOUS.

    The drug industry is a shamble and I am getting ready to enter it in 2 days. I would rather sell a generic drug any day than a namebrand one. We make no money on namebrand drugs. Insurance won't reimburse for it, and I don't make any money off of it.

    I think we can learn a lot from other healthcare systems. A total socialized system will not work in America. There are many other systems that could help (especially those without health insurance). The biggest issue I have is that the people without insurance are the one's working 3 jobs to put food on the table, not the lazy ass who sits at home and eats KFC 3 meals a day. SOMETHING needs to be done. I don't think Scotts option will work for those who don't have insurance now. They still can't afford healthcare with that.

    I don't know what to do, but I'm tired of being scared I will cause someone to have a heart attack when I tell them how much something costs in the pharmacy. The "free market" trade isn't working in pharmacy...............

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  17. Well, I’m glad to see at least someone read my incredibly long post. Thank you, Scott. Lol

    I definitely wasn’t implying that doctors are bad. Though some of them are very much so in it to make large profits and so the ethics of their practice would be called into question. No, I think most doctors go into their field with a love for what they are doing and are genuinely trying to help people get better. It’s a shame that many doctors do not look for knowledge outside of their small accepted frame of thinking. This leads to a case of the blind leading the blind. People trust their doctors for everything, and doctors are thought to be the ultimate authority, though there are some areas in which a doctor has almost no training or expertise. An example of this would be nutrition, which is the most fundamental building block to good health that there is. You’d think they would teach this in medical school. This is why I feel we need reform in medical schools if we truly want a healthy population. A very good doctor and there are some indeed, go outside of their training and their narrow minded way of thinking, and learn other things, such as nutrition or alternative therapies. If a medical doctor says there is really nothing he can do for your back pain but prescribe pain killers and refers you to a chiropractor, then he would be someone I would be more inclined to trust.

    So, no it’s not the evil doctors. But they are taught only one way to believe and think about health. They also do many things because that is how they were taught- they do not deviate nor do they question- even if something is not evidence based practice. This is extraordinarily evident in the field of obstetrics. Things become the “standard of care” even if they may be harmful and if you do not perform them, you are thought to be incompetent. So, what we really have with healthcare is a very dysfunctional system, insurance and costs aside. Nurses and doctors are caught up in the system with a do as you’re told and don’t ask questions mentality.
    Yes, germs do a good enough job making people sick, and our food industry and drug industry do a great job keeping people sick. The physician prescribes the medication or uses his latest gadget of technology because that is all he knows how to do. There is no way to be healthy when toxic food and medications that are toxic to the body continue to be put into the body because there is no way for the body to maintain its balance. Great example. I suffered from sinus infections a ton as a kid. I would get one. My mom would dutifully take me to the doctor instead of see if my body may get better on its own. He would hand out the antibiotics. I’d take them all. A month later, here came one again. Over and over. This is precisely what antibiotics do! Kills all bacteria and gives the body a hard time to balance itself, so you get sick again. Instead of a doctor or parent being able to reasonably figure this out given that they understood how antibiotics work, it took a 4th grader to say no more antibiotics and I healed my recurrent sinus infections through nutrition and other health principles.
    So, while antibiotics work well in some more extreme circumstances, it’s usually best to leave the body alone. Health and healing come from within by the body, no external force can do this for the body.

    You seem to have a good understanding of some health principles, Scott. Which is great and probably why you don’t get sick often.

    A point I was trying to make was that if we were a healthy nation that didn’t require so much healthcare (because with proper health principles our bodies could overcome even viruses and bacteria), then the industry would be out of a job, doctors and the drug companies included. Which will never be allowed to happen, so yes, maybe not doctors, but big corporations do work to keep us sick. By law, they have to work to increase their own profits. It is possible for the body to resist bacterial and viral infections and virtually never get sick. If that happened, doctors would even be out of a job.

    Yes, penicillin was actually discovered and worked wonders when it was first used. It never treated the underlying cause of an illness however, but there was no vicious intent with its discovery. The problem is the concept was taken and run with and look where we are today. Over drugged and under nourished. People need a medication for everything under the sun. To have a bowel movement to sleep at night. These are natural bodily functions. We would be better off figuring out why they aren’t occurring properly.
    Cancer treatments work for some and don’t for countless others. However, they are extremely toxic to the body, have horrible side effects, and cannot produce true health even if the cancer goes away. Being cancer free does not necessarily equate to good health. If you found out you had leukemia, of course you would be proactive in doing something about it. But would you rather take expensive horrific treatments that made you feel like actually dying or would you rather take some vitamin D supplementation as that is a cause of many cancers? My point is even with a terrifying disease like cancer, there are cheaper, easier alternatives. But vitamin D doesn’t make anyone much money, so it is of course not mainstream.

    No, medicine is not bad in itself, but it is abused. Emergency circumstances are a great example of when medicine can be a lifesaver (pun intended). Yes, we can keep ourselves healthier, so my point is no matter which system of health we end up with up, we will still have exorbitant costs of care because we are a diseased nation. Sure, some systems are going to be much better than others and government run healthcare would be an atrocity. But, really solving our healthcare crisis won’t happen no matter what system we come up with if we are still a very very sick nation. That’s why having good health in the first place is of paramount importance.

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  18. I want to ask something, WHERE in these new health care proposals going through Congress does it say ANYTHING about socializing health care?!

    Maybe I just have the wrong idea of what socializing health care would involve, but I assume it means government-run hospitals where doctors are employees of the government, and everything is funded by tax dollars so that no one has to pay for health care?

    When has Obama said ANYTHING about socializing health care or making it "government-run"?

    What I have been hearing is that they want to make it ACCESSIBLE FOR ALL. If you can already afford it, then GOOD FOR YOU. Keep it. But for those who CAN'T AFFORD IT, there are now going to be means to make it more accessible.

    The hospitals are NOT going to be government-run. The doctors are NOT going to be government employees. The proposal simply gives MORE PEOPLE access to a healthier life, and I like that.

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  19. Martha, you make some excellent points about drug companies. At least someone else gets it. You say we need to do SOMETHING. And you are correct.

    What I'm wondering though is why everyone seems to think that something runs along the lines of more technology, more drugs, or a better run healthcare system? Why can't we obtain it simply by making ourselves a healthier nation? The average person knows so very little about actual health. If we were a healthy nation, we would need extremely small amounts of healthcare in the first place, making this entire discussion obsolete. Instead of spending money on prescriptin drugs you can't afford, why not spend it on proper nutrition? I say you don't have to choose between your BP or cholesterol meds. If you were healthy, you wouldn't need either. I'm not about to feel sorry for someone not being able to afford it later in life because they didn't take care of themselves when they were younger and had the chance. Illness is not an natural part of getting older. Common definitely, but not natural. It is simply the accumulation of unhealthful effects on the body for a lifespan. Bad cholesterol can be controlled with proper nutrition. It is ludicrous to think it is destined because of bad genes or whatever.

    There were some good points made about HDHP's though. There is a great concern with some people affording them. My husband and I had one for years during college. We had it in the case of an emergency. If one of us happened to get in a nasty car wreck and need to be on life support for a week racking up some hospital debt, at least we had the insurance. But no, we couldn't use it worth a darn. If we needed something, we couldn't really get help. Because we couldn't afford the bill. Thankfully though due to healthful living practices we didn't need the help. So, no this plan would not work for everyone who may want to use it but can't afford it. It would work however for those that take their health into their own hands and only use the medical establishment sparingly and in emergencies. Which is precisely what we need in this country. Therefore, it actually has the potential to work great. It's just a matter of what do we as a nation want. True health or affordable healthcare?

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  20. Whoa, whoa, one problem at a time. When you start talking about getting "average people" to learn about living healthy, it sounds like you're talking about EDUCATION. There's a lot of talk on here about how privatizing everything is the right way to go. So, if we privatize education first, then the poor can't afford to send their kids to school, so their kids have no idea what's healthy. Then, we make sure they can't afford health care, so what we have is... My word! I've figured it out! I can't believe I've been missing it this entire time! Eventually the poor will die off! And that will solve ALL of society's problems! MARVELOUS! You guys are brilliant!!

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  21. Greiner, calm down. The tax credit would allow the poor access to Scott's health care plan.

    Wow, lot of arguing about stuff not actually related to the health care debate. Sure we can spend time talking about what the right of life is about or how to address the causes of some of the health problems in this nation.

    (By the way, almost 75% of all health care problems come from personal choices, however, most of these problems come from choices that we didn't know are bad - i.e. my dad died from complications from smoking for 13 years of his life. He quit for health reasons, but the damage was done and he didn't know that. I have the same genetics and I am trying like hell to avoid things that can cause lung problems, but it is nearly impossible. Everytime I decide to go outside, my lungs face possible damage from others smoking or pollution or ... My fault, I don't think so. My choices, yes. I know one example is not scientific, but conservatives like to use the one example to always point any possible flaw in social policy. Sorry, couldn't help myself.)

    What most of you have done is create red herrings from the original issue. Our failing health care. Many posts have pointed to flaws in the conservative philosophy of Scott, but haven't issued alternative plans. Yes, I am as liberal as the next person, but pragmatism is more important.

    Scott, I am happy to hear your willingness to compromise. Your proposal is solid and your willingness to consider the tax credit points to some real pragmatism. We would see immediate savings from converting everyone to a $3,000 deductible plan with contributions to an HSA credited back. By the way, I assumed a person would be spending a $1,000 per year on routine health care things such as physicals, blood work and other things. That is why my number was lower. Your right though, compound interest confuses me.

    I see a budget that would include $800 billion for common defense and $900 billion for our health care proposal, these leaves still $1 trillion (and a balanced budget) for other things such as education, NASA, EPA, FTA, FDA, etc. We could offer more savings if we made the airlines pay for air traffic controllers (they would pass the expense on to passengers, but safety is something the airline passenger should pay for). Drug companies should pay a fee to have the FDA review drugs and their safety.

    These however are issues for another post. We need to set aside some philosophical differences and come up with practical solutions so that health care is available and affordable for all Americans.

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  22. By the way Scott, I am a liberal and very happy. I know a lot of miserable conservatives as well as miserable liberals. I don't think political philosophy has anything to do with happiness. I know you said your statement as a tongue-in-cheek statement, but I don't want it to become a focus of the debate and take time away from your health care proposal.

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  23. Another thought that needs to be hammered. Prescription drug coverage. Some of us on them now (me for allergies) and the rest of us will need them sometime in the future. How does the HDP and prescription drug coverage work? I have to admit an ignorance on this one, but the cost of prescrptions is somethine we must deal with and I don't think anyone should ever have to choose between food or prescription drugs as many seniors have had to, and some still do, make as their life needs help continuing to live. I am open to ideas on this, but it is a deal breaker.

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  24. On the prescription drug front I think Martha already eluded to the fact that when a drug company has a drug, they have a really long time that their drug is under a patent. Maybe she could throw in a couple more cents on this one too?

    I know drug companies spend a TON of money on research and development and on many experiements that just don't end up panning out but like she mentioned, Lipitor has made Pfizer some serious cake!

    It seems like the best answer would be to inject a little competition on the prescription drug front, but how? I can definitely see the benefit of a patent because it would hardly be right, or constitutional, for a company to pour a lot of money in to a drug and just have another company produce the same thing and then undercut the price.

    But just because a company, like Pfizer, has a phenomenal breakthrough doesn't mean that everyone who has high cholesterol automatically has a right to that drug!.

    Now, I know just what the argument is going to be for that.

    "But Jon, Pfizer is in the business to develop drugs to help people! When they discover a breakthrough they have a responsibility to provide it to those people they are in business to help!"

    To which I say they are also in the business to make money.

    Yes, Lipitor might be the best option concerning those drugs nowadays, but what was the best option before that? Was that drug essentially no different than a placebo? Why is the choice automatically between Lipitor or food instead of Lipitor or a cheaper alternative? Is there really nothing else that will do anything?

    Not only that, what if Pfizer doesn't come up with anything good in a couple years or maybe ever again? All of a sudden Lipitor and Viagra are now in the generic stage and they're not making much more at that point, then what? What if they end up going out of business and then never have an opportunity to research ever again. Maybe the gov't would bail them out too.

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  25. I wholeheartedly agree that it is the competition among drug companies that has led to a remarkable amount of drugs that have helped us live better and longer. I know price controls would destroy that. At the same time, I believe that access to such drugs should not be defined as you are rich so therefore you get to live longer.

    If somehow we were to allow the HDP deductible to allow prescription drug purchases and we could use our HSAs to purchase such drugs, then we are back to a pragmatic solution. If we got to choose medicine based on choices that our doctor gives us and we have the ability to choose what form the treatment is and don't have too worry about facing bankruptcy because we chose to stay alive, then all is well.

    Anything short of that does give equal access to the American dream. Before you go crazy on that statement, please remember that a lot of people are poor not because of bad choices. They are poor because the system has not worked out for them (i.e. the inner city. What sort of choices does a child born there have to make it in this life? Sure some make it, but well over 95% do not.)

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  26. " I believe that access to such drugs should not be defined as you are rich so therefore you get to live longer."

    What about "you are rich, therefore you get to buy a better education"? Or "you are rich, therefore you get to buy higher quality food"? What about "you are rich, therefore you get to go on more luxurious vacations?" Or "you are rich, therefore you get to own a larger house, drive new cars, tool around the lake in your private yacht, or cruise the skies in your private jet"?

    I would argue that all of these things could contribute to living a longer life, especially the food quality one. Certainly if you are rich, you can afford the highest quality health insurance and the best prescription drugs and the most advanced healthcare techniques.

    My point here is that these are all outcome based results. There is nothing inherent among human beings that separates the wealthy from the poor. As Wardo has pointed out in previous posts on Facebook, something like 75% of the Forbes Top 100 wealthiest people alive are self made.

    I don't mean to go off on a tangent about the accumulation of wealth, but we've come to the crux of the argument once again. It seems you (SJ) and others of your leaning believe that everyone is entitled to the best healthcare America can provide, regardless of economic stature. Yet, those treatments and drugs are not free to produce. There is an opportunity cost for the doctor's time. There is the research and development costs of the drugs and other technology. So we have to pay for them somehow.

    It seems we've come to agree (for the most part) that Single Payer healthcare, as Obama is proposing we move to, would devastate our healthcare system with rationing, fewer doctors, price controls, and lower quality and access to care.

    SJ, my HDHP does not give me much additional benefit when it comes to drugs. That is the reason behind the anecdote. I do get preferred drugs and providers, but there is not much discount given.

    Also, I am not sure I am okay with just giving a tax credit of the amount of the HDHP deductible to all Americans. As you pointed out, that is roughly $900,000,000,000. Unless this system COMPLETELY replaced all of medicare, social security, medicaid, etc, we would have some trouble funding it.

    As others have pointed out, a HDHP may not be a one size fits all solution. Other forms of insurance may be more appropriate for some individuals or families. But those forms of insurance need to be market based if they are to succeed.

    Another problem with gifting the $3,000 is that you have effectively neutralized any market related benefit of switching to that form of insurance. If you get the exact value of the deductible and then after those expenditures, you are 100% covered, you have ZERO accountibility. The greatness of this system is that it puts some "skin in the game" from the policy holder. I have to decide where to spend, or not spend, my healthcare dollars. I own the HSA and if I don't spend it, it grows with interest. We would not be doing away with any of the waste associated with government provided care.

    I think the bottom line is whether or not we want equal availability of the best possible care or rationed availability according to some government means testing methodology of mediocre care.

    I choose the former. Lets put private charities to work helping those who cannot afford insurance make up the difference toward that deductible. I have faith that if given the opportunity, our charitable agencies in this country would be all over helping people out.

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  27. Oh! That reminds me of a point Greiner was trying to make a while back. He said something relating to me always espousing charity, but not wanting the government involved. Here is why:

    Charities (and government) cannot function or exist without the for-profit side of the economy. It is a yin-yang relationship.

    Like I've said before, government (and indeed, charities) do not produce anything. They do not grow the economy; they are growth inhibitors. They feed off of the productive citizens of a nation. Therefore, in order for charities and government to have more power and funding, they must take a larger piece of the economic pie.

    However, the for-profit sector of the economy DOES produce goods and services. They create profits, which actually grow the overall size of the economy. If you allow the private sector, the for-profit side of the economy greater access to the means of production and you allow them greater freedom, they will produce an ever-growing economic pie.

    I agree that we need both the not-for-profit side and the for-profit side, because I am a compassionate person and I understand that there are people who simply do not have the means to care for their own needs. I am not a Darwinist, so I want to help these people. The question becomes "who is better at helping the poor?"

    I think the evidence is overwhelmingly in favor of privately run charities than government. That is why I advocate as limited a role as possible for government.

    Get onerous government out of the way of the private sector to allow the profit-motive to drive large economic expansion, which then creates ever growing total dollars of prosperity, thus making ever growing amounts of funds available for charitable enterprises.

    It seems so simple to me, I am truly stunned at liberals' inability to comprehend this system.

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  28. Scott, thank you for addressing my question. But, when you ask "who is better at helping the poor?", it seems like (according to your answer) that you're really asking "who is better at helping the poor more efficiently?". While non-profits may be run very well, I don't think they come close to providing all the support required to meet people's needs. Yes, charitable enterprises do a lot of good, but we can't rely on them to meet the needs of ALL those that need support.

    So if it seems "so simple" to you, let me try and understand it: You advocate that the government should not provide ANY support to those in need, and that all of this should instead come from charitable enterprises. Thus, you are advocating that ALL support for those in need will come solely from the "goodwill of others." This is where I have an "inability to comprehend." You stated that you "have faith" that the charitable organizations would be "all over helping people out," and I have the same faith. However, I do NOT have the same faith in the American public. These charitable organizations will not receive anywhere near the donations necessary to meet the needs of the American poor. They may have the greatest intentions and the most efficient processes, but if Americans don't donate, they can't provide help. And I personally do not think that the American public has enough "good will" to fill that need. First, since everything will be privatized, then people will need to pay for all of their own needs first. So whatever is left over is how much they CAN give to charities. But how much will they actually give? We have NO way of knowing. I personally don't think it will ever be enough to meet the needs of the poor. Especially in tough economic times (such as now), when everyone is struggling and bringing in less income. People on the lower end of the scale need MORE help, but the people on the higher end of the scale have less to give.

    It's not that I don't comprehend your "system", I just DO NOT think it would work. You simply cannot rely on the good will of others to provide for those in need. While it may come through in many instances, it is NEVER guaranteed. And the fact that you're "truly stunned" truly stuns me.

    Also, you never answered my question. Where are you getting your information about Obama's proposals? Such as means testing? And a single payer system?

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  29. Scott - Greiner makes a fair point. Where are you getting your facts? From what I have studied, President Obama's plan is to make the Federal plan (the one that he and Congress have) available for individuals and companies to buy into. According to the principles of the free market, this plan would then compete with other plans and become the minimum standard of coverage. You would still be able to buy your insurance from another company, but you would only do so if it has a better deal than the Federal plan. As long as public coverage is tied to the minimum coverage provided to the lawmakers that approve the plan for themselves, then I don't see the how the scare tactics you use would be present.

    On the other hand, as long as you can guarantee affordibility to ALL Americans, then your plan can work. I still want to hear from you on that.

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  30. "However, I do NOT have the same faith in the American public."

    If you have any lack of faith, it is in your own side, that is, people of the liberal persuasion. The Heritage Foundation has done some really great research on this topic and they found out that people self-identifying as "moderate" to "very" conservative gave an average of about 4% of their annual pay to charities, whereas "moderate" liberals gave 1.6% of pay and "very" liberal people gave a mere 1.3% of pay.

    My point about charitable giving is that if the government were to give a LARGE tax-deduction on charitable giving, along with sending out information at tax time of the local charities that needed help, we could drastically increase all of those percentages.

    But you've demanded to know the source of my claims.

    Its true, that currently, the popular idea being bandied about by many in Congress and Obama is a so-called "public plan" option. They market this idea as just another player in a competitive world of insurance companies.

    Again, the Heritage Foundation has some great research that picks apart why A) a truly equal counterpart to private insurance run by the government would not only fail miserably due to the fact that those in government have little to no real experience running such a plan, but it would not succeed in achieving the stated goals, health-insurance for all Americans, and B) the "public plan" option is meant to pave the way for a true Single Payer System.

    So while Obama can claim all day that all he wants is to provide us with another option, that option will NOT be available on a level playing field with private insurance.

    SJ, you say I could choose to keep my private insurance, and I would, personally. However, the public option cannot be run as a fair alternative, not with Government as both the plan sponsor and as the Arbiter of the insurance industry. Thats like letting the manager of one team be the umpire as well.

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  31. The truth of this proposed public option is that it would set artificially low premiums and everyone would jump ship to it. The plan would be overrun by participants and would see a large amount of antiselection (actuarial term that essentially means choosing insurance coverage when the buyer knows of some preexisting condition that would otherwise cause them higher premiums). This antiselection risk would inevitably lead to ever-increasing claims, but due to the artificially low premiums, the government plan would quickly be running at a deficit.

    Funding shortfalls in the public plan would necessarily be followed by the clamping down of claim-payments, ie. the rationing I've been talking about throughout this entire discussion.

    You see, whether the plan begins as a full-fledged "Hillary Care" Single Payer System, or as a government subsidized "public plan option", the conclusion is the same. The advantage Obama gains over using language such as "level playing field" and "competition" is to conceal his true intention of imposing a single-payer government system. There can be no fair competition with the government...they are the ones setting the rules.

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  32. "On the other hand, as long as you can guarantee affordibility to ALL Americans, then your plan can work. I still want to hear from you on that."

    Affordability to what extent? Does everyone get to drive a Lexus or do some people only get to drive a 1986 Buick Lesabre?

    You are stuck on the idea that it is the civic duty of Americans who have worked hard and earned a good living to sacrifice enough of their success so that others who have not done the same can enjoy a comparable level of success.

    I mentioned above that perhaps the HDHP as I've described it is not a "one-size fits all" healthplan. Maybe all you can afford is catastrophic health insurance. Maybe you choose not to drive the best car, or have cable TV, etc etc and instead choose to buy a richer insurance policy.

    We already have medicaid and medicare. We have the VA. We have part D for drugs. These plans mostly suck. Its estimated that as many as 10 million uninsured people who are eligible for Medicaid CHOOSE not to enroll.

    Plus, we are back to what is a right versus what is a life-enriching good/service.

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  33. With america in depression people now days need to have medicaid ans medicare. Because some people (midclass) can't afford healthcare and it's ashame that it's happen. Alot of people can't even get these plan that really sucks. You have to be dieing to enable you to get these plans it isn't fair.

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  34. I agree with Deepkia. With the economic stress everyone is dealing with; there needs to be some type of healthcare available. The people who need the health insurance are the people who are suffering. I have been denied from numerous insurance companies because I have "preexisting conditions." The only way I am able to get insurance is through my work. You shouldn't have to be a your death bed to get a decent health care plan.

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  35. With the way the economy is going it is so hard to afford anything these days especially healthcare. Depending on how much you pay a month for health care, depends on how much co-pay you pay before seeing a doctor. Before getting any medicine you have to see a doctor and than you have to come back every six months or year after that to check to see if the medicine is okay or not. That’s where the scamming comes in. I don’t think I should have to pay all this money just to see a doctor especially when they are just check ups. Also prices for medicine these days are so expensive even the generics. It is crazy how much they want for some of these medicines especially ones that people need the most like heart or blood pressure medicine.

    One of the ways many people abuse their right for healthcare is by being on Medicaid for the wrong reason. Medicaid is for people who need assistance to help pay for things if you’re a single parent. Well some women keep having kids so the government will keep them on Medicaid and so the state will keep paying for them to live. I think the government should look more into a person’s background before just giving them assistant money. These parents need to get out and look for a job. It was one thing if they try and don’t receive but it’s another if they don’t even try and depend on others. It is not fair that every one else in the world has to work but just because you have a kid you can’t. Having a kid is not a reason to be lazy.

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  36. Healthcare is a scam all together. I pay all this money every month but for what? I still have to pay for my doctor visits and my prescriptions. Sometimes I even have to pay for times I was in the hospital. Isn't that the whole reason to have insurance? Isn't it supposed to help you financially when you are sick or can not work? I also think the drug companies only want MONEY! Nothing else. They do not care how many people need a certain prescription. They probably think that if more people need it, they can just make the price higher and then they will gain money. They most likely do not think about those people who will not be able to afford the medicine and might have to quit taking it. What will happen then? I am sure that they never even consider these questions. Health insurance is something that will always baffle me. If only things could be more fair and equal.

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  37. I know health insurance is the hot topic right now, and everyone is up in arms about it. Whichever way you think, I bet we all believe that the general state of medicine and how healthcare works could really use some changes. Lots of people have "very good" insurance, but if a very serious health problem occurs, they may end up going over some "limit." Unfortunantely, that pre-set "limit" is not as high as you would think for the premiums people pay for their "very good" insurance policies. Healthcare costs are sky-high and in many places is still sub-standard compared to national recommendations. Add to that the projections of the populations of people who are 85 years or older by 2025... Something has to happen. All of these older adults will not be able to pay for all of their care. The only thing that makes sense to me is a single-payer system. It will probably be a bureaucratic mess, but younger working people can pay for the older folks to get adequate care. I'm in the health care field, and believe me, the insurance companies are already doing what most people are afraid the government will do. They deny coverage (and therefore care)even if a patient have legitimate medical needs, telling doctors!!!! what kinds of diagnostic procedures they can perform, and still, the premiums just get higher and higher. What you fear is already happening to you right now! I say let's work together to close loopholes, implement effective systems, and see what we can do to reform healthcare where everyone pays into one system.

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  38. I think healthcare is a joke. I pay twenty dollars every time I visit the doctor and I still get bills in the mail from those same visits. I do believe healthcare needs to be reformed, but I can't say how at this point. All I know is that people are being charged outrageous rates for insurance and still aren't getting the treatments and services needed. Healthcare cost today is not helping us,but making us sick. Right now I have a total of 750.00 in medical bills and I have healthcare insurance. I have two appointments coming up next month and I have already made up my mind that I am not going until I can pay down those other bills.Having to pay twenty dollar co-pays and 20% of the bill is a crime within itself.

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