Nationalized Healthcare
Righty: The U.S. healthcare system is the finest in the world: the best doctors, the best facilities, the best research. To tamper with it and bring it under federal control would be a disaster. Doctors are already smarting from HMO red tape and absurd amounts of paperwork. Do we want our medical facilities to be staffed by doctors or bureaucrats? The best healthcare isn’t cheap, and it shouldn’t be. But why should people who watch their diet and take time to exercise (like me) have to pay for the follies of chronic smokers and couch potatoes who stuff themselves with corn chips? Typical socialism: just dump everyone into the same pot without regard to individual habits or initiative. Grrr… why don’t you malcontents just move to Sweden?
Lefty: Nobody should ever have to face bankruptcy because of illness, but that’s precisely what’s happening to millions of Americans under the current system. Our health insurance system is an international disgrace: profit-hungry insurers routinely deny coverage to the people who need it most and gouge those who have to pay for it themselves. It almost seems as if they go out of their way to make life miserable for the sick and needy among us. There’s your social Darwinism in action, Righty! Ain’t it grand? We need a sweeping reform of our entire medical establishment, and we need it now. No more delays!
The New Moderate:
I have an important question, and now is the time to ask it: why do we have to choose between totally nationalized healthcare and our current “too bad if you can’t pay” system? These seem to be the only two options under discussion, and they’re both unacceptable. Why can’t we simply opt for federally subsidized, universal health insurance? Seems sensible enough, doesn’t it? But nobody’s even talking about it.
Here’s the perfect centrist solution to our healthcare crisis. We’d let the doctors practice medicine the way they’ve been practicing, and we’d let patients see their doctors at will — without having to wait six months for a tonsillectomy. But we’d fund the health insurance system with our taxes to create a safety net for those who aren’t covered by an employer. That way, no individuals are denied coverage and nobody is forced into bankruptcy.
Under this plan, we wouldn’t have to nationalize the insurance companies (even though this irate moderate thinks they deserve to be nationalized!). We’d simply nationalize the payment of premiums. End of story. We’re long overdue for universal coverage, and we can’t wait any longer as our population continues to age. Wake up, Washington!
Summary: Let’s stop pushing for a totally revamped, nationalized healthcare bureaucracy and simply fix the system where it needs to be fixed: by providing tax-funded health insurance for those who don’t already receive it from their employers. That way, nobody gets left out.
THE NEW MODERATE 
I wrote this three-way “debate” back in 2006, before Obama’s presidency and the current discussions in Congress. At this point, nobody is calling for an entirely government-run healthcare system; our representatives (and the people themselves) are butting heads over who pays the insurance. Should we opt for a public, government-sponsored health insurance plan (a.k.a. “single payer”)… should we include both public and private insurance options in the reformed system (“Obamacare”)… or should we stick with our exclusive private-insurer system (favored by numerous Republicans)?
The details of the proposed systems are mindboggling, and I’ve never claimed to be a policy wonk. But Obama’s two-way plan strikes me as the most reasonable, the least disruptive, and (surprise!) the most moderate. (See, the president really IS one of us; that’s why he’s taking so much heat from both sides of the aisle.)
Granted, the single-payer system would be simpler and probably fairer to the citizenry as a whole (everyone would receive the same level of insurance coverage), but the two-way plan offers the most options AND covers the entire population as well — the ideal combination of free choice, fair competition and essential safety-net services.
One requirement: the public option must be so well designed that all federal employees (including Congress) would be enrolled in the plan.
Human health shouldn’t have EVER been a capitalist venture.
Agreed. I can’t blame insurance companies for not wanting to insure the sick and the old, but hey — SOMEBODY has to insure them. Nobody should go broke because of illness (or because insurance premiums are so damned high).
while I agree that human health shouldn’t be a capitalist venture, we also need good staff. The average medical training is 8 years after college and the average dept is about 200,000. The public wants the best physicians, but doesn’t want to pay them for it. Why would a person work that hard for 125G a year when you can be a pharmacist in 4-6 less years and make the same.
What the public doesn’t realize is that the reason health care costs so much is because medicare sets the reimbursment rates. All insurance companies base reimbursment off medicare. The problem is that these rates are completely non-sensical. They are not in any way based in medical evidence. The highest paid physician at my institution is a dermatologist. He shaves off basal cell carcinoma’s all day and makes over 700,000 a year due to the rates set by our government. It doesn’t make any sense to expand the role of the same government that is the source of our health care problems. What we need is appropriate reimbursement policies, universal coverage and a cap on the percentage an insurance company can make. The best system would be a completely nationalized insurance system, but why would you increase the role of the very entity that has caused our health care crisis. In full disclosure I am a physician.
I believe that the employer based system is fundamentally flawed for a number of reasons. Obamcare is basically making it more expensive for employers to hire employees – not the smartest thing to do in a recession. Most of our major competitors finance health insurance in other ways.
I agree that no one should go broke for getting sick and that some provisions need to be made for elderly and the chronically ill.
I don’t believe it makes sense to have separate policies state by state. Opening the market to multi-state or national coverage would be more efficient
I believe the insurance companies are, for the most part, fundamentally morally corrupt. Their business plan depends on insuring the healthy and restricting coverage of the ill. I would prefer to see the companies regulated as if they were a public utility. One of the dirty little secrets about health care costs are the administrative costs – that must be simplified. I agree that government involvement is problemmatic and that reimbursement rates are disconnected from reality. Hopefully, the regulatory body could be established with health care professionals and granted the kind of independence the Federal Reserve has in setting monetary policy.
I forgot to include my preferred financing methods – tax credits. I think individuals should be allowed to shop around for the plan that best suits them and that the government would reimburse them up to a certain amount. Chartering insurance companies as entities similar to utilities would remove the profit motive – allow the companies a certain rate of return and require them to cover everyone. I think that if the government subsidized the highest risk pools that would help hold down rates for the healthy.
The problem is that insurance companies exist to make money. Medical insurance companies should be made to run as Not-for-profit companies and streamline the administrative costs (where most of the money now goes). If this is done we would see the cost of Medical insurance drop incredibly and there would no longer be any reason not to insure the sick as well as the healthy. The government could then have a back-up insurance plan to pick up anyone not insured by these not-for-profit insurance companies so that everyone is covered.
[Hopefully this website is current. No posts on this page since 2010 and I’d like to share this website with others]
I’ve finally relented to believe a universal plan for all model. Government run, similar to Medicare, that provides a basic coverage. Tax supported, meaning increase federal taxes. Those who want to supplement the plan with additional coverage, expedient non-life-threatening procedures/surgeries, amenities, etc. may purchase through a competitive market. (Some employers may elect to use these supplemental plans as employee benefits)
With profitability the prime objective in the private market, we cannot achieve premiums, medical and prescription costs that are or will remain affordable for the non-wealthy. Of course this brings us into the soaring costs of health care – government will have to set rates for services, procedures, prescriptions, etc.
As noted above, doctors spend a heck of a lot of years and money for their education – why can’t their educational costs be relieved after a certain amount of years in practice (via loan forgiveness, tax credits, or something else)? Understandably, a change this drastic would trickle to other needed changes within the specter of this, but there is no reason why Americans should not be able to get adequate healthcare in this country.
One final notation – according to two of my friends who work in hospitals, the patient without insurance is priced the highest for services and supplies, the medicare prices come in second and the insurance prices come in third. That is different from what others have said here – is there a difference between hospital price structures and doctor office price structures?
Not sure if this will make it to “deb” since your comment was 2years ago. But a try.
Federal regulations require all hospitals to charge all patients using the same charge master for prices. I was the finance director ( Controller) for 35 years at a 400 bed heallthcare facility.
What your friend was referring to was the reimbursement rates between different payors. The difference being a contractual adjustment ( charges written off) based on contractual rates. Medicaid pays the least, then Medicare, then insurance and finally self pay pays full charges. For evefy dollar that Medicaid and Medicare does not pay, private pay patients end up charged more to cover that cost.
Now if it costs $10.00 to provide a service, the charge is $15 and Medicaid pays $3, who is going to pay the $7 in cost that medicaid doesnt pay. The private pay. And the $15 in charges for the medicaid patient is not even in the formula.
As for Medicare for all, the coverage will be Medicaid for all. Very poor coverage since many “good” docs will not accept new patients covered by Medicaid.
Free medical is too liberal/Bernie Sanders. Private group insurance is not the problem. Kaiser, Blue Cross Blue Shield , etc.manage cost because their group members are healthy, they have preventative services, maintenance and management of chronic illnesses, and they also have the really ill. All cost offset/spread among members.
More members the better. The problem is people who can’t afford insurance or have no insurance through employment. All kinds of people with health or no health problems.
For people who can afford reasonable premiums but have no access to “groups:, ” each state can group these people and negotiate coverage, preferably with at least two insurers, and evenly distribute “members” among insures so no heavy burden on any insurer. Sounds simple but some employees pay the entire medical premiums out of their pay check, some have employer contributions. Needs to be studied and an income based subsidy maybe required in some cases but this is probably the cheapest way to deal with this part of the problem. States can manage this.
Private groups insurers are not providing a public service. They should be able to make a profit but not to the ridiculous so there has to be some mandate. Because this adds to health care cost. This is true of drug manufactures who charge 200+% over cost. Ridiculous.
The elderly, handicap, and minors should be subsidize. This maybe Medicaid or Medicare. This does not necessarily mean “free.” It should be Income based and include family contributions where possible and again, out into the group mix and again, let States managed.
Unemployed on unemployment payments: ditto the above – in the group – or something like Cobra that is a 90 day “gap” or inbetween jobs coverage.
Veterans: VA should only be caring for Vets with emotional, mental or physical ailments or injury. Someone who serves two, three or four years and comes back whole in body and mind should get their insurance like everybody else. They chose the military, received benefits while serving ( housing or housing subsidies, education, training, commissary, heath care and VS home loan.) They are now civilians and can get coverage through their jobs or as a group member as described above. They should not have access to the VA.
Healthy adults with money. Sorry, they are on their own.
Healthy adults win no money. Here lies the real problem that should be a focus. No money to join a group. Tax payers don’t want to subsidize an able bodied adult. Their access to health care is usually through the ER due to injury or sudden illness. This is costly to the health care industry if they can’t pay their bill this kind of access can cause small community clinics to bankrupt. Here is the problem that needs a solution. The extreme solution is to deny access but I’m betting ER, hospital, or clinics do not want someone moaning and/or bleeding on their sidewalk.
Recap: what insurances can reasonably charge for premiums, cap drug makers profit over and above drug development and manufacturing. Figure out solution for able bodied w/o money.
What about this, for a moderate/purple solution: Initiate universal health care, paid for with taxation. But, allow for the use of private care if one decides to do so and has the means to pay for it. Any money spent on private care could then be deducted from taxes the following year.