Health Care Reform: The Good, the Bad, the Ugly

[mijan]

The Good: 
- Private health insurance can't deny you for a pre-existing condition under this bill.
- You can't be dropped from a policy because you get sick.
- If you have insurance, they can't "cap" your coverage and say "you've been sick enough now, so we're not paying any more."

The Bad:
- It's not REAL universal health care.  YES, I am "one of those" who fully wants this backwards country to switch to a single-payer system like Canada's system.  I think anything less is a travesty - humiliating and ludicrous.  Time to join the modern world, people.
- Because it's not real UHC, this will do nothing to help the over-complicated network of insurers and the grossly high overhead costs of the health care system.
- Private insurance still rules our health care system.  I'm sorry, but for-profit health "insurance" is a crime against humanity, as far as I'm concerned.
- Nothing to attenuate costs of malpractice insurance, which is putting even GOOD doctors out of business, even if they've never been sued for malpractice.

The Ugly:
- Fining people for not having health insurance.  WTF?!?  I'm sorry, but for the self-employed to have to afford policies on their own when they're BARELY making ends meet... this is going to bankrupt many individuals.  That's STUPID.


Want to chime in with your thoughts?  Go for it, but no flaming.  Civil discourse, please.  Actual facts, please.  Insight from those who live in countries with UHC are welcomed and encouraged to share their experiences.

Comments

[scabbyfish.livejournal.com]

Okay, so I unfortunately know little-to-nothing about the US healthcare system (I'm in the UK myself *pets the NHS*) but Fining people for not having health insurance made me boggle enough that I had to comment. Just - what? I don't even. How is that logical? oO

[mijan.livejournal.com]

It's not. NOTHING about our system is logical. Not now, and not with the "reform" bill either. I'm not on EITHER party's side right now. They're all being stupid douche-bags.

[affreca.livejournal.com]

Addressing the fining people angle - it is the stick to get healthy people to buy into the system, i.e. get everyone covered by some health insurance. Insurance works by having people without need of health care pay for those who do. The trick is that people change between those states, and often without warning. Those barely making ends meets are supposed to get subsidies to help them afford coverage, and it should protect them from going into bankruptcy when shit hits the fan.

Another way to think of it is that it would be the taxes you'd pay for a single payer system.

Downside is, I'm not sure there will be a self pay insurance option that will be affordable enough. Non employer insurance costs are highly variable (Lawnchair and I had a high dectuctable plan in KS at $120 a month for the two of us, but that was the perfect storm of KS low regulations and young people with apparently good health, vs. the thousands a month for COBRA I've known people to pay).

So, I don't know. There were some stabs at making the system better (using MA as the template). I'm afraid it was the best plan that could be passed. We'll see if it works.

[rina-riku.livejournal.com]

Forcing everyone to have health insurance is basically making people pay to live. The big reason for making everyone pay for health insurance is thta only people who are healthy and don't go to the doctor often make the insurance companies money.

[affreca.livejournal.com]

It is logical in the sense that it gets more people to play. In the current system, not having insurance is a type of gambling - will you stay healthy. If you do, you win because you don't have to pay anything. If you get sick (cancer, car wreck), you're screwed. You get to spend your own money until you run out, file for bankruptcy, get put one Medicaid, and hope that you get enough medical care that you don't die.

Supposedly, there will be subsidies to help poorer people afford insurance. I believe they are also increasing the number of people eligible for Medicaid.

So there is a logic to it, just not an obvious logic.

[gmonkey42.livejournal.com]

I agree completely.

Fining people for not having insurance just boggles my mind. "You don't have enough money for insurance so we're going to punish you by taking your money." WTF

[lurkitty.livejournal.com]

I am a strong proponent of UHC, and goodness knows, I've fought for it and will continue to fight for it. At this point, I'm not going to toss the baby out with the bathwater. I'm feeling like this is the vegetarian vs. vegan argument: both are steps in the right direction and we're arguing about incrementalism.

With respect to malpractice, I have argued and will continue to argue that the largest driving force behind malpractice suits is health insurance or lack thereof. First from the perspective of people looking at a lifetime of disability and no means of paying for healthcare to cover it, and second from the standpoint of insurance companies that force their policyholders to sue by denying claims if they don't. If everyone is covered, the first of those reasons go out the window. I am concerned that we'll still see the petty turf battles between which company should pay tying up courts, but I'm hoping that will decrease as well.

As to the fines, I don't like it, but I'm willing to wait and see given the structure of tax credits in place. If I look at it from the standpoint that those who willfully don't buy into the system when they have the money are jeopardizing it for the rest of us, yeah, I'd like to see them pay a penalty (the way that works is that we still have to pay for them when they have a heart attack or their kid gets hospitalized with the flu and they can't pay due to not having insurance). But I don't want to see anyone suffer that genuinely can't afford it.

[gmonkey42.livejournal.com]

It's not logical at all, it's a sop to the insurance companies who are whining about not being allowed to screw their customers quite as much as they have been. The government actually forcing people to buy something from a private company: it blows my mind that they're getting away with this.

[vampireanneke.livejournal.com]

It's bad, but better then what we have now. Atleast those who need coverage can get it. Those who have 'pre-existing conditions' can get covered. My older sister (as much as I hate her) has juvienial diabeties (found while with Kaiser). As such, even when my parents didn't have the option of Kaiser, they have paid seperately and have kept her on Kaiser. She continues to have Kaiser to this day because if she tries to go anywhere else they consider it an 'existing condition' and won't get anything covered.

It sucks to force people to get covered but it's stupid to not be covered. Because even if you don't have much money, that's when it seems something else is going to go wrong and you need the help. In southern california the uninsured are bankrupting hospitals, so much that ALOT of hospitals have now closed, meaning those with insurance are just as screwed. Alot of it has to do with illegals, and if it gets even 10% of the illegals to avoid hospitals (fear of fees and maybe deportation) then that's going to help the system out alot.

[mijan.livejournal.com]

I know that health insurance is gambling. That's one of the reasons I hate it.

There's logic in only the most illogical way. It's taking the most complex, cumbersome approach to something that could and should be much more simple.

But still, it would be much MORE logical if everyone were to pay into a not-for-profit, PUBLIC, single-payer fund, which would then be used directly to pay for health care, which would continue to be run privately as it is now (and as it is in Canada).

[gmonkey42.livejournal.com]

The logical way to force everyone to participate in the system is single-payer, not this mess. It's infuriating that the government is so in the thrall of corporations that not allowing them to continue making obscene profits off human suffering is out of the question.

[emiliglia.livejournal.com]

One of the parts I like is that you don't get kicked off your parents' insurance until you're 26, now, instead of 23 before. Which doesn't help me at all but it'll help my siblings. I'm actually kinda getting screwed by it because I got kicked off at 23, didn't have health insurance for all of 2009 until I bought my own, despite being unemployed, in December, so it expires this coming December, but then next year I turn 26. *facepalm*

[mijan.livejournal.com]

I still think that forcing people to buy the product of a private business should be illegal, even with subsidies. I don't want my tax dollars subsidizing private health insurance companies. I want private health insurance to die a fast, painful death. It's a scam, even if everyone participates, because it's a for-profit system that makes money by denying coverage as often as possible.

Right now, an employed adult making $40K per year who can't get health insurance (which was me four years ago) STILL pays more for health care in this country than most people pay for health care in most countries with a universal system, whether directly or indirectly. Now, add to that the FORCED purchase of an insurance plan that the person can barely afford (who determines who gets subsidies?), and the fact that some insurance plans barely cover anything, and this is doomed to fail.

The single-payer system is more fair, more efficient, and not for-profit. So no, it's not "the taxes I'd pay for a single payer system." The overhead costs are still hideous. And while they can't deny people with pre-existing conditions under the terms of this new bill, they can sure as hell charge more! That's making me EXTREMELY nervous right now.

The ONLY logical solution is UHC, in the manner of a single-payer system.

[mijan.livejournal.com]

Also, you said that by forcing healthy people to participate, you make the insurance plans more viable to keep coverage for sick people. I say that's false, because at the moment, insurance companies KEEP healthy people and DROP unhealthy people from policies.

and furthermore

[gmonkey42.livejournal.com]

In response to a few comments:

The problem with forcing people to be covered is there's no cap on how much the insurance companies are allowed to charge under this plan. As long as for-profit insurance companies are the only game in town (for most people, given most people aren't eligible for Medicaid), they will do whatever they can to avoid insuring people who will actually need their services: this bill prevents them from outright refusing to insure people but fails to prevent them from making policies for people with preexisting conditions outrageously expensive so nobody can afford them. Or from hiking up your premium so you can no longer afford it if you're already insured and you get sick. And then the government fines you for it. There is nothing to force insurance companies to offer affordable plans and there won't be.

What I don't like about this bill is it'll make it harder to make the changes that really need to happen. It encourages the mentality that "hey, they just made a bunch of reforms! We're fine now!" and there will be even more resistance to single-payer, which is what we need.

[gmonkey42.livejournal.com]

Oh that's good. I hadn't seen that.

[gmonkey42.livejournal.com]

I still think that forcing people to buy the product of a private business should be illegal

YES. Exactly.

[mijan.livejournal.com]

Yeah, that's one of the good parts. Very very good.

[affreca.livejournal.com]

I'd love single payer. But I'm not going to get it, just like I'm not going to get the US to stop starting small wars. The block of people who don't want to give up what they have is to big. So we're stuck with trying to reform an imperfect system. I

Sadly then, the only way to get universal coverage is to have mandated coverage.


Starting in 2014, most Americans will be required to buy health insurance or pay a penalty.

*

The penalty will be phased in, starting at 1 percent of income in 2014, and rising to the maximum of $2,085 for a family in 2016.
*

American Indians donâ™t have to buy insurance. Those with religious objections or a financial hardship can also avoid the requirement. And if you would pay more than 8 percent of your income for the cheapest available plan, you will not be penalized for failing to buy coverage.
*

Those who are exempt, or under 30, can buy a policy that only pays for catastrophic medical costs. It must allow for three primary care visits a year as well.


http://www.nytimes.com/interactive/2010/03/21/us/health-care-reform.html

[gmonkey42.livejournal.com]

And they will continue to do it by increasing premiums for people who have the audacity to require the insurance company's services.

Re: and furthermore

[abusing-sarcasm.livejournal.com]

I believe I'm in love with you. I hope you don't mind. :)

Signed,

A self-employed person with numerous preexisting conditions who is scared shitless about how much her family will have to pay to become compliant.

[abusing-sarcasm.livejournal.com]

- Fining people for not having health insurance. WTF?!? I'm sorry, but for the self-employed to have to afford policies on their own when they're BARELY making ends meet... this is going to bankrupt many individuals. That's STUPID.

THANK YOU for providing a balanced commentary on this issue. I'm scared to death about how much we'll have to shell out for health insurance. I was in tears last night because I'm so worried about how this will impact our family. Right now, we are able to save and put money away for our daughter's future, but if we have to add a bill of several hundred dollars a month, all that's going out the window.

I understand that UHC raises taxes, but that would spread the bill so much more evenly amongst EVERYONE. With this plan, the burden is going mainly on the shoulders of people who can't handle it. I would LOVE to see a *real* health care plan that doesn't punish enterprising citizens.

*goes off to mope more*

[mijan.livejournal.com]

Hang in there, hun. I wish I could offer reassurance, but I can't.

Yes, UHC would raise taxes, but it would also mean that all the money that's currently being spent on our FAILED system won't be spent anymore! No Medicaid and Medicare necessary. No insurance premiums to be paid.

The biggest eye-popper is the amount of money spent by employers on their employees insurance. People who say "my employer provides insurance" miss the big picture. My employer covers 95% of my insurance premium. YAY, right? That means I only pay $22.68 per pay period. And then... wait a minute... so how much is ACTUALLY being spent on my premiums per year? $22,680 per year. On the premiums. And then how much more do I spend in co-pays and co-insurance? IT'S A SCAM. I'm not paying so much out of pocket, but I know where the money goes! I make $40K per year. If I made, instead, the entire $62,680 in cash, and then paid taxes at the same rate as my Canadian counterpart to pay into the single-payer system, I'd STILL be making more money, and at the end of the year, would have far more money left in the bank because co-pays and co-insurance payments don't exist in a single-payer system.

And now that I'm likely to be stuck with a diagnosis label that will follow me for the rest of my life, I can't imagine how much this would cost in the long run.

Yeah, I know where the money goes.

Yes, there were some good parts of the bill... but it's still an epic fail.

[gasphemer.livejournal.com]

Agreed. I make about $10k on my own, my mother recently got a job and was required to get insurance through her employer- for me, her,and my brother.

Her job pays $26k a year.

The insurance premium is $550 a month.

It's fucking robbery, and I still copay out the ass for something as simple as a doc visit.

[neru-kudasai.livejournal.com]

Didn't they also take out the part that covers abortions?