Election 2008

[KCMax]

For those that want to know more about what the WH is proposing, here is their 8 point plan for people that already have coverage:

    No Discrimination for Pre-Existing Conditions
    Insurance companies will be prohibited from refusing you coverage because of your medical history.

    No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays
    Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

    No Cost-Sharing for Preventive Care
    Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

    No Dropping of Coverage for Seriously Ill
    Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

    No Gender Discrimination
    Insurance companies will be prohibited from charging you more because of your gender.

    No Annual or Lifetime Caps on Coverage
    Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

    Extended Coverage for Young Adults
    Children would continue to be eligible for family coverage through the age of 26.

    Guaranteed Insurance Renewal
    Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won?t be allowed to refuse renewal because someone became sick.

They are also proposing a "public plan" for the uninsured that would compete with private plans. This has drawn a lot of the criticism, but the vast majority of Americans would still be privately insured.

[chrizow]

to balance things out a bit, here is chuck norris's take on "obamacare:"

http://townhall.com/columnists/ChuckNor ... ments=true

[AJoD]

Max and Lenexa, thanks for your points of view.  I do think the implied costs are not the malpractice judgments but the insurance costs.  I've heard anecdotally that the premium increases have been really hard from family doctors, but don't know what that means (and of course people complain about increasing costs).  I would guess those costs are a fraction of inefficiencies elsewhere in the system, those other "inefficiencies" (e.g., huge pharma profits)...it's a lot harder for me to connect specific solutions with specific problems.  I wondered about the deterrent aspect of the judgments...an interesting question.  But with insurance covering damages anyway, how much more of a deterrent is the current system.  Lots of unanswered questions, of course, (as above) re: what would actually cause license removal/suspension.

Makes sense re: tax breaks for employers.  Do you really think that disconnecting health benefits from employers wouldn't fly?  I hate that.  I feel like I'm switching insurance every year or two either because the employer switches or I've switched jobs.  It's a really helpless and frustrating feeling.  I don't mind checking in on my auto insurance every once in a while.

Thanks for posting this list Max (and I feel a little pathetic that I'm getting my health care info here, no offenses to anyone). A few off-the-cuff thoughts.


For those that want to know more about what the WH is proposing, here is their 8 point plan for people that already have coverage:

   

No Discrimination for Pre-Existing Conditions
    Insurance companies will be prohibited from refusing you coverage because of your medical history.

Sounds good, but hard to say what that means.  Presumably they can still charge you whatever rate they want?  Wouldn't that effectively be the same thing?  The whole insurance business model is predicated on scaling risks with cost of premium, right?

   

No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays
    Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.

This simply seems vague.  (And see above.)

   

No Cost-Sharing for Preventive Care
    Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.

I would really like to see more emphasis system-wide on smart use of preventative care.  Not sure that the cost wouldn't just be folded into premiums, but even still, I think that's probably a much better system.  You still pay, but there's less of a barrier.  From a system perspective, seems like it would be good if costs were scaled to the expertise required to do the job.

   

No Dropping of Coverage for Seriously Ill
    Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

Seems like a good idea.

   

No Gender Discrimination
    Insurance companies will be prohibited from charging you more because of your gender.

Doesn't make sense to me, really, as there are different health risks by gender; but I don't know what the actual differences in treatment cost are.

   

No Annual or Lifetime Caps on Coverage
    Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.

Again, like a lot of this stuff...I guess I kind of don't get where it's coming from.  I'd guess these caps come from all the actuaries who figure out a sustainable business model.  Is the plan to have the government subsidize all these things? (extra coverage, fewer copays, etc.)

   

Extended Coverage for Young Adults
    Children would continue to be eligible for family coverage through the age of 26.

Don't like this idea at all.  Young adult/parent dependency is a huge complaint of mine.  26?  Cut the cord, kid.

   

Guaranteed Insurance Renewal
    Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won?t be allowed to refuse renewal because someone became sick.

Makes sense (with above caveat).

They are also proposing a "public plan" for the uninsured that would compete with private plans. This has drawn a lot of the criticism, but the vast majority of Americans would still be privately insured.

The "public plan" option doesn't really seem particularly objectionable to me, I don't get (based on this extremely rudimentary understanding of the health care debate) why more conversation doesn't revolve around what sounds like a complete overhaul of the current insurance system, which drastically raises costs for the insurance companies.  Or maybe it is

[Highlander]

Max and Lenexa, thanks for your points of view.  I do think the implied costs are not the malpractice judgments but the insurance costs.  I've heard anecdotally that the premium increases have been really hard from family doctors, but don't know what that means (and of course people complain about increasing costs).  I would guess those costs are a fraction of inefficiencies elsewhere in the system, those other "inefficiencies" (e.g., huge pharma profits)...it's a lot harder for me to connect specific solutions with specific problems.  I wondered about the deterrent aspect of the judgments...an interesting question.  But with insurance covering damages anyway, how much more of a deterrent is the current system.  Lots of unanswered questions, of course, (as above) re: what would actually cause license removal/suspension.

Malpractice has an impact beyond the costs of judgements and insurance, the impact they have on cost through defensive medicine.  Malpractice costs may be only a small fraction of the cost we pay for health insurance, but it still makes a contribution.  All the insurance cost, the awards, the cost of defensive medicine still have to come out of the health care dollars you, I and everyone else pays so it is a significant part of the debate.  

As for huge pharmaceutical profits; the pharmaceutical industry is an extremely high risk industry.  Without the potential reward of high profit, we simply would not have many of the drugs available that we have today.  The development of a particular drug can take billions of dollars with little certainty that it will ever make it to market; I don't think you are going to find the dollars necassary for that kind of investment if the reward is not there.

[LenexatoKCMO]

Malpractice has an impact beyond the costs of judgements and insurance, the impact they have on cost through defensive medicine.  Malpractice costs may be only a small fraction of the cost we pay for health insurance, but it still makes a contribution.  All the insurance cost, the awards, the cost of defensive medicine still have to come out of the health care dollars you, I and everyone else pays so it is a significant part of the debate.  

You honestly think a worker's comp-style solution will somehow be less costly, more efficient, and reduce "defensive medicine"?  Since when has adding several additional layers of government bureaucracy to an otherwise straightforward process ever delivered that kind of result?

As for huge pharmaceutical profits; the pharmaceutical industry is an extremely high risk industry.  Without the potential reward of high profit, we simply would not have many of the drugs available that we have today.  The development of a particular drug can take billions of dollars with little certainty that it will ever make it to market; I don't think you are going to find the dollars necassary for that kind of investment if the reward is not there.

Have you looked at the financial statements of major pharm companies lately?  The thought that reforming the drug approval process and the pharm patent process is somehow going to shrivel R&D budgets is a joke.  The current system is generating so much cash that patent holders can afford to pay all of the generic manufacturers to delay entering the market for years after patents run out.  That is not a sign of a healthy, competitive market place. 

[Highlander]

Have you looked at the financial statements of major pharm companies lately?  The thought that reforming the drug approval process and the pharm patent process is somehow going to shrivel R&D budgets is a joke.  The current system is generating so much cash that patent holders can afford to pay all of the generic manufacturers to delay entering the market for years after patents run out.  That is not a sign of a healthy, competitive market place. 

I've looked at Pfizer, the largest pharmaceutical.  Their stock has been flat to declining over a five year period, not just during the recession.  They still make big profits, but they are a BIG company with a larger market cap than the #2-3 largest oil companies in the US. 

[aknowledgeableperson]

I'm a lawyer and tend to be against tort reform, but that makes some sense. However, in some cases, the malpractice leaves the patient permanently disabled and unable to work. A small tax on premiums will be able to fund the loss of income for their entire life? Perhaps, but I'd like to see the numbers on that - this is all theoretical.

I also worry about removing much of the deterrent for malpractice. He still leaves the deterrent of loss of license - but when is that invoked? For all malpractice? Only the most severe cases? How do we keep doctors from practicing non-lethal, but still injurious malpractice? The health care field is not like the normal marketplace. If a mechanic sucks, we stop going to him and shop around. We have no way of knowing which doctors are bad and which are not, and by the time we find out, it is too late.

The problem with the current system of fault is that it may take years and years before an injured patient sees any money given discovery, negotiations, trial, appeals, etc.

[LenexatoKCMO]

The problem with the current system of fault is that it may take years and years before an injured patient sees any money given discovery, negotiations, trial, appeals, etc.

So a bureaucratic administration with hearing panals and ALJs is going to speed that all up and make it go fast? 

Besides, your complaint with the current system is pretty far-fetched.  Do you know what percentage of med mal cases actually ever make it to discovery, trial, and especially appeal?  Not many. 

[NDTeve]

To simplify health care: Make it like car insurance.

[chrizow]

http://www.theatlantic.com/doc/200909/health-care

a compelling argument for dismantling the insurance and government-driven health care system in favor of a pay as you go system.

[aknowledgeableperson]

Besides, your complaint with the current system is pretty far-fetched.  Do you know what percentage of med mal cases actually ever make it to discovery, trial, and especially appeal?  Not many. 

One case I do know about took "three" years from injury until settlement just before court.  Don't know if true but was told that was a typical amount of time.

[AllThingsKC]

[LenexatoKCMO]

Don't know if true but was told that was a typical amount of time.

Horseshit - thats not remotely typical.  A small minority of any litigation cases filed ever actually make it to trial, let alone appeal.  In a med mal case, the defense is going to be entirely managed by the insurance company and the only way they let it go to trial is if there is some really debatable question about whether the doctor was in the wrong.  Insurance companies aren't going to pay expensive defense attorneys to argue at trial in cases where the facts are clear - it isn't their reputation on the line. 

[aknowledgeableperson]

I wasn't talking about trial.  I was talking about the length of time to settle before trial, which usually happens just beforehand, or at least what I was told.  I know very few actually make it to trial so the issue is what is the lenght of time before settlement or to trial time?