Fix America's Health Care

[manualman]

Most Americans have realized that Obamacare is a bureacratic mess. Fewer have yet realized that it is a tyrant’s dream come true (broad rule making powers granted to executive branch).

But catholics should recognize that our current system stinks. I find rhetoric about health care being a ‘right’ innacurate and misleading. Nobody has a ‘right’ to the fruit of someone else’s labor, skill and resources. Instead, I think the discussion should center on the fact that as decent human beings, Americans have a “duty” to establish a system that respects the human dignity of all persons and provides a mechanism to give basic health care services to all.

Leftists have a point that our current system is utterly biased to the rich and moreso all the time. Rightists have a point that if you impose a Euro-care system, you will eliminate the entrepenuerial profit motive that has resulted in massive research and development behind many of our near miraculous medical advances.

So why not establish the best of both worlds? Don’t aim for Utopia, aim for providing a dignified level of care for the needy.

I propose that we create a Canada - style health care system that covers ALL Americans, but ONLY covers relatively low-tech care. For starters, we can say that it covers all (name removed by moderator)atient and outpatient types of care routinely offered as of, say, 1970 and all meds beyond their patent coverage time frame. Vaccinces and (legitimately defined) preventive care is covered, as are routine checkups and ER care with a small copay.

Those who want more advanced care, must still pay cash or purchase supplemental insurance. This part is little different than our current system.

Tort reform starts right now (zero punitive damages and esoteric “pain and suffering” sorts of awards limited to $15k total). No limit to quantifiable economic damages. Plaintiffs that lose must cough up $10k in restitution to the defendent or 10% of the award sought (whichever is less). Mandatory licensing board review hearings for any doctor found guilty in a civil malpractice lawsuit.

Many who consider health care a “right” will find the above inadequate. I contend that this is because such an opinion is impractically utopian. Health care is a highly skill, labor and money intensive endeavor. One is never ‘entitled’ to the skills, services and labor of another (that’s the definition of slavery!). Instead, what we really have is a duty of decency and charity to provide a dignified level of care for those unable to provide it via their own resources. I believe that a hybrid system of single payer for basics and health insurance for advanced care is the best way to do it.

 

[gabanzo]

What you are describing is a 2 tier system. The Canada I live in is a 1 tier system. Equal for all Canadians. If you want better care you must go abroad.

 

[Dale_M]

If you want better care you must go abroad.

Here in the US, if you want more affordable care you go abroad. Medical tourism is an important part of the economy in some parts of the world. But you have to be wealthy enough to travel to take advantage of it.

I agree with Manualman that medical care is not a right, if “right” means free. Perhaps a good comparison would be with housing or food. Collectively, we have a responsibility to make sure that everyone in our society has access to adequate housing, food and medical care. We don’t have a responsibility to provide such things free of charge to everyone.

I am not sure what the best solution is for the US. We have had a system with multiple tiers of care, provided in a patchwork manner with large holes in it. I am glad we are finally dealing with the issue.

 

[ManOnFire]

If govt is going to be forceful, why not have govt force all insurance providers to bid on 3 basic levels of insurance? The levels of coverage would be defined by govt. The coverage levels would be medium, low, and very low. Every insurance company would be free to offer 50 different insurance plans, as long as those 3 are offered. That way, people could shop across state lines for pricing for these 3 plans because they would have the same benefit levels from state to state. Then, citizens could decide to move up one level if they choose, depending on how much they are respect health and are willing to pay to be healthy. Those who want more or different coverage can buy one of the other 47 plans already in place, preserving the free market and choice.

My biggest fear is that too many people have been baited into dreaming of free healthcare so they can spend more money on personal entertainment. Entertainers are the world’s purest capitalists.

 

[Jaypeeto4]

The question is moot now.
The SCOTUS blatantly betrayed us and the constitution with it’s vote today,
declaring constitutional what is NOT constitutional, as many have noted.

I say vote out the whole mess of RINOs and Liberals in November, and get to work
REPEALING the whole shebang and starting over. This seizure of 1/7 of
the US economy is outrageous.

And just as Justice Brennan, a Catholic, provided the swing vote FOR abortion in 1973,
so today, another Catholic provided the swing vote for our neomarxist administration’s
goals today.

 

[JimG]

There are a couple of physicians practices in city who have completely opted out of insurance entirely. They are a primary care doctors, and they don’t accept any insurance–not private insurance, not Medicare. They have no insurance clerks and no one to file claims. For a fixed monthly fee they will provide patients with whatever primary care they need.

But the patients will still need insurance if they are referred to an outside specialist.

I suspect a great many more practices will go that route when national healthcare is fully effective.

The only way to prevent having a 2-tier system is to mandate that all physicians essentially work for the government.

It is said that the ACA will cover 30 million additional people. But there are not enough doctors to handle them. Which means that just because they have insurance doesn’t mean they will be able to access healthcare. It will inevitably lead to a 2-tier system.

 

[Joe_5859]

I don’t really know enough about how the whole system works to know if you have presented a good idea or not, but I agree with both points that Obama’s plan is a bureacratic mess, and that something needs to be done.

I know that nowadays, people tend to go overboard with the “rights” language, but in this instance, it really doesn’t bother me to speak of a “right to health care”. Pope Benedict XVI has used the phrase. So did John Paul II. So has the USCCB. If they feel comfortable using it, then I really don’t mind.

I think Dale’s analogy to food and shelter are good one. Those also require the fruit of another’s labor, but each person still has a right to them in lieu of their dignity as a human person. But, that doesn’t mean it all needs to be handed out. He who does not work does not eat, and all that (not that there aren’t legitimate exceptions, of course, for those who are disabled, etc.)

In any case, I’ve been wondering if the SCOTUS decision isn’t a blessing in disguise. If the law were repealed completely, Congress wouldn’t go near health care reform for decades out of fear of subjecting themselves to the same debacle. I don’t think that would be good. Even though Obama’s system is severely flawed and deficient, perhaps it can be fixed via subsequent legislation to be less so. Or maybe I’m just trying too hard to find the silver lining.

 

[Cristiano]

The question is moot now.
The SCOTUS blatantly betrayed us and the constitution with it’s vote today,
declaring constitutional what is NOT constitutional, as many have noted…

I think that SCOTUS has not betrayed anyone. SCOTUS called it the way things really are. The problem is not with SCOTUS and not even with POTUS alone the problem is that in the USA people want a Congress and a Senate that vote that way, deep down people like big government. The results are very evident by the amount of social participation before the elections and from the electoral results at every level. I am very disappointed with the way things went because now we have to deal with a major can of worms but I think that we get what exactly what we ask for with our participation or lack of participation in the political life.

 

[JimG]

I think that SCOTUS has not betrayed anyone. SCOTUS called it the way things really are. The problem is not with SCOTUS and not even with POTUS alone the problem is that in the USA people want a Congress and a Senate that vote that way, deep down people like big government. The results are very evident by the amount of social participation before the elections and from the electoral results at every level. I am very disappointed with the way things went because now we have to deal with a major can of worms but I think that we get what exactly what we ask for with our participation or lack of participation in the political life.

Yes, but you are saying that the most citizens pretty much want the constitution to be ignored or misconstrued. The Court did not allow the law to be upheld on the basis of the Commerce Clause, and the 10th Amendment is still in place. If the citizens want overarching government, perhaps they should lobby for repeal of the 10th Amendment and expansion of the Commerce clause to include whatever the Federal government wants.

 

[Cristiano]

Yes, but you are saying that the most citizens pretty much want the constitution to be ignored or misconstrued. The Court did not allow the law to be upheld on the basis of the Commerce Clause, and the 10th Amendment is still in place. If the citizens want overarching government, perhaps they should lobby for repeal of the 10th Amendment and expansion of the Commerce clause to include whatever the Federal government wants.

I think that you are correct with your reading of the SCOTUS actions. The problem is that we can still have a constitutional overreaching government, there is no need to repeal the 10th Amendment to achieve such a result. I am just commenting from what I observe at the local, state, and federal level. The vast majority of the people want the government involved in everything, the only difference is where and how they want it involved, to me it is not anymore a political problem it is a moral problem and within a couple of decades we might end up being in a worse shape than Greece.

 

[JimG]

I think that you are correct with your reading of the SCOTUS actions. The problem is that we can still have a constitutional overreaching government, there is no need to repeal the 10th Amendment to achieve such a result. I am just commenting from what I observe at the local, state, and federal level. The vast majority of the people want the government involved in everything, the only difference is where and how they want it involved, to me it is not anymore a political problem it is a moral problem and within a couple of decades we might end up being in a worse shape than Greece.

Yes. According to the Courts reading of the Constitution in this case, I suppose the Court might order everyone to buy contraceptives and impose a tax on those who do not do so. Chief Justice Roberts seemed to base the decision on the government’s power to tax. If he was only looking for a way to avoid overturning the law, maybe he thought that was better than trying to expand the meaning of the Commerce clause. But the unforseen consequences in respect to other potential laws are extremely disturbing.

I think you are correct that most people do want the government to solve their problems. In doing so they are likely to bankrupt the government, and the crisis will likely come rather suddenly and could result in civil unrest when the government is unable to deliver on its promises.

 

[fakename]

Most Americans have realized that Obamacare is a bureacratic mess. Fewer have yet realized that it is a tyrant’s dream come true (broad rule making powers granted to executive branch).

But catholics should recognize that our current system stinks. I find rhetoric about health care being a ‘right’ innacurate and misleading. Nobody has a ‘right’ to the fruit of someone else’s labor, skill and resources. Instead, I think the discussion should center on the fact that as decent human beings, Americans have a “duty” to establish a system that respects the human dignity of all persons and provides a mechanism to give basic health care services to all.

Leftists have a point that our current system is utterly biased to the rich and moreso all the time. Rightists have a point that if you impose a Euro-care system, you will eliminate the entrepenuerial profit motive that has resulted in massive research and development behind many of our near miraculous medical advances.

So why not establish the best of both worlds? Don’t aim for Utopia, aim for providing a dignified level of care for the needy.

I propose that we create a Canada - style health care system that covers ALL Americans, but ONLY covers relatively low-tech care. For starters, we can say that it covers all (name removed by moderator)atient and outpatient types of care routinely offered as of, say, 1970 and all meds beyond their patent coverage time frame. Vaccinces and (legitimately defined) preventive care is covered, as are routine checkups and ER care with a small copay.

Those who want more advanced care, must still pay cash or purchase supplemental insurance. This part is little different than our current system.

Tort reform starts right now (zero punitive damages and esoteric “pain and suffering” sorts of awards limited to $15k total). No limit to quantifiable economic damages. Plaintiffs that lose must cough up $10k in restitution to the defendent or 10% of the award sought (whichever is less). Mandatory licensing board review hearings for any doctor found guilty in a civil malpractice lawsuit.

Many who consider health care a “right” will find the above inadequate. I contend that this is because such an opinion is impractically utopian. Health care is a highly skill, labor and money intensive endeavor. One is never ‘entitled’ to the skills, services and labor of another (that’s the definition of slavery!). Instead, what we really have is a duty of decency and charity to provide a dignified level of care for those unable to provide it via their own resources. I believe that a hybrid system of single payer for basics and health insurance for advanced care is the best way to do it.

I’m not married to what I’m going to say now, but I suspect that our health/medical problems could be solved by just eliminating the AMA, the FDA, and allowing insurance to be regulated by simple supply and demand. The few losers in this system can be compensated by some form of charity or low-price alternative.

It’s an impractical suggestion but it could also be correct.

 

[Elizabeth502]

This is a (serious!) invitation to suggest how you would restructure, incentivize, penalize, or make no changes to the various players in U.S. medicine (from people to institutions & agencies), if you had an opportunity to introduce legislation and policies (as HHS Secretary, POTUS, congressional leader, outside professional consultant, etc.).

Be prepared, though, to defend how your proposals align with Catholic doctrine on social justice, upfront or if challenged on that.

And if you happen to have some expertise/experience as one of the professional players (medicine, insurance, etc.), it would help for you to state that, for perspective. But it 's not necessary to be a professional to contribute. I have my own amateur ideas but would rather wait a little bit to hear from others first.

 

[Bartolome_Casas]

The best health care reform?

DON’T GET SICK!

DON’T HAVE SERIOUS INJURIES!

I’m not joking.

A really powerful and totally available to all way to avoid MANY illnesses is to not let yourself get or stay OVERWEIGHT.

A way to avoid serious injuries is to never drive under the influence, and to always drive with great care. Four thousand Americans DIE EVERY WEEK in auto accidents! Another 60,000 are slightly or severely injured in auto accidents each week! Motor vehicles are DANGEROUS.

One reason health care insurance is such a huge issue in the USA is that we are using health care services way too much. And so much of it is UNNECESSARY.

 

[BlueEyedLady]

I’m not married to what I’m going to say now, but I suspect that our health/medical problems could be solved by just eliminating the AMA, the FDA, and allowing insurance to be regulated by simple supply and demand. The few losers in this system can be compensated by some form of charity or low-price alternative.

It’s an impractical suggestion but it could also be correct.

I don’t like that. Especially if food and drug safety was left up to insurance companies.

And I like that the AMA is a non profit group of doctors that sets out medical guidelines. Could you imagine health insurance companies doing that?

 

[AthenaC]

I work as a financial auditor, and I specialize in hospitals, although recently I have worked on some state Department of Health jobs. I also majored in economics in college, although to be fair that was some time ago.

Also, keep in mind that I am not convinced there is any sort of healthcare “emergency” in the U.S. Maybe it’s because I’ve mainly worked on Catholic hospitals that have managed to be profitable, despite the horrendous Medicaid reimbursement rates in some states. and despite being rather (in my opinion) generous with charity care. I fully acknowledge I don’t know exactly how it is all over the country, but from what I’ve seen, everyone who needs care and *asks for *care gets care. The providers are managing. Somewhat.

Here’s what I would do:

1. Force insurers to compete across state lines.

Then stop. Give the market a few years to normalize after that change.

1. Allow a person with an insurance policy to add / delete people off their policy at will. This will probably mean that a person pays an additional premium for each additional dependent they have, similar to how a person pays additional auto insurance for each driver and car they add to their policy. However, this will allow parents to keep their children (or grandchildren) on their policy indefinitely if they do desire. Elderly parents can be added to their childrens’ policies when the time comes. I can add a down-on-her-luck friend of mine to my policy while she stays with me for a bit. Things of that nature.

Then stop. Give the market a few years to normalize after that change.

1. Pre-existing condition reform.
2. Re-examine what we consider “necessary” medical care, especially among the elderly and unhealthy on public assistance, in order to keep costs down.

For specifics on #3 and #4, I would first want to see how exactly #1 and #2 would play out before hashing out specifics on #3 and #4.

 

[JimG]

I’m not married to what I’m going to say now, but I suspect that our health/medical problems could be solved by just eliminating the AMA, the FDA, and allowing insurance to be regulated by simple supply and demand. The few losers in this system can be compensated by some form of charity or low-price alternative.

It’s an impractical suggestion but it could also be correct.

Unfortunately, the very existence of health insurance distorts the working of supply and demand. If the market was simply between consumers and physicians, for example (or hospitals), demand would likely drop because consumers would evaluate the cost before going to the doctor. No one would order tests unnecessarily if they had to pay for them out of pocket.

But insurance is a guaranteed payment system. Patients don’t worry about cost because they aren’t paying it (directly anyway), and physicians don’t have to worry about keeping costs down; they just have to worry about having sufficient insurance clerks on hand to get everything coded correctly so the insurance company will pay. And insurance companies will charge us–or the government–which is us–enough to cover all the cost for everything the patients want and the doctors order.

I’ve used the example before of such things as Lasik surgery, which insurance doesn’t cover. Prices for Lasik have dropped drastically; ophthalmologists have advertised lower prices–because insurance doesn’t pay!

Most of the power in healthcare has moved from physicians to insurance companies, who now call all the shots. Things don’t really change much by moving the power to the government.

 

[Ridgerunner]

I propose that we create a Canada - style health care system that covers ALL Americans, but ONLY covers relatively low-tech care. For starters, we can say that it covers all (name removed by moderator)atient and outpatient types of care routinely offered as of, say, 1970 and all meds beyond their patent coverage time frame. Vaccinces and (legitimately defined) preventive care is covered, as are routine checkups and ER care with a small copay.

Those who want more advanced care, must still pay cash or purchase supplemental insurance. This part is little different than our current system.

But low-tech stuff is not expensive. Almost anybody can afford it, and one wonders why in the world people are so intent on not paying for small things like vaccinations. And for a lot of things (like vaccinations and a lot of tests) the county health departments and free clinics will do it. It’s exactly the advanced care that people need insurance for.

People are used to having their insurance pay for the smallest things and this government is determined to pay for even more of them, and to force that kind of coverage on everybody. And everybody wonders, then, why health insurance is so expensive and why government imposition of even more of it promises to create horrific budget deficits.

Seems to me there ought to be self-pay for the very ordinary things. Furthermore, if all states (some do) allowed nurse practitioners to have their own practices for such things, the cost would drop dramatically. We’re going to end up with mostly NP care anyway, so why not allow the costs to go down?

 

[Elizabeth502]

Congratulations to both of you for already mentioning some important factors in the cost of U.S. health care: (1) Overuse (not being proactive/preventive, but being irresponsible) and (2) Pauses for adjustments to change.

Athena, I think I was subconsciously concerned about this the other day, when listening to sudden positives/negatives about the SCOTUS ruling, and when considering myself the aspect of unforeseen consequences. Many of the commentators, while initially excited and enthusiastic, also admitted being uncertain of outcomes to all the parties involved, and even being anxious about that.

Like you, I think a much better idea would have been a stepped, incremental experiment, with measured adjustments in between. There are complex economic factors involved in U.S. healthcare, which have a dynamic, and because of that dynamic, it will be difficult to isolate what is and is not beneficial when “everything” happens at once.

Bartolome, What measures would you craft either to incentivize responsibility in the patient (for use of health care) or to discourage overuse?

And I should have added in my OP that contributors should also include what they would definitely not recommend as part of health care reform. (Such as, Single Payer or other features.)

 

[Elizabeth502]

Wow, slow me: I just noticed that manulaman started a similar thread about 26 hours before I did (I think). I’m going to ask Matilda Bennett if she will merge these. In the meantime, I copied Ridgerunner’s post from the recently closed World News thread (due to size), because I want to know if anyone thinks some of these French ideas can be imported to the U.S., and if not, why not.

I also may copy our posts since this thread is short, and add to the mix on the similar thread in this same forum.

Thread: Supreme Court Ruling on Health Care
*Ridgerunner *:

One more comment about the “cost of healthcare” in other developed countries, then I need to leave and do other things.

You can’t compare them without totally dissecting and rearranging how various countries account for healthcare. U.S. costs are pretty easy to know, because of the way records are kept and concentrated at the point of service. But in France, for instance, government pays for medical school and it is not counted as part of the cost of healthcare. In the U.S. med students graduate with a lot of debt, typically, and that has to be recouped in medical costs, so it is counted.

Again in France, the government pays for the malpractice insurance of the doctors in the “public” system (about 2/3 of the whole system) That’s not counted as part of the cost of healthcare. But since doctors in the U.S. have to recoup that cost in fees, it’s counted.

And the cost of malpractice insurance is lower there, because all malpractice cases are tried before specially-trained judges, not juries, and the attorneys can only charge hourly fees, not fees based on awards. The cost of those judges, court clerks, etc, is not counted. Since the costs of litigation in the U.S. are paid by insurers who charge premiums based on them, which have to be recovered in medical fees, they are counted.

And of course, in some countries the government purchases the medication in enormous bulk, but also chooses which meds to buy at all. In many countries, the “top of the line” drugs and “orphan” drugs are not purchased at all and are not available in the public systems. So that skews the apparent cost as well.

And naturally, if the U.S. has, for example, vastly more MRIs per capita than other developed countries (which it does) and if I pull my shoulder and am in severe pain, the great likelihood is that I will have an MRI of my shoulder within minutes or within hours at most. Most of the time, the outcome will be benign, and I will recover by tincture of time. I could refuse it, but if I have insurance and it’s there to do, chances are I will do it. If I have something like a rotator cuff tear, likely it will be repaired surgically very quickly. If I have to wait months for an MRI, chances are that I will never have it at all because I will either simply get well or the condition (like an incomplete but full thickness rotator cuff tear) becomes irreparable in fairly short order. Eventually, my pain goes away, but my rotator cuff remains torn and vulnerable. My motion is limited, but I learn to live with that.

We do a lot of things they don’t do in other countries because the means of doing them are ready to hand, and because somebody else is almost always paying for it.

One last thing, and I’ll quit.

Nobody, in promoting Obamacare ever took into account one major reason why, at the time, insurance rates were so high. A significant part of that is because interest rates have been so low and because mortgage backed securities crashed. Insurance companies make a very large part of their income on investments, and the only place they can go to make up for low returns is in higher premiums.

One can blame Clinton for appointing Greenspan or Bush for re-appointing him, or Bush for appointing Bernanke, or Obama for re-appointing him. Or one can blame congress for the overspending that has forced the Fed to over-purchase government securities. Or one can blame Dodd, Frank, Schumer and Obama for not curbing the bad loan buying of FNMA and FHLMC. Or one can blame Bush for not defeating Dodd, Frank, Schumer and Obama politically when he tried to reform those entities and they opposed him.

Lots of blame to go around, but the insurance companies themselves are probably the least at fault of all. But they’re happy now to soak their biscuits in government gravy as long as they stay in the health insurance business, which might not be all that long. And almost nobody in all of this mess has really been looking at the right things…or perhaps cared to.

And again, I feel disappointed in Roberts in a way. I do. But if Roberts really was looking at what an incredibly stupid thing this country did in 2008 by electing candidates based on unreasonable expectations, emotions and ignorance and simply told us all that we made our beds and now have to lie in them until we learn not to have unreasonable expectations and romantic notions, then maybe he’s just the most reflective thinker in this whole country.