Universal healthcare

[mrld20]

So I’ve noticed that this has been something of a controversy for many Catholics. After going back through several news archives and Catholic news sites it would appear that the Church takes a very keen interest in healthcare reform.

While social justice is a big area of disagreement by Catholics on how to approach issues such as poverty, healthcare, income inequality etc. The Church it seems tends to take a somewhat unique view in my opinion.

Some Catholics are in favor of a free market charity type approach to poverty and healthcare (many Republican Catholics) while many Democratic Catholics are in favor of a government approach.

It seems Catholic social teaching takes a middle of the road approach to the issue. The Church has at times condemned by aspects of capitalism, liberalism, socialism, and other forms of political ideology on solving problems.

In relation to healthcare reform I’ve noticed the Bishops calling for a “universal” system that ensures equal access, protects all life (no abortion, euthanasia, contraception etc), help for the poor, and is economically viable.

In heavily Catholic countries in the European Union (Not the recently secularized ones like Ireland or Spain) such as Malta, Poland, and Hungary there are government run healthcare systems.

For example in Malta; the Church endorses the state run healthcare system because it provides for equality in access, is cost effective, and life is protected.

But where does that put the United States? It seems like some Catholics here abhor the idea of any kind of “universal” system.

A lot of Catholics want a free market system like the Republicans. How does a free market system ensure that the insurance industry doesn’t abuse it’s positions like denying coverage to people with pre existing conditions or pricing the poor out of the market? All things the Church has condemned. How does a free market system ensure the Church’s definition of universal access and equality in care while protecting life?

Would a state run system be any better? What should be the ideal interpretation of the Church’s position on healthcare reform?

 

[Swiss_Guy]

well, if you look at the usccb website, you’ll see they support universal healthcare that is pro-LIFE. Besides that it’s pretty vague.

Personally, I think we should just have (free) coverage provided by the government to all, and for those who want better coverage, private insurance companies.

I like what Switzerland does.

But universal healthcare for sure is they way to go - and healthcare that isn’t pro-death in any way.

 

[Wesley7]

Hmm, real insurance is when you actually pay for the health services.

 

[Muze]

There are two sides to the health insurance problem:

1. Most of our health “insurance” isn’t insurance at all. Insurance is supposed to be a transferrance of risk. Insurance companies take our money, pay their costs, take a profit, and pay for claims. In the case of the financially catastrophic event that is low risk, this is a good deal. Paying $20/mo for $500,000 of life insurance make sense, if your family needs that amount to continue living. The reason this works is that the insurance companies expect only 1 person in 30,000 to die (in this risk category), such that they take in $600,000, and only pay out $500,000. And that works for everyone.

However, for the non-catastrophic financial event, or one that is expected to happen, this doesn’t make any sense. Say you go to the doctor twice a year, and he charges $100 for each event. You could pay the $100 to the doctor, or your insurance company could pay the $100, plus the costs of processing the claim, the overhead costs of doing business, and take a profit. And where does that money come from? Well, your paycheck, of course.

That’s right. If the insurance company’s cost/profit is $110 for the doctor visit, then they’re charging you (based upon their calculations of your group’s risk) $110 for something that you could have paid $100 for.

Yes, it’s a ripoff. Why does it work?

Because your government gives you and your company a tax break to take health “insruance” benefits rather than take the money directly.

So, think for a moment. In a given year, a typical employer based health insurance plan will cost around $10,000 per person. When was the last time you spent $10,000 on health insurance in a year after deductibles, co-pays and 80/20%? Chances are the answer is “never.”

That’s right, you lose money every year on health insurance

Government run health care just makes this even worse, because the government is HUGELY INEFFICIENT in everything it does. Overhead costs are going to be huge, and that will impact how much money the government needs to pay for health care.

What we need medical insurance for is the financially catastrophic and low risk event. Like a heart attack or stroke or cancer. Generally, none of us should ever use our health insurance on an annual basis.

Now, this is different from Medicare, which is important in honoring our parents in their elderly years.

BUT WAIT, THERE’S MORE!

There is also an effect of having costs paid for by health insurance companies: Patients stop caring what health care costs.

Why is this important?

Consider two doctors. One has a small office with a cramped, uncomfortable waiting room, and a nurse who doubles as the receptionist, and small waiting rooms, and the doctor has to send all tests out to be run. But this doctor charges $25/cisit.

The other has a large building with vaulted ceilings, a big, comfortable waiting area with a 52" HDTV, and the receptionists is there to cater to your needs, including complementary water and coffee, a large play area for the kids, and free wi-fi. The treatment rooms are large, and the doctor has a complete lab on site for all tests. This doctor charges $100/visit.

Now, if everyone is paying for these doctors out of their own pockets, each doctor gets some patients, because some like the $25 cost, and some want the amenities of the more expensive doctor.

But, if we move to a $20 co-pay for doctor visits, everyone goes to the $100 doctor, and the $25 doctor goes out of business, because patients no longer care what the doctor charges. The $25 doctor then goes and gets a bigger building, with more amenities and charges $120/visit, and people start going there. So the $100 doctor gets more amenities, and charges $150/visit… you get the idea.

That’s why our health care costs ahve been skyrocketing for so many years: There is no market price control for those with health insurance. That’s also why insurance costs have gone up and coverage has gone down. Insurance companies try to negotiate fixed costs for services from hosptials and such, but now you have a huge amount of contention over these things, and that’s just a recipe for disaster.

How does government fix these things? Government fixes prices for procedures, and hospitals and doctors are forced to live with it. Again, not a good solution. Unless you want doctors leaving their practices because they’re losing money.

So, we can see two MAJOR problems both with the current “insurance” system, and how these things will get worse with government run health care.

The solution? Repeal the mega tax break companies get for offering insurance on things that ought not be insured. When patients start caring what non-financially catastrophic care costs, prices will go down. For the insured AND uninsured. ANd people will get more money in their paychecks, as the cost of health insurance goes way down, as well.

I know there wasn’t a lot of religious stuff in here, but I’ll cite from the 10 commandments: Thou shalt not steal. Offering “insurance” for the non-catastrophic and expected event is flat out stealing. ANd we should stop doing it.

 

[JimG]

I really like Muze’s analysis of the problem. Health insurance itself forces health care costs up, because it causes overusage of services, and no one cares about cost. Insurance ought to be more for catastrophic events rather than ordinary care. Yet we have generally been going in exactly the opposite direction, asking insurance to pay for even normal office visits.

As long as somebody else is paying, usage increases, and prices rise. But that “somebody else” is just us.

(Health insurance companies, of course, will take a cut of the premium dollar for administering the claims. With nationalized health care, the bureaucracy will similarly take a cut of the health care premium, probably a bigger cut.)

 

[mcrow]

However, for the non-catastrophic financial event, or one that is expected to happen, this doesn’t make any sense.

Certainly, if you are not ill during the policy you are going to pay significantly more than you use. I guess that’s the definition of insurnace, it’s how auto insurance works, no accidents and no repairs as a result needed, then you are “over paying”.

That’s right. If the insurance company’s cost/profit is $110 for the doctor visit

I have been working in medical billing for 10 years, I have a degree in Health Information Management. The above statement isn’t close to true.
The way it works is if you go to the doctor you generally pay a Co-Pay, most comon is around $15-$25. So, you pay $15-$25. The insurance company typically will have a contract with that clinic or hospital and a certain amount of the total bill is discounted. So, say the bill was $110, insurance gets a bill for $110. A typical contract will discount for ~40%. The Insurance company takes that bill of $110 x.40= $66 left. Then they subtract the Co-pay of $25= $41. They pay the MD $41 and the MD recieves $25 from you, so they get $69 total for a $110 bill.

Now, some services like ER or Hospital stays generally have a deductible and/or Co-Pay.

Two years ago I had a surgery that costed $60K. I have a 20% Co-insurance on hospital services or out-of-pocket max of $2000. So, I paid around $1500(had some previous bills that year), for a $60k surgery. My insurance paid $15K for the surgery and the rest was discounted per contract.

I had another minor surgery that Costed $9K, but I paid nothing because I was over my out of pocket max. Insurance paid $4k per contract for that.

So that year I got about $75K worth of medical services just for those two surgeries and my average yearly pay in (including my employers contribution) was around $8K per year over about 8 years to that point. Not to mention my daughter had a major surgery for $60K, two rounds of ear tubes and sees a cranial facial and neuro surgeon twice a year for follow up and a gentic counselor once per year. Plus my wife is on the policy and uses some services as well, but mostly maintenance stuff. I would say since I started this plan we’ve had over $500K in medical services and paide in less than $100k (our contributions and employers)

That’s right, you lose money every year on health insurance

Yes, if you are perfectly healthy, never get sick , never need to go to the ED. You get broadsided in a car accident, go to the ER, need surgery and are in the hospital for a week you can easily be over $200K.

the government is HUGELY INEFFICIENT in everything it does. .

This is 100% true. Governemt would be worse. In my studies in health care delivery systems, it’s pretty clear that National Health Programs/Insurances are very inefficient. Not only that but instead of having access to technology, you may have to wait 6 weeks for an MRI (or similar technology) and/or may have to travel twice as far to recieve the services.

What we need medical insurance for is the financially catastrophic and low risk event.

I think people should be able to buy al la cart policies. Right now in many states insurance companies are required to cover 60 types of services, that many of their customers do not use. For instance, every single man with insurnace is paying for OB/GYN coverage by government policy. A young, healthy, single man should be able to buy insurance that only covers emergency services and major hospital services if they so chose. Or if they have a wife, perhaps they should be able to add OB/GYN services coverage as well. However, as the laws sit in many states now you have to buy pretty much full coverage of everything wether you use it or not.

BUT WAIT, THERE’S MORE!

Consider two doctors.

Not exactly true.

Generally, insurance companies pay based on the services provided regarless (mostly) of the overhead of the provider. That’s why there is a universal coding set (CPT and ICD-9). Insurances pay based on the CPT and ICD-9 codes submitted on the claim. The setting does play a role in the rate of reimbursement but that has nothing to do with how fancy the office or hospital is. Most of the time there is a different rate for (name removed by moderator)atient hospital services, Outpatient services among others. So, if two MDs submit a bill with the same codes they will be reimbursed at the same rate, under the same contract regarless if one office is plated with gold or the other is rundown. Some clinics will negotiate a better reimbursement rate than others, but that’s more to do with contracting than overhead.

That’s why our health care costs ahve been skyrocketing for so many years:

Overuse of insurance does drive up cost of insurance and that is also a result of the vast amount of technology we have these days. People want access to it and want to use it and they do. There are many situations where the patient could be treated without using certain services but those services make treatment and diagnosis much easier and many times results in faster recovery.

So, it’s a balancing act. The technology is great and improves care, the speed at which it can be delivered. However, that technology is very expensive and the same outcome could be had without out it.

How does government fix these things?

.

Again, I agree except for the fact that the insurance companies in many states are not even allowed to offer policies with only catastrophic coverage.

Also, we sort of already have a national health care system in Medicare and Medicaid and the fact that you can go to any county/community hospital ER and get free care.

 

[RosaryFan]

“What the government provides, it also controls. What the government controls, it also rations.”

I don’t remember where I read that quote, but that’s scary.

 

[Muze]

Certainly, if you are not ill during the policy you are going to pay significantly more than you use. I guess that’s the definition of insurnace, it’s how auto insurance works, no accidents and no repairs as a result needed, then you are “over paying”.

WHich is why real health insurance, protection against catastrophic financial loss is appropriate.

I have been working in medical billing for 10 years, I have a degree in Health Information Management…

Which forces doctors to raise their prices so that this percentage results in a profit, and has the effect of forcing the uninsured to pay even MORE.

Now, some services like ER or Hospital stays generally have a deductible and/or Co-Pay.

Two years ago I had a surgery that costed $60K. I have a 20% Co-insurance on hospital services or out-of-pocket max of $2000. So, I paid around $1500(had some previous bills that year), for a $60k surgery. My insurance paid $15K for the surgery and the rest was discounted per contract.

Which is what insurance is supposed to cover.

I had another minor surgery that Costed $9K, but I paid nothing because I was over my out of pocket max. Insurance paid $4k per contract for that.

So that year I got about $75K worth of medical services just for those two surgeries and my average yearly pay in (including my employers contribution) was around $8K per year over about 8 years to that point. Not to mention …

And that’s what insurance is for. That’s why you do group policies. For the very large, catastrophic financial events that are low risk. In your case, you’re taking money from your co-worker’s premiums.

Yes, if you are perfectly healthy, never get sick , never need to go to the ED. You get broadsided in a car accident, go to the ER, need surgery and are in the hospital for a week you can easily be over $200K.

Even going to the ER can result in a reasonable financial event. My point is that we’re covering things that shouldn’t be covered.

I think people should be able to buy al la cart policies. Right now in many states insurance companies are required to cover 60 types of services, that many of their customers do not use. For instance, every single man with insurnace is paying for OB/GYN coverage by government policy. A young, healthy, single man should be able to buy insurance that only covers emergency services and major hospital services if they so chose. Or if they have a wife, perhaps they should be able to add OB/GYN services coverage as well. However, as the laws sit in many states now you have to buy pretty much full coverage of everything wether you use it or not.

We should also end the government tax break for health insurance.

Not exactly true.

Generally, insurance companies pay based on the services provided regarless (mostly) of the overhead of the provider. That’s why there is a universal coding set (CPT and ICD-9). Insurances pay based on the CPT and ICD-9 codes submitted on the claim. The setting does play a role in the rate of reimbursement but that has nothing to do with how fancy the office or hospital is. Most of the time there is a different rate for (name removed by moderator)atient hospital services, Outpatient services among others. So, if two MDs submit a bill with the same codes they will be reimbursed at the same rate, under the same contract regarless if one office is plated with gold or the other is rundown. Some clinics will negotiate a better reimbursement rate than others, but that’s more to do with contracting than overhead.

This is how insurance companies have tried to control skyrocketing costs, but then we find that insurance companies and medical providers are having huge battles over these costs, because doctors want more, and insurance providers don’t want to raise their rates, and want to keep their profits.

Which is why many medical proviers are organizing into ever larger medical systems: to increase bargaining power with the insurance companies.

Overuse of insurance does drive up cost of insurance and that is also a result of the vast amount of technology we have these days. People want access to it and want to use it and they do. There are many situations where the patient could be treated without using certain services but those services make treatment and diagnosis much easier and many times results in faster recovery.

But without price controls, these things continue to be expensive.

So, it’s a balancing act. The technology is great and improves care, the speed at which it can be delivered. However, that technology is very expensive and the same outcome could be had without out it.

The problem is that with most technology, the price comes down after an initial R&D recovery period. However, without customers demanding lower prices, these items have stayed high cost.

Again, I agree except for the fact that the insurance companies in many states are not even allowed to offer policies with only catastrophic coverage. /;quote]

Well, that’s a problem, too. No surprise that politicians are idiots.

Also, we sort of already have a national health care system in Medicare and Medicaid and the fact that you can go to any county/community hospital ER and get free care.

But that’s different. I don’t even call those “insurance” That’s welfare for the poor and the elderly, which we should provide. Even though they are poorly run and (from my hospital sources) most providers lose money on ever medicare and medicaid patient they see.

 

[1ke]

Government intervention in wages during WWII started this whole mess, it fostered the rise of the “fringe benefit”.

 

[mcrow]

Government intervention in wages during WWII started this whole mess, it fostered the rise of the “fringe benefit”.

True, but most of the first policies were purely workman’s comp types of insurances. Insurances became a fringe benefit because of wage freezes and for the fact that the governement passed a bill allowing employee insurance premiums to be taken pre-tax.

It became even more popular when unions came about.

 

[Rdunbar123]

I don’t understand the ins and outs of the health care industry, but it seems to me that government healthcare neccessarily leads to some rationing and that is not always a bad thing. a 50 yr old with a family would need most procedures more that a 65 yr old retiree(I’m 61). Also Government healthcare should only pay for catostrophic events and not mere maintenance of life.Any thing beyond that should be up to the individual to pay for or have insurance for. It does seem strange on a website on which most people claim to look forward to meeting the Lord, very few(myself included) seem anxious to do it. The old Soviet union had universal health care and the quality was terrible.

 

[mcrow]

I don’t understand the ins and outs of the health care industry, but it seems to me that government healthcare neccessarily leads to some rationing and that is not always a bad thing. a 50 yr old with a family would need most procedures more that a 65 yr old retiree(I’m 61). Also Government healthcare should only pay for catostrophic events and not mere maintenance of life.Any thing beyond that should be up to the individual to pay for or have insurance for. It does seem strange on a website on which most people claim to look forward to meeting the Lord, very few(myself included) seem anxious to do it. The old Soviet union had universal health care and the quality was terrible.

Well, it’s sort of a chicken or the egg thing. If you don’t pay for maintenance things you end up paying more costs of more cases of catastrophic care. You also endup having an overall lowering of quality of life across the whole country because you will have a lot of poor, disabled and elderly people without any health maintenance.

There has to be a balance. Now, back in the preindustrial era, most hospitals were charitable organizations that were run nearly completely on donations. There were also almshouses for the poor, destitute, and those with mental illness who had nowhere else to live and get basic medical needs taken care of. These were also run on donations.

This model wouldn’t work today, but I think there could be more of that.

 

[Rdunbar123]

Well, it’s sort of a chicken or the egg thing. If you don’t pay for maintenance things you end up paying more costs of more cases of catastrophic care. You also endup having an overall lowering of quality of life across the whole country because you will have a lot of poor, disabled and elderly people without any health maintenance.

There has to be a balance. Now, back in the preindustrial era, most hospitals were charitable organizations that were run nearly completely on donations. There were also almshouses for the poor, destitute, and those with mental illness who had nowhere else to live and get basic medical needs taken care of. These were also run on donations.

This model wouldn’t work today, but I think there could be more of that.

I still haven’t mastered the art of using quotes correctly all the time. I agree, maintenance is important, but much of it is free and depends on exercise correct choices.

I have battled weight all my life and since my mid thirties at 5’ 8" and 252 I have lost and maintained my weight by eating habits and exercise. I look around and see all the extremely obese people who are going to have health problems of unimaginable magnitude and I do resent paying taxes to take care of their negligence. It is a choice. I love food more than most and would like to go home tonite and have double helping of fried whatever. Instead I choose to eat baked chicken with stir fry. I do this because I want to have a decent quality of life. The people that choose not to take care of the temple of their body should not be subsidized by my money.

I guess my point is that maintenance is largely controlled by your habits. when a fat person gets type two diabetes at 40 and doesn’t control it that is there choice.

 

[mcrow]

I still haven’t mastered the art of using quotes correctly all the time. I agree, maintenance is important, but much of it is free and depends on exercise correct choices.

I have battled weight all my life and since my mid thirties at 5’ 8" and 252 I have lost and maintained my weight by eating habits and exercise. I look around and see all the extremely obese people who are going to have health problems of unimaginable magnitude and I do resent paying taxes to take care of their negligence. It is a choice. I love food more than most and would like to go home tonite and have double helping of fried whatever. Instead I choose to eat baked chicken with stir fry. I do this because I want to have a decent quality of life. The people that choose not to take care of the temple of their body should not be subsidized by my money.

I guess my point is that maintenance is largely controlled by your habits. when a fat person gets type two diabetes at 40 and doesn’t control it that is there choice.

Well, the problem with that is maintenance is more than simply knowing how to eat right and exercising. Do you know what the death rate would be these days for cervical cancer or breat cancer if “maintenance” care wasn’t paid for? Or death rates from prostate cancer would be? Insert any common cancer here. How about the person who has high blood pressure , but isn’t overweight or anything like that?

A lot of things that can go unnoticed for years and later cause an early death if untreated are found in routine maintenace exams. Having worked in the health care field, you’d be surprised by how many patients don’t have any idea there is something wrong or what they are doing with their lives is what is causing it.

 

[jgs777]

I do not think Universal Health Care is a good idea. I would if it was run by the Church, but not by the government, a government who does not always have the right intentions.

I also have a question for you, in relation to your question on how to regulate insurance companies, Who regulates the government and controls there power in a Socialistic approach to healthcare?

I don’t mean that in a sarcastic way truely, but in my opinion we are better off with reform, and letting us have private insurers, than letting the government have absolute authority over healthcare.

God Bless You!!!

 

[mcrow]

I do not think Universal Health Care is a good idea. I would if it was run by the Church, but not by the government, a government who does not always have the right intentions.

I also have a question for you, in relation to your question on how to regulate insurance companies, Who regulates the government and controls there power in a Socialistic approach to healthcare?

I don’t mean that in a sarcastic way truely, but in my opinion we are better off with reform, and letting us have private insurers, than letting the government have absolute authority over healthcare.

God Bless You!!!

The funny thing is that historically charitable orginazations have been the most efficient and cost effective means to deliver health care. It may be a step back in technology but they tend to put every penny to best use.

 

[Swiss_Guy]

I do not think Universal Health Care is a good idea. I would if it was run by the Church, but not by the government, a government who does not always have the right intentions.

I also have a question for you, in relation to your question on how to regulate insurance companies, Who regulates the government and controls there power in a Socialistic approach to healthcare?

I don’t mean that in a sarcastic way truely, but in my opinion we are better off with reform, and letting us have private insurers, than letting the government have absolute authority over healthcare.

God Bless You!!!

You can have universal health care run by private companies. Look at Switzerland.

 

[Rdunbar123]

Well, the problem with that is maintenance is more than simply knowing how to eat right and exercising. Do you know what the death rate would be these days for cervical cancer or breat cancer if “maintenance” care wasn’t paid for? Or death rates from prostate cancer would be? Insert any common cancer here. How about the person who has high blood pressure , but isn’t overweight or anything like that?

A lot of things that can go unnoticed for years and later cause an early death if untreated are found in routine maintenace exams. Having worked in the health care field, you’d be surprised by how many patients don’t have any idea there is something wrong or what they are doing with their lives is what is causing it.

I still maintain that at least half is due to overweight obviously you’ve never been to Texas

 

[Swiss_Guy]

I still maintain that at least half is due to overweight obviously you’ve never been to Texas

Yep. the midwest (at least Wisconsin and Minnesota - mcrow is from MN) is pretty fit.

 

[Dan_Daly]

Sadly, we are already beginning to see the fruits of embracing socialism in the name of providing for the poor. If the proposed “religious exemption” becomes law, it will be illegal to be Catholic and work in the healthcare industry.

This is a good example of the power of language and how it used deceptively. The “religious exemption” which sounds like protection is no such thing. It’s Anti-Catholic religious persecution disguised as tolerance and caring.

There is a public comment period on the proposed rule until Sept 30. Many of the Bishops have awaken to the danger and encouraged Catholics to contact their government leaders. I have and suggest others here do likewise. From what we’ve seen from Obama so far, I don’t think it is likely to change the rule though. So we’ll have three options:

1. Catholic hospitals and charities involved in healthcare all shut down.
2. Catholic hospitals and charities violate the teachings of the Faith by providing sterilizations and contraception.
3. Catholic hospitals and charities provide healthcare in a method consistent with the Gospel, and stand ready to take any persecution that comes from the government- fines, imprisionment, slander, etc.

Pax and God Bless.