If not single payer universal health care, what would YOU find an acceptable "compromise"?

[Stinky The Clown]

[dem629]

1. Open up Medicare to everyone. It works. And for those who want to keep their

private insurance, let them.

Let the private companies try to compete with Medicare, a program that is much more efficient than these private companies.

If some of them survive, fine. If not, that's fine, too.

I'm no expert obviously, but I favor opening up Medicare as the answer.

[AndyA]

2. Medicare makes the most sense to me as well if single payer

is off the table.

[bkkyosemite]

4. I'm on Medicare yes open it up but make sure it covers the whole deal. It does not cover 20% of it's

fee schedule right now so these insurance companies are having a hay day with us out here.

Medicare should pay 100% of medical, dental, vision, and prescriptions. I am paying Medicare, a prescription, vision and lousy dental thru my husband's retiree plan and paying for the advantage plan to take care of the 20%. What a rip off

How many adults that can pay $100 a month out of a 337 million population. I'm sure that would cover it for every man woman and child IF insurance companies were kicked out of it.

[dem629]

7. Good points.

I think they need to ditch that formulary of covered drugs, too, and cover them all.

[Hannah Bell]

9. yep. get rid of that bush theft.

[comtec]

32. $100 a month is dirt cheap compared to what I was paying once... so yes, OPEN UP MEDICARE!!

I can't even imagine what it's up t now.

I currently pay about 100€ a month, but that's covered by my employer as an expense, along with my travel.

Medical needs to cover 100% and doctors need NOT be afraid of demanding care for their patients.

The major problem here in Holland is the doctors are either over worked, or just lazy, and I honestly don't know which.
they may also be being bullied a bit by insurance, even tho that kind of pressure is supposed to be illegal.

Point being my insurance covers 100% on most things, or asks a fairly small pittance for others.

Was anyone else on kaiser when they were a kid? remember free/$5 medical/prescriptions?

wtf happened to that model?

it was a great model, 5 bux to see a doctor, you didn't have a ddicated doctor but your medical history was open to whomever was looking at you that day and you could go anywhere in the country - to a kaiser hosptical of course - and get top notce treatment...

W T F!?

THAT is the system i'd like to see.

sure, i'm happy to leave pay-medical in place, let the rich have their own system, i really don't care, and it would seem wrong to me, to prevent that.

but really why should anyone have to worry about being covered in this FIRST (lol) world nation of ours?!

we could cut the pentagon budget IN HALF and STILL OUT SPEND EVERYONE! and have so much money left over for medical, education, welfare (because YES, I do believe some people should NOT be in the working sector, and I believe if you're disabled you should not be forced to work, if you are retired you should be taken care of as well, you put in your 40+ years for the good of the country you DESERVE to have a comfortable retirement.

but that's me... i have these crazy ideas about proper compensation, and keeping things running smoothly and logically.

[blindpig]

3. Nothing else will do.

This is a baseline demand. Any and all compromise will be a bouquet for the insurance industry or an unworkable clusterfuck(like the original Clinton plan).

[phantom power]

6. +1

[CTyankee]

36. It sounds like you are saying "Single payer or nothing." The problem with that

is we will probably get nothing. Of course "nothing" is not even an option, things have gotten so bad.

I'd rather see single payer, of course, but since Obama says it isn't possible "now" we HAVE to look at the next best thing, esp. if it would lead to singlepayer down the road.

[stopbush]

5. There really is no compromise available.

I would be more than willing to compromise by paying a higher rate for SP than, say, citizens do in Canada.

But the private-held insurances have nothing of importance to offer in the way of compromise.

Would private insurance be able to offer:

* a policy that travels with the insured person, no matter where they live and/or who they work for?

* lowered and standardized rates for medical procedures?

* lowered costs for medicines reached through negotiation?

* lowered overall expenses due to decreased paperwork?

* no-fault, no-pre-existing clause insurance for anybody who wants it at the same rate as a healthy person?

* government-reviewed and approved increases in premiums?

All the private insurers have to offer me is what I'm getting now: overpriced insurance with a high monthly premium, ridiculously high premiums to add family members to the policy, limits to what treatments I can get, stacks of paperwork to fill out, extra visits to physicians to get specialist treatments pre-approved, etc. The usual HMO shit.

[Oregone]

17. "I would be more than willing to compromise by paying a higher rate for SP than..."

Here is the problem...

The higher the premium, the less people who can afford them. Hence, the more people who need a subsidy. Hence, the higher the premium (in a big circular cycle).

Here in my province we have $108 dollar premiums for a family. This is ONLY for basic coverage. Private extended costs another $100. This allows you to maintain a low premium and still offer enough services to keep people alive. It also creates a downward pressure on private insurance (because a lot of their risk is taken away), thereby, lowering their premiums to affordable rates.

The point is to make public just keep people alive/well/healthy without being bankrupt and losing a house. You do it in a manner affordable enough for everyone. If anyone needs more, its easy to purchase it.

[stopbush]

20. My employer pays my monthly premium which is $567 for an HMO.

Were I to add my wife and my two school-aged kids to that policy, it would cost me over $900 per month out of my pocket.

I can't afford that, so my wife and two kids are currently on a COBRA from her job. That costs me $755 a month, and it expires in August, at which point I'll need to put them on my policy thru my employer. That will be $150 more a month than I'm paying now.

Right now, the total monthly premium for my family is over $1300, for a fucking HMO.

In August, that will climb to $1500 PER MONTH. That's $18,000 per year in total premiums to insure my family, and I will be paying $10,800 of that...did I mention that's for A FUCKING HMO?! My wife will most likely need to change all of her doctors and go with doctors in the HMO. Fun times for all!

So, when I say I would gladly pay more for SP than my Canadian friends, I mean that I would gladly pay $500 per month or $6000 a year for my whole family. I would not even mind paying $600 a month if that extra $100 was used to subsidize a family less well off than me. I'd still be ahead with SP, even if it cost me 2 to 3 times what it costs you all in Canada.

I don't think my current situation is unique, and I think it amply demonstrates why the Congress, Big Pharma and the private insurers have no interest whatsoever in allowing SP a seat at the negotiating table.

[Oregone]

22. I understand...

But what I am saying, is that the higher the premium, the plan may be more unfeasible due to increased subsidies for those who cannot meet those costs (which increase premiums for everyone reciprocally). Even if you want a more comprehensive plan, its better to fund it primarily via taxes and stick with a low premium due to this mechanism. Of course, convincing Americans they need to pay more taxes for health care is a no-go (and shifting money from the military is also a no-go). A lite plan has logistical benefits

[backscatter712]

8. A few things.

Public option that's open to all who want to pay in, pretty much like Medicare for all, not watered down.

But that's not enough, We also need laws that require all health insurers to 1. Accept all customers who can make the premiums. They cannot shut people out because of pre-existing conditions. 2. Forbids them from jacking up premiums or axing coverage due to health conditions. In other words, the healthy 25-year-old male with no health problems pays exactly the same as the transplant patient, and 3. Requires all of them to have policies that provide a mandatory minimum standard of care, and gives more power to the doctors to override insurers, give a necessary treatment to a patient, and stick the insurer with the bill whether they like it or not.

Generous subsidies and financial aid for poor and some middle class folks - the ones that can't afford coverage, and subsidies to help defray the costs of insanely expensive care, such as transplants and long hospitalizations.

Now granted, I'd prefer real single-payer, but I'll take the above conditions if that's all we can get.

[MercutioATC]

10. Expand FEHBP to cover everybody.

It's an existing plan and it works.

[Kitty Herder]

28. Not a solution at all. Under FEHBP, you can only afford copays if you're GS9 or above.

It's no good for those making less. They still can't afford health care. The premiums and copays are too high. It wouldn't solve the problem at all. It's just mediocre insurance.

As a matter of fact, when my mom went from working for county government to federal government, she ended up with insurance (FEHBP) that was far inferior to what she had at the county. Fortunately, she makes enough money that she can afford the premiums and copays. But some of the people she works with who make far less refuse to go to the doctor when they're sick because they can't afford it. And these are people with FEHBP.

[MercutioATC]

30. If it was nationalized, the premiums would be on a sliding scale.

Unemployed? Pay zero.

Lower wage earners would pay less than the standard 33% that federal employees pay.

[TheCoxwain]

11. None whatsoever... I am acting Republican on this ...call for purity.

[dysfunctional press]

12. nothing.

there is no compromise position.

[damntexdem]

13. Two payers, both governmental.

;-)

As in Medicare and some other plan. People could choose between them.

[Oregone]

14. What I have in Canada is acceptable: Single-Payer for neccessity, private for supplemental/extended

You cannot allow the private market to compete with the public on basic coverage. They will use the public system as a repository for their high-risk patients, thereby increasing their profits and bankrupting the public system. On the otherhand, only having limited public coverage reduces costs and keeps the public healthy while not being bankrupt.

[phantom power]

15. How is the distinction between necessary and extended delineated?

[Oregone]

18. Public policy makers arbitrarily define what is basic/necessary

And private market magic creates packages that fill in the holes.

This is essentially what my MSP covers:

medically required services provided by a physician enrolled with MSP;
maternity care provided by a physician or a midwife (see the BC Midwifery Program);
medically required eye examinations provided by an ophthalmologist or optometrist;
diagnostic services, including x-rays and laboratory services, provided at approved diagnostic facilities, when ordered by a registered physician, midwife, podiatrist, dental surgeon or oral surgeon;
dental and oral surgery, when medically required to be performed in hospital*;
orthodontic services related to severe congenital facial abnormalities.

And that also includes partial coverage of sex changes, believe it or not. Alberta use to have full coverage on them. Its an open debate what should be covered and what shouldn't. It is rationing. But, it also allows you to pick up extended at minimal costs ($100 a month for a family). So, as long as the government deems enough procedures as necessary, it drastically lowers the price of having it all when you pick up private.

But one of the key parts of this is: "medically required services provided by a physician enrolled with MSP". Most of the time, its what your doctor tells you that you need (covered by tautology)

[grantcart]

16. anything that allows for the evolution of a 'crowd out' is fine with me

[mmonk]

19. What could be a compromise if you are using the same system?

[endarkenment]

21. A not for profit public plan that puts the for profit plans out of business.

I'm fine with letting single payer in through the back door.

[mwooldri]

23. Vouchers for everyone to buy healthcare.

This is how it would work:

1) Everyone would be entitled to get a voucher to pay for healthcare, without regard to their means or income.
2) Insurance companies who want to accept these vouchers must accept anyone who comes to them with a voucher without any regard to pre-existing conditions or any nonsense like that.
3) Insurance companies who want to accept these vouchers must offer a program where service is free at the point of delivery. That means no co-pays, deductibles, co-insurance. Voucher pays for all covered medical services for the entire year.
4) There must be some form of government insurance like FDIC for banks to prevent an insurer going bust and leaving people high and dry. Furthermore, the government must be free to set up as an insurer itself and offer plans to the public. This would be necessary if an insurance company decides that it's not worth covering people in say, Florida, and decides to withdraw from offering the public health insurance in that state... if there's no other provider willing to step in the government must provide a service.
5) There must be a defined minimum level of coverage, which in actual fact should really be quite extensive. In other words: if the UK's NHS system covers it then the insurance company must cover it too.
6) Vouchers would be funded by an expansion of Medicare tax.
7) Insurance companies should be free to provide services where the voucher pays for most of the cost but the consumer can pay extra for extra services like elective cosmetic surgery. However if the consumer can no longer afford to pay the extra premiums that insurance company must accept them into a "basic" tier without the requirement for extra premiums.

A single payer system for the basic healthcare needs of the nation is really the best way forward. Universal healthcare is a sticking plaster on the wound that is the private sector raping of the health care system in this country. This fudge I propose called vouchers could work but it's definitely not as efficient as a straight single pay system... but it has all what I deem essential in a health care system: access available to all, free (or ridiculously low cost) at the point of delivery, covers virtually all health conditions, and affordable to everyone.

Mark.

[Warpy]

24. Being able to opt into Medicare at a younger age

Nothing else will come close to working, not even a high risk insurance pool with companies forced to take all of us and no idiotic Hillarycare plan with regional for profit insurance consortiums.

That's the very least that would be acceptable.

[Thothmes]

26. Most physians in my area will not accept any new

medicare patients.

[On the Road]

25. Creating a Single Risk Pool

goes a long way towards addressing the need for universal health care. Not all, because it's still not universal. There would need to be provisions for the unemployed and uninsured children. Establishing a regulatory mechanism for prices and coverage would be even better. But if those things happen, it could be managed by the private sector.

[stray cat]

27. We have to be willing to pay for good health care - an added 15% tax on income might cover it

[Lydia Leftcoast]

29. Banning deductibles

They prevent people from getting early care.

[MercutioATC]

31. That would be called an HMO.

We have those already.

[tkmorris]

33. Uhh, HMO's have deductibles

:shrug:

[MercutioATC]

37. Mine doesn't...

...neither do any I know of.

You might have copays, but no deductibles.

[Lydia Leftcoast]

38. Then you're very lucky

When I was in Oregon, I had Kaiser, with no deductibles and a $25 copay for office visits and tests. Wonderful! Sitting around a doctor's office is not my idea of a good time, so I wasn't tempted to overuse it, but when I needed it, it was there, and I got all my checkups on schedule.

However, recently, I looked at Kaiser's website to see what I would be paying if I still lived in Oregon: twice as much as in 2003 for the highest deductible. There is no longer a non-deductible option for new patients.

Besides, I've done research, and that no-deductible option simply doesn't exist in Minneapolis, at least not for self-employed people, even though my insurer is supposedly an HMO. Maybe for people whose employers have negotiated a gold-plated plan, but not for anyone else.

[regnaD kciN]

34. It's not so much "what?" as "how much?"...

If we don't go with single-payer, I assume we're looking at some form of individual-mandate plan (the exact sort of thing that made me not support Hillary Clinton during the primaries...sigh...).

If it's an individual-mandate plan, I suppose a public-option (i.e. Medicare for all) alternative would be better than the original -- but not necessarily so. For, when we talk about a "Medicare-like" plan, it doesn't mean a plan where the government picks up the tab. Without a doubt, a "Medicare-like" plan would still require the payment of premiums by all those under 65. In that sense, it doesn't make all that much difference if it includes a public option, or merely a guaranteed low-cost option for private insurance.

The bottom line, in each case, would be the bottom line. As I have often pointed out, the current premium for individually-purchased insurance for a family is around $1,000-$1,500 per month. An "individual-mandate" plan that would require payments on that level would, in my opinion, qualify as a crime against humanity. In our family, we are insured through my wife's government job; the (highly-subsidized) premiums still come to over $400/month in out-of-pocket expenses. Putting it bluntly, that's still way too much for a working-class family to have to shell out every month. For many such people, an additional, required-by-law $400 health-care charge would mean loss of their home, or having to make the choice between meeting their "individual mandate" and putting food on the table.

So, in the long run, I don't really care if we have a public option or not, or the mechanism by which lower-income Americans could have their premiums subsidized. BUT, what is important is that there be a comprehensive health-care option that, for the majority of working Americans, costs no more than, say, $100/month for an individual or $250/month for a family. A plan, in short, that will not bankrupt average Americans already struggling to make ends meet.

Any plan that fails to provide such a reasonable-cost option would, in my opinion, be worse than no plan at all.

[Fumesucker]

35. Pitchforks..

With a side order of tar and feathers..