A question for single-payer only folks

[liberalpragmatist]

I don't think there's a person on this board that thinks single-payer wouldn't be the best solution. But if neither single-payer nor a public option can get through Congress, then the divide seems to be between those who would rather not do anything and those who would prefer to at least try to make the current private system work better.

Let's say we have a young woman: let's call her Kelly. She's aged 25, who is uninsured with a pre-existing condition. She earns 300% federal poverty level, is unmarried and has a 3-year-old child. She cannot get insurance on the individual market. And without insurance, she cannot visit a doctor at all and must use emergency room services and gets no preventive care. There are three policy options:

(A) Single-payer: everyone pays in, and she is covered by a government plan.

(B) Non-single-payer, (near-)universal: she receives subsidies for private insurance and as a result is able to go to a doctor and receive preventive care. However, private insurers make a small profit and skim money from a government subsidy.

(C) No reform: The current system remains in place and she must continue going to the emergency room for care. However, the private insurance system continues to be unsustainable and may collapse in 10-20 years.

Again, I don't think there's a person on this board who wouldn't pick option A as their first choice. But if option A isn't available, then I absolutely go for Option B. Yes, private insurance is an imperfect product, but for the overwhelming majority of people, having even private insurance is far better than having no insurance at all.

I get the impression, though, that for a lot of people on this board, they would prefer Option C to Option B, since Option B could count as "corporate welfare." Under Option B, Kelly may be able to see a doctor, but it's not as good as a hypothetical single-payer system would be. And Blue Cross makes a 5-10% profit covering her.

I also read many people arguing that shoring up this system is immoral, because left to its own devices, the system will collapse on its own and we'll get single-payer by attrition. Maybe. But doesn't this strike people as immoral? It reeks of letting people suffer while the system gets worse so that at some point in the future it can get better.

So in the absence of "Option A," single-payer, if the only options available are "Option B" and "Option C," what do you prefer?

[Bicoastal]

1. Once again, you live up to your name.

:thumbsup:

[Cleita]

2. I have said I hope this bill passes so we can move on to getting real

reform. Apparently, our federal government can't do it so we need them to put this away and focus on other problems. We need to move on to where it can be done. I don't believe this bill will be fixed because Medicare Part D is structured the same way and no one has made an effort to fix it other than to close the donut hole. In the meantime because the private insurance companies and PhRMA are feeding at the government trough, it's draining Medicare of money faster than it should. So I really don't think this will work in the long run. Just read up on how the Massachusetts plan is imploding fiscally and it's only been in place since 2006.

[liberalpragmatist]

3. Well, we're mostly on the same page then

This absolutely is going to require expansions and changes down the road.

With Massachusetts, the issue is getting costs controlled, and the issue there is less the insurers - who are all non-profits and were already pretty heavily regulated prior to 2006 - then it is getting the overall medical system under control. The issue is that Massachusetts not only has a high cost of living to begin with, but that with the concentration of medical schools, biomedical research, and prestige hospitals, medical care in MA is extremely expensive because providers charge a lot. There does seem to be movement towards shifting the whole system away from fee-for-service, and that's what needs to happen on the national level too.

Keep in mind though that the federal reform plan actually includes far more cost-controls than MA did. There's a major move towards bundling payments, there's a Medicare payments commission, there's the much-criticized excise tax (which basically works as a premium cap). It's not enough, but it's a decent start, and it's a much more ambitious effort than MA attempted.

[Cleita]

5. There are increasing uninsured in Mass. too, in spite of the mandates.

People not poor enough for subsidies but too poor to pay for insurance prefer to pay the fines. It still leaves them uninsured. Affordable health care is not the same as access to health care regardless of ability to pay. We are going to have to do better in the future. There is a movement afoot for doctors to start refusing health insurance and asking for cash up front. It's what is going to happen. They are tired of paying a staff of extra workers on their bottom line to deal with the privatized health care insurers and find asking for cash is easier on their bottom line. My employer, a doctor, has already started this practice.

[Loge23]

4. Re: System collapse

To answer your ?: B
Unfortunately, the scenario you presented at the end - system collapse - will probably occur eventually anyway.
It is akin to the old traffic light issue - one isn't installed until someone dies at the intersection.
...and liberal issues in this country are not adopted until a significant social-pain threshold is reached.
I suppose by 2014, that threshold may be quite a bit closer.
I am somewhat optimistic about all of this since virtually all of the opposition from the right has been based on fantasy.
I totally wanted much more that what this will deliver, but this bill appears to be the best route from A to B, as slow as that route is.

[OHdem10]

6. I go with Option B. Here is my thinking. She is better off getting

health care. Having Universal Health in Law establishes
a precedent and this is a good thing.

Further, this bill will change over time. For example,
right now ( I am not bashing here), the Medical Professions
do not seem to recognize that the American Economy is
changed. Salary Standards for everyone will be lower.
Doctors, Hospitals, Labs etc, Medical Suppliers seem
to think they will be able to charge these high rates
forever. Wrong, this will change. Once the Medical
Section has to "harmonize downward" there will be room
and probably need for something more like single payer.

To me, I held out forever. It is better to have Health
Care as a Law (albeit, not the best plan) than not have
protection of law and possibly have to depend on Republicans.
I do not fall into the "rich" category myself but I believe
in a country that does not leave it citizens by the side
of the road to die.

[denimgirly]

7. I agree however i guess with No Reform the logic is that people will get angrier

and the democrats will get more bolder...but sadly it can go the other way and they could be more timid and either do nothing for more years (lick their wounds) or try another attempt but evne more watered down. And so when you think about it, assuming (A) is not on the table you are absoultely correct that (B) is the best option...No reform is the worst thing you can do. And this is from someone who has been apposed to this bill for a very long time (and still am). But pragmatically (B) should be passed.

[Hello_Kitty]

8. 80% of US households do not have children living in them

I hate when people hold up the "family of four" or the "single mom" to illustrate this or any program or policy as though they represent the norm. The 25 year old at 300% FPL would have to come up with $220 a month for the premium and gets no subsidy. Because her premium is only 8% of her income, she does not get an exemption from the mandate.

I have gone from opposition to (very) grudging support for passage of the bill because of the Medicaid expansion that is badly needed by my state, Arizona, because the morons running it have decided to cut 350,000 people off Medicaid to balance the budget. But there are numerous gaping flaws in it, not the least of which is being designed so as NOT to be affordable to many of the people we are now forcing to buy insurance.

[liberalpragmatist]

9. I'm within that age bracket and single

I pay over $100 per month for insurance as is (I live in a low-cost area) and would gladly continue to pay as much as $200+, both so that I have insurance and so that as a young, healthy person I am in the risk pool keeping the costs low for everybody else.

And while our system is no doubt costly, in any functioning universal health care system, young people are going to have to pay into the system and pay more than they would if they were entirely on their own. That's true in a single-payer system too, where they would be taxed heavily, and it's true in private-based systems like The Netherlands, Switzerland and Germany.

[Hello_Kitty]

11. Are you buying your insurance on the individual market or through work? eom

[liberalpragmatist]

13. It is through work

So it's less than I would probably get through the individual market. I would be willing to pay, however, if I were in the individual market.

[Hello_Kitty]

14. That's what I figured. Nothing is going to change for you.

You will not be paying twice as much for the coverage you currently have so your being willing to pay more is a nice gesture, but meaningless.

[liberalpragmatist]

15. So what's your solution to getting the young covered if single-payer can't pass?

There isn't a universal health care system in the world that doesn't rely on mandates - either you are mandated to pay through taxes (single-payer) or through individual contributions (Germany, The Netherlands, Switzerland) or a mix. And though costs vary throughout the world, and though the U.S. overall does spend much more than other developed nations, people in Western Europe generally pay about 10-15% of their income towards the health care system.

I'm not being facetious here. I would be quite happy to embrace a mandate-less system if you can ensure there are no adverse selection issues.

[eridani]

17. The problem isn't mandates--it is that you are not guaranteed actual care just because you pay

The insurance company will remain free to deny your hypothetical woman's claims on a whim.

[Bluenorthwest]

10. If you are being beaten by thugs, and the only option is to

be beaten less, you take that, and you remember the people who refused to help you stop the beating. They become equal to the thugs. So sure, we all take 'beaten less' over 'beaten more' but those who refuse to stand for 'not beaten at all' are part of the problem, not the solution.
And I'd be happier with a bill that is not discriminatory toward millions of American families to please religious bigots. Not being in Congress, I do not have to shout support for discriminatory policy. Some are fine with bigoted laws, if they are not the victims. I understand that. But I have no reason to pat them on the back for being that way.
It is going to pass, it is discriminatory, mediocre, and apparently the best that can be done by the talent pool we have in DC. Perhaps we will be beaten less.

[jtrockville]

12. Let's put the profit in perspective.

I am delighted to be able to help the mythical "Kelly" and her child receive health care. I feel it's my duty to help those less fortunate than me. But I deeply resent having to pad the pockets of those who are more fortunate than me in order to help "Kelly".

I took a look at Aetna's profits - 2009 was a bad year for them. Their profits fell to a mere $1.28 billion.
http://finance.yahoo.com/news/Aetna-4Q-profit-falls-15-apf-1160966411.html?x=0

Why am I expected to contribute to the wealth of the shareholders of Aetna? And let's not forget executive compensation, which is taken off the bottom line and doesn't count as profit.

I'm glad this legislation will help "Kelly" and her child get health care, but it could have (and should have) been done at far less cost.

[eridani]

16. You have a reasoning error. B does NOT allow her to go to the doctor

She will be responsible for 40% of her costs with the shitty Bronze level insurance that will be all she can afford. She will stay away until option C comes up, which it probably will.