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| Re: Gibbs Can't Name Countries Where Government Health Care Works Better (466041) | |||
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Re: Gibbs Can't Name Countries Where Government Health Care Works Better |
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Posted by trainsarefun on Tue Jun 23 23:42:29 2009, in response to Re: Gibbs Can't Name Countries Where Government Health Care Works Better, posted by Orange Blossom Special on Tue Jun 23 21:08:53 2009. A, I remember the people survey'd for HSA satisfaction was 81%.I think that a lot of that has to do with a few factors - not enough of the qualifying plans to link the HSAs to, the contribution limits are just too low for some places, and the last is more of a PR thing: most people don't know what on earth it is or how it works, which can be remedied (a few years ago, until then First Lady Clinton came out with her husband's healthcare plan, not many people knew what an HMO, PPO, and all of that jargon was either). One thing that I like about the HSA route for those that it helps is that it's probably going to be cheaper to do effective tax credits rather than to borrow whatever the HSA covered share of the $1-2 trillion would be and then paying the interest on that (which will surely be higher than the interest rate now). I forget the general health plan percent, but i remember when you add them up it's closer to 90%. Seems awfully high to have 90% satisfaction for anything except orgasms, but OK. I do think that satisfaction with service and satisfaction with cost of the service need to be distinguished though. Fun fact, most people use less than 5000 a year in health costs. Actually I forget the number exactly, it's more like 2-3k but I don't want to lowball it. The distribution problem is very real. I love one person, one vote but one person, one healthcare dollar would end up overcovering most and severely undercovering others. Here, I think that the questions really are thorny, and they're questions that we generally don't want to confront. If a person can pay his way, he gets whatever he wants - I think that we all accept this. But then what happens when someone wants some procedure that is relatively low probability success but at very high cost, and he's on insurance. (Doesn't matter for this purpose whether it's public or private - it's still other peoples money). To what extent is this person owed, or not owed, a subsidy by the rest? Economics is the dismal science, and I think that we have to accept that if costs keep accelerating or even stay where they are now, we are going to have a lot of these tough choices to make. I know that everyone wants to help, but at a certain point this ends up eating into ability to cover many more people. And what happens then? With that fact out there, you've given the most expensive states #'s with the only state left to even really have HMO's. With NY's regulations, and HMO's, it's the highest profit state in the country for insurance companies. As a NYer, I know that there is something wrong with our health insurance rates, which are linked to in that previous response, and it really hits the people who aren't covered by the employer and who make too much money to qualify as poor for medicaid. The ones with less regulations and CONSUMER driving plans have razer thin margins. The same as car insurers do. If we can increase the fraction of those plans much closer to unity, we're solving a lot of problems right there. Before my current job I was about to get a gap plan. Looked at several. I think that those coverage gaps are a huge problem. If I see one role for state coordination, I think that it's in covering people for at least as long as they're eligible for unemployment benefits, and then educate them during that period on what their options are if they don't get a job with health insurance benefits. There are Catasphropic only plans. Part of the problem with some of these is that cost can be so high that it's easy to think, oh, what are the odds of catastrophe versus my having to pay monthly premiums on this thing. And then some unfortunate fraction of these people do have a catastrophe, don't have any coverage, a few nights at the hospital wipes out any savings really fast especially for the younger people for who this is an option, and they're headed in bankruptcy while everyone else pays a higher share. So I want to see some sort of catastrophic coverage that's easy enough to purchase so that one doesn't have to put chunks of life savings at risk, but I don't want to see mandates for coverage - and like I said before, I don't see that passing politically anyway. Such as hospital only plans. The trouble with a lot of these plans that I gather from reading on it is that they don't cover a lot. They cover the hospital's bills. But then there are the bills of some of the physicians who work at the hospital (at some pretty high rates). So I think that there is the core of something here, but that people should know that this kind of catastrophic coverage might not be quite the right gamble for all types of cases. Don't always need to pay 700/month for a 75 dollar Urgent clinic visit. I agree, but it's tough to get those $75 urgent visits in some places. It would be great to have that option, so that at worst, it's more like going to the dentist than emptying out your bank accounts, but in too many places, the clinic is the ER, and they sure aren't cheap. I wouldn't recommend it for older people as they don't have the time to save up, but it's ok so far. I think it's a good idea. If your employer contributes. Older people get higher contribution limits, but I think that generally the holdup with HSAs is that we really have to up them, and more than than that, up them based on what insurance costs in the region. Or else get rid of this regional thing, and just have a national market with one federal set of rules and no 50+ markets nonsense. If it were great it would've worked in Hawaii. Just not following where you're going here... The only issue I don't have any answers for are the people who are self-employed etc. It's a very big issue for them, and for smaller businesses too. High deductible plans might be good for them. Why spend 1000 a month when you can have a 5000 deductible instead. It's a LOT of money, but if you can afford a grand a month, it'll be cheaper to just deal with the deductible when you need it imo. I think that may be right, especially if maybe this can be linked to some sort of reserve pool that they can build up by the time they really tend to get into the older years. It is still a problem, and I agree that this is one of the tougher areas. The only reason to control the money of the system, instead of the system itself, ie doctors etc, is for corruption and cronyism on a massive scale. People like Obama has a lot of friends and family members that need rewarding. The economy will not come back with 4/gallon gasoline just because we decided to tax people MORE for a public health system than whatever we pay now. I think that President Obama's heart is in the right place, but the question is whether the plan makes sense. We're talking about borrowing a lot of money - on the trillion dollar order, and that will have to be repaid. The program of bailouts and stimulus, whatever the merits, wasn't cheap. The war in Afghanistan and supporting our massive defense infrastructure isn't cheap. Supporting social security and medicare is going to be impossible if things don't change. Etc. In some ways, even though many critics of the President are lambasting him for proposing a single payer plan, I would have been much happier had he actually done that. At least we know what kind of creature that is, how it's run, the good points, bad points, all of that. We have endless vagueness on the current plans on many points, but based on what we do know, I think that it's a non-starter. And same thing for the bipartisan compromise bill, which I think is going to really be where the main battle is, going forward. |
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