General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsLet's solve the Health Care Cost Issue!
Our country has a serious problem with the cost of health care. The GOP bill is no answer. The ACA was no real answer, either. The free market system was disastrous for the people.
So...let's fix it! What will it take?
The goal: Decent health care for EVERYONE. Children, young adults, middle aged, seniors. Healthy people and those with medical conditions of any sort.
My proposals:
1. Single payer. This spreads the cost across the entire tax base, and even better, does so proportionately. It also gives the government leverage in bargaining for prices.
2. Do away with the provision that PROHIBITS the fed from negotiating pharma prices. This is CRITICAL.
3. Allow the govt to bargain pharma prices, whether it's single payer or the ACA.
4. Most important is to GET RID OF INSURANCE COMPANIES. They have profited throughout all of this. They make hand over fist buckets of profit, no matter what the system is. They are in the driver's seat. All the billions (trillions?) suck money out of our economy. Millions would be out of work, if ins. cos. were to go away, so I don't know how to handle that.
5. A PR campaign by the fed. Television & media ads focused on the citizens, urging a healthy lifestyle. Walking regularly, eating vegetables, going easy on fatty meats, eating fewer processed foods, spending vacations and family time going to parks and on hikes rather than out to eat and such, letting people know that if they are prediabetic they can reverse that through lifestyle, etc. Ads work. That's why all products do it. (Obesity and diabetes are real problems in our country, even among children. It wasn't always this way.)
What are YOUR ideas? This is difficult, but not rocket science. There are other countries with better systems that we can get ideas from. NONE of them pay as much as we do with as poor results as we have.
Yavin4
(35,438 posts)1. If we want universal coverage, everyone has to pay for it. I would add a small sales tax on non-essential goods and services (excl. food, energy, transportation, housing, education, clothing under $500 per item, and health care). I would also impose a slightly higher tax on alcohol and cigarettes.
2. I would grant student load forgiveness to health care providers that accept single payer patients. I would offer tuition reductions in exchange for health care providers accepting single payer patients.
karadax
(284 posts)In other words you'd like to see a VAT (value added tax) go into place for good boughts in the US.
That is a tough sell. Both sides of the aisle in congress are opposed to it. President Trump, surprisingly, has voiced support for a VAT like system in the past.
Yavin4
(35,438 posts)That's how the rest of the world does it. They impose taxes on EVERYONE to pay for their national health care.
Demsrule86
(68,556 posts)I think this is a Republican meme. There will always be some who can't pay...and I am a Democrat. I do not believe in letting the poor die because they can't pay...seems like that is close to what Trumpcare came out with. I can't even believe you are arguing for that.
Yavin4
(35,438 posts)The difference between what I am saying and what the Republicans are saying is that if everybody pays in, then everybody pays less, much, much less. The Republicans want everyone to pay on their own which makes insurance super expensive.
Demsrule86
(68,556 posts)system is unfair to the poor. So answer my question...if you are too poor to pay then you die?
Stallion
(6,474 posts)and pass it in the Republican controlled House and get the President to sign it. There has never existed a point when those votes were there
crazycatlady
(4,492 posts)No prescription drug ads on TV, no hip replacement surgery ads on the radio, no glossy spread about how great XYZ hospital chain is.
Honeycombe8
(37,648 posts)for-profit companies.
genxlib
(5,524 posts)To me this is one of the single most insidious issues.
It drives up costs on the back end by adding marketing expenses to the drug costs.
And it drives up usage on the front end by generating the perceived need within the marketplace. Hell it even seems to be inventing disorders that never existed just so the drug can be sold.
And it leads to preference of name brand over generics.
I bet even the doctors hate it since the patients come in telling them what they want.
Not to mention that they are really painful to watch.
Just stop it.
Honeycombe8
(37,648 posts)in patients who come in, asking for that drug. Rather than going to the dr for the condition and relying on the dr suggesting or prescribing a drug.
Freddie
(9,265 posts)Employee pays 7% and the employer matches. The other side will howl and scream about a "tax increase" but **you and your employer are not paying health insurance premiums**.
That would save my employer and the vast majority of others huge $$. So why is big business opposed to single payer? 1. They want to be free to pay NOTHING towards health care if they can and 2. They want you chained to your job.
If 7% seems low, consider that Medicare is financed by a 3.45% payroll tax. And the under 65 population is vastly healthier.
Tweak the tax code so the 7% tax is negated for lower incomes.
Get rid of health insurance for the most part. Allow the sale of supplemental plans like Medicare supplements and for dental and vision. Have special longtime unemployment benefits and career training for the insurance co. paper pushers and medical billing specialists who will now be out of work.
Doctors and hospitals will still be private practice (like Canada). Fees per service will be determined regionally and, like Canada, each practice/hospital will get 1 payment a month from the government.
One can dream.
Yavin4
(35,438 posts)Aren't they getting "free" healthcare?
Freddie
(9,265 posts)Unless you are totally "under the table" and that's a different issue. The self-employed would pay the whole 14% (both sides) just like they pay both sides of SS and Medicare now.
The current Medicare tax has no lower or upper income limit, it's a flat tax. Which I think is fair in this case.
Yavin4
(35,438 posts)They don't pay into SS or Medicare now but they get it when age-qualified (SS if you worked enough, SDI if you didn't due to disability). What I like about a flat payroll tax is that the rich pay more. "Your healthcare is worth 7% of your income, whatever that is."
Yavin4
(35,438 posts)You've just lost the political will to maintain the system over the long term. In order for Single payer to work, everyone pays into it and everyone gets it. Without that, you don't build a political constituency for it.
Buckeye_Democrat
(14,853 posts)... for universal healthcare.
I hope that you were being sarcastic and it went over my head.
Demsrule86
(68,556 posts)Those who get their money through capital gains and that needs to end...why should gambling be taxed higher than work?
Honeycombe8
(37,648 posts)Demsrule86
(68,556 posts)raising or lowering the tax schedules is a joke.
zipplewrath
(16,646 posts)Basically, make the federal government the payer of all medical expenses. That will also allow them to control prices. After that, it is merely a case of figuring out who to charge what. You can means test "premiums". You can get some funding from general taxes, or specific ones. You can charge for "cosmetic" surgeries and roll those gains back into the general system. The government already pays both directly, and indirectly for a huge portion of all medical care in this country. So getting the costs down will directly reduce their costs which can then be rolled back into the system.
And to some extent this doesn't have to spell the end of insurance companies. We can offer regional contracts to manage the fiscal aspects of all of this. There can be incentive fees for efficiencies as well. But the surgeon generals office, not the insurance companies, would decide what care people did and did not get.
Honeycombe8
(37,648 posts)Shandris
(3,447 posts)...but with civilian, rotating, non-lifetime oversight committees (banned from entering the medical or any supporting field after serving).
Doctors don't pay for schooling; they sign commitment terms, the government pays for all schooling, salaries for teachers, salaries for doctors, and the cost of services performed in addition to subcontracting out hospitals (with oversight and accreditation similar to JHACO) who are also reimbursed for the cost of needed, applicable medical equipment.
Hospitals would gain the ability to place/run gyms and other health-related centers with proper oversight and accreditation (this is to incentivize revenue streams for hospitals so that there isn't a vested interest in attempting to fleece the government).
Criminal undertakings are moved to the UCMJ. This includes such things as prescription abuse, fraud, and so forth and is applicable to hospital settings as well.
Problem. Solved. And cheaper than Obamacare.
But it would require politicians and a political system that is designed to actually help people instead of rob the country. Wake me up when we decide to make one of those.
Demsrule86
(68,556 posts)this is why we lower the age of medicare when we get back in power and ultimately we get single payer without all the stuff that would be unacceptable to Americans...much written on this page is unacceptable to me...as if some person has to jump through health hoops to deserve care...completely against such a thing. People fear the government controlling them...and much of what has been suggested on this post would do just that.
kristopher
(29,798 posts)That's a barroom plan for single payer, not "single payer". You've outlined a legitimate plan for "single payer" that almost assuredly will be the law of the land in the not too distant future (In my not so humble opinion).
Demsrule86
(68,556 posts)in will scare people off...medicare for all...lower the age until it is zero.
Shandris
(3,447 posts)I didn't suggest one solitary thing that is a hoop to jump through; in fact, it is dealing with transgender people and gatekeepers that fuels much of my hatred for the current system (Informed Consent notwithstanding). People choose their doctor and/or hospital (probably rebranded in name since it allows other things, like 'Wellness Center' or something equally corporate no doubt), go and get their needs filled. On the back (administrative) end, the government is billed and pays.
No insurance, no gatekeepers, no claims, no claim paperwork, no triple redundancy, nothing. Go see your doctor when you need to.
As someone who was born and raised conservative* and has always lived in a red state, I'm particularly sensitive to concerns about governmental power but this isn't it. I'm not sure what part you find concerning, but hopefully this clarifies some.
AUTHOR'S EDIT: * - It ~should~ be needless to say, but just in case: clearly, I am not conservative anymore (although I am, on certain topics, on the more conservative side of our party).
Demsrule86
(68,556 posts)premiums...in other countries, people pay for health care with taxes...the right pretends to believe that if you don't have insurance or huge amounts of cash you can get health care...it simply isn't true...and I would rather have access to medical care with insurance than no access because I can't afford to pay...spent five days in the hospital in September...$25,000 bill which was less than half of what a person without insurance would have to pay...my insurance company has a deal with the hospital. Care is un-affordable and often denied for those without insurance. You don't get chemo in an ER...and the hospitals in my area are barely hanging on...and we expanded Medicaid in Ohio...in Georgia, Grady, the only trauma hospital in the state may close.
Honeycombe8
(37,648 posts)Demsrule86
(68,556 posts)American people.
Phoenix61
(17,003 posts)Medical coders will still be coding. Admin folks will still be pushing paper. All those claims will still have to be paid. Medical insurance sales people will be out of work as will insurance executives.
taught_me_patience
(5,477 posts)Have a standard set of acceptable end of life care options. If you want to go above and beyond, then you either have to pay out of pocket or have secondary insurance pay for it.
2) Focus on preventative medicine. Type 2 diabetes is killing us in this country and it's preventable with the right diet and exercise. My wife is a primary care physician and it's diabetics that, by far and away, use the most care.
Demsrule86
(68,556 posts)provision in Europe, and they do just fine...I should add that our European cousins drink like fishes and smoke incessantly.
Honeycombe8
(37,648 posts)Orsino
(37,428 posts)Lee-Lee
(6,324 posts)I truly believe that the only way in this country we can make a single payer plan work and control expenses is to stay tough on people who are not responsible with their own health.
Americans more than any other county are very unhealthy.
For example there are states where you don't have to wear a helmet on a motorcycle. Facts show that greatly increases the odds of a head injury. Should everyone else be on the hook for potentially millions in treatment because you don't want to wear a helmet?
Another example when I was a deputy we had a women with diabetes who was on Medicaid who average one EMS call a week because she refused to manage her diabetes properly. The paramedics would lecture her, the doctors would lecture her, she didn't care and went right back home to full sugar sodas and junk food. Responsible management of her own health would have eliminated 90% of those trips. I bet she ran up in excess out $100,000 in ambulance and ER bills every year for several years running. And in a rural county she would take an ambulance out of service when they only had 4 for the whole county delaying responses for people in real need.
There will have to be a way to force people into responsible behaviors so their irresponsible actions don't bankrupt the system. I don't know what it should look like- fines, higher taxes, denied care- but I am convinced it will have to be a part of any plan for it to suceeed.
Demsrule86
(68,556 posts)They will always find a reason to not give you care if you did that...you encourage good health with education and with well care. And consider that the poor can't afford to do those things that would have an impact on their health,
Lee-Lee
(6,324 posts)They are not to blame and bear no responsibility if they rack up hundreds of thousands in medical bills?
I'm not talking about everyday stuff. I'm talking about the glaringly obvious ones.
Add smoking to that list too. We all know what it does. Under a national system all kinds of cessation mess and therapies should be covered and people who choose to smoke anyway should not be treated the same as those who are responsible with their health.
Demsrule86
(68,556 posts)you suggest makes me ill.
Lee-Lee
(6,324 posts)Demsrule86
(68,556 posts)And that is how costs should be controlled...not by some system where an arbitrary decision is made by a faceless bureaucrat of who live and who dies...and such a system would be corrupted in a matter of hours in my opinion.
Lee-Lee
(6,324 posts)Here is one example- in England if you smoke or are obese you are likely to be denied surgery as a way to control costs.
https://www.google.com/amp/www.telegraph.co.uk/news/2016/09/02/obese-patients-and-smokers-banned-from-all-routine-operations-by/amp/
If you look into all the other health systems in Europe I expect you will find similar standards.
taught_me_patience
(5,477 posts)I think that some here are under the delusion that there is no rationing of care in Europe.
Lee-Lee
(6,324 posts)Any system will have only so many resources and will have to allocate them. That means unless you can create and endless supply of hospitals and doctors and medicines and an endless supply of money to pay for them if must be rationed.
Look at the VA- they ration from the beginning when you sign up. You are assigned a Priority Group and what care you get and how fast depends on what Priority Group you are in- some get it all, some are back of the line. I am in the middle, I can get most things but they flat out tell me don't even try for dental or eye care we don't have the resources and your not a high enough Priority Group and you don't have issues with them they make you jump the line because of service connection.
Honeycombe8
(37,648 posts)Only because Americans are SO far out of whack unhealthy with the rest of the industrialized nations. And this is a big change from a couple of decades ago.
For the first time in our history we are seeing a large number of children getting adult onset Diabetes Type 2, which is caused by lifestyle. I read that 1/3rd of kids are obese, now. This means that those kids will grow up unhealthy with expensive care required, contrasted with normal weight or slightly overweight kids, unless their conditions are improved.
But we have a country that protests against schools serving healthier lunches (low sodium, enough protein, fewer refined carbs) because "the kids don't want to eat that."
We have more and more morbidly obese adults. I am seeing more people on those go carts in stores these days than ever before; the people are morbidly obese. With morbid obesity comes what's called the metabolic syndrome, a trifecta of conditions that includes diabetes type 2, high blood pressure, and heart disease. That's not an "if." That's a sure thing, to my understanding.
Diabetes is one of the most expensive medical costs. It's chronic and lasts a lifetime. HBP increases risk of strokes, another very expensive condition.
The risks for these things can be lessened substantially through lifestyle. I see no reason not to encourage people to get their weight less obese. Being chunky is not a health hazard. But being obese is guaranteed medical problems for life.
It could be through maybe a financial incentive, if they go in for annual weigh-ins, and if they are obese, if they lose a % of weight, there is some sort of financial reward? I learned in Weight Watchers that just a 10% reduction in weight has huge impact on a person's health.
As it is now, doctors are more than happy to prescribe insulin and other medications. Surgery for heart issues. They treat conditions. That's how they make their money. Doctors do not deal in prevention. That needs to change, IMO.
I know a man who is about 64 years old who at 63 had major heart surgery. Despite being very tall and thin when young, he started boozing and eating a lot of the wrong things, so that he ended up unhealthy and obese. After he was released from the hospital, he went back to his daily morning routine of wolfing down doughnuts at Dunkin' Donuts, and boozing. This is the way that many Americans view health care these days. Fix the immediate problem, then go back to your regular lifestyle, until the next time you need something fixed.
Lee-Lee
(6,324 posts)So an "obesity tax" of some form would seem appropriate under a national health system.
If your behavior creates a greater cost to society then you pay more.
As I said before, we tax smokers now with higher taxes on cigarettes for the exact same reason. The only difference is the tax is applied at purchase instead of in a more direct form, but it is a tax all the same and one targeted at unhealthy behaviors to pay for the costs and discourage the activity. A tax on other unhealthy behaviors is absolutely no different than taxes on tobacco or on sugary drinks.
Honeycombe8
(37,648 posts)But then, you have the problem of non-obese people not getting the credit, so it's like the obese person gets paid for being obese in the first place.
I'm sure it could be worked out.
Maybe just a strong PR campaign against a lifestyle that results in obesity. Even with that, people will cry foul, since it criticizes obesity, which is a COMMON condition, now. And it IS a medical condition caused in most instances by lifestyle (though not always...there's a genetic or drug cause for some, but that's rare, I read).
It should be treated like, say, smoking. Being 75 # overweight is equal to smoking a pack of ciggies a day, I've read. And both are voluntary behaviors.
Demsrule86
(68,556 posts)penalty it seems for those who don't meet your standards...The comments about the woman on medicaid... do not reflect Democratic values in my opinion.
Lee-Lee
(6,324 posts)Isn't a Democratic value either. At least it shouldn't be.
I get that my perspective as someone who has been on the front line of this before is different than someone who views it more in the abstract. But controlling costs is going to be essential in any health care system if we want it to succeed. Part of that is reigning in drug costs, medical device costs, etc. But part of that must include dealing with elimination of unnecessary expenditures either in some way or another.
If someone chooses to ride a motorcycle without a helmet we absolutely should do all we can to fix their head injury. But we should also acknowledge that their decision was stupid and greedy because they put their enjoyment ahead of the responsibility they have to everyone else sharing the burden of health care expenses and cost everyone else a lot of money. So while we fix them we should have some sort of penalty for causing the unnecessary expense purely from stupid behavior.
How that should look, I don't know. But it needs to be there and it needs to be a strong enough penalty to make people not engage in that behavior.
Let's not act like what I am proposing is anything revolutionary or groundbreaking. We tax cigarettes to make smokers pay more both to cover the public expense of treating them and to discourage smoking. Some places are doing the same with sugary drinks. A few places are taxing ammunition and guns to discourage ownership and pay for costs of treating gunshots. What I am proposing is really no different, a penalty attached to behavior that incurs a greater public health cost for everyone.
Demsrule86
(68,556 posts)arbitrary judgement. Sorry...your posts are disturbing to me. I am against a penalty which by the way could be called a pre-existing condition...I completely disagree.
Honeycombe8
(37,648 posts)Type 2 diabetes. She "managed" her diabetes that way. Eat something bad for her, then give herself a shot to control her insulin.
Demsrule86
(68,556 posts)That is not a Democratic and certainly not Democratic policy...we don't judge people and decide who is worthy of healthcare...we leave that sort of atrocity to the Republicans...surprised to see someone on DU advocating such a policy.
taught_me_patience
(5,477 posts)it is actually progressive policy to try to figure out solutions to these problems in a pragmatic way. A major driver of the cost of health care in America is the poor health of citizens due to obesity and diabetes... two things that are preventable with healthier living. There is a legitimate discussion to be had in how to get people to be more healthy. What we're doing now is not working. What's your solution to the obesity and diabetes issue?
Demsrule86
(68,556 posts)taught_me_patience
(5,477 posts)Everybody knows obesity and diabetes (and smoking) is not healthy and creates expensive health problems down the road. People care when their pocketbooks are affected. Rationing of care happens all over Europe and smokers and obese patients are routinely denied care in order to save money.
Demsrule86
(68,556 posts)and kill people based on some version of punishing people for health 'violations'. There will always be people who are not perfect and they fit in the system or what we have is a death panel not health care...might as well enact Trump care as what you describe...your ideas are just as bad.
Demsrule86
(68,556 posts)However, I am careful...you are not advocating denying insurance to those who can not pay or for those who are not perfect in their lifestyle?
Demsrule86
(68,556 posts)The idea that now is the time when you have no governmental power to push something Republicans will never go along with is useless. Instead of putting in a single payer bill which will die in Congress...the pols who did so would have better spent their time fighting to save the ACA and ultimately American lives.
Honeycombe8
(37,648 posts)billions or trillions of dollars off the top for profit.
Plus, the ACA is not working well. I don't think many Dems will go along with what has to be done to make it work so that insurers aren't withdrawing and so that the plans really are competitive, and that cost lowers. Many Dems won't even acknowledge that the ACA is having serious problems.
Demsrule86
(68,556 posts)improve it...as for the ACA...the problems are the result of GOP sabotage...and it certainly could work...and it is the only game in town...and don't believe for one minute you will get single payer if the ACA goes down...you won't. But thousand perhaps millions will die...this bill the GOP has dreamed up also hurts those with employer healthcare...who will be tossed into expensive pools if they have pre-existing...and more than likely lose their insurance.
kristopher
(29,798 posts)Who is PNHP
Physicians for a National Health Program is a non-profit research and education organization of 20,000 physicians, medical students and health professionals who support single-payer national health insurance.
Lancet studies explore U.S. health inequity
Lancet_CoverLeading British medical journal The Lancet has published a special issue devoted to health inequity in the U.S. The April 8, 2017 issue includes a series of papers curated by PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler, along with Dr. Samuel Dickman. To access the full series, visit thelancet.com/us-health. To view supplementary materials, including media coverage and an extensive infographic, click here: http://www.pnhp.org/lancetusa
Honeycombe8
(37,648 posts)MedusaX
(1,129 posts)Healthcare is currently just one of the many weakened organs under attack by their own body's immune system
The dysfunctional immune system has been compromised by excessive toxins
which are continuously consumed by the body, to satisfy its addiction,
as quickly as they are offered by external actors in the environment...
The organs will remain weak & under attack, despite any treatment , as long as the immune system continues to attack them rather than to Protect them.
An immune system is required for the body to function....
so eliminating the immune system is not an option...
The only way to save the body from itself is to eliminate access to the external agents' toxic offerings....
Send the body to rehab ... so it can figure out how to function without needing the toxins ....
Allow time for the body to rebuild its immune system in the hopes that, in a toxin-free body, the rebuilt immune system will function properly ...
Then the organs can be addressed as is appropriate, up to and including transplant if necessary.
IOW: Our political body is addicted to the monies & perks provided to it as a result of the existing campaign finance structure...
Our elected officials are willlingly attacking & destroying our policies, laws, programs, etc rather than protecting them ....
Clean up the campaign finance situation first
Then purge/detox the system
Rebuild the immune system in the hopes that it will protect the programs, laws, policies that are in the people's best interest...
And then work to restore functionality to the organs , like healthcare, which were attacked &/or destroyed.
Honeycombe8
(37,648 posts)A lot of politicians and rich people have a vested interest in the current system. They rely on the ins. cos. (special interests) donating tons of money to campaigns, trips, gifts. As well as Big Pharma. Then these companies hand out cushy jobs worth millions to politicians when they leave office.
Drs. get kickbacks from Big Pharma.
Most hospitals are profit-based and rely on ever increasing fees from rich insurance companies.
This is a huge problem.
Demsrule86
(68,556 posts)So I completely disagree with you...you don't try to decide how a house should be renovated when it is burning down...you put out the fire.
workinclasszero
(28,270 posts)1. The Republican party will NEVER allow single payer...ever!
Without getting rid of republican blockage we will never have a solution to health care and many other important issues that every other decent country in this world has solved decades ago.
jimjc
(69 posts)there's been a alarming increase in cancer and heart disease and others etc...Our food is being pumped with all kinds of things we know nothing about...Mfg's are polluting our air and water, this has a negative impact on our health...hospitals, doctors, insurance companies have priced their services past what people can afford, except the rich of coarse.
so what's the answer simple "not for profit, single payer healthcare" nothing less..Price controls on hospitals, doctors, drugs,...lose the insurance companies.
it's called "healthcare for all" all people, businesses, wall street, everyone pays period...
Honeycombe8
(37,648 posts)Australia has universal care!!! Trump didn't even know that. Too funny.
The sad part is that Trump was right, for once. Australia DOES have better healthcare than we do.