On Demand
30 Issues in 30 days: Health Care
Amanda Austin,, senior manager of legislative affairs for the National Federation of Independent Businesses talks about the impact of health care mandates on small businesses.
Then
John Oberlander, visiting scholar at the Russell Sage Foundation and associate professor at the University of North Carolina, Chapel Hill outlines both candidates' health care plans.
Then
Bob Kuttner, co-founder and editor-in-chief of The American Prospect, joins Oberlander to discuss the feasibility of a single payer health care system.
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NFIB is a good choice.
Interesting story: During the Clinton health reform, the NFIB sent their members to DC to lobby against it. The Wall Street Journal profiled one of those members -- and the reporter asked an accountant to look over her books. The accountant said she would *save* money under the Clinton health plan. When the reporter asked her about it, she said, "I don't know anything about that. They just asked me to come down and help."
My question for your guest:
Suppose you have an electrical contractor in the U.S. and an electrical contractor in Canada. In America, the employer buys health care through an insurance company, and pays $10,000 insurance premium per family per year. In Canada, they buy health care through the government, and they pay taxes of $5,000 per family per year.
(And according to studies in medical journals, which we've linked to on our show's Wiki, the health care in Canada is as good as the health care in the U.S.)
Why would Jose the electrical contractor want to pay $10,000 a year rather than $5,000 a year for the same service?
Please ask your guests to discuss the reasons for the 6-12% health care inflation and the fact that the delivery system, besides being inefficient is upside down, with all the incentive on the side of expensive intervention and none of the incentive on preventive and primary care. We can argue until the cows come home about single payer or not, but if we don't begin to grapple with this in a real way we will run out of money and political will in a very short time.
According to CMS, 4.5% of health care dollars out of the $2 trillion spent goes to private insurers' administrative costs and profits. 2.2% for government costs. Obviously the government programs save money but we have to deal with the fact that eliminating the insurance companies alone will not solve the problem.
My employer pays $22,000 per year for my family health care plan. The high price is to provide an "out-of-network" option, a feature that is essential in NYC because the insurer's reimbursements to providers are so low (Blue Cross/Blue Shield) that almost none of our doctors are "in network."
In addition to paying half the $22,000 premium out of pre-tax dollars, my family incurs 6-8,000 per year in additional costs for out-of-network copayments, mostly for treatment for our son's learning disability. Medical care is the biggest item in our budget after our mortgage and property taxes.
Next year, our son will "age off" our plan. His learning disability has thus far prevented him from attending college full-time, so he will be dropped from my policy. A "low-cost" policy purchased by us to cover him would pay for NONE of his therapy costs because his disability would be a pre-existing condition. COBRA costs $750.00 per month, and lasts only for 18 months.
Obama's plan would give my family comprehensive insurance at a reasonable price, plus the option of buying supplemental insurance with the saved dollars. In my view, anyone who doesn't support Obama on health care is out of his or her mind.
Meanwhile, I do yoga breathing, to try to keep calm until November 4th.
Karen,
You think that is bad. I have an idiot friend whom thinks that the churches should provide healthcare and welfare to everyone. I am scared, she wants to be a nurse.
Mccains healthcare proposal is horrible $5000 to buy into a healthcare policy, what about deductibles, co-insurance, co-pays if you purchase a policy in another state and that state is not in-network with your state you may only be covered 50, 70 or 80%, then some out of state insurances policies wont cover certain procedures, that are covered in the state that you purchased that particular policy. This proposal is a train wreck dont buy into it!
I second David.
What is to stop the health insurance companies from raising their prices?
United Healthcare pays its top CEO Willaim McGuire 1 billion dollars a year. The private insurance companies have to take a 15% administrative cost where Medicare instead only takes a 3% administrative cost. We can extend Medicare for everyone for universal healthcare.
It is very simple. If we view healthcare as a RIGHT (like, for example security) and not as a priviledge then we will make it a priority and it will work. It is clearly no more complicated or expensive to set up a healthcare system that is universal than, say, sustaining the biggest war machine in the world and going to war in at least two countries at once (at least one of them being totally superfluous).
How about, before going to war and before allowing ANY of our politicians to receive healthcare we make sure that EVERY LAST CITIZEN of the United States has healthcare; I gaurantee this will not longer be an issue. Take healthcare away from congress, and Bush and Cheney and the judges immediately and we will quickly have a smooth running healthcare system providing state of the art medicine to all of us.
And how did healthcare become something you have to work for to deserve to do anything other than be a citizen and pay your share of taxes?
Oh take healthcare away from the ceo's too!
knowledge.wharton.upenn.edu/article.cfm?articleid=1481And
Look at how food is important, even more than healthcare. No food, you die.
But it is cheap (or at least OK), in the US. This is because there is intense competition. There is no such competition in the healthcare field. This is one of the last industries that is still protected by a cartel (the AMA) and has resisted outsourcing.
Now, whichever way we go, it will be expensive if the cost of receiving care itself is expensive. Maybe one way is more efficient, but in the end, it is still shuffling around expensive bills.
Not mentioned in the debate, regarding "Joe the plumber" he would, under Obama's plan earn tax credits for hiring employees.
Tony from San Jose,
You are right. We have to address the reason that the care itself is so expensive or no reform will stick.
I also think that we have to be careful when we talk about a service that people provide as being a *right* as in the right to free speech is a right. I think society has a duty to make sure everyone has access, but Americans need to wrap their heads around the fact that this is not going to be free or even cheap
Hey Brian
you had your man from Fact check verifying Obama's statement yesterday, but today you press to se if he was lying...
stay consistent dude
My brother recently told me about friends of his who went to Italy. Their young son had a health emergency & had to go to a hospital. The child's life was saved, & the couple never had to pay a cent *or* fill out a form. Oh, the horrors of "socialized" medicine!
I'm sure no country's gov't.-paid health coverage is perfect, but every country's system is different. The US could look at all the alternatives & choose the best one for us, rather than look for which ones they can hold up as "what's wrong" w/the entire idea.
The problem to me is the costs that the health industry imposes. I'm a diabetic who just recently bought my bottle of Lantus insulin for $100. Last time I purchased it, it cost $85. That is a 15% increase in little more than three months! This medicine is not a luxury item for me. I have to buy it, no matter what the cost. The drug companies know this. They have us all by the neck.
I am an Obama supporter but his health care plan is simply adding additional layers of band aids to a broken system (Clinton and Edwards had better ideas). The country must move towards a single-payer system and must stop linking health care to employment.
I don't want choice. I don't understand the differences b/w healthcare programs & I can't foresee my own health.
Jeffrey Slott,
Indeed. And why should you have to pay 15% more? Is it 15% more effective? I doubt it.
Food it totally different. You can eat this or that, you can budget etc. But if you need a heart transplant then you have to have it or you will die. Why are we set up as a community to say that some people deserve to get the service while others do not.
As far as 'rights' are concerned at what point do we say that one ceo bringing home a billion dollars and being totally backed by the government while there are children, CHILDREN(!) (not to mention plenty of hard working tax paing individuals) who are going without any healthcare whatsoever is somehow 'just' or 'democratic'.
talking about enlarging the pool of insured to spread the risk - what could be more simple than national health care plan - one plan open to everybody. not small plans for each employer separately...
So Amanda Austin, the senior manager of legislative affairs at NFIB, believes that we should stay with an employer-based system because it's familiar, and we can reduce health insurance premiums by increasing competition nationwide.
The Nobel laureate economist Herbert Simon said that you don't necessarily get better purchases by having more choices. In fact, Simon said, it's often more difficult (and therefore expensive) to have to choose between more offers.
I wonder what kind of evidence people have for assuming that more health insurance choices would give us lower prices.
irena,
Great idea. But do you remember the argument over individual mandates? Can we get the public to buy a tax to support the whole thing if we are fighting about the concept of indivdual responsibility? What about the 85% of people who have insurance many of whom are satisfied with it? Did you know that it was the Obama campaign that insisted on dropping single payer from the Dem platform?
The conflation of 'choice' and 'freedom' is totally bogus in this case. Because I can choose more types of cereal at the grocery store I am more free? That is the problem. With health we need to have equality NOT choice. We have to have access to healthcare ALL of us like we do to clean water etc. It has turned into an industry in this country becaue of greed and for no other reason.
It's worse than you think, Jeffrey. That increase would be 15% if you were already paying $100, but it's 17-18% of $85.
How do we deal with the relationships among doctors, pharma companies and labs. I understand MRI labs provide kickbacks to the doctors.
Also, don't we need uniform pricing, profit removed from pharma, doctors or insurance to lower costs. In the other countries that have healthcare for their people, that is what has happened. So doctors don't make as much money as they do in the USA. And, in switzerland, the insurance companies don't make a profit on basic services.
Also, you can't sue the doctor and the doctors don't have very high malpractice insurance.
Another anecdote:
When I was eighteen, I and a friend took our first trip abroad, to England. It was a two-week "package deal" and, on the plane going over, we met a group of young women who were traveling through GB on a "walking tour."
On the way back, we flew with the same group. One of the young women (we were girls, really) was all bandaged up. She'd been hit by a car in Scotland and spent several days in the hospital getting bones (her ankle and arm) set and otherwise receiving top-flight medical care.
She told us that it had all been free. We marvelled. "Free?" we asked. "Was it a charity ward." She told us that, no, GB had a medical plan and everyone's care was paid for.
That was 40 years ago, friends. When will the U.S. catch up?
mc
I am not saying that there should be only one possibility of insuring oneself. a combination is fine with me. but there needs to be an alternative to employer based system. anybody should be able to buy into an affordable plan if they are not happy with what they have or have nothing at all. in Europe there is usually a combination of a national system and regulated private system and I don't know of many uninsured people there.
??? $4,000.00 is single coverage for him ? What about spouse and children coverage.
Obama forgot in his reply that a younger person might be able to get a policy for $5,000, however, if that person is single he/she is only getting $2,500.
The "average" cost of a policy of $5,800 that McCain claims is ridiculous. It is an average of all the individual and family policies including the catasrophic, bare bones policies. Family plans average $13,000 yearly.
Aside from the fact that $5,000 wouldn't be enough for many families, what with deductibles, copays, & coinsurance (& it's only $2,500 for individuals, which I've never heard McCain mention), how would he make sure people *could* take it to any provider? Would he make it a mandate--which he keeps objecting to in Obama's plan? How would he enforce it? Many health care providers are turning down Medicaid/Medicare patients because the payments are too low--why wouldn't they do the same under McCain's plan?
Also,
How can a guy who spent the vast majority of his life on a government paid healthcare program all of a sudden talk about the free market and choice?
Where can I get a healthcare policy for 5,000? Plus its not like I am given the cash, its a credit. What planet is Mccain living on?
irena,
In Europe the concept of an individual mandate is not contraversial. If it's not a tax, everyone is required to buy in.
Botox injections and most other elective cosmetic procedures are not covered by insurance. People pay for them directly at the prevailing market rate. Which is one reason why so many doctors are going into this area as oppoaed to family practice, ob/gyn, etc.
Why do we have to be consumers? Why can't we just be patients?
Okay, my doctor has directed that I have not one, but two breast sonograms per year because of a benign condition that, in rare cases, becomes cancerous. My insurance company want to pay for one sonogram per year. The idea is that the chance that I will get cancer from the condition is too slim to justify the extra costs of the extra treatment.
It's a slim chance, but real. Some women who have this condition are going to develop cancer, and the extra six months prior to diagnosis will mean delayed treatment for those cancer patients.
Do the insurer's policies mean that, if you fall into the "slim percentages," you die?
Neither presidential candidate has the power to impose a health care plan no matter how perfect. No new health care plan will be passed pr implemented without input from Congress, insurance companies and the many other vested insterests. The question that has never been posed to any candidate -- but should be -- is: How will you build the coalition necessary to create a plan that has an actual chance of being made into legislation , passed by Congress and voted into law. Without that ability -- we'll never get health care reform.
Karen,
These are exactly the realities that people in other countries live with now. I support universal coverage but we need to get our heads out of the sand and have a serious conversation about what gets covered and how much we are willing to spend. $2.2 trillion with the patient results we get now seems excessive to me.
We need doctors to stop ordering $3000 MRIs for a knee sprain. Problem is that doctors get paid by the number of procedures they order, a clear conflict of interest when it comes to keeping costs down. Patients want all the test they can get because they think the insurance company pays, not them. In fact, we all pay.
Gold plated health care for Botox?! Over and over during my door to door canvassing I came upon families struck by health care catastrophes. primarily cancer)Even those with supposedly good employer based health insurance agonized that it gave out quickly and they are left with bankrupting level copays and uncovered costs. Try losing your job, with (any) pre existing condition, much less cancer, then taking your $5,000 credit to buy insurance on the open market. Good luck!
I am one of the uninsured (and paying for it dearly), and I want to know... WHICH of the uninsured will Obama's plan help, and which will it leave behind? After all, Obama's plan is not universal, so which of us will still be on our own here? I'm 29 and new to the workforce, having just finished grad school this past May. Will I continue to be left out of an affordable system? Between my student loans, rent, food, transportation, other bills, etc, I am not optimistic that Obama's plan will help me.
P.S. You know who's plan would? Cynthia McKinney's - one major reason she is getting my vote.
Chris from NJ,
Thank you. And while we're at it, let's look at CT scans. The machines cost $1 million. Of course the cardiologist who owns one is going to make sure it gets used a lot. But the tests are usually inconclusive. So goes $1200 down the drain.
I've posted previously that Obama told a fundraiser group last weekend that he would need to "cut out" expensive items, such as healthcare and some education supports legislation. And he would have to fight "his own Democratic Party" to achieve not funding those programs.
I wish I knew what he was really talking about, what he really meant. He does have history of saying one thing, then doing another.
How will actually govern?
The DC establishment, aka The Villagers, are already telling him he must be a fiscal conservative (as they told Clinton, as well), that since the Repubs were so profligate, Dems cannot enact or expand social programs.
Same old story. Repubs spend well beyond our means--Dems have to come in and clean up.
Will we get any meaningful healthcare legislation? What's the line in Vegas?
I'm totally for capitalism in all areas where real competition on the market is avaliable.
However healthcare hardly market oriented business. You can not select doctor the way you select car at a car dealer or fish in a supermarket. That is why cost of healthcare is growing uncontrolable. Some kind of socialized healthcare is the only solution I can see.
Thanks, Pavel.
I can see why Kuttner thinks that it may be too hard to tackle the first year. But please don't say it's not important. It contributes to almost all our costs, including infrastructure building (have to cover those workers).
Ironically, McCain's plan could lead us to single-payer more quickly that Obama's in that McCain's program would very likely bring about a breakdown in the status quo (employer-based programs).
Ah, the dream of single payer! We of course have single payer healthcare--in the form of Medicare.
Which I'm trying to hold out for as my individual insurance is now a hair under $1500 per month. That's $18,000 per year. And it will go up next year and the next and may be restrained slightly in the third year, as NJ reviews the private insurers only every 5 years (or so I was informed by the state insurance commish's office).
I cannot move out of NJ, btw, until I can get on Medicare since I have a type of cancer which must be closely monitored--and will not be covered for this preexisting condition in another area with another insurer.
Please, may Kuttner be right that Obama will be inexorably lead to single payer.
(I thought I was going to be able to handle the insurance costs until this Big Me$$ meltdown of my savings.... This not a lot of fun.)
So what? does that mean we shouldn't fight for it? It's time we did fight for it and get rid of these healthcare companies and, BTW, even the pharmaceutical companies.
Yes, we are SICK of it and so is my Dr--although he and it cronies are partly responsible as well as we who don't fight to get rid of this horrid system.
Of course doctors support universal care as long as you don't expect them to be on a budget.
This guy wants the GOVERNMENT to take over because they will be more efficient!?!?!? Good lord! Even if an HMO is inefficient, another, more effecient HMO or Insurance Co. will come along and put that ineffecient company out of business. If the government is slow or inefficent - oh well! Just tell our children how we screwed up their health care.
I would love to hear the comparison between the coverage and cost of both the Canadian and the Australian systems with our own current system.
From what I understand the Australin system has health care for all with the option for the more affulient of the population to buy additional coverage which allows them to get faster treatment as well as elective procedures (for example: no waiting for MRIs and the like, the hair plugs that McCain is so worried about).
I wonder if this isn't something that the US should look at as it would cover the uninsured while still allowing those who can and want to pay for the "gold plated" plan that they want.
Why don't we hear about the different types of government provided healthcare that is provided throughout the world?
Good program.
Good job, everybody.
No one mentioned the possibility of adverse selection in Obama's public health plan. It would attract the sickest and oldest because of the regulations on it. Because of the lack of a individual mandate, healthier and younger people will stay on the bare bones or HSA's driving up the costs of the public plan. Nice going.
McCain is even worse. Let's dumb down al the state protections by allowing plans to sell across state lines in a race to the bottom a-la Delaware for the credit card companies. And let's have a federally funded plan for ALL of the people who can't buy on the market because of a pre-existing condition. Hmm. How long will THAT public plan last?
health care should be treated like infra-structure, not subject to the whims of the free market. where is the free market when a patient (or more likely an insurance company)in a hospital is forced to pay 7 dollars for a tylenol, we are not given the choice just to take our own. i am sickened every time i see or hear a commercial for a hospital. how are marketing fees going to lower health care costs? disgusting
Sarah,
The Australian system sounds a little like the UK. The problem that the UK is having is that wealthier people are going outside the system for tests so that they don't have to wait in line but coming back in for the big treatment. You can probably guess what it is doing to their costs.
I'm a little disappointed in this segment. Considering how important people say this issue is it is a shame that it had to compete with the fundraiser. 8 minutes for a discussion of feasability? I understand the need for fundraising, but I think this could have been planned better.
I guess we know how important it is to everyone since we seem to have nominated a couple of lightweights in this area.
Maybe by the time I qualify for Medicare people will be ready to really take this on.
mc on "In Europe the concept of an individual mandate is not contraversial. If it's not a tax, everyone is required to buy in."
accepting the mandate you are assured that if you can't pay yourself, the government will pay your health care (children and full time students, elderly, unemployed) and your own health care is affordable. I think that's a mandate I'll gladly take anytime.
btw I was very surprised to hear the praise of Medicare recently on this show and I think so was Brian. That's making me even more convinced this could work for us all here.
#54--thank you for noting the paucity of time given to single payer. Wow.
I guess it's considered low priority and low probability.
I remember back when the Clintons were trying to get their plan passed (which I think failed bcz they started out by trying to meet the objections of the right and Repubs--had they started with single payer, then compromised toward something, we have a somewhat better system now--or be at single payer. Repubs only compromise by getting the Dems to give up almost everything.) and the news media was so flummoxed by the Canadian system. They had the Repub talking points, but found it hard to actually do any fact-based reporting.
Guess the distance and language "problems" made it too difficult?
Or the "corporate" part of the Mainstream Corporate Media didn't want genuinely honest reporting??
irena #56,
I absolutely agree. I'll take it anytime. But do you remember the argument that went on about it?
#57 Jawbone,
I think people like to talk about it being important, but then they don't like to talk about it.
I went back and re-read the '93 Clinton plan. It is amazing how many of the provisions were unfamiliar then, but quite familiar now. I had my problems with that plan because I, individually fell through its cracks, however, only Jim McDermitt and Lincoln Chafee even tried to come up with alternatives. I am impatient with the right's harping on "market solutions" but I am just as impatient with the left's insistance that if we just get rid of the evil insurance companies are problems will be solved.
Pavel,
I agree totally. There's so much talk of consumer choice, but no one chooses the maladies that befall them. No one chooses to get cancer. I got hit by car once, and I didn't get to choose the make, the model or even the color of the vehicle that struck me. (By the way, it blue Pontiac sedan from the mid-eighties.) The idea of negotiating with insurance companies is the same. At the beginning of cold season, no one calls up the virus to schedule a time that's mutually convenient. I didn't get to call the driver who hit me and negotiate her speed. We need to reframe the debate, so that we are considered patients who need care and not consumers who are marketed to.
There's a lot of information on the Wiki for this program http://issues.wnyc.org/wiki/index.php/Health_Care:_Whose_Plan_Rules%3F that will answer some of the questions you've asked above.
In particular, in response to Sarah's question, there's a link to a good evaluation of the costs and quality of Canadian and U.S. system
http://www.openmedicine.ca/article/viewArticle/8/1
Open Medicine, Vol 1, No 1 (2007)
Home > Vol 1, No 1 (2007) > Guyatt
Research
A systematic review of studies comparing health outcomes in Canada and the United States
Gordon H Guyatt et al.
There is also at least one article in Health Affairs comparing the quality of U.S., Canadian, U.K. and Australian system in those areas for which there was good evidence, including several types of cancer. All of the systems were about the same, although the U.K. did a little worse in some areas.
Yeah, the wiki on this program was a lot better than the program turned out to be.
Ah, well...
jawbone [45]: I'm sorry to hear about your medical situation. I hope you can hold out till Medicare kicks in (& that it's still adequate by then) & that you're doing as well as possible.
JWG [48]: Not everything the gov't. does is inefficient. Did you hear Brian's segment on 10/7, when caller after caller sang the praises of the Social Security system, saying not only how efficient but how humane & compassionate it is? Comments posted on that segment also talk about being satisfied w/Medicare. And studies of gov't. health care in countries that have it show it's more efficient & wastes less money than private health insurance. Sounds like you're making kneejerk assumptions. Can you give an example of an HMO/insurance co's. putting another one out of business by being more efficient (rather than, say, by cherrypicking the healthier patients?)?
mc [54]: I agree, the issue that was voted #2 in importance shouldn't have been aired during the pledge drive. It took way too much time away from the discussion.
A way to bring down the health care costs while improving the effectiveness of the health care system is to bring on board the so called complementary and alternative medicine (CAM).
Complete health models such as Acupuncture, which is actually integrative and evidence based medicine, effective yet affordable, but lacks the founds for lobbying in the health care system to defend the facts, obscured by the money driven business of the bio-medicine, wrongfully called traditional medicine.
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