Streams

A Rational Health Care Debate?

Friday, June 26, 2009

Today wraps up a key week in the health care reform debate. Much of the disagreement centers around the notion of "rationing" - so, just who should make decisions about who gets care? Carrie Budoff Brown is covering health care and the White House for Politico.

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Carrie Budoff Brown

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Comments [44]

PD from brooklyn

The Australian model has been commented upon by Chomsky and others as being one which promotes competition and choice whilst simultaneously guaranteeing everyone a base level of medical care. Medicare Australia is the goverment managed body administering health care for all Australian residents. This government department covers approximately 60% of all your health care needs. If you choose or require further coverage (e.g. major dental, optical, physio therapy)you can either pay upfront or buy into a PRIVATE Health Fund. If you buy private health coverage Medicare Australia will subsidise it by 30%. This results in everyone's entitlement to health care being maintained and preserved and also allows for private competition. It also results in lower premiums for private health fund customers with the average payment for full quality health insurance being $AU60/month. I feel like the US government is so hung up on these anachronisms of the government being inefficient and the private sector being beyond reproach. Unfortunately, our ageing population and longer average life spans make the cost of health care to spike dramatically. This would be the case regardless of who manages the system. The health care debate requires some very creative thinking which has not been fostered by Democrats or Republicans in recent months.

Jun. 27 2009 06:59 PM
James B from NYC

If we socialize healthcare further, we need to be sure to make people aware of the intimate connection between their life-style & the costs of health care. There will have to be higher premiums (or taxes) on people living unhealthy lives: i.e. overweight or obese, smokers, heavy drinkers, drug addicts, high-risk activities like skiing, xtreme sports & stuff where accident rates are high. If not, there will be a revolt by those of us who live responsibly & with regard to our well-being. I don't want to pay high premiums for people who can't or won't live responsibly. Socialize (i.e. collectivize) the costs of health care & u guarantee more health expenses for ALL to be bear.

Jun. 27 2009 01:36 AM
eva

I vote for mc, #9.

MC, you should be a guest on the Brian Lehrer show.

I'm completely serious. You not only work in the industry, but you know a lot more about it than most people.

And you're IMO very fair in your criticism.

Jun. 26 2009 05:32 PM
Susan from Brooklyn, NY

Its disturbing to see elected representatives out in force opposition of a pubic option (which 2/3 of us want) and fighting feverously in favor of for-profit insurance companies as “better”, when it is the insurance companies own history which is long for being wrought with denial of coverage as policy! We all know they’ve ALL been handsomely paid to obstruct. As they defend their position, it’s like watching someone reading Where The Wild Things Are, to a child. Frightening to me is knowing they are charged with running our country.

To observe “prevention” and “taking responsibility for ones own health” get redefined as “rationing” and become an effective fear-mongering tactic says a lot about how far we have to go in educating the public on how to stay healthy. But that will be another fight, another day, with Food Inc. Will we make it? I hope so. The story continues…

Jun. 26 2009 12:57 PM
Susan from Brooklyn, NY

Its very disturbing to see elected representatives on the hill out in force opposition of a pubic option (which 2/3 of us want) and fighting so feverously in favor of the for-profit insurance companies as the “best”, when it is the very insurance companies own history which is long for being wrought with denial of coverage as policy, first and foremost! But we all know they’ve ALL been handsomely paid to obstruct, so its not surprising. Just watch their facial expressions as they defend their position, it’s like watching someone reading Where The Wild Things Are, to a child. What is truly scary is knowing these are the adults charged with running our country.

Throwing out huge deficit numbers as what “your health” will cost your kids and grandkids is only a distraction, as clearly a healthy society will not cost what it does today down the line, and it will all balance in the end.

To also observe that the mere mention of “prevention”, and “taking responsibility for ones own health,” can be an effective fear-mongering tactic says a lot about how far we have to go in educating the public on how to stay healthy. But that will be another big fight, on another day, with Food Inc. Will we make it? I hope so. The story continues…

Jun. 26 2009 12:46 PM
phyllis from piermont, ny

This may not be the right question - insurer or govt., at least not enough choices. A lot of doctors do not take Medicare as they are not obligated to do so apparently. And none of these plans cover dental, acupuncture, nutrition and other preventative measures that people who do not prescribe to an all allopathic solution would want. It is a closed system at best and only allows for the most conventional approaches. We don't all want the medicines that are advertised on tv and that is what most doctors prescribe. A good majority of doctors just have their prescription pad in hand and offer you one of those drugs. The entire system needs to be revamped and not just who pays whom.

Jun. 26 2009 10:38 AM
Nancy from NYC

Would you rather have your care rationed by a "government bureaucrat" or a bureaucrat charged with making a profit?

The insurance companies' goal is to deny coverage, so their companies make the most money.

I'd rather have someone in the government decide, because they're looking at what works, not how to spend the least money.

Jun. 26 2009 10:36 AM
peter from Brooklyn

I have a relatively good private plan (or so I'm often told by service providers), but the few times I've had to deal with them directly on trifling matters have been time-wasting Excedrin headaches. On the other hand I recently had to deal with the IRS on a revised tax return. The service was helpful, knowledgable and courteuos, with spot on follow up. Who would I rather deal with? If the privqate sector has to be part of this process, let the government paln set the policy and they can outsource claims processing to the insurance companies, the only thing they seem to do well already.

Jun. 26 2009 10:33 AM
mc from Brooklyn

Your analysis of what the caller was talking about vis-a-vis HSA's was wrong. I'm glad he cleared it up. The Repubs never had a mandate on the HSA's and also no government provided catostrophic plan.

Also, Brian, Obama does NOT favor taxing health benefits. He has acknowleged that he might have to swallow it, and Peter Orszag has said it is on the table but Obama himself is trying to avoid it. He campaigned against it last year, so he will pay a political price if he agrees to it.

Jun. 26 2009 10:31 AM
BrettG from Astoria NY

As someone who worked in a teaching hospital here in NYC, I know that we must have Medicare For All for bother personal & public health. When I was there Medicare & insurance reimbursement rates determined which new units/clinics were started. Even then, the billers & registrars were hired before medical staff to assure proper claim filing.

With genetic diagnostics, drugs & other gene-based research in the future, I don't think anyone should trust private insurers with such critical information.

The employer/private insurance model doesn't work. I have a chronic illness that forced me to stop work & it took me 6 years to get SocSec Disability.

It's time that we try providing health care not insurance that doesn't insure the patient once the patient is ill or injured & they're dropped.

It also means 1 set of forms, decreased admin costs vs. the present "system" that penalizes our companies vis a vis international competition.

The consumer-based "plan" for MSAs suggested by the listener from Queens is unworkable in emergencies & other situations where the patient is unable to understand & make fully-informed "consumer" decisions.

Jun. 26 2009 10:31 AM
Robert from NYC

I think there should be more coverage as to who is receiving money from the insurers and pharmacos and make a point of that. It IS the point. What the hell does congress care, they get excellent insurance and WE pay for it.

Jun. 26 2009 10:30 AM
Michael from Long Island

CC That is an interesting point. But I wonder wouldn't the government have more of an incentive to care for people that are still paying taxes than to care for people who are being paid by the government through social security and medicare?

Jun. 26 2009 10:29 AM
Richard Johnston from Upper West Side

"Insurance" company is a misnomer. It is a simple risk-avoidance mechanism that will never voluntarily accept the difficult-to-insure, because they do not fit the for-profit model. The only viable long-term solution is to make health care a public service all citizens are entitled to and government funds prudently.

Jun. 26 2009 10:29 AM
Mary from Bronx

Having helped both my parents and in-laws monitor their Medicare, and knowing many persons who are very happy with Medicare coverage ("efficient, helpful, responsive"), I think that government-run insurance is far more trustworthy and efficient than private, for-profit insurance. HMOs are notorious for rationing health care according to their profit motives. I have friends whose HMOs denied important tests, with near-catastrophic results. (At one point my insurance company abruptly dropped me simply because I'm a female in the wrong geographic area. The alternatives I looked at were either very restrictive HMOs or very expensive PPOs.)

Jun. 26 2009 10:28 AM
CC from NYC

Corrected:

Remember as Paul Krugman of the NYTimes has often pointed out that only the governments has an actual interest in your lifetime health *and* potentially keeping costs down. As long as for-profit insurers have a profit motive in conflict with your health and no real moral obligation--and the ability to cherry-pick the healthiest people (pre-existing conditions, transfer to medicare as you get older) they will never emphasize preventive and lifetime health. Additionally the real savings of government options are reduced overhead (no CEO making millions, no additional millions wasted in denying appropriate care) and bargaining power based on size. Remember that private insurance would never be profitable if they could not cost shift the burden to medicaid or medicare once you age or become chronically ill. And as for as the role of the government bureaucrat, most people are more satisfied with medicare than private insurers.

NYC pediatrician

Jun. 26 2009 10:28 AM
Gene

I have a very good hmo. However, nothing is done in a timely fashion, every missive they send me--and they send about 1 a week from my (simple) operation last Sept., and the poor anaesthesiologist STILL hasn't been paid.

I get a massive amount of paperwork, all the time, and can't make heads or tails about it. I call them once every 2 weeks and ask the current status (the CS people are VERY nice and knowledgeable; I've actually sent medical personnel to my customer phone #, because they were getting the runaround everywhere else.

What a bunch of sheer waste.

AND, you can't tell what you owe till MONTHS later. There's recently been a congressional hearing on how hmos design their bills, especially for out-of-network care, to confuse people.

Obviously, the "free market," she doesn't work in this regard.

It's only the insurance cos. that are holding up this essential service.

Jun. 26 2009 10:28 AM
Robert from NYC

Sadly, Kathy's case now under the "new" Medicare D for Rxs that was written by the Pharmacos might not pay for that treatment because they are the ones the Medicare D plan uses for Rx but under the old Medicare Rx plan she would probably get the treatment if her Drs ordered it and explained why they think it would work.

Jun. 26 2009 10:27 AM
CC from NYC

Remember as Paul Krugman of the NYTimes has often pointed out that only the governments has an actual interest in your lifetime health *and* potentially keeping costs down. As long as for-profit insurers have a profit motive in conflict with your health and no real moral obligation--and the ability to cherry-pick the healthiest people (pre-existing conditions, transfer to medicare as you get older) they will never emphasize preventive and lifetime health. Additionally the real savings of government options are reduced overhead (no CEO making millions, no additional millions wasted in denying appropriate care) and bargaining power based on size. Remember that private insurance would never be profitable if they could cost shift the burden to medicaid or medicare once you age or become chronically ill. And as fast as the role of the government bureaucrat, most people are more satisfied with medicare than private insurers.

NYC pediatrician

Jun. 26 2009 10:26 AM
Jeffrey from upper west side

The dirty little secret is that no one needs insurance companies in the health care loop. You have the public that needs care, and the providers of that care. Who needs INSURANCE, of all things, in the mix? They add cost (and private profit) and nothing else!

Jun. 26 2009 10:26 AM
Melinda from Manhattan

Follow the money! There is a general rule in NYC that 25% of your income will go to housing. There is an assumption that health insurers are entitled to charge ANY amount of money for coverage because medical care is so expensive. Yet, health insurers make wild profits. Despite it's inefficiencies, there is no reason to doubt that the federal government can manage health care costs any worse than private health insurers, and given that it works well in all other Western countries, plenty of reason to expect that government oversight and management will bring costs down.

Jun. 26 2009 10:24 AM
mc from Brooklyn

Actually, Tad #10 it is not 30%. It is more like 5%. If you look at the CMS pie chart of health care expenditures, administrative costs and profits make up 7% of the pie. Private insurance companies make up 5% of that 7%. That does not mean that single payer is not a good idea, it just means that by itself it will not save us enough money.

Jun. 26 2009 10:24 AM
Judith from New York

Not doctors, at least while they are still being paid by proceedure! How about an independent board of doctors, economists ( yes it is about money) and other experts. A friend of mine just died after six months of suffering extensive and pointless treatments for her multiple cancers, made possible by her state ( not NY) funding of all treatments. She should have been allowed to die quickly.
Personally I can't wait to be on Medicare - much better than my ( major) corporate subsidised coverage!

Jun. 26 2009 10:22 AM
Jim from Tuxedo,NY

We should only have catastrophic health insurance. Regular office visits should be paid out of pocket. You can bargain with a doctor when paying cash. Home insurance doesn't cover light bulbs. Car insurance doesn't cover rust.

Jun. 26 2009 10:22 AM
Michael from Long Island

Everything is already being rationed. There is a finite amount of all products, that is a premise of economics. How does society distribute a limited resource?

Well lets take gasoline as an example. When supply outpaces demand prices drop until the two forces reach equilibrium, and when demand outpaces supply, prices rise and producers ramp up production. However, when government gets involved, as it did in the 1970's and place price controls on the market you create shortages. It has happend with housing in New York, food shortages in North Korea and The same will be true with healthcare in the U.S. It has happened in every country that has nationalized their system, and it will happen here if we place government control on healthcare.

Jun. 26 2009 10:22 AM
Robert from NYC

Look, I say this over and over and over, in a nutshell here, if you pay a somewhat higher tax to get full coverage as we see in other countries then you don't have to pay the exorbitant fees for the for-profit folks and not having full coverage because they won't cover some treatments. They charge outrage price to have the insurance in the first play then there are copays, deductible fees, Rx fees that are not very good, inter alia. The public system would cost some more in tax but you don't have to pay the exorbitant fees of the private healthcare insurers.

Jun. 26 2009 10:22 AM
Scott Smith

To get at how much the public plan will cost compared to private plans, the first question has to be to what extent the public plan would discriminate between healthy and sick customers. If it doesn't discriminate, then the ratio of healthy to sick customers will certainly affect its cost.

Jun. 26 2009 10:21 AM
sm

Oh, I read a great analogy recently - what if the US Postal Service didn't exist, and we depended entirely on private companies for mail delivery??

A public option would provide a consistent level of service, no matter what your state of residence. Private insurers can provide supplemental "luxury" coverage.

It's a shame that my international travel insurance (Medex) is far superior to my own health insurance. Ironically, I usually travel to countries with some form of universal coverage.

Jun. 26 2009 10:21 AM
Marylin from New York

I sure like the idea the health insurance companies will be going to the waste side. Every year, they are increasing their rates and I pay the whole amount because I am a computer consultant and my consulting company will not pay any part of it.

Jun. 26 2009 10:19 AM
Marissa from Manhattan, NY

Although I agree that insurance companies have profit motivations in determining what health care to offer their customers, what to accept and what to deny; I believe that each of us should have some accountability or incentive for reducing the health care costs we incur, via preventative measures. If we do have a government-funded health care system, perhaps we could get tax credits for physical activity, or healthy diet, or attending regular annual doctor's visits.

Jun. 26 2009 10:19 AM
David from Montclair

I do not want health insurance. I just want to visit my doctor when I need.

I am wary of bureaucrats, government and corporate. They do not read market signals.

Jun. 26 2009 10:18 AM
Marianne Bongolan from Staten Island

Who rations healthcare for members of the Congress?
Until they (Congressional body) is willing to give up their taxpayer financed health care their protest against the Obama health initisative rings hollow and hypocritical.

When they drop their government-sponsored taxpayer-payed health insurance and pick up their own PRIVATE health insurance they will get some credibility from the public. The money saved would also provide a bonanza for the uninsured!

Jun. 26 2009 10:18 AM
KS from Brooklyn

Even though my husband and I are both currently employed, we're desperate to have an option for a public healthcare plan. My husband works for a financial company and doesn't know whether his job will be secure, and I am a teacher who is, for various reasons, switching to being a P3 (special ed) provider in private practice. I also have chronic health problems and I CAN NOT lose my medical coverage--it would be devastating to us. We're making a little less than $100k/year and have a mortgage, and we're scared.

Jun. 26 2009 10:18 AM
Mary Arnold from NYC, Queens

The way the Republicans are framing the debate is disingenous. People with insurance don't have a totally free market where they and their doctors can provide whatever is wanted. Insurance companies decide what care insured Americans receive and who can provide it to them. They are in the business of rationing healthcare for profit. Another form of rationing is that if you can't pay, you die. This country needs a nonprofit healthcare system whose goal is fostering health. The private system has gone in the opposite direction -- a self-serving for-profit corporate model.

Jun. 26 2009 10:17 AM
mc from Brooklyn

Thank you for asking the question about what the public plan would cost a family. Howard Dean never answered that question.

Jun. 26 2009 10:17 AM
Tad from Saddle River

Government should decide which treatment is best for us. This will save money for taxpayers. If private insurance does it, it will enrich pockets of their executives and shareholders.

Everybody steps around the real reform: single payer system. Taking the private insurance out of business will save 30% in health care cost right away. It will save medicare and medicaid.

Jun. 26 2009 10:17 AM
mc from Brooklyn

Brian, with all due respect, this is the wrong question. We spend about a third of the $2.2 trillion on procedures and treatments that are unproven, ineffective and sometimes dangerous. It is statistically riskier to have surgery than to drive a car. We should be looking at the Mayo Clinic which has all its doctors on salaries. Right now, the motivation is to do more so more cna be charged. Problem is, it does not lead to better outcomes. More MRI machines and more ICU beds means more MRI's and more patients in ICU, not healthier people.

Jun. 26 2009 10:16 AM
sm

Demetri, you'd think this would be the most obviously logical solution. I can't understand how so many Republicans can justify anyone else BUT doctors making these decisions.

Jun. 26 2009 10:16 AM
David Hunter from Kensington, Bklyn (Ocean Parkway)

Scare tactics. That's what congressional Republicans are using to argue against a public-sponsored health insurance option.

We need a public option!

Jun. 26 2009 10:16 AM
Ken L from brooklyn

WHY AREN'T YOU COVERING THE CLIMATE BILL THIS MORNING???!!!!!!

Jun. 26 2009 10:14 AM
Demetri from Brooklyn

Why do we not have a not-for-profit insurer who can essentially split the pooled costs without a profit motive?

Jun. 26 2009 10:14 AM
Demetri from Brooklyn

Doctors should ration healthcare. They are in the best position to fairly determine who is best suited for particular treatments. Insurers motivation is only to save money.

Jun. 26 2009 10:12 AM
RJ from Brooklyn

The promo question for this segment--"who should ration health care?--is based on a false premise, and uses a loaded word that distorts the debate.

The underlying question is: How can all Americans have: 1) access to 2) affordable 3) high-quality health care?

We know that 50 million people don't, and that with the recession/depression, many more soon will not. We know that both public and private components of the existing system have enormous waste: Medicare and Medicaid have been defrauded; insurance companies require enormous infrastructures not directly connected to care. We know that research costs that result in promising treatments are often underwritten by public dollars (in grants to university research programs) only to be bought by profit-making companies that take them through costly FDA approvals, marketing, distribution, etc.

So where are the causes, the blockades, that prevent 1) access to 2) affordable 3) high-quality health care?

Those are the core questions. Not "who gets to ration" health care.

Jun. 26 2009 10:05 AM
j from brklyn

would it be possible that given that a publicly funded healthcare plan would also be in fact, a large, onoing clinical trial of sorts, and that the data from this could be sold to pharmaceutical companies, or atleast used as a bargaining chip for drug prices. The same way that these companies used taxpayer funded NIH trials and the genome database for their own profits, shouldn't the taxpayers who provide the "data" be paid back for this at some sort of market value. When companies do these clinical trials, the are often very expensive, and this would be a bonus since it would also involve a large and diverse population for them to sift through.

Jun. 26 2009 09:39 AM
Ed Helmrich

We're not going to be able to find a health care solution that isn't seriously problematic. There should be 45 million more young people, mostly healthy, paying for health care insurance, and balancing the older people who need care. And using medical equipment, which would decrease the per patient cost. But these people are not here. Not much we can do now.

Jun. 26 2009 08:14 AM

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