Americans set to get standardised/universal healthcare

[Humodour]

Warning: technical (politically) post ahead.

 

Health Care Bill Likely in October

 

The Democrats made a strategic decision about health care reform this week that has major implications for the elections of 2010 and 2012. The decision was fairly technical--to attach health care reform to the budget reconciliation if agreement has not been reached by October 15--but the political consequences are immense.

 

Very briefly, budgeting works like this. In February, the President proposes a budget, which President Obama has already done and which Congress has approved. But this is only step 1. Next the Senate and House committees dealing with taxing and spending hack on the President's proposal and come up with their own plans, which merely sets general spending limits for each of 19 broad categories of government expenditures. After much arm wrestling, the committee chairman come up with a single proposal in each chamber, which is then brought to the floor for a vote. Since the Senate and House versions invariably differ, a joint Senate-House conference committee then works out a compromise, called the budget resolution, which both chambers then pass.

 

If Congress so desires, language can be inserted into the budget resolution directing one or more committees to produce specific legislation by a specific date. The legislation produced by these committees is generally bundled into a single bill called the reconciliation bill. According to Senate rules, budget resolutions and reconciliation bills are subject to a straight up-or-down votes. Filibusters are not allowed. The Democrats plan to use this process to get a health care reform bill through this year. In effect, as long as 50 Democratic senators support the bill, it will become law with a little help from Vice President Joe Biden if needed. Up to nine Democrats, such as Sen. Ben Nelson (D-NE) can oppose the bill and it can still pass.

 

Poll after poll has shown that Americans are very worried about their health insurance. People are afraid to quit jobs they hate because they are worried they won't be able to get health insurance after their COBRA coverage expires. The core of the problem, of course, is the insurance companies' desire not to insure anyone who is sick or likely to become sick. All other industrialized countries solve this problem through laws saying that health insurance companies must offer a standard policy at a standard price to anyone who asks for one. Cherrypicking good customers is illegal everywhere except the U.S. To prevent young healthy people from going uninsured util they suddenly get sick and then applying for insurance, other countries make carrying health insurance mandatory, the same way most states in the U.S. mandate that car owners have accident insurance on their cars.

 

The Democrats and Republicans differ hugely on their views about cherrypicking and mandates. Any bill the Democrats came up with containing both of these items would be filibustered to death in the Senate. However, now that Senate Democrats (with Obama's blessing) have decided to make health care reform part of the reconciliation bill, the Republicans will not be able to filibuster it. This will make them absolutely furious--even though George Bush used the reconciliation process himself on a number of occasions.

 

Now it is not certain that health care will have to go into the reconciliation bill. If Al Franken is ultimately seated in Minnesota, then the Democrats will need only one more vote to pass a health care bill the usual way (which in this session of Congress means invoking cloture). That vote won't come from Arlen Specter due to his tough primary, so the targets will be Sen. Olympia Snowe (R-ME), and to a lesser extent, Sen. Susan Collins (R-ME). Majority leader Harry Reid (D-NV) will undoubtedly spend a lot of time talking to these two women and trying to cajole them into voting for cloture on the health reform bill. However, since they know their votes aren't really essential (because if they vote against cloture health care reform will be dumped into the reconciliation bill which can't be filibustered) they are not in a strong negotiating position and may be content with small changes rather than having the bill go into reconciliation, in which case they get nothing.

 

If the Democrats manage to ram health insurance through Congress this year, they will be crowing about it in 2010 and 2012 as fulfilling a major campaign promise and Republicans will be dissing it as socialized medicine. But given the public's desire to see the health insurance system fixed, a bill this year is likely to help the Democrats, hence the decision to put health care reform in the reconciliation bill if all else fails.

 

Source: http://www.electoral-vote.com/evp2009/Sena.../Apr25-s.html#4

 

My 2 cents: Re the bolded bit, I simply can't believe insurance companies in America are allowed to do that. It's insane.

Edited April 26, 2009 by Krezack

[Meshugger]

It's the free market, you can pick your customers as you see fit. Even if it is their prospects in health. I of course disagree that health insurance should go by the same principles as any other insurance.

 

In before 'socialized medicine/collectivism/end of personal liberty/fascism/end of a free nation'.

[Hell Kitty]

Obama wants to destroy America with the Socialism.

[Gorgon]

Go Socialism, America ain't worth preserving as it is.

[Syraxis]

It's all a conspiracy by those damn communist-liberal hippies to tax me more and take my money!

[Atreides]

From what limited info I have, antiselection's pretty bad in the US because insurance is so expensive that it's skewed towards people with higher chances of making claims. And of course the insurance companies need to price to reflect that. It's a vicious cycle.

 

On the other hand going mandatory universal healthcare can be done but it's not perfect either. Long queues and very strict criteria on what you can or can't get treatment for. That's why private medical care places still exist and do well in universal healthcare places.

 

Read up on Undercover Economist's chapter on that. He proposed a system combining market forces and universal healthcare. I think it was a mandatory saving fund from your earnings. You're covered for basic stuff, but you can dip into the fund if you want more treatment. But the incentive is to save because you'd get access to the fund on retirement etc.

[Gorgon]

Private operators in a public health care system can help improve the overall efficiency of the system, as long as continuous care is taken in defining their role.

 

In Denmark treatments are guaranteed by law, and if the public system can't cope the government has to pay for private treatment, this includes in theory treatment overseas.

 

In the US a system of public hospitals in direct competition with private hospitals does not seem possible.

Too much ideology to overcome, and even if it was government lacks the strength to kick the private operators back in place when needed.

Edited April 26, 2009 by Gorgon

[Humodour]

On the other hand going mandatory universal healthcare can be done but it's not perfect either. Long queues and very strict criteria on what you can or can't get treatment for. That's why private medical care places still exist and do well in universal healthcare places.

 

a) I've almost always used the public health system and rarely ever had a problem with wait times. Certainly I've never had a problem with coverage.

b) What's your point? Any coverage is better than no coverage for the people this affects.

c) Public healthcare keeps private insurance costs down. Health insurance in America is twice the cost it is in almost every other Western country, and the biter is that in America, government expenses spent on health insurance as a percentage of GDP are identical to countries with universal healthcare! So it's not like Americans even get the benefit of smaller government spending by not having universal healthcare.

 

Read up on Undercover Economist's chapter on that. He proposed a system combining market forces and universal healthcare. I think it was a mandatory saving fund from your earnings. You're covered for basic stuff, but you can dip into the fund if you want more treatment. But the incentive is to save because you'd get access to the fund on retirement etc.

 

Well, as long as it's mandatory that could work. I haven't looked into it.

[Atreides]

Point it's hardly the silver bullet either. Lets get Walsingham's observations on this if he's willing/available.

[Monte Carlo]

Here we have the National Health Service (NHS), set up shortly after WW2 by the Labour (i.e. Socialist government, although no UK political party has been fully 'socialist' by any objective standard which can only be a Good Thing). That, along with the 1944 Education Act and another that I can't remember right now (I think it was socialised pensions / national insurance... it's been twenty years since I did social history) were seen as the pillars of 'The Welfare State', a cradle-to-grave system of the Government looking after everybody. Depending on your POV, this is either (a) marvellous or (b) really scary. A muscular, Ayn Rand worshipping American conservative probably thinks that people dying, untreated, of cancer living under plastic sheeting is a sort of Darwinian weeding system (I don't), but I digress.

 

The mantra of the NHS is that the service is free to all, regardless of ability to pay. Now, I will declare my own position here. I am a small-state conservative (note the small 'c') with socially liberal views. In the UK this puts me on the Centre Right, in some parts of the US it makes me a Birkenstock wearing, Volvo driving, freedom-hating pinko (although I'm not, actually). Please view my observations accordingly. If you consider the old classical liberal saw that the primary role of government is to provide security, both internal and external, then I'd agree. But add healthcare as a 21st century take on that position.

 

 

 

The funding of public services is a dry subject. It's never ever done me any favours on a date. However, the problem with the universal healthcare model is that you end up with rationing. You queue. You also make yourself a magnet for economic immigrants from countries that do not enjoy universal healthcare systems, putting further pressure on the system. The NHS is also the UK's biggest employer - it is a massive bureaucracy that employs more managers and logistics people than it does doctors and nurses. Despite years of tinkering with internal markets, new management doctrine and regionalised funding it is still fairly inefficient: our current government has flooded it with cash for the last twelve years with performance improvements that simply wouldn't be tolerated in the private sector.

 

Private healthcare in the UK is, as a result, hellish expensive and you can't ensure yourself with existing ailments unless you are quite wealthy. An alternative often discussed here is the Australian insurance plan model (unfortunately, more people live in London than the whole of Oz, making it a bit of an apples-and-oranges comparison), or similar subscription based alternatives. In France, for example, you pay to see your General Practitioner, effectively the Gatekeepers of the healthcare system.

 

So, what would I do? You know what? I don't know. On a level of principle, I agree with a non-socialised system. OTOH, I remember being in hospital in London with an American undergoing protracted treatment for a serious illness. Her mother, a wealthy realtor, couldn't believe that it was free as a dozen consultants buzzed around (she was married to a Brit, so they are entitled to the service). When I asked what would have happened in the USA, she said that she would have had to sell her house to pay for the treatment.

 

Then it struck me that the NHS is far from perfect - funding it is like pouring money into a leaky sieve, but bejaysus when you need it and you feel the Reaper's scythe nick a loved one, you don't care.

 

I'm not a big fan of the American Democratic party - allowing a Clinton back into public office speaks for itself. However, if President Obama does anything to put in place some sort of healthcare safety net, I think his place in the political history books are assured. The stranglehold that healthcare lobbyists have on US domestic health policy is corruption worthy of the Medicis. What he will have to do, however, is respect the robust US political tradition of self-help and make it a scrupulously efficient, waste-free system. And therein lies the rub.

 

Cheers

MC

Edited April 26, 2009 by Monte Carlo

[Humodour]

Point it's hardly the silver bullet either. Lets get Walsingham's observations on this if he's willing/available.

 

In a way it is. To the point I was initially confused it was even an issue in America (any Australian politician who complained about universal healthcare would be crucified). No, it's not perfect, but it is better than America's current situation in many, many ways, no?

 

Monte Carlo's post was interesting. It seems the British model is different (inferior? ) to the Australian model, so of course one's mileage may vary when it comes to government-run healthcare systems.

 

For reference, about 50% to 60% of Australians have private health insurance alongside Medicare. Myself included.

[Kaftan Barlast]

Personally, I think the American healthcare system is GREAT as it is. If poor people cant get medical treatment, they will slowly but surely die out until there is not a single pesky poor person left. And by then, we will have an army of solid-gold robots to do our chores for us, so the grass will still be trimmed and the garbage taken away. And, you can safely buy all the smack you want from the internet and have it delieverd right to your door instead of having to risk being mugged when trying to score some in the bad parts of town. Everybody wins.

 

 

Its not like here in Sweden were we just hand out free kidey transplants to everyone who wants one. I cant even pay extra so I wont get one from a black person.

[Hurlshort]

Actually, poor people get health care in the US. Hospitals and clinics cannot refuse service to anyone.

 

 

They do get a mountain of debt though.

[theslug]

Going to be awesome when im actually making money but ill be shelling out like 50% of it to the gd us government bunch of a freakin a holes. Obamatron wants your land, wealth and the sweat of your brow.

[Monte Carlo]

Monte Carlo's post was interesting. It seems the British model is different (inferior? ) to the Australian model, so of course one's mileage may vary when it comes to government-run healthcare systems. For reference, about 50% to 60% of Australians have private health insurance alongside Medicare. Myself included.

 

I'm pretty sure that the Australian system is more efficient than the NHS. Note, however, the economies of scale I mentioned. Australia is a big country with a good economy and a relatively small population. In fact, I think comparison with Scandiavian countries are valid more than the UK - we are a small country with a colossal population. We're more like Japan, actually, in that respect.

 

Let me clarify, though. My experience of our healthcare system is this - my local doctor's surgery, which is completely free at point of use (prescription fees for medicines notwithstanding) is good. NHS treatment of critical accidents and emergency is also solid - I have experience of this with my son, and there are no complaints there either. The staff and resources were superb.

 

Where the NHS tends to frustrate, and can resemble a Soviet meat queue circa 1978, is with chronic illness and pallative care. Fracture? Physio? Pain clinic? You might as well pay your own way unless you don't mind waiting a couple of months. And the refusal of UK politicians to deal with this aspect (a 'Third Rail' issue of epic proportions) is where it all falls down. What I'm saying is that if Obama offers a system where prevention (i.e. the local doctor) and critical cover (run over by a bus? Cancer?) is affordable then he'll easily be able to sell private cover to a grateful American public for a sprained ankle, piles, migraine and other non-terminal but pesky complaints.

 

We pay a lot of tax in the UK IMO. One year I got my money back ten times over with the resources the NHS put out for my child. It's a 50/50 and all things being equal I'm glad it's there. But I'd also like to see politicians deal with the lag in the middle and offer Medicare-style insurance to make the system more efficient.

 

Cheers

MC

[Gorgon]

I've not been hospitalized since I fell down a flight of stairs when I was 8, so I suppose it has been a really bad quid pro quo for all the taxes I have spent. I'm glad the safety net is there though. As opposed to having to trust a health ensurer who spends a lot of time and effort finding loopholes and reasons to deny claims.

[Kaftan Barlast]

Actually, poor people get health care in the US. Hospitals and clinics cannot refuse service to anyone.

 

 

They do get a mountain of debt though.

 

 

But why did that heavy metal guy die a few years back because he couldnt afford an operation?

[taks]

Go Socialism, America ain't worth preserving as it is.

that is, without a doubt, the most ridiculous statement you've ever made. unbeleivable gall.

 

taks

[Gorgon]

You're welcome

[LadyCrimson]

Actually, poor people get health care in the US. Hospitals and clinics cannot refuse service to anyone.

 

 

They do get a mountain of debt though.

 

 

But why did that heavy metal guy die a few years back because he couldnt afford an operation?

Because actual operations are expensive, while allowing people into the office and having a doctor look at you, tap your knees and say "yes, you're sick, here's a reference for an expensive dude you can't afford." is not.

 

I believe Emergency Room check-ins can't be entirely refused, but that doesn't mean they're going to perform the major surgery when you have no insurance to pay for it.

[Rosbjerg]

What do you do in the case of a pandemic? Everyone is burried in debt (having your entire family in the hospital probably isn't cheap) or does the goverment pay in such a case?

[Asol]

Universal health care is fantasy induction, I wish the average dodo would look in the mirror and see the only 'free' health care provider anyone can give him.

[Gorgon]

I suppose that would release federal discretionary funds, like a natural disaster.

[Humodour]

Universal health care is fantasy induction, I wish the average dodo would look in the mirror and see the only 'free' health care provider anyone can give him.

 

You're right: universal healthcare is a pipe dream. Why did all those silly countries-that-aren't-America bother implementing it? The fact that's it's been working for decades now is an illusion. Soon the debt fairy will come to collect all in one lump sum!

Edited April 26, 2009 by Krezack

[Asol]

Universal health care is fantasy induction, I wish the average dodo would look in the mirror and see the only 'free' health care provider anyone can give him.

 

You're right: universal healthcare is a pipe dream. Why did all those silly countries-that-aren't-America bother implementing it? The fact that's it's been working for decades now is an illusion. Soon the debt fairy will come to collect all in one lump sum!

 

Of course you think this is untouchable. What aspect of 'working for decades' says sustainability to anyone in todays climate?

The unavoidable fact is that an ounce of prevention(responsibility) while free to begin with is worth a pound of cure. Why meet the demand for free pounds of cure except to capture the vote of the irresponsible. Another 'obama promise' to dig people out of the hole they dug themselves while piling on ever more debt.

Edited April 26, 2009 by Asol