Health Care: The Reality

[R. Richard]

There have been a lot of opinions expressed. Here's the reality, admittedly from a right wing web site. However, the items in the articles offer names, dates and numbers. If the data is wrong, cite the correct data, with sources. Let's not have a flame war, just a rational discussion.

Debt, Legal Problems Plague Obama-Touted Healthcare Reforms in Mass., Tenn.

Wednesday, August 19, 2009 1:14 PM

If you're curious what life would be like under Obamacare, experts suggest that you consider reforms instituted in Massachusetts and Tennessee that have left Massachusetts residents deeply dissatisfied and threatened to bankrupt the Volunteer State.

It's hard to imagine two more divergent testing grounds for government-subsidized healthcare reform: Massachusetts, a northeast corridor commonwealth with the fourth-highest per-capita income in the nation, and Tennessee, a proud Southern state with the nation's 36th-highest per-capita income.

For both, however, the push for universal coverage followed a familiar pattern: noble goals and initial optimism, followed by mounting bills and legal problems, and finally, a disenchanted electorate wondering if the whole enterprise was ill-conceived from the very start.

"As soon as I heard about this public option, I thought, 'I know how this works,'" said GOP Tennessee Rep. Phil Roe, a physician who has labored under that program. Roe recently told The Wall Street Journal he's been warning congressional colleagues to stay away from public-option healthcare reform "until I'm hoarse."

Initially, the TennCare public insurance system in the Volunteer State got rave reviews. It planned to cover all uninsured, essentially by expanding Medicaid coverage to all those who presented a letter showing a private insurer had rejected them. It spent its initial budget of $2.6 billion signing up half-a-million uninsured people. In some ways, it seemed a model program. The Wall Street Journal has reported it had "the lowest per capita cost of any Medicaid program in the country." And it covered the additional cost by squeezing savings out of the inefficient healthcare infrastructure, just as President Obama has promised to do.

But the ranks of uninsured just kept coming, as did the medical bills. Soon, it had enrolled 1.4 million.

By 2000 annual costs had skyrocketed to $5.4 billion. By 2004, they reached $8.5 billion — and the state's solvency was in serious jeopardy.

In 2005, state officials had no choice: They took a scalpel to the program and enacted major cuts and changes to keep the state budget from going into cardiac arrest. Tennessee is no longer a model of universal care, but it's able to balance its budget.

In the case of Massachusetts, the financial complications stemming from the healthcare reform law former GOP Gov. Mitt Romney pushed through are just beginning to emerge. During the last presidential primary season, Romney presented his healthcare measure, which provides subsidized coverage and mandates that all adults purchase healthcare insurance, as the perfect prescription to cure what ails the nation's healthcare system.

At first, it was immensely popular. A poll by the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, conducted in July 2008, showed that 69 percent of Massachusetts residents supported the reform.

That popularity would fade quickly, however. In fact, about one year later, a Rasmussen Reports survey indicated that only 26 percent of Massachusetts voters thought the state's healthcare reform was a success. Thirty-seven percent labeled it a failure. Only 21 percent thought it had made healthcare more affordable, and just 10 percent felt healthcare quality had improved, compared with 29 percent who complained it had gotten worse.

The frustrations that led to that quick about-face in public opinion are manifold. Although Massachusetts succeeded in covering close to half a million previously uninsured individuals, it paid for it by shunting state payments away from hospitals, which were left to struggle with high treatment costs.

Boston Medical Center has slapped a lawsuit against the state, trying to get it to pay up. And once again, the bottom line in healthcare reform has become the bottom line: Who will pay for it?

Whether Massachusetts can correct a reform that appears to have gone awry remains to be seen. But the specter of costs ballooning to the point that tax hikes and greater subsidies become inevitable has been one of the concerns protesters have voiced as they descended on town hall meetings around the country.

The cost of trying to insure everyone has affected other states, too. Long-term concern about red ink was one reason California legislators, struggling with massive financial problems, rejected compromise legislation that GOP Gov. Arnold Schwarzenegger supported last year. It would have provided for near universal coverage but did not reach the full state senate.

Similarly, in New Mexico, Democratic Gov. Bill Richardson's plan for universal healthcare coverage failed in 2008.

Among the other major healthcare reforms under way on the state level, as reported by the Kaiser Family Foundation:

Oregon — In June, legislation was passed expanding healthcare coverage to children and some low-income adults. The measures will add 80,000 children and 50,000 adults to the state's insurance plan.

Minnesota — GOP Gov. Tim Pawlenty signed legislation in May 2008 that broadens healthcare coverage by expanding eligibility for adults, reduces premiums for the state MinnesotaCare plan, and encourages all employers with 11 or more full-time employees to offer insurance.

Wisconsin — Launched Badgercare Plus in February 2008, which the Kaiser Family Foundation said aims to "provide universal healthcare coverage for children and expand coverage to adults below 200 percent of the federal poverty level." Over 130,000 new members have been enrolled.

New Jersey — In July 2008, Democratic Gov. Jon Corzine signed into law a reform bill intended to be a first step toward universal healthcare coverage for the state's 1.25 million uninsured — about a quarter-million of whom are children. It required all children to have private or public coverage within one year.

Vermont – In May 2006, GOP Gov. Jim Douglas signed the 2006 Health Care Affordability Act. It provides financial assistance with premiums for individuals and families. Individuals with incomes below 200 percent of the poverty level pay $60 per month.

Of course, advocates of the public-option simply point to the difficulties the states have encountered as evidence that it's time for a bigger player — the federal government — to step in to bring private markets under control.

Those who have experienced healthcare reform on the state level, such as GOP Rep. Marsha Blackburn, R-Tenn., aren't buying it, however.

"The promise of TennCare has gone unrealized," she wrote in July correspondence to her fellow members of Congress intended to serve as a cautionary tale. "Many of the concerns we have expressed about the proposal before us today are the stark realities of a system that went terribly wrong in Tennessee."

 

[xssve]

I'm not sur ewhat kind or rational discussion is going to result from an article that call's it "Obamacare", but here goes.

I agree it's a can of worms - private health care is often inconsistent and inadequate, otherwise there would not be so many lawsuits, and making it public is only going to exacerbate the problems if it isn't a market based solution that at least promises to resolve the worst problems over time (theoretically), and either way, they both cost money - a lot of it.

What with something like 300 lobbyists for every congressman, I predict an ungainly, and probably ultimately unworkable system that will start as a giveaway to the Pharmaceutical industry and end in financial fiasco.

It's not the government that will fuck it up, it's the private sector - HMO managed Medicare worked mostly perfectly until Bush cut payments, now it basically useless since almost no doctors will take Medicare patients anymore, and the ones that do tend to be medi-mills, or offer limited, and often difficult to obtain services - there's a six month waiting list at the PMS dental clinic here for example, the only dental clinic that still accepts Medicaid.

Personally, my basic concerns at this point are regular checkups and dental care for the kids which besides being the right thing to do, happen to be mandated by law, emergency services in case of accident, and care for my older son's chronic conditions.

I myself require a little dental work, and the occasional antibiotic treatment (I recently contracted MRSA, treated successfully by a Nurse practitioner for around a hundred bucks), and I could use some dental work - I could probably use regular checkups, cancer screening etc., as I'm getting to be around that age, but the the truth is I don't go to the doctor unless I think it might be potentially fatal not to.

And, I think this is probably what most people need, even the ones that can afford health insurance, the ones who can't afford health insurance probably can't afford to to pay out of pocket - having a boil lanced in an outpatient procedure a few years ago ran me about Four Hundred dollars, an emergency room visit, is a minimum of around $500 if you drive yourself in - that's more than half a months wages for a person working for minimum wage.

Chronic conditions and accidents are what tend to drive prices up, the former being ongoing conditions requiring repeated visits, the latter requiring premium emergency services.

Again, personally, and from anecdotal evidence, a lot of people are currently electing to engage in medical tourism rather than pay for American health care - it's still expensive, what with travel costs, but most of the time, still cheaper than having anything done here.

That's called globalization.

 

[R. Richard]

Congrats XSSVE! You just pointed out the first major reason why universal health insurance won't work. The reason is pent up demand. There are a lot of people, like yourself, who need and want certain health care services. However, they can't really afford to pay for the needed services, except when it becomes a matter of near life and death. All of a sudden, everybody has health insurance and they flock to the doctor, dentist, eye care, etc to get the long standing problems taken care of. It's a tsunami of demand and the lines are out the door and around the block.

= MELTDOWN!

 

[TE999]

Congrats XSSVE! You just pointed out the first major reason why universal health insurance won't work. The reason is pent up demand. There are a lot of people, like yourself, who need and want certain health care services. However, they can't really afford to pay for the needed services, except when it becomes a matter of near life and death. All of a sudden, everybody has health insurance and they flock to the doctor, dentist, eye care, etc to get the long standing problems taken care of. It's a tsunami of demand and the lines are out the door and around the block.

= MELTDOWN!

It all comes down to one salient point: Who will pay for all this medical largesse?

The Rich? I don't think so. They didn't become rich by being stupid. Assets and earnings will disappear like rabbits down a hole. BTW, anyone who makes over $250,000.00 a year is 'rich' according to the government. We all can't be trust fund babies.

The Middle Class? Most probably. Not at first of course, but as things really get rolling and funding shortfalls arise, guess who gets the bill? The Middle class is also the most probable to opt out of private health care (if possible), because the government plan is cheaper. That's more spendable income for TV's, cars, season tickets for football, eating out more often, etc. Once again, taking money from the right hand and putting it in the left hand.

The Poor? What do you think?

There's an old expression to the effect that 'money talks and bullshit walks'. Right now we're getting bullshit on this health care reform...the money part comes later when it says 'goodbye' as it leaves your paycheck to solve someone elses problems.

The last government program, the so-called 'War on Poverty', that was passed by both Houses in a burst of feelgoodisim and our presumed moral obligation to help the less fortunate, didn't do diddley squat except put a whole bunch more people on welfare and into soviet-style housing projects. We lost that war, big time.

You'd think Washington would learn from it's mistakes instead of perpetuating them.

 

[Handley_Page]

Universal Health Care can and does work.
It's paid for by a small tax (or tax credit).
Provided there's a willingness to do it: And no lobbying by BigBucks Buisiness and self-interest groups.

 

[R. Richard]

Universal Health Care can and does work.
It's paid for by a small tax (or tax credit).
Provided there's a willingness to do it: And no lobbying by BigBucks Buisiness and self-interest groups.

It didn't work in Massachusetts or in Tennessee. The reasons include things like pent up demand and the usual government incompetence.

Whatever is delivered to everyone has to be paid for. If the average health care user spends $1,000, then the average health care user pays $1,000. Now then, who pays the costs? The rich have tax accountants who can find the holes in the IRS code that the same tax accountants helped write. The poor can't pay very much, because they don't have very much. Who's left? You guessed it, the middle class. Every time the government comes up with a spending plan, the middle class pays for it. The middle class is really the only place where the money can come from.

There'll always be lobbying by self-interest groups, that's what lobbiests are for.

BigBucks Business? Large businesses mostly self insure. They aren't really part of the scheme. Small and medium business? That's where the jobs are created and the fact that they can't afford it is mainly why their employees don't have it now.

Every time the government tries to 'help the poor,'by raising the minimum wage, all they do is cost the poor jobs and give union employees a pay raise, since union contracts are generally based on the prevailing minimum wage, but higher. Union employees vote, the poor often don't.

 

[Handley_Page]

Pent-up demand caused a few problems at first in the UK, but they got over it.
In trying to start one now, I think the ideal is to introduce it gradually. The Tax (aka Insurance Contribution) would start immediately and not be subject to loopholes. As the Fund gets bigger, more folk from the bottom of the pile (the needy) are introduced.