Get off of your fantasy "Planet 30-A La-La Land" and find your place amongst the real Global Village. As soon as big corporate America realizes it has to embrace Universal Healthcare in order to survive the global competition being thrust at it, the tide will turn, with or without President Hillary Clinton.
The American taxpayer and the uninsured will not be the only beneficiaries of Universal Health care. Corporations like General Motors, Boeing, Ford and Exxon that employ millions of Americans might save billions of dollars. By reducing health care costs to our businesses, we are creating excess capital, which in turn aids corporate growth and global competitiveness. GM currently spends $1,525 per car on health care costs while its Japanese rival Toyota spends only $201 — and Japan has Universal Health Care. In other words, globalization renders it impossible for American corporations to compete as long as they must pay for employee health care. Lowering health care costs would make American corporations more profitable and could save thousands of American jobs.
Providing health care as a basic service is also in line with conservative ideology concerning personal responsibility and merit. Not worrying about escalating health care costs will allow individuals to hold steady jobs and make ends meet more easily. Uninsured families would be free to engage in private enterprise without the burden of paying for health care. They might choose to spend more money on consumer goods, thereby stimulating the economy, or to save money so they can send their kids to better schools and universities, thus making our workforce more competitive.
To ease the minds of all the conservative skeptics on 30A, Universal Health Care does not mean that the American taxpayer is going to foot the bill for 100 percent of all health care costs for all Americans. That is socialized health care, which is vastly different from universal health care. Universal Health Care only means that everyone is covered. Depending on the program we put in place, the government could be paying only for those who cannot afford health insurance on their own. I am not advocating a 100 percent government controlled and managed health care plan. I believe letting insurance companies compete to provide insurance to Americans will help to lower costs. I simply oppose the denial of care to anyone born or naturalized as an American citizen.
I may live on Planet 30-A La La Land, but which planet are you living on Hnooe2000?
First, you state that corporations will be forced to stop providing health care coverage to their employees in order to remain competitive in the global marketplace. Well, this may indeed be true. Corporations today are primarily supply-chains, and most manufacturing has already moved overseas where it can be outsourced for pennies. Many service jobs, such as customer service, have also been relocated to other countries where labor is cheap and health care as we know it is practically non-existent. As outsourcing has increased, we have seen many people who worked in middle class jobs end up low end service jobs that do not provide health care. I think that is what has gotten us into the mindset that we have a health care crisis that must be fixed. While corporations (which are not large groups of people spending their working lives in one industry under a benevolent corporate statesman to benefit its customers, employees, and America, but a supply chain working to maximize returns to investors -- the notion of an American corporation is antiquated) may be able to "create excess capital," but who will that benefit besides the shareholders? I believe something like 1% of Americans own 80% of the stocks. Lowering health care costs may indeed make corporations more profitable and save American jobs, but it will do so by lowering the average American's standard of health care to that of the average Pakistani's.
You quote the cost of health care per car for a company based in America vs. one based in Japan, but this ignores the fact that the Japanese company manufactures as many cars in the U.S. as the American company. The primary difference in the cost is due to the unions that have so far managed to keep the solidly middle class compensation and benefits historically associated with auto manufacturing jobs at the American company, while the workers at the Japanese companies' plants in this country make relatively low wages, have little room for advancement, health care benefits that require a much greater level of cost sharing, and little to no job security. The American auto-working career has been replaced by a Japanese auto-working job that does not lead to a middle class lifestyle. If we rush to embrace this migration of former members of the middle class to the ranks of the working poor in order for corporations to be more profitable, I seriously doubt that the result will be that they "might choose to spend more money on consumer goods, thereby stimulating the economy, or to save money so they can send their kids to better schools and universities, thus making our workforce more competitive."
Also, you claim that Universal Health Care will "reduce health care costs to our businesses" and provide "health care as a basic service is also in line with
conservative ideology ", but then go on to state that "does not mean that the American taxpayer is going to foot the bill for 100 percent of all health care costs for all Americans. That is
socialized health care, which is vastly different from universal health care. So which is it? Are you advocating we move to single payor (government) system to enable corporations doing business in America to compete by lowering labor costs to match those in China and India? Or are you advocating that we force people to buy insurance coverage through some unfunded mandate that will ultimately not result in any fundamental change to our current health care system? I remember when the government first began to discuss mandating car insurance because it would theoretically lower insurance rates for everyone. Is there any state where the cost of car insurance went down once it was mandatory? Besides, at least driving is a privilege that can be denied...what exactly is the penalty for a person who can't afford health insurance coverage? The whole mandating coverage thing is just so ridiculous...for it to have any real impact one must believe that most of the people going without health insurance are doing so by choice because they prefer to take a gamble, they have plenty of money to cover premiums but would rather spend it on shoes and satellite radio. Sure, there are probably a few people out there like that, but those are the people who pay exorbitant rates out of pocket when they do get sick so that they don't ruin their credit. The people that burden the system are the ones that can't afford the premiums, and can't afford to pay their bills when they have to seek emergency care. Further, if we were somehow able to make an affordable health insurance available to people whose employers don't offer insurance and who cannot afford a standard individual policy, how would we prevent employers from dropping health benefits en masse and swelling the program well beyond its intended scope? People seem to be up in arms when WalMart relies on the government to subsidize its employees' health care, but the mandatory subsidized health insurance program would encourage more and more companies to do the same thing.
If Universal Health Care only means that everyone is covered, someone still has to pay for that coverage. The government already pays for coverage for people that cannot afford coverage on their own, it's called Medicaid. And even though most health care providers lose money every time they see a Medicaid patient, the program is still so expensive that every attempt to expand the program to include more of those too poor to afford health insurance fails because of concerns it will result in higher taxes. Of course, health insurance companies like Medicaid because they make loads of money by contracting to administer the program for the government. And as long as the insurance companies are administering the program for the government, they can call it Universal Health Care instead of socialized health care. Instead of forcing everyone into the single payor system, they let people migrate to it as their employers drop health benefits. Regardless of the route we take to get there, taxes will still have to be raised to pay for this new coverage or the per capita spending on health care will have to be greatly reduced and the quality of health care for every American will be lowered to achieve these cost savings.
The only reference to cost-savings I see in the above post is the suggestion that "letting insurance companies compete to provide insurance to Americans will help to lower costs." How might this work? Insurance companies are simply administrators and gamblers that attempt to guess the cost of health care (and they are very, very good at making those estimates) and then tack on a fee of 3-5% of real costs to pay for their services. Today, they compete with each other to negotiate contracts with hospitals, physicians, and other ancillary providers of health care to limit the costs their commercial customers pay and in that way do work to keep the cost of health care down (today these are all negotiated as a percentage of Medicare fee schedule). If they are no longer competing with each other for group business, they will simply be bidding against each other to administer the program for the government. The government programs already pay a set rate for programs as determined by the CMS' relative value scale based fee schedule. There really isn't much cost savings to be realized from health insurance companies competing to service a single payor that sets its own prices.
Finally, we should all think about the logical consequences which would flow from the Universal Health Care proposals. I've already touched on the way it would enable employers to divest themselves of health expenses and send most Americans into public health care. Today the average doctor has a patient mix of 10-20% Medicaid/Medicare. Physicians lose money when they see a Medicaid patient, and break even when they see a Medicare patient. Most physicians do this without too much complaint out of a sense of medical altruism. It is when that patient mix gets out of whack that you see the good physicians begin to refuse to accept Medicare or Medicaid. If we begin to drastically increase the number of Americans on Medicaid, it will impact the number and quality of physicians and hospitals. Health care decisions will be made based on cost/benefit analyses that factor in the greatest good for the greatest number. In our lifetimes, we have all seen the astounding pace of innovation in medicine. Our current system rewards new and innovative treatments with high reimbursements, and is the only system in the world that does so. Americans have effectively been paying for medical innovation for the rest of the world. If we move to a single payor system, the current standard of care becomes what is good enough for everyone and the pace of innovation will lag. Universal Health Care will not take what we have and give it to everyone for the same price through some bit of magic that will be painless to everyone.
To fix our broken health care system, we need a courageous leader who will be honest about our choices. It's not a matter of mandating coverage for everyone, it's a matter of taking on special interests and making fundamental changes to the way Americans buy health care. It's a matter of fixing some of the problems that have made many of the pigs at the trough very wealthy, and they've used that wealth to buy influence. If you want to make healthcare affordable to Americans, then make it more efficient and competitive, not less. A leader would start with a few simple changes...
- Change the tax credits to employers who offer health insurance to employees to encourage employers to offer health care spending accounts in conjunction with catastrophic health insurance. This would reintroduce the notion of paying attention to what health care actually costs and making choices based on quality, services, and cost. It would also greatly reduce administrative costs on both the provider end and the insurance end. It will ultimately have a negative impact the revenue of insurance companies, pharmaceutical companies, and some hospitals -- all of which have huge lobbying and PR budgets they'd unleash like it's 1994.
- Get rid of JCAHO -- the hospital accreditation organization that causes so much inefficiency and ridiculous privacy and staffing rules in the name of insuring quality, which it fails to do. It does make it impossible for hospitals and physician groups to be innovative, and makes start up costs prohibitively high thereby limiting competition. In lieu of JCAHO, open up the National Provider Database or enact laws that will make it possible for Health Grades or some other J.D. Powers for health care to emerge so that consumers have access to information that will make it possible to make to factor quality into health care decisions. This will be opposed by physicians, nurses, large hospital groups, and unions.
- Repeal the Privacy and Security provisions of HIPAA. Replace them with laws that prohibit insurance companies from collecting and selling data about individuals health care utilization to other companies and make it illegal to commoditize individuals' medical records. This will decrease administrative and software costs for providers greatly, resulting in increased competition. It will also give Americans real security and privacy with regards to their medical history. This will be opposed by large hospital groups, health care administrators, medical software companies, insurance companies, and anyone who believes the Privacy and Security provisions of HIPAA have anything to do with privacy or security.
These things would address the costs of health care in a way that would improve the quality. It would go a long way toward putting health care within reach of almost all Americans. Unfortunately, most Americans don't have the attention span to read this post, let alone listen to a politician explain all of this and understand it enough to not be swayed by the barrage of negative PR the various groups who'd be opposed to the proposals would let loose. That is why we end up with solutions that can be explained in a sound bite, backed by inaccurate and contradictory talking points.
Lest I be accused of being a conservative skeptic, let me state clearly that I am a flaming Liberal. I, too, oppose the denial of care to anyone born or naturalized as an American citizen. I even oppose the denial of care to illegal immigrants who have an urgent need. Mercifully, I've never seen anyone denied care in all my years of working in health care based on their ability to pay. Not ever. I've found that the vast, overwhelming majority of people working in health care will find a way to help people in need. Besides, it is illegal for a health care provider to deny care in an emergent situation and opens the provider up to all kinds of lawsuits. The only reason care can be denied is if the physician is absolutely sure the patient is drug-seeking.
What can happen is that a person will receive the care they need, be unable to pay, and find their credit destroyed and never financially recover. That is an issue no one will address. A file at Equifax can be bought and sold and impact every aspect of a person's life -- the government can even use it to target surveillance -- and yet it is completely unregulated. Why does no one even talk about the huge numbers of Americans unfairly or inhumanely saddled with bad credit and the discrimination they face? Why not address the way medical debts are calculated (a bill an uninsured patient would receive from a hospital would be about four times the amount and insurance company would pay) and how much/how long they impact a credit score.
