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Old 07-30-2009, 09:36 AM   #6  
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Originally Posted by FighterHayabusa View Post
Let me first say I'm not in favor of public options expanding (since the US already has 2 public options). But I see people arguing this issues from two extreme ends when the solution lies somewhere in the middle, or arguing about the Canadian "Straw Man" single payer when it's virtually impossible for us to quarter our health care spending per capita, force single payer, and end up with that system. The only good thing coming out of this is Republicans being amenable to hyper-regulation of the health insurance market, which in concert with tort reform and shifting the actual cost of health care back to the consumer would go a long way toward fixing this system.

- "Forty-five million people in the U.S. are uninsured."
Even if this were true (many dispute it) should we risk destroying a system that works for the vast majority to help 15% of our population?

Our system would not be destroyed. This is a slippery slope fallacy. There are no bills with any chance of passing that would create Canadian single payer or British governemnt owned health care. 46% of Americans are already on a public option, and it has not destroyed the private market. Yes you have to be old or poor, but those are two examples of how you can ensure the public option doesn't kill the private insurance market. Another is buy-ups, for example public option you have to share a room, private gets you your own room. Really, all you have to do is make sure a public option sucks as much as conservatives say it will and private options will stay alive and well. There are also provisions that prohibit companies from dropping their private insurance. I don't think we need a public option, but saying it will kill private insurance is a scare tactic, not a real argument. Yes, private insurance may look different, but dead? No.

- "A universal plan will reduce the cost of health care."
Actually single payer systems do slow the RISING of costs of health care simply because it's very hard to raise people's taxes en masse to improve the system. In Canada, people are older now and there are less people paying into than taking out of it when it was first introduced. Something had to give, thus the rationing. If Canadians spent as much per capita as the US, we probably wouldn't be able to use it as the health care straw man. Take Taiwan, which much more recently introduced single payer. People were already used to paying more, so the single payer costs are higher, and it is successful. For a while a while anyway, until they need to raise taxes and/or reduce care.

The bills in congress will likely raise the cost by not really addressing the core issues of consumers not really being aware of how much their health care really costs. In a way, single payer is more free market than the system we have now since single payers are a lot more aware of their higher tax bill than we are of the nickels and dimes extra we pay for everything as businesses pass the cost of employee healthcare back to the consumer.

Canadians want better care, but they don't want to pay more for it as a group. If Canada didn't OUTLAW private insurance (the only reason there are no private insurance competitors) they'd be much better off. There are 2 Supreme Court decisions that have just overturned laws that there can be no private insurance in Canada, health care there is about to get very interesting as well.

- "Congress will be strictly neutral between the public and private plans."

Again, slippery slope fallacy. Fedex and UPS may not be able to mail a letter for 50 cents, but they can provide far better customer service, and do a better job at moving bigger packages with sweet tracking systems. This could be analogous to health care where we make sure the public option sucks so you only go on it when you have to. I never stand in line at the DMV for example, I gladly pay the extra 4 bucks at a private company to do everything I can do at the DMV with better service and no wait.

- "Decisions will still be made by doctors and patients and the system won't be politicized."
Your (his) answer assumes government ownership of hospitals. Even in Canada doctors and hospitals are still private. Single payer means exactly that, only 1 insurance company, the government. Everything else is still private, and why are we even discussing this since it's so unlikely? There are more than just the two worst industrialized nation's health care systems to compare to. Switzerland or the Netherlands or Sweden or France are far better comparisons of what the US would be likely to look like, only ours would be better because it will cost at least twice as much. It won't likely be twice as good, mind you.

I think this ignores the proverbial "Law of Unintended Consequences." A law doesn't have to specifically require something for it to happen.

Suppose I run a small business. I would like to provide health insurance to my employees. I can't afford a plan that covers chiropractic care, acupuncture, psychiatric counseling, or has a $5 prescription copayment. But I would like to offer a basic plan that covers hospitalization and regular care, and perhaps a $20 prescription copayment.

Now we have a government that will have the authority to limit out-of-pocket costs, and require certain things to be covered. Necessarily, a plan that has $5 copayments and a $100 deductible is more expensive that a plan that has $25 copayments and a $1000 deductible. If the government allows only a certain maximum out-of-pocket cost, (this is a key provision of the latest proposal) the plans that cover that will be more expensive. I may decide that I can't afford the plan with richer benefits, but the government doesn't allow me to offer a a plan that I can afford. So I drop coverage for my employees.

So much for being able to keep the plan you have if you are happy with it.

Or suppose I am young and healthy. My employer offers one plan with better benefits that costs $50 per pay period, and another one with more basic benefits that is free. I may decide the free plan is better for me. But if it doesn't cover what the government decides is a minimum level of benefits, it won't be available to me.

Maybe I'll decide to go without to save the $50 a pay period. Many of those 50 million uninsured are young people who make that decision. Or maybe the government will require me to take the more expensive plan, or to pay a penalty or tax. So much for increasing my choice and keeping costs low.

The result could be even more uninsured, and even more people in a government-run or government-sponsored pool. This is the slippery slope to a single-payer system.

Medicare/Medicaid are NOT examples of effective government-paid healthcare. Most healthcare institutions lose money on these patients (witness the fact that more and more doctors are refusing to accept Medicare and Medicaid patients). If everyone in the country was on medicare, and all hospitals and physicians were reimbursed for all patient care at Medicare rates, they'd go bankrupt. Many, many hospitals are already in dire straits precisely because medicare rates have not kept up with actual costs, and have been cut through various budget proposals and "reform" acts over the years.

More people in a "pool" that pays Medicare rates will put further strain on healthcare providers, increasing the calls for a single-payer system.

Interestingly, one of the latest "compromise" proposals would require "exchanges" to negotiate with healthcare providers (just as insurance companies currently do) rather than pay medicare rates, as earlier proposals of a "government option" were going to do. In that case, it seems they wouldn't be able to offer insurance prices any better than what an individual could get from an insurance company now. And since insurance companies would be charging higher rates to cover the higher level of benefits that the government will require, there wouldn't be much option for someone without group coverage.

Unless of course the government subsidizes the exchanges. Which runs counter to the argument that a public plan would compete on a level playing field with private insurers, and would increase the government's cost. Subsidies to a public option, which make it harder for private insurance to compete, would be another slippery slope to a single-payer system.
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