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Yeah but when you tell the public universal healthcare will entail a 10% tax hike, they will tell you to go jump off a cliff.
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I actually think it's a good idea to have a private health insurance system as a backup or supplemental. In this case, I would expect the cost of private health insurance to go down substantially because they would no longer need to cover things like chemotherapy, which would be covered by the public system. If Canada is a guide, private health insurance would cover things like semi-private or private hospital rooms for example. In Spain, private health insurance covers some minor care so that the patient can see a physician more quickly. Also, things like extra vision or dental coverage might be covered with private health insurance. I could not see anyone spending money on something like major medical coverage if the government is going to pay for that care and health insurance companies certainly won't.
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I agree; it shouldn't be a prerequisite. I would advocate that physicians should be allowed to continue taking private health insurance and/or cash. This would enable some physicians to perhaps make a lot of money serving these niche markets and provide at least a small amount of competitive pressure on the public system.
The UK does have a lousy healthcare system. However, have you checked with the Danes? What about the Dutch (are you dutch)? What about the Austrians. I have an uncle/aunt/cousins/nephews who are Austrians and they never complain about their healthcare system. If they have a problem, they get the care that they need. No issues to report. If anything, they get more care and pay more for it. Their doctors appear to be excellent: http://www.nashvillechamber.com/business/international/trademission06/polish-austrian.pdf
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Yes, true, which is why politicians would never state a 10% tax hike for universal healthcare.
But don't worry, politicians are very good at wording things so that they pass muster with the public. That's part of their job: wordsmithing. I have full confidence that they can pull this off with 75% of the public wanting universal healthcare. Politicians will come up with a "payment plan." I'm not a politician, but I've heard that Edwards is proposing "rolling back Republican tax cuts on people with income over $200K." This is the kind of funding statement you're going to get. Maybe employers will get a 5% health insurance tax added to their payroll. I'm not sure. Let's see what Hillary and friends tell us about funding. Looks like Hillary will just call it "health insurance" and the tax might just be called a "health insurance premium" rather than a tax. Let's see.
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I was saying malpractice insurance will not go down if we maintain the same tort system universal healthcare or no universal healthcare. Even the extremists calling for socialized healthcare are still wanting to maintain the same tort system that leaves doctors hanging high and dry with rising malpractice premiums.
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Oops sorry. That seems to be a separate issue. Here is some information about that. I don't see that politicians are linking medical malpractice reform to universal healthcare.
Here is a little info (maybe you already knew this stuff):
http://www.ncsl.org/standcomm/sclaw/medmaloverview.htm
premium rates. States are also looking at litigation alternatives such as the "Sorry Works" program. As of May 1, 36 states are considering medical malpractice legislation in some form, and nine states have enacted bills this year. Please see this list for details.
Thirteen states are noted to carry over legislation from 2005 as part of their 2-year sessions or to reintroduce various bills. New legislation has been located in some of these. Six states - Arkansas, Montana, Nevada, North Dakota, Oregon and Texas - conduct biennial sessions which are not scheduled to convene in 2006.
2006 Federal Activity
President Bush reiterated a call for Congressional action on medical liability reform, as he has done multiple times, in his 2006 State of the Union address. The U.S. House has not considered any new legislation beyond the bills it passed in 2005, most notably HR 5. The U.S. Senate has planned a "Health Care Week" at the beginning of May 2006, which will include consideration of Senate Bills 22 and 23. Senate Bill 22 contains the provisions listed above; Senate Bill 23 is focused primarily on obstetrics.
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Yes I am dutch, and doctors actually get payed well there. That is why the german doctors are trooping to the Netherlands like crazy. Holland and the U.K decided to start paying doctors very well because their economies was discouraging the bright students from going into medicine due to low pay and better alternatives. One thing that gives me concern though is: Healthcare systems aside, people in Europe seem to be healthier than Americans by default as someone pointed out. With a universal healthcare system, we might just be picking up the tab of an unhealthy society. In a sense, bighting off more than we can chew.
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The poor health of Americans also concerns me a great deal. Add an aging population and you have the "perfect storm." Keep in mind that just because we have a "sicker" population doesn't mean that we currently do deliver or will deliver more care. Obese people will just live lives that are shorter and of poor quality (unless eating a cheeseburger and fries somehow makes up for being able to walk up the stairs @ age 65 -- I don't think so). We are not giving them more care as far as the stats show (more money just appears to be wasted):
One bright spot: American men are smoking less than other world citizens (thanks to in part to anti-smoking campaigns. Maybe anti-obesity campaigns will have a similar effect?? I hope so.):
http://www.who.int/tobacco/en/atlas5.pdf
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The poor health of Americans also concerns me a great deal. Add an aging population and you have the "perfect storm." Keep in mind that just because we have a "sicker" population doesn't mean that we currently or will deliver more care. Obese people will just live lives that are shorter and of poor quality (unless eating a cheeseburger and fries somehow makes up for being able to walk up the stairs @ age 65 -- I don't think so). We are not giving them more care as far as the stats show (more money just appears to be wasted):
Yeah but in a Universal system, they will demand for more care. America cannot stomach the idea of ignoring treatment for the old(well practiced in europe). These old people account for the bulk of healthcare expenditure. The older they get the more sick they are, and the more expensive it gets. Americans will still want to carry on treating old folks(rightfully so). so don't expect the expenditure to come crashing down. My guess is that it will fly out of orbit.
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Have you visited a nursing home recently? You know, one where the smell of urine overpowers you when you walk in the door? I'm also a hospice volunteer and I get to see the living conditions of our elderly who have a lot of money and those who do not. The European families I know would never tolerate having their parents in some of the conditions I see, but most of the Europeans I know are are a bit old-fashioned and traditional. Europe is changing a lot and so is the U.S. Sadly, many Americans do neglect their elderly right now (few visit them; even fewer pay for their care). I know elderly patients who live at home and cannot get to the pharmacy to pick up their medications because no one will drive them. It is so sad. Many people do volunteer, but the needs exceed the number of volunteers and family members willing to help the elderly. I hope that under universal care that healthcare for elderly will improve, but I'm not expecting that. My expectation under universal healthcare is that people who work full-time to support their families will now be able to afford healthcare as needed, even if their employer cannot offer health insurance. I do not expect any improvement in care for the poor & elderly who are already covered by Medicaid or Medicare and are technically already insured.
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It couldn't be any more well said. Thanx for sharing Def Jeff.
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I assume you mean in my direct costs (as opposed to reduced wages due to employer taxes). About $12K/year, which is about what my family's healthcare costs right now in insurance & out-of-pocket (including dental). We are hoping next year that our insurance costs will improve (more employer paid) so that they will go down to the $6K/yr range (maybe $8K/yr is more realisitic). Keep in mind that it goes up about $1-$2K per year. It's those increases that are the killer. My guess is that under universal health care, they would be around $10K/yr for a family (similar to an insurance premium), but that's my best estimate based on the idea that the cost would be controlled with a single-payer system. Thankfully we don't have anyone seriously ill in our family, in which case current costs might be closer to $20K-$30K/yr, but still only $10K/yr in a single payer system per my estimate.
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I doubt people with lower incomes will have to pay 10s of thousands, but the middle class could really get screwed. Health care costs shouldn't be more than 5-10K for a middle class household... Obviously a rich (>400K) household could afford 30-50K insurance, but even that is almost unpalatable.
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Hmm thewebthsp ... you changed your numbers (above is your Revision "A"). I understand; this can get tricky.
In any case, it would be higher for the rich and less for the poor (based on income). Middle class cost $10K-$15K in direct "premium-like" costs (i.e., in addition to the $10K-$15K that employers pay per year for an employee+family) is in line with my expectations for a family. If you based it on a family of 4, the government would have about $24K / 4 = $6K/person/year to work with on average (about $1.8 trillion nationwide based on 300 million people). If they don't need that much -- great!!
Looks like projections are for this to double over the next ten years or so unless something drastic changes (like single payer, perhaps).
My numbers are in line with what I'm seeing quoted on a national scale (note that the numbers below are old and are higher now):
http://www.nchc.org/facts/cost.shtml
In 2004 (the latest year data are available), total national health expenditures rose 7.9 percent -- over three times the rate of inflation (1). Total spending was $1.9 TRILLION in 2004, or $6,280 per person (1). Total health care spending represented 16 percent of the gross domestic product (GDP).
U.S. health care spending is expected to increase at similar levels for the next decade reaching $4 TRILLION in 2015, or 20 percent of GDP (2).
In 2006, employer health insurance premiums increased by 7.7 percent - two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $11,500. The annual premium for single coverage averaged over $4,200 (3).
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Initially they are expected to increase (as in Canada's case by ~35% -- might vary some by province). However, it seems that over time, the tend to not increase as rapidly, which is why physician salaries in countries with universal care might have lower wages than they do in the U.S. (I'm unsure about the long-term part -- maybe someone has data to show this).
http://www.pnhp.org/facts/singlepayer_faq.php?page=2
What will happen to physician incomes?
On the basis of the Canadian experience, average physician incomes should change little. However, the income disparity between specialties is likely to shrink.
The drop in income that a physician might experience under a single-payer system could be mitigated by a drastic reduction in office overhead and malpractice costs. Billing would involve imprinting the patient's national health program card on a charge slip, checking a box to indicate the complexity of the procedure or service, and sending the slip (or a computer record) to the physician-payment board. This simplification of billing would save thousands of dollars per practitioner in annual office expenses.
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Interesting factoid:
Percentage of people going without needed health care due to costs:
Country____All adults____"Poor" Adults
======================================
US____________40%___________57%
New Zealand___34%____________44%
Austria________29%____________35%
Canada________17%____________26%
UK_____________9%____________12%
Source: Commonwealth Fund (2004)
Based on this information, I'm under the impression that we might be in for a real "shocker" (huge demand) if/when healthcare becomes universal in the U.S. However, this is apparently not what has happened when other countries switched to a universal healthcare system. From the experiences of other countries, there was not a huge spike in wait times initially. I'm still trying to understand why a big spike in demand didn't occur in those other countries....
This backlog in needed healthcare could overwhelm the U.S. system when we switch to universal healthcare (a 1/0.6 - ~1.2 = ~50% increase in number of adults people wanting services in the U.S. if the latent demand due to cost issue is brought down to that of other universal healthcare countries). I guess if the increase happened gradually for whatever reason, it might be ok. I'm still learning about the predictions on this issue.
Percentage of people going without needed health care due to costs:
Country____All adults____"Poor" Adults
======================================
US____________40%___________57%
New Zealand___34%____________44%
Austria________29%____________35%
Canada________17%____________26%
UK_____________9%____________12%
Source: Commonwealth Fund (2004)
Based on this information, I'm under the impression that we might be in for a real "shocker" (huge demand) if/when healthcare becomes universal in the U.S. However, this is apparently not what has happened when other countries switched to a universal healthcare system. From the experiences of other countries, there was not a huge spike in wait times initially. I'm still trying to understand why a big spike in demand didn't occur in those other countries....
This backlog in needed healthcare could overwhelm the U.S. system when we switch to universal healthcare (a 1/0.6 - ~1.2 = ~50% increase in number of adults people wanting services in the U.S. if the latent demand due to cost issue is brought down to that of other universal healthcare countries). I guess if the increase happened gradually for whatever reason, it might be ok. I'm still learning about the predictions on this issue.
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Yes, in time they surely will. And presidents will seek to cut the budget as much as they can so they can realign money towards projects that will pay their friends and friend's companies. Talk about theft.
Private insurance, as much maligned as it is, is still the way to go. If doctors can get on the bandwagon for negotiation associations then we will be set.
Hell, I'd found the national physician association (NPA). Our sole mission is to negotiate fair reimbursement and secure adequate time per patient to protect the high quality of patient care. Now who here is good at negotiating? We need good representatives
.From ncpa.org:
"Prior to the advent of Medicare and Medicaid in 1965, health care spending never exceeded 6 percent of gross domestic product. Today it is 14 percent. These two government programs unleashed a torrent of new spending and led to rising health care prices. See Figure 1 Even the federal government estimates that each additional $1 of Medicare spending yields only 35 cents worth of additional care. The other 65 cents buys higher prices. The private sector shift to more third-party payment has exacerbated this trend."
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Yes, in time they surely will. And presidents will seek to cut the budget as much as they can so they can realign money towards projects that will pay their friends and friend's companies. Talk about theft.
Private insurance, as much maligned as it is, is still the way to go. If doctors can get on the bandwagon for negotiation associations then we will be set.
Hell, I'd found the national physician association (NPA). Our sole mission is to negotiate fair reimbursement and secure adequate time per patient to protect the high quality of patient care. Now who here is good at negotiating? We need good representatives
There may be some "issues" with your approach:
http://www.atg.wa.gov/pressrelease.aspx?&id=5122
FOR IMMEDIATE RELEASE
September 24, 2003 backYakima Physicians Barred from Jointly Negotiating Reimbursement Rates
OLYMPIA -- The Attorney General's Office and the Federal Trade Commission (FTC) have filed consent orders that will change the way some Yakima physicians negotiate with private insurance plans over reimbursement rates for physician services.
The settlement is with a physicians' group called Surgical Specialists of Yakima (SSY), which has approximately 24 physician members, including nine of the 11 general surgeons in the greater Yakima area.
A local complaint about the physicians' business practices was brought to the attention of federal and state authorities, who commenced investigations.
The investigation resulted in a consent order the Attorney General's Office filed today in U.S. District Court in Yakima naming SSY and two member groups of Yakima surgeons. The consent order will need to be reviewed and approved by a judge before becoming final.
A similar proposed consent order has been filed with the FTC by commission staff.
The investigation led by the FTC and joined by the Attorney General's Office concluded that the physicians' method of negotiating reimbursement rates violated state and federal antitrust laws by restraining competition, increasing the price of physician services and depriving health plans, employers and individual consumers of the benefits of competition among physicians.
"The practice of medicine is a noble calling, and it is a business," Attorney General Christine Gregoire said. "We have joined the FTC in taking this action to ensure that people who need to pay for the services of a physician continue to benefit from competition among the doctors who can provide those services." According to a complaint filed with the state's consent order, Yakima physicians founded SSY in 1996 in an attempt to prevent health plans from decreasing reimbursement rates to physicians.
State and federal officials maintain that the practice constituted anticompetitive conduct in violation of antitrust laws because the physicians were still competitors when they were jointly negotiating rates. In addition, SSY included Cascade Surgical Partners and Yakima Surgical Associates, two general-surgery practices that had nine of the Yakima area's 11 general surgeons. The two surgeons' groups are named with SSY as defendants in the case.
The state and federal consent orders bar the defendants from joining to negotiate reimbursement rates, or refusing to deal with insurance plans based on reimbursements paid to other physicians. SSY will have to divest itself of one of the two general surgery practices in order to reduce its market power in the Yakima area.
The orders also require the defendants to notify insurance plans of the orders, and to terminate without penalty the existing contracts with any plans that make such a request.
In addition to the antitrust actions by the FTC and the state, two private lawsuits have also been filed in Yakima County as a result of alleged conduct by SSY.
A class action suit alleging price fixing by SSY sought damages on behalf of individuals and businesses that directly paid SSY for services provided by the physicians. SSY has also been sued by a Yakima physician who claims SSY retaliated against him after he left the group.
Some physicians indicated that negotiating rates through SSY was necessitated because of a concern that low Medicare and Medicaid reimbursement rates would make it impossible to recruit and maintain skilled doctors in the area.
"I too am concerned about the level of Medicare and Medicaid rates, but that is not a legal justification to engage in these business practices," Gregoire said. "The solution is to get Congress to fix the federal programs."
************************
Here are some approaches that actually do seem to work (acting as a single practice):
http://www.aafp.org/fpm/20041000/31cany.html
* Negotiate individual fees. Unless you dominate your market, payers are unlikely to grant sweeping fee increases. However, you may be able to negotiate increases for individual services if you can demonstrate inequities using your data analysis ....
* Drop the plan. If a health plan's payment levels are extremely low, you may be tempted to bypass negotiations and simply no longer accept patients from that plan. Whether this is a sound strategy depends on your local market. ... Whatever your situation, don't threaten to drop out of a plan unless you intend to follow through. Most plans will call your bluff.
* Close to new patients. While you may not want to drop a health plan completely, you may wish to stop accepting new patients covered by the plan. Over time, your number of patients covered by the plan will decrease as they switch to different plans or leave the practice and are replaced by new patients with better reimbursement.
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Yeah I've seen the FTC actions. The problem is the monopolies or duopolies the insurance companies have. This isn't fair because the insurance companies get to eat up so much market share, but the physicians aren't. Only workaround is national associations which heavily lobby congress and also do group negotiations. There are other creative (legal) ways around the FTCs attempted restrictions (like publishing of "guidelines" for its members -- even if they don't have to follow them). These groups may wholly go cash only also.
These associations also collect dues which can go towards IT investment, reduction in overhead, etc. So there's a case to be made against government splitting them up.
These associations also collect dues which can go towards IT investment, reduction in overhead, etc. So there's a case to be made against government splitting them up.
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Part of it is just having sound antitrust legal advice. As long as the legal advice is followed, there shouldn't be such problems. Guidelines could be a huge problem.
Here is an example from a related industry (pharmacies):
http://findarticles.com/p/articles/mi_m3374/is_n7_v16/ai_15354613
...As a result, chain drug leaders agreed to a series of compromises in the structure and operation of PDN. To begin with, the network will be organized as a separate corporation, independent from NACDS and responsible to its own board of directors.
...Among other things, the PDN board will be barred from contract negotiations with third-party prescription plan sponsors. To avoid antitrust exposure, these responsibilities will be left to PDN staff employees.
...Additionally, the directors of the network will be limited in their ability to share information concerning the terms and conditions with prescription drug insurers and payors.
...Similarly the participation PDN pharmacies will be insulated from potential antitrust problems by the unusual organizational structure of the new company - a "for--profit, non-stock corporation with no owners.
...Antitrust considerations also prompted the framers of PDN to require participating member pharmacies to accept all contract terms negotiated by network staffers, sight unseen.
...Members of the network "cannot opt in and out of contracts and must accept all contracts executed by PDN," NACDS explained. "To remain competitive while avoiding antitrust concerns, PDN will not consult member pharmacies prior to preparing a response or executing a contract with a plan sponsor."
(Extremely complicated)
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Be carefull using information provided by common wealth sources. Don't you know since we chased the British out of hear they have been determined to discredit our system? while glorifying every common wealth system.
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Good luck convincing Americans to join your quest to pay 12K/yr extra in taxes. Remember paying taxes is not a choice it's an order.
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Yeah, I was concerned about the source -- it makes the Brits look good
. However, there is no better source for this information that I'm aware of (if you know of one, please share it). Even if the numbers are bit off, the bottom line is there are a lot of people not getting treatment or delaying it in the U.S. due to cost. These might be minor concerns (cyst removal, etc.). I'll try to learn more about this and will pass along what I learn.
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I'm simply saying that instead of paying Blue Cross Blue Shield or UnitedHealthCare, pay that to the gov't. It isn't going to cost more. The total amount needed to pay for healthcare isn't expected to change -- just the way the money is collected and distributed. The amount paid would vary with income. Small wage earners would have a small deduction. Large wage earners would have a large deduction. A lot of this would probably happen on the employer side of the paycheck, so the average American would not see any difference in his or her paycheck unless they don't have health insurance (it would just change where the money is going).
Americans know that they would pay for healthcare with their taxes. When asked whether they would support universal healthcare even if it raised their taxes, something like 75% said yes in polls. Seems like it isn't going to be that hard to convince Americans because they are already convinced that it is a good idea. The challenge will be more on the political maneuvering to get it implemented and then in the actual implementation itself.
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It changes big time. Research, new technology infalation etc will force the costs up. That is why socialized systems are going bankrupt, because you only have a fixed source of funds while your costs are rising. Why do you think some of those countries have one MRI machine per city. You cannot go back and ask people to pay more taxes either. I think some italian lawmakers recently suggested making people pay some extra money out of pocket for some hospital visits. Basically heading back towards what private insurances do. Another thing they do is to outright cut down the number of hospitals available. Either way the management of any single payer system is tricky beacause you have inevitable rising costs with limited funds.
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You know what, though? I'm not surprised to hear that (the liberal, almost communist environment). And as far as raising my voice, I agree that it is not within a student's place to do that. But med students will be attendings one day, and these are issues that we will have to tackle when the time comes.
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That is funny because I read this
http://www.csmonitor.com/2004/0520/p06s01-woeu.html
"France is not alone in finding it increasingly hard to fund cradle-to-grave welfare systems. Across Europe, aging populations and ever more expensive medical treatments are busting budgets. The German government recently scandalized voters by introducing small charges for doctor visits and medicines"
"The minister unveiled his plans Monday, estimating that the nation could save $18 billion a year: Reforms included computerizing patient records, encouraging patients to visit their family doctors before going to expensive specialists, boosting the use of cheaper generic drugs, and making patients pay a nominal $1.19 charge for each visit to a doctor."
Copay for Universal healthcare? WTF? I think universal healthcare will be like any other government program. Starts of good, but will ultimately leave a burden for later generations.
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http://www.theadvocates.org/freeman/8903lemi.html
Don't know if it has been posted before but really good synopsis of the defficiencies in the Canadian system.
Here's one of the many good quotes:
"When prices are zero, demand exceeds supply, and queues form. For many Canadians, hospital emergency rooms have become their primary doctor -- as is the case with Medicaid patients in the United States. Patients lie in temporary beds in emergency rooms, sometimes for days. At Sainte-Justine Hospital, a major Montreal pediatric hospital, children often wait many hours before they can see a doctor. Surgery candidates face long waiting lists -- it can take six months to have a cataract removed. Heart surgeons report patients dying on their waiting lists. But then, it's free."
Don't know if it has been posted before but really good synopsis of the defficiencies in the Canadian system.
Here's one of the many good quotes:
"When prices are zero, demand exceeds supply, and queues form. For many Canadians, hospital emergency rooms have become their primary doctor -- as is the case with Medicaid patients in the United States. Patients lie in temporary beds in emergency rooms, sometimes for days. At Sainte-Justine Hospital, a major Montreal pediatric hospital, children often wait many hours before they can see a doctor. Surgery candidates face long waiting lists -- it can take six months to have a cataract removed. Heart surgeons report patients dying on their waiting lists. But then, it's free."
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I actually agree that we should have private health insurance available as a supplemental and backup and still maintain a private healthcare system even with a single-payer system that that provides comprehensive coverage. The reason I'm in favor of maintaining private health insurance as a backup is that if the government does under-fund the healthcare system, there is something that people can do -- purchase additional insurance themselves.
As I have mentioned before, I view this similarly to public education. I believe that just as the government should provide public education, it should provide public financing of healthcare. Private schools and the option of homeschooling should still exist for those that do not want to send their children to the public schools for any number of reasons, for quality to personal reasons. However, most people use the public schools and we would have a less educated public without the availability of public education. Also, the limited private sector could provide innovations that could be copied into the single-payer system.
As we know to well, there is never enough money for public schools. They could always use more. Some people want to eliminate public schools altogether and only have private schools that everyone must pay for. I don't think this is the right approach anymore than I think our current approach to healthcare is the right approach. There is a process for deciding how the taxes will be spent on education, and a similar approach could be used for healthcare.
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(The web address of the above is ... http://www.ncpa.org/pub/ba/ba572/)
The main problem with the above opinion piece is that it gives no sources or studies of any kind. It's like an infomercial where we are supposed to take the author's word. While interesting, it provides inaccurate information.
Keep in mind that 1965 was before a lot of civil rights where implemented and before many modern treatments (such as treatments for cancer) were available. I was born in the 1960s -- into a "whites only" hospital. It was a different time, a different era. I asked my mother whether there were any black people at my hospital. She said ... now that you mention it ... there were not. I asked here where black people went to get their health care. She said she didn't know, but it wasn't at that hospital. There were many things going on then that are considered illegal and immoral today (such as racial discrimination). What I'm telling you is that you can't blindly base healthcare in 2007 on practices of the 1960s. The argument could be made that minorities such as blacks and latinos (and poor whites for that matter) were not give proper access to healthcare in the 1960s. Once such access was provided, the cost of care went way up over time. It didn't go up instantly, but there was a consistent increase. It was the right thing to do then, and we shouldn't turn the clock back now.
Also, in 1965, the diagnosis and treatment of cancer was very crude and ineffective by today's standards. Care has improved and that has come at a cost. What I'm concerned about is the relative cost. I value modern healthcare and think it is valuable. However, even something valuable can be provided at a cost that is prohibitive or unreasonable. When we compare our cost with the cost in single-payer systems, we find that we are paying way way above average. When you look at what we are getting for that care and its contribution to health, you find that we are not getting more care and our health outcomes are not better. On top of that, there are many millions of people going without care because they don't have access to health insurance and many who do cannot afford it.
It is also true that there have been a number of scandals where people have essentially defrauded Medicare and Medicaid. Many of the people who did this were physicians (and many others, includig patients as well, of course) and benefited financially as a result of their crimes. This is a problem and has been addressed to some extent, although not perfectly.
http://www.medicare.gov/FraudAbuse/Overview.asp
... there are a few individuals who are intent on abusing or defrauding Medicare, cheating the program (and in some cases the people with Medicare who are liable for co-payments) out of millions of dollars annually. Medicare fraud takes a lot of money every year from the Medicare program. People with Medicare pay for it with higher premiums. This section of the website is dedicated to helping you to help Medicare to avoid making inappropriate payments to fraudulent entities.
Progress is being made:
http://www.taf.org/FCA-2006report.pdf
Based on an analysis of data for the fi ve-year period FY 2000–FY 2004, we
conclude that the U.S. taxpayers are getting a return on their dollars invested
in fighting health care fraud that is nearly double the rate of return identified in our first study. Specifically, federal government recoveries from civil health care fraud over this period totaled approximately $7.3 billion as shown in fi gure 1; after deducting payments to whistleblowers, the net recoveries to the federal government amounted to $6.64 billion over the 2000–2004 period. We estimate the
"For every
dollar spent
to investigate
and prosecute
health care
fraud in
civil cases,
the federal
government
receives fifteen
dollars back in
return."
Statement of Purpose and Summary of Findings
1. Net Medicare mandatory outlays (mandatory outlays less total off setting receipts including
premiums and amounts paid by the states) are projected by CBO to reach $326.8 billion in FY
2006. This is only the cost to the federal government; Medicare enrollees also pay a very large
share of the cost through premiums, deductibles, and co-payments. A more inclusive measure
from the National Health Expenditure (NHE) Amounts shows that when the enrollees' share of
spending is added, total Medicare outlays in 2006 will be about $420 billion.
4
government's costs over this five-year period to be $443.8 million.
Th us, for every dollar spent to investigate and prosecute health
care fraud in civil cases, the federal government receives $15 dollars
back in return.
Why did the federal government's return on investment improve
from 8 to 1 over the 1997–2001 period to 15 to 1 from
2000 to 2004? This jump occurred because the federal government's
recoveries between FY 2000 and FY 2004 increased far
more rapidly than its enforcement costs. Civil health care fraud
recoveries in FY 2004 were $1.8 billion, about two and half
times the level recovered in FY 2000. Government enforcement
costs were also a little higher over this fi ve-year period than the
previous ones, and total outlays related to civil health care fraud
enforcement were about $100 million in 2004. But the overall
estimated increase of about $32 million between 2000 and 2004
was not nearly as large as the gain in recoveries.
The benefit/cost ratio of $15 to $1 is likely to underestimate the real return
that the taxpayers are receiving on outlays for civil health care fraud enforcement.
That is because, in addition to the actual monetary recoveries resulting
from FCA investigations and prosecutions, there are also deterrent eff ects that affect the behavior of other firms in the industry.
Of course, fraud is not limited to Medicare and Medicaid. Private health insurance suffers from fraud as well:
http://www.bcbsm.com/home/health_care_fraud/fraud_statistics.shtml
Health care fraud is a serious crime. Under Michigan's Health Care False Claims Act, it's a felony, punishable by up to four years in prison, a $50,000 fine, and loss of health insurance.
Blue Cross Blue Shield of Michigan's fraud investigation unit coordinates investigations with law enforcement agencies such as the Federal Bureau of Investigation, The Office of Inspector General for the Department of Health and Human Services, Michigan State Police, local police departments, and state and federal prosecutors.
The Blues are committed to protecting members and providers and keeping down the cost of health care by stopping fraudulent activity. The following data represents Blue Cross Blue Shield of Michigan's fraud investigation unit activity from July 1980 to September 2006.
Cases
29,415 Opened
27,259 Closed
$240,409,248.76 Recovery cost / savings
Many cases handled by BCBSM's fraud investigation unit result in further action by law enforcement agencies.
Law Enforcement
3,273 Referrals
2,371 Warrants Issued
2,239 Arrests
1,838 Convictions
People who have studied both Medicare and private health insurance find that medicare has an administrative cost around ~2%, whereas private health insurance has a cost of around 13% (see my previous message for the source -- or just ask). Also, Mediare and Medicaid cover patients who private insurance has dropped or will not cover. It's difficult to make an apples to apples comparison, but when you try covering a patient with private health insurance and compare that with the cost to Medicare, you find that costs for private health insurance are much much higher (e.g., $14K vs $9K for one of the cases I cited previously).
This isn't just the U.S. experience. It describes the experience pretty much around the globe. The U.S. has the highest healthcare costs in the world and does not get more care or care out comes. What good does an MRI machine do you if you cannot afford to go to the doctor to get an MRI? For millions of Americans, even basic care is out of reach. A single payer system would help rectify this.
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If people are not buying insurance right now, what makes you think they will but private insurance when they have "free" government insurance ask the Germans how that is working for them. Check this out:
http://www.csmonitor.com/2002/0828/p01s04-wogi.html
"Canadian model of healthcare ails"
"Solutions would likely include greater home care, user fees for patients who can afford them"
"Some provinces could independently impose user fees or copayments,"
We are talking within 25 years of existence here, wait and see what will happen in 50 years. Someone once said that socialism and capitalism don't mix very well, this is evidence. The United states has an opportunity to learn from the failures of all these systems and model a system that makes financial sense, instead of running with high emotions.
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Dutchman, a $1.19 charge for each visit to the doctor?? You say there is a problem!??
Heck, make it an even $2. You can't even buy a cup of Starbucks coffee for $1.19 (or a glass of French wine). That would be a tiny sacrifice. I'm sure they pay $15 for parking or bus fare to get to the doctor anyway.
As I mentioned about the schools, our public schools have problems also. Do you suggest eliminating public schooling? What about public roads -- should they go as well?
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You make an excellent point. I agree with a nominal charge or co-pay, say $20 per doctor visit and $100/hospital visit and $5 for generics and $25 for copays. I'm not sure where the public stands on such copays, but I would support that. Most patients could pay for this by cutting down on smoking for a couple of weeks or holding off on lottery purchases for a month.
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The main problem with single payer that I referenced earlier is the fact people aren't paying for the services they're getting. It's like going to the buffet and eating 2 kg of food for 8.99 -- if all the diners ate 2 kg of food (and many do, look how many obese people go to the buffet) the restaurants would have to charge more, bring in more ppl who ate less or close down.
So what's happening worldwide is people are just being refused service -- thus rationing/wait lists, etc. Now if we had 2 or 3 tiered system where you get guaranteed service with more $$ that might make some sense, but then again health care costs are likely to spiral. Also, lots of minorities and poor would be in the health "underclass"; maybe a worse system than today (there being some ways for uninsured to get care that might be scrapped in the new system)
If it's only one 1 tier (Canada system) then it's communist health care; everyone gets the same bad, expensive service and health care costs spiral like crazy, further clamping down the rationing and waiting lists. This would be horrible for innovation, which is what the US's strength is.
13% of US GDP is yeah 2 TRILLION -- vs. 6 or even 10% which would be hundreds of billions less. Imagine it being 20, 30% of GDP in the next 20 years (where it's heading if we don't change the system!!!) -- 4-6 TRILLION/year. This will strangulate businesses, not to mention the current working class will diminish somewhat and the elderly population will skyrocket (baby boomers). I agree with you ONCOcap that we need to change the system NOW -- but what we do is very very important.
The major problems, as i see it:
1) Too rapid increase in health care costs (reasons include too many tests due to defensive medicine, and too many unnecessary services being performed... more research needed here to stop this)
2) Health Care fraud
3) No legal basis to stop racketeering practices by lawyers (frivolous lawsuits, excess judgments, inefficiency of the legal system)
4) Excess health care burden on low income ppl and those without insurance
5) Marginalization of physicians in decision making and reimbursement
6) Overhead and poor business practices by health insurance companies
7) Poor triage of less sick patients to other care providers
So what's happening worldwide is people are just being refused service -- thus rationing/wait lists, etc. Now if we had 2 or 3 tiered system where you get guaranteed service with more $$ that might make some sense, but then again health care costs are likely to spiral. Also, lots of minorities and poor would be in the health "underclass"; maybe a worse system than today (there being some ways for uninsured to get care that might be scrapped in the new system)
If it's only one 1 tier (Canada system) then it's communist health care; everyone gets the same bad, expensive service and health care costs spiral like crazy, further clamping down the rationing and waiting lists. This would be horrible for innovation, which is what the US's strength is.
13% of US GDP is yeah 2 TRILLION -- vs. 6 or even 10% which would be hundreds of billions less. Imagine it being 20, 30% of GDP in the next 20 years (where it's heading if we don't change the system!!!) -- 4-6 TRILLION/year. This will strangulate businesses, not to mention the current working class will diminish somewhat and the elderly population will skyrocket (baby boomers). I agree with you ONCOcap that we need to change the system NOW -- but what we do is very very important.
The major problems, as i see it:
1) Too rapid increase in health care costs (reasons include too many tests due to defensive medicine, and too many unnecessary services being performed... more research needed here to stop this)
2) Health Care fraud
3) No legal basis to stop racketeering practices by lawyers (frivolous lawsuits, excess judgments, inefficiency of the legal system)
4) Excess health care burden on low income ppl and those without insurance
5) Marginalization of physicians in decision making and reimbursement
6) Overhead and poor business practices by health insurance companies
7) Poor triage of less sick patients to other care providers
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Well it is clear that there are advantages and disadvantages to both systems. The only thing I am weary of is the fact that our insurance system is only one suspect amongst many reasons why we are not healthier than some of these countries. It will really suck ass if we adopt a socialized system and slip further in the rankings because we ignored the real problems. I am just sorry for my kids, because either way, they will be inheriting a whole bunch of junk. I don't think the American economy's #1 status amongst industrialized nations is unrelated to the fact that we think independently and have the least taxes. Europe and it's common wealth allies determined to put America in it's place are now dangling the fake carrot of increased taxes in front of us, and we are about to fall for it.
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This United States is a Republic, not a true representative democracy. Your argument reaks of an ideaology that 51% of the population can force anyone to do anything. You still HAVE NOT answered why this majority of people who want the system can't do it privately. Here's the reality. You think the system is great, but you realize that people won't actually want to keep paying. You say health insurance is 10k/family, but what that really means is an AVERAGE of 10k per family. To pay for the medical care of Joe IV drug abuser who has no income, every family will have to pay more.
In a private system, the top 50% of income people in the system will flee, realizing that they can cover their expenses more cheaply. What you want to do is sell the system, and FORCE people to pay with taxes. It is a hidden soak the rich scheme. In your public system, the lower classes will progressively push the burden up the income ladder. "Oh yes, this is a social good, but I'm just not able to pay for it. Why don't we let everyone with income above me pay for it?" It's amazing that EVERY tax increase proposal hits people making over 200k/year. That way, most Americans can demand whatever they want without having to pay for it. Free money for everyone at the expense of our most productive citizens.
By the way, even in your majority rules mentality, this board seems to unofficially indicate that the majority of providers are NOT in favor of Universal Healthcare. The AMA is opposed to it. The majority of doctors in practice and the majority of posters on SDN are opposed to it. Doesn't it mean anything to you that the majority of the people you want to bring into your system by force DON'T AGREE.
Also, I think that the public school system is an excellent example of why the government shouldn't take over healthcare. Literacy is dropping, teachers lives suck, the process keeps getting longer (1st grade, then kindergarden, then K4), and people keep paying more for less. What a disaster.
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there are two conflicting themes here -- a) how do we find a mechanism to enable all Americans to have some basic type of coverage and b) how do we avoid making a worse system then we have now.
Single payer only is a bad system -- I think everyone on the board agrees with this, including Oncocap.
Single + tier insurance is supported by ONcocap -- but not by most others. I don't agree either-- the government has shown itself many times to be inefficient, disproportionately helping out the politician's friends and screwing over a lot of others -- and there isn't much to be done about it!
MSA/Mandatory insurance -- why can't we enact this? Or rather, Oncocap, why not this instead of single payer? Overhead alone is not sufficient reason (see my previous post why).
At the same time, it is fair to ask the rich to pay more than the poor because their quality of life takes much less of a hit than someone with less income. However, to force the rich to pay egregious taxes (like 70% or something, was the case from the 1960s-1980s) usually results in severely stunted growth for the GDP. A communist system of redistribution of wealth would destroy America. The reason there are economic disparities, at least much of the time is because of better quality ideas/economic productivity of those who make more money. Another reason to limit government involvement as LITTLE AS POSSIBLE...
Single payer only is a bad system -- I think everyone on the board agrees with this, including Oncocap.
Single + tier insurance is supported by ONcocap -- but not by most others. I don't agree either-- the government has shown itself many times to be inefficient, disproportionately helping out the politician's friends and screwing over a lot of others -- and there isn't much to be done about it!
MSA/Mandatory insurance -- why can't we enact this? Or rather, Oncocap, why not this instead of single payer? Overhead alone is not sufficient reason (see my previous post why).
At the same time, it is fair to ask the rich to pay more than the poor because their quality of life takes much less of a hit than someone with less income. However, to force the rich to pay egregious taxes (like 70% or something, was the case from the 1960s-1980s) usually results in severely stunted growth for the GDP. A communist system of redistribution of wealth would destroy America. The reason there are economic disparities, at least much of the time is because of better quality ideas/economic productivity of those who make more money. Another reason to limit government involvement as LITTLE AS POSSIBLE...
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Agreed. It's a very difficult issue. The standard political knee-jerk reaction is "tax the rich." Oh well. Anything we can do to make people pay their share and reduce fraud (including collecting benefits for something you can pay for yourself) has my attention. The current system is increasingly not meeting the needs of ordinary Americans, so something needs to be done, and we agree on that.
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Yes, true. It's an expensive system, and it's expensive now. Your criticisms are totally valid.
There could be a private solution. Personally, I actually like your ideas of cash-paid healthcare for ordinary expenses (we might differ on major medical; I'm not sure if you are fine with private health insurance for major medical expenses). However, when it comes to policy (politics) and economics, I'm in favor of a single-payer system.
Where will they flee to? Canada? They already have a single-payer system. Mexico? Also single-payer.
Yes, we need to do what we can to make sure that everyone pays their fair share, so to speak. I'm not an expert when it comes to the political side of things, so I'm not sure how to accomplish that. Maybe by having co-pays for everything, we can help ensure that even the poor pay something. The reasons you give are some of the reasons why we might not have a single-payer system.
Well, my thought is with respect to voters overall, not just physicians. So, recent polls of all voters are 75% pro-universal healthcare.
The AMA now has their own universal healthcare proposal. I'm not sure that it is a very good proposal, but they are getting on board, so to speak.
So do you want to get rid of public eduation?
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This could be an option. If we went this route, we would probably need to limit the number of providers to cut the billions in wasted paperwork and administration. Big companies do this with contract staffing for example. A company like Applied Materials (AMAT) will have a single staffing contractor and all the individual subcontractors work through that provider. Every so often (e.g., 2-3 years), AMAT will hold a reverse auction for the amount of "margin" that the contract staffing company will be allowed to make off every contract staff member (20% or whatever).
We could do something similar. Each state could have 2-3 "slots" for insurance companies, which would bid the amount of "administrative cost + profit" that the company is allowed to make off insurance premiums. Those slots might be good for 2 to 4 years, after which they would go out for competitive bid again. Each person in the state would be automatically assigned to their preferred insurance provider (of the 2-3 choices) or to their next highest choice if the preferred on is full (we could do lotteries as well). In any case, every person would get a bill and would need to pay it. If they don't it would be same as not paying your taxes or traffic ticket; you would have a legal problem. Similarly, drug prescription plans, vision plans, and dental plans could vie for slots. In this way, the state would negotiate the best prices and overhead and the system would be managed by private administrators.
So yes, I could see something like that working as long as it doesn't involve 4000 insurance companies.
Keep in mind that we are paying for healthcare right now somehow. I don't know if it's the rich, poor, or middle class, but somehow we are paying $1.8 trillion. If we can pay it now, we can pay it tomorrow. If the system becomes more efficient and equitable, we will all benefit. Is it scary ... yes, it's very frighting to have such huge changes. However, we need to look at the situation and come up with the best plan. The current system is not very good, as you will agree.
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Here is some more information from Students for Policy Awareness @ Rice University:
"Medicare does qualify as a quasi-single-payer system. It is sponsored by a
payroll tax (1.45% employee + 1.45% employer or 2.9% self-employed) just like the national systems in Canada and Australia, by copayments, and by optional premium (part B and part D).
Quick info on Medicare:
http://www.kff.org/medicare/upload/1066-09.pdf
OVERVIEW OF MEDICARE
Medicare is the federal health insurance program
created in 1965 for all people age 65 and older
regardless of their income or medical history. The
program was expanded in 1972 to include people under
age 65 with permanent disabilities. Medicare now
covers nearly 43 million Americans. Most people age 65
and older are entitled to Medicare Part A if they or their
spouse are eligible for Social Security payments and
have made payroll tax contributions for 10 or more
years. People under age 65 who receive Social Security
Disability Insurance (SSDI) generally become eligible for
Medicare after a two-year waiting period, while those
with End Stage Renal Disease and Lou Gehrigs disease
become eligible for Medicare when they begin receiving
SSDI payments.
Medicare plays a vital role in ensuring the health of
beneficiaries by covering many important health care
services, including a new prescription drug benefit.
However, there are also gaps in coverage, notably
dental, vision, and long-term care. Medicare benefits
are expected to total $374 billion in 2006, accounting for
14% of the federal budget (CBO, 2006).
CHARACTERISTICS OF PEOPLE ON MEDICARE
Medicare covers a diverse population: 35% have three
or more chronic conditions, 17% are African American or
Hispanic, 14% have limitations in three to six activities of
daily living, and 12% are age 85 and older (Figure 1).
Many people on Medicare have modest incomes and
resources: 39% have incomes below 150% of poverty
($19,600/single and $26,400/couple in 2006). Fifteen
percent nearly 7 million in 2006 are under age 65
and permanently disabled.
As for administrative costs for Medicare. One of the sources is Institute for
Health and Socio-Economic Policy (3.2%). It is also quoted in many other
sources such as the NNOC's website, which you might find helpful:
http://www.calnurses.org/healthcare/facts/
Did you know?
Half of all personal bankruptcies are caused by illness or medical bills.
From 2000 to 2005, health insurance premiums rose by 73%, compared to an aggregate increase in workers income of just 15%.
Over 30% of every healthcare dollar is spent on administrative overhead in private insurance compared to just 3.2% in Medicare administrative costs.
Here are issues with HSA's:
Top 10 Problems with HSAs
1. HSAs do not control costs. They shift costs from the insurers to the patient. They also have no or minimal impact on the 10% of the population that account for 69% of healthcare spending.
2. HSAs do nothing to increase access or reduce the number of uninsured.
3. HSAs are combined with limited, high deductible health plans, exposing consumers to high
out-of-pocket costs which leads to rationing based on ability to pay.
4. HSAs encourage consumers to gamble with their health. Those experiencing an illness or injury
may suddenly find their high deductible plan which may also include caps on payments for services
subjects them to massive debt and financial ruin.
5. HSAs discourage prevention. Patients are more likely to forego primary and preventive care, and to
delay other needed care. That can lead to worsened health outcomes, as well as more expensive
healthcare costs.
6. HSAs increase administrative costs, such as the servicing fees paid to the financial institutions to
manage the accounts beyond the 30% share of administrative costs already consumed by private
health care for billing, other paperwork, and profits.
7. HSAs deplete funds from the insurance risk pool. While the poor and sick quickly deplete any HSA
funds, the rich and healthy retain their unspent money which would have previously gone into the
pool to help subsidize care for the sick. The dollars removed from the system will likely need to
be replaced by increasing premiums, additional other fees or cutting benefits for those still in.
8. Many consumers with HSAs are dissatisfied. A June, 2005 study by the pro-HSA McKinsey consulting
firm found 56% of those with HSAs were less satisfied than with their previous health plans.
9. HSA rules about what they can cover and what expenses apply to the deductible are so complicated
that Bruce Bodaken, CEO of Blue Cross and Blue Shield of California, said he cant understand his
own plan.
10. HSAs amount to another tax break for the wealthy who have already been showered with tax
breaks by the Bush Administration. The right to pay medical expenses with pre-tax income is worth
a lot more to high-income individuals than to low income people who lack the ability to place the
maximum permitted amount in their savings accounts.
(Note that: "Medicaid is off the table as it is a welfare public assistance program that is funded according to need from general revenue.")
"Medicare does qualify as a quasi-single-payer system. It is sponsored by a
payroll tax (1.45% employee + 1.45% employer or 2.9% self-employed) just like the national systems in Canada and Australia, by copayments, and by optional premium (part B and part D).
Quick info on Medicare:
http://www.kff.org/medicare/upload/1066-09.pdf
OVERVIEW OF MEDICARE
Medicare is the federal health insurance program
created in 1965 for all people age 65 and older
regardless of their income or medical history. The
program was expanded in 1972 to include people under
age 65 with permanent disabilities. Medicare now
covers nearly 43 million Americans. Most people age 65
and older are entitled to Medicare Part A if they or their
spouse are eligible for Social Security payments and
have made payroll tax contributions for 10 or more
years. People under age 65 who receive Social Security
Disability Insurance (SSDI) generally become eligible for
Medicare after a two-year waiting period, while those
with End Stage Renal Disease and Lou Gehrigs disease
become eligible for Medicare when they begin receiving
SSDI payments.
Medicare plays a vital role in ensuring the health of
beneficiaries by covering many important health care
services, including a new prescription drug benefit.
However, there are also gaps in coverage, notably
dental, vision, and long-term care. Medicare benefits
are expected to total $374 billion in 2006, accounting for
14% of the federal budget (CBO, 2006).
CHARACTERISTICS OF PEOPLE ON MEDICARE
Medicare covers a diverse population: 35% have three
or more chronic conditions, 17% are African American or
Hispanic, 14% have limitations in three to six activities of
daily living, and 12% are age 85 and older (Figure 1).
Many people on Medicare have modest incomes and
resources: 39% have incomes below 150% of poverty
($19,600/single and $26,400/couple in 2006). Fifteen
percent nearly 7 million in 2006 are under age 65
and permanently disabled.
As for administrative costs for Medicare. One of the sources is Institute for
Health and Socio-Economic Policy (3.2%). It is also quoted in many other
sources such as the NNOC's website, which you might find helpful:
http://www.calnurses.org/healthcare/facts/
Did you know?
Half of all personal bankruptcies are caused by illness or medical bills.
From 2000 to 2005, health insurance premiums rose by 73%, compared to an aggregate increase in workers income of just 15%.
Over 30% of every healthcare dollar is spent on administrative overhead in private insurance compared to just 3.2% in Medicare administrative costs.
Here are issues with HSA's:
Top 10 Problems with HSAs
1. HSAs do not control costs. They shift costs from the insurers to the patient. They also have no or minimal impact on the 10% of the population that account for 69% of healthcare spending.
2. HSAs do nothing to increase access or reduce the number of uninsured.
3. HSAs are combined with limited, high deductible health plans, exposing consumers to high
out-of-pocket costs which leads to rationing based on ability to pay.
4. HSAs encourage consumers to gamble with their health. Those experiencing an illness or injury
may suddenly find their high deductible plan which may also include caps on payments for services
subjects them to massive debt and financial ruin.
5. HSAs discourage prevention. Patients are more likely to forego primary and preventive care, and to
delay other needed care. That can lead to worsened health outcomes, as well as more expensive
healthcare costs.
6. HSAs increase administrative costs, such as the servicing fees paid to the financial institutions to
manage the accounts beyond the 30% share of administrative costs already consumed by private
health care for billing, other paperwork, and profits.
7. HSAs deplete funds from the insurance risk pool. While the poor and sick quickly deplete any HSA
funds, the rich and healthy retain their unspent money which would have previously gone into the
pool to help subsidize care for the sick. The dollars removed from the system will likely need to
be replaced by increasing premiums, additional other fees or cutting benefits for those still in.
8. Many consumers with HSAs are dissatisfied. A June, 2005 study by the pro-HSA McKinsey consulting
firm found 56% of those with HSAs were less satisfied than with their previous health plans.
9. HSA rules about what they can cover and what expenses apply to the deductible are so complicated
that Bruce Bodaken, CEO of Blue Cross and Blue Shield of California, said he cant understand his
own plan.
10. HSAs amount to another tax break for the wealthy who have already been showered with tax
breaks by the Bush Administration. The right to pay medical expenses with pre-tax income is worth
a lot more to high-income individuals than to low income people who lack the ability to place the
maximum permitted amount in their savings accounts.
(Note that: "Medicaid is off the table as it is a welfare public assistance program that is funded according to need from general revenue.")
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Here's another idea: Maybe the government should float it's own competing medical insurance company(non-profit), not funded by taxes but operated like any other insurance company with profits rolled back to subsidize premiums. People can buy this insurance as a choice and the company will be run under free market dynamics. If the other insurance companies are doing anything strange then this company should be able to knock them flat on their asses. This will also show us that the government is capable of really managing something, as opposed to handing them 10% extra taxes only to end up with a bankrupt system.
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Yes, we could play all kinds of games (President Bush's tax deduction scheme is another). However, we're not in a position to experiment with a $1.8 trillion system. The only proven systems for something of the magnitude of a country's healtchare system are variants of single payer system with taxes (my preference) or perhaps socialized medicine (less in line with our values). In any case, a non-profit insurance could never scale it fast enough, even if it was successful without tax revenues. Non-profits simply don't have the growth rates to address an immediate problem like we have in healthcare. It's too slow and won't cover enough citizens.
If you are hellbent on having private management of the system, the federal government could outsource most of the routine daily management, data processing, fraud detection, etc. (this outsourcing takes place on a large scale anyway). Many government functions are actually performed by private government contractors, so there really is no difference between public and private in terms of efficiency (since it is the same people who do the work either way). What is different is that instead of spending billions denying people coverage or coming up with yet another claim form so as to maximize profit, the function of the universal healthcare system would be to efficiently fund healthcare, similar to Medicare, which is the true purpose of the system instead of making billionaires at the expense of patient health.
As an example, apparently Blue Cross Blue Shield of Texas as a relatively successful non-profit health insurance company. (http://www.bcbstx.com/about/history.htm) It was bought by a for-profit entity (Health Care Service Corporation) and is now for-profit. The parent looks like it earned around $1.4 billion in net income on revenues of $11.7 billion. Pretty well in line with other large companies. However, Blue Cross Blue Shield did not succeed in addressing the concerns that are driving Americans toward universal health care (even as a non-profit). At the end of the day, non-profits are just to small to serve healthcare and for-profits benefit by covering mostly healthy patients and denying coverage to the young, old, or otherwise high-risk members of population (dumping them on the government). It's not until you move away from private health insurance as it is today toward a single-payer system that you get a cost-effective system that is comprehensive enough to cover all citizens. In private health insurance the needs of patients and the incentives of executives are at odds with one another. A non-profit can't scale enough. That's why a single-payer system is so attractive.
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First of all, Universal healthcare has been tested and they are all financially distressed all over the world. If we go by what you are saying then we should not even touch it with a stick. It is not a trillion dollar experiment to float a government owned private insurance co. So you don't think the government can employ the right talent to handle a smaller insurance company, but you want to entrust them with the entire enchilada. It is not a game. For you who is struggling with private insurance, single payer is a good idea, but remember there are Americans who are just fine with their $100 a month insurance that they get from their work. It will entail you telling them to loose so that you can gain. You also forget that there are Americans that choose to go without insurance. That is their own business IMO. It is not in my place to try to force them into anything. If you truly believe that private insurance companies are evil and they are grabbing money and running, then why are you afraid of a government owned non-profit insurance company that you could choose to buy your insurance from at a cheaper rate and won't defraud you. Telling me that will be a risky experiment or a game shows me that you might just be promoting a bandwagon political philosophy without an interest in viable alternative solutions.
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I don't think that everyone agrees that this is fair at all. The majority of the benefit will go to the poor. The rich can already afford healthcare. There is no way to properly measure "hit to quality of life." The second part of your statement shows the problem with the first part. The wealthier population by and large is a more productive population. When you divert resources from the more productive, total productivity goes down. 30% isn't as bad as 70%, but it is worse than 20% or 10%. Due to the free market system in the US, 90% of millionaires are SELF-MADE (Statement from the book The Millionaire Next Door. Why is it fair to ask ANYONE to give up a rightfully earned quality of life against their will? This ideaology taken to the extreme is exactly what happens in some places, and it is exactly why we tanked our economy for a good part of the 60s and 70s.
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