oh boy... public option for U.S. health care?

[rei]

i said "oh boy" because i can see the potential of this thread to get intense. but hopefully we can all play nice. ...i would ask, though, that you cite any facts you use to support your position, and i would prefer that you share your own personal opinion, independent of what others may think about this issue (i.e. signs of critical thinking are a big plus!).

apparently the U.S. health care reform process is not going well (according to those of us who believe we should be like every other industrialized country). the public option (arguably the most important reason to reform our health care system) has been squashed - since Congress must often go through a lot of extra steps before something is squashed completely, i am maintaining some hope.

i wanted to create this thread to discuss the issue of U.S. health care reform. long overdue? do you think the public option may be the most useful idea in this reform, or do you think the current system is actually better and who cares about those who fall through the cracks between eligibility for Medicaid and ability to pay a third party? (yes, i admit i reveal my bias in that question!) prefer the for-profit system? are you tired of special interest groups overshadowing what the majority of Americans want? (the loudest voices are definitely not an accurate barometer for majority opinion.)

again... please be respectful, or at least civilized, in sharing your view point. also, if you have suggestions on how we can get the public option back on the table (or to get the pharmaceutical/for-profit folks to give some space for actual competition and accountability) feel free to share that.

ok... here goes!

[TheColonel]

As a former insurance regulator, I can promise you that a public option is far from being "the most important reason to reform our health care system."

It could help - if it were set up and executed correctly, but there are some serious inherent challenges to this approach. Keep in mind, I am intimately familiar with the way government works in the insurance industry. Even at its best, it is highly inefficient.

In my opinion, malpractice lawsuit or "Tort" reform would support a much broader series of benefits.

There are some other cost reduction initiatives that include changing the way government is involved in insurance that I believe would dramatically lower costs and reform the industry.

[aggie]

i am for the reform.

health care is not a privilege, as some opposers of the reform seem to believe.

i am disheartened by the continuous misquoted, taken out of context presenting of the reform by the right wing media.

we should have a system, where even if it means an increase in taxes that we have concern and learn to take care of our people as others have.

it is not a matter of people standing with their hands out getting something for free.

there is no death panel, just end of life decisions that people have been making for years about living wills, health care surrogates, etc.

as someone with a healtcare job, i see people fall thru the cracks everyday.

even if you had to wait for care, it is better than having no care to wait for.

the taxpayers and hospitals are absorbing the cost of those that are using the emergencies for health care without insurance.

medicare and the va are government run, and doing well.

it should be about having a healthly society, not dollars and cents.

thanks for allowing my input.

[rei]

Originally Posted by TheColonel

As a former insurance regulator, I can promise you that a public option is far from being "the most important reason to reform our health care system."

TheColonel, if you will re-read the OP you will see that i said it may be the most useful. i don't really feel qualified to suggest what may be the most important aspect of reforming health care.

i think you seem to show a focus on cost reduction, which is also a consideration of course. but how do the rights of all Americans to live healthfully, and access medical support if they fall ill, play into your position? isn't America rich enough to fund these changes? if we have abundance, and all humans are part of a collective being, then are we not hurting ourselves by not sharing... isn't there more than enough to go around?

while we're at it, i think it would be useful to follow the European model (well, the British model, possibly other regions as well) by removing preservatives and all synthetic additives from our food. removing the sanctions that make high-fructose corn syrup the cheapest sweetener would also be a good idea. i don't think most people realize just how much diet affects health. or maybe they don't care, until they get cancer? anyhoo, while we are overhauling things i think it would be useful to change the FDA guidelines.

[aggie]

i agree, i have always felt that the British/Europeans
were more progressive in that area...but a healthy society does not generate a lot of income for insurance companies, pharmaceuticals, or health care providers.....it is a big picture that needs revamping, re-prioritizing and re-thinking of people as a whole.

healthy, organic, non garbage food in the usa costs are astronomical...but you can comfortably feed a family for six for very little in the drive thru....

we depend more and more on the bandaids, the drugs, the spare body parts and the high cost of after care instead of preventative measures.

[TheColonel]

Originally Posted by rei

apparently the U.S. health care reform process is not going well (according to those of us who believe we should be like every other industrialized country). the public option (arguably the most important reason to reform our health care system) has been squashed - since Congress must often go through a lot of extra steps before something is squashed completely, i am maintaining some hope.

That's the part I was quoting. I think we all agree that reform is needed. But the devil's in the details, and that's when emotions start to flare.

My premise is that we should plug the leaks that cause healthcare costs to skyrocket - before we create more government involvement.

Medical malpractice lawsuits and lottery-sized awards cause "Defensive Medicine."

Defensive Medicine causes doctors to order redundant tests, unnecessary procedures and whole plethora of other actions. These actions drive the cost of healthcare higher and higher.

If you simply raise taxes before plugging the leaks (such as Defensive Medicine), you end up with an economy that sinks even faster. This is because so many expensive and unnecessary tests & procedures are being ordered by doctors who are scared of being sued into oblivion.

And who will pay for the expensive and unnecessary tests & procedures?

You guessed it. Taxpayers.

[rei]

Originally Posted by TheColonel

That's the part I was quoting. I think we all agree that reform is needed. But the devil's in the details, and that's when emotions start to flare.

My premise is that we should plug the leaks that cause healthcare costs to skyrocket - before we create more government involvement.

Medical malpractice lawsuits and lottery-sized awards cause "Defensive Medicine."

Defensive Medicine causes doctors to order redundant tests, unnecessary procedures and whole plethora of other actions. These actions drive the cost of healthcare higher and higher.

If you simply raise taxes before plugging the leaks (such as Defensive Medicine), you end up with an economy that sinks even faster. This is because so many expensive and unnecessary tests & procedures are being ordered by doctors who are scared of being sued into oblivion.

And who will pay for the expensive and unnecessary tests & procedures?

You guessed it. Taxpayers.

ok yes i can see now how you were quoting a different aspect of the OP. oopsie! and... the expensive tests and procedures... are they not usually covered by the third-party payer? wouldn't the tax payers only be involved if the person is covered by the government? and don't the third-party payers often have to approve those tests ahead of time?

and how would we decide what is and isn't a fair malpractice suit? what about a major medical decision resulting in negligent homicide? or, to use something that happened to one of my sisters, what if the doctor's chosen course of treatment or failure to catch a serious problem results in a person of normal intellectual functioning becoming so brain damaged that person is now mentally retarded? (my mother did not sue the doc over this, even though she could have.)

p.s. since we already have the intention of reforming health care, why can't we do both? create more regulations (across the board imo, but also regarding medical malpractice suits) and also create a public option to keep health insurance companies more honest? it seems many of these companies will not legitimately provide fairer prices unless they are forced to compete with a public option. and i don't think i understand why it isn't possible to tackle both the tort reform and the public option at the same time. can you explain how it is that we can't do both?

[aggie]

insurance companies are denying these tests for some people who may legitimately need them at this time.

if patients get to the point where they need to go to the emergency room and have the tests done on an urgent basis, the taxpayers or the hospitals eat it anyway.

there needs to be a more preventative outlook by healthcare providers and i believe, from my observation, if there was more quality than quantity service...there would not be so much fear of malpractice suits.

not that this is always the providers fault...but the way the system is the greatest amount of patients seen for the smallest amout of time each is the way they are making up for what ever perceived losses they have monetarily...and that is not what the hippocratic oath is supposed to be about.

[rei]

Originally Posted by aggie

insurance companies are denying these tests for some people who may legitimately need them at this time.

if patients get to the point where they need to go to the emergency room and have the tests done on an urgent basis, the taxpayers or the hospitals eat it anyway.

there needs to be a more preventative outlook by healthcare providers and i believe, from my observation, if there was more quality than quantity service...there would not be so much fear of malpractice suits.

not that this is always the providers fault...but the way the system is the greatest amount of patients seen for the smallest amout of time each is the way they are making up for what ever perceived losses they have monetarily...and that is not what the hippocratic oath is supposed to be about.

very good points aggie, and thanks for adding your perspective here! i read that the e.r. patients cause the biggest financial burden on taxpayers because, in part, the hospitals charge so much for treatment (something like $20 for a single Tylenol pill, crazy). and also... in most cases the issue they go to the E.R. for could have been treated in an urgent care or family practice setting for a much lower amount. so instead of patient X being treated for a sinus infection at a grand total of $100 (or $300 including non-generic/OTC medication), patient X develops pneumonia and ends up needing $5000 worth of treatment. (part of that cost is the high price of medical equipment, and yes, part of it is docs who charge as much as they do to afford their malpractice insurance and maintain their chosen lifestyle.)

quality and prevention - amen/awomen! and providing coverage for alternative treatments (proven ones like acupuncture and homeopathy) would be a wonderful thing. as for quality... i think most people would enjoy spending a bit more time with their physicians. when i saw my old doc he actually would spend like... 20-30 minutes with me, probably more. he would sit there and debate things for fun, and of course that was great bedside manner (manor?) imo, but it was also unusual. i think most people would prefer more time to ask questions.

oh, another great idea for reform i think - stop allowing the pharmaceutical companies to run commercials! let them share their new drugs with the docs and the N.P.s and let the docs decide whether it's right for us, instead of us hearing about them and asking if it's right for us. (many docs want their patients happy, so even if they wouldn't prescribe that particular drug, if we bring it up they will often write the script just so we will be happy with the treatment and service. not always this way, not all docs are this way, but health care has become a business - sadly - and customer satisfaction is part of it.)

[aggie]

oooohhh....don't get me started on pharm reps!

some are very capable, knowledgable individuals, who know their product and having savings techniques and promotions out of genuine concern for the patients to benefit from their meds....

but some...prostitution in a different form

[rei]

p.s. i should follow the guidelines i have suggested for this thread. what i shared about e.r. patients was actually an article in the AARP magazine. lemme find a link for anyone interested... ugh... the link is not working but the name of the article is in the link for anyone interested: http://bulletin.aarp.org/yourhealth/...er_visits.html

i just would really like to see people valued over profits, but maybe that's just me.

[aggie]

most of what i have stated comes directly from working for a healthcare provider. i work for a private institution now going on nine years, but was in the hospital setting for 18. my job descriptions have caused me to learn a lot about how the system works on many levels. and it is i, that must give the disappointing news and directly see the financial drain on people, the fear and frustration and sometimes the outright noncompliance because the system just doesn't work for them anymore. i do read aarp articles but mostly listen to am radio news...where direct readings from the proposed reforms have been read, the town hall meetings have been reported on and professionals and politicians and lay people alike are interviewed and can express their opinions.

regardless of what anyone thinks about her politics randi rhodes is a learned woman who tells the truth and always backs up her info and sources. she knows american history, (was in the military) (lived in n.y., fla, and now the capital.), the constitution, and she will call out anyone..whether democrat or republican if they need it. what i don't have time to research...she does for me...and anyone that states anything on her program has to be able to back it up with facts as well.

[rei]

aggie, i find it interesting that both you and TheColonel have experience in the industry informing your position. since he worked with insurance, perhaps cost control seems to be a bigger priority to him. (TheColonel i am still interested to know why you seem to be saying we can't do tort reform at the same time we implement a public option.) and since you deal more with the patients, it seems you are more focused on the personal aspect of this. very interesting.

[aggie]

it definitely comes from working in a hospital...regardless of what is going on in the business offices of the doctors and the hospital...you know the docs are getting paid...and a patient can be on their deathbed and someone will be coming around to ask about payment if there is an insurance problem.

but in the end what i did was focused on the care and well being of the patient.

when i got into the private sector...i saw my abilities and job description as important, a cog in the wheel so to speak, but i do not deal with the money collecting aspect at all. i bring in no direct revenue...but i am a liason that needs to walk the tight rope of keeping happy healthy patients and keep them coming back at the same time.

i have been negotiator, pr, counselor, middleman and sometimes i take my lumps from within and sometimes i am the scapegoat for the patient's frustration and fears.

i love what i do, however...and i hate being part of a compromising situation, but sometimes no matter what i do, it cannot be avoided.

i also live it personally with my own care, that of my husband and my aging mother.

if i didn't know what i know we all would have gotten steam rolled a long time ago.

the biggest shame is when brilliant providers are part of a system that can eventually cause the price tag to take priority. they may not have started out that way...but like in many aspects in life, you can learn how to play the system for your benefit....and if you are helping someone along the way....the end, for now justifies the means.

[ar81]

During WWII british government gave people the right to kill, but also the right to help. NHS is exactly that.
Do you want to compare systems?
Go to UK and France, and ask Americans who live there if they would replace european health care system with the one in US.

Some people in US go illegally to Canada, hoping to make use of their system.
It is not necessary to go illegal.

You may like to register before Caja Costarricense del Seguro Social (CCSS) in Costa Rica, Seguro Voluntario regime, and declare the amount of minimum wage as independent worker, as your income and pay 15% of it every month. Every month they will issue a document called "orden patronal" which you will need to be serviced, so you may need to find a way to have it mailed.

And in case of health problems, go to Costa Rica with that document, your CCSS ID, your passport, and you will not need to pay for attention. It is very cheap, becuase if I am not mistaken, a minimum wage is about $200.

Most of problems are covered, except for some complex surgery that may require highly specialized personnel. But for example, birth, pregnancy, accidents, and many other common problems, are covered. No need to preaprove anything, no ambulance bill. No need to pay several thousand dollars to fix your body.

If a third world country can afford it, US should be able to afford a cheap system too.

Costa Rica in 1956 suffered some kind of epidemics. So it was a time to strengthen the system where everyone should be covered. Healthy people are more attractive workers for employers.

Thinking about not receiving medical attention because you have no money is unthinkable in Costa Rica.

[Michelle]

There is an excellent article in today's NY Times concerning the Swiss health care system. http://www.nytimes.com/2009/10/01/he...q=swiss&st=cse

It is a system which guarantees each person health care, it is obligatory and yet not run by the government.

The most important part is: it works.

As an American who grew up without health insurance in the U.S., the system here seems like true paradise.

Of course, no system is perfect. However, almost anything would be better than what the U.S. currently has.

I think that when the U.S. has made the leap in consciousness needed to guarantee health care to all citizens, it will have an amazingly positive effect on the country and therefore the world overall.

[ar81]

Originally Posted by Michelle

There is an excellent article in today's NY Times concerning the Swiss health care system. http://www.nytimes.com/2009/10/01/he...q=swiss&st=cse

It is a system which guarantees each person health care, it is obligatory and yet not run by the government.

The most important part is: it works.

What is the problem of that system?
Its cost. Privately run system is very expensive.

The system is subsidized by government, so basically taxpayers are paying a partially public option which is more expensive than a public option. And in Switzerland people have a bit of influence in the country politics, unlike US, because it is a small country, and that makes abuse of companies to come back as political retaliation from people.

Be advised also that a sick population is more expensive than a healthy one for the government, so unless US has people as healthy as people in Switzerland, costs would be a problem for government. And cost is exactly the reason for reform.

Patients have been the losers since 1994 Act that made insurers to be the winning cartel.
Switzerland seems to aim at imitaing US problems.

[rei]

Originally Posted by ar81

What is the problem of that system?
Its cost. Privately run system is very expensive.

The system is subsidized by government, so basically taxpayers are paying a partially public option which is more expensive than a public option. And in Switzerland people have a bit of influence in the country politics, unlike US, because it is a small country, and that makes abuse of companies to come back as political retaliation from people.

Be advised also that a sick population is more expensive than a healthy one for the government, so unless US has people as healthy as people in Switzerland, costs would be a problem for government. And cost is exactly the reason for reform.

Patients have been the losers since 1994 Act that made insurers to be the winning cartel.
Switzerland seems to aim at imitaing US problems.

yes a sick population is more expensive for the gov't. so quite likely american taxpayers would feel the pinch from a public option. BUT within a few years, i'd say a decade or quite possibly less, those who were unhealthy due to inadequate health care treatment (or no access at all) could be in a healthier place. if america stopped using synthetic stuff in our food then we'd have even fewer problems. (if it causes cancer in a rat, i don't care whether it's statistically significant or not. please don't put it in my food.)

[TheColonel]

Originally Posted by rei

(TheColonel i am still interested to know why you seem to be saying we can't do tort reform at the same time we implement a public option.) .

It can be done. But last time I looked, there was no tort reform in any of the bills. The republicans want it, but the democrats don't for some reason.

To me - a moderate - I don't understand why they won't include some medmal reform in the legislation. It just seems so obvious.

Another thing the republicans want is Federally-regulated insurance (as opposed to the current state-regulated insurance). That would allow any US citizen to shop at hundreds of insurance companies (like you would shop at Progressive for auto insurance) instead of whoever is licensed to sell health insurance in their state. For example, in my state, only 5 companies sell health insurance.

5 companies = little competition = high prices
100s of companies = lots of competition = lower prices

[rei]

Originally Posted by TheColonel

It can be done. But last time I looked, there was no tort reform in any of the bills. The republicans want it, but the democrats don't for some reason.

To me - a moderate - I don't understand why they won't include some medmal reform in the legislation. It just seems so obvious.

Another thing the republicans want is Federally-regulated insurance (as opposed to the current state-regulated insurance). That would allow any US citizen to shop at hundreds of insurance companies (like you would shop at Progressive for auto insurance) instead of whoever is licensed to sell health insurance in their state. For example, in my state, only 5 companies sell health insurance.

5 companies = little competition = high prices
100s of companies = lots of competition = lower prices

Republicans actually *wanting* more Federal gov't. regulation? that is fascinating... would you be willing to link a resource that says this?

[TheColonel]

Originally Posted by rei

Republicans actually *wanting* more Federal gov't. regulation? that is fascinating... would you be willing to link a resource that says this?

Ok. Here you go: Health Care - GOP Solutions for America - GOP.gov

The second bullet point says "Let's also talk about letting families and businesses buy insurance across state lines."

This can only be accomplished by federal regulation.

It's been discussed for years, and state insurance agencies have formed interstate compacts to prevent federal regulatory takeover. (States like having total control over how insurance is sold within their borders.)

Unfortunately state-level legislation and regs tend to have unintended consequences that limit the competitive environment. Hence some states have almost no competition because most companies can't or won't do business there.

Federal insurance regulation would level the competitive playing field. Republicans support this. So do I.

[rei]

Originally Posted by TheColonel

Ok. Here you go: Health Care - GOP Solutions for America - GOP.gov

The second bullet point says "Let's also talk about letting families and businesses buy insurance across state lines."

This can only be accomplished by federal regulation.

It's been discussed for years, and state insurance agencies have formed interstate compacts to prevent federal regulatory takeover. (States like having total control over how insurance is sold within their borders.)

Unfortunately state-level legislation and regs tend to have unintended consequences that limit the competitive environment. Hence some states have almost no competition because most companies can't or won't do business there.

Federal insurance regulation would level the competitive playing field. Republicans support this. So do I.

i did check out that link... there are several links at the bottom of the page. i figured one of them would take me to proposed legislation that includes - in an obvious and stated way - something about federal regulation of providers. but i did not find any legislation proposed that stated this point. did i overlook it?

[ar81]

Originally Posted by rei

yes a sick population is more expensive for the gov't. so quite likely american taxpayers would feel the pinch from a public option. BUT within a few years, i'd say a decade or quite possibly less, those who were unhealthy due to inadequate health care treatment (or no access at all) could be in a healthier place. if america stopped using synthetic stuff in our food then we'd have even fewer problems. (if it causes cancer in a rat, i don't care whether it's statistically significant or not. please don't put it in my food.)

No. You are thinking about traditional markets.
In normal markets high demand is desirable (so profit system is desirable too), and almost perfect information about pricing and quality are available for customers.
None of those are desirable for health markets.

In the case of health, you have supply (health services) and demand (patients). Under a private system, increasing demand helps to make more profit. Costs increase as demand of more specialized services increase. Only people with money are served. People will try not to use health services to "save money", but health problems get worse if not serviced, and it makes them more expensive. Also, insurance companies produce nothing, no value added, so the only source of profit is to give less money than they actually collect, so it implies a mechanism to deny health to people.

Under a government system reducing demand is the way to reduce costs, and preventive medicine and optimizing health services in levels, is the way to address cost problems. Everyone is served, as the duty of government is to care about population. Does it have problems? Yes. Any system has problems.

Those who write articles have an ideology or an agenda. Try to enroll in the Costa Rican system, as well as in the US system. Compare them and make a decision. Costa Rica is as far away from Florida as California. Using evidence, not just words, is the best way to make a decision.

The reason why insurance companies fear public option is because they know it would level competition and would make prices quite cheap and affordable for Americans, they fear real competition. With government regulation and no public option, insurance companies may lobby and stop any attempt to level competition and bring fair prices, as well as it would set entry barriers for new competitors.

[rei]

Originally Posted by ar81

No. You are thinking about traditional markets.
In normal markets high demand is desirable (so profit system is desirable too), and almost perfect information about pricing and quality are available for customers.
None of those are desirable for health markets.

In the case of health, you have supply (health services) and demand (patients). Under a private system, increasing demand helps to make more profit. Costs increase as demand of more specialized services increase. Only people with money are served. People will try not to use health services to "save money", but health problems get worse if not serviced, and it makes them more expensive. Also, insurance companies produce nothing, no value added, so the only source of profit is to give less money than they actually collect, so it implies a mechanism to deny health to people.

Under a government system reducing demand is the way to reduce costs, and preventive medicine and optimizing health services in levels, is the way to address cost problems. Everyone is served, as the duty of government is to care about population. Does it have problems? Yes. Any system has problems.

Those who write articles have an ideology or an agenda. Try to enroll in the Costa Rican system, as well as in the US system. Compare them and make a decision. Costa Rica is as far away from Florida as California. Using evidence, not just words, is the best way to make a decision.

The reason why insurance companies fear public option is because they know it would level competition and would make prices quite cheap and affordable for Americans, they fear real competition. With government regulation and no public option, insurance companies may lobby and stop any attempt to level competition and bring fair prices, as well as it would set entry barriers for new competitors.

yes... the for-profit companies don't want it to be fair, which is one reason i have trouble with capitalism (fair market is personally preferable to "free market").
but, i thought what i said would be an example of reducing demand. people who need treatment get it, then the number of people who need treatment goes down and thereby there is less demand.
i am not very familiar with economics, took one class in college that's it. so if you would be willing to explain how, specifically, this approach is not the same as reduced demand (though it would not be immediate, it would happen in a moment over the course of history) i'd appreciate it. are you saying it is not reducing demand because it would not do this immediately?

[ar81]

Originally Posted by rei

yes... the for-profit companies don't want it to be fair, which is one reason i have trouble with capitalism (fair market is personally preferable to "free market").
but, i thought what i said would be an example of reducing demand. people who need treatment get it, then the number of people who need treatment goes down and thereby there is less demand.
i am not very familiar with economics, took one class in college that's it. so if you would be willing to explain how, specifically, this approach is not the same as reduced demand (though it would not be immediate, it would happen in a moment over the course of history) i'd appreciate it. are you saying it is not reducing demand because it would not do this immediately?

On the contrary, what you define as free market is not free.
When someone hides pricing information, when people are in debt, when you have no way to evaluate quality, customers are not free as they can't make informed decisions.

In the case of bank abuse, abuse is not freedom.

The problem is that US seemed to pass from a system that guaranteed freedom to people to a system that guarantees freedom for banks, insurance an other speculative companies, albeit US citizens. It passed from a system where economy served people to a system where people serve economy.

And if you thought that the housing bubble was a problem, there is another bubble looming that would make the housing crisis look like a fireworks show. It has to do with derivatives. That is the place where the real crisis will come from. Housing crisis was just the tip of the iceberg.

They are derivatives becuase they derivated from a document with nominal value like stocks. There are several types. For example, future contracts on any commodity, forward exchange operations, but the most concerning are the options, where an investor gets the power to buy or sell with a fixed price for a certain time. Those are very speculative operations where lots of money can be made, but also the risk is too high.

Investor basically bets that a stock will be above or below a certain price, and this is what determines if he will buy or sell. If he is a buyer, and deadline gets close with a higher price, he buys another contract as seller to cover the gap, and so on until the deadline comes and he tries to make as much money as he can.

Stock markets say speculators give liquidity to markets, while money is not used to produce and used for activities that produce nothing. It is an ocean of papers and nothing tangible. The danger is that these markets are several times the size of stock markets.

[rei]

ar81, i think we see this issue in a similar way. i do not think the free market really is free, that is why i said "free market" - because i think they take a self-serving approach to things and try to put a pretty bow on it by calling it free... to appeal to what is supposedly a core value for americans. but it is not really a free market, i think there is freedom in fairness and in what is best for everyone, not just me and mine.

i guess, when i asked you to clarify, i thought you were saying my comment about a public option did not decrease demand. but now it seems you are focusing on the negative aspects of American's political/economic structure. but maybe i am confused. at any rate, i do not agree with corporate greed and i do not agree with money being raised above people. just because i live in America, that doesn't mean i agree with corporate lobbying. i think Americans should shift our focus and organize our power to revamp this system that makes politicians capable of being bought off to vote a certain way. those members of Congress do not really vote in the interest of their constituents. so, ar81, if i am misunderstanding you feel free to clarify but i think we agree on this issue.

i don't really like the idea of making money without putting something of concrete value back into the community that will be beneficial to the collective. i think this encourages hoarding of resources and instability. so, ar81, you are preaching to the choir i think. the reason i asked you to clarify is because i thought you said my idea about reducing demand for health care by providing a public option was invalid. but maybe i misunderstood.

[ar81]

There is a difference between freedom, and lawlessness.

Freedom is about having civil rights.
The price of freedom is eternal vigilance.
It means vigilance by people, so civil rights are not lost.
Curiously in US the "vigilant" entity is government, not people.
A surveillance based government is what the USSR had: Government intervention to restrict individual freedom.

Deregulation is a beautiful word for lawlessness, the wild west.
It removes rights of consumers to give them to companies.
The idea that market regulates itself ignores basic concepts like the need of regulating dumping, oligopolies and monopolies.
With deregulation some frauds that are forbidden for people, can be committed by companies.

Government intervention? It is fine when it protects people. How is that US soldiers protect Americans against foreign combatants, but it does not protect Americans against insurance companies, banks, and it does not even offer a public option so American people may have a chance to save themselves if sick.

It seems the right to life is not granted in the constitution. Else, government should pay for your health care if you can't. If you have no money, you would not be able to have access to services to stay alive. So it means that the rights of people are determined by the amount of money they have, not granted by the US constitution in the real world.

As vote in US does not elect anyone for Federal Reserve, it means that monetary policy is not part of democracy, so US democracy is a municipal democracy with an army. And in terms of economics, it is a monarchy. They command, you obey.

[aggie]

this is why we need reform.

why have lay people in insurance companies that can't even pronounce the medical terminology they are asking me about when i try to get authorization for a test.

the reform would allow an across the board gov. regulation of insurances so this could not happen. so a test for a potentially life threatening condition would not be deemed "experimental," (which i see happen everyday), so patients that need daily maintenance meds for chronic conditions that are damaging to their health don't decide to not take them because the insurance companies won't pay for them.

i have in the last year seen two patients with proven cancer be denied a pet scan to determine the origin and possible metastisis of the disease, until a biopsy was done...they are waiting, without the dreaded "socialized" medicine, wasting precious time at the whim of archaic insurance guidelines.

at one town meeting, forget where, a congressman coldly suggested someone who needed cancer treatment and was fired from her job an lost her benefits to seek state assistance...which she would never qualify for unless she lost all of her assets, which at this point was just her home.

when asked what they want at town meetings one congressman was told: i want what you have...they were basically told to get a legislative job. nice

there is so much talk about the president and the democrats with government spending...we need to spend regenerate our ecomony...besides a big chunk of that deficit is from dubbaya's brilliant medicare d program that was never paid for.

[ar81]

It means you may register before CCSS (Caja Costarricense de Seguro Social) and pay a monthly fee in Costa Rica and that would give you right to use health services for free. If you declare a minimum wage (not sure, but I think it was like $200) the fee would be between 15% or 20% (if I remember correctly) under Seguro Voluntario (voluntary insurance) regime for independent workers.

Every month they will issue an "orden patronal" which is a document that proves that you have paid and you do not need any pre-aprovals of any kind. You may need to find a way to have it mailed to you. The only down side is that you can't quit the system unless you prove you have a job in Costa Rica.

Going to Costa Rica is like going from Miami to California.

Probably there must be some other details I forgot, because for some time, I was under that regime in the past, when I was there as independent worker. For me it was very simple: Go pay the fee every month, and if health services are needed, bring your "orden patronal", CCSS ID, and your ID (passport) to the corresponding health care center near the place where you are supposed to live.

The good thing about it is that in case of emergency, you do not have to care about any bills. Except for very specific types of complex surgery, most of problems are covered and they give you the medicines for your problem at no cost.

Of course there are a few doctors that try to promote corruption by trying to make you to use their private services, or to buy medicines outside of CCSS, but those actions would subject doctors to investigation by CCSS. Fortunately I did not have to deal with any of those. The only final recommendation is that the medical culture there is that if you pretend to be valiant and not show yourself sick, they may think you are ok, so do not do that.

It is a very useful system for things like births or accidents. You may not want to care about bills under such cases. Mothers must attend medical follow up during pregnancy, and if a mother under CCSS regime does not, then it is very likely that doctor may preach the patient for being careless.

[ar81]

I found this site that explains health reform.
Health Reform

What is proposed there reminds me very much the European health system.
I think Americans should support it.
My bet is that the final outcome may not be exactly like NHS in UK, but the closer it gets, the better for Americans.

Some stories posted at government website.

Your Stories

“My wife and I are both self employed, she left a state job 2 years back when we moved to Florida where I had taken a consulting position, I have been self employed for 15 years. We no longer were entitled to the great health benefits we enjoyed when my wife worked for the state. The issue is that our son has a pre-existing condition and we are unable to get insurance coverage for him. yes it is possible to get this coverage but at the cost of going bankrupt! I am not against paying toward health care but I do take issue when a child of 7 years of age can not get coverage due to insurance companies refising on grounds of pre-existing conditions that he shows no signs off? If we are supposedly the most advanced and caring nation in the world then how come a 7 year old child is refused health care or can not afford health care due to the high cost? Shame on us. Reform is needed urgently to address this shameful situation in our country.”

– Stephen from Florida

Your Stories

Health care reform is as important as vote of women or putting down racial discrimination.
Nowadays if you have no money, you have no right to be healthy and alive.
There is no right to life in US, only economic discrimination that kills those who are discriminated.