To all of you that are against health care reform

My neighbot's husband died last year from cancer. When he had to quit work, they lost all health insurance. Now she can't afford to buy her own insurance and is a bit too young to get Medicare. So when she need a colonoscopy, she sold her car to pay for it. She does work at 2 part time jobs, but does not make enough to pay for insurance. There is something just not right about that.

Brenda, thanks so much for starting this thread.  It's sad and infuriating to hear about situations like yours, but also important.  Because health care reform isn't some distant, abstract thing.  It's about whether or not folks will be able to keep their homes.  It's about our abililty to send our kids to college.  And in some cases, it's about life and death.

I wasn't thrilled by the process that gave us the patched-together Senate bill - all the horse trading was unseemly.  But that's what happens when an urgent issue bumps up against the insanity that is the Senate's filibuster rule. 

Here's hoping that sanity eventually wins out.  The thought of drifting along while the problems get bigger and bigger, and more people get hurt, is just intolerable.

Linda

It's always been black and white for me. How can the United States be the *only* advanced industrialized nation on earth that does not provide a public option for its citizens unless they are totally impoverished (Medicaid) or over 65 (Medicare)? It's an obscenity. We should be looking at the nationalized care systems that work the best around the world, France for example, and taking the best elements from them and ditching the rest. I have always felt this way, but getting diagnosed nearly a year ago of course brought it home. I am terrified of being laid off and facing this. My company has had two major rounds of layoffs since the crisis. I didn't take any days off for chemo except the actual hours of the infusions. I scheduled my radiation before work to disrupt as little as possible. All to be more protective of my job. People shouldn't have to hold a bake sale to get cancer treatment! I'll say it again. It's obscene.

There is a common thread in so many of these accounts, someone lost their job.  Whether through illness, or downsizing, or other cause. 

We will get health care reform.  Hopefully it won't look much like the mess that has been floating around DC lately, but it will come.  If we concentrate on starting somewhat small with those parts most people can agree are needed, neither party will be able to afford to work against it.

Bill Clinton's campaign in 1992 had a saying reminding them to focus on the economy. That advice still holds up.  If the economy is good, people are working, have money to spend, and much of the rest falls into place. 

We won't solve the healthcare crisis with one in ten people out of work.  We need everyone working to make this work.  The more financially healthy people who can contribute to the solution, the less onerous it will be on each of them. When you take the elderly, the children, the infirm, and their unpaid caretakers out of the mix, the burden on those remaining who are able to work is large, but doable.  Taking one in ten of those workers, from the group working and earning money and moving them to a position of not working and needing assistance significantly increases the burden on each remaining worker. 

I would have to agree with lassie that now, when the economy is down, is the time to get going on fixing the health care issues that the majority of your citizens either have or are very close to having. 

Didn't someone famous say something about the true test of a nation is how they treat the less fortunate and how they react in bad times?  Something like that anyways. 

I've been reading up on the healthcare reform instituted by Massachusetts in 2006, and an interesting article at boston.com by Dr. Suzanne King about why the "reform" hasn't worked.  (And it's helped me understand why Mass voters turned to Brown).

It seems to be a prime example of how to make the health insurance industry healthier, but not Mass patients.  My question is -- didn't Congress carefully examine the problems with Mass. reform?  Seems to me that the Senate bill looks to copy these "mistakes".  IMO, there is probably no way to get around it other than adopting a single-payer system, which would eliminate the "insurance guy who stands between you and your doctor".  Maybe it needs to be a state-run system, with federal dollars collected through taxes paid to the states (as we have here in Canada).  Would this help to eliminate some of the "fear of feds" that seems rampant amongst some?  In other words, simply extend Medicare to everyone......

And Enjoyful, as you pointed out earlier, a slight increase in fed taxes would offset your costs of insurance premiums, deductibles, co-pays etc., as well as the problem of pre-existing conditions and over-crowded emergency rooms.  At least you-- as a voter -- would have some say over tax increases, whereas you have no say whatsoever with rising insurance costs.

Or am I being hopelessly naive?

Beesie, I think your analysis is very thoughtful . . . but I also think you're wrong in your conclusion that a more modest bill would have been better.  The problems with U.S. healthcare are so deep, and so systemic, that you can't do modest reform and have it be meaningful.  Take the issue of coverage for people with preexisting conditions (like us).  Virtually everyone agrees that they need to be able to access coverage.  But how do you fix that in a modest way?  You can't just force private insurance companies to stop medical underwriting - then everyone would wait until they get sick to buy insurance.  So just to make  that one "modest" change requires that you either abandon private insurance altogether, or come up with some combination of regulation, mandates and subsidies.

The reason the House and Senate bills were so complicated is precisely because they WERE so modest.  They kept most of our existing system in place, and patched together fixes for the most gaping holes.  The result was Rube Goldberg-esque.  That was a huge problem, but it's not because the bills tried to do too much. 

Add in the fact that the Senate's dysfunctional rules effectively require a 60-vote supermajority to get anything significant (or even insignificant!) done, the venality/inflated egos of various Democratic and Independent Senators (who shall remain nameless here), and the unbelievably intense partisanship of the Republicans and you've got - a mess.  I totally agree that the Dem's could have handled things better, but it's important to realize the depths of the political challenge.

Linda

Linda, I see your point but I'm not sure I agree.    To the example you raised, I think that most people - the vast majority - want the security of having health insurance.  Yes, if the current provisions on pre-existing conditions were removed, some people may wait until they are sick to get insurance but those are probably the same people who today choose not to get insurance, even though it's available to them and they can afford it.  A few more people might jump into that pool, but not many, I suspect. 

And maybe the 'fix' for the type of scenerio you suggest is to include a provision in the bill that in order for the 'no exclusions based on pre-existing condition' clause to apply, someone applying for insurance must have been covered (either by a company, by their own policy or by a policy owned by someone else like their parent's) within the previous 3 months (or 6 months or whatever is reasonable).  That would encourage people who are well to get coverage because they would know that once they have coverage, they will never need to worry about losing it, should they become sick. 

That might not be the right fix but my point is that I think many of these obstacles can be worked around and figured out, if a bunch of smart, determined and committed people put their heads together.  Are many of the healthcare issues in the U.S. inter-related?  Yes, of course, and maybe some of the solutions do need to be tied together, but that doesn't mean that it's not right to try to quickly fix the problems that can be fixed, or at least, to develop partial fixes that solve the problem for as many people as possible.

Edited to add:  Lindasa, I saw your comments after I posted mine.  Ultimately single payer may be the best solution, but it's simply a fact that single payer is not acceptable to a very large percent of the American public.  Even at that, with the Democratic majority, until last week they could have pushed through single payer, if it was what they wanted.  But lots of House and Senate Democrats don't want single payer.  So it's not going to happen.  Just my opinion, but I think that the fixation on single payer by some of the left wing Dems may be the biggest roadblock to getting healthcare reform, since it keeps them from being flexible and open-minded about other options.  Less ideal options, perhaps, but still, if they can solve a lot of the problem, isn't that better than solving none of the problem with an ideal solution that can't pass Congress?

I think Beesie understands the "big picture" here in the U.S. even better than many of us who live in the U.S.

I'm a "moderate"/independent by voting record.  I've tended to alternate between the two major political parties in big elections, with an occasional nod to the libertarian candidate when I get ticked off at both the Dems and Repubs.  (See my recent comments on the "What Americans thnk..." thread if you'd like to hear what I think would be widely supported among people from both sides of the fence.)

Anyway, Beesie, you said this:

"And maybe the 'fix' for the type of scenerio you suggest is to include a provision in the bill that in order for the 'no exclusions based on pre-existing condition' clause to apply, someone applying for insurance must have been covered (either by a company, by their own policy or by a policy owned by someone else like their parent's) within the previous 3 months (or 6 months or whatever is reasonable).  That would encourage people who are well to get coverage because they would know that once they have coverage, they will never need to worry about losing it, should they become sick."

That's exactly the scheme my dh and I came up with, when we were discussing the healthcare reform dilemma while driving across the middle of Arkansas yesterday.  He and I both agreed that something needed to be done to ensure coverage of pre-existing conditions.  It's not unusual for someone applying for individual (as opposed to group) coverage here in the U.S. to be told, "Okay, we'll issue you a policy; but we won't cover any medical claims associated with the coronary artery blockages that were found in the angiogram you had last year" (etc.).  That type of coverage is almost as worthless as not having insurance at all.

But, dh and I also agreed that it was not economically realistic (here in the U.S.) to require insurance companies to cover pre-existing conditions if people are allowed to wait until they were sick before they applied for insurance.  The whole reason "insurance" works is because lots of healthy people pay into the system in advance, to cover the claims they will file years later when they get sick.  That principle is true for both private insurance and government-provided healthcare coverage (e.g., Medicare), as well as other types of insurance. 

Imagine an auto insurance company being required to issue a collision policy to someone who had just totalled his car by running into a tree and wanted the repairs to be covered?  Or, a homeowner's insurance company having to issue a policy that included fire-related damage, to someone who applied while standing among the ashes of his burned-out home?  Or, maybe a life insurance company being required to issue a policy to someone being read the last rites?  Not very realistic, is it?

But, that's the dilemma.  Nearly everybody agrees about coverage of pre-existing condtions.  But, many people (and that's a big "many", if we look at the whole country and not just a snapshot) don't think every single person should be required to have health insurance.  That feeling is so strong here in the U.S. that neither the House nor the Senate bill would have required everyone to get insurance.  Both bills were riddled with exemptions. 

If people weren't required to have insurance, but insurance companies were required to cover anyone who applied, anybody with a lick of sense and a half-empty pocketbook would drop their insurance and wait until they were sick to re-enroll. Heck, I might have even done that. That behavior would bankrupt the insurance system, whether we're talking about private insurance companies or a government-run system.

So, Beesie's suggestion is a good one.  Require companies to issue no-rider, individual policies (requiring coverage of pre-existing conditions) if the applicants can demonstrate that they had "qualifying" coverage, say, up until 6 months ago.  That would take care of the COBRA issues and job-termination and downsizing problems.  There still might need to be government (i.e., tax-supported) assistance, but the financial and philosophical hurdles wouldn't be so great.

That would be a small start.  It would motivate people to maintain coverage, as Beesie said, rather than try to game the system into giving them something for free.

otter 

Google "Remote Area Medical" I think that's what you're looking for. (ramusa.org)

It's an organization that was founded to bring free medical care to remote places in the world but they have also held clinics here in the US that attracted thousands of people. Some of whole slept on a parking lot in LA overnight so that they could see a doctor. Their stories are heartbreaking.

Patmom .. I have to agree with you.  Unemployment is at 23.9% in my area.  That means 1 in 4 have no health insurance ... and of the remaining three, many of those jobs don't offer employee medical coverage.

I truly see this as an overall economic problem.  The economy is in the tank and employers are cutting back on benefits and raising premiums for their medical plans.  Dental and eye coverage are being cut.

A while back I did a comparison of the Canadian tax system and ours.  The difference was only (generally) about 2% more in income tax, depending upon your income bracket.  Expecting the rich to pay for the poor in this time of poor economy is a stretch.  I would prefer to pay the extra 2% and have everyone covered.

A good start would be offering Medicare immediately for those on SSD.  So many of our friends with Stage IV or any other disability can't afford Cobra for the two years until SSD kicks in.  And who can afford Cobra if you've lost your job. 

I think about my dear friend who is working full time while on IV chemo for Stage IV.  She's the sole support of her family.  She has to work or she will lose her insurance and her home.  I'd pay the extra 2% if she could get coverage for SSD and stay home.

I think this is a great discussion ... and I'm learning a lot.

Bren

Interesting points, everyone.  I have a few questions:

Otter said:   Nearly everybody agrees about coverage of pre-existing condtions.  But, many people (and that's a big "many", if we look at the whole country and not just a snapshot) don't think every single person should be required to have health insurance.  That feeling is so strong here in the U.S. that neither the House nor the Senate bill would have required everyone to get insurance.

Why is that?  Does it have to do with one's "freedom" from having to pay into an insurance plan?  What good is that freedom when one is faced with a major illness -- or even a compound fracture? Or is something else involved here?

Shirley wrote:   I certainly think we could look at these states and learn from their experiences. The U.S. has probably more than its fair share of smart, educated and well-informed people working on Capitol Hill.  Why indeed haven't they studied (and learned from) the failures in states (and countries) which have instituted health insurance reform?  There are oodles of examples and lessons to be learned.  Well, my own most humble opinion is that they have done so, but when those ideas are brought to Congressional comittees, the self-interest of Congress people takes over.  Don't judges have to recuse themselves if they have a personal interest in the case brought before them?  I wonder what would happen if Sens and Reps had to do the same thing?  Or would the Committees dissolve for lack of members...

P.S.  This is such an interesting discussion to be having on a rainy Sunday afternoon!

The bottom line is that it doesn't matter if you have insurance or not, what matters is that you can afford the health care that you need.  If the price of care was more reasonable, people might not be so dependent on insurance to cover relatively routine care. 

Doctors and hospitals routinely charge insurance companies significantly less for proceedures and care than they charge their clients without insurance.  If they were forced to charge everyone the same price, then people without insurance, or who are "out of network" or who have insurance that denies coverage for something won't be subsidizing the insurance companies.

Maybe people who need care for pre-existing conditions should have to pay a penalty or fine like a large additional deductible so if they choose to go without insurance and then find out they have an problem after they get insurance, they get treatment, and it is covered, but they also offset some or all of the cost that they would have paid in premiums had they been covered all along.

Knowing that you'll get stuck paying sooner or later may help encourage people to participate from the start who might otherwise try to game the system.

There are so many good potential solutions out there, that there is no excuse for the garbage that the politicians have tried to pass off on us.  If they don't have the imaginations to come up with a good, fair, workable solution, then they should ask for help from people who do.

I don't like the idea of being forced to pay for insurance or face a tax penalty for several reasons.  Americans are fiercely independent and have had quite enough of the government forcing them to do other things.  The other thing is the concept doesn't make sense - the whole problem right now is the fact that people don't have the income to pay for even reduced insurance premiums.  Take my daughter for example - she doesn't have insurance available from her work and she barely makes enough to make ends meet.  How is she supposed to squeeze out more money for an insurance policy that she doesn't have?  So the way I see it is, penalizing the people who can't afford insurance is just punishing the ones who are the hardest up.  That particular group of people needs help the most, and our brilliant politicians want to squeeze them just that much harder.  Well, thanks for thinking that one out!  Doi!! 

One other point on that subject - it wouldn't help anyway because you don't have to pay taxes if your income is less than a certain amount, so millions of Americans who don't have to file taxes would still be uninsured.  I'm telling you, mandating insurance is NOT the answer anymore than taxing insurance policies you get at work.

The crux of our problem is the fact that we have a well-established health insurance industry now that no politician is going to put out of business with socialized health care, so they come up with all these random answers that aren't really solutions.  As long as people have to rely on insurance companies, there's no practical way to get meaningful healthcare reform.  Take for example the idea of forcing insurance companies to insure anyone regardless of their medical background.  Insurance companies base premiums on risk - that's the way the insurance industry works and they aren't in it for charitable purposes.  So if you force them to insure anyone and everyone, that will actually drastically increase the already outrageous premiums.  That way no one will be able to afford health insurance.

The only solution is a plan that provides medical assitance on a case-by-case basis according to medical bills vs income.  You can get medicaid if you're on welfare, so why shouldn't there be a medicaid program for someone other than non-productive members of society?