Suggested Discussion Outline

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johnkarls
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Joined: Fri Jun 29, 2007 8:43 pm

Suggested Discussion Outline

Post by johnkarls »

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A. International Review (examples A-2 thru A-4 come from The New Yorker article)

A-1. All other industrialized nations have single-payer (i.e., the Government) universal health care.
A-2. Britain’s government health-care system was caused by World War II and formalized in 1945.
A-3. France’s system evolved from a payroll-tax-funded system which existed long before World War II, to include the self-employed in the 1960’s and, finally in 2000, to include everyone.
A-4. Switzerland, in 1994, required every resident to purchase insurance, limiting the cost to 10% of income.
A-5. The U.S. pattern of employer-provided insurance evolved from World War II wage controls to limit inflation – employers competed by offering health-care insurance which was not covered by the wage controls. The U.S. tax law also provides a “loophole” – if the employer paid more in wages and the employee purchased her/his own health insurance, the employee would be taxable (the employer gets a tax deduction either way, whether it pays health-insurance premiums for its employees or pays an equivalent amount in increased wages).
NB: The World Health Organization ranks the U.S. health-care system 37th in the world!!!

B. Existing U.S. Governmental Programs That Could Be Expanded to Cover Everyone

B-1. Medicare (single-payer governmental program that costs the elderly about $1,200/person/year)
B-2. The federal workers’ subsidized private-insurance programs
B-3. The Veterans’ Administration health-care system (1,200 government-run hospitals and other medical facilities which, per the New Yorker article, provides excellent care despite public perceptions).
NB: President Obama and Congressional leaders seem, according to the New Yorker article, to be focusing on opening up Medicare or the Federal Worker’s insurance to everyone – with subsidized premiums for low-income persons.

C. The Massachusetts Program

B-1. On 7/1/2007, Massachusetts began offering an online choice of four private insurance plans for people without coverage – subsidized so that the premiums are limited to about 8% of income.
B-2. A “mandate” was included with fines for failure to purchase the insurance.
B-3. Employers are required to provide insurance coverage or pay a tax, the proceeds of which partially fund the subsidy for the private insurance in B-1.
B-4. Extremely popular – all polling shows public support in excess of 67%.

D. President Obama’s Economic-Stimulus Bill Vis-à-vis Health Care

D-1. $150 billion total in new funds for health care, most to be spent within 2 years.
D-2. Includes $87 billion for Medicaid, $24.7 billion to subsidize private insurance for the unemployed.

E. President Obama’s 10-Year Budget Blueprint

E-1. $630 billion over 10 years as a “down payment” to “finance fundamental reform” to reduce costs and expand coverage.
E-2. Half funded by new revenue and half funded by savings.
E-3. Unclear (or at least “yours truly” hasn’t found an explanation), whether the $150 billion in the Economic Stimulus Bill for the next two years is part of the $630 billion “down payment” over 10 years.
NB: The $630 billion over 10 years = $63 billion/year which, per our Short Quiz Answer 7 does not even cover the $63.8 billion/year cost of health care for the 9.6 million Americans who cannot afford coverage, much less begin to make a dent in the $318.9 billion/year cost of health care for all 48 million Americans who are currently uninsured – which, in turn, does not even begin to contemplate how American employers (such as General Motors, Ford and Chrysler) will try to shift their costs for providing health care to employees/retirees to any federal program.

F. Private-Insurance (vs. Medicare expansion) Issues

F-1. Do we require insurers to provide a small number model policies (such as the 4 model policies in the Massachusetts program)? (Note that the article posted by Utah Owl entitled “Physician’s Comments” claims that private insurance companies currently provide more than 300 different policies and the physician’s cost of administering them eats up more than the excess that the policies pay above Medicare!!!)
F-2. Whether or not there is a mandate requiring everyone to buy the insurance, what about the inner-city poor who don’t buy it (if, for no other reason, than dysfunction) – do we subsidize inner-city hospitals who treat such patients gratis in their Emergency Rooms so that such hospitals no longer wind up in bankruptcy?
F-3. To what extent should insurance companies be able to tailor premiums to risks? (note that this issue relates both to F-1 (model policies) and F-2 (mandates))
F-3-a. An idea often bandied about is that requiring premiums to ignore age would mean the young are subsidizing the old and would put pressure on enforcing any mandates against the young.
F-3-b. What about other factors, such as previous health problems, etc.

G. Cost Containment – Obesity (diabetes, heart disease, strokes) and Smoking (cancer, respiratory illnesses)

G-1. More than 75% of all medical costs in America go for the treatment of chronic diseases caused by obesity or smoking – according to the President of the American Medical Association on the MacNeil-Lehrer Report (aka The News Hour with Jim Lehrer) last Thursday evening.
G-2. Should an excise tax be imposed on fatty foods and should the excise tax on cigarettes be increased either (A) to pay for the increased health care costs of disease caused by fatty foods and cigarettes, or (B) to discourage consumption.
G-3. If such an excise tax is imposed on fatty foods and cigarettes to pay for the increased health care costs they cause, should such taxes be imposed on a pay-as-you go basis or should they be imposed on an actuarial basis that takes into account future health care costs caused by current consumption?
NB: THIS ISSUE (G-3) IS THE “ELEPHANT IN THE ROOM” THAT NOBODY WANTS TO TALK ABOUT!!! HOW THE AMERICAN ECONOMY WILL SOON “HIT THE WALL” AS HEALTH CARE COSTS SKY ROCKET BECAUSE OF RECENT DRASTIC INCREASES IN AMERICAN OBESITY!!!

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