What is your opinion on Private vs Public Insurance

[GingerSnaps]

I have a 6 page report due this week on the economics of private vs public health insurance.

I had a knock down drag out argument with the two freeper sisters (again) over the cost and savings on why our country would save money in the long run if we changed over to the health care system like Canada and England has.

My Professor told me that there are other public health care systems ie. The VA, Public Aid and Medicare and I can't think of any other forms of public insurance.

Private would be HMO, PPO and the old standard BCBS. He said that I was missing a few.

My argument is going to be about the cost of the hospital, pharmacy expenses, medical care, etc.

Also, we had a debate about the uninsured and my opinion is that the middle class are the ones that are uninsured. Freeper sisters said that I was wrong and that it's the poor. I debated them back about the poor being able to qualify for Medicaid and the rich can afford private insurance.

If you have an opinion of this can you please tell me if i am wrong or not?

:shrug:

[cmd]

1. Check out SPAN Ohio

http://www.spanohio.org/

WHO WE ARE – The Single-Payer Action Network Ohio (SPAN Ohio) is a statewide coalition of individuals and organizations in Ohio that seeks fundamental health care reform in our state and country so that every resident is guaranteed full and comprehensive coverage. This includes the full range of medical services, hospitalization, prescriptions, vision care, dental care, mental health care, long-term care, and care for all injuries and illnesses. We advocate the establishment of a public fund that would pay all health care bills without co-payments or deductibles. The plan we call for is sometimes referred to as a single-payer, health-care system.

If you PM me your address, I can get you some literature in the mail tomorrow. I just went to my first SPAN meeting last week. It's an interesting, bold concept.

[GingerSnaps]

2. How much are they charging?

Is it for single individuals as well as families?

[cmd]

7. A few quick answers

It would cover everyone. There would be no point of service charge. Bills would go to the Ohio Health Care Fund.

So, you ask, who pays for it? Individuals making less than $87,900 a year would pay no additional taxes. Incomes above that would be assessed a rate of 6.2 per cent with an additional 5% kicking in for those making over $200,000.

There would be an administrative cost savings of 11.6 billion.

Employers would pay a 3.85% tax, far below the 12-15% they now pay for private insurance.

Businesses would pay up to a 3% gross tax receipt tax.

The remaining funds would come from existing government source.

[burythehatchet]

3. You do need to round out your market research a bit

but your basic thesis is headed in the right direction. Private health plans are essentially marketing organizations. They inflate the cost of delivery by 25 to 35% when profit and administration are included. So there is a natural proclivity towards adverse selection. Rather than stay with a patient, the patient must always change his insurance depending on employer (WHY????). So there is plenty of opportunity to drop "at-risk" persons. This leads to poorer care planning.

Patients are also have an incentive to reduce the level of health care access. Deductibles, coinsurance, and other cost sharing measures do little to encourage timely access. This leads to public health care systems to come under great stress. Why? Because the emergency room is often the first level of care. Especially in urban areas.

At its core, the problem is the huge profitability that is built into the system. Just as with the drug companies, our costs keep increasing becasue we continue to pay for the required rate of return set by investors.

HMO's and other forms of managed care were going to be the delivery system that saved healthcare. By providing early intervention to health problems and by offering preventive services Kaiser Permanente developed a promising model in California. But the model was co-opted and the entire system turned on its head. I had to wait a year to be treated for a sports injury. It ended up costing them 4X as much.

Universal healthcare is the only logical solution. Personally, my philosophy is that if a service is necessary for survival, it should not be privatized. We regulate electricity more than we regulate health care. (not reimbursement, which is incredibly regulated, but the actual delivery structure).

[GingerSnaps]

5. I also think that the insurance industry shouldn't be profit driven

If someone is making profits off of the premiums and they want to give investors a big return on their investment dollar then somewhere along the line the money will make the decision on whether or not you will be treated for an illness and if the illness at some stage is considered too far gone to pay for.

I also think that Doctors shouldn't be able to do assembly line surgeries.

If someone goes into the medical field to become a millionaire instead of wanting to save life's then medical care would be questionable. You would always be afraid to have surgery because you wouldn't know if the Doctor was performing the surgery for profit or because it was necessary.

[nbsmom]

4. You've confused delivery systems with payor types

Yes, I do tend to have a few opinions about the state of the health care system in our country. ;-)

I do know a bit about current health care systems, pros and cons, and the biggest argument against switching to single-payor is that it gives individuals little, if any, incentive to remain an active participant in the delivery of their health care.

Free market -type solutions work on a couple of levels that single payor does not, specifically in terms of providing most appropriate level of care at the most efficient cost ... IOW, it provides an incentive for patients to become smarter consumers about the best outcome, in terms of quality of care and time to delivery as well as the cost of care.

I agree that single-payor does also offer some advantages, most specifically, it allows everyone to have a level of coverage (so no uninsured), but then where do the incentives for those with chronic conditions maintaining a certain level of self-care go? Currently, those programs are in their infancy, but they hold a great deal of promise. It's kind of scary to think that if the employer-sponsored version of health care is replaced by a government-sponsored version how little incentive people will have to stay involved in the quality and cost of their care. In Canada, it tends to be you get what you get when you get it...a sentiment I don't see going over very well here in the land of the free to flaunt your wealth.

A hybrid program would be an HMO or PPO type program with some cost-containment/quality of care incentives built in. The HMO-type program would be most useful for people who are dealing with a chronic condition like asthma or diabetes. There would be a greater level of information available to all of the care providers involved, because the interaction with the patient would be continuous, from Rx to regular checkups. Remember, chronic conditions left untreated tend to come back into a health care delivery system at a very expensive and difficult to treat level, so we would want to have that as an option. On the other hand, people with good overall health would probably appreciate having a greater flexibility in terms of when and where they'd enter the system...something more along the lines of a PPO, meaning that they would still have some level of information sharing, particularly because if they did need emergency hospitalization or some sort of medication, you would want to have that information available to the care providers. But health care delivery systems

Public health care systems are Medicare, TriCare (Military), VA, Medicaid.

Current types of health care delivery systems through private/Employer-sponsored health plans: HMO, EPO (Exclusive Provider Organization), PPO, POS (point of service), fee-for-service, BCBS (contracted fee for service arrangement).

Regardless of whether the system stays private or goes single-payor, nothing will really happen unless they get Big Pharma and hospital chains to sit down at the table and truly negotiate. That's why the Medicare Rx benefit is such a joke, because Medicare recipients got robbed and Big Pharma is the big winnah. They have no incentive so far as I can tell to change their ways. And if Bush does have his way in his attempt to privatize social security, medicare will be the next to get gutted.

[miss_kitty]

6. it is my understanding that one of the largest consumers of

socialised medicine is the US Gov't. The Military, the federal employees.

And one of the few sentences i allowed the asshat in chief to finish was that the superior system enjoyed by our lawmakers, him and his cabinet could not POSSIBLY be extended to us, the unwashed, the hoi polloi because it's too expensive. $7000 and some change per year. Total bastard

[yellowdogintexas]

8. a key element is the size of the group

The larger the group, the broader the spreak of the risk.

example: a group (such as employees of a certain company) of 100 or
less employees will incur very high premiums and reduced negotiating clout in setting up their plan

This type of plan can be fully funded (underwritten by an insurance company such as Blue Cross, Aetna, Pacificare, etc. Also, a fully funded plan is usually subject to all regulations the state insurance board can dish out...... or the plan can be
self funded by the employer. In this case, the employer develops a coverage plan, usually in hand with a Third party administrator to handle the claims, and agrees to pay out of its own pocket the actual medical expenses up to an annual cap for each covered person. Premiums are still pretty high; also some state regulations do not apply to self funded plans.

now if your group has 1000 potential covered person, you have more clout w/ the networks and insurance companies and you get lower premiums. The reason is that you automatically factor in more healthy people...and so on . One of the reasons the fed govt employees have such a good plan is that there are so many of them. Same w/ any large employee pool.

For the life of me, I have never been able to understand why all of us who are uninsured for whatever reason could not go into some sort of national risk pool ..there are supposedly 45 million of us who are not iinsured and make too much money in the household for Medicaid, too young for Medicare. If such a plan were available, if you lost your benefits, you could immediately join the national pool, stay there until you got your benefits back and never lose your continuity of coverage. Rates could be means tested..if you make less money you pay less premium.

The structure of your plan can be a straight fee for service, a PPo discounted plan, EPO discounted plan, a hybrid of these two, or an HMO plan. Networks exist all over the country for various plans to use and these networks negotiate fees with insurors in exchange for guaranteed patients.

I worked for a Third Party Administrator for several years and learned about a large number of different plan structures during that time. I have also worked for HMO's, small group and individual companies and Medicare, all in claims..the complexity and confusion in the health care coverage industry is nothing short of mindboggling.

One of the other responders mentioned profitability..you hit that nail on the head.
Either the self funded insurers are trying to keep their plan from bankrupting the company or the fully funded ones are trying to keep their premiums down...and the underwriting insurance company is building a profit margin into those premiums. Bet ON it!

And the number one reason they do not want a national plan that is the same for all of us is their fear of losing all their high paying clients.

Hope this helps