So at some point in the future there is going to have to be an attempt among the moderates of both parties to address the ACA. Fully half of the nation felt very strongly for a very long time that this in not the long term solution. For there to be any long term answer it is going to have to be a bi-partisan effort.

So here is KU challenge - can we, on a neighborhood chat room, set aside parochial interests and fighting for our team, long enough to have a respectable dialog on the issues.

So here is my proposal - I will start with an outline of the issue and some objectives of the system - just as a starting point - and invite all to add, subtract, comment - and see if after some time we can agree on some basic framework of a health care plan.

Let's see if we can do what we want the folks in Washington to do, just focus on a solution.

Rules:
1 respect
2. no personal value judgments - ideas can be different, better or worse - even good and bad. But not stupid etc. And no personal attacks
3. no trolling please
4. support your points - doesn't have to be with research or anything - just make it a complete thought. For example " get the government out" is not a complete thought and is difficult to argue - but "get the government out because ??? " is much better.

Ok as a starting point I will just throw a few ideas out - how about we just focus on a better definition of the problem and a better set of objectives for now.

I see 4 primary stakeholders in the healthcare system. The providers ( dr, etc), the insurers, the users, and the government. Any long term plan should be at least acceptable to all 4.

The problems:

Healthcare costs, both for actual services and insurance have been rising for a long time. They are becoming prohibitively expensive.

Too many people have no or severely limited insurance coverage. They place a burden on the rest of the system.

The objectives:

Some level of competent health care for everyone.

Healthcare insurance should be reasonably priced. 

I think regulation of costs imposed by the providers to the insurers would help in a private insurance market.

The providers currently charge insurers exorbitant amounts for procedures. The US has the highest healthcare cost (50% more than second place, which is France) with generally poor outcomes. The additional cost of healthcare is profit generation, not quality of care.

Also, private insurance only works when everyone pays in to spread the cost. 

Expand Medicare to cover every citizen. If anyone wishes to purchase additional insurance, they can. 

so to paraphrase fuzz - you would say a significant problem is the cost of services. With the reason being profit.

a second problem is not 100 pct participation.

Butter - would say your is more of an objective - to have 100 pct coverage, with a recommendation for a single payer (government system) 

Yes, exactly.

A large part of the current population rely on Medicare and Medicaid for their insured medical costs already, including Veterans care.

I'm fully aware that it involves a major change in thinking about the role of government. Unemployed people who have medical needs many times can't get reemployed without resolving those issues.

Medical care that floats with the person gives a more stable workforce. Preventative care is economically productive; it makes sense.

Other nations have figured out how to do it. We can also. 

In order to have a healthcare system that works for every citizen, we have to change the mentality of healthcare being a privilege. When people post memes about healthcare not being in the constitution, it shows how ingrained that way of thinking is.

Second, having a system where even with good insurance, a family is out thousands of dollars for a necessary procedure is wrong, imo. The average family cannot afford care which has high deductibles and will forego necessary procedures because of the cost. The fact we need to have fundraisers to help people with medical bills is wrong. This system is built on profiting off of the sick, why are we ok with that?

Same with medications. Why would any medication be hundreds of dollars for one month supply? It does not cost that much to make it. It's just another way to take advantage of an ill person.

We would need a major overhaul in how the system works, in order to make it affordable and there isn't a lot of incentive on the part of our government to do so. They talk and talk and nothing changes. Lip service doesn't help anyone. 

Same with medications. Why would any medication be hundreds of dollars for one month supply? It does not cost that much to make it. It's just another way to take advantage of an ill person.



BOSTON ? March 10, 2016 ? The most recent analysis by the Tufts Center for the Study of Drug Development of the average cost to develop and gain marketing approval for a new drug?pegged at $2.558 billion?has been published in the Journal of Health Economics, it was announced today.Mar 10, 2016



The cost to develop a new drug is about the same as developing a new car. 

seems like so far there is a view to have significant government involvement to provide universal coverage, and exert price control.

So a question to these proponents - do you envision the government acting as the insurer, or as provider ??

In some countries the government actually hires providers and therefore sets prices.

In some countries they act as insurer - paying the providers.

Which way do you see it as best, or some hybrid of these poles.

Also - is there any one who thinks there should be no, or at least minimal government involvement - and if so - how do you envision that working ? 

The cost to develop a new drug is about the same as developing a new car.?



Development and manufacturing are two different things... 

Medicare is not free. If you put everyone on Medicare, will they pay the $105/mo. premium? Medicare only pays 80%. Supplemental ins. plus prescription ins. adds hundreds per month. Is Medicare for all supposed to be free or will premiums be paid like those on Medicare now pay? 

The magical govt money tree will provide all. 

This system is built on profiting off of the sick, why are we ok with that?



A lot of people enjoy watching the rich get richer at their expense... 

The magical govt money tree will provide all.

A lot of people enjoy watching the rich get richer at their expense...

Soup - Jacka

do you have a view on this - what type of system do you see a workable? What should be the objectives of the system? What is the current problems we are trying to solve ? 

toidboid - just to take a step back - do you think that everyone in the US should have access to some level of health care ?? 

Medicare for all. Pay the $105/mth. Preventive care covered at 100%. 

So Smarty - is medicare the only insurer? or like england is private insurance is available, and providers can opt out from accepting medicare ?? 

I would like government to stay out of health care as much s possible. Did you ever read or see the movie the "Fountain Head." What government did to Rourke's design is what government does to any good private sector idea.

The solution could be a hybrid of private and government

On the private side, we could follow what Sen. Cruz proposed:

"What was surprising was that he clearly spelled out the Republican alternative to Obamacare ? something that Republicans have failed to effectively explain to the American people. He talked about portability ? how individuals should have the ability to keep their health insurance and not have their health insurance tied to an employer, especially nowadays as individuals change jobs more frequently. He also discussed how insurance prices could decrease with increased competition and an individual would be able to find the best deals by being able to buy insurance across the 50 states."

The Federal government can step in to offer a catastrophic insurance program. Where they pick up the bills after the first $5k or $10k. 

Why healthcare is so expensive

good article on why healthcare is so expensive.

No surprise - but main point of the article is we have a market based system - but the market does not work - for a few reasons.

in general i think one major role of government in this system is to regulate prices - with some combination of directly - as it does with medicare-medicaid and with enforcing or enacting anti competitive activities.

health care providers charge alot, and have huge variations in costs because they can. Insured buyers are not very price sensitive, and do not have very good information. Insurance companies just spread out these non competitive prices to their base - making them more palatable. I think there is a role for government here. 

It is not a true market based system because the consumer is taken out of the buying decision.

Allow the consumer to negotiate prices by voting with their money and you would see an immediate reduction in prices.

Universal Health care will never work, because it will have to rationed.

What should be done, is to have tiers of health care broken out by age. And government care can come in after age 62 and only offer a catastrophic plan for those under 62. We already have a system in place for poor people.

There really is no reason for a person younger than 50 to be paying through the nose for Health Insurance. 

Allow the consumer to negotiate prices by voting with their money and you would see an immediate reduction in prices.

Agree - but how do you make this happen? That is what is supposed to be happening now - but it is not working -

per the article price variations between providers for the same service can be 17 times more expensive.

How can consumers compare price and quality to make a market work ?? 

now with a nod to practicality -

I hope we can all agree that either extreme is unlikely to pass any congressional vote. -

either purely private, market base, very lightly regulated system or

Or a completely government controlled system.

No real value judgement here on which is better or worse - but neither would make if through the process. There is just too much opposition to each.

So we have to push ourselves to look at what in our ideal plan is negotiable to the other side and work to a middle. 

The KU Health Care Proposal

Cradle to grave European model. 

Quote:

the Markster --- 8 min ago - quote - hide comments The KU Health Care Proposal Cradle to grave European model.

Excellent. You get to pay for my insurance. 

Excellent. You get to pay for my insurance.

And you get to pay for mine. 

Wouldn't it make more sense for me to pay for my insurance, and you to pay for your insurance? 

Quinn - here is the issue with that. I am a 27 year old waiter in good health, never really go to the doctor. If I put that 500 bucks a month into a car payment instead of healthcare, I can trade in the scion for a 911. Chicks did Porsches, not so much health care. You ok if i don't buy in? 

When I was 20 I paid for health insurance, a car payment and rent and also contributed to a 401k.

Most young people are not irresponsible idiots. 

Regardless, the problem remains that many young people are not as responsible as you, what do you do about them? 

Were you that irresponsible? Are your kids that irresponsible? 

If you look it up, I believe it was about 25% of those under 30 that were uninsured in 2014 Let me see if I can find some more recent numbers. 

Hey I know - Let's vote everybody deserves a vacation in Hawaii and let the other people pay for it.

It seems there are just too many that are unaware of how the real world works. Somebody has to pay - it can't be free.

BTW: Nobody deserves anything.

You have the God given opportunity to earn whatever it is you heart desires. Go get it. 

I don't care if someone decides not to buy health insurance, ride a cycle without a helmet, over dose on drugs, etc. That should be their choice, but when the worse happens, they should not make the rest of us pay for their care. I've known people who would rather go on vacations, have the nice car, etc. instead of pay for insurance. They should have that choice. I'm sorry, but I'd like the government out of my business. They have never done anything better than a private company, except make everything cost more, take longer to accomplish and it usually still doesn't work. 

The trouble is when the gov't gets involved usually $0.90 of every dollar goes to admin and only $0.10 goes where it needs to go. Government needs to stay out of the insurance business. 

I agree with Sheddy and jw. A large portion of medical costs are for paperwork and malpractice insurance.
When the founders of this country said, "all men are created equal," they meant in the eyes of the law. 

If insurance companies would allow for everyone to be able to purchase insurance, there wouldn't need to be any government involvement.

As long as they pull the "pre-existing condition" card, both parties are getting involved. 

I also agree, in a perfect world - the government should not be involved.

sadly the world is not perfect.

So with no government involvement - what happens in your world when my 27 year old uninsured waiter shows up at the emergency room complaining of chest pains ?? 

what happens in your world when my 27 year old uninsured waiter shows up at the emergency room complaining of chest pains ???

Two things: They would receive the highest quality care in the world.
And then receive the highest bill in the world. 

Two things: They would receive the highest quality care in the world.
And then receive the highest bill in the world.

agree - by law they must treat him. And when he says he cant pay the bill - the hospital eats it, and then that cost is passed on to the rest of the system.

In the real world - I can not see a scenario where the government does not play some role.

The pragmatic discussion is what part between 100% and 0%.

So if you want to be an idealist and unwilling to move off either extreme - you are in effect advocating the status quo. 

So if you want to be an idealist and unwilling to move off either extreme - you are in effect advocating the status quo.?

I like the current system of insurance mandates. I work for a hospital system and non-pays (no insurance) are a killer. 

If insurance companies would allow for everyone to be able to purchase insurance, there wouldn't need to be any government involvement.

As long as they pull the "pre-existing condition" card, both parties are getting involved.

And this is the sticky part. Insurance companies will say, we are happy to cover pre existing conditions, if there is a system in place to mandate or place a high incentive for people to buy insurance.

Otherwise - they believe - people will only buy insurance - once they are ill. Insurance can not work that way.

For private insurance to work long term it must be profitable ( assume that is obvious) to be profitable - it must be able to spread risk, which means health people need to buy insurance.

It will be very hard to get existing conditions covered without mandated or very high incentives to ensure near all - or all who can purchase insurance.