Getting rid of entitlements or County Cooperatives

reefedjib · Feb 7, 2010

megaprogman said:
Yeah, sorry I missed 4. It was like 5 am and I have a stomach virus right now, so I may not be completely mentally here.

My only remaining question is #2. During a recession, we have a choice, either let services suffer or we borrow. I believe it is often better to borrow because increasing desperation and decreasing funds in a recession will often lead to a deeper recession and more suffering. Right now most states and counties have to have a balanced budget. This would have to be changed. So, I am not sure we would be better off overall in terms of overall debt.

Ok, that what you mean. I did address this in the proposal on page 6. I talk about establishing intragovernmental loans, so the fed can borrow from the market, which the state/county cannot do, and then extend it to the state/county.

The problem with this on reflection is as you say, states and counties need a balanced budget. It should not incur debt.

An alternative may be to allow the fed to borrow money and then give the money to the state/county as a "bailout" - no debt incurred by the state/county.

I hope you feel better.

You claim to be a Very Conservative Democrat? What's that? Blue Dog?

Slartibartfast · Feb 7, 2010

reefedjib said:
I hope you feel better.

You claim to be a Very Conservative Democrat? What's that? Blue Dog?

Thanks. Especially since I have a job interview tomorrow for something that could possibly get me 20k per year more. I need to recover fast

I am not registered with any particular party, but I am actually liberal, I just forgot to change it.

reefedjib · Feb 7, 2010

megaprogman said:
Thanks. Especially since I have a job interview tomorrow for something that could possibly get me 20k per year more. I need to recover fast

I am not registered with any particular party, but I am actually liberal, I just forgot to change it.

You should be a Whig!

If you are in Georgia, they have a strong chapter running. (GMWP - Home)

reefedjib · Feb 7, 2010

drz-400 said:
reefedjib said:

Well, it isn't like the public option since the public option is a direct government program. Co-ops are semi private. There funding comes from public sources, but their operations are private.

How else can you guarantee universal coverage?

Click to expand...

I support a public option or the co-ops like you proposed. Your right, it is not exactly the same, because yes it will be privetly operated, however, the main idea of it is the same. Its main function would be to control health costs and to provide to those who cannot afford them at the current prices. Its a good idea.

there was one proposal on the health care reform somewhat similar to yours earlier from senator kent conrad in north dakota. He wanted to make some state level co-ops as a way to compromise with republicans and democrats about a public option.

Senator Kent Conrad | North Dakota

Health Care Co-Operatives: Doing It the Right Way

I think it may have died however because the cbo released a report showing it would have a relatively small impact on the budget defecit.

Thanks for the link from the Heritage Foundation! I learned a lot and it seems that what I am proposing is specifically a GSE, a government-sponsored enterprise - like Fannie Mae, since the "Co-op" would be taking government subsidies.

Let me talk specifically about the Healthcare "Co-op", since that is the larger of the two I am proposing.

The Heritage link on Health Care Co-Operatives never actually states what a co-op is. It is a bit of a political piece in it's own right. They never actually say that a co-op is a member-owned and operated organization. They talk about how they are used to concentrate purchasing power for their members.

Heritage said:
The co-op concept is also longstanding and widespread in the insurance sector, where it is known as a "mutual" insurance company.

Heritage said:
When it comes to health care, a group that "organizes" coverage provided by insurers could be structured as a co-op, and a company that provides insurance could also be structured as a co-op. Both could be present in the same market.

Heritage said:
In the case of cooperative or mutual insurers, while they are a longstanding feature in most other insurance markets, they are not found in today's health insurance market. Instead, current health insurers are organized either as stockholder-owned companies or as non-profits operated (at least in part and at least in theory) for charitable purposes beyond simply selling health insurance. There is a reason for this, as discussed below.

Heritage said:
If Congress wants to provide Americans access to health co-ops, it would need to make it possible for an institution to combine tax-exempt (non-profit) status with mutual insurance status, something health plans cannot do today. Congress should allow mutual health insurance companies to form based on the credit union model. Under this model, Congress would simply grant non-profit status to mutual insurance companies, justified by the "member benefit" they provide.

Now, in talking about a GSE model, where the co-op receives subsidies:

Heritage said:
A health insurance GSE, with its close relationship to the government, would tilt the market playing field and open the door to political manipulations--both of which would ultimately harm consumers. It would also create unjustifiable and unaffordable taxpayer exposure to financial risk.

The article does not go into why these may be true. I think that since our co-ops are not federal, that that changes the picture.

Heritage said:
Health care cooperatives can work as private entities in a private market and give another choice to families, but they have to be done right. Here are several principles that must be a part of any co-op model:

Cooperatives must be voluntary, open to individuals who choose to freely join together without coercion or restraint, and controlled by its members, not the government;

Cooperatives must be viable on their own and must not receive anti-competitive government support in any form including assumption of risk, "start-up" capital, or continuous subsidies to the organization--which would turn them into government-preferred public plans;

Health plans must be selected only by a co-op's members, not the government;

Competitiveness must be based on the member strength of the cooperatives and not on any favored status, including government subsidies, access to government pricing, coverage or coding decisions, or regulatory intervention;

Any necessary regulation to keep a level playing field among health plans must be reserved for the states;

State reforms should open doors to competition, including the competition that cooperatives would bring; and

All individuals--including those who receive public subsidies and individuals eligible for Medicaid or SCHIP--should be free to join cooperatives of their choice.

Here is how the Healthcare Co-ops, I am proposing, fare on these principles:

It is controlled by it's members and is voluntary
FAIL - we accept continuous subsidies to pay for uninsurable members
It is member-controlled
Given the subsidies, it is unclear how that affects competitiveness
indeed it is
it should - we should open the door to competition across state lines
indeed they are. Only those with private healthcare are not free to join

The problem we are facing, as I see it and others have mentioned, is that the elderly, those with pre-existing conditions and the poor are all uninsurable. With a straight co-op, the membership premiums would be through the roof. So how do we insure them? It is a community problem, as the community ought to care for them, therefore, local taxes are used to insure them. This meets the set of criteria:

Necessity: Healthcare is a necessity for a well functioning society, designed along the lines of education.
States’ Responsibility: Each county will implement their own healthcare coverage.
Coverage: Everyone is covered - no exclusion for pre-existing conditions.
Affordability: Co-pays and a maximum outlay.
Choice: You can choose the doctors, specialists and drug companies you do business with.
Competition: Drug companies, hospitals, research labs, equipment/device companies all compete.
Portable: Healthcare services can be utilized away from your home county.
Funding: Property taxes at the county level forms the baseline. State income tax and consumption tax allows the state to assist targeted counties. Intragovernmental loans should be available from the federal government to bridge recessions. Per doctor co-pays of $50, with a maximum amount per year. Assistance for the poor can be provided.

especially numbers 1, 3 and 4.

I feel comfortable continuing to call my proposed organizations, Co-operatives, even though they receive government subsidies. This is because they are member-owned.

reefedjib · Feb 7, 2010

I did a little more research into what defines a Co-op. Wikipedia is my friend!

First a link on Co-ops: [ame=http://en.wikipedia.org/wiki/Cooperative]Cooperative - Wikipedia, the free encyclopedia[/ame]

Then a link on: Consumers' cooperative - Wikipedia, the free encyclopedia

Finally a link on the: [ame=http://en.wikipedia.org/wiki/Rochdale_Principles]Rochdale Principles - Wikipedia, the free encyclopedia[/ame] of what defines a Co-op.

These principles are:

Voluntary and open membership
Democratic member control
Member economic participation
Autonomy and independence
Education, training, and information
Cooperation among cooperatives
Concern for community

Based on this list, Healthcare Co-ops

Unsure - If membership is defined as all homeowners, then membership is mandatory. If membership is defined as all Co-op customers, then membership is voluntary for all the poor, elderly and those with pre-existing conditions.
How do members vote? Depends on who the members are.
Capital is reinvested - facilities are purchased and staff is hired. "developing their co-operative, possibly by setting up reserves, part of which at least would be indivisible".
This is the interesting one - funding is external.
Definitely!
Definitely! Cooperation between neighboring counties is a must.
By it's very essence.

While the answer to the first one is important to define, the fourth item is most interesting given the funding model. The fourth item states:

ICA's Statement on the Co-operative Identity said:
According to the ICA's Statement on the Co-operative Identity, “Co-operatives are autonomous, self-help organizations controlled by their members. If they enter to agreements with other organizations, including governments, or raise capital from external sources, they do so on terms that ensure democratic control by their members and maintain their co-operative autonomy.”

So the question of membership becomes doubly important. If the membership is defined as a tax-payers, or property tax payers, then the members are the funding source.

The Mark · Feb 7, 2010

reefedjib said:
Links, lists, and stuff...

Very informative, I thank you.

This, indeed, seems like an at least somewhat plausible idea to greatly reduce or eliminate health care issues.

I am curious, however, as to what opponents of this proposal/idea have to say.

reefedjib · Feb 7, 2010

The Mark said:
Very informative, I thank you.

Sweet, glad you like it!

The Mark said:
I am curious, however, as to what opponents of this proposal/idea have to say.

Me too, me too.

Arch Enemy · Feb 7, 2010

I love the plan.

I think a card system could be helpful not just for keeping track of patients home counties, but for their medical conditions. If you find some guy passed out on the high way and he is check into the local emergency room, they could identify if there's been any previous issues with this guy with the card.

I think that a system is do-able at the county level, but at the Federal level is borderline insanity to believe a handful of people could possibly figure out what is best for the nation.

lizzie · Feb 7, 2010

The idea is certainly intriguing, but a couple of hitches I see would be:

Tax sources widely range in specific geographical areas. Large urban areas have large businesses and a higher concentration of wealthy people (as far as I currently know- maybe I'm wrong). Smaller towns tend to have a higher porportion of elderly and poor, thus lower tax receipts at the property and/or state tax end of the scale. These more rural areas probably have a higher requirement for outlay based on the population. Again, maybe I'm wrong, but this is my personal anecdotal observation. You would have to have more "regional" rather than local sources for payment.

Since Social Security and Disability funding come from the Federal level, then it seems that there would be a problem with the Feds dictating who "qualifies" for "poor health care", and the locals would have no say in determining where their local/state tax dollars are going.

Last, but not least, when the Feds have any part whatsoever in funding or determining funding of any program, they set the rules and regulate it.

I don't know. I'll have to mull this over more. My first reaction was generally positive, but having dealt with the Federal government on reimbursement, in a business setting (healthcare business) in the past, I'm skeptical with what I can glean from how this plan would work.

Goshin · Feb 7, 2010

reefedjib said:
I am curious whether people would be in favor of the following proposal. It is only 4 pages long so please take a moment. The budget is not worked out, but assume it will be.

http://vawhigs.org/dp/County Cooperatives.pdf

If you answer NO, please post and tell me why.

thanks.

It's not the worst idea I've heard, but I have reservations.

In a sense it is moving the problem of entitlements from the Fed level to the State and local level. States and counties would typically have to increase their taxes. Presumably the Fed would be lowering their rates... presumably. I wish I could trust that.

On one hand it puts things more in local control, and I like that aspect of it. That could also be a problem for some states and counties... some places have far more people on the dole than others, and if they have to pay their own way locally then property taxes are going through the roof. This can result is productive people moving out, further worsening the producers-to-leeches ratio.

Also, any plan that purports to address the entitlement problem without taking on Social Security isn't really fixing the issue. SS is going to either go bankrupt, or break us entirely, within a generation. It has to be reformed or phased out or replaced with something more workable.

On the whole it is an intresting idea, but I don't think it would really help overall. It might "solve" certain Fed problems, but at the expense of creating state and local problems.

reefedjib · Feb 8, 2010

Arch Enemy said:
I love the plan.

I think a card system could be helpful not just for keeping track of patients home counties, but for their medical conditions. If you find some guy passed out on the high way and he is check into the local emergency room, they could identify if there's been any previous issues with this guy with the card.

I think that a system is do-able at the county level, but at the Federal level is borderline insanity to believe a handful of people could possibly figure out what is best for the nation.

Wow, I am really glad you love it!

For sure, it isn't perfect. I am increasing the number of people covered, by a lot, so the taxes is an issue.

The issue with card-based medical records, whether they are stored on the card or the card can be used to unlock the records over the net, is security and privacy. If the card carries or unlocks data, how do we insure that only authorized users can access it?

Thanks for commenting!

reefedjib · Feb 8, 2010

lizzie said:
The idea is certainly intriguing, but a couple of hitches I see would be:

Thanks for commenting, lizzie! I am so glad you find the idea intriguing.

For sure, it isn't perfect. I am increasing the number of people covered, by a lot, so taxes is an issue as they will have to increase.

Tax sources widely range in specific geographical areas. Large urban areas have large businesses and a higher concentration of wealthy people (as far as I currently know- maybe I'm wrong). Smaller towns tend to have a higher porportion of elderly and poor, thus lower tax receipts at the property and/or state tax end of the scale. These more rural areas probably have a higher requirement for outlay based on the population. Again, maybe I'm wrong, but this is my personal anecdotal observation. You would have to have more "regional" rather than local sources for payment.

I had thought of this as well, but I didn't make it clear. Different states will use a different mixture of taxes available to it. These can be property taxes, which would be an advantage to populous states with urban areas, or income/consumption taxes, which may be more appropriate to rural states. One concern I had was farmers. They have large property holdings but low incomes. They tend to operate on a margin. Increasing property taxes would be devastating. The bottom line is that it is up to each state.

There is also the issue of who will need to be covered. There seem to be higher elderly populations in certain states, increasing their burden. Balancing this is that many urban areas have many poor. I definitely think that each state needs to be able to care for the people it has, so no federal funding. It is up to each state how they pay for this.

Since Social Security and Disability funding come from the Federal level, then it seems that there would be a problem with the Feds dictating who "qualifies" for "poor health care", and the locals would have no say in determining where their local/state tax dollars are going.

I need to separate these two, as I haven't given any thought to Disability.

For Social Security, I didn't realize there was an evaluation of "poor". I thought simply that you were covered. As such, they would be eligible in the Co-op as retired and not have a premium. Am I wrong?

What's Disability? Is there a federal program? It should be included in programs that are removed from the federal level. It may result in the situation you are describing, where the feds determine eligibility. Tell me more.

Last, but not least, when the Feds have any part whatsoever in funding or determining funding of any program, they set the rules and regulate it.

We want to avoid that at all costs. It is none of their business.

I don't know. I'll have to mull this over more. My first reaction was generally positive, but having dealt with the Federal government on reimbursement, in a business setting (healthcare business) in the past, I'm skeptical with what I can glean from how this plan would work.

I am glad your reaction was positive. But tell me how it wouldn't work. Where is it weak? How would you structure healthcare reform?

Cheers!

reefedjib · Feb 8, 2010

Goshin said:
It's not the worst idea I've heard, but I have reservations.

Thanks for commenting, Goshin!

In a sense it is moving the problem of entitlements from the Fed level to the State and local level. States and counties would typically have to increase their taxes. Presumably the Fed would be lowering their rates... presumably. I wish I could trust that.

It would be part of the legislation enabling this. The fed's budget would fall 37%. Whatever that amount is, states are going to have to take it on. Therefore, the fed has to drop it's tax receipts by that amount. A couple of things: first is that we are not touching Social Security, so those receipts are untouched. This means that the $$ amount of 37% of budget comes out of non-SS tax receipts. Second, the fed runs a deficit, therefore, if we remove the $$ amount of 37% of budget, it actually reduces the tax receipts by more than 37%. The fed would run a higher deficit. It's totally screwed up.

On one hand it puts things more in local control, and I like that aspect of it. That could also be a problem for some states and counties... some places have far more people on the dole than others, and if they have to pay their own way locally then property taxes are going through the roof. This can result is productive people moving out, further worsening the producers-to-leeches ratio.

Please see my response to lizzie on this topic.

Also, any plan that purports to address the entitlement problem without taking on Social Security isn't really fixing the issue. SS is going to either go bankrupt, or break us entirely, within a generation. It has to be reformed or phased out or replaced with something more workable.

I am claiming to take on a significant part of the entitlement problem, but not the entire problem. SS is screwed up. It is an unfunded liability in that current payments from productive works pays for current recipients. The government has obligated to the current recipients the payments. Furthermore, these payments are based on income of the recipient.

The government can't tell future recipients that they wont be covered but they still have to pay.

We can't take on SS recipients through the Co-op and expect a Co-op in SC to pay for the income-base payment for a retiree from NY.

I decided not to touch it and let it get resolved separately.

On the whole it is an intresting idea, but I don't think it would really help overall. It might "solve" certain Fed problems, but at the expense of creating state and local problems.

It does shift the burden to the local government, but they would be the one collecting taxes to resolve those problems.

Cheers!

lizzie · Feb 8, 2010

reefedjib said:
One concern I had was farmers. They have large property holdings but low incomes. They tend to operate on a margin. Increasing property taxes would be devastating. The bottom line is that it is up to each state.

They also have large property holdings, but pay relatively low property taxes due to agricultural exemptions. Their property taxes would likely not rise.

reefedjib said:
There is also the issue of who will need to be covered. There seem to be higher elderly populations in certain states, increasing their burden. Balancing this is that many urban areas have many poor. I definitely think that each state needs to be able to care for the people it has, so no federal funding. It is up to each state how they pay for this.

The concentration of elderly populations seems to be in small towns and rural areas, where costs of living and taxes tend to be smaller, but the needs of the community (health related) seems to be higher, due mostly to aging-related health problems.

reefedjib said:
For Social Security, I didn't realize there was an evaluation of "poor". I thought simply that you were covered. As such, they would be eligible in the Co-op as retired and not have a premium. Am I wrong?

It's not so much an evaluation of "poor", but federal programs seem to be mostly focused at that level in the general population when it comes to handing out subsidies such as welfare and other programs. I would think a good portion of those who qualify for free health care at a local or state level, are already on the federal roles for federally funded welfare programs, so what I am saying is that the government subsidized programs, at local, state, or federal levels, will be close to the same targeted population. I don't foresee differing standards of determining who qualifies for subsidies, and it seems it would be adding a new level of bean counters and paper pushers on the local or state level. We would in effect be paying more people to determine the same data and information.

reefedjib said:
What's Disability? Is there a federal program? It should be included in programs that are removed from the federal level. It may result in the situation you are describing, where the feds determine eligibility. Tell me more.

There's two different disability programs at the federal level. The funding for one of them comes from the general fund, and the other comes from Social Security funds. They pay monthly incomes for those who qualify as disabled, for a variety of reasons. The numbers on these rolls are growing and keeping lots of people out of the working population, adding to the tax burden on the productive. Some of them truly are unable to work, but it seems to be a highly abused and over-utilized system.

reefedjib said:
One concern I had was farmers. They have large property holdings but low

I am glad your reaction was positive. But tell me how it wouldn't work. Where is it weak? How would you structure healthcare reform?

It would shift the burden from the federal to the local and state levels, and most likely (from what I can tell) wouldn't lessen costs, and perhaps raise them instead.
If I were going to restructure health care, you wouldn't recognize it.

It would look more like the health care model in the 60's, and shift the responsibility of payment for routine care back into the hands of the consumer.

Slartibartfast · Feb 8, 2010

Ok. I have been watching this thread and while Reefedjib is doing a great job answering questions, the very fact that there are so many questions about what happens to which group tells me that this scheme will not work or at least it will not be any simpler or less costly than what it will be replacing.

Think about it, if you have any system where you have to start accounting for the multitude of different situations that occur for different groups of people, you are going to end up with a system as complicated and as bloated as the one you are replacing.

reefedjib · Feb 8, 2010

megaprogman said:
Ok. I have been watching this thread and while Reefedjib is doing a great job answering questions, the very fact that there are so many questions about what happens to which group tells me that this scheme will not work or at least it will not be any simpler or less costly than what it will be replacing.

Think about it, if you have any system where you have to start accounting for the multitude of different situations that occur for different groups of people, you are going to end up with a system as complicated and as bloated as the one you are replacing.

There is another option which is that the domain is complicated and any plan will have to meet that complexity. In addition, I am attempting to do more than just healthcare.

I see the complexity rising in a few areas:

state/local funding - how are taxes raised to pay for this?
personal payment - what are the peremiums and co-pays? It is up to each state.
benefits - who is covered and who gets subsidized? Poor, elderly, disabled.

There definitely needs to be a way to classify people as poor, elderly or disabled.

reefedjib · Feb 8, 2010

lizzie said:
One concern I had was farmers. They have large property holdings but low incomes. They tend to operate on a margin. Increasing property taxes would be devastating. The bottom line is that it is up to each state.

Click to expand...

They also have large property holdings, but pay relatively low property taxes due to agricultural exemptions. Their property taxes would likely not rise.

I think that agricultural exemptions would apply.

The concentration of elderly populations seems to be in small towns and rural areas, where costs of living and taxes tend to be smaller, but the needs of the community (health related) seems to be higher, due mostly to aging-related health problems.

This would have to be funded through state level taxation and disbursement by need to the appropriate counties.

It's not so much an evaluation of "poor", but federal programs seem to be mostly focused at that level in the general population when it comes to handing out subsidies such as welfare and other programs. I would think a good portion of those who qualify for free health care at a local or state level, are already on the federal roles for federally funded welfare programs, so what I am saying is that the government subsidized programs, at local, state, or federal levels, will be close to the same targeted population. I don't foresee differing standards of determining who qualifies for subsidies, and it seems it would be adding a new level of bean counters and paper pushers on the local or state level. We would in effect be paying more people to determine the same data and information.

So who determines whether someone is on welfare or disability. That's a great point. I'll have to let that rest a bit. I do think that the county reps know best. We would eliminate the federal programs.

There's two different disability programs at the federal level. The funding for one of them comes from the general fund, and the other comes from Social Security funds. They pay monthly incomes for those who qualify as disabled, for a variety of reasons. The numbers on these rolls are growing and keeping lots of people out of the working population, adding to the tax burden on the productive. Some of them truly are unable to work, but it seems to be a highly abused and over-utilized system.

So, like welfare, they would pay a stipend. Like I said about, I don't know who would evaluate them as disabled. When they are, they would be covered under both the Community Co-op and the Healthcare Co-op. For the Community Co-op, they would receive a stipend, but perhaps reduced with access to a food co-op to get free groceries.

It would shift the burden from the federal to the local and state levels, and most likely (from what I can tell) wouldn't lessen costs, and perhaps raise them instead.

Yes, it would shift the burden and since I am talking about covering people who were not previously covered, the costs would go up.

If I were going to restructure health care, you wouldn't recognize it. It would look more like the health care model in the 60's, and shift the responsibility of payment for routine care back into the hands of the consumer.

I'd love to hear it! It might give me some good ideas...

lizzie · Feb 8, 2010

reefedjib said:
I'd love to hear it! It might give me some good ideas...

Okay, here goes.

I don't know your age, but I would bet you don't remember the era of people who paid for doctor's office visits and their own prescriptions.

In the 1970's, Congress passed HMO legislation, effectively requiring insurance companies to provide coverage for routine care and drugs. What this has done, in effect, is contribute to the rising prices of these services. People who have health insurance (private) do not have to be conscious of costs. They pay their monthly premium and it's all taken care of with the exception of small co-pays for office visits and prescriptions. That all sounds really fun, but it has taken the responsibility off of everyone but the insurance company to care about costs. The doctor doesn't care if drugs are expensive, the patient doesn't care because he's just paying his small co-pay. This has contributed to a national mentality that running to the doctor and taking a pill for every perceived problem is cheap. It's not cheap. What is happening now is that the astronomical costs of covering all these things that used to be paid out-of-pocket, is being seen in rising insurance premiums.
The primary problem (imo) is not one of money, but one of mind-set. We think and act like sick people who want all our needs met free-of-charge. It is a problem that cannot be fixed with entitlements.

reefedjib · Feb 8, 2010

lizzie said:
Okay, here goes. I don't know your age, but I would bet you don't remember the era of people who paid for doctor's office visits and their own prescriptions.

In the 1970's, Congress passed HMO legislation, effectively requiring insurance companies to provide coverage for routine care and drugs. What this has done, in effect, is contribute to the rising prices of these services. People who have health insurance (private) do not have to be conscious of costs. They pay their monthly premium and it's all taken care of with the exception of small co-pays for office visits and prescriptions. That all sounds really fun, but it has taken the responsibility off of everyone but the insurance company to care about costs. The doctor doesn't care if drugs are expensive, the patient doesn't care because he's just paying his small co-pay. This has contributed to a national mentality that running to the doctor and taking a pill for every perceived problem is cheap. It's not cheap. What is happening now is that the astronomical costs of covering all these things that used to be paid out-of-pocket, is being seen in rising insurance premiums.
The primary problem (imo) is not one of money, but one of mind-set. We think and act like sick people who want all our needs met free-of-charge. It is a problem that cannot be fixed with entitlements.

I don't know if you noticed, but I set the co-pay for the Healthcare Co-op to $50 to try and place more fiscal responsibility on the patient.

Kandahar · Feb 8, 2010

Here are my objections to this idea:

1. You can't simply devolve a program from the federal government to the local governments and expect it to work the same. In many ways, this is no different than simply abolishing the entitlements altogether, as that is exactly what many local communities will inevitably do. If we, as a society, consider these programs important enough that they require federal involvement because they affect the entire nation, then they must remain at the federal level.

2. The document cites lowered federal spending/taxes as a benefit of this idea. But if that is offset by higher local spending/taxes, it's no better from the taxpayer's perspective.

3. It will be funded by property taxes, which I think is a bad idea for anything other than basic local services and infrastructure...and certainly for entitlements. Just as we've seen with public schools, those in wealthy areas will continue to shine while those in poor areas will get worse and worse.

4. "For coverage to those with pre-existing conditions, there will be premiums assessed." Enough said.

5. The promises this proposal makes are not realistic IMO. There is no way that I can think of in which we can have universal coverage, affordable outlays, and complete freedom regarding our choice of doctors/insurance/pharmacies. We can pick any two of those three, but I don't see any realistic way to have them all. Also, the document promises that it will be portable across county lines. But if you've just devolved this responsibility back to the counties, I don't see any way that is possible.

6. The document correctly points out that you can't do this with social security, because it wouldn't be fair if a person works in New York and then retires in South Carolina. However, the same logic applies to these programs as well. People could work wherever they wanted, then move to the county with the best benefits as soon as they got sick.

7. Very few local communities would be on board with this idea. For the last 50 years (when revenues exceeded outlays for Medicare/Medicaid), the federal government has been in charge of the program and collecting the money. And now that the programs are about to become a budgetary time bomb, the feds want to hand them over to the local communities? I think most mayors and governors would strongly oppose this.

There are lots of great ways to get our entitlement spending under control and to cover everyone, but I don't think this is one of them.

Harry Guerrilla · Feb 8, 2010

Kandahar said:
Here are my objections to this idea:

4. "For coverage to those with pre-existing conditions, there will be premiums assessed." Enough said.

Everyone should pay something, otherwise you have the situation like we have now.

Having a decent premium is good and an artificially low premiums just invites people to use the system more without weighing the cost vs benefit.

Kandahar · Feb 8, 2010

Harry Guerrilla said:
Everyone should pay something, otherwise you have the situation like we have now.

I agree. But if I understood that correctly, it's saying that there will be an extra premium for those with preexisting conditions.

Harry Guerrilla said:
Having a decent premium is good and an artificially low premiums just invites people to use the system more without weighing the cost vs benefit.

Premiums have little to do with how much people use the system. The DEDUCTIBLE is what really affects that, and I'm completely in favor of high-deductible catastrophic plans. I think the government should be pushing harder to make them the norm.

Harry Guerrilla · Feb 8, 2010

Kandahar said:
I agree. But if I understood that correctly, it's saying that there will be an extra premium for those with preexisting conditions.

I don't think that was it, maybe I'm wrong.

Kandahar said:
Premiums have little to do with how much people use the system. The DEDUCTIBLE is what really affects that, and I'm completely in favor of high-deductible catastrophic plans. I think the government should be pushing harder to make them the norm.

Can't argue with that. :2wave:

lizzie · Feb 8, 2010

reefedjib said:
I don't know if you noticed, but I set the co-pay for the Healthcare Co-op to $50 to try and place more fiscal responsibility on the patient.

That would be a great start. One of the reasons private insurance costs have soared is because people don't have to take the responsibility for their own care, and they do not need to be cost-conscious. Look at it this way: If someone told you that you must own a car, and they would buy you a new car, whatever kind you wanted, no limits, you would buy the Mercedes or Rolls. If, on the other hand, you were told that you had to buy a car, and it would be coming out of your pocket, and you had no choice, you would compare prices, compare reliability, compare features, and you would buy the car that gave you the most bang for the buck. When it's your money, you will by nature, try to get the best you can for what you spend. It creates competition in the market.

lizzie · Feb 8, 2010

Kandahar said:
I'm completely in favor of high-deductible catastrophic plans. I think the government should be pushing harder to make them the norm.

Not only does the government not push them, they don't allow them, except in temporary policies in some states.

Getting rid of entitlements or County Cooperatives

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