Republicans/conservatives: Which of these health care reforms would you support?

Io0011 said:

If you subsidize something you get more of it. The government can't even pay for my GI Bill for college. States can't pay their local fire and police departments. The nation is broke. This is the framework your going to be in favor of spending federal money on an entitlement for every citizen, or someone skilled enough to pretend to be a citizen of the nation?

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Where did I say "every citizen" or anything even close to it?

I would like to give subsidies primarily to the people who are right above the Medicaid threshold. These are the people who would not be able to afford insurance otherwise, and who would be otherwise covered under a Medicaid expansion in any of the Dems proposals. I think giving people a small subsidy to help them pay for insurance themselves is preferable to giving them Medicaid for free.

RightinNYC said:

Where did I say "every citizen" or anything even close to it?

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Ah, I got confused there. Sorry about that.

Kandahar said:

I realize that, but I don't see why meds should be any different than any other treatment. Say you get a catastrophic plan that covers 0% of your first $X and everything beyond that. Why not just incorporate both treatment and meds in the same plan?

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Because that won't affect the outrageous costs of medications. One of the reasons medication and physician office visits have gone up so much is because no one has to take responsibility for controlling costs. The doctors can charge what they want, pharmaceutical companies charge what they want, patients don't care because it's covered by insurance, and the insurance companies are having to pay out more and more money because there is no competition in the marketplace. It is more complicated than just this one factor, but it definitely factors in to rising costs.

Kandahar said:

I think mandating a couple free checkups is one area that the government definitely needs to be involved, because the insurance companies will never coordinate this on their own. If they all assume that their customers are likely to be using a different plan with a different company 5-10 years down the road, they don't have any incentive to provide preventative care. It'll result in a continuation of our "sick care" system. It's a classic prisoner's dilemma: All of the health insurance companies would save money if they all offered preventative care...but none of them want to be the sucker that does it on their own.
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I disagree, but not due to your line of reasoning. The reason this won't work is because of the American mindset. Americans don't want to be pro-active and prevent illness. They want to live lives of carelessness, then have someone else pick up the tab when they become ill. Besides that, insurance companies already have what are almost free visits- the consumer pays what is usually a small co-pay out of pocket. This has not contributed to keeping people healthier as far as I can tell.

lizzie said:

Because that won't affect the outrageous costs of medications. One of the reasons medication and physician office visits have gone up so much is because no one has to take responsibility for controlling costs. The doctors can charge what they want, pharmaceutical companies charge what they want, patients don't care because it's covered by insurance, and the insurance companies are having to pay out more and more money because there is no competition in the marketplace. It is more complicated than just this one factor, but it definitely factors in to rising costs.

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But the same is true of any medical procedure. If I have to get $40,000 in chemotherapy, a catastrophic insurance plan will cover it (as it should). Sure, it might increase the cost but there's no way I'd be able to afford it on my own anyway. But the same is just as true if I have to get $40,000 in medicine. Both of those would fall under the category of "catastrophic" as far as I'm concerned, and the medicine wouldn't be any more or less price-sensitive than an equally-priced medical procedure covered by insurance.

lizzie said:

I disagree, but not due to your line of reasoning. The reason this won't work is because of the American mindset. Americans don't want to be pro-active and prevent illness. They want to live lives of carelessness, then have someone else pick up the tab when they become ill. Besides that, insurance companies already have what are almost free visits- the consumer pays what is usually a small co-pay out of pocket. This has not contributed to keeping people healthier as far as I can tell.

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I think offering something for free creates a much stronger incentive for people to take advantage of it than offering it for a $10 or $20 copay. It's not rational, but that's the way the human brain works IMO.

If this is suppose to be a poll for conservatives, then there really should have been a choice about eliminating the tax incentives for healthcare benefits from someone's workplace.

That would drastically reduce health care spending, so if anything, I don't think anyone should support the tax exempt status of employer provided health care services.

nerv14 said:

If this is suppose to be a poll for conservatives, then there really should have been a choice about eliminating the tax incentives for healthcare benefits from someone's workplace.

That would drastically reduce health care spending, so if anything, I don't think anyone should support the tax exempt status of employer provided health care services.

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That is one of the poll options.

Taxing some/all health insurance benefits as regular income

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I completely agree with you, they should not be tax-exempt. If we're going to make any progress on controlling the costs of health care, we need to sever the link between health insurance and employment. This is very economically inefficient, because it traps people in jobs that they would otherwise leave.

Kandahar said:

But the same is true of any medical procedure. If I have to get $40,000 in chemotherapy, a catastrophic insurance plan will cover it (as it should). Sure, it might increase the cost but there's no way I'd be able to afford it on my own anyway. But the same is just as true if I have to get $40,000 in medicine. Both of those would fall under the category of "catastrophic" as far as I'm concerned, and the medicine wouldn't be any more or less price-sensitive than an equally-priced medical procedure covered by insurance.

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Chemotherapy is a limited-time expense, and totally unexpected. Medications are long-term, recurring expenses, and one of the few ways to keep costs contained is to place responsibility on the person who is using the resources. If I have hypertension, for example, my blood pressure could be controlled with a wide variety of drugs. Some of them are expensive, some are not, but many of them work well. If I have to pay for my own drugs, I could most likely take a generic form of a long-used drug for 4 dollars per month. If my insurance has to pick up the tab, I don't have to worry about the cost because my insurance company is paying. That's all fine and good, but there is no incentive to be responsible when I pretend that the insurance company is paying it. What it amounts to is that we are all paying in skyrocketing insurance costs. The one utilizing the service does not have to be cost-conscious.

Iow, it's not your responsibility that I have high blood pressure. My blood pressure may be high because I eat too many double cheeseburgers or live a high stress lifestyle. You should not be expected to pay high premiums because of people who make poor lifestyle choices.

Kandahar said:

I think offering something for free creates a much stronger incentive for people to take advantage of it than offering it for a $10 or $20 copay. It's not rational, but that's the way the human brain works IMO.

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I think you missed the point I was making.

RightinNYC said:

He's absolutely right in the sense that if you believe health care is a "right," then that means every person is entitled to the services of a health care provider. If the government reduces its reimbursement rates below what providers are willing to accept, then the only way to ensure that people are able to exercise their "right" to health care is to use the law to force health care providers to give them service, whether through pro bono licensing requirements or government-imposed qualifications that must be met to practice.

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Look at what you are doing here. If health care declared a legal right, and if the reimbursement rate is dropped too low, and if the government is the only insurer, and if there are not enough doctors, and if the government is willing to force doctors to do things, then, maybe, you might have a point. However, that chain is highly unlikely and can be discounted. The slave comment is, in all reality, overblown rhetoric designed to elicit an emotional reaction, and has zero real basis in logic or this discussion.

Redress said:

If health care declared a legal right, and if the reimbursement rate is dropped too low, and if the government is the only insurer, and if there are not enough doctors, and if the government is willing to force doctors to do things, then, maybe, you might have a point. However, that chain is highly unlikely and can be discounted.

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Not likely in the short term, but entirely possible in the long term.

RightinNYC said:

I voted subsidize some of the poor and tax all/some benefits as income.

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I would argue just the opposite of what I bolded. One thing I've found as an agent is the biggest selling point in many policies I deal with are tax benefits, life and annuities are easy to sell because life policies are non-taxable and annuities are tax deferred, one thing I've found about the overall consumer opinion of health insurance is that it doesn't have a tax benefit and acts as "yet another expense", so if we actually gave tax credits for purchase or tax deductions(like mortgages), I would think more young people and those who are just above the poverty line would start to purchase more.

I'm leery about the non-discrimination requirement and the lifetime cap requirement for the reasons that WI Crippler mentioned, I don't like the mandate for plenty of reasons, and I honestly haven't seen anything that would indicate that the antitrust exemption is anything other than a tiny issue being hyped to score political points.

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I don't like a general ban on PECs, but some companies take them too far, I think there should be some protections against potential abuses of the risk management model.

I don't see a problem with subsidizing some of the poor, though not as generously as either of the bills being proposed. As a nation, we need to realize that thanks to our abhorrent lifestyle choices and our sense of entitlement in regards to quality of care, health care is expensive as **** and will be that way for the foreseeable future.

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Exactly right.

Rather than act all outraged when they're expected to spend 10% of their income on insurance, people should fully expect to spend 15-20%. I've got no problem helping out people for whom this would be a true burden, but I think it's absolutely absurd to be handing out $10k subsidies to families of 4 making $60k while the family only pays $5k, as would happen under the Senate bill.

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You nailed that point too.

As to taxing the benefits as income, I'm surprised more people didn't pick this. It seems like the most logical way to reduce overall spending while simultaneously getting rid of a tax break that just skews economic incentives.

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I think this is the lousiest of the options. If you want a revolt the best way to do it is to add additional expense to something people begrudgingly pay for anyway.

lizzie said:

Not likely in the short term, but entirely possible in the long term.

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Almost anything is possible in the long term. A president could declare himself dictator for life and run the country as a complete fascist state. That is about as likely or moreso than doctor slaves.