Redstate

Thanks! I think it's about time we look for a conservative answer to this problem. We can't just bury our heads and hope it goes away.

The general idea of causing everyone to have insurance for that minimum level of health care that the law mandates from providers seems necessary and appropriate to me. For that reason I was excited about the Romney initiative.

The complaints about the plan are much more than just the $295 opt out though. Employers (with more than 10 employees) will be held responsible without limit and with stiff penalties for the medical costs of employees they choose not to insure. IMO, this has unacceptable side effects. The question is then, can a universal insurance plan be financially viable without placing this burden on employers? Is there a more palatable place to shift the burden?

The plan also requires insurance for things I would consider non-essential, like eye-care, chiropractics, and acupuncture. It also severely limits choices regarding simple catastrophic coverage and PPOs. Can state plans be politically and economically viable without these kinds of mandates?

in a state where the State insure a significant portion of the population either as employees or on Medicaid, I can tell you that it is a sinkhole.

Once the state is a major player in providing health care, everybody with a checkbook is trying to get his specialty required by law in the state's health care plan.  A few thousand to politicians here and there and you're buying midwifrey, accupuncture, sex therapy, and on, and on.

And forget about PPOs; try to designate one and everyone who didn't get designated is holding fundraisers.  This is just something, among the many things, that government just MUST stay out of.

If do appreciate the effort of states to try to address a serious policy issue, but employer mandates are not the way to go. Regardless of where on the market/socialist spectrum you fall regarding healthcare, a big source of our current problem is the assumption that employers have an obligation to provide health insurance for their employees. This assumption is so pervasive that it is difficult to get health insurance any other way, unless you are poor or old.

I'm a physician, too. I practiced in the military and in civilian life, and had experience practicing in civilian European hospitals as well. I have an MPH and a strong interest in public health.

You indicate that "the United States medical care is the best in the world," and that the US has the best medical care system in the world. There is simply no empirical evidence that these are true; certainly, if you have access to care, the US can provide care that is technologically as good as anywhere in the world--and I would be happy to have my care here. But we do not have a decent medical care system--treatment, records, and prevention are fragmented, and we have 44 million uninsured Americans. We rank at or near the bottom of the industrialised world in every important health outcome measure, including patient satisfaction.

Yes, I know there are waiting lists for care in other countries. And I know some wealthy Canadians come here for care. And certainly the very rich fly halfway around the world to come to our finest medical centers. But walk a few blocks away from any of those medical centers, and you will find people who see no evidence of any health care system.

Other advanced nations have longer life spans, better outcomes from all sorts of interventions, and are happier with their healthcare. And the cost to them? Half to two thirds of the cost to us. Better care, lower cost.

I wish we were number one, but we are not, and saying were are does not make it so. With work--and some honesty--we might become best.

I'd like that for all Americans. I hope you do as well.

And the solution is universal health care.

walk a few blocks away from any of those medical centers, and you will find people who see no evidence of any health care system.

I call BS. Any homeless derelict in the United States can get into a hospital bed tonight if he needs one, and you know it. I know it because I used to put them there. Why are you trying to sell us nonsense that isn't true?

Once the state is a major player in providing health care

ALL KINDS of problems arise, and EVERY solution (besides getting government completely OUT) just makes it all worse. THIS CHART shows the history of government impact on health care costs.

Will it work? I predict that since people will have insurance they will seek outpatient primary (preventative) care early in their disease course instead of stumbling into emergency rooms on death's door. If this helps keep people out of emergency rooms and hospitals where costs are massive then this will work AND improve the general public health . . . and, not to mention, solve the problem of "the uninsured."

I am reading this as an assumption made by you that people seek outpatient preventive care because it is cheaper and more convenient with insurance.  That assumption would be incorrect imo.  In my own personal case, it would be much cheaper to do nothing, end up in the emergency room and pay that bill 100% than to stay on the routine preventive maintenance required to sustain life paying insurance deducts and co-pays.  My desire to live is greater than the cost of outpatient treatment, but these days just barely.  Paying with insurance is not necessarily cheaper than paying without insurance if you can find a medical provider that will service you without it.  

I don't know the details of this plan and I'm not sure I could comprehend them if offered, but I'm hopeful that when all things are considered, this plan will result in lower insurance costs for people like me.

without lower insurance costs and broader anti-discrimination laws.

To give another personal example, due to serious health issues, I had to quit a good-paying, excellent insurance plan job.  After time and through a chain of events, I was able to make my way back to work parttime.  It's a very good job, but I don't meet the minimum hour requirements for health insurance.  

Unfortunately, because of my health issues, it was really necessary for me to inform my boss of my condition.  I say unfortunately because when COBRA from my previous job ran out, I was up a creek.  I asked my current boss to place me fulltime, and he said he couldn't get it approved by upper management because it would hike the insurance rates significantly.  Brutally honest and not a thing I can do about it legally.  I would have to be physically unable to work in order to file a discrimination suit to get my employer to give me a fulltime job so I could have insurance.  LOL

So much for employer mandated insurance.  

After jumping through many hoops I finally got my own situation resolved.  I am insured outside of my place of employment and I am still working parttime which is extremely beneficial to my health.  I'm in a good place at the moment even though I was able to itemize on Sch. A this year based on medical alone.  

Why do you think drugs and care in other industrialized countries, particularly Europe, is cheaper?  They control the prices!  This is especially true of prescription drugs.

Secondly, the real problem with the American system is that we have a de facto universal healthcare system here under laws like EMTALA, but no one pays for it.  And by no one, I actually mean healthcare providers themselves pay for them, which is a sure way to force them to hike up their costs to compensate.  There are plenty of other reasons for the high healthcare costs in this country, but that is a major one.  As a physician, I'm surprised you're seemingly not aware of things like this.

however also makes the problem worse, and has the additional consequence of handing the liberals an important issue on a silver platter. If conservatives don't try to get out front on this with sensible market-based solutions we will end up with some kind of socialized medicine eventually since neither the public nor employers can tolerate the current situation much longer. Sure, to be politically feasible any plan is going to have compromises that people here might not like, but don't make the perfect the enemy of the good, or you may just get the worst.

Re: I asked my current boss to place me fulltime, and he said he couldn't get it approved by upper management because it would hike the insurance rates significantly.

Your employer has run afoul of the ADA is this is true. Discrimination for heath-based  reasons (as long as you are capable of doing the work) is illegal.

Government is not the solution; government is the problem.

-Ronald Reagan

Remember . . . Romney was working in the bluest of blue states while getting this done.  Mass isn't the most business friendly environment around.  I'm sure Romney would have loved to restructure all the needless regulations on insurance companies (i.e. have to provide fertility, chiropractic, and "alternative medicine" coverage in many cases).

Romney just got done what he could get done . . . not every aspect of the plan is perfect . . . but the fact that just about everybody has a minor objection and almost nobody has a major objection is a sign to me that it is an issue people realize won't have a simple and easy fix.

The employer mandates under this plan were minimized by Romney as much as possible.  Again, he was working in Massachussetts and they were heading toward something.  I wish his vetos would have held up.

You are right, of course. Anyone may walk into an ER--or be brought there by police or EMTs--and they will receive good care for that episode. But it's very difficult for the patient to receive follow-up care for the primary problem, and often impossible to arrange care for unrelated conditions.

I should note that the Bush administration has added or expanded 865 federally funded community health centers, and has promoted these. So that was a good idea But the administration also zeroed out funding for primary-care education the first couple of years--and you have to have primary care providers to staff these places; I don't know why the administration did this.

And other posters have made good points, too: other nations do have lower drug prices because of regulation of prices. The arguments about controls on prices, funding new research, availability of new drugs, TV advertising of drugs, political funding, and so on are all interrelated and merit thoughtful inquiry way beyond what anyone can do here. I'll stipulate that we have higher-cost drugs because drug companies here can charge what the market will bear, that other nations are what economists call free-riders. And the pharmaceutical industry here is beginning to address the needs here in a more organized fashion.

As for care donated by physicians: It's a wonderful act, performed by people who care--they are heroes, much as rescuers pulling drowning folks from a river. And two thirds of physicians still report that they give some free or low-fee care. This proportion is in decline: perhaps it's the increased debt that medical students graduate with, or it's government regulation. Back when I was in practice, anyway, it was illegal to give anyone care for a lower fee that Medicare allowed, but folks pretty much ignored that reg. But my point is, if you are standing by a river, and there are bodies and drowning people floating by, yes, you want to pull the bodies out, but you also want to go upstream and stop whatever is pushing people into the river. For me, the lack of a universal health care system is that problem.

We still pay more for shorter, sicker lives than much of the rest of the industrialized world. That is not a lie.

I dont see how a trip to the emergency room (beyond very minor problems) could be cheaper than the premiums which Romney has reduced by 50%

This program is designed to get rid of large hospital emerency room bills that can easily reach up way over $100,000 that the state is footing the bill on. Assuming a basic plan is around $100 a month, and the you have a total deductible of $10,000 if you were to have a major accident that cost $100,000 it would take you 75 of not paying premiums to break even.

So you would have to go 75 years with out medical coverage, loose alot of money w/out insurance or stick the goverment with the bill. Hence, his plan has a good chance of creating positive change.

Citizen Joe, You said:

"You indicate that "the United States medical care is the best in the world," and that the US has the best medical care system in the world."

Reading my post, you did quote me correctly . . . but no where do I state or even hint at your second point (and that ended up being the thrust of your argument . . . misguided as it may be).  The US DOES NOT have the best medical care system in the world. Anyone who thinks so does not know a lot about the issue.  

However, I don't think that a country as large and as diverse as ours (not to mention one that has so many illegal immigrants) will EVER have the "best medical care system" in the world.  Socialized medicine may have some points to tout in other nations, but they are generally much smaller nations with much less diversity, better educated citizens, and higher per capita incomes.  That kind of population is more likely to take much better care of themselves and thereby are less of a burden on the healthcare system.  

The fact that the U.S. population is SO BIG (in total #s and as individuals . . . viz OBESITY . . . again minority populations especially) makes socialized medicine/universal coverage a sure road to higher costs and worse care.

Socialized medicine, as practiced in other countries, would not fly here in the U.S.  In the U.K. if you're 72 and have a suspected brain tumor or aneurysm you will not get an MRI . . . The thinking is that your time has come and the health care dollars shouldn't be spent in that manner.  If you're wealthy, then this is the kind of person who comes to the U.S. for diagnosis/treatment.  The questions of when and where to spend the health care dollars are difficult ones and, personally, I think this is where Medicare is going to have to go to avoid going bankrupt (or they could just keep cutting physician fees again . . . and again . . . and again, heck, the lawyers are calling the shots in D.C. . . . the good old doctor/lawyer rivalry does not end up in our favor)

The main reason socialized medicine is bad for our nation is that it drives out any attempts at efficiency and it will not reward someone with a strong work ethic (ever worked in a VA hospital? Can you still want a larger government healthcare system?)  

Medical costs in this nation keep spiraling out of control because of increased drug costs.  I am NOT a fan of Medicare Part D (what were you thinking Pres. Bush and Congress> . . . that desperate to get the elderly votes?)  Drug costs are so high here mostly because of the high cost of "R&D" of the pharmeceutical companies.  Other countries massively restrict what companies can charge for their drugs.  They get the same drugs for much cheaper than U.S. citizens can get them.  The Pharmeceutical industry therefore seeks to recoup its costs on the back of Medicare and the U.S. population in general.  In essence, the cost of driving medical research/advances forward for the entire world is set directly upon the backs of U.S. Citizens/taxpayers.  These are issues that are beyond the scope of the new Mass. Health care initiative.  We need to make other countries participate more equally in the cost of these advances since they are getting the benefit at a strikingly discounted rate.  NOW THERE'S SOMETHING WORTHY THAT THE U.N. COULD TACKLE!

Romney's plan does not create or enlarge any government sponsored healthcare, yet it still tries to tackle the problem of the uninsured/underinsured.  It is not perfect . . . but I think it's a giant stride in the right direction.

Government-created problems do not go away by themselves.  Government must fix the problems that its created.  

I see Romney's plan as a "fix" to the problems and mandates created by EMTALA laws.  On the surface it's easy to conclude that it is more "big government", but one must look beyond that easy stereotype to see that this is a fiscally conservative plan.

because I don't live in Mass.

I fear he will try to implement this at the federal level. Regardless of how effective it is, it has no business being imposed on all the States.

Someone who mentions the age-old comparison of apples to oranges.  There's NO WAY you can compare the healthcare needs and requirements of say Sweden to the US.  Everything from the size of our country, its population, ethnic diversity and so on, make it IMPOSSIBLE.  Countries that are even slightly close in population, say Bangadesh, Mexico, Brazil...would you want the medical care offered there? Or even China or India

who blow us away as far as population and land mass...want to get your appendectomy there?

Also a large majority of those so called socialized countries are finding it harder and harder to pay for it and keep taking more and more of the peoples hard earned wages to try.

And just a side note, let's get real and understand that these countries with their socialized medicine are riding on the coat-tails of medical technologies and medicines that,

for the most part, are being sold to them by us.

They are paying the cost of purchasing the product and learning how to use it but are not bearing the burden and cost of creating it.

and Romney is back in my good graces now. Thank you.

Someone who mentions the age-old comparison of apples to oranges.  There's NO WAY you can compare the healthcare needs and requirements of say Sweden to the US.  Everything from the size of our country, its population, ethnic diversity and so on, make it IMPOSSIBLE.  Countries that are even slightly close in population, say Bangadesh, Mexico, Brazil...would you want the medical care offered there? Or even China or India

who blow us away as far as population and land mass...want to get your appendectomy there?

Also a large majority of those so called socialized countries are finding it harder and harder to pay for it and keep taking more and more of the peoples hard earned wages to try.

And just a side note, let's get real and understand that these countries with their socialized medicine are riding on the coat-tails of medical technologies and medicines that,

for the most part, are being sold to them by us.

They are paying the cost of purchasing the product and learning how to use it but are not bearing the burden and cost of creating it.

Jeff, I too am a physician with a conservative/libertarian bent. Your comments on the reasons for high drug costs is an old shibboleth that is no longer true. It changed a few years ago. The drug companies spend more on marketing than on R&D.

My source is a patient who very recently retired as an economist for the FDA. I suspect one of the worst errors of Richard Darman (OMB with Bush I) was to develop "user fees" for the FDA. The FDA now petitions the drug companies to provide more dollars for their activities. One can readily see how this can squeeze out small companies.

I changed from GOP to independent over the Bush II Medicare Part D program. But they pulled a fast one on the drug companies by turning the administration over to insurors. The insurors can put in price control procedures, while the law demanded prices could not be negotiated between govt and pharmaceutical companies.

   I like it. Now if we could get the illegal aliens all over the nation to pay health insurance, it would improve the life of legal citizens!

I've been derelict in my duty to respond to your thoughtful comments. Hope you see this, Jeff.

You are right. You never said we have the best health care system in the world. I swear, it's such a mantra, I HEARD you say it, anyway, cause everyone else does

(The President's Proposals for Health Security in the World's Best Health Care System ; http://www.whitehouse.gov/query.html?col=colpics&qt=medical+care+system
&submit.x=10&submit.y=20)

I don't think national health insurance would bankrupt America. I think it would make us wealthier. I'm sure you saw Woolhandler and Himmelstein's article four years ago (Woolhandler and Himmelstein, Arch Intern Med.2002; 162: 973-975.) I think they made a persuasive case. And they do suggest a trial in a state or a few states, which seems perfectly reasonable.

My only experience with a VA hospital is as a medical student (Psych inpatient rotation, where the attending met with the patient once, for about ten minutes, and, I'm pretty sure, never again) and I do not wish that system on anybody, especially vets.

But the VA argument is a red herring, I think. The national health insurance plan is just the funding aspect--it leaves the delivery (Lord, I hate that term, like it was delivering milk and eggs) to the current delivery system.

When I was in private practice, I hated dealing with Medicare. But I hated dealing with private insurance companies more, and in one case, I found myself financially responsible for a company when it collapsed. Ouch.

The fee structure sucks--especially for primary care (IMHO). I don't know if private companies are any better now than is Medicare/Medicaid.

I'm no fan of Medicare D, either. And I have eaten some exceedingly nice dinners that I am sure got charged up to R&D.

So, color me both a hypocrite and a derelict.

To good health--yours and our nation's.

Joe