Things that are untrue and even silly about healthcare beliefs and baby steps to improve things.

http://tinyurl.com/kphwxs
Obama's own party worried health plan lacks votes AP WASHINGTON – A Republican senator seeking a bipartisan health deal spoke Sunday of "dialing down" expectations while one of President Barack Obama's Democratic allies questioned whether the White House had the votes necessary for a such a costly and comprehensive plan during a recession. Obama's proposal to provide health insurance for some 50 million Americans who lack it has become a contentious point for a Democratic-controlled House and Senate struggling to reach a consensus Obama desperately wants...
Things to be clear about:
1) There is confusion between health CARE and health INSURANCE. No one can document instances where someone was denied health care because of lack of insurance. Anyone can go to an emergency room and not be denied care. This is,however, wasteful because it is a very expensive way to provide non-emergency care.
2) The number of people who are uninsured depends on definitions and what qualifications one puts on them.
a) The number of uninsured is not a static group but, rather, it includes many people who are TEMPORARILY without insurance as they change jobs or circumstances.
b) Perhaps 60% of the uninsured are not American citizens and not here legally. The responsibility of American taxpayers to pay for them ( most do not pay American taxes) is unclear.
c) Many people are able to bear the costs of health insurance premiums but CHOOSE not to do so because they are young and healthy and don't see the need or economic benefit to taking on insurance against things they don't worry about including mandated inclusions of chiropractic services,etc.
3) The benefits of Medicare are highly over-rated. Strange to say, Medicare does NOT foster preventive care and severely circumscribes even pay for routine checkups designed to catch things early. Medicare is highly bureaucratic, Congress mandates what Medicare pays for various procedures without regard for usual economic mechanisms for pricing and costs. Suffice it to say that Medicare uses its monopsony power to drive medical reimbursements down, often below what it costs to provide the services. Nevertheless, its strictures pervade all of healthcare with even private insurers compensating healthcare providers with some MULTIPLE ( > 1 ) of Medicare rates.The Medicare process is inefficient with several transfers of paperwork among the providers, Medicare and other insurers covering the same patient, often with disagreements as to who pays for what.
4) The cost of healthcare is vastly increased by the defensive medicine that has to be practiced in view of the litigation threat from tort lawyers engaged in medical malpractice, often relating only to results, not to breach of professional standards. Codifying this to avoid the present abusive system would reduce costs enormously.The situation is so absurd that certain sections of the country have difficulty attracting doctors. More amusingly, certain parts of Florida see prospective mothers with any affiliation to lawyers find it hard becoming patients of OB-GYNs.
5) The connection between employment and health insurance is not necessary or even rational and creates unnecessary trouble and discontinuity when someone loses or even changes jobs, and COBRA only partially address this. There is actually no reason for this linkage except the historical one that, during WWII, providing health benefits was a way for employers to circumvent wage controls in a manner that was tax deductible to the employer and not taxable to the employee. This system has persisted and many employees are not even aware of the value of the benefits they get, how much these cost them in terms of wages they might otherwise receive, and produces a mismatch between what the "average" employee wants in insurance and what individuals might choose from an a la carte menu of risks to be insured against.
6) It is difficult for individuals to get personal insurance independently since pools of uncorrelated employees protect insurance companies against adverse selection.Fear of adverse selection also makes it difficult to find private insurance that will cover pre-existing conditions (changing employment usually entails the same problem.) This serves as a barrier to free movement between jobs. There is, nevertheless, adverse selection in that young and healthy people often do not see the need to participate in insurance plans.
7) It is uneconomic for an individual to pay cash for medical services since there is a "retail" price paid by almost no-one ( except the rare cash payer ) and a discounted price schedule negotiated separately by every insurance company including Medicare ( although the negotiation is completely one-sided in the latter case.) It is probably unique in economic situations for a cash customer to pay much more than someone in a "plan,"(sometimes of the order of twice as much.)
8) These impediments to individual payment makes it difficult for patients to discern the actual cost to them of healthcare since the third-party intermediary makes it seem like a good with a fixed cost, irrespective of usage. Co-payments and Individual Savings Accounts go a long way to redressing this particular issue.
9) People use privacy protections to rip off the emergency room system by refusing to identify themselves when getting care. Identifying all patients would help in their care by indicating previous treatments and possible conflicts in medication or procedures. It would also track the fiscal responsibility of those able to pay. Being uninsured and accessing an ER is as irresponsible as driving a car without liability insurance. If one is a "good risk", the premiums might be adjusted accordingly although there is moral resistance to the symmetrical idea of raising the premiums for people who are bad risks (although there might be an exception for voluntary life style choices such as smoking, obesity, drug use, drunkenness, etc.)
A compromise might be to have an optional menu of things to be covered so that a confirmed bachelor might not feel the need to pay for insurance against obstetrical, gynecological, pediatric, neo-natal care, fertility treatments, etc Quite often, coverage is mandated by pressure groups such as chiropractors, chiropodists, aromatherapists, acupuncturists, etc and one should probably be capable of opting out of insuring against these costs. So long as the pool is large enough to minimize adverse selection, it should be possible to insure against only those things that are individually desired. Even young, healthy people would see the advantage of insuring against accidents and unanticipated diseases afflicting even the youthful.
10) The bruited idea that a government plan provides "competition" for the private sector is generally incorrect since many private plans actually lose money on an actuarial basis but make it up by investing the "float". The government, whether Medicare, Medicaid or some new plan doesn't have this recourse and merely lowers its reimbursements to "save money."
11) "Saving money" is an insidious goal for any insurance plan, particularly a monopolistic one, to have. The most straightforward way to save money is to deny service to anyone seriously ill and not likely to pay in much more over a number of years than taking care of their immediate needs would entail. Thus, the NICE program in the British National Healthcare System decides when, or even if, an older person should get expensive medication, a quality-of-life-enhancing procedure or even one that is a matter of life and death. When people claim that the results of the American system are "not better" than those of others costing a lot less, they leave out the enormous costs of the first and last years of life, the fact that the American system makes herculean efforts to extend and save life even at long odds and that quality-of-life counts. The NICE system, or any rationing system similar to it, would improve the cost structure but impair the quality of life for all citizens eventually. Yoda had occasion to inquire about a Whipple procedure for pancreatic cancer for an elderly patient ( who was 96 but, cancer aside, otherwise in excellent shape ) and was told that the "record" was 98 years and that an appropriate candidate for the procedure would not be disqualified because of age. This is unthinkable under the British or Canadian systems. Joint replacements for the elderly become increasingly problematic with age for these systems but not yet for our American one. When one is as old as Yoda deviating from American mores becomes unacceptable, and it should be expected that AARP would feel similarly.
12) Screw the doctors and you'll get fewer of them. People cross the Canadian border heading south all the time because of the lack of availability or time delay of care. Individual states in the U.S., known as havens for tort lawyers, are finding it difficult to attract and keep doctors.
It's already the peculiar circumstance that it's harder to get into veterinary school than medical school. Veterinary care suffers neither from the custom of health insurance nor the affliction of medical malpractice. Rush Limbaugh has raised the interesting question of why the extensive system of veterinary care and services flourishes in the U.S. without health insurance.
13) The salient suggestion is to make people aware of the cost of healthcare which the system of third-party payers obscures. Co-pays help but more options might be desirable such as varying them when only the services of a nurse-practioner or physician's assistant are sought. Insurance traditionally is not for the purpose of paying bills but for assuring against the ruin of a catastrophic event. Any insurance must be priced at least 7-8% more than the actuarial cost.Self-insuring for acceptable charges is a way to lower premiums although what is acceptable will vary with income level and circumstances. Evening out this variation might be a proper role of government.