Health Care Reform

[Voronwë the Faithful]

Here's another reason I'm not excited about co-ops: under the Baucus bill, the Blue Cross/Blue Shield behemoth would probably qualify as a co-op. Some innovation there.

What is the basis of this claim?

[Primula Baggins]

Here's the New York Times article from August 18th (link):

Mr. Conrad’s own state demonstrates the uncertainties surrounding cooperatives. Blue Cross Blue Shield of North Dakota dominates the state’s private insurance market, collecting nearly 90 percent of premiums. As a nonprofit owned by its members, the company would hope to qualify as a co-op under federal legislation, said Paul von Ebers, its incoming president and chief executive.

Darren Huber, a spokesman for MeritCare, a not-for-profit clinic and hospital company in North Dakota, said his company would welcome greater competition among insurers.

Any new insurer in North Dakota would probably try to take members from the local Blue Cross plan, but that would not be easy to do.

[Voronwë the Faithful]

But most Blue Cross and Blue Shield entities are not non-profits. Blue Shield of California, which provides my so-called insurance coverage, certainly is not.

[vison]

I dunno. Canada's system works fine with our population - about 10% of the US.

[Primula Baggins]

But Canada's plan has the benefit of covering just about everybody, meaning the pool includes the young and healthy who use the insurance less. A co-op would probably have a smaller proportion of young and healthy people, since they have an easier time finding insurance anywhere.

Voronwë, I know not all the BCBSs are nonprofit; my insurance is through BCBS of California also. But those that are would qualify, and nonprofit BCBS plans cover a lot of the market:

It is estimated that nonprofit Blue Cross Blue Shield plans have about 34% of the commercial risk medical market and 32% of the commercial administrative services only (ASO) medical market.

Link (pdf)

[vison]

I know. I'm just arguing again that our scheme is good, and you guyz ought to try it.

[Túrin Turambar]

I prefer ours

In seriousness, the sheer size of the U.S. population is a real issue, regardless of whether insurance is offered through a Co-op, public insurer or single-payer system. It's not insurmountable by any means - both the IRS and Social Security among others manage to deal with it - but it's there.

[Primula Baggins]

I wish, vison. I just read a blogger's account of her gallbladder attack (she lives in BC) and how she walked into the hospital and was admitted and in bed within minutes, hooked up to pain meds a few minutes after that, got all her tests, spent the night in the hospital, and checked out the next morning by getting dressed, picking up her purse, and walking out. No preapprovals, no copays, no deductibles, no bills.

Link (liberal blog warning)

[Frelga]

I wish, vison. I just read a blogger's account of her gallbladder attack (she lives in BC) and how she walked into the hospital and was admitted and in bed within minutes, hooked up to pain meds a few minutes after that, got all her tests, spent the night in the hospital, and checked out the next morning by getting dressed, picking up her purse, and walking out. No preapprovals, no copays, no deductibles, no bills.

Link (liberal blog warning)

As opposed to my mother in law who had to wait for four hours in the emergency room with the same condition. Or my son's teacher who spent six hours with a fish hook in her finger without being so much as a painkiller. Or my co-worker who waited for three hours when his son cut his arm open on a piece of glass and was bleeding all over the place.

Terrible thing they have going in that durn Canada.

[elfshadow]

I know. I'm just arguing again that our scheme is good, and you guyz ought to try it.

I don't think a state-by-state system would work the same as Canada's province-by-province one. There are a lot more states and a lot greater chance that each one will have vastly different insurance options. Given the mobility of people between states, I don't think that would be the best system.

Massachusetts has already tried a state-run insurance program (Commonwealth Care) and it has had a lot of problems. Also, each state runs Medicaid differently and there are some huge issues with that program.

[vison]

People can wait for hours in ER here, too. Depends on the city, and the day of the week and the time of the day. Saturday night is enlivened for the ER staff by presenting them with the results of bar fights, for one thing.

While I do keep bragging on our system, I don't deny that there are faults aplenty.

But the one fault it doesn't have is refusal of coverage.

[Frelga]

Another fault it does not have is people going to ER because that's the only form of medical attention they can get. And I am guessing it does not suffer from for-profit hospitals buying out other hospitals and closing ERs to consolidate operations and increase profits, which is one of the reasons I have never heard of anyone, anywhere NOT having to wait for hours.

[vison]

Another fault it does not have is people going to ER because that's the only form of medical attention they can get. And I am guessing it does not suffer from for-profit hospitals buying out other hospitals and closing ERs to consolidate operations and increase profits, which is one of the reasons I have never heard of anyone, anywhere NOT having to wait for hours.

You're kidding! Good heavenly days.

There are people who go to ER instead of having a family doctor. There are a lot of reasons for that, mostly to do with lack of transit, shortage of doctors, lack of babysitters, etc., reasons like that.

[Erunáme]

I have never heard of anyone, anywhere NOT having to wait for hours.

The one time Iavas went to the emergency room, he was seen pretty quickly. I'm sure it wasn't over 30 minutes...maybe not even 15. I honestly can't recollect how long we waited but I do remember it wasn't hours. Of course I experienced what that blog writer wrote about: wondering how much each of the tests were going to cost. When all was done he was diagnosed with a panic attack (which is what I was sure was going on) and we were left with a hefty bill.

Iavas was shocked and angry when he saw how much the bill was. I had tried to convince him he was having a panic attack and to try to calm down at home but he insisted on going to the ER. He had just immigrated to the US so he just didn't realise what medical care in the US was like without any insurance. He got a big shock and an eye opener that day. He was far too used to be able to go to the doctor for any little thing. You just can't do that in the US, even if you do have insurance....or unless you're quite well off.

[JewelSong]

The wait in any ER depends on how many other people are there and the severity of your injury or illness.

In the US, the only times I ever went to the ER was because of an actual - well, emergency when my regular doctor was closed. Middle of the night kinds of things...and once when my daughter cut her leg wide open and needed stitches. There was a charge, but my insurance covered most of it. Most insurances have a surcharge for the ER to discourage you from going for non-emergencies.

Here in the UK, I've been twice - once for a badly sprained ankle (I was seen within an hour) and once when I cut my finger badly. That time I waited for a long time...the place was packed. But I was eventually seen and got good care.

When my son was here in the UK and developed a severe infection, he was seen within 45 minutes - they triaged him and saw him almost right away.

In the US, it is recommended that you contact your regular doctor first if you can before going to the ER (unless it is clearly a life-or-death kind of situation, like your hand has been cut off or something!) Often the doctor can treat you in the office.

[Dave_LF]

My father has worked in an ER his whole career. He's also a far-right GOP voter. But the former outweighs the latter on this particular issue, and he favors having major procedures and true catastrophes covered by the government, with routine office visits and the like paid out of pocket (or covered by private insurance, if you choose to buy it).

[elfshadow]

Most of the problems with ER crowding could be solved if everyone--both the insured and the uninsured--stopped going there for non-emergent problems.

[Voronwë the Faithful]

Here is an AP article about quiet, behind the scene efforts to compel an yes or no vote in the Senate by getting moderate Democratic senators to agree to vote to oppose a filibuster even if they also end up opposing the final bill.

Analysis: Dems eye yes-no vote on health care

Meanwhile, as promised, Max Baucus unveiled his Finance Committee proposal today, despite having failed to get any Republican support, at least so far. The proposal has, predictably, been panned from both the right and the left. However what people on the left are forgetting (and I have seen some truly, um, disappointing, comments from so-called progressives) is that Baucus's plan (or whatever version of it that passes the Finance Committee) is the most conservative plan of the five different plans passed by different House and Senate committee, and merely represents a starting point in the subsequent negotiations in reconciling the different plans. The final version that reaches Obama's desk won't look like the Baucus plan, though it will take some parts of it. When looked at from that point of view, it actually looks pretty good.

[Primula Baggins]

That's, frankly, the only angle from which it looks good to me. Some of the details that are emerging would be terribly disheartening if this was the best we could hope for.

The regulations about pre-existing conditions, for example, are toothless—companies can start cherry-picking again if they simply declare they only want to insure a certain number of people (link).

Co-ops can't compete on a level playing field with the private insurers and would be subject to state anti-trust regulations, as private health insurance companies are not. Co-ops would not be available in every area of the country, and the exchanges where they're sold would not be open to anyone who wants to buy into them.

Insurers are allowed to charge premiums up to five times higher for people 46 and over than they charge for people 45 and under (link).Under the formulas a middle-class family can spend 13% of its gross income on health care and that is considered perfectly reasonable, not cause to allow them to shop elsewhere (link).


ETA: Links are to liberal blogs, but their analysis of these points should nevertheless be accurate. I can't find this level of detailed coverage from any mainstream source.

[Voronwë the Faithful]

Firedoglake is better than some, but still some of the statements in those links are very distorted, particularly the piece about how the insurance companies are going to "get around" the pre-existing conditions provision. The bill simply doesn't say what firedoglake implies that it says. The fact that insurance companies would be able to limit the number of people covered under a plan does NOT mean that they could limit it based on whether people have pre-existing conditions or not. On the contrary, it explicitly states that they could not do so. It is completely false to say that companies could start cherrypicking if they simply declare they only want to insure certain numbers of people.

There is much to not like about the Baucus plan, including the potential ineffectiveness of the co-ops in providing true competition and controling premium costs, and the fact that the subsidies for lower income people is way too low to effectively complement the mandate, but relying on analysis by 'progressive' blogs that are driven by a strong partisan agenda is not likely to provide a balanced and reasoned view, any more than relying on analysis from 'conservative' blogs would.

In my opinion, of course.