A View From The Press Box

I wonder how many of the uninsured choose not to buy insurance as opposed to not being able to afford it.

I suspect if small-business owners could pool thier risk together, that would take care of quite a few by making coverage more affordable.

Also, millioniares may want to self-insure and not worry about what's covered and what's not.

The bottom line is the people who truly cannot afford coverage should be helped, but we don't have to trash the entire system to accomplish that.

How low would reimbursements to doctors be if the federal government were in charge? You would see more boutique doctors accepting cash only.

Also, the uninsured should not have to pay rates that are higher than the insured people for various procedures.

SAM RESPONDS:
Good points, Greg. Mitt Romney says about one-third of the 45 or so million uninsured are that way by choice, which still leaves at least 30 million who want coverage but cannot get it (pre-existing conditions) or afford it.

However, don't forget that as Michael Moore demonstrated in his movie, "Sicko," the problem isn't only limited to those without any coverage. Even those with health insurance have huge gaps in coverage, and sometimes no coverage at all, depending on the treatment, facility, drug, etc. Universal health insurance would address that as well, at least I hope it would.

"Is health care reform doomed?"

Hopefully the answer is yes.

SAM RESP0NDS:
That would be bad news indeed for the 45-50 million without health insurance, and for the tens of millions left with huge gaps in the coverage they do have.

I honestly don't understand responses like Tiger's. Is he/she saying that the system is acceptable the way it is? Is universal health insurance supposed to be an undesirable thing?

If the answer to these questions is "no," then we obviously need reform. The nature of that reform should be the subject of vigorous debate, but I'm surprised that anyone questions the need or desirability of reform.

Tim Dodge, AU, ARM, CPCU
Director of Research & External Communications
Independent Insurance Agents & Brokers of New York, Inc.

To Sam and Tim:

IT ISN'T THE GOVERNMENT'S JOB TO TAKE CARE OF YOUR MEDICAL BILLS! What country are you guys from, the Soviet Union?

Socialism is immoral, has never worked and generally serves to destroy lives and bring down economies.

I'm your average idiot, and I've managed to find a job that handles my health care very well.

And, yes, Tim, I like the system the way it is. I have choices of doctors, hospitals, types of care and all that goes with it for me and my family.

Snap out of it, guys. Stop feeling guilty...It isn't very becoming.

SAM RESPONDS:
Guilt has nothing to do with it. I don't want to live in a society with people dying because they cannot afford health care. My morals and politics say that society has a responsibility to provide a basic standard of living for all--if you want to call that "socialism," that's your problem, not mine.

So your health coverage is okay. Good for you. No one is suggesting taking that away from you. But there are 50-million of your fellow citizens who are not so lucky. If "socialism" means rejecting an "every man and woman for themselves" philosophy, so be it.

Social Security, Medicare, public education, regulation of markets for safety, public libraries, all of these programs could be considered "socialism," I suppose, but their effect is to raise the standard of living for the entire society.

If YOU don't like that, sir (or is it madam?), perhaps YOU should relocate to one of those Third World countries where beggars line the streets because their governments do nothing to establish an equitable distribution of wealth and services.

And how will the financing of universal healthcare be any different than the financing of Social Security?

Oops, we underestimated. You'll need to pay more in taxes or the whole thing will collapse. Sorry. We didn't plan on the increase of participants and costs. Just trust us. We're taking care of you.

Oh, by the way, we control your pocketbook through automatic deductions from your paycheck, so there's not a whole lot you can do about it.

Tiger is absolutely correct. The government is not authorized or equipped to take this on. But that won't stop politicians from trying to expand their power base.

For the 45 million who cannot afford it, subsidization is not the answer. I think the answer lies in reducing the cost of supplying medical care, not throwing government money at it. Sounds like an argument for tort reform.

SAM RESONDS:
On Social Security, the problem is not that the program is underfunded. In fact, we've been running up tens of billions of dollars in surpluses for years now.

The problem is that a gutless Congress authorized the spending of these surpluses on general budget issues, giving the Social Security Administration Treasury bill IOUs in return. This camoflouged the need for higher income taxes or budget cuts.

Now that the day is drawing near when SS contributions are falling short of payments owed, all of a sudden there is a "crisis." Repay the IOUs!

Now, critics of national health insurance might argue that this gross financial mismanagement is stark evidence why Uncle Sam should not be given any bigger role in the system. But with the proper legal safeguards, I still believe this could be pulled off. I actually don't think we have a choice, unless you want people dying in the streets before long.

TIGER GETS THE LAST WORD:
Mandatory participation is not the way to go for several reasons.

1. Where in the Constitution is the authority to implement universal health care?

2. Insurance is a personal matter. When the government assumes a personal responsibility, the individual relinquishes control to the government. It is packaged as help for the uninsured, but the result is a shift of power from the people to the government.

3. The uninsured are already being helped through government programs WITHOUT universal health care. Arizona has a program to pay 100% of the medical bills for the uninsured, while other states may have similar programs.

Of course, this is funded by the Arizona taxpayers, but there is no mandatory participation. This achieves the goal of paying for the medical expenses of the uninsured without mandating participation.

4. The federal government is a lousy insurer. Just this year there is a proposal to charge actuarially justified premiums for properties valued at $600,000 for flood insurance.

The federal government has offered flood insurance since 1968!! For 38 years, the premiums have been inadequate, and now the proposal is to only have inadequate premiums for properties below $600,000.

5. Didn't the SS fund have the proper legal safeguards to prevent borrowing against it? If it did, then why should we trust the same government to abide by the safeguards for universal health care?

If it didn't, then why would we trust the federal government that raided the SS fund?

As an agent in what some would consider a small town, let me tell you all about the real world out here in fly-over country.

The price of health insurance is pretty dang expensive, and working people or families who do not have the luxury of having it provided by an employer are struggling just to buy food, heat and gas to get to work.

I just love the comments suggesting that some uninsured are that way by choice, and not because the cost of insurance, so let's leave things the way they are. I would bet that number is a small percentage.

The choice is having food or health insurance. Single, young, healthy people who are just starting out do not have an extra $200 to $400 a month for health insurance. Families that are starting out do not have $600 to $1,000 per month. And these have pretty high deductibles.

There are some companies that are now making the employee pick up the full cost of insurance for the rest of the family. And the workers are finding out how expensive health insurance is.

I do not want the government totally running health care, but some type of health insurance for all is needed. I believe there is just not one answer for healthcare/health insurance problems. There are at least four things needing to be addressed:

--First, health insurance companies should not be allowed to dictate prices and how much they pay for medical procedures, and the whole network, out of network thing should be outlawed. If I have insurance and go to a provider, the insurance should pay.

--Second, health insurance should have to pay for complete physicals for insureds yearly with blood work and x-rays. If you find something medically wrong in the beginning stages, then there is a much greater chance for successfull treatment and it costs a whole lot less.

--Third, malpratcie laws and lawsuits have to have some type of control put on them. Doctors and medical providers sometimes have to do procedures which are expensive and just because they are affraid of a lawsuit. Reform is a must in this area.

--Fourth, this country cannot afford to give free healthcare via the emergency rooms to all the millions of illegal people who are in this country. I know they are here, and I do not want people laying on the streets who are sick, but we need to get the illegal people out of the country. Then contol the borders so we can have legal immigration.

There are probably a few more things to help, but this demonstrates just how complex the problem with healthcare is.

Sam and Tim, I'm with Tiger.

If YOU want to pay somebody else's medical bills, feel free to do so. Just do it with your OWN money, not mine!

"Society" does NOT have a responsibility to provide a basic standard of living for anybody. All it ought to do is provide an environment that is free of coercion, violence and fraud, so everybody can pursue his standard of living on his own.

People who have secured health insurance for themselves haven't obtained it by being "lucky"--they have made good decisions and worked smart.

There needs to be consequences for making poor decisions and avoiding productive work.

Why do you think that Social Security, Medicare and the rest "raise the standard of living of the entire society"? They don't. All they do is raise the standard of some people by reducing the standard of other people.

Income or wealth redistribution (playing Robin Hood) is at best a zero-sum game. Iin fact, it's a losing-sum game, because it impairs the incentives of both the losers and the winners in the game to produce.

Free trade in goods and services CREATES income and wealth, coerced transfers DESTROYS them.

SAM RESPONDS:
Mikk, we've butted heads on this topic many times, and we just have to agree to disagree on a fundamental level, vote our consciences on Election Day and live with the result. We have very different visions of society.

I believe capitalism and some level of socialism is compatible. You do not. I believe history in this country supports my view. We remain the wealthiest nation on Earth, yet remain compassionate enough to secure a decent life for all.

The benefit to all is a more prosperous, healthier, more secure and happier society.

MIKK HAS THE LAST WORD:
Sam, I have no objection to compassionate sharing of one's wealth, as long as it is done voluntarily.

But as soon as government makes it mandatory, it is no longer voluntary, it's coerced. The recipients of the sharing no longer recognize that what they are receiving is charity--they come to see it as their legal entitlement.

And all kinds of unintended consequences flow from that--all bad. To deal with those unintended consequences, more coercion is required. And pretty soon, we no longer have a free society, we have a totalitarian one.

Sam, I find your response to Tiger to be both harsh and mean-spirited. I'm also saddened that educated individuals like yourself would be willing to put your faith in the government to solve issues like this.

Of those 50 million fellow citizens without medical coverage, do you really think that "luck" has anything do with why they don't have coverage? I'm betting there's a whole host of reasons that don't have anything to do with luck. Personal accountability might fit in there somewhere.

For those that do find themselves in unfortunate circumstances by no fault of their own, I have found the American public to be very generous without the intervention of the government.

I also find myself questioning at what price are we willing to allow the government to intervene. Using the Canadian health care system as an example, I find the price to be quite high in terms of delayed and poor care, resulting in a reduced quality of life and even loss of life.

That's not a price I'm willing to consider to change the position of those individuals not accountable enough to take care of themselves or take advantage of the many services that already exist in this country.

SAM RESPONDS:
I did not mean to sound harsh or mean-spirited, but sometimes the folks who think we should just let the sick, poor and elderly die in the streets sound exactly that way to me.

There are certainly some scam artists and irresponsible folks among the 50 or so million who are unemployed. After all, how many millions shield income or otherwise fail to pay their fair share of taxes, or work off the books to avoid paying their taxes altogether. They aren't exactly patriots.

But I cannot imagine anything but a relative handful would fall into that category. Meanwhile, our social safety net seems to have huge holes in it.

The system is broken, and, as you all know, the government never fixes anything that's broken other than by smashing it into smaller pieces, and creating a huge bureaucracy headed by a Humpty-Dumpty, who probably was one of those who helped the downward spiral in some way to begin with.

Reasonably priced, accessible healthcare is possible if we stop all the giveaway programs and focus on providing healthcare for the truly ill, and real preventive care for those who will benefit from it.

Quit providing free care for all the illegals, including free birthing. Stop filling the ERs with minor care problems and use common sense in triaging and treating non-emergency issues.

Use community clinics as urgent cares and fund them so they stay open later to handle the inflow of people needing minor care, and keep the hospitals available for major care needs.

We're paying thousands of tax dollars for a simple cold in many cases, and nobody is doing a damned thing about it, except trying to figure how to get everyone on the system and making the taxpayer foot the bill!

Yes, everyone wants healthcare. Yes, everyone wants it at a cost they can afford. But everyone also seems to want someone else to pay that cost, regardless of where that cost ends up--which, as we all know, is out of our own back pocket!

No easy answer, but as long as we continue to provide every imagineable service for those who never paid and who will not pay, while the American worker and their family suffer because they can't afford it, and make just enough to keep them off the "gimme gravy train," we'll never have a system that will work for the country, regardless of the bureaucrats' promises.

Maybe if one of the candidates had to sit unnoticed and wait in line like everyone else in one of our local hospital ERs unannounced, they might understand the gravity of what the system is staring in the face. And that, my friends, would scare them into reality I should think!

If you want to make health care affordable, you need to start at the top and work your way down--not the other way around, which is what most headlining politicians try to do.

The affordability of health care does not start nor end with price fixing within the industry rating guideline. Health care is proportional to the amount caregivers are charging.

Before trying to fix the payment method, why not fix or "regulate" the charging method? Doctors and hospitals are famous for overcharging in order to subsidize the unpaid debts of many.

If you regulate these costs it's a good first step in making health care costs fair and equitable across the board.

As an example, I went to urgent care for the flu in December. My bill was billed as an "office visit" amounting to $670.00 all for the pleasure of waiting 2 1/2 hours in order to speak with a doctor for 5 minutes.

For anyone keeping track, that's $134.00 per minute. Now you fix that problem and healthcare suddenly becomes more affordable for eveyone.

I believe Tiger is referring to socialism as a form of government which, it is true, we are not. We are a democratic Republic.

This would support the comments he made with regard to the potential for our government to provide 100% entitlements, paid for through astronmical taxes. This would stunt capitalism if you compare us to some European friends.

I agree with Sam that we need to have a minimum standard of living in this country. And, as his example points out, we already succeed in doing more than Third World countries do for their citizens.

In the state I reside in, our social service program budget is over $5 billion dollars. $3+ billon of this is money collected from citizens by the federal government and $2 billion is money collected from citizens by our state. And my state is nowhere near the size of New York or California in tax income.

So, what we, as a society, are already doing is admirable. Nationally, 60% of the tax dollars collected goes toward social programs.

Is there room for improvement? Of course. But, based on the fact that Social Security and Medicare have been in dire straits and will be underfunded in the not too distant future, I'm worried about the goverment jumping into another federal program without fixing the ones that are currently experiencing problems.

The goverment is already good at borrowing from its citizen's Social Security benefits. Visit its Web site yourself. If universal health care experiences underfunding, where would the feds get the money to fix their new program?

Its no longer the 1990s with rampant growth in the economy by 401K investors, and the stock bubble has burst. We need to start acting like grown ups.

It amazes me to see the "let them eat cake" attitudes of some of the prior writers in this blog.

Health care is a basic necessity of life people, not a luxury! And to have the power, both politically and financially, to assist those less fortunate should be considered a blessing.

But to take the attitude that we might have to lower our standard of living a little bit to accommodate the poor and especially the innocent victims of poverty--the children-- makes me very sad.

I can see why people don't want the government involved, but if the government doesn't carry out the needed reforms, who will? The AMA? The drug companies? Health insurance companies?

Finally, it continues to befuddle me why so many people think our health care system is so great in this country. Last I heard we rank #47 in terms of quality of health care.

Seems to me we should be ashamed of ourselves and be much more open to adopting the ways of the other countries instead of blindly defending our own.

If I hear one more time from a politician, both Democrat and Republican, that we have the greatest health care in the world, I think I will be sick! Good thing at least I have health insurance.

I don't think anyone who's contributed to the forum wants people dying in the street, as Sam suggests. And we know this does not happen due to the Medicare/Medicaid programs we have had in place for low-income families and seniors.

There is a lot to be said for the medical developments our country's citizens have achieved for the world. And we will continue to achieve them through our R&D. But, like everything, our healthcare is not perfect.

I think what most people are attempting to get across is their discontent with their government. My own post was positive in its notation of what we currently do to support those in need. As I said, 60% of our tax dollars go toward social service programs.

I think my own resentment of the government, at times, comes from personal experience.

I went to college for many years to complete my degree, while I worked full time to pay for it and my expenses. At the time, I attended college with individuals who were given a house to live in rent free while they were going to college full time.

The diference between my situation and theirs was that they stole to pay for drug habits and the law finally caught up to them. In lieu of jail time, these individuals were offered a drug-free program which paid for their detox, counseling, rent/food and college tuition.

So, on one hand, I think this is a great country that we continue to do this for individuals who have sunk low. On the other hand, it feels like my government won't lend me a hand unless I become like these people.

Now, should I be grateful that I am not in these dire straits? Yes, of course. But I've worked very hard to get where I am and it sounds like my government just wants to coninue to take more from me.

In response to David:

Health care by others is NOT a "basic necessity of life." The human race survived and thrived for 100,000 years without a single MRI or bypass.

That said, good health is certainly desirable, and I'd like to see everyone live forever in perfect health. But how much of our national income do you want to devote to achieving that goal?

There are a few other things that matter, too. Making health care an open-ended entitlement that someone else is going to be forced to pay for is a mandate for ever-expanding government bureaucracies with ever-expanding powers and budgets, and ever-shrinking individual freedoms and responsibilities.

Having the power to help the less fortunate is indeed a blessing. Use it to your heart's content. Adopt a family, pay their medical bills, or do whatever you want. Just don't put the government's gun to my head.

SAM RESONDS:
Mikk, what makes you think that universal health insurance means some sort of unwarranted subsidy for the poor. I think you are confusing that with Medicaid!

Let everyone pay their fair share of premiums. If everyone pays, everyone benefits. That's the whole point of insurance, is it not? Spread the risk and everyone pays less yet is covered in case the worst happens.

MIKK HAS THE LAST WORD:
Sam, even today, without any coercion by government, health insurance is available to everyone at a fair premium. "Fair" meaning as accurate a reflection as is possible on the basis of the available information of the policyholder's probable future covered health care costs--such as the likely number of claims times the likely average cost of those claims, plus the expected administrative and anti-fraud costs.

A fair price is commensurate with perceived risk. No subsidies.

Universal availability of health insurance is not the problem. For a couple of well-identifiable segments of our society (the poor and the sick), the premium is the problem.

If they are going to have health insurance at a fair premium, another well-identifiable segment of society is going to have to pay it for them (some or all of it). That's a subsidy of one pre-identifiable group by another pre-identifiable group.

Another problem is that laws have been passed that force health care providers to provide care even if it's clear the patient is never going to pay for it. With a law like that, why even bother to buy health insurance? We've created a "free rider" problem.

So to "solve" the free rider problem, you just propose to force everybody to "buy" insurance. A forced purchase is a tax, not a purchase. A whole big bureaucracy will have to be created to enforce such a mandate, and it won't succeed anyway. Even if you could find "everybody," they can't all pay their fair premium anyway.

Sam, it's just another involuntary wealth-transfer program.

Unfortunately, people ARE dying in the streets, and it's not because of lack of coverage. It's because of overuse of the system we have now, which would only get worse with any "universal" healthcare system.

The facts are that people die on gurneys in waiting ambulances and paramedic vans all the time because the ERs are too jammed now, while the triage nurses are trying to sort out the onslaught of those seeking care for the sniffles, from those having coronary occlusions and respiratory failure.

They do the best they can, but they're outgunned! The ERs are so jammed at many hospitals that they run at capacity and are regularly on "bypass," yet still have patients brought to the door because every other ER is also on bypass due to the same situation.

The facts are that doctors are under such pressure in some hospitals to treat patients on an "assembly line" basis that patients are discharged before paperwork is completed, and care is severely compromised.

In two recent cases I am very familiar with, patients have been involved in accidents, one fatal, within minutes of being discharged from the ER because of inadequate processing and discharge procedures.

Spend some nights in a local ER and you'll be amazed at what you see brought in for emergency care. And, unfortunately you can't turn these people away due to laws, so you have to triage and treat, even though the issue should be looked at by a clinic, if at all.

A child puts his shoes on the wrong feet and his feet hurt; that becomes a reason to bring him to the ER with his shoes still on the wrong feet! Come on!

Before any system will work, there needs to be some controls on who receives what and when.

I know, here I am again on the soapbox about all the free care for the illegals, but come on, if they need true emergency care, give it to them. Nobody wants to deny true emergency care for emergencies that are life threatening.

But quit the free care for all the minor issues that's clogging up the system.