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  1. Did you know that "Mandated Health" is already a failure...?
  1. Which was the first state to enact a universal system?
  1. Who is Rube Goldberg and why is he designing my health care system?

If you said Massachussetts you'd be only half wrong...

Those of you who have been working on health care reform for many years likely came up with Hawaii. Yet you don’t hear much anymore about Hawaii’s universal system. Why is that?  After all, soon after the enactment of Hawaii’s health insurance law, those lacking insurance dropped to 2 percent. Following "success" in Massachusetts, we are hearing about mandated plans from governors in California, Pennsylvania and New Jersey.  Surely Hawaii should be touted as proof that Mandates work? Surely Massachusetts is well on its way to success...?


While Hawaii's "Prepaid Health Care Act" required employers to provide health insurance for employees working twenty hours per week or more, there is no such requirement to provide coverage for employees working less than twenty hours per week.  On top of that increasing health care costs, insurance premiums, employer costs, prescription drug costs, long-term care costs, together with the growing number of uninsured individuals, and inadequate Medicaid reimbursements have led to uninsured over 10%... and unmangeable costs.

Ah... but that is old news. Surely the brilliance of bipartisan compromise (always a good thing, right?) in Massachusetts must have led to their mandated plan being a runaway success?

Uhhmmm... not in the real world, once they actually got down to the details reported reported the Boston Globe:

A state panel yesterday outlined for the first time the minimum requirements for coverage under the state’s new health insurance law, a package estimated to cost $380 a month on average for an individual.

Panel members struggled yesterday to balance affordability with protection from catastrophic medical bills and remained divided on many issues.

"If we’re going to mandate this, people need to see that they’re getting some value," said panel member Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology. But, he added, the premium is "bad news."

"I’m trying to think of something to get this number down," he said.

The minimum plan would limit annual out-of-pocket expenses to $5,000 for an individual and $7,500 for a family and include prescription drug coverage, according to the proposal by a subcommittee of the Commonwealth Health Insurance Connector board, which is implementing the new law.

As proposed, deductibles would run no higher than $2,000 per individual and $4,000 per family.

Advocates for the uninsured were stunned at the price, considerably higher than the $200 estimated by Mitt Romney when he was governor and first proposed universal coverage. A spokesman for insurers said the requirements were too prescriptive and could undermine the goal of universal coverage.

"For a large proportion of the folks not eligible for subsidized care, the bare minimum plan is flat-out unaffordable, not only because of the premiums, but the deductibles and out-of-pocket expenses," said John McDonough, executive director of Health Care for All, an advocacy group that supports the health law. "This is a significant disappointment. We think the Connector and particularly the insurers need to go back to the drawing board."

Eric Linzer, vice president of the Massachusetts Association of Health Plans, said the Connector committee’s recommendations were boxing insurers into a corner.

"There’s really a limited number of ways you can make premiums affordable," he said. "If the minimum credible coverage is too high and coverage is unaffordable, it runs the risk of not achieving universal coverage."

Romney won't have this Massachusetts miracle to fall back on. Requiring each person to purchase a private health plan (individual mandate), "works" only if the plans were affordable. Mass also decided that the plans must meet a reasonable standard of coverage. So what did they do? They declared that the plans would have to meet a reasonable standard of coverage and that they would have to have low, affordable premiums.  And they decided to do this via fragmented risk pools and the existing plethora of private for profit insurers.

It was not as if this fundamental flaw in their proposal was simply overlooked. Many pointed out that you can have insurance premiums that are affordable, or you can have coverage that makes health care affordable, but you can’t have both. Health care simply costs too much. To be effective, the fragmented private for profit insurance pools must have adequate funds to pay reasonable health care costs. That means that the private insurance funds must charge high premiums to fund them. Simply declaring otherwise is not reality based.

California Gov. Arnold Schwarzenegger plans to copy the Massachusetts reform in shrinking the numbers of uninsured people by forcing them to buy stripped down, bare-bones policies.

With premiums for family coverage now averaging $10,000 a year, the only way that states can make premiums affordable is to strip down the plans, which then forces policyholders to pay out of pocket when they get sick. High deductibles, co-payments and benefit reductions are destroying the financial protection that insurance should provide.

Half of U.S. bankruptcies are a result, in part, of medical illness or medical bills. Three-quarters of Americans who are forced into medical bankruptcy had health insurance at the onset of the illness that bankrupted them. Worse, suffering and death can occur when patients cannot afford the care that their private insurance does not  

The big winners in the Schwarzenegger and Massachusetts health plans are private health insurance firms. The new insurance mandates will hand them billions in wasteful administrative fees that do not occur in government insurance programs such as Medicare. Private insurers will continue their cream-skimming, enrolling primarily the low cost, healthy workforce and their families, while leaving the costs of the unprofitable sick and elderly to the taxpayers.

State health programs are interdependent on federal programs such as Medicare, Medicaid and the Veterans Affairs' system, and are regulated by federal laws. The states alone cannot enact the structural changes that would be required to cover everyone and control costs. They are limited to building on the existing system by tweaking it to nominally expand coverage to the uninsured.

Total dollars are not the problem. We already are spending enough on health care to provide high-quality, comprehensive services for everyone. But our inefficient, private-sector insurance bureaucracies have failed and need to be replaced with single-payer national health insurance. Every other developed nation has covered its citizens through some form of non-profit national health insurance.

Here's the part I don't get: With all the actual programs out there... the various real world systems in place throughout every other country in the developed world, why do some in the U.S. keep insisting on inventing new and untried Rube Goldberg systems of care?

Only by including the healthy and wealthy in the same universal pool... Only by tapping the saving available by moving from the combined 31% overhead & profit extracted by the for-profit sector to the 4% of the public sector (e.g,. Medicare) ...can we provide universal care without increasing overall costs!

  • Only Single-Payer, such as the easy to explain, understand and sell "Medicare for All" makes economic and social sense
  • It is easily understood. people have heard of Medicare and it has wide support.
  • Uses single existing bureacracy to administer. Don't need to create something new, just expand existing.
  • Actual expansion is less than people think since if measure is acutal health care use, visits to doctors and hospital, then over 65 and/or disabled is proporationally more than general population; and same agency CMS, also already administers federal part of Medicaid which takes care of lots of kids.
  • Simple description, eligibility for Medicare is now at birth instead of at 65.
  • Still have competition at the DELIVERY side of the equation.
  • No it is not "socialism" or "communism."
  • Hospitals, doctors, health centers, clinics, even regional provider groups (e.g,. Kaiser, Puget Sound or other HMOs in the original sense of the word), still compete to attract patients, deliver care on the basis of quality, patient satisfaction, convenience, whatever.
  • People still have choice. They still choose which provider to go to, who gets there service.
  • The percent of costs going to care goes from 69% (current private sector) to 96% (current Medicare), which more than pays for making the coverage universal. I want 96 care not 69 care!
  • Because have single nationwide pool, there is no skimming of the health & wealthy. True spread of risk. True purpose of insurance.
  • Because one insurance bureacracy it is simpler, and easier and cheaper for everybody... for the patient (people) and for the providers (doctors, hospitals, etc.)
  • Make every other business except health insurers happy by relieving them of the burden of health care.
  • Separates care and insurance from job, employment and employers.

Spread the word...

Here is what you can do now:

Rep. John Conyers has reintroduced HR-676 this year. The bill garnered nearly 80 co-sponsors in the last Congress, more than any other reform proposal, and at least three of the newest members of Congress made support for single payer national health insurance a key issue in their campaigns. Senator Kenneday has been the Senate sponsor in past years. 225 Unions including 17 State AFL-CIOS have endorsed it, as have many other civic and religious organizations.

Ask your congressperson to sign-up as a co-sponsor of HR-676!
You can look-up your elected officials here

Get any organization you belong to -- civic, religious, labor, community, etc. to pass an HR-676 endorsement resolution. Here is how to that. Or here here if you prefer.

Just do it!

Originally posted to DrSteveB on Thu Feb 01, 2007 at 04:47 AM PST.


Had you head of Rube Goldberg before?

95%47 votes
4%2 votes

| 49 votes | Vote | Results

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Comment Preferences

  •  Tips for Rube Goldberg (8+ / 0-)

    You gotta love Rube Goldberg but why do U.S. pundits and politicians think he should be desiging health care insurance systems?

    Recommend "Medicare for All" national single payer.
    Good for Business and good for people.

  •  And (1+ / 0-)
    Recommended by:

    And all this time I thought our health care system was designed by Murphy...

  •  Add Ct to your list (1+ / 0-)
    Recommended by:

    Our Republican Governor proposed something similar to Mass only it didn't get much publicity.

    The Mass plan is doomed for failure.  $380 a month is a deal breaker, especially when you consider that you'll still have to shell out $5,000 BEFORE you see a dime in coverage.  So in essence you're shelling out $9560 a year before getting any benefits.

    Yeah, that'll fly with people making $40,000 a year and paying 50% and up of their gross income just for housing.

  •  While this is a bad deal for Massachussetts... (1+ / 0-)
    Recommended by:
    johnshaft's a good thing for universal care...

    It just highlights the stupidity of the current system, and now that people are paying out the nose for it, are going to demand more for their money.



  •  I would have said Hawaii (0+ / 0-)

    I first heard about it on a United Airlines flight years ago. And I have from time to time wondered why I never heard any more about it.

    Thanks for the update.

  •  Nice diary. (0+ / 0-)

    On purely a technical level - any English teacher would give you an A.  Right off the bat, your first paragraph (indeed the first sentence) sets out the premise and then goes on to explain as we read on.

    These health issues are complex and the sound bites we hear on tv - "Gov. Schwartzenagger should consider running for president with the success of this health plan." or "Mitt Romney's stunning success."  People - busy people, lazy people - believe this soundbite stuff.  I know - I was one of them.  I had little time to read critically and think critically.  Now that I'm retired - or perhaps more importantly, have some experience in life, I look back on my past beliefs, and I could weep.

    Rube Goldberg - there's a reason that term survives every generation.


    I have no patience with people who grow old at 60 just because they are entitled to a bus pass. Mary Wesley, British novelist

    by xanthe on Thu Feb 01, 2007 at 05:22:38 AM PST

  •  Once again DrSteveB (2+ / 0-)
    Recommended by:
    eddienic, Fungible Chattel

    you pull back the curtain to show the real mess that it conceals.  

    Medicare for all is the straightforward answer to our national health care woes. Sometimes the answer is so obvious, you just can't see it, sometimes forces conspire to keep you from seeing it.

    The health insurance industry (cartel?) should view this as an opportunity and not a threat.  They will surely flourish in providing Medi-gap type insurance and Medicare Advantage plans as they do today to Medicare recipients. This would give both National Health Care and competition.

    Employers would begin to offer and unions would negotiate such additional coverages to cover deductibles and co-pays that exist in Medicare. I imagine such coverage would be relatively inexpensive, yet attractive to workers and employers alike.

  •  The easiest plan to implement the hardest to pass (1+ / 0-)
    Recommended by:
    Fungible Chattel

    Why the easiest plan to implement is the hardest to pass -- I JUST DON'T GET IT.

    The only reason I can come up with (and all the proposals mentioned above verify this answer) is that our rich politicians don't have a clue how to live on $40,000 a year or less.  Those multi-thousand deductables every year -- EVERY YEAR make health insurance a sick gamble for most people.

    I've got one question about Medicare for All.  Deep inside it mentions a 15 year phase-in.  What do they mean by that, do you know?  It doesn't make me against it.  But, I'd like to see Everyone Covered before I turn 70.  Just Asking.

    Eat 4 Today: Defeating Republicans through diet and exercise!

    by katiebird on Thu Feb 01, 2007 at 05:37:45 AM PST

    •  15 Year Phase In? Are They Kidding? (0+ / 0-)

      In 15 years I'll be on Medicare anyway.  Almost all the boomers will be.  That solves their demographic problem, covering the huge population bulge entering their fifties now, that is part of the reluctance to go ahead and do this.  That's meaningless reform.

      We don't need Medicare in 15 years when we'll already have it.  We need it now.  Now is when we are raising our families, sending our kids to college and hearing that we should pay 50% of our adjusted gross income for college while also being told we should pay $500 a month for insurance and $5K a year in deductibles.  Not to mention those caring for their parents. Now is when we're always bleeding from the wallet, and sometimes from the wounds they won't stitch at the ER without the $100 ER co-pay.      

      A 15 year phase in removes the immediacy from this.  Imagine the public appeal of a plan that guarantees everybody will be covered by health insurance, NOW, without the deductibles, the preexisting conditions and the prospect of medical bankruptcy (no longer dischargeable).  Imagine the reaction to the stump speech of the candidate who says, "a Medicare card in your mailbox tomorrow.  Next doctor visit - covered.  Show the card and see the doctor.  No preexisting conditions, no premiums, no preapprovals for a test you need this afternoon, no waiting.  Covered.  Tomorrow."  

      No wonky discussion that makes a lot of people who ought to support this in their own self interest rebel against the idea because they're being lectured by elitist Volvo drivers.  No purchasing pools, no mandates, no b.s.  Everybody at the water cooler understands the plan.  Just like Grandma, or Mom.  

      The policy guys need to stop their circle jerk and get this going before the last middle class family in the country goes on display at the Smithsonian.  

      •  Or Else Make Them Explain (1+ / 0-)
        Recommended by:

        Why it is that a plan we know works exactly the way it should is only suitable for people 65 and older.  What policy reason can they possibly articulate that justifies drawing that line?  If I am 65 and I am diagnosed with congestive heart failure I get care, but if I am 64 I can die?  

        We've been kicking around the questions we'd ask candidates if we could meet them and ask just one.  That's mine.  If you don't favor single payer, right now, but you do support Medicare, why do you draw that magic line at age 65?  

        Take a minute, Hillary, Obama, et al. I'll wait.  

      •  It's just one sentence buried pretty deep (1+ / 0-)
        Recommended by:

        It's just one sentence buried pretty deep -- there is no explanation about what aspects or what order or what, exactly they mean by the 15 year phase in.

        (I'd post the text, but I can't find the text today.  I'll look again at lunch time)

        Eat 4 Today: Defeating Republicans through diet and exercise!

        by katiebird on Thu Feb 01, 2007 at 07:45:25 AM PST

        [ Parent ]

  •  Answers (1+ / 0-)
    Recommended by:

    Good post, please check out mine on universal health care reforms at the Federal and State-by-State level.

    As I understand it, there are two types of mandates, employer mandates and individual mandates.  It's obvious that an employer mandate alone won't cover everybody because, well, not everybody works (or works long enough hours in the case of Hawaii).  It is possible to cover everybody as Switzerland does using an individual mandate only if you are able to actually regulate the price of a basic plan.  Of cource, strict regulation and price setting are poisonous to Republicans so Romney didn't add it in the plan!  He just accepted the fact that Insurance companies would naturally play nice... (yeah right)

    The reason that all of the state plans (and the failed 1993 Clinton plan) look like Rube Goldberg designed them is twofold: 1-people are afraid of being called Socialists in the U.S. and 2-the lobbying power of the insurance industry.  A single payer system won't be enacted here until the American people see it as the pragmatic thing to do.

    Also, FYI, the Conyers plan--H.R. 676--is different from the Kennedy plan in the Senate.  There is no companion bill for 676 in the Senate.  Kennedy's plan is literally to expand the existing Medicare with some improvements to everyone.  Kennedy's plan also has a companion bill in the House put forth by John Dingell (D).  

    Unlike the Kennedy/Dingell bill, Conyer's bill has little to do with "Medicare" as it exists today.  It would literally scrap the existing health insurance industry, Medicaid, Medicare, the VA, etc. and replace them all with a single payer system.  

  •  No matter How You Slice it, it is still only (2+ / 0-)
    Recommended by:
    katiebird, Fungible Chattel

    Half a Loaf.

    Let's go all the way.

    Single Payer gets rid of something less than 40% of the unnecessary cost in the Health Care System.

    Having the Government totally take over all aspects of the Health Care Industry and then provide these services as a basic Human Right and as a Common Good for the nation, will get rid of 100% of the excess costs, while at the same time dramatically improving the quality of care.

    The cost reduction alone will be on the order of One Trillion Dollars per year.

    There are somethings that the private sector cannot do as well as the Central Government. For the past 58 years the industrialized world has run a very public experiment that shows beyond a doubt that one of those things that it cannot do is to deliver Health Care Services at high quality and low cost.

    Don't let the "S" word scare you.

    The time has come to Nationalize the Health Care Industry!

    •  I agree. (0+ / 0-)

      But let's not go crazy on the numbers.

      U.S. health spending was projected to be $2.1 trillion this year (or in 2006, I'm too lazy to look it up at CMS).

      About a third (31 percent) of that, was administration (NEJM, 2003). About half of that administration is recoverable/re-directable (Canada's system runs at roughly 16 percent administration). That's about $325 billion, not a trillion.

      Also, its important to note that this is not a reduction in total health spending, its a redirection of funds currently in the system necessary for the comprehensive benefit package. We figure care dollars being spent now should rightly go for patients, not for profits.

  •  rube funny/rediculous ,these schmes cynical/redic (1+ / 0-)
    Recommended by:

    I feel like im being mugged every time I get an insurance bill.I think mugging Americans emboldens our enemies.

    have we hit bottom yet?

    by eddienic on Thu Feb 01, 2007 at 05:53:30 AM PST

  •  Bad Public Policy (0+ / 0-)

    Despite the fact that employer provided health care is a huge cost, most employers were willing to bear it because it gave them some added control or protection against poaching. Unfortunately for them, many are seeing that those handcuffs hold on both ends in a way they don't like.

    A few years ago I wrote an essay about what I would do if I were creating the system. Aside from a few implementation details and the funding source, it's not much different from a Medicare for All or other universal single payer.

    One of the things I concluded there and still conclude, is that it is not only the inefficiency of the insurance system that costs us, but that our current system adds inefficiency to our employment system.

    I am completely opposed to Bush's proposal, but it might be a modest improvement over the current system if it goes back to community underwriting and forces insurers to sell insurance to individuals for the price of group. We also need to get employers out of the self-insurance business.

    Single payer universal healthcare coverage saves money and saves lives.

    by freelunch on Thu Feb 01, 2007 at 06:12:44 AM PST

  •  Exactly (1+ / 0-)
    Recommended by:

    It's the cost of healthcare that will eat up our entire federal budget by 2050.  We need to do something about the gouging that takes place and have a system that is run at cost plus allowing for those in the business to make a decent living.  For some reason, the best doctors are attracted to academic medicine and it's not due to the high pay.  Maybe we should aspire to have doctors who want to be in medicine for the same reason as those who choose academic medical settings and not those who go into it for the money.

    Winning without Delay.

    by ljm on Thu Feb 01, 2007 at 06:47:41 AM PST

  •  Single payer health care (2+ / 0-)
    Recommended by:
    katiebird, Fungible Chattel

    What a clear succinct explanation of why the current plans won't work and why single payer, Medicare of all, is the only answer.

  •  an Oregon health-care bill (1+ / 0-)
    Recommended by:

    Why no discussion of the Better Health Act now before the Oregon legislature?

    The shortcomings in the California and Massachusetts plans were obvious from the get-go.

  •  sent an email to my congressman and phoned his (0+ / 0-)

    local office.

  •  It's hard to understand their surprise (0+ / 0-)
    Advocates for the uninsured were stunned at the price

    I can only conclude that none of the people involved in the effort had ever shopped for their own health insurance. I personally think that's a bare minimum qualification for anyone who's working on reform in this area.

    The cost is the deal breaker. Everything else can be worked out. But fundamentally, the cost of health insurance, at least in our current system, is too large to bear unless you're quite well off, and too large to impose on a short-term basis even for people making above the median income.

    BTW: although it sounds right, the idea that you don't see any benefit from these high-deductible plans until you've paid the whole deductible isn't quite right. Prescription drug coverage is frequently independent of the deductible, and even if you're in the deductible range, you get the insurance company's negotiated rate which can be half of the "list" price.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Thu Feb 01, 2007 at 08:49:20 AM PST

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