Second Presidential Debate

[PeppyGPhiB]

CrackerBarrel (love your rocking chairs, btw), what do you pay each month for health insurance?

I don't get why we attach health insurance in this country to employers. The two have nothing to do with each other.

[KSig RC]

Originally Posted by PeppyGPhiB

I don't get why we attach health insurance in this country to employers. The two have nothing to do with each other.

I agree completely, this is exactly (one of) the key problem(s) with modern health insurance, and it's a bastardization of market conditions that has led to awful unintended consequences.

However, the solution to fixing this issue isn't necessarily nationalization or "forcing" insurance on people. Indeed, this sort of nationalization would seem to play exactly into the current problems with health insurance - namely, that the insurance companies themselves are the policymaker (pun completely intended).

If you want affordable medical care for every American, this is a completely different issue than nationwide health insurance for every American. The entire concept of insurance is pooling risk - simply handing out insurance without additional intake in premiums would be a disaster, and would force the insurance companies themselves to round up more income. Guess how that would happen?

Again - health insurance is a commodity. Medical care is, as well, to a certain extent - but one that can be subsidized by the State. Why do we focus on the former instead of the latter? Why allow the insurance cabal to affect the cost of the latter, period, in a misguided attempt to "have it both ways" and prop up a crappy system?

For the record, neither candidate's plan seems to address this fundamental disconnect in a substantive fashion.

[UGAalum94]

Originally Posted by KSig RC

I agree completely, this is exactly (one of) the key problem(s) with modern health insurance, and it's a bastardization of market conditions that has led to awful unintended consequences.

However, the solution to fixing this issue isn't necessarily nationalization or "forcing" insurance on people. Indeed, this sort of nationalization would seem to play exactly into the current problems with health insurance - namely, that the insurance companies themselves are the policymaker (pun completely intended).

If you want affordable medical care for every American, this is a completely different issue than nationwide health insurance for every American. The entire concept of insurance is pooling risk - simply handing out insurance without additional intake in premiums would be a disaster, and would force the insurance companies themselves to round up more income. Guess how that would happen?

Again - health insurance is a commodity. Medical care is, as well, to a certain extent - but one that can be subsidized by the State. Why do we focus on the former instead of the latter? Why allow the insurance cabal to affect the cost of the latter, period, in a misguided attempt to "have it both ways" and prop up a crappy system?

For the record, neither candidate's plan seems to address this fundamental disconnect in a substantive fashion.

Yep.

[CrackerBarrel]

Originally Posted by PeppyGPhiB

CrackerBarrel (love your rocking chairs, btw), what do you pay each month for health insurance?

I don't get why we attach health insurance in this country to employers. The two have nothing to do with each other.

I've got grad student health insurance through my school, so it's pretty low.

I think that insurance attached to employers for reasons that are two-fold: one is that companies with highly skilled workforces need to keep their workers healthy because they are hard to replace, so it was in their interest to insure them. Then unskilled workers saw what was going on and collective bargaining led to a lot of union workers getting health insurance, and it kind of spread from there.

[pinksirfidel]

Originally Posted by PeppyGPhiB

I don't get why we attach health insurance in this country to employers. The two have nothing to do with each other.

I never thought of that... you bring up a valid point!

Originally Posted by CrackerBarrel

I think that insurance attached to employers for reasons that are two-fold: one is that companies with highly skilled workforces need to keep their workers healthy because they are hard to replace, so it was in their interest to insure them. Then unskilled workers saw what was going on and collective bargaining led to a lot of union workers getting health insurance, and it kind of spread from there.

That makes a lot of sense.

[AGDee]

"The Straight Talk Express lost a wheel on that one".. lol. They just played that clip of Obama on tv this morning. I must've missed that line when I was getting home and had to go from car to home. I think it trumps "Say it ain't so, Joe" as a one liner (and it's grammatically correct).

Mortgage bailouts: It seems to me that McCain's plan would be doing exactly what he argues against in most instances.. nationalizing our mortgage system rather than leaving it to the private sector. I don't think I want the government being our primary mortgage lender. I think regulation of the private sector's practices makes more sense than creating yet another large government agency.

Health care: I've been working in health care for 21 years now so I feel like I know a bit about it. There are so many facets to this. Some facets are commodities (pharmaceuticals, durable medical equipment, etc), some are not. In Michigan, all hospitals are required to be non-profit. As a non-profit, I don't think you can argue that it is a commodity. However, all the vendors that a hospital must use are commodities. It's just not cut and dried. *If* we don't see health care as a right, then why must hospitals treat anybody who walks into the ER and eat the cost? They should be able to require payment immediately. Physicians in our medical group earn approximately $150K a year. This is NOTHING compared to what the top earners in "commodity" businesses make. They aren't getting $47 million severance packages, that's for sure. They are saving lives, keeping us alive, making us healthy and that's what they make. They also spend significantly more than the rest of us on their educations and pay extraordinary amounts of money in malpractice insurance (another commodity that feeds off of the health care industry). Blue Cross/Blue Shield of Michigan is non-profit. Other health insurances in Michigan are not.

Dictionary.com's first definition of commodity is: 1. an article of trade or commerce, esp. a product as distinguished from a service.

Health care is a service that needs to utilize commodities to provide that service. I wouldn't call it a commodity in and of itself. I believe it is a right as in "The right to life, liberty and the pursuit of happiness". Without health care, the right to live and pursuit of happiness is pretty near impossible for many. Personally, I put it in the same category as Education. Education is also a service that utilizes commodities to provide the service. We have a right to equal opportunity to education and it is my personal belief that health care should be treated the same way. I don't think the agencies (hospitals) that provide the service should be the ones who bear the burden when the people don't have a way to pay for it. Car mechanics aren't required to fix your car if you can't pay for the service and parts. Why are hospitals required to fix people if they can't pay? Because we (society) recognize that human life is valuable.

People will always say "well there's a free clinic in my neighborhood" and that's great to hear. It's not true in many neighborhoods. In many neighborhoods, the only way people get free care is for the hospitals to eat the cost of ER visits for things like strep throat, sinus infections and indigestion.

And yes, this credit crisis is also hitting the health care industry. If the credit market doesn't open up soon, health systems may not have cash flow to purchase the needed commodities to provide their service. The health care system that I work for had much invested in the Reserve Primary Fund (money market), which is where our Pensions were. If you haven't heard of this fund, you can read more about it here: http://www.usnews.com/blogs/new-mone...-may-lose.html
But it fell below $1 because it was holding bonds from Lehman Brothers. What a mess. They have to guarantee our pensions so that money has to come from other sources now. Add that to the extra millions of dollars of free care we're providing now that the unemployment rate in Michigan has been over 7% for months on end...

My basic point is that health care is not nearly as cut and dried as "is it a commodity, right, privilege or responsibility?"

[KSig RC]

Originally Posted by AGDee

Health care: I've been working in health care for 21 years now so I feel like I know a bit about it. There are so many facets to this. Some facets are commodities (pharmaceuticals, durable medical equipment, etc), some are not. In Michigan, all hospitals are required to be non-profit. As a non-profit, I don't think you can argue that it is a commodity. However, all the vendors that a hospital must use are commodities. It's just not cut and dried. *If* we don't see health care as a right, then why must hospitals treat anybody who walks into the ER and eat the cost? They should be able to require payment immediately. Physicians in our medical group earn approximately $150K a year. This is NOTHING compared to what the top earners in "commodity" businesses make. They aren't getting $47 million severance packages, that's for sure. They are saving lives, keeping us alive, making us healthy and that's what they make. They also spend significantly more than the rest of us on their educations and pay extraordinary amounts of money in malpractice insurance (another commodity that feeds off of the health care industry). Blue Cross/Blue Shield of Michigan is non-profit. Other health insurances in Michigan are not.

To be clear - I'm not saying that medical care is a commodity, but rather than pooled insurance risk is a commodity. Under the definition below, this is clear:

Originally Posted by AGDee

Dictionary.com's first definition of commodity is: 1. an article of trade or commerce, esp. a product as distinguished from a service.

Insurance is not a service - it's a product. You're paying for the ability to pool risk with others.

Originally Posted by AGDee

Health care is a service that needs to utilize commodities to provide that service. I wouldn't call it a commodity in and of itself.

Remember that when these two specific politicians talk about "health care" they are NOT talking about "medical care" - each of their plans calls for nationwide health insurance coverage. That's why I'm using the commodity angle - otherwise, I agree that medical care is a service and separate. That's my entire frustration.

Originally Posted by AGDee

I believe it is a right as in "The right to life, liberty and the pursuit of happiness". Without health care, the right to live and pursuit of happiness is pretty near impossible for many.

This is kind of a strawman - remember that the original ideals of the frames were "life, liberty and the pursuit of property" . . . and 'life' refers to the ability to live without impediment from others or murder at the hands of the state or individuals, not the ability to live until you're 80.

Originally Posted by AGDee

Personally, I put it in the same category as Education. Education is also a service that utilizes commodities to provide the service. We have a right to equal opportunity to education and it is my personal belief that health care should be treated the same way. I don't think the agencies (hospitals) that provide the service should be the ones who bear the burden when the people don't have a way to pay for it. Car mechanics aren't required to fix your car if you can't pay for the service and parts. Why are hospitals required to fix people if they can't pay? Because we (society) recognize that human life is valuable.

I think this paragraph kind of argues against itself - there is a key difference between education and health care, as well: people are far more willing to pay high-end prices for high-end health care, and the individuals who practice are much more specialized and highly trained.

Teachers don't get paid nearly what they're worth, and I think most of us agree that we suffer for it. What would happen if doctors suddenly became (de facto or literal) government employees, too? Will people move to the suburbs to live near the good schools and hospitals? Does the inner city get screwed again (and I realize they already are in this regard, but the point remains)?

Again, I think there are dozens of unintended consequences that we miss when we argue for the idyllic 'forest' of universal health care and don't examine the 'trees' of "how on Earth did this system get so screwed up, and why aren't we simply tearing it down instead of applying a Band-Aid?"

I agree completely that the burden should never be on the hospital itself - the rise of "mandatory-care" ER policies and the like is probably just as detrimental to the average person as the conduct of insurance carriers to drive up costs and reduce coverage.

Originally Posted by AGDee

My basic point is that health care is not nearly as cut and dried as "is it a commodity, right, privilege or responsibility?"

Agreed completely - great post, Dee. Thanks!

[LeslieAGD]

Except for a few questions, last night's debate was a snore for me. If I had to listen to McCain say "my friends," "I know how to fix it," or hear either candidate say "look here" one more time, I would have been ready to stab myself in the eye.

[Senusret I]

Originally Posted by LeslieAGD

Except for a few questions, last night's debate was a snore for me. If I had to listen to McCain say "my friends," "I know how to fix it," or hear either candidate say "look here" one more time, I would have been ready to stab myself in the eye.

Every time Barack said "LOOK" I thought it was my dad or Principal about to give me a stern lecture.

[UGAalum94]

Originally Posted by Senusret I

Every time Barack said "LOOK" I thought it was my dad or Principal about to give me a stern lecture.

I'm used to it that way too as kind of a you're screwing-up-and-not-paying-attention-kind of sentence starter. Last night, I admit I was letting my attention drift frequently, so it was appropriate.

[lyrelyre]

Originally Posted by AGDee

Personally, I put it in the same category as Education. Education is also a service that utilizes commodities to provide the service. We have a right to equal opportunity to education and it is my personal belief that health care should be treated the same way.

It's worth noting that education is not a fundamental right. It is true that access to existing public education is protected. However, the Supreme Court has specifically stated that there is no fundamental right to education.

[UGAalum94]

Originally Posted by lyrelyre

It's worth noting that education is not a fundamental right. It is true that access to existing public education is protected. However, the Supreme Court has specifically stated that there is no fundamental right to education.

Yeah, and some times it's interesting to me that things have gone this way.

We accept a public educational system that most of us regard as less than awesome for the majority of citizens and assume it's a legitimate governmental service, but most of us really don't want a system of public doctors and hospitals paid for like schools are paid for.

Maybe if companies hadn't started offering health insurance benefits as a way to attract workers when they essentially had salary freezes, we would have simply developed a more extensive system of public clinics and hospitals supported though taxes and more moderate billing. ETA: such a system would probably be about as uneven in quality as the public schools are, but it's interesting to think about how these two areas diverged.

[MysticCat]

Originally Posted by lyrelyre

It's worth noting that education is not a fundamental right. It is true that access to existing public education is protected. However, the Supreme Court has specifically stated that there is no fundamental right to education.

The Supreme Court has said that there is no fundamental right to education under the federal constitution. However, I believe you'll find that many if not most state constitutions do make education, and a free education at that, a right.