You certainly know a lot more about this topic than I do, and you definitely raise some excellent points. Maybe the mistake I made was to take what works in europe and apply that to the U.S. People definitely should have the right to pay out of pocket for healthcare if they wish to, and that should be preserved even if a free healthcare option is employed. As for Large corporations benefitting, they will benefit in either case so its might not be as relevant.
No arguing with the fact that it may be an excuse to regulate what you eat drink and smoke, that would not be right if they could do that. But does that happen in other countries? I can see how it could happen but I've never heard of it.
If its not part of the Constitutional Duties, fair enough, thats the law, but it seems like assuring the health of you people should be a priority.
As for the rest of the points you raised, they are entirely specific to the U.S, and above all true. So there is no argument there.
If it were not for the culture in America that involves everyone wanting to sue everyone else, than maybe the premiums would not be so high and the current system would work better.
Just out of interest, are you opposed to change entirely or would you be in favour of (if it was possible, I don't know) a system that allowed those to pay out of pocket if they want to, but also provided cover for those who can't afford to?
Care is already provided for those who can not afford it. Doctors are bound by the hypocratic oath to help people first and foremost with out concern about the ability to pay.
Hospitals are obligated to provide care to any who go to their emergency rooms seeking care and are not permitted to turn people away due to lack of insurance. The hospitals are then protected by bankruptcy law, which does not permit medical debts to be lumped with other debts and dissolved by law.
Such debt can then be turned over to a collection agency, and they can attempt to collect, but they are not guaranteed success. It would seem that when I earlier said that this system would just cost millions of jobs in insurance I was wrong. It would seem that this will also cost additional millions of jobs in the collections industry, and thus is a horrible bit of reform.
It does no one any good to have "access" to non-existent medical care. There was a saying in Russia amongst the common workers near the end of its days, "They pretend to pay us, and we pretend to work."
As far as favoring reform
Law Suit Reform would go a far way to limiting punitive damages.
Consider the example above where the surgeon pays $200,000 a year. If the surgeon only performs 200 surgeries a year (3 - 4/week) then the cost passed onto to patients is $1,000 per surgery. If the surgeon performs 400 surgeries a year (6 - 8/week) then the additional cost is $500. This is the kind of cost pyramiding that brought down GM, and appears to be strangling doctors.
On top of the fact that the Surgeons and Doctors get screwed by the insurance companies is the fact that they then get screwed by their government. Much of a surgeon's actual costs are overhead. Billing Companies, or Billing Specialists which can take 3 - 10% of the gross receipts. Assistants, Nurses, Front Desk Managers, Account Managers. The number of people that rely upon doctors for their jobs is immense, but most of them exist due to paper pushing.
The biggest source of paper pushing is the federal government (and the insurance companies) mounds upon mounds of regulations that restrict what the doctor can and can not do. Requirements to get pre-approval to test the efficacy of a drug against something that it has not been approved for (which insults the intelligence of the doctors by making them answer to bureaucrats.)
But all of that is inconsequential to my biggest problem with this legislation. That is the fact that the government seems to believe that it has the right to order me to contribute to an abusive monopoly established under its protection against my will, and then threaten me with penalties if I do not.
Get Insurance or Sacrifice 2.5% of your income.
I don't see why some one in my position should be obligated to get insurance. I pay out of pocket, and have no problem with it, despite the fact that I am in the process of paying $8,100 or thereabouts for a lot of dental work. It is work that I was able to determine that I wanted done, and I was able to get it. I paid cash, the dentists started on it right away, the only other people involved have been the dental assistants, and the billing department of the dentists office. There was no need to waste time dealing with an insurance company, or with the socialist insurance institutions of the federal government, state governments or local/city governments.
I went in, said I wanted care, schedule an appointment, and then paid. In 8 weeks I'll be done paying, and everything that I needed done will be done. The level of service is not restricted by the government. The dentist had to inject me with an anaesthetic three times before it took hold for the last bout of fillings. Under the system being proposed he would probably have been prohibited by paperwork from actually wanting to choose that course of action, and instead of following the hypocratic oath he would have been forced to tell me that I was SOL if it hurt.
The system being proposed is built upon lies.
The biggest of those lies is the picture of the uninsured that the government is pushing.
http://2.factcheck.org/2009/06/the-real-uninsured/
Summary
Former Sen. Fred Thompson said on "Meet the Press" that "the 45 million
figure of uninsured is probably about twice the real number of people who cant afford insurance or dont have access to it really." Hes not the only one saying that the number is inflated. We find that many of the numbers cited are accurate, but may need to be seen in context to get a true picture.
- The Census Bureau estimates that 45.7 million lacked health insurance at any given time in 2007. But fewer lacked coverage for the full year, and more did without for one or more months during the year. All three numbers are likely to be higher for 2008 due to massive job losses.
- Twenty-six percent of the uninsured are eligible for some form of public coverage but do not make use of it, according to The National Institute for Health Care Management Foundation. This is sometimes, but not always, a matter of choice.
- Twenty-one percent of the uninsured are immigrants, according to the Kaiser Family Foundation. But that figure includes both those who are here legally and those who are not. The number of illegal immigrants who are included in the official statistics is unknown.
- Twenty percent of the uninsured have family incomes of greater than $75,000 per year, according to the Census Bureau. But this does not necessarily mean they have access to insurance. Even higher-income jobs dont always offer employer-sponsored insurance, and not everyone who wants private insurance is able to get it.
- Forty percent of the uninsured are young, according to KFF. But speculation that they pass up insurance because of their good health is unjustified. KFF reports that many young people lack insurance because its not available to them, and people who turn down available insurance tend to be in worse health, not better, according to the Institute of Medicine
The first admits that the number being bandied about is not that were actually uninsured but the maximum number that did not have insurance coverage in 2007, due to being in transition between jobs.
26% are able to get public coverage, thus reducing the real number by just over a quarter, to 33.8 Million.
21% are legal and illegal immigrants, the number of illegal immigrants isn't separated, but as it is likely that those people do not want insurance or will be deported as they are criminals they can be safely excluded from the "uninsured" that we need to even worry about. There's another 9.6 Million that have been fraudulently included in the number of uninsured for partisan reasons, thus reducing the number to 24.2 Million.
20% don't need it due to making enough to do with out (> $75,000) thus they need to be removed from the quoted figure to avoid being biased. That reduces the number by 9.14 Million to 15.06 Million.
Of the remaining 15.06 Million you need to keep in mind that there is a large portion (40% of the total figure) that are young. For obvious reasons the young could probably get insurance if they wanted it, but have for whatever reason, choosen not to get it. 40% of the 45.7 would have been 18.3 Million, bringing the total to an impossible negative number for uninsured.
Now, it is absurd to believe that the government which already provides services that a quarter of the uninsured qualify for is going to convince them to get insurance coverage. I would imagine that those people enjoy being independent, fully-functional adults, and wonder how the hell they have found themselves in a land of dependency-issue laden dysfunctionals.
The other groups are the affluent (which I probably fit into being single with no dependents) that pay out of pocket.
The third group is the young (which I also fit into.) For obvious reasons, being in fine health, there is no benefit to me to have insurance. If circumstances changed, or if they were different (If I had a wife and kids) I would probably elect to get coverage for them, but if the government forces me to pay 2.5% of my income, or get insurance, then it is likely that I will be deprived of my ability to afford that.
Actually, if the government does that, I'm saying fuck it and leaving the country. Nothing flies as high as the eagle that flies free.
The real question, which the media has glossed over by reporting their fictitious numbers, is do we actually need reform?
If people don't want insurance that is their business. Clearly they are coping just fine with out it, and thus there is no reason to force them to get it.
More importantly is the fact that the system being proposed interferes in the rights of the insurance companies to run their own businesses. It violates the rights of the shareholders, employees, executives, managers, creditors and customers of the insurance companies.
It violates freedom of contract which is the foundation for commercial law and makes a mockery of the 8th Amendment (No Excessive Fees and Fines.)
I also mentioned something about the cost not being revealed in total to the public. The $1.2 Trillion over 10 years is what the CBO thinks it will cost the government (they thought Medicaid would only cost $10 Billion by 1990 when it was in fact costing $100 Billion + by 1990)
There are the additional costs to the public, which under the current plan amount to the lesser of the cost of insurance for 45.7 Million individuals (many of which don't want it) or 2.5% of their income.
We'll assume that they average to earning right around $46,000 a year (though it is probably higher) which would mean that for those 45.7 Million the cost would be 52.5 Billion/year, which is easily excluded from the CBO estimates if they elect to pay the 2.5% fine. If they elect to get coverage then the cost will be probably on the order of $2,500/year per each, which amounts to an additional 114 Billion per annum.
So over the next 10 years the real cost of this legislation has leaped from between $1.2 Trillion (which we don't have) to $1.7 Trillion - $2.2 Trillion (which we definitely do not have.)
Luckily, for the politicians, not for us so much, they can turn shitstained paper into dollars, so they do this act of borrowing money, or devaluing it, to pay for the costs. Which means that inflation goes up, (don't think I'm not going to demand a pay raise from my boss to adjust for the 2.5% I'm losing) which means costs go up. If costs go up 2% on rent, houses, food, water, electricity and other major services that we take for granted. We will see an additional cost of easily $1 Trillion to the people that this flawed proposal is supposed to help.
So the real cost becomes $2.7 - $3.2 Trillion over 10 years.
Oh, and of course depriving people of their natural liberties and freedoms, which is infinitely more valuable in my not so humble opinion.
Let's not forget that if doctors quit, then the system fails, because all of a sudden there's no way to provide the healthcare that government is TAXING everyone for.
OOPS, EPIC FAIL, and make no mistake the United States is already facing a shortage of doctors (despite soaring demand) so the arguments that demand will create supply fail. The only thing that could possibly create more supply at this point is to actually ease restrictions on medical practitioners so that more man-hours are available, and less taken up by pointless paper shuffling.
But this system will require even more paper-shuffling, thus reducing availability even further. Oops, now the doctors wastes another 2 minutes of the 15 minutes he assigns to a patient on paperwork, reducing the amount of time that he'll spend with a patient even further.
No, you can't talk to the doctor, he's busy blabbing to Uncle Sam about your condition and thus violating your rights to privacy. Yet another liberty that is being infringed upon by this legislation. I do not think it is any of the government's business what medical care I get (provided I'm paying for it myself, or through a third party.)
Thus, an unwelcome agent, has once again violated the security of patient-physician confidentiality, and based on the track record of the government in securing records (Sandia Area National Labs any one) I am not confident that my records will not suddenly become a commodity to be bought, sold, traded and marketed.
Then there's the spectre of medical insurance fraud. Now, let's say that you have a serious condition, but some one gets your information, pretends to be you and gets care that should have been yours. You got to get care, and get refused, because you have exceeded your allotted care for the year. You die, and the person that perpetuated fraud benefits from care that the government promised you, and even pre-charged you for.
Pre-charged you for, when there is no guarantee that you'll even need it. So if you don't use it, you lose it. WTF kind of system is that. That's the equivalent of your water company saying that you have 1 hour to get as much water from their system as you will need for the month or you will not have water for the rest of the month.
This system doesn't benefit the majority of the uninsured (who don't need medical care) it makes them pay for services they don't need, or will use. Now, that's social injustice.