RTG – I think we found a spot of common ground here. I believe in the free market but that it to say that I believe in it when it is working properly. For the system to work all parties must act in good faith. Clearly there have been many instances in which someone has been turned down or denied by an existing health carrier for suspicious reasons. I have always been under the belief that if you pay your premiums you should be afforded the care you require when you require it. The case you sighted, re acne, is a good example (though I might point out that in England women with breast cancer were denied a drug which could have saved their lives but were not given it because it was to expensive – hadn’t they paid their premium via taxes). I believe this is a space which could use additional legislation to off-set the imbalance of power between the corporation and the individual. What we need is a system which provides better outcomes to individuals by ensuring they are treated fairly.

That said let’s look at these two systems. On the private side you have health insurers who currently do not face competition in many territories (though to my mind they should) offering products to the majority of Americans. While there certainly are complaints to be made about this system, including denial rates and cost which must be addressed, I would argue that by in large people believe that they receive a high quality of care for their health care dollar.

Medicare/Medicade which I think have done a good job are relatively expensive programs and will continue to grow in costs with an aging population. Here too I think people have been generally pleased with their care.

So where is the argument? Let’s review a couple of facts which we should be considering before we pass this huge piece of legislation:
1) Profits before people. Let us consider this question, whether or not we believe in free markets or the government, is there a true difference between the profits earned by companies based on the free payment of premiums or the taxes paid to the government for the same cost. At the end of the day both groups must administer their plans, pay staff, pay for their property, plant and equipment- and at the end of the day no matter which way it is sliced it comes out of our pocket. The question is which one can do it more efficiently and more humanely.

a. My answer is that the private sector can do it more efficiently because government programs suffer from one fatal flaw – the costs do not affect them directly because they are paid by other people’s money. It is important to note that on average the cost of public programs are underestimated by a factor of seven and historically Medicare has been underestimated by a factor of nine. So if the averages hold, what will Nancy’s bill cost us?
i. I would also like to point out that part of this bill requires cutting the fraud in Medicare which accounts for $300 billion. That means that all these years a few million in auditors could have saved us billions of dollars. They knew there was fraud and didn’t do anything about it. This is the problem with paying for things with other peoples’ money. You just don't care.

b. Who can do it more humanely – this is the tough question. As I stated earlier there are definite issues with denies in the public sector but let us not forget that on average Medicare turns down twice the number of people annually then private coverage. Why is this, the government only has so much money and must make hard choices as how to use it wisely. If you could only give one heart valve to a 95 year old or a 65 year old, who would you give it to? These are the decisions Medicare must make. At the end of the day both groups ration care but I think the private sector takes it on the chin more often because people pay premiums directly, unlike Medicare where we all pay the premium.

c. My answer as above is to first allow all insurance to be sold across state lines and mandate restrictions on denials or a mitigation process. Further, instead of sucking everyone into a government system, have the government create a high risk pool such that we can handle those cases directly and administer this pool through the established framework of Medicare/Medicade. Allow, the 20 and 30 somethings that don’t buy health care to purchase discounted rate policies in the high risk pool. This will bring more money into the system while marginally effecting the costs.

2) We should also consider the control aspects for both cases. In the case of private health insurance if they deem an activity risk sensitive they may charge me an extra fee. I then have the choice to continue with this activity and pay a higher fee, or not. If we go down the road of public health care (and while we can argue about this later – this bill would lead to single payer over time ) the government will also have to review risks. The government has two options, to pass a tax (not drastically different the a premium increase) or ban the activity.

a. I don’t want to live under a system in which the things I enjoy can be removed because they may be risk sensitive. I enjoy riding a motorcycle, let’s say that the government said this as twice as risky as a car so we will outlaw this activity (not the best example but you see where I am going). At the end of the day if we have government health care I don’t trust either party not to use health care as a pretext to advance their agendas by allowing , disallowing or taxing activates.

b. The other example is raising taxes on products such as soda. This is a regressive tax disproportionately affecting those of lower income. Let’s be honest a $.03 per can of sugary drink doesn’t affect the rich. However, we know from recent literature that people in low income neighborhoods have lower positive food choices and are more like as a whole to consume the beverages that will be taxed. The fact is that to support the cost of health care the government will need to raise these types of regressive taxes across many categories which only serve to lover the ability of the poorest amongst us to break the cycle of poverty.

3) At the end of the day you don’t have to be a math major to know that you cannot add 40 million people to the medical system and be deficit neutral. Sure you can play games with how the numbers come out but at the end of the day the program has to be paid for and that is taxes, taxes, taxes and more taxes. All on top of a program designed behind closed doors, not meant to be understood by the common reader and which has not fully addressed the issue of the un-insured and which has an astronomical price tag. IS THIS REALLY WHAT WE NEED????

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