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Thursday, July 6, 2017

I am a conservative that believes in universal healthcare. I said that out loud.

A FB friend posted this:
I am a conservative that believes in universal healthcare. I said that out loud.
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Lee: Let me say that having been in the healthcare industry for some time, I think it is antithetical to believe that "free-market" has the solution for this challenge.

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Me: Can you recall when it was we had free market healthcare?

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Lee: That is a legitimate question/point, but it does not go toward solution, at least in my opinion. To me, the expectation that "free-market" can actually exist in it's truly pure form, is unrealistic. I am not a cynic, but I am a realist. There is way to much money and political power involved to make a transition possible. We don't have a model to go back to, unless it is one that was before there was really functional "healthcare", as an institution. We have got to look at what we are going to go forward to. Admittedly, government is a horrible manager of almost anything when measured against benchmarks of cost, efficiency, timeliness, etc. BUT, I would rather deal with managing, revolutionizing, and re-inventing THAT, than continuing to reject any form of universal healthcare, even a partial form, based upon how crappy the current management system is. Let's fix it and move forward.

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Me:  I'm not asking about a pure form of markets; such a status does not exist. However, there was a time when health insurance was cheap, covered a lot, and wasn't complicated. And it was that way all the way into the early 1990s. 

I sold health insurance
 back then, and it was as close to the free market as is could be. Until increasing govt intervention, regulation, and coverage mandates made health insurance one of the most heavily regulated of all industries. The system began to reel under all this. 

Every single problem in healthcare can be laid at the feet of heavy-handed government. More government control will not help.


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Lee: I am not arguing or advocating for "more government", just some. I think you and I might differ a bit on the matrix for what is "successful" in terms of healthcare provision. I think standards of care, who gets it, how they get it, how long they have to wait, etc., are questions that probably need to be defined. This is a huge discussion, obviously, with lots of moving pieces. For instance, I think tort reform is key to lowering costs, and big pharma has WAAAAAAAY to much power in the discussion, even usurping that of doctors. In addition, we need to ask ourselves WHY there began to be larger and larger regulation of the industry, particularly on the insurance side. It might be a strange discussion for me to enjoin, but I think the big criteria is not what WAS covered, but what was not. The "was not" factor is usually the part that involves "the least of these". That isn't a perfect statement, but from what I have seen, it is true more often than not.

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Me: I'd like to try everything you just posted before we have single payer. Plus, removing coverage mandates so that people can buy the coverage they want (i.e., I don't want to buy maternity coverage or well child care.).

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Esse: So you are saying you prefer government funded healthcare to private industry? I am not very smart on these issues and technicalities, but leaving healthcare to government has a funny stink to my nose.

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Randall: Rich you understand the reason the old 90's insurance system broke was because of greed and then the government overstepped it's role in regulation along with all of it's costly/wasteful bureaucracy . There has to be balance as Lee stated. " I think standards of care, who gets it, how they get it, how long they have to wait, etc., are questions that probably need to be defined" Providing the general public good healthcare is almost impossible in light of the monetary factor and regulations to find a balance for those who have the funds and those who do not. Rt

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Me:  No, greed has nothing to do with it. Government does not regulate to control greed, it regulates to exert power. Every piece of legislation (Medicare, 1965; HMO Act, 1973; COBRA, 1985; HIPAA, 1996; S-CHIP, 1997; Medicare part D, 2003; and finally, ACA, 2010, cumulatively adds up to a huge government incremental power grab, and none of it has to do with greed. 

Well, except government greed.

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Aleshia: Awww man, you lost me at the free market doesn't have a solution... the problem with the health care industry is too much regulation (always a factor where govt is involved)... without regulation the free market will always provide ðŸ˜ŠðŸ˜Š

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Pamela: I have worked in the healthcare industry as a clinician for over 20 years. Prior to managed care there was a lot of abuse from facilities, patients and insurance companies. Fraud and misrepresentation was all part of it. There was a practice by some unscrupulous facilities called "cream and dump" . They would bill and max out the insurance and then discharge the patient if they couldn't pay out of pocket. Managed care has helped tremendously in this area. However there does need to always be checks and balances that's where auditors come in like the Department of Managed Healthcare in Calif. In terms of Universal care like Ombamacare tried to be. It backfired. I have a friend on limited income who had good doctors and insurance she could afford. When Ombamacare activated she could no longer see her doctors and the options were beyond what she could afford. Mandating and financially penalizing is wrong and very Big Brother (watch 1984 and you will understand).

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Kathy: Then we should also have universal housing, universal healthy food as no one should go hungry and only healthy food to keep costs down...and universal travel so I can get from point a to point b for Dr appointments and work (if anyone would still want to work after being taxed to death) also universal......

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Lee: Okay, this is literally exactly what I was hoping for, a frank discussion. Let me give a few thoughts in response to some of you.  Aleshia the Great  I am not denigrating the function of the free market to create the most economical and efficient solution for those that CAN pay, I am saying that by definition, it cannot provide a solution for those that can't. Let me go on record here and say that when I mean can't, I really mean can't. I am not referring to folks who just choose not to until a bad thing happens to them. Rich, I recognize the fact that governments by nature (apart from Christ) always progress toward ever larger levels of control, or as you say, power. However, I believe that this ultimately is indivisible from the issue of money. I have no problem whatsoever with folks, corporations, groups, making money. Even obscene amounts of it when it is tied to objects or services that are "elective" in nature. Obviously there is a whole world of debate out there about what is elective and what is not. I also don't think that anyone has an "obligation" to pay for other folk's elective stuff. Do I think that we should decide to spend money on something that has the potential to advance us as a culture? Yes. To me this is actually no different than the fact that we all pay to both build, and maintain, infrastructure. We argue about how much we should spend, but the issue of whether or not we ought to be mutually involved in it is a forgone conclusion. Esse  my glorious and brilliant bride.... I am always distrusting of the motive of government in our healthcare and you and I both agree that the current propensity for government to be unduly (I would actually go as far as criminally) influenced by big pharma and other special interests, is horrific. These "powerful players" work very hard to dis-allow treatment protocols and natural preventative health solutions which cannot be patented for profit. I would mention casually that many European health care plans, which are almost all in some form of universal coverage, are much more accepting of these alternative protocols. My last point, at least for now, is that the problem with ACA and other legislation like it, is that by design it operates on the very model that Ayn Rand exposed in "Atlas Shrugged". The reason that health insurance skyrocketed with the implementation of the ACA, is for the common-sense reason that it operates on the basic premise that businesses can be forced to operated like they aren't in business. Insurance at core is about you or I paying someone else to take on risk. It is very simple. In order to be profitable (this is business, that's the point of business) insurance companies MUST be able to manage their level of exposure to risk. This stuff is business 101... The ACA was doomed before it started because it assumed that we could demand that insurance carriers provide insurance to anyone, without being able to limit very substantial risk factors like pre-existing conditions. The only way for them to attempt to remain solvent, was to jack up premiums to offset the nearly guaranteed costs of providing coverage at the levels and conditions that the ACA demanded. I expect insurance companies to make a PROFIT, therefore it is intellectually disingenuous for me to expect that they will provide something for nothing. Universal healthcare doesn't work when you start on a foundation of unrealistic expectation. The ACA is a case in point. Atlas WILL shrug, and frankly should. All this is to say, let's consider moving past the idea that we can expect a free-market to provide basic universal coverage to everyone. I am not interested in a discussion of whether healthcare is a "right", that is a red herring and is utterly unhelpful in coming up with a real solution.

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