Compulsory insurance can work

[SpartanDem]

there are many major western countries with it as the basis for their universal health care systems. So I don't understand the reactions by so many on DU that it some major affront this isn't anything that would unique to the US. Of course, the devil is in details, but I'd think it'd be more useful to compare how things like the Kennedy bill stack up against other countries that use similar systems.

[SmileyRose]

1. No it can't

as long as providers have to pay an army of people to fight with a hodge podge of insurers we are all screwn.

[Greyhound]

2. Name 5. n/t

[SpartanDem]

9. Japan, Switzerland, the Netherlands, Germany, Belgium

[Oregone]

11. Whats the average rates there?

Copays and deductibles? Are they allowed to arbitrarily deny care?

Forcing people to buy expensive shit isn't the same as forcing them to buy an affordable and useful service.

[SpartanDem]

17. I know for sure they all open enrollent

coverage can't be denided. I'm not sure of the cost which I why wanted to have this dicussion, but all these countries have better systems than Canada according to the WHO with Japan and the Netherlands ahead of the UK

[Oregone]

20. Well, costs and usefulness are paramount to the conversation

1. Id rather doubt these other countries costs are even comparable, especially after figuring in copays and deductibles. If you know otherwise, let me know. Mandating a financial burden on people seems to be counter-intuitive

2. Id assuredly hope they are more useful than insurance in the US. 50% of bankruptcies are from people with medical problems who ARE insured. 22,000 people with insurance are estimated to die annually from inadequate coverage. Mandating this type of useless coverage in the US will not fix the health-care system.

[Greyhound]

25. Cool. Of those you named, Japan is the best at #10 from the same organization

you used (WHO), followed by The Netherlands #17, Switzerland #20, Belgium #21, and Germany #25. All far better than the USA #37.

However, this list also makes it pretty clear that non-insurance based systems are still far superior. It is also true that in each of those countries the health insurance companies themselves are very heavily regulated and none of them are really comparable to the parasitic monstrosities we have here.

I would also point out that none of the proposed "solutions" we have so far address any of the fundamental issues that make insurance based health care work in those nations.

Do you imagine that our insurance companies would stand for the regulation that, say, Japan has for it's "insurance" companies?

[SpartanDem]

31. The point my of post wasn't

to advocate for this type of system as much as it was to try to get an honest comparison between what's being proposed here and what's done elsewhere. Becuase it's clear that we're not headed toward a non insurance system I think getting clear understading where we're at is very important.

[Greyhound]

34. It is indeed very important and you have demonstrated many of the reason's

we must not trust what is likely to be presented to us.

Terminology is tricky and simply stating that "compulsory insurance can work" is misleading.

So, just because Japan and Switzerland (for example) call their systems insurance based doesn't mean that they are comparable to our insurance companies. As always, the Devil is in the details.

[tsuki]

47. Name a company in one of those countries whose CEO makes 1.78 billion

dollars like William McGuire by deny health coverage to its premium holders.

American corporations cannot be trusted.

[wroberts189]

26. self-delete

[SpartanDem]

28. ok

The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.<60[br />
Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductibles, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company

Switzerland - Switzerland has a tightly-regulated private insurance market, in which a compulsory, basic level of service is mandated by all insurers, and patients are guaranteed nearly complete access to any doctor or medical provider in their region. Additionally, many Swiss opt to purchase complementary insurance on top of their basic insurance. The complementary insurance covers items like dental care.

Japan - The majority of the public is covered by compulsory private insurance which is, again, tightly regulated. A basic level of care is mandated across different insurers, and nearly all hospitals are run as non-profits. Funding for the private insurance market, known as the Social Insurance System (SIS), comes through fees paid by employers, supplemented by premiums paid by individuals. Premiums are determined by income. The insurers - "health insurance societies" - are 1800 in number. 63% of the public is covered by these "health insurance societies," in the SIS. The other 37% of the public - mostly the self-employed - is largely insured through a government plan, or National Insurance, which is funded both by premiums on individuals and by government funds and which is administered by local bodies. Additionally, there is supplemental government-financed care for the elderly.


Germany has a universal multi-payer system with two main types of health insurance: "State health insurance" (Gesetzliche Krankenversicherung) known as sickness funds and "Private" (Private Krankenversicherung).<17><18><19> Compulsory insurance applies to those below a set income level is provided through private non-profit "sickness funds" at common rates for all members, and is paid for with joint employer-employee contributions. Provider compensation rates are negotiated in complex corporatist social bargaining among specified autonomously organized interest groups (e.g. physicians' associations) at the level of federal states (Länder). The sickness funds are mandated to provide a wide range of coverages and cannot refuse membership or otherwise discriminate on an actuarial basis. Small numbers of persons are covered by tax-funded government employee insurance or social welfare insurance. Persons with incomes above the prescribed compulsory insurance level may opt into the sickness fund system, which a majority do, or purchase private insurance. Private supplementary insurance to the sickness funds of various sorts is available. In 2005, Germany spent 10.7% of GDP on health care, or US$3,628 per capita. Of that, approximately 77% was government expenditure.<12>






From here
http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=132&topic_id=8394360 and various wiki articles on the respective systems

[Greyhound]

30. Just learned that Japanese "health insurance companies" are also what we would

designate as not-for-profit. Any excess money collected is carried over and applied the following year.

Sorry, but your premise, or at least the prejudicial wording of your post, is flawed.

Profit is the problem, making it from people's pain and suffering is just wrong and we're the only fools on earth that can't see it.

[Oregone]

32. Yeah, its sort of comparing apples to down syndrome oranges a bit

While it may be compulsory, the systems don't even resemble each other at the end of the day

[bornskeptic]

50. The public option under Kennedy's plan would be non-profit.

It would be an option for anyone who did not want to give money to for profit companies. The Dutch companies are all for profit, and the Dutch system is working great. Of course there is no guarantee that our system would work as well as the one in the Netherlands, but the only alternative to an insurance based system is a government run healthcare system. I don't see much support in this country for nationalizing all the hospitals and drafting all the doctors and nurses into government service. So we are going to end up with an insurance based system no matter what we do, and there are no successful insurance based system in the world where insurance is not mandatory.

[Greyhound]

54. That is a false premise.

There are dozens of options besides "a government run healthcare system".

Single payer is one and it is not "a government run healthcare system".

[depakid]

42. So what happens if you're on the dole or can't afford coverage?

and in Europe's case, how do those countries' systems square with EU requirements?

[tsuki]

45. Switzerland, the primary coverage insurance company cannot be

a For-Profit company. Tell that to United Health.

[Fovea]

3. Honest brokers of healthcare.

Our insurance houses have been so far from the concept that if the words were mt. rushmore sized,
they could not see them from here.

The problem is trusting any details these devils touch.

[wroberts189]

4. Yes but they are all single payer are they not? nt

[SpartanDem]

16. No they're multipayer

[wroberts189]

24. So where is this place? nt

[LeftyMom]

5. Which is why car insurance is cheap and pays out promptly, right?

:rofl:

[Skittles]

6. I will join you on the floor, LeftyMom

:rofl:

[leftstreet]

8. LOL Exactly! They're going to 'Geico' our friggin healthcare!

:rofl:

[Oregone]

7. When premiums are $100 bucks a family for everyone, then compulsory insurance works

Get back to me when they get the prices down to a reasonable amount.

[alarimer]

10. Not without extreme regulation and price controls.

Insurance companies should be barred from cherry-picking their clients. No pre-existing conditions and no charging outrageous rates for higher-risk people. No outrageous copayments or deductibles and reasonable (less than $200 a month say based on income), etc, etc.

No golden parachutes for CEOs, no multi-million dollar salaries. They make their profits by denying care and that has to stop.

[SpartanDem]

14. I'm pretty sure open enrollment

is a feature of both bills and the Kennedy one for sure. The New York Times story said the Kennedy bill would have a minimum benefits package which I know is another common feature. But I don't proclaim to be an expert and honest comparisons of countries that use similar system is pretty non existent here because a large part of conversation by DU is "eww it's not single payer this sucks" which isn't helpful

[Greyhound]

56. The term, "minimum benefits package" in a for-profit system is just another

way of saying tiered system. If you're poor, you get the very worst care in the worst facilities, from those that can't make it in the "regular or elite" systems. It also lead to the recipients of that "minimum benefits package" being killed through negligence and lack of resources with no recourse.

Since there is no Kennedy Bill yet, debating it is pointless, but the draft looks like it guarantees company profits without guaranteeing quality of care.

Sometimes nothing is better than half a loaf, especially when the loaf is old and moldy.

[ThomCat]

12. It can only work if you really have a universal risk pool

not when insurance companies are separating people, competing for young healthy people and weeding out people like me.

It can't work when insurance companies are allowed to set the rules to ensure they make profits, so that you get high co-pays and high deductibles on your insurance. They you're paying for insurance you won't ever be able to afford to use. That's just a rigged system of them taking money and giving no service back in return.

It can work, but in order for it to work the insurance companies have to be very well regulated and the government has to be on top of them to make sure that people are able to get real coverage with real access to real healthcare.

That's going to take a lot of work with a lot of built in safeguards. We're not going to get those safeguards if the industry lobbyists are getting the changes they want.

[JeffR]

13. Universal public insurance works much better

and sidesteps this whole framing of the issue.

And many major western countries use that as the basis for their universal health care systems. The devil is not only in the details, but in the entire framing of the debate. As an American resident in Canada, I find the framing of the debate ludicrous. We either join the 21st Century on this or we don't. I'm worried that we won't. Sow's ear, silk purse and never the twain shall meet. That's how the whole "reform" initiative is beginning to shape up for me.

Despite how it's being approached, this really isn't rocket science. There's no need for half measures here. Oh, it'll hurt the insurance industry? Trifling compared to what's gone on in the auto industry and the broader manufacturing sector.

Medical coverage has no rational or logical tie to employment, for one.

And the private insurers should never have had a stake in this to begin with, except over and above what is guaranteed by a public plan that in the year of our Lord 2009 doesn't even exist, and apparently never will.

Sorry, but this is all just madness. It's nothing short of a national shame, an embarrassment, a disgrace, along with our absolutely pathetic excuse for a safety net, our relative rankings in any number of health metrics and our very viability as a "civilized" nation. We're very busy throwing that viability away. Some piss-poor, feeble stab at so-called reform ain't going to do it.

[leftstreet]

15. Excellent post

:thumbsup:

[JeffR]

18. Coming from you, that means a lot.

Thank you.

[SpartanDem]

19. You say that like it's an automatic fact

all the countries I listed above have systems that ranked better than Canada's according to the WHO. Given that I think this merits a serious look and not an automactic dimissing that happen too often to DU that if it's not single payer then it must be second rate, clearly these systems can and do work.

[Oregone]

21. Isn't Japan single payer also?

Canada's problem is not the system's architecture. Part of it is the funding (which forces low billable rates leading to staff shortage and wait times) and the other part is that rural communities with sparse populations have skewed statistics downward in the past a bit deceptively.

[SpartanDem]

23. They're a multipayer system

It is compulsory to be enrolled in a Japanese insurance program if you are a resident of Japan. The two main categories of health insurance are referred to as Kenkō-Hoken( health insurance) and Kokumin-Kenkō-Hoken (national health insurance). National health insurance is generally reserved for self-employed people and students, whereas social insurance is normally for corporate employees.<1>


Public health insurance covers most citizens/residents and pays 70% or more cost for each care and each prescribed drug. Patients are responsible for the remainder (upper limits apply). The monthly insurance premium is 0–50,000 JPY per household (scaled to annual income). Supplementary private health insurance is available only to cover the co-payments or non-covered costs, and usually makes a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure. In 2005, Japan spent 8.2% of GDP on health care, or US$2,908 per capita. Of that, approximately 83% was government expenditure

http://en.wikipedia.org/wiki/Health_in_Japan

[Oregone]

27. Hm, I thought they were single-payer as stated here:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=103&topic_id=450664&mesg_id=450664

Canada also has supplementary private health insurance. Only the provincial medical plans are mandated though, as well as cheap and subsidized for the poor.

[JeffR]

29. They can work, yes. I'm actually not a single payer zealot at all.

And a lot of Canadians purchase supplemental coverage, because they need it and because they can. The biggest health issue I have to deal with, touch wood, is my eyes, and there's no coverage whatsoever for that through the public plan here.

On this issue, all I'm left with at the end of the day is a country that hold itself up as a beacon to the rest of the world, yet can't even guarantee health coverage for at least 20% of its citizens, while many of the rest find that their so-called "coverage" stinks when the rubber meets the road in a real health crisis.

I really don't give a crap about the WHO's rankings. All I know is that my American wife went through a life-threatening health crisis a couple of years ago, and all it cost us was the taxes we pay and some overage for a few prescriptions. In and out of three hospitals, two clinics and a family doctor's office for a total of about 15 visits over 4 or 5 months. If what you're advocating here could supply the equivalent of that, well, fair enough.

Yes, single payer isn't necessarily the be-all-and-end-all, but compulsory insurance, first off, is an idea that candidate Obama resisted, and second, automatically creates an expensive bureaucracy to administer for all those who would require subsidies, some sort of means testing for exemptions and so on. Britain's or Canada's systems, adopted lock, stock and barrel, wouldn't be ideal, but would a great step forward from what exists now. Adopting Cuba's system would be a great step forward, for that matter, and they're one of the most desperately poor nations in the Western Hemisphere. How embarrassed do we need to be before something substantive gets done on this?

[Oregone]

35. I never view supplemental insurance as a drawback to the plans

Rather, by privatizing those fields, the public provincial plans are lightweight and streamlined (hence, affordable). Dental (expensive) and eye-care can sometimes be optional cosmetic expenses, and maybe better ran with a deductible/co-pay system that encourages self-rationing (which is a bit contradictory to the public health plans). But, because of the existence of the public plans, private supplemental insurance is extremely cheap and provided by a lot of employers.

"I really don't give a crap about the WHO's rankings. All I know is that my American wife went through a life-threatening health crisis a couple of years ago, and all it cost us was the taxes we pay and some overage for a few prescriptions. In and out of three hospitals, two clinics and a family doctor's office for a total of about 15 visits over 4 or 5 months. If what you're advocating here could supply the equivalent of that, well, fair enough."

Thats gotta sum of my thoughts. I just had a child here, and my friends in the states pick up $6-$12 grand a child when covered. We had our office visits, home visits, birth, and everything else, pretty much covered with no debt. Rankings or not, I don't have to get a HELOC on my home to cover medical expenses. I don't have to fear Ill lose my ass each time I get behind the wheel of a car. I don't have to fear of choosing debt and poverty over life and health. Whatever it takes to accomplish that, fine. Yeah, Single-payer will probably be a good step in that direction. A bit better than what Ive heard floated so far.

"Adopting Cuba's system would be a great step forward"

Isn't that insanely unfeasible?

[JeffR]

38. Good points.

Cuba's system isn't feasible because apparently that said Third World nation still represents an imminent commie threat. China, on the other hand, well we just can't get cozy enough with them, it seems, to the point where basically they own us.

[JeffR]

36. And by the way

that crisis would have completely bankrupted us back home as things stand now. And that's ludicrous. "Backward" doesn't begin to describe it. "Barbaric" would be a better description.

[Greyhound]

33. You're conflating government health care with single payer, that's an error because

they are different. In government health care systems, everybody works for the government and it owns/runs the facilities and equipment, etc.

In a single payer system, delivery is unchanged but the bills all go to the same payer (Usually, but not necessarily the government).

Canada has government health care and is the favorite whipping boy for the RWAs, though it is still far better than what we have.

[Oregone]

39. No, Canada is single-payer

"Canada has government health care"

While there are a fair share of public hospitals (some owned by city/region rather than province), most of the doctor clinics are privately owned and ran. There is a single provincial payer to all facilities/doctors enrolled in the MSPs. By no means does everyone work for the government.

[Greyhound]

40. My mistake. n/t

[Ginny from the Block]

22. Only in Switzerland, because health insurance co.s are all non-profit!

The only other industrialized country where this works is Switzerland because their health insurance companies are all non-profit. You've got to take the profit motive out of the equation to make it affordable and stretch those health dollars farther.

A public option has GOT to stay on the table............another possibility might be setting up hospital or physician co-ops where people pay their monthly premiums directly to the health care providers. The only time indemnity would be involved would be if the patient were out of town. Federally Qualified Health Care Centers and County Hospital Districts could offer a sliding scale monthly premium and government employees as a starter could be signed up for these public plans. If private health insurance is so great, let it compete with the Medicare-type option that offers more for less. People want options, but let private insurance be the more expensive cadillac plan those who can afford it choose. The vast majority of us want something affordable and comprehensive! Go to www.1payer.net for info. on the Single Payer option and the upcoming National Sickout Day on Thursday, 6/25!

[tsuki]

46. Not all health insurance companies are non-profit. Only those offering

primary care are.

[SpartanDem]

37. You know I've probably could've been more clear

I didn't want a huge debate of the mertis of this type of system itself. I was just somewhat ticked knowing this type of system works in other places that there was just no real dicussion of how our proposals compare and maybe get info on this for a change

[bread_and_roses]

44. You want us to debate exactly how much blood to pay the vampires?

Sorry. It's the wrong debate.

[Warren Stupidity]

58. "this type of system"

but that is the problem, all of the countries you listed, with perhaps the exception of the Netherlands and Switzerland (and I only include the Swiss as I haven't bothered to look them up) have systems that are non-profit or have a major public component and/or are highly regulated to prevent abuses and keep down costs. They have NOTHING AT ALL like what seems to be in the process of being baked up on capital hill, other than requiring everyone to participate.

We have a HUGE problem with for profit health insurance providers who are extracting hundreds of billions of dollars in profits every year for providing as little actual health care as possible for as much money as possible. All they provide in terms of a useful service is a billing service - they transfer money between accounts. And that industry is doing its best to legislate in their obscene profits for perpetuity.

[lbrtbell]

41. It can't work when you can't afford it

Seriously, until unemployment is down and the economy is moving again, forcing people to incur another big expense is only going to drive up the number of bankruptcies and foreclosures.

If you have a job and can afford mandatory insurance, I'm happy for you. The rest of us, meanwhile, are being thrown under the bus. :(

[eridani]

43. Only if it is single payer

Fuck forcing people to pay private for profit insurers to kill them or make them bankrupt.

[stray cat]

48. If someone doesn't participate they are not treated - that seems even harsher

than requiring insurance. However, otherwise not having people participate prevents full coverage from working. The young who think they will always be healthy have to participate to make the system work. There are people still who choose a large screen TV and going out to paying for insurance.

[Fumesucker]

49. I would like to know what the "compulsions" are in the various systems.

Compulsory covers a remarkably wide spectrum really.

Don't have insurance, go to jail?

Don't have insurance, can't get a job?

Don't have insurance, pay a tax penalty?

Other?

Furthermore I would like to know what support there is in the various systems for those who lack income to purchase insurance and at what income level such support might become engaged.

In the USA in order to qualify for many kinds of aid you basically have to be one step away from living on the street, or in some cases even living on the street would not qualify you for aid. Even owning a fairly ratty car (a necessity in many parts of the country) will disqualify for a lot of public assistance.

Frankly I think that anyone who believes compulsory insurance in the USA is going to be other than extremely punitively based and have pathetically low levels of support for those who cannot afford insurance is drinking some of the most potent and adulterated of moonshine.

[ayeshahaqqiqa]

51. I think the problem is that for-profit inusrance companies

don't work now. Their methods are to make it as difficult as possible to file claims (staring with not even printing the address to file claims on the insurance cards), denying needed labs (one major insurance company refuses point blank to pay for food antibody profiles, even if their client is diagnosed with something like Celiac disease), and insisting that clients NOT be given prescription meds the doctor has ordered but that something else be substituted (not always a generic, btw; and some companies refuse to pay even when the doctor shows that the patient has an adverse reaction to the drug they want to push).

I work in a non-profit health clinic, and part of my job is filing insurance claims. If we are going to have mandatory insurance, there are some things that must be mandated for the insurance companies:

1. All cards are uniform in making it clear where to send claims, where the ID number and group numbers are on the card

2. No labs can be ruled out for all patients--labs should be paid for when the diagnosis warrants it

3. If a patient has a bad reaction to a drug, the insurance company should have to pay for a drug that will work for the patient.


I don't think these rules are so difficult, but I won't hold my breath to see them become requirements.

[Shagbark Hickory]

55. PFFT. LOL. How do you expect the ins cos to stay in business if they tell you where to mail the bill

The only way they can stay in business is to keep ripping people off and not paying claims.
Providing actual health benefits is not a business model that works. Everyone eventually needs to file a claim many times more expensive than they ever paid in.

[Greyhound]

57. Not to mention the "experimental treatment" evasion. n/t

[cherokeeprogressive]

52. What else would you like the goverment to compel citizens to do?

:beer:

[Fench Mistake]

53. Only if.

All people are taken no matter what. No pre-existing, no refusal on any basis, no "rebate" payment premiums by tax code or voucher, no skimming of the profitable and dumping the rest on the government, no cancellation for non payment, no accounting/billing tricks like the card companies, no "exclusive" drug sources, no internet only availability, no "basic" plans that collect money and provide nothing because the copays are too high, and a host of other items.

People out of work can't make a premium payment. They also can't wait for a voucher or tax credit. They need care and coverage now.

[BlooInBloo]

59. It's impossible. I know this because DUers say so.