Time for some definitions:

[docB]

Universal Healthcare ≡ A system that ensures that every individual is provided with access to healthcare whether they contribute to the system or not.

Single payer ≡ A system where there is only one entity that pays for all covered healthcare. Single payer by itself does not necessarily imply government or private control although it does imply that there will not be both.

Socialized Healthcare ≡ A system that uses public resources to pay for healthcare. Portions of the American healthcare system are socialized such as Medicare and Medicaid.

People are interchanging these terms and it makes it hard to figure out what they really mean.

 

[SB100]

I read in a blog recently that some people are pushing for calling patients "clients." Please, PLEASE, let's not get these two mixed up or else it'll spell disaster for the purpose of the health care system.

 

[Miami_med]

A useful thread

 

[DrB]

Can't we have a universal system that is single payer? And for that matter, a "socialized" universal system??

Docb... isn't the Emergency Medical System a socialized, universal system?


BTW, thanks for teaching me last month I had a great time in the ER

 

[docB]

Can't we have a universal system that is single payer?

Sure. Different systems have overlap and/or different combinations. The system Hillary envisioned in the early 90s was a socialized, single payer, universal system.

And for that matter, a "socialized" universal system??

Absolutely. The current favorite for what will happen in the future is a system that expands medicaid to cover everyone who can't or won't buy insurance on their own. That will be a socialized, universal system. It probably won't be a single payer system as people will likely be able to buy their own insurance outside the system (we'll see).

Docb... isn't the Emergency Medical System a socialized, universal system?

No. The unfunded mandate of EMTALA creates a universal right to emergency care but not to anything else. In general the concept of "universal coverage" is thought to mean access to primary, outpatient and non-emergent care as well. But that's a good point and is a weakness in my original definition.

It is also not socialized since the EMTALA mandate is unfunded. There is no public money allocated to pay the costs of EMTALA care to the uninsured. If the patient happens to have insurance or Medicaid, etc. we can get some reimbursement from that but if the patient is a no pay we (the docs, hosptials, lab, etc.) just eat the cost.

BTW, thanks for teaching me last month I had a great time in the ER

Glad to hear it. If you woked with me you know all about unreimbursed indigent care .

 

[radslooking]

Great thread, make it a sticky!

Half the time people are arguing because they haven't defined what their terms mean.

 

[LeemerDO]

No matter what you call these things, they all end up with the same result...DISASTER, CHAOS, and MISERY for all!

 

[docB]

No matter what you call these things, they all end up with the same result...DISASTER, CHAOS, and MISERY for all!

I agree with you but I was hoping to keep this thread free of opinion and just use it to provide definitions as a reference for folks posting in the other 10 zillion socialized medicine debate threads.

 

[docB]

Cost ≡ When talking about an industry, such as healthcare, cost refers to the amount of resources that must be expended to provide a good or service. For example if you run a lab and the supplies and chemicals to do a certain test cost $10 then that (plus several other additions) is the cost.

Those "other additions" are where most in the general public don't understand the true costs of healthcare. The common costs are taxes, labor, facilities, equipment, utilities and supplies. Healthcare has higher costs associated it than most people think.

Labor- you need highly trained workers, e.g. phlebotomists
Liability Insurance- liability insurance in healthcare is astronomically expensive
Facilities- ORs, ERs, HIPAA compliant records, billing, biohazard waste disposal, isolation rooms, and so on
Equipment- Gurneys to CT scanners, medical equipment is incredibly expensive as the makers have to carry liability insurance in addition to the costs of design and manufacture.

All of these things factor into the cost of delivering a good or a service such as healthcare.

Price ≡ The price is what a consumer must pay for a good or service. Price is usually determined by the seller based upon their cost + the profit they want to make.

Profit ≡ The amount of money a seller makes above their cost. Price – cost = profit. The percentage of profit to cost = the profit margin (or simply the margin).

Demand ≡ Demand refers to the number of parties willing to pay a certain price for a good or service. It’s a little more complex than simply something people want. E.g. the demand for gas at $1/gal is huge. The demand of gas at $20/gal is much less. Some necessities will be in demand no matter how expensive they are such as food, water and healthcare. Other luxury items such as air travel and electronics see their demand drop precipitously as price increases.

I bring these things up because folks don’t seem to understand that cost and price are not interchangeable. When people refer to “the cost of healthcare” they really mean the prices consumers pay. By thus oversimplifying they fail to take into account the factors that increase the cost in its actual definition.

People also erroneously assume that just because something is expensive the seller is making a big profit. That’s not necessarily true.

People also assume that demand is a static entity, that when the commodity in question is a necessity (such as healthcare) that there is no change in demand in relation to price. That is not true either.

Happy debating.

 

[docB]

The term “Cadillac health insurance” has been thrown about in the healthcare debate lately. Some people do not understand what this term means. I was confronted by this fact in an awkward way when an acquaintance defined “Cadillac health insurance” as “the federal government’s plan to insure GM workers now that the government controls the company.” Everyone laughed except the person who said it because she was serious .

So what is “Cadillac health insurance?”

Well first let’s update the youngsters who might not know that Cadillac (a division of American automaker GM) was once considered the best, most luxurious car one could own. The name was once held in such high esteem that it was used as an adjective to describe the quality of other things. For example one might have said “RCA is the Cadillac of TVs.” Again this was from a time in America before imports eclipsed American manufacturing.

So what does that have to do with health insurance?

Nothing really except that who ever coined the term “Cadillac health insurance” was using the brand name Cadillac to denote high quality as in the example above.

So even if “Cadillac health insurance” = really good insurance why is that important to the healthcare debate?

Glad you asked. The answer has to do with income taxes. When an employer pays an employee the employee pays tax on that income. But there are other ways to compensate employees besides paying wages. One other way is by providing benefits such as health insurance. The government currently does not tax that compensation. That policy came to be because it was thought that having more people insured by their employers was a benefit to society. Because of that tax policy there was an incentive for employees and their unions to negotiate for more and more extensive health coverage because that type of compensation was nontaxable.

Now that the entire American healthcare system is being looked at for reform many have noted that if this type of compensation were taxable the government would take in more revenues and be able to pay for more benefits (this is a debatable point, fiscal conservatives would argue that higher taxes will not lead to increased government revenue over the long term but we’ll leave it as is for the sake of this discussion). Others suggest that in proposed systems that seek to expand the number of people covered it would be reasonable to tax those whose health plans provide better coverage than whatever baseline coverage is achieved. Consequently there are proposals to tax these high benefit health plans, i.e. the “Cadillac health plans.”

Just a few notes to finish up:

A major source of discord among the proponents of taxing the Cadillac plans is that many unions have spent decades bargaining for these plans for their memberships (ironically the auto industry is having a lot of difficulty living up to its contracted Cadillac plans). They don’t want to see this benefit reduced by taxation. There have been proposals to exclude union and government workers for any new taxes on health benefits which has raised some glaring questions about fairness.

Another source of controversy that comes from the proposals to tax only the high benefit plans, the “Cadillac plans,” rather than all currently nontaxable benefits is the question of whether the government should have any role in setting the bar for what constitutes acceptable or baseline coverage with any benefit beyond that being taxable. This would have the effect of causing the insurance industry (should it continue to exist) to have little to no market for any plan that provides more benefits than the baseline. In other words the government will have mandated the extent of benefits allowable. Anyone who wished to purchase more or wished to give more to their employees would be hard pressed to do so.

 

[Stitch]

These terms haven't come up specifically, but they are useful to the healthcare discussion, especially when we are looking at other models around the world. Not all 'universal' systems are the same (and I'd argue that no system is truly universal). Feel free to delete if you don't think it's relevant, DocB.

The Bismarck model of health care: both health care providers and payers are private entities, but are heavily regulated by the government. Germany, Japan, France and Switzerland use this model. The big difference is that 'insurance' companies are generally non profit and referred to as 'sickness funds.' However they often are allowed to make a profit selling more extensive plans.

The Beveridge model: health care is provided and financed by the government, and directly through taxes. Physicians are government employees. This model is what most people freak out about and refer to as 'socialized medicine.' England (Great Britain), Spain and Italy use this method.

The National model: mixes both aspects described above. Providers (physicians) are private contractors, but the government picks up the tab. It's funded by taxes. Canada (as well as Taiwan) uses such a system if I understand it correctly, and each individual province is in charge of keeping it running.

 

[docB]

Not all 'universal' systems are the same (and I'd argue that no system is truly universal). Feel free to delete if you don't think it's relevant, DocB.

Those are very cool. I've never heard them before but they are a great illustration of the differences between the universal plans.

I wonder if the Bismarck plans where the payers are heavily regulated private entities suffer from some of the same institutional problems that we have had with our highly regulated private entities Fannie Mae and Freddie Mac. Different industry but seems like a good cautionary example.

 

[Stitch]

I wonder if the Bismarck plans where the payers are heavily regulated private entities suffer from some of the same institutional problems that we have had with our highly regulated private entities Fannie Mae and Freddie Mac. Different industry but seems like a good cautionary example.

Oh, that's a fascinating comparison. I haven't thought about it.

The main problems the sickness funds seem to have is staying solvent, and that was even before the economic downturn. They periodically require infusions of goverment money to stay afloat (except in Sweden it seems). I haven't read about any specific scandals, but I'm sure they exist somewhere.

France in particular has 'reformed' health care at least 3 times in the past decade, but they neutered the health insurance industy sometime before that. France in general keeps a tight government hold of its economy. They are non profit, and have to pay any claim by any physician within 5 days. But the government strictly regulates what you as a physician can charge for any specific service and posts these allowance/prices publically. As a result the average physician salary is around $55,000, much lower than the rest of Europe or other Bismarck systems.