My main thought is that it's bullshit for health insurance and legit for everything else. Car and homeowners insurance offer much more choice than health insurance because most people get health insurance through their job and are told what provider they will use. If you want to use a different one, you have to pay fully out of pocket or change your job.
He does have a point in that it's ridiculous that it's pretty much impossible to get health insurance with reasonable coverage at a reasonable rate unless you get it through your job.
All insurance companies still do have that same inherent difficulty with them. You never know how well your insurance company will perform until it comes time to call upon them, which is usually a really bad time in your life.
You could have the shittiest insurance company in the world for a decade and never find out until you get into that one car accident or develop cancer and they go "Nope, not covered because of a, b and c. So long and thanks for all the cash!"
Romney's statement was directed against universal healthcare, so no, I do not agree. I think the idea that most people have any meaningful choice in their healthcare insurance is illusory. If you don't have a range of attainable choices, then market competition becomes pretty meaningless.
No, Romney is saying the current system is better than a government system with no choice.
I am saying that there is no choice with the CURRENT system, so he is making a wrongful distinction. I would rather have a single option universal healthcare with a guarantee of coverage than a single option for private healthcare.
Nuri, I totally agree with your stance. As an admitted leftist, I would like to divorce health insurance from employment. I see too many of my artist contractor/freelance/self-employed friends suffering because private health insurance is totally out of their reach. These are not people who are destitute, they work 40+ hours doing your arts. (Of course, people often counter with "Why are you drawing? Get a real job!") It also hurts small businesses, because they have to pay people so much more to cover their health insurance. My work pays 50% of the monthly cost and it is still expensive for both the employer and the employee. It is actually a barrier to hiring people full time!
Maybe he is saying we need a system with MORE accessible choice. I would be in favor of that as long as the choice was real and affordable for the majority of Americans. However, I am not optimistic that that can become a reality.
Or regulate the amount of profit they are allowed to make the way we regulate utilities. Insurance companies function in a lot of the same ways as utilities, but they are not subject to many of the same limits. Of course, that creates a crapload more work for the government. You'd have to have a Public Healthcare Commission whose job it is to set rates and oversee everything... ugh.
Yup. I really want people to stop saying "get rid of the regulation of X industry" and start saying WHICH regulations they want to get rid of. If you don't point out the specific regulations you think are a problem, your credibility is zero.
Actually, a lot of industry leaders who want to move forward request regulation that will force the rest of the industry to keep up with them so they won't be at a competitive disadvantage. "We would like to stop dumping waste into the river, but we can't be competitive and pay for waste processing unless the other companies have to as well."
Regulations are only a bane when they are unfairly implemented or enforced.
See, this is what I don't understand. I too agree that poorly implemented regulation and unwieldy bureaucracy are harmful to the people of a nation and their endeavors. However, why is it that I don't hear most Conservative pundits talking in this way? Why they just say things that amount to "get rid of the EPA!" rather than "Let's evaluate all the programs, following a legitimate cost/benefit analysis, decide how we can make worthwhile programs slimmer and more efficient!" It's not like I watch Brazil and say "Yes, that's a good way to be," which is how it is often presented on Fox, etc.
I was reading about some fuel regulation a few days ago that people were bitching about because the additive described in the law does not exist yet companies are being fined for not using it. If true that is a bad regulation.
I think that regulation has made our food safer, our water and air cleaner, and our corporations more accountable. However, regulations must constantly change to fit a changing technological landscape. Some of the current regulation of communications infrastructure is very outdated, basically applying things that were put in place decades ago. We should be far more agile and adaptable in government, but I don't believe that slashing programs and regulations indiscriminately is the way to go.
With "government" run healthcare you have zero choice.
This is demonstrably false. Even Medicare has different schedules and options now; also, a single payer insurance system like the one originally supported by Democrats would not force private insurers to hang up their hats.
What Jason says is true. I also would like to see the whole "pre-existing" clause to go away. It seriously is bullshit for many people who aren't trying to game the system or commit insurance fraud.
I would like to see a genetic screening system implemented but not in the way many might think.
I would like to see it implemented it a way that benefits both parties. For example, if a health problem is found that can be treated via dietary methods I feel the insurance company should offer the customer to cover the issue for no extra cost as long as the customer agrees to dietary treatment plan. When possible this sort of solution should be offered.
Regarding expensive treatments there could be some sort of insurance pool that the companies themselves pay into. Not unlike how big insurance companies currently pool risk when one company can not insure the risk on their own.
I would like to see a genetic screening system implemented but not in the way many might think.
I would like to see it implemented it a way that benefits both parties. For example, if a health problem is found that can be treated via dietary methods I feel the insurance company should offer the customer to cover the issue for no extra cost as long as the customer agrees to dietary treatment plan. When possible this sort of solution should be offered.
This is not possible. We understand such a tremendously small fraction of genetic diseases that screening for most is currently impossible. Couple that with the ins and outs of epigenetics (you can inherit detrimental changes to how your genes are expressed, based on your parents' habits or their environment, which cannot be easily changed) and that makes the idea of a "cure" or "treatment" to genetic conditions on the patient's side relatively laughable barring retroviral gene therapies or tissue engineering. Furthermore, even in cases where we do have an inkling as to genes that may influence a disease (breast cancer, etc.), we frequently are missing most of the picture. Consider: we know of one mutation that plays a role in Lou Gehrig's Disease. Of all ALS cases, this mutation appears in about 20% of them. The rest of the cases appear for no discernable reason. In all cases, the most that can be done is to administer a drug that can extend life expectancy for several months at most; occasionally, outliers (like Stephen Hawking) go on to live for long periods of time, but they are the extreme minority and the reason for their extremely long life expectancy (relatively speaking) is completely unknown.
Others here who have completed their degrees in the field may disagree with me (and I'd welcome the discussion; I find bioethics fascinating), but speaking as someone studying molecular and cellular bio, it's my belief that the only way to avoid creating a set of "healthcare orphans" who are constantly denied coverage due to a cruel cast of the genetic dice is to disallow the usage of genomes as a tool to assess insurance coverage. The same goes for pre-existing conditions and "high risk diagnoses" like bipolar disorder and epilepsy.
No, if a person agrees to the genetic testing they can not become a "healthcare orphan" unless they choose not to follow established preventative and maintenance treatments for whatever genetic maladies show up in the testing where such treatment is possible. If a genetic malady is of a sort that can not be treated until it becomes active but early treatment is known to cure or stabilize said condition then regular testing will help identify it once it becomes a problem. If said condition is not found in your genetic makeup than routine testing for it can be done at much longer intervals.
Why waste the resources testing for something when you are 99% certain the person is unlikely to get it? It would be like testing woman for prostrate cancer!
For example, let's say a customer takes the genetic test and it is found that they have the genetic markers for Hemochromatosis. Knowing this the customer is advised to pay attention to their iron intake, avoid alcohol, avoid vitamin C supplements, and to avoid seafood. They are also scheduled for therapeutic phlebotomy on a regular basis to keep an eye on this problem.
As long as the customer follows these established guidelines they can never have their coverage cancelled for issues arising from this condition. If they are found to not follow these guidelines then the insurance provider may raise their rates or possibly drop their coverage depending on how far away from the guidelines they have strayed.
There would also be the added scientific benefit of having a large portion of the population genetically mapped. This data would be scrubbed of most identifying information and provided to research facilities so that diseases and illnesses could not only be tracked based on genetics but also location so as to possibly find environmental sources of diseases.
Not only that, but in many cases preventative care is significantly less expensive than the treatment for a condition once it has become full-blown. You'd think the insurance companies would be all about hedging their bets this way.
The problem is that there are hardly any genetic conditions which can be perfectly controlled through "preventative and maintenance" treatments. Hemochromatosis is nifty like that, but almost every other disease we've found with a genetic component is infinitely more complex. You also fail to understand the nature of a genome; scrubbing a genome of identifying information destroys the integrity of the entire map. The entirety of a genome is identifying information, especially when you figure in the increasingly necessary epigenomes that have been found to play heavily into the development of cancer. "Scrub" any of that data and you render it useless to research groups; we don't know what genetic switches are responsible for what nor what portion of non-coding DNA interacts with coding sequences or how it does it. The slightest alteration would make a person impossible to identify and also make any scientific conclusions that could be drawn from the tampered genome completely worthless.
Also, I'm not saying that sequencing shouldn't be used. Sequencing should be (and, increasing with conditions such as breast cancer, is) to determine the likelihood of a patient developing a condition. That said, insurance companies should have absolutely no access to that information. They don't know how to interpret it, and people would be unfairly denied coverage.
Not only that, but in many cases preventative care is significantly less expensive than the treatment for a condition once it has become full-blown. You'd think the insurance companies would be all about hedging their bets this way.
True, and I support that, but genetic screening wouldn't let us do that. Not now, and not in the near future.
I'm referring to personal identity information scrubbing. So that while you can see the full info on the person's genes and such you can't identify the person by name.
My ideal screening would include family background information so that things that "run in the family" can be identified without expensive testing.
Also, under my system the insurance company could not deny you coverage for things that come out of the genetic testing. This system would work well for both parties because preventive care is often cheaper than emergency care.
I'm referring to personal identity information scrubbing. So that while you can see the full info on the person's genes and such you can't identify the person by name.
My ideal screening would include family background information so that things that "run in the family" can be identified without expensive testing.
Also, under my system the insurance company could not deny you coverage for things that come out of the genetic testing. This system would work well for both parties because preventive care is often cheaper than emergency care.
1) A genome is personal identity information. It's as personal as it gets; it's the entire instruction set needed to build the person it comes from.
2) Family background info is routinely checked for right now. People have been denied coverage due to family histories, IIRC.
3) So you're advocating for a system in which insurance companies mandate that people undergo genetic screening, but cannot see or use that information? That's no different than what we do now with breast cancer genetic screens, save that no one mandates them. Also, I feel that a preventative care focus based on poorly-understood genetic models of disease is an inherently bad idea that would decrease the overall quality of medical care by allowing insurance companies to focus on preventative treatments based on incomplete evidence rather than cures that are based on our actual understanding of disease etiology. I know, you might say, "An ounce of prevention is worth a pound of cure," but I assure you that when it comes to these genetic disorders, all bets are off.
Furthermore, the medical system is way too stressed presently to handle the massive time burden that comes with preventative medicine. I've talked to many physicians in the past about this, and they all come up with the same answer: It would be nice to practice preventative medicine, but their schedules and the needs of their hospitals and practices are such that they cannot devote enough time to each patient to make such a system work. That argument doesn't even take into consideration the huge amount of time that would need to be spent on trials and Cochrane reviews to make sure that the preventative measures work...nor the money necessary to do those things.
It's a nice dream, but without the complete restructuring of the entire US healthcare system and the end of the increasing doctor shortage nationwide, you'll never see anyone in the healthcare profession with enough time available to work on preventative care.
If the genetic datasets can not work with privacy laws then the entire system will not work.
Insurance companies would be privy to the information, how else would they know the customer's unique makeup and care needs?
It could be trialed on a small scale by aiming it at disorders that are easy to diagnose and cheaper to treat than deal with later. Obesity comes to mind...
I don't trust health insurance companies as far as I can throw them. I certainly don't trust them to peer into my genetics and make decisions on my health based on that. For example, I struggled with juvenile epilepsy from ages 9 up until around 12, when I got an effective treatment for it. Around two or three years ago, an EEG determined I have no more seizure activity. That's excellent. However, the way insurance companies currently operate, and with our incredibly limited understanding of the genetics behind these things, my history coupled with the profiles of myself and my next of kin could be used to deny coverage to those down the line.
Furthermore, with small scale trials, the problem of actual etiology arises. Yeah, you can aim a gene assay at people with obesity and see what's going on. You might see a handful of genes associated with metabolic disorder or leptin-related syndromes, if you're lucky. What you will neither see nor understand is the likely-millions of acetylations and methylations controlling the expression of seemingly unrelated factors that may correlate with obesity, nor the action of an incomprehensible number of DNA switches that act to control these elements. Even worse, you'll miss out on the action of complex RNA interference systems that we're only just beginning to understand; someone could express a gene that usually helps cause obesity, and you could be treating them based on that, when it might be turned off after transcription but before translation.
It's easy to diagnose a disorder like obesity or Type II diabetes using traditional methods, but impossible to determine almost anything of importance about those things with just a patient's genome. To quote Craig Venter, "We have learned nothing from the genome." To even begin to treat a patient through lifestyle changes based on the molecular etiology of a disease, you would need not just the genome, but also the metabolome, membranome, physiome, proteome, transcriptome, and glycome of a patient, in addition to traditional tests. That'd push the average cost of care into the billions per patient--and that's assuming you've already discovered the tech needed to find most of these things. Which we haven't.
Comments
You could have the shittiest insurance company in the world for a decade and never find out until you get into that one car accident or develop cancer and they go "Nope, not covered because of a, b and c. So long and thanks for all the cash!"
What do you do then? Live and learn?
Again, the words you write appear to show you in agreement with what Romney has said.
I am saying that there is no choice with the CURRENT system, so he is making a wrongful distinction. I would rather have a single option universal healthcare with a guarantee of coverage than a single option for private healthcare.
As an admitted leftist, I would like to divorce health insurance from employment. I see too many of my artist contractor/freelance/self-employed friends suffering because private health insurance is totally out of their reach. These are not people who are destitute, they work 40+ hours doing your arts. (Of course, people often counter with "Why are you drawing? Get a real job!") It also hurts small businesses, because they have to pay people so much more to cover their health insurance. My work pays 50% of the monthly cost and it is still expensive for both the employer and the employee. It is actually a barrier to hiring people full time!
The only way I see such a system existing is if we start by making all health insurance companies become non-profits.
Actually, a lot of industry leaders who want to move forward request regulation that will force the rest of the industry to keep up with them so they won't be at a competitive disadvantage. "We would like to stop dumping waste into the river, but we can't be competitive and pay for waste processing unless the other companies have to as well."
I was reading about some fuel regulation a few days ago that people were bitching about because the additive described in the law does not exist yet companies are being fined for not using it. If true that is a bad regulation.
I would like to see it implemented it a way that benefits both parties. For example, if a health problem is found that can be treated via dietary methods I feel the insurance company should offer the customer to cover the issue for no extra cost as long as the customer agrees to dietary treatment plan. When possible this sort of solution should be offered.
Regarding expensive treatments there could be some sort of insurance pool that the companies themselves pay into. Not unlike how big insurance companies currently pool risk when one company can not insure the risk on their own.
Others here who have completed their degrees in the field may disagree with me (and I'd welcome the discussion; I find bioethics fascinating), but speaking as someone studying molecular and cellular bio, it's my belief that the only way to avoid creating a set of "healthcare orphans" who are constantly denied coverage due to a cruel cast of the genetic dice is to disallow the usage of genomes as a tool to assess insurance coverage. The same goes for pre-existing conditions and "high risk diagnoses" like bipolar disorder and epilepsy.
Why waste the resources testing for something when you are 99% certain the person is unlikely to get it? It would be like testing woman for prostrate cancer!
For example, let's say a customer takes the genetic test and it is found that they have the genetic markers for Hemochromatosis. Knowing this the customer is advised to pay attention to their iron intake, avoid alcohol, avoid vitamin C supplements, and to avoid seafood. They are also scheduled for therapeutic phlebotomy on a regular basis to keep an eye on this problem.
As long as the customer follows these established guidelines they can never have their coverage cancelled for issues arising from this condition. If they are found to not follow these guidelines then the insurance provider may raise their rates or possibly drop their coverage depending on how far away from the guidelines they have strayed.
There would also be the added scientific benefit of having a large portion of the population genetically mapped. This data would be scrubbed of most identifying information and provided to research facilities so that diseases and illnesses could not only be tracked based on genetics but also location so as to possibly find environmental sources of diseases.
Its not a perfect plan but it's a starting point.
The problem is that there are hardly any genetic conditions which can be perfectly controlled through "preventative and maintenance" treatments. Hemochromatosis is nifty like that, but almost every other disease we've found with a genetic component is infinitely more complex. You also fail to understand the nature of a genome; scrubbing a genome of identifying information destroys the integrity of the entire map. The entirety of a genome is identifying information, especially when you figure in the increasingly necessary epigenomes that have been found to play heavily into the development of cancer. "Scrub" any of that data and you render it useless to research groups; we don't know what genetic switches are responsible for what nor what portion of non-coding DNA interacts with coding sequences or how it does it. The slightest alteration would make a person impossible to identify and also make any scientific conclusions that could be drawn from the tampered genome completely worthless.
Also, I'm not saying that sequencing shouldn't be used. Sequencing should be (and, increasing with conditions such as breast cancer, is) to determine the likelihood of a patient developing a condition. That said, insurance companies should have absolutely no access to that information. They don't know how to interpret it, and people would be unfairly denied coverage. True, and I support that, but genetic screening wouldn't let us do that. Not now, and not in the near future.
My ideal screening would include family background information so that things that "run in the family" can be identified without expensive testing.
Also, under my system the insurance company could not deny you coverage for things that come out of the genetic testing. This system would work well for both parties because preventive care is often cheaper than emergency care.
2) Family background info is routinely checked for right now. People have been denied coverage due to family histories, IIRC.
3) So you're advocating for a system in which insurance companies mandate that people undergo genetic screening, but cannot see or use that information? That's no different than what we do now with breast cancer genetic screens, save that no one mandates them. Also, I feel that a preventative care focus based on poorly-understood genetic models of disease is an inherently bad idea that would decrease the overall quality of medical care by allowing insurance companies to focus on preventative treatments based on incomplete evidence rather than cures that are based on our actual understanding of disease etiology. I know, you might say, "An ounce of prevention is worth a pound of cure," but I assure you that when it comes to these genetic disorders, all bets are off.
Furthermore, the medical system is way too stressed presently to handle the massive time burden that comes with preventative medicine. I've talked to many physicians in the past about this, and they all come up with the same answer: It would be nice to practice preventative medicine, but their schedules and the needs of their hospitals and practices are such that they cannot devote enough time to each patient to make such a system work. That argument doesn't even take into consideration the huge amount of time that would need to be spent on trials and Cochrane reviews to make sure that the preventative measures work...nor the money necessary to do those things.
It's a nice dream, but without the complete restructuring of the entire US healthcare system and the end of the increasing doctor shortage nationwide, you'll never see anyone in the healthcare profession with enough time available to work on preventative care.
If the genetic datasets can not work with privacy laws then the entire system will not work.
Insurance companies would be privy to the information, how else would they know the customer's unique makeup and care needs?
It could be trialed on a small scale by aiming it at disorders that are easy to diagnose and cheaper to treat than deal with later. Obesity comes to mind...
Furthermore, with small scale trials, the problem of actual etiology arises. Yeah, you can aim a gene assay at people with obesity and see what's going on. You might see a handful of genes associated with metabolic disorder or leptin-related syndromes, if you're lucky. What you will neither see nor understand is the likely-millions of acetylations and methylations controlling the expression of seemingly unrelated factors that may correlate with obesity, nor the action of an incomprehensible number of DNA switches that act to control these elements. Even worse, you'll miss out on the action of complex RNA interference systems that we're only just beginning to understand; someone could express a gene that usually helps cause obesity, and you could be treating them based on that, when it might be turned off after transcription but before translation.
It's easy to diagnose a disorder like obesity or Type II diabetes using traditional methods, but impossible to determine almost anything of importance about those things with just a patient's genome. To quote Craig Venter, "We have learned nothing from the genome." To even begin to treat a patient through lifestyle changes based on the molecular etiology of a disease, you would need not just the genome, but also the metabolome, membranome, physiome, proteome, transcriptome, and glycome of a patient, in addition to traditional tests. That'd push the average cost of care into the billions per patient--and that's assuming you've already discovered the tech needed to find most of these things. Which we haven't.