Government considering mandatory health insurance

Tigerandahalf

http://www.irishtimes.com/news/health/reilly-proposes-mandatory-basic-health-cover-1.1699400

This was always a possibility once the insurance companies started losing young customers. It means there will be even less net money in young people's take home pay at a time when many of them are struggling for work.
It's also another reason why house price increases are unsustainable.

Are we seeing more signs of the generational war emerging between the older and younger generations. The older generation have the jobs and the higher incomes yet want the younger generation to subsidise their health cover.
This can't last.

touts

€1600 per person. And I presume that is AFTER income tax etc has been deducted.

And even after you've paid that amount they seem to be reserving the right for some civil service bean counter to look at your case and decide "should all life-saving treatments be considered essential or should quality of life and life expectancy be taken into account". So they might just let you die if its too expensive to keep you alive or if they decide your life isn't worth living. Which means anyone who can afford it will still opt for private health insurance to cover the stuff that the public system won't gurantee (such as saving your life in the event of serious illness requiring expensive treatment). Which means we just threw €1600 per person per year into a black hole to stay pretty much where we currently are.

km79

Encourage more people to stay at home and have more babies as they will get this for free.......penalize people who work ......oh and any sign of the free GP care for under 5s yet ? No I thought not.

bee06

€1600 euro per person seems crazy high. You'd get what I would consider to be good cover for about €1000 and that is taking into account the increased prices due to so many people cancelling. In theory if the insurance customer base increased then prices should decrease.

force eleven

Oh and they propose to take this directly from your pay packet. So as well as all the gold plated pensions for the older generation, we are also to pay for what is largely their health cover. Fair and equitable eh?

slimjimmc

force eleven wrote: »

Oh and they propose to take this directly from your pay packet. So as well as all the gold plated pensions for the older generation, we are also to pay for what is largely their health cover. Fair and equitable eh?

Perhaps some are, but most of the older generation are not on "gold plated pensions", far from it, and quite a few don't even have a personal pension at all.

Sconsey

Tigerandahalf wrote: »

The older generation have the jobs and the higher incomes yet want the younger generation to subsidise their health cover.
This can't last.

Not forgetting that most of that older generation spent their working lives paying health insurance, now as they naturally get older their health deteriorates. If no new subscribers are coming online then the insurance company cannot pay out for the claims of the elderly and all the years of payments by the older generation were for nothing.
So the older generation are stuck, they have so much invested they cannot drop out now, they have to pay the higher premiums.

Nobody is getting away lightly, young or old. It's natural for younger (healthier) generations to subsidise the older generation. The young people will need the same support as they age.

Tigerandahalf

Sconsey wrote: »

Not forgetting that most of that older generation spent their working lives paying health insurance, now as they naturally get older their health deteriorates. If no new subscribers are coming online then the insurance company cannot pay out for the claims of the elderly and all the years of payments by the older generation were for nothing.
So the older generation are stuck, they have so much invested they cannot drop out now, they have to pay the higher premiums.

Nobody is getting away lightly, young or old. It's natural for younger (healthier) generations to subsidise the older generation. The young people will need the same support as they age.

Ya I agree with you there. But many others probably didn't pay a penny into the system. On the other hand those who did pay health insurance were more than likely in comfortable secure employment and thus were in a good position to pay.
Maybe we are all losers in the current climate.
Unless more people get back into sustainable long term employment more problems like this will arise. But even then you have a bubble of retirees who are no longer going to be net contributors to the system.
Perhaps pension rates of pay, free bus and rail travel and other subsidies for older people will have to come under scrutiny. But because of the larger pool of votes that the elderly have will any political party ever approach this issue.
It is surprising that no youth group has organised itself at this stage given the huge threats coming down the road.

hmmm

Universal health insurance is fine as long as it is universal. If they propose "exemptions" or "subsidies" it will end up as yet another tax on people earning at or above the average wage, with half the population enjoying "free" services.

nicol

Let's be honest, the system as it currently stands is evolving slowly but surely into an American style healthcare system, where only the well off can afford healthcare and even then they are still being stumped with large bills for what would be regarded as routine procedures.

The government are trying to come up with an alternative, which is commendable but the figure of €1600 per person is very high in my opinion. Also I didn't see any mention of how healthcare for children is to be funded, will the parents be hit with extra insurance levies or is it case that all working adults pay the same amount irrespective of whether they have children or not??

I would also hope that if we are going to be hit by a health insurance levy then we should see the rates of income tax decrease as some of this money would have been ring fenced for financing the Department of Health / HSE. Wishful thinking??

Sconsey

To be honest my biggest concern here is that the money will just be dumped into a hole called the HSE*, all this money will just be wasted on inefficiency without any significant improvement in service. I could stomach paying a levey (spelling?) if I thought the overall service would improve, but the cynic in me just sees this money going to waste.

*not having a go at doctors or nurses, especially frontline staff, those people are pure pros in my experience, deserve every penny they get.

Tigerandahalf

I don't believe anything should be given for nothing.
I don't believe in free GP care for the under 5s either. It is just a bad system and encourages doctors and some users to abuse the system. Even paying just €5 for every visit with a maximum amount of €100 per year would be a much better measure. The same with free travel and all others areas where things are given out. Some form of contribution should be given.
I also do think that the older generation will have to give more.

woodoo

There will be no improvement for the ordinary person who will be made pay for the basic plan. Those that can afford a better plans will skip the queue. It will be no different to what we have now. The 2 tier system will still be in place. I don't know how working people will be afford this.

Geuze

bee06 wrote: »

€1600 euro per person seems crazy high. You'd get what I would consider to be good cover for about €1000 and that is taking into account the increased prices due to so many people cancelling. In theory if the insurance customer base increased then prices should decrease.

1600 seems low to me.

Note that UHI would have to replace much of the tax currently spent on healthcare.

So spending by the Govt would fall, and be replaced by UHI expenditure.

Example:

Say Cork hosp gets 100m from the HSE now.

With UHI it might just get 40m from the Govt, to cover uninsured activity, and then it would bill the insurers for the rest.

Note that the total expenditure would not change, just the composition of spending would change.

If we had a balanced fiscal budget, then this is what would happen:

Before UHI - note that these are estimates

Tax-financed govt exp = 13bn
Health insurers exp = 3bn
Out-of-pocket fees = 3bn
Total exp on heath = 19bn


After UHI - estimates

Tax-financed Govt exp = 6bn
UHI = 11bn
Cash paid by patients = 2bn

In some sense, overall spending should not change. After all, there won't be more sick people just because of UHI.

So my tax bill will drop, and instead I pay UHI.

Now I admit that is a bit simplified.

Geuze

woodoo wrote: »

There will be no improvement for the ordinary person who will be made pay for the basic plan. Those that can afford a better plans will skip the queue. It will be no different to what we have now. The 2 tier system will still be in place. I don't know how working people will be afford this.

Note that as UHI replaces tax-financed public exp, then tax revenue can fall.

Geuze

Tigerandahalf wrote: »

I don't believe anything should be given for nothing.
I don't believe in free GP care for the under 5s either. It is just a bad system and encourages doctors and some users to abuse the system. Even paying just €5 for every visit with a maximum amount of €100 per year would be a much better measure. The same with free travel and all others areas where things are given out. Some form of contribution should be given.
I also do think that the older generation will have to give more.

I fully agree.

5e or 10e co-pay or excess makes sense.

People abuse the GMS scheme, e.g. the look for Calpol prescriptions, as it's on the GMS list.

This wastes the time of the GP.

A small fee should discourage spurious cases.

Geuze

German system = social health ins

200+ insurers, all not-for-profit mutual insurers

Premium is approx 15.5% of wages up to 48,600, approx half paid by employee, half by employer

So max premium is 7533 pa.

The worker pays roughly half, so 3700 approx.

Note that I think your kids are covered by parents premium.

Note that if you earn 20k or 30k, you are being subsidised by the higher earners.

Geuze

French system = social health ins + voluntary supp insurance


3 large insurers, state-organised
They reimburse 70%-80% of GP / hosp fees
It seems the premium is 15%-20% of wages


Note that the 2012 GP fee is 23 euro!!!!
And the insurer reimburses 70% of that.

Mongfinder General

Isn't what O'Reilly's doing basically the same thing as Obamacare?

GCU Flexible Demeanour

Geuze wrote: »

German system = social health ins

200+ insurers, all not-for-profit mutual insurers

Premium is approx 15.5% of wages up to 48,600, approx half paid by employee, half by employer

So max premium is 7533 pa.

Geuze wrote: »

French system = social health ins + voluntary supp insurance


3 large insurers, state-organised
They reimburse 70%-80% of GP / hosp fees
It seems the premium is 15%-20% of wages


Note that the 2012 GP fee is 23 euro!!!!
And the insurer reimburses 70% of that.

Is it fair to point out that both the German and the French systems need taxpayer bailouts as well, as even that quite substantial level of premiums doesn't keep pace with cost escalation.

One factor in play is that demand for health insurance is quite insensitive to price. That means a rational insurer actually doesn't have a strong incentive to keep costs down, as its always easier to just put prices up; the numbers of subscribers dropping out will be more than compensated for by the increasing premiums. That's why VHI are earning more in total premium income now than in 2008. A similar dynamic will apply, even in those "not-for-profit" systems. For instance, one effect of tying the contribution to employer payrolls is it pushes people out of formal employment.

The contributions paid under those systems are much higher than Irish people would be used to. The highest-earning 10% of households here spend, on average, about €2,000 per year on private health insurance (according to the HBS). A family with a household income of €60,000 p.a might face a total tax burden (including USC and PRSI) of about €15,000. The idea that half of that would be going on healthcare just doesn't seem feasible.

GCU Flexible Demeanour

Mongfinder General wrote: »

Isn't what O'Reilly's doing basically the same thing as Obamacare?

Not really. The US actually has a significant portion of the population uncovered. Here, everyone at least gets access to public hospital services, although if you don't have a medical card you can be charged up to about €750 per year if you've ten or more nights in hospital.

What Reilly is doing is closer to the Dutch system. The motivation for following that model is far from clear, as it doesn't really address any problem that the Irish system is experiencing.

hmmm

GCU Flexible Demeanour wrote: »

The motivation for following that model is far from clear, as it doesn't really address any problem that the Irish system is experiencing.

It doesn't address any problems, but it is a new tax under the guise of "insurance". The current system is collapsing under the weight of exorbitant salaries and numbers of unnecessary administration staff, and too little expenditure on actual healthcare - if a government is unwilling to get rid of people who do too little work, the only way to pay for the actual "healthcare" system is to increase tax on those paying for it.

Personally I'd like to see privatised (or charity/not for profit) hospitals supplying services to public health purchasing authorities. That at least will give us the best opportunity of getting good public healthcare without the overheads and waste of a public system.

Princess Consuela Bananahammock

Geuze wrote: »

German system = social health ins

200+ insurers, all not-for-profit mutual insurers

Premium is approx 15.5% of wages up to 48,600, approx half paid by employee, half by employer

So max premium is 7533 pa.

The worker pays roughly half, so 3700 approx.

Note that I think your kids are covered by parents premium.

Note that if you earn 20k or 30k, you are being subsidised by the higher earners.

Worker pays the full whack if he's self employed.

It does however cover GP visits and is paid for if you're unemployed (not sure how this would work in Ireland).

the groutch

hmmm wrote: »

Universal health insurance is fine as long as it is universal. If they propose "exemptions" or "subsidies" it will end up as yet another tax on people earning at or above the average wage, with half the population enjoying "free" services.

seems to be the status quo for FG, keep squeezing the working middle, while the big earners and the spongers of this country get an easy ride.

dinnyirwin

Sounds like bins and water all over again to me.

You paid for these in your taxes. The government fooled people into thinking that they got them for free and must now pay for them.
Your taxes didnt go down, but you paid extra for bins and water.

So, you pay for health service in your taxes. The government are trying to fool people into thinking they get this for free and must now pay for it.
Your taxes wont go down, but you will pay extra for your health service.

NOBODY wins from this. So resist the temptation to turn against others who will be victims of this new smoke and mirrors tactics just as much as yourself.

harpsman

Princess Consuela Bananahammock wrote: »

Worker pays the full whack if he's self employed.

It does however cover GP visits and is paid for if you're unemployed (not sure how this would work in Ireland).

That sounds right-if theres one thing Irish politicians(and politicos elsewhere Im sure) hate its the self employed.

harpsman

hmmm wrote: »

It doesn't address any problems, but it is a new tax under the guise of "insurance". The current system is collapsing under the weight of exorbitant salaries and numbers of unnecessary administration staff, and too little expenditure on actual healthcare - if a government is unwilling to get rid of people who do too little work, the only way to pay for the actual "healthcare" system is to increase tax on those paying for it.

Personally I'd like to see privatised (or charity/not for profit) hospitals supplying services to public health purchasing authorities. That at least will give us the best opportunity of getting good public healthcare without the overheads and waste of a public system.

Agreed but that aint gonna happen.

harpsman

Tigerandahalf wrote: »

I don't believe anything should be given for nothing.
I don't believe in free GP care for the under 5s either. It is just a bad system and encourages doctors and some users to abuse the system. Even paying just €5 for every visit with a maximum amount of €100 per year would be a much better measure. The same with free travel and all others areas where things are given out. Some form of contribution should be given.
I also do think that the older generation will have to give more.

+1.But you,me and Maggie Thatcher the only ones who believe this.

Farmer Pudsey

THe biggest issue in Ireland is that GP care is too expensive. 50 euro/visit is crazy. Because of this a lot of GP's want to turn over customers fast, this has lead GP to exit small injury's etc and point such people towars Accident and Emergency. Why spend 30-40 minutes accessing and stitching a person when you coud see 4-6 other 50 euro pops.

In one way I agree with the U5's plan. It is terrible to have a sick child and be worried about the cost of visiting the Doctor. We were lucky when our childern were young we were going to a doctor who was and still reasonable to pay. He never charged for a repeat visit for the same illness or bug. And if two of the kids were sick it was the same fee. However I would not disagree with a modest even of 10-15 euro maybe to include prescription and max it at 30/month or 250/year.

I think mandatory HI will be bought is as the government drops the rates of USC charged. In reality health costs have got completeluy out od control with some new medicines and procedures crazy in price. With compulsory HI it will be a provider limiting access not a government department.

People also need to remember the punter needs to live as well so there is a limit to any taxation etc. The other thing is to remember is that the Compulsory plans will be quite basic and may only give access to public hospitals so private HI will still be in place

I think it is a good idea, I have health insurance any way, as along as it not astronomical It probably wont make any difference to me, I would be concerned that it could produce poverty traps and interfere with people taking up paid employment like a lot of income related benefits do.

In the mean time I want someone to invert pick and mix health insurance for example I would like insurance that covers all diagnostic tests and scans and cover all orthopaedic procurers but I would be happy to have cancer care in the public system( because it is very good ).

Geuze

mariaalice wrote: »

I would be concerned that it could produce poverty traps and interfere with people taking up paid employment like a lot of income related benefits do.

One advantage of UHI is that it reduces poverty traps, as your healthcare status does not change if you get a job.

NOW - move from unemployment to job - lose med card

UHI - move from unemployment to job = no change, same insurance

Geuze

Geuze wrote: »

One advantage of UHI is that it reduces poverty traps, as your healthcare status does not change if you get a job.

NOW - move from unemployment to job - lose med card

UHI - move from unemployment to job = no change, same insurance

Yes but if you were getting a subsidy towards you health insurance because you were unemployed they when you take up employment you would loose this subsidy. This had the potential to interfere with taking up employment.

Geuze

Farmer Pudsey wrote: »

THe biggest issue in Ireland is that GP care is too expensive. 50 euro/visit is crazy. Because of this a lot of GP's want to turn over customers fast, this has lead GP to exit small injury's etc and point such people towars Accident and Emergency. Why spend 30-40 minutes accessing and stitching a person when you coud see 4-6 other 50 euro pops.

Most French GPs charge a rate of 23 euro, 70% of which the patient gets reimbursed by the compulsory insurance.

It's very difficult to explain the gap between 23 in France, and a headline rate of 50 here.

Geuze

mariaalice wrote: »

Yes but if you were getting a subsidy towards you health insurance because you were unemployed they when you take up employment you would loose this subsidy. This had the potential to interfere with taking up employment.

Yes, fair enough.

Geuze

Farmer Pudsey wrote: »

In one way I agree with the U5's plan. It is terrible to have a sick child and be worried about the cost of visiting the Doctor. We were lucky when our childern were young we were going to a doctor who was and still reasonable to pay. He never charged for a repeat visit for the same illness or bug. And if two of the kids were sick it was the same fee. However I would not disagree with a modest even of 10-15 euro maybe to include prescription and max it at 30/month or 250/year.

Yes, a fee of 10e per GP visit would be fine.

Geuze

Farmer Pudsey wrote: »

I think mandatory HI will be bought is as the government drops the rates of USC charged.

Yes, we need to know what other taxes will fall, as UHI replaces tax-financed healthcare?

Germany/France have UHI, but they have lower VAT, lower excise duty on tobacco/alcohol, and sometimes lower income tax.

Geuze

Farmer Pudsey wrote: »

T
The other thing is to remember is that the Compulsory plans will be quite basic and may only give access to public hospitals so private HI will still be in place

The Basic Care Package being discussed in media covers primary care + hosp care, so it does not seem too narrow.

Now, it may not cover the so-called "hotel" benefits of a single room, and yes, supplementary insurance may be available for that.

But for simple treatments, I presume all hosps will compete for patients....

EB_2013

Will GP visits for all be free under these new plans?

professore

Geuze wrote: »

Most French GPs charge a rate of 23 euro, 70% of which the patient gets reimbursed by the compulsory insurance.

It's very difficult to explain the gap between 23 in France, and a headline rate of 50 here.

Insurance I'd say can explain at least some of it - people don't sue half as readily on the "continent" as they do here. That's why if you go to parks in France the health and safety is not up to the same standards as here, i.e. everything wrapped in cotton wool - water slides only open for 10 minutes every hour etc.

EDIT: I consider this a positive for France !

solerina

I don't have health insurance as I simply cant afford the luxury, coupled with the fact that I havnt been to a doctor in over ten years I feel its a waste of my money (hopefully I keep healthy)...I feek its unfair to force people to pay into a scheme - it should be available but not compulsory. What really annoys me is yet again there are many many people who will be deemed unable to pay and will get it free. Just like all the other taxes that the normal working person is forced to pay....its time they realised we cant lose anymore in our wages !!

Mucco

I'm somewhat confused by this, as I thought we all had basic health cover anyway, paid through our taxes. I'm not sure why changing to a private financing system would improve anything. Taxation is progressive, so can be seen as fair, but apart from subsidising those on low income, this proposal scheme charges everyone the same.

I suppose the real meat is in selective contracting with hospitals. This is where the insurance companies choose not to use certain hospitals. The intention is that they selectively contract the best hospitals in order to give incentives to improve quality. However, this is high risk for the insurance companies as the automatic assumption will be that they are trying to save money. The approach here will be to generate good quality indicators that they can use to prove they're contracting based on quality. Such indicators are not so easy to develop, the current batch is here.

Here are a few links:
Boards thread from 3 years ago
ESRI report
Presentation on Dutch system

Jolly Red Giant

Mucco wrote: »

I'm somewhat confused by this, as I thought we all had basic health cover anyway, paid through our taxes. I'm not sure why changing to a private financing system would improve anything. Taxation is progressive, so can be seen as fair, but apart from subsidising those on low income, this proposal scheme charges everyone the same.

I suppose the real meat is in selective contracting with hospitals. This is where the insurance companies choose not to use certain hospitals. The intention is that they selectively contract the best hospitals in order to give incentives to improve quality. However, this is high risk for the insurance companies as the automatic assumption will be that they are trying to save money. The approach here will be to generate good quality indicators that they can use to prove they're contracting based on quality. Such indicators are not so easy to develop, the current batch is here.

Here are a few links:
Boards thread from 3 years ago
ESRI report
Presentation on Dutch system

This is an analysis of FG's universal health insurance proposals. It was written in 2011 but is still relevant - in fact things have got a lot worse since it was written (including the fact that the Dutch government has said it will allow 15 hospitals to go bankrupt).

http://www.macliam.org/Health/AnalysisFineGaelFaircare.pdf

Idbatterim

Will GP visits for all be free under these new plans?

No doubt, we will lose the E1600 and then have to pay E50 or so per visit if you are working :rolleyes:

EB_2013

Idbatterim wrote: »

No doubt, we will lose the E1600 and then have to pay E50 or so per visit if you are working :rolleyes:

You're probably right

Icepick

Farmer Pudsey wrote: »

THe biggest issue in Ireland is that GP care is too expensive. 50 euro/visit is crazy.

You need to subsidize medical card holders with that €50.

Idbatterim

what another absolute joke that medical card holders pay nothing to visit a GP,even if it was E10 or 20, it would be more equitable and they would think twice about time wasting visits...

spank_inferno

Idbatterim wrote: »

what another absolute joke that medical card holders pay nothing to visit a GP,even if it was E10 or 20, it would be more equitable and they would think twice about time wasting visits...

You are right.

But 1/3 of the population have them, so its politically a no-go.

Mucco

Jolly Red Giant wrote: »

This is an analysis of FG's universal health insurance proposals. It was written in 2011 but is still relevant - in fact things have got a lot worse since it was written (including the fact that the Dutch government has said it will allow 15 hospitals to go bankrupt).

Hospitals have to be allowed to go bankrupt for the system to work otherwise there's no incentive to improve. Insurers will selectively contract good hospitals. Poor hospitals will go out of business. Of course, many people prefer a poor hospital to no hospital so this is very difficult politically.

Idbatterim

when we hear about the constant spiraling of health care costs, could someone point out to me what exact costs are spiraling?

Geuze

It's more that the level of healthcare costs are too high here.

Many examples:

GP fees
Consultant fees
Drug costs


A tiny example: paracetamol is under 20p in NI for 12 tablets, maybe 99c - 1.49 here.

Geuze

http://www.cso.ie/en/releasesandpublications/er/cpi/consumerpriceindexdecember2013/#.UwvdhON_uE4

See table A above.

Health costs in the CPI have increased by 5.4% over four year, so the "spiralling" seems to have stopped, but of course costs are still stuck too high.