Are you sick of health care threads yet?

[Julie in Austin]

As much for me as for you, dear reader, I thought I'd sketch out my thoughts about health care reform.

 

(1) I am an ardent believer in free markets. However, we have what economists call an information problem when it comes to health care. I go to my doctor and she says, "We can do a [long Latinate word] for $2400 or a [longer Latinate word] for $3200." I'm a well-educated person, but I just don't have the information to choose between those. Now add another doctor to the mix who says, "I'll do the first for $2000 and the second for $3000." Is that a good deal? Or is it a rip off because his results are worse? Another information problem. And that's for someone with a sound mind and body and two advanced degrees who isn't having an emergency and who knows how to do research on the Internet! What kind of decision would my 80+ year old, half-blind, hard-of-hearing grandmother make when given those options?

 

To sum: I believe in free markets, but I also believe that free markets don't work for health care because we don't have enough information to make the kinds of decisions that functional free markets need.

 

(2) In our current system, a huge chunk of our health care spending goes to the insurance companies. It has been estimated that if we redirected that money to actual health care, we could cover everyone who isn't covered.

 

(3) Our current system stifles other free markets: it is likely that the car companies would have been fine without their health care burdens. I would never, never let my husband start his own business because we need his health care. I know people with 2 degrees working at Wal-Mart for the benefits. We are crippling other sectors of the economy by forcing people into certain jobs just because those jobs carry insurance.

 

(4) Therefore, I favor single-payer, universal care. I would like a system where a board of doctors, medical goods makers, patient advocates, and economists would set prices for all procedures. If you had that procedure done, the fed would write a check for that amount to your provider. The doc would be free to charge more and you could choose to pay that or pick a different doctor.

 

(5) People like Sara R rightly point out that this could get expensive. It could, but I believe we can reap a lot of savings via what I have outlined above. More importantly, however, what are the costs of doing nothing? Health care costs have been skyrocketing. This pushes middle-income families into bankruptcy, which is expensive to the rest of us. It pushes poor people into the ER, which you and I end up paying for. It pushes all sorts of people to live with untreated conditions that inhibit their ability to become taxpayers and instead pushes them onto disability.

 

(6) Now, to counter some arguments:

 

(a) This is no more the slippery slope to socialism (although that is fun to say--try it!) than libraries, interstate roads, the military, or colleges are. Every single industrialized nation except for the US has universal health care, many for over 50 years, and not a one has become a remake of Orwell's worst nightmare.

 

(b) It doesn't mean the fed "owns you." If anything, right now, the insurance companies "own you." I'd rather be owned by a gov't with a free press and free elections than an insurance company that makes un-appeal-able decisions behind closed doors.

 

© There will be waste and fraud. I know this. Nothing is perfect. But if designed right, there may well be less waste and fraud than we have now.

 

(d) There is only a limited moral hazard. I can get how someone might take advantage of welfare--there's a lot of fun you can have with free money! But how many people do you think will get extra appendectomies just because they are free? Medical care is always enough of a PITA that abuse will be limited.

 

(e) I'm not persuaded by complaints about rationing. We have rationing now, and it works like this: if you are lucky enough to have a job with insurance and/or wealthy enough to pay out of pocket, you get the moon. If you aren't, you don't get anything. I think it would be far more moral to have rationing that went like this: the government will provide a basic level of care to everyone and if you want more, pay for it yourself.

 

(f) I'm also not persuaded by anecdotal evidence about your cousin in Canada who died after waiting six months for something. On average, other countries spend half what we spend for similar or better outcomes.

 

This is a huge, complicated issue with many facets. (I have ideas for tort reform, too!) Thanks for reading this far--I wanted to sketch out what I've been thinking in light of recent threads around here. And I welcome reasoned and reasonable critiques.

[NoPlaceLikeHome]

:iagree::iagree::iagree:

 

:hurray:

 

I could not agree more with your post:) I only wish that I could be as eloquent;)

[Jugglin'5]

I think you've made a very persuasive argument. I would rather be under a true single-payer system than a fascist mishmash of private/public like we have now.

 

Personally, I would rather our system go MORE free-market by deregulating the market and freeing employers from the obligation to provide insurance. I think the link between insurance and employers has done great damage to our system.

[Perry]

 

I agree with everything you said.

[Heather in the Kootenays]

but this is an excellent post.

 

Thank you

 

Heather

[TeacherZee]

Could not agree more

[Anita in NC]

Well said. :iagree:

[littlebug42]

 

(d) There is only a limited moral hazard. I can get how someone might take advantage of welfare--there's a lot of fun you can have with free money! But how many people do you think will get extra appendectomies just because they are free? Medical care is always enough of a PITA that abuse will be limited.

 

(e) I'm not persuaded by complaints about rationing. We have rationing now, and it works like this: if you are lucky enough to have a job with insurance and/or wealthy enough to pay out of pocket, you get the moon. If you aren't, you don't get anything. I think it would be far more moral to have rationing that went like this: the government will provide a basic level of care to everyone and if you want more, pay for it yourself.

 

(f) I'm also not persuaded by anecdotal evidence about your cousin in Canada who died after waiting six months for something. On average, other countries spend half what we spend for similar or better outcomes.

 

 

 

 

Unlike other posters here, I do not agree with you but felt the need to address a few points only.

 

(d): Abuse of the system is already a problem. I work in the health care industry and I cannot tell you the number of medical tests that I come across every day that are unneccessary. I do not doubt at all that if there is a guaranteed paycheck for those exams, the amount of them will increase. Since I began my job 7 years ago, I have already seen that as the economy worsens I get busier. Prior to my health care job, I worked in government funded low-income housing. I know the government cannot manage those needs and I have no faith that health care would be any better.

 

(e) I take exception to the fact that if you have insurance you "have the moon". I will use my daughter as an example. She was born with a clubfoot, typical treatment of which is surgery - lots and lots of surgery often. We chose a nonsurgical treatment that I currently have the freedom to obtain the best treatment we can for her - in another state. I have had to fight hard for that (separate from my insurance) and I don't want a board of anyone telling me what is right for my child.

 

(f) You don't want to hear negative stories from other countries to color your opinions - well, I have heard them first hand over the last 5 years from many concerned parents that have little to no choices for their children's feet. This does color everything about my decision making in this matter. I would like to believe that things will work out but I can tell you, I have a sick feeling in the pit of my stomach that if this legislation passes, it will mean nothing but bad things for my daughter. That may make me selfish but that is what I see in our lives. We fit just inside a tax bracket that puts more of everyone else's burden on our shoulders when we have enough of our own to bear.

[elizabeth]

Bravo, well stated!!! This is a post I enjoyed reading you have raised the level of discourse on the issue.

[Julie in Austin]

Unlike other posters here, I do not agree with you but felt the need to address a few points only.

 

(d): Abuse of the system is already a problem. I work in the health care industry and I cannot tell you the number of medical tests that I come across every day that are unneccessary. I do not doubt at all that if there is a guaranteed paycheck for those exams, the amount of them will increase. Since I began my job 7 years ago, I have already seen that as the economy worsens I get busier. Prior to my health care job, I worked in government funded low-income housing. I know the government cannot manage those needs and I have no faith that health care would be any better.

 

(e) I take exception to the fact that if you have insurance you "have the moon". I will use my daughter as an example. She was born with a clubfoot, typical treatment of which is surgery - lots and lots of surgery often. We chose a nonsurgical treatment that I currently have the freedom to obtain the best treatment we can for her - in another state. I have had to fight hard for that (separate from my insurance) and I don't want a board of anyone telling me what is right for my child.

 

(f) You don't want to hear negative stories from other countries to color your opinions - well, I have heard them first hand over the last 5 years from many concerned parents that have little to no choices for their children's feet. This does color everything about my decision making in this matter. I would like to believe that things will work out but I can tell you, I have a sick feeling in the pit of my stomach that if this legislation passes, it will mean nothing but bad things for my daughter. That may make me selfish but that is what I see in our lives. We fit just inside a tax bracket that puts more of everyone else's burden on our shoulders when we have enough of our own to bear.

 

Thanks for your thoughtful comments. A few responses to your responses:

 

d: I believe that there are ways to design a single-payer system so that there is less room for abuse. My understanding is that a lot of medicine is done for the purpose of avoiding lawsuits--that's something we could address. We could also require people to verify that the doctor did, in fact, perform a certain thing before the reimbursement is given. We can maintain statistics so we can investigate if 80% of dr x's patients get cat scans but only 20% of the people in another office.

 

e: The "moon" rhetoric was an exaggeration for effect, and I do apologize if it is offensive to those who have had to fight insurance companies. I probably should have phrased it differently. As for the issue, you said, "I have had to fight hard for that (separate from my insurance) and I don't want a board of anyone telling me what is right for my child." I wonder why you would conclude that it would be harder to fight a board than to fight the insurance company. I would think that the way the incentives are structured, I'd rather fight the govt than the company! Further, what I proposed wouldn't limit care, just who pays for it.

 

f: I don't want to hear stories--good or bad--because it is merely anecdotal evidence. I would hope that on a classical education homeschooling board we would all know better than to rely on anecdotal evidence! A far better way to understand what happens in other countries is to look at aggregate statistics--not individual cases that might not be representative. And that data shows other countries spend far less for similar-to-better results.

 

Thanks again for your response.

[sandellie4]

:thumbup1::thumbup1:

 

Nice, nice post, Julie.

 

Sandy

[Dirtroad]

Sadly, none of us have ever had a free market medical world. Between insurance companies getting between you & the doctors... and the government getting in ALL of it... we have not had the opportunity to try a free system ....

 

You are right on free market also about things like Libraries... they should be the same way... private & competitive.. .not sitting and waiting on grants.

 

Police & military are more understandable b/c gov't has a duty to protect borders & citizens.

 

And it is NOT GOOD at all that someone's cousin dies b/c Canada made them wait 6 months for care.... just be/c a few others save a few dollars & don't have to worry about insurance payments.

Edited July 20, 2009 by Dirtroad

[Jugglin'5]

Sadly, none of us have ever had a free market medical world. Between insurance companies getting between you & the doctors... and the government getting in ALL of it... we have not had the opportunity to try a free system ....

 

 

:iagree:

[Sara R]

Thanks for your thoughts, Julie. I always respect your input.

 

I agree that the American health insurance system is near a crisis point. We feel that in our budget. :) Reform is definitely needed, and soon, but I disagree that the single payer system is the way to go.

 

The main problem with the current system is the cost. You are probably right that one place where the costs currently go is towards the insurance company's bureaucracy and profit. Under a single payer system, there would be a government bureaucracy in its place. I don't know the numbers enough to determine if there could be a big savings there, but I doubt it.

 

To sum: I believe in free markets, but I also believe that free markets don't work for health care because we don't have enough information to make the kinds of decisions that functional free markets need.

 

You have a point here. However, I do think that some reforms could improve "transparency" so the free market could work better in this case, with things like standardized policies and posted prices. I also believe that health insurance should not be provided by employers.

 

(d) There is only a limited moral hazard. I can get how someone might take advantage of welfare--there's a lot of fun you can have with free money! But how many people do you think will get extra appendectomies just because they are free? Medical care is always enough of a PITA that abuse will be limited.

 

I disagree with you here. Yes, health care is a pain, and that discourages abuse. But sometimes life is painful, and people don't accept that like they used to. It's not so much abuse that's the problem, but rising standards in general. I was just reading a post by PariSarah from last year, and she said it well:

 

Well, it's not one problem. It's about twelve problems.

 

2. It's a research & development problem. Every time an advance is made, the standard of care goes up. "Normal care" is advancing at such a rapid rate that our economy can't keep up. It's not like the computer industry, where $2000 buys you a better computer today than it did 5 years ago. It's as if computers kept getting better without getting any cheaper, and the old computers were so unsafe as to be immoral. I don't know how to solve this one without either violating basic principles of justice (a doctor should give the best care available) or quashing medical research.

 

3. It's a research & development problem, part 2: the patent system all but guarantees that medical advances are tied to profitability. This has the effect of keeping prices high and advances rapid (which is the problem of #2, above), but it also has the effect of funneling the greatest share of resources (both financial and intellectual) into a very select segment of medical science. Some people are suffering simply because there is no profit in curing them or caring for them. I don't see any solution to this one that doesn't involve the collapse of the stock market and/or the entire medical system.

 

4. It's a problem of professionalization. Rapid advancement in medicine has made people want the best care possible; that care requires training; that training costs money, and the people who get it deserve to feed their families as well as repay their student loans. All of this saves lives, but it's very, very expensive. There are some ways to mitigate this problem, like parish nursing programs, hospice care, empowering people to do more self-health-care, and a general increase in people's willingness to help each other rather than relying on a "medical" solution to social and personal problems.

 

5. It's a problem of professionalization, part 2. As with #3 above, financial considerations dominate the health care professions. Medicine is simultaneously charitable and lucrative, and in the US, only the insurance industry has any interest in controlling the costs of health care. (And their interest is in controlling health care costs so that they can maximize their own profits. So it's hardly a charitable concern there, either.) Socialized medicine controls costs by . . . well, controlling costs--price controls, government limits on salaries, that kind of thing. This tends to result in a "brain drain"--people either leave the country to practice medicine in a more lucrative environment, or they choose other, more lucrative careers. I don't know how to fix this problem without cultivating something like the standards of my profession--pastors understand that they're getting into a field that will never (or almost never) be very lucrative for them. The "charitable" part dominates their lives. Should that be true of health professionals, too? It could be. But the consequence would be a decrease in that rapid advancement and exceptional care that we've all come to expect.

 

8. It's a moral problem. We've come to expect that rapid advancement and exceptional care that I just mentioned. We would find it immoral for society to decide not to advance medical science. We suffer so little, compared to past generations, or to the third world, but we still expect all of our suffering to be healed. It's an irrational, unreasonable expectation, but our entire system is built around it. Our entire system is built on the expectation that all suffering should be eradicated, ASAP. The solution here is to make people more willing to suffer. How do you do that?!?!

 

The standard of medical care has been advancing quickly, which makes medical care more and more expensive on a large scale. However, the economy is contracting, and I think we're just seeing the beginning. If this trend continues, and we don't see economic growth at the pace we are used to, then medical care is going to become simpler of necessity. I read a memoir about a family in the Great Depression. Because cash was so scarce, they treated everything possible, including a blood infection, at home.

 

If we collectively are getting poorer (and I'm sure there are those who disagree with me on this point), and if downgrading medical care is seen as immoral, how in the world do you solve that one? Universal single payer care would only work if most people accepted that the government is broke, and could accept 1960s-style medical care from the government. But people aren't going into universal health care with that expectation. Everyone still expects top-notch medical care, and having an already near-bankrupt government provide that for everyone will just drive us to disaster even faster.

[Kim in Appalachia]

I wish the gov't had the *guts* to just redo the whole system. Overall a single payer system would be better than what is being proposed, and better than what we have right now.

 

My only problem is that the other countries that have a single payer system are still struggling to meet the cost. Plus we have the added problem of the fact that we are not those countries. This is a big country, and very diverse. Meaning one area of the country can be and is quite different from another area. The geography, types of businesses, along with the diffent cultures of different regions, make it hard to have a universal system to fit the whole country.

 

I would like to see some sort of new system in place, but I don't envy the policy makers who are trying to figure it out.

[TXMomof4]

My disagreement with the whole issue is how on earth are we going to pay for it? All of those other industrialized countries have tax rates out the wazoo. The powers that be are saying this would raise our tax rate to approx. 56%. HELLO?!?!?!! Fifty-six cents out of every dollar going to the government? Not to mention the rules about not having the option of paying for your own healthcare without another tax.

 

I don't see how we can support this financially. America is broke right now. Adding another huge burden doesn't make sense. Everyone says the first stimulus didn't work, most everyone agrees we aren't at the bottom as far as this recession goes, so lets go pass something else that will increase taxes, and lets work on this environmental bill at the same time that will increase living expenses and taxes even more, and while we're at it - let's find something else to spend money on. I think the gov. needs to take a deep breath and slow down. I feel like we're on this rollercoaster with no one having any idea how to stop it.

[theresatwist]

As much for me as for you, dear reader, I thought I'd sketch out my thoughts about health care reform.

 

(1) I am an ardent believer in free markets. However, we have what economists call an information problem when it comes to health care. I go to my doctor and she says, "We can do a [long Latinate word] for $2400 or a [longer Latinate word] for $3200." I'm a well-educated person, but I just don't have the information to choose between those. Now add another doctor to the mix who says, "I'll do the first for $2000 and the second for $3000." Is that a good deal? Or is it a rip off because his results are worse? Another information problem. And that's for someone with a sound mind and body and two advanced degrees who isn't having an emergency and who knows how to do research on the Internet! What kind of decision would my 80+ year old, half-blind, hard-of-hearing grandmother make when given those options?

 

To sum: I believe in free markets, but I also believe that free markets don't work for health care because we don't have enough information to make the kinds of decisions that functional free markets need.

 

(2) In our current system, a huge chunk of our health care spending goes to the insurance companies. It has been estimated that if we redirected that money to actual health care, we could cover everyone who isn't covered.

 

(3) Our current system stifles other free markets: it is likely that the car companies would have been fine without their health care burdens. I would never, never let my husband start his own business because we need his health care. I know people with 2 degrees working at Wal-Mart for the benefits. We are crippling other sectors of the economy by forcing people into certain jobs just because those jobs carry insurance.

 

(4) Therefore, I favor single-payer, universal care. I would like a system where a board of doctors, medical goods makers, patient advocates, and economists would set prices for all procedures. If you had that procedure done, the fed would write a check for that amount to your provider. The doc would be free to charge more and you could choose to pay that or pick a different doctor.

 

(5) People like Sara R rightly point out that this could get expensive. It could, but I believe we can reap a lot of savings via what I have outlined above. More importantly, however, what are the costs of doing nothing? Health care costs have been skyrocketing. This pushes middle-income families into bankruptcy, which is expensive to the rest of us. It pushes poor people into the ER, which you and I end up paying for. It pushes all sorts of people to live with untreated conditions that inhibit their ability to become taxpayers and instead pushes them onto disability.

 

(6) Now, to counter some arguments:

 

(a) This is no more the slippery slope to socialism (although that is fun to say--try it!) than libraries, interstate roads, the military, or colleges are. Every single industrialized nation except for the US has universal health care, many for over 50 years, and not a one has become a remake of Orwell's worst nightmare.

 

(b) It doesn't mean the fed "owns you." If anything, right now, the insurance companies "own you." I'd rather be owned by a gov't with a free press and free elections than an insurance company that makes un-appeal-able decisions behind closed doors.

 

© There will be waste and fraud. I know this. Nothing is perfect. But if designed right, there may well be less waste and fraud than we have now.

 

(d) There is only a limited moral hazard. I can get how someone might take advantage of welfare--there's a lot of fun you can have with free money! But how many people do you think will get extra appendectomies just because they are free? Medical care is always enough of a PITA that abuse will be limited.

 

(e) I'm not persuaded by complaints about rationing. We have rationing now, and it works like this: if you are lucky enough to have a job with insurance and/or wealthy enough to pay out of pocket, you get the moon. If you aren't, you don't get anything. I think it would be far more moral to have rationing that went like this: the government will provide a basic level of care to everyone and if you want more, pay for it yourself.

 

(f) I'm also not persuaded by anecdotal evidence about your cousin in Canada who died after waiting six months for something. On average, other countries spend half what we spend for similar or better outcomes.

 

This is a huge, complicated issue with many facets. (I have ideas for tort reform, too!) Thanks for reading this far--I wanted to sketch out what I've been thinking in light of recent threads around here. And I welcome reasoned and reasonable critiques.

 

:iagree::iagree::iagree:Why aren't you in Washington? This is what we need.

[Julie in Austin]

If we collectively are getting poorer (and I'm sure there are those who disagree with me on this point), and if downgrading medical care is seen as immoral, how in the world do you solve that one?

 

I have no idea if we, in the middle to long run, are getting poorer, but in any case:

 

I don't see downgrading medical care (in the sense of: what care the govt pays for) as immoral at all. I imagine universal care being a basic safety net. I've heard the British condemned for paying for correction for only one eye if you have cataracts, but that is, I think, a good model for the US: the gov't covers the basics and if you want more, you can pay for it yourself. It wouldn't be a perfect system and I definitely would not expect for it to pay for the latest and greatest. But it would cover the basics for everyone. And people would still be free to buy supplemental insurance and/or pay out of pocket for any extras that they wanted.

 

I'd also add that the current system does not avoid the problem of advances in care being more expensive. It does, however, have perverse incentives for (a small number of) doctors, big pharma, and insurance companies that keep costs high for everyone.

[Dirtroad]

Another issue.... the Single Payer is going to be the Single Provider!

 

Maybe single payer won't effect cost... but a single provider? That will skyrocket.

[Renee in NC]

Another issue.... the Single Payer is going to be the Single Provider!

 

Maybe single payer won't effect cost... but a single provider? That will skyrocket.

 

Why would that happen, though? It hasn't happened in Canada has it? Why is the assumption that if we do one we'll end up with the other?

 

The military went the other direction - they went from all military provided health care to Tricare. My dh was in the Army when the transition started, so I got some care on post and some off.

[Julie in Austin]

My disagreement with the whole issue is how on earth are we going to pay for it? All of those other industrialized countries have tax rates out the wazoo. The powers that be are saying this would raise our tax rate to approx. 56%. HELLO?!?!?!! Fifty-six cents out of every dollar going to the government? Not to mention the rules about not having the option of paying for your own healthcare without another tax.

 

I don't see how we can support this financially. America is broke right now. Adding another huge burden doesn't make sense. Everyone says the first stimulus didn't work, most everyone agrees we aren't at the bottom as far as this recession goes, so lets go pass something else that will increase taxes, and lets work on this environmental bill at the same time that will increase living expenses and taxes even more, and while we're at it - let's find something else to spend money on. I think the gov. needs to take a deep breath and slow down. I feel like we're on this rollercoaster with no one having any idea how to stop it.

 

I addressed your concerns about cost in my (2), (3), (4), and (5) in the original post.

 

Frankly, I support universal care not because I'm a bleeding heart liberal but because I am extremely concerned about health care costs for individuals, employers, and the federal government. If we don't get this beast under control, all three groups are going down with the ship. (Forgive me for mixing metaphors.) I believe that a single-payer plan done right (and I'm not convinced that the current bill being considered is done right) is our best shot at cost containment.

[Julie in Austin]

Another issue.... the Single Payer is going to be the Single Provider!

 

Maybe single payer won't effect cost... but a single provider? That will skyrocket.

 

I don't quite follow you here?

[mommyrooch]

:iagree::iagree::iagree: I really enjoyed the OP's post. :hurray:

[JWSJ]

As much for me as for you, dear reader, I thought I'd sketch out my thoughts about health care reform.

 

I enjoyed reading your points and understand your reasoning behind the majority of it.

 

However, I believe you're being too optimistic. I've worked for and with the federal government and US national health insurance companies for over 10 years. The health insurance companies are greedy, but if you have insurance, the system (for the vast majority) works.

 

The federal government is corrupt beyond belief. Corruption is part of its culture. Those in government accept it. They would love the opportunity to help with healthcare.

 

If you don't like how health insurance works now just wait until the government is more involved with it.

 

In theory, everyone will be covered, but with the side effect of the existing subscribers' insurance coverage degrading.

[Sara R]

I don't see downgrading medical care (in the sense of: what care the govt pays for) as immoral at all. I imagine universal care being a basic safety net.

 

I agree that downgrading medical care isn't immoral. The practical details are going to be hard to iron out though. "Basic care," especially in cancer care and other expensive care (transplants and so on), means that more people are going to die than do now. If things are arranged right, hopefully that number will be small, but that's not going to go over well.

 

I'd also add that the current system does not avoid the problem of advances in care being more expensive. It does, however, have perverse incentives for (a small number of) doctors, big pharma, and insurance companies that keep costs high for everyone.

 

Agree with you 100% here too. I'll also note that Medicare is an offender here, from what I've seen in our family. There's no way that Medicare will have the money to give quintuple bypass surgeries for 85 year olds by the time we're 85.

[Dirtroad]

Why would that happen, though? It hasn't happened in Canada has it? Why is the assumption that if we do one we'll end up with the other?

 

The military went the other direction - they went from all military provided health care to Tricare. My dh was in the Army when the transition started, so I got some care on post and some off.

 

I am refering to this huge, massive regulatory nightmare being proposed in the US. Everyone keeps mentioned other countries & even states... but this isn't really modeled after them. This doesn't even attack the real issues.... it seems (honestly) is more of a power grab of a huge section of our economy. England atleast allows private care for those who have the cash... we will all be forced into this fed system with no private options.

 

The doctors will be told when they can treat & how.... so, if they have their hands tied by the rules... it is a ONE PROVIDER system b/c little to no flexibility. The gov't pays & dictates.

 

May have 10 doctors... but they must conform. May get good decor in waiting room & a better bedside manner... but they will have little choice in how they treat you when the cost out weight YOUR need.

 

I am also shocked that anyone would support a medical system that lets an 85 year old die b/c the numbers/$$ don't support their living any longer.... They may still have 15 to 20 years.... I can't say that for some 50 year olds. But to deny their treatment is the same as killing them!

 

Also, Docs, Pharmacists & Drug companies have incentive to make profits (or we would have none of them to complain about)... but it is not in their best interest to keep the prices inflated by huge amounts.... business wise, that is suicidal & another company would take their place in a heartbeat!

 

And I don't hear any discussion of the money that is going to be shifted from Medicaid to this NEW program.... that means even fewer $$ around for Grandma to get help.

Edited July 20, 2009 by Dirtroad

[theresatwist]

I am refering to this huge, massive regulatory nightmare being proposed in the US. Everyone keeps mentioned other countries & even states... but this isn't really modeled after them. This doesn't even attack the real issues.... it seems (honestly) is more of a power grab of a huge section of our economy. England atleast allows private care for those who have the cash... we will all be forced into this fed system with no private options.

 

The doctors will be told when they can treat & how.... so, if they have their hands tied by the rules... it is a ONE PROVIDER system b/c little to no flexibility. The gov't pays & dictates.

 

May have 10 doctors... but they must conform. May get good decor in waiting room & a better bedside manner... but they will have little choice in how they treat you when the cost out weight YOUR need.

 

I am also shocked that anyone would support a medical system that lets an 85 year old die b/c the numbers/$$ don't support their living any longer.... They may still have 15 to 20 years.... I can't say that for some 50 year olds. But to deny their treatment is the same as killing them!

 

Also, Docs, Pharmacists & Drug companies have incentive to make profits (or we would have none of them to complain about)... but it is not in their best interest to keep the prices inflated by huge amounts.... business wise, that is suicidal & another company would take their place in a heartbeat!

 

And I don't hear any discussion of the money that is going to be shifted from Medicaid to this NEW program.... that means even fewer $$ around for Grandma to get help.

 

In the US doctors keep people alive when they know that they have no chance. We use machines to keep people breathing, etc. We a huge sum of money on these end of life procedures that, truth be told, are really more for the family than for the patient. The doctors are simply prolonging the goodbye. I'm not saying this is true in every single case, but it's true in the overwhelming majority. We need to come to terms with when it's really over. I just read a great book on this topic: Last Rights: Rescuing the End of Life from the Medical System.

[WishboneDawn]

.

 

My only problem is that the other countries that have a single payer system are still struggling to meet the cost. Plus we have the added problem of the fact that we are not those countries. This is a big country, and very diverse. Meaning one area of the country can be and is quite different from another area. The geography, types of businesses, along with the diffent cultures of different regions, make it hard to have a universal system to fit the whole country.

 

 

Just a note. Canada may be the closest example in terms of diversity and size. Here health care is actually run by the provincial governments. The provinces are accountable to the feds in terms of meeting certain expectations but they essentially run their own systems and can tailor things to meet their own needs. That might be something for the US to consider.

[WishboneDawn]

I addressed your concerns about cost in my (2), (3), (4), and (5) in the original post.

 

Frankly, I support universal care not because I'm a bleeding heart liberal but because I am extremely concerned about health care costs for individuals, employers, and the federal government. If we don't get this beast under control, all three groups are going down with the ship. (Forgive me for mixing metaphors.) I believe that a single-payer plan done right (and I'm not convinced that the current bill being considered is done right) is our best shot at cost containment.

 

I think that's a great point. The costs of the current system in the US often get swept under the table but it costs the US more then other western nations as a percentage of GDP, it stifles new business, it damages productivity, it hinders the repayment of consumer debt, etc. It may be that the US can't afford to let other western nations have the advantage of UHC over it for much longer.

[WishboneDawn]

Also, Docs, Pharmacists & Drug companies have incentive to make profits (or we would have none of them to complain about)... but it is not in their best interest to keep the prices inflated by huge amounts.... business wise, that is suicidal & another company would take their place in a heartbeat!

 

But it's a simple fact that costs ARE inflated in the US. Drug companies operate at a profit in Canada and yet they sell their products to the provincial gov'ts here much cheaper. Besides, drugs especially are not like other products. Someone else can't step in if the prices are too high because new drugs are protected by legislation.

[My3Boys]

I agree that downgrading medical care isn't immoral. The practical details are going to be hard to iron out though. "Basic care," especially in cancer care and other expensive care (transplants and so on), means that more people are going to die than do now. If things are arranged right, hopefully that number will be small, but that's not going to go over well.

 

 

 

Agree with you 100% here too. I'll also note that Medicare is an offender here, from what I've seen in our family. There's no way that Medicare will have the money to give quintuple bypass surgeries for 85 year olds by the time we're 85.

 

Wow. I'm sorry, but I find this attitude frightening.

 

I wonder, if that cancer patient that died was your child or the 85 yo who was denied the surgery your parent or grandparent, would you feel the same way?

[Karen sn]

Any time I have really needed help I have gone to an alternative doctor.

It was more affordable, I received excellent care, and I was healed.

My children go alternative as well.

Should we ever need Western medicine.....I don't know that we could go.

 

I agree whole heartedly with you on the insurance companies.

They rule the world and I am disgusted by them.

 

If the US government would quit taxing us to death, I think more of us could afford to pay for the basic medical care that we need.

Obviously not including the exorbant price of chemotherapy or long hospital stays.

But your basic prevention and maintenance could be paid out of pocket if we could quit being taxed to death.

[Mama Bear]

...would you feel the same way?

 

Jumping in to say: I think she was commenting on the realities of such a system rather than endorsing them as her own.

 

Interestingly, there are those who think quite the opposite would happen because so many simply don't seek care now -- they can't afford it. Perhaps such a system would suggest something like carrying individual catastrophic care policies ($10mil limit per person) while simultaneously making sure that benign ovarian cysts that can eventually kill someone would actually get removed, or that a parent who sees something alarming in their child wouldn't wait to go in until they're in crisis.

[Catherine]

For anyone who is interested, there was a recent article in the NYT Sunday magazine on rationing. I couldn't agree with all of it, but it addressed at length one topic you touched on Julie. It's absolutely true that rationing happens now, every day.

 

To the poster who suggested that Americans are basically satisfied with their insurance, if they have it, I strongly disagree. Satisfaction studies show only 40-60 % satisfaction, compared to nations with single payer systems, where, despite the single cataract repair, much higher proportions of patients are satisfied. And although it's anecdotal, I think just talking to ANYONE in the USA betrays this assumption.

 

I would also encourage ANYONE who is interested in this topic to read Atul Gawande's New Yorker article on the Texas county that has the highest per capita Medicare costs in the country. It *doesn't* reflect well on my peers (I'm a doc) at all-these people were unbelievable rapacious in their overzealous testing and procedures (and these are procedures that carry considerable risk). Yikes. But it is a good illustration of how allowing a doctor's judgement, when the doc is paid directly for every single test and procedure, can lead to a costly, unethical and potentially harmful situation. What is also concerning about such a situation is that it becomes a feature of the local medical culture, and patients will start to believe they *need* a cardiac cath every time they have chest pain, because everyone they know was handled that way.

[Mama Bear]

Another issue.... the Single Payer is going to be the Single Provider!

 

Maybe single payer won't effect cost... but a single provider? That will skyrocket.

 

Respectfully, I don't think anyone is looking at a single provider system. Medicare/medicaid surely aren't that. Could you clarify?

[Margaret in GA]

"My disagreement with the whole issue is how on earth are we going to pay for it? All of those other industrialized countries have tax rates out the wazoo. The powers that be are saying this would raise our tax rate to approx. 56%. HELLO?!?!?!! Fifty-six cents out of every dollar going to the government? Not to mention the rules about not having the option of paying for your own healthcare without another tax. "

 

 

All I can say is that I'd be surprised if they tax me more than I pay already for our insurance. We pay probably 18K a year for medicine. And they can cancel me any time. I have no protection whatsoever from these guys if they decide they don't want to pay for something. Nevermind that I've given them thousands and thousands of dollars "just in case" for many years. They'll drop me like a hot potato first chance they get.

 

How many people have a fantastic business plan but cannot leave their jobs because of insurance? How many guys would like to free lance and have flexibility in their careers while spending more time with family but cannot because of insurance? How many mothers have to leave their children in childcare so that they can continue to have their family covered by work insurance because of some pre-existing condition? It's entirely silly.

 

I've said it before on this board, but it bears repeating. We have been so whipped into a state of fear of the unknown when it is the current system we should be afraid of.

Margaret

[Mama Bear]

Medicare currently shows 4% of costs going to admin., whereas private for profit insurance shows 20%. These statistics are alarming, but they don't even begin to tell the whole story -- or even ask the right questions.

 

What about those who don't fit into the citable stats? What about the fact that some sort of restructure *has* to answer appropriate reimbursement for providers? We seriously cannot continue to lose good primary care providers as they go into other fields just so they can meet their office overhead -- because their staff of five billing specialists in a two doc, two PA office can barely keep up the ongoing argument with the insurance companies.

 

There's much to question and very little solid, calm, factually based information to be readily had. I've found particularly enlightening reading about experiences of those in countries other than the US. Thanks, Julie, for initiating this part of the conversation. Very nicely said.

[brehon]

Wow. I'm sorry, but I find this attitude frightening.

 

I wonder, if that cancer patient that died was your child or the 85 yo who was denied the surgery your parent or grandparent, would you feel the same way?

 

I don't think it's a matter of feeling one way or another. It's simply recognizing that health care is expensive whether the gov't provides some form of universal health care/insurance, private insurance companies provide insurance, one bears the full cost oneself, or any combination of the above. I didn't read her post as advocating that position; just recognizing that something will have to give at some point. And that something (or, more precisely, one of those somethings) will need to be the expectation that we (Americans) have for top-notch medical care for all medical conditions basically on demand. Our country simply does not now and won't for the foreseeable future have that kind of money.

 

I was glad that a PP linked PariSarah's post from a year ago. I knew I remembered she wrote something about healthcare, but couldn't find it. There simply isn't one reason for the healthcare crisis and there won't be one solution that fixes everything.

 

Dawn, so the Canadian federal gov't provides the provinces a certain amount of money per year and they are free to run provincial health care as they see fit, within certain (hopefully well-defined) criteria and expectations? Is this right? This is entirely different from what is being currently proposed in the US. The House bill reads like the federal gov't will oversee and run the program at a federal (not state) level.

 

This is one of the main reasons why certain of us are against this bill. We've seen how "well" our federal gov't currently runs Medicare and the VA (for instance) and we're simply not convinced that this same entity can run health care/insurance for the entire country. Not to mention the "small" fact that running health care/insurance is not a power explicitly given to the federal gov't. Under our Constitution, it is by default delegated to the states. This is specifically spelled out in Article 10 of the Constitution.

 

There's no doubt that the current system needs radical overhauling. I don't think a mandatory (explicitly or implicitly - when private companies are priced out of the market because of the guarantee of the federal gov't) universal health care system or universal health insurance system is the answer. Personally, I'd like to see the complete decoupling of insurance from employment and a concomittant rise of private insurance companies set up kind of like the auto insurance industry. That way an individual can decide how much coverage he wants and how much he wants to pay. Of course, the big problem with that solution is that having auto insurance is mandatory (at least in TX) and punishable by fines, losing your license, etc and I'm generally anti-gov't dictating my life to me. As I say, there's no easy or simple answer.

[bairnmama]

(3) Our current system stifles other free markets: it is likely that the car companies would have been fine without their health care burdens. I would never, never let my husband start his own business because we need his health care. I know people with 2 degrees working at Wal-Mart for the benefits. We are crippling other sectors of the economy by forcing people into certain jobs just because those jobs carry insurance.

 

 

 

I certainly agree that the cost of healthcare is a heavy burden on businesses today and can be crippling... but the plan proposed by the House does nothing to lift that burden, and actually might make it worse.

 

Section 312.b.1.A states that the minimum employer contribution for the health benefits of full-time employees is

in case of individual coverage, not less than 72.5 percent of the applicable premium... of the lowest cost plan offered by the employer that is a qualified health benefits plan,

.

 

Section 312.b.1.B continues this:

in case of family coverage which includes coverage of such spouse and children, not less than 65 percent of such applicable premium of such lowest cost plan.

 

So... what if an employee decides to opt out of the employer plan and go with another Health Insurance Exchange plan? Does that save the employer any money? NO!

 

Section 311.3 states that

if an employee declines [employer's offer of coverage] but otherwise obtains coverage in an Exchange-participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependant...), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee...

 

But what about small business you ask? In order to be considered a small business, a company has to spend less than $400K annually in all payroll for all employees in order to get any break. Another section on special rules for small business details that

related employers and predecessors shall be treated as a single employer for purposes of this subsection. Sec 313.b.4

 

Other sections make the distinction of small businesses as those that have 20 or fewer employees... all others seem to have to play by the same rules as much larger companies.

 

Do employers have to provide insurance to their employees? No... but if they choose not to then according to Section 412.c.1

In addition to other taxes, there is hereby imposed on every nonelecting employer an excise tax, with respect to having individuals in his employ, equal to 8 percent of the wages (as defined in...) paid by him with respect to employment (as defined in...).

Again, to be considered a small employer for this part, total payroll has to be less than $400K per year for reduced taxes, and less than $250K per year to avoid paying an excise tax. A business only needs 14 employees making around $30K per year to not be considered a small business!

 

And it keeps going... I can't find the exact section right now, but the bill states that reduction in salaries cannot be used to pay for health benefits. Where's the money going to come from? From the consumer of whatever product or service the employer offers, of course! Certainly not the company's profits. So we may then be able to afford health coverage, but be struggling with trying to provide food, electricity, clothing, etc. How is that better?

[Sara R]

Wow. I'm sorry, but I find this attitude frightening.

 

I wonder, if that cancer patient that died was your child or the 85 yo who was denied the surgery your parent or grandparent, would you feel the same way?

 

Thanks brehon; you're right--it's not a matter of how I feel. I dearly love my husband's grandmother who had the quintuple bypass at age 85. She's still around 1 1/2 years after her surgery, and she still ties dh's family together. I love to visit and learn from her.

 

I don't know if Medicare paid for the surgery; I assume they paid for a good part of it. I personally glad Grandma had the surgery, but in the big picture, that kind of government expense is unsustainable.

 

You've probably read about the Social Security crisis coming our way (previously scheduled for 2017; now even earlier since the recession is lowering Social Security taxes and increasing distributions). You've probably heard that there's no way that we will be drawing on Social Security. The baby boomer population is large and the succeeding generations are too small to continue to support Social Security.

 

Medicare is seven times the problem as Social Security, financially speaking. The costs go up several times the rate of inflation each year. (I imagine that part of the reason is heroic health care like Grandma received.) There is just no way the country will be able to afford that level of care by the time we are that age, whether (as brehon said) the costs are borne by a public system, private health insurance, or pay-as-you-go by the individual and family.

 

Our country was already at the brink of disaster just because of Social Security and Medicare. (David Walker, former head of the GAO, explained it on 60 minutes a couple of years ago.) Then the government irresponsibly added a trillion or so of bailouts on top of that, with money that we have to borrow from the Chinese and have no hope of honestly repaying. Now the government is looking at adding another entitlement onto the ones that we already can't afford? While at the same time increasing everyone's energy costs if cap and trade passes, leaving much less money for other areas of the economy? While unemployment keeps rising, and it's unclear where the job recovery, because manufacturing is all overseas now? It's just insane.

 

Readjusting health care expectations is going to be painful, no doubt about it. Back 50 years ago, if someone got sick and died of something doctors couldn't cure, they accepted it. Now, over the next generation or two, as we get to the point where we can't afford super expensive chemo and radiation, transplants, neonatal care for super-premies, and so on, people are going to blame those sicknesses and deaths on someone.

 

All lives are worthwhile and precious. But the simple truth, that modern medicine doesn't quite accept, is that the mortality rate is still 100%. I've had to contemplate what death would be like at my age, and I'm very glad (and my children are glad) that my time is not yet up, knock on wood. At the time I was going through cancer treatment, I sometimes found myself irrationally jealous of the elderly, who had had the chance for a full life, and impatient with their complaints about their health. If I get to live to see my kids all the way to adulthood, I will count myself blessed.

Edited July 21, 2009 by Sara R

[farmmom4him]

As a family who DOES NOT use any of the government assistence programs, I have to say that if the government get further involved in our helathcare we are going to have huge issues.

 

My husband farms. We DO NOT use any of the farm assistance programs that are available. WE do qualify, but seeing farmer X who is making over a 6 digit income use them abuse them and still whine, really makes us balk all the more away from them. Farmer x has brand new equipment, cars, house and all. My dh still funs our small farm with cabless tractors (1952-1975) :D and we are proud of that fact. Farmer X by the time he takes out all his deductions for his new equipment has his kids on state funded healthcare. We pay for our health insurace out of our pocket every month. Honestly for the most part those programs are not helping the small farmer that they were designed to help. They are helping the mass producers and us little guys are suffereing.

 

Seeing as how that has gone, if the government gets involved in our healthcare, we are going to be one sick nation. A better approach would be to get rid of the foods that are causing a ton of health problems. Make it illegal to use certain harmful ingredients (high fruittose corn syrup, msg, etc).

 

More education on natural remedies would be helpful. Many prescriptions end up causing one to need another prescription to offset a side effect of the orginal prescription. :glare: How many dr appts do you suppose it took to get those prescriptions? Many back surgeries could be prevented if they would see a chiropractor... actually consitpation, ear infections, allergies, asthma, many pregnancy issues. and so forth. I can give more information on the above.

 

Don't even get me started on forced vacinations. There is nothing good coming from immunizing your child. Yeah, they may not get the illness that was immunized for, but what other things did that immunization cause? Autism, aspergers, SID, asthma, adhd, neurotransmitter issues etc.

 

 

If you think the government directed healthcare is going to be a good thing, why are you homeschooling? Do you agree with everything that is going on in public schools? They are directing the public school. Just saying...

 

I think there is a place for government regulation, but I don't think it is for them to take over. I believe they could make some changes along the lines, of what our insurance companies do.. The provider can only charge $30 for an xray, rather then $300. Yes, my ds broke his leg. The unadjusted bill was $328 for the x-rays. Our insurance changed it and it was $30. Right there is how the government could help. Set charges across the board. period. Why is it, I can go to the dr here and only be charge $30 for an office visit, but in our nearby town it is $65? The dr here even gives out samples of what he would prescribe. Why is it that pharmacy A charges $147 for a 10 day supply of prevacid, but Pharmacy B charges $128 same dosage, and all?

 

I can see the government limiting the amount of allowable charges, rather then getting involved in the all in all...

[OHGrandma]

If you think the government directed healthcare is going to be a good thing, why are you homeschooling? Do you agree with everything that is going on in public schools? They are directing the public school. Just saying...

 

I think there is a place for government regulation, but I don't think it is for them to take over. I believe they could make some changes along the lines, of what our insurance companies do.. The provider can only charge $30 for an xray, rather then $300. Yes, my ds broke his leg. The unadjusted bill was $328 for the x-rays. Our insurance changed it and it was $30. Right there is how the government could help. Set charges across the board. period. Why is it, I can go to the dr here and only be charge $30 for an office visit, but in our nearby town it is $65? The dr here even gives out samples of what he would prescribe. Why is it that pharmacy A charges $147 for a 10 day supply of prevacid, but Pharmacy B charges $128 same dosage, and all?

 

I can see the government limiting the amount of allowable charges, rather then getting involved in the all in all...

 

I've been thinking about how many people on this board want the gov't to run health care. Many people have varying philosophies about homeschooling but a common link seems to be the conviction that a parent can educate their own child better than the gov't run schools.

[stripe]

I've been thinking about how many people on this board want the gov't to run health care. Many people have varying philosophies about homeschooling but a common link seems to be the conviction that a parent can educate their own child better than the gov't run schools.

Do you really see a connection?

 

I call a plumber to put in new pipes and a mechanic when the car breaks, although I am sure some people could do it themselves. But I could not have performed my daughter's eye surgery, given my son stitches, or filled my own cavities -- nor do I have a license to prescribe my family medicine. These require a specialist. Therefore, I need to take my family members to a doctor when we become ill.

 

Having the government guarantee that all citizens have access to some basic healthcare so they don't DIE is a noble goal, as far as I am concerned. Just like public schooling -- I'm not required to send my kids to a public school, but I would be uncomfortable in a society that provided NO WAY for people who could not do-it-themselves to educate their children. I have relatives who are only marginally literate, and they have children who have graduated from college. I am not certain this couldn't have happened without public schools.

 

I find the angry "pay for healthcare yourself, you lazy lout" threads to be offensive. Medical costs are simply prohibitive in this country. I have been in another country where it is possible to pay for one's own healthcare. Health insurance costs are rising at ridiculous rates, and most of us are suffering.

 

I refuse to believe that the current medical insurance scheme is great, given that the #1 cause of bankruptcies is due to medical costs, and those people have insurance, and that millions of Americans are uninsured.

 

Something needs to change.

[OHGrandma]

Do you really see a connection?

 

I call a plumber to put in new pipes and a mechanic when the car breaks, although I am sure some people could do it themselves. But I could not have performed my daughter's eye surgery, given my son stitches, or filled my own cavities -- nor do I have a license to prescribe my family medicine. These require a specialist. Therefore, I need to take my family members to a doctor when we become ill.

....

I refuse to believe that the current medical insurance scheme is great, given that the #1 cause of bankruptcies is due to medical costs, and those people have insurance, and that millions of Americans are uninsured.

 

Something needs to change.

I don't call the gov't when I need a plumber or mechanic or doctor.

A quick google search showed an article at http://www.msnbc.msn.com/id/6895896/ that said in part

Illness and medical bills were cited as the cause, at least in part, for 46.2 percent of the personal bankruptcies in the study. Himmelstein said the figure rose to 54.5 percent when three other factors were counted as medical-related triggers for bankruptcies: births, deaths and pathological gambling addiction.

While it would be accurate using those figures to say the #1 cause of bankruptcies is medical costs, it's not an overwhelming majority of the causes.

[NoPlaceLikeHome]

By OHGrandma I don't call the gov't when I need a plumber or mechanic or doctor.

 

 

It is sad to see so much goverment bashing. Our goverment is our fellow Americans and does get it right some of the time. Our military, police, fire-fighters are shining examples of our goverment getting it right. I know that I have 3 close family members who work for the goverment and they care and work very hard.

 

Of course, our goverment is not perfect and I can think of many shenanigans in goverment that make me crazy. However, I also think that there are many hard working Americans who make up our goverment.:patriot:

 

On the flip side, private industry has shown itself to be capable of corruption, greed, and the like. I can also testify there are many examples in my own family of hard working, honest business men as well. I do think that business needs appropriate oversight though.

 

I am most definately in favor of universal public healthcare since the private health insurance companies only care about the bottom line and excess profits and not the health care consumer.

 

Just my 2 cents:)

[Alice]

I would also encourage ANYONE who is interested in this topic to read Atul Gawande's New Yorker article on the Texas county that has the highest per capita Medicare costs in the country. It *doesn't* reflect well on my peers (I'm a doc) at all-these people were unbelievable rapacious in their overzealous testing and procedures (and these are procedures that carry considerable risk). Yikes. But it is a good illustration of how allowing a doctor's judgement, when the doc is paid directly for every single test and procedure, can lead to a costly, unethical and potentially harmful situation. What is also concerning about such a situation is that it becomes a feature of the local medical culture, and patients will start to believe they *need* a cardiac cath every time they have chest pain, because everyone they know was handled that way.

 

This article was really interesting and as a physician, convicting. I think it highlights yet another problem in our health care system...that we are paid for DOING and not for THINKING. For example, if I take a splinter out of a kid's foot I can charge $120 (removal of foreign body). Insurance will typically pay that. I agree that the idea of charging $120 for removal of a splinter is ridiculous (Although I kind of think that if you bring your kid to the doctor to have their splinter taken out you kind of deserve to be overcharged. Just kidding. Sort of. ;)). But if I do a one hour consult on a child who is having developmental delay and behavior problems and during that hour discuss my concerns that the child has autism and exactly what autism is and what the next steps are....we charge about $180 but only would get paid a small percentage of this by an insurance company.

 

The point is that the whole system is skewed to doing more procedures, to ordering more tests, etc. To seeing more patients quickly as you aren't getting paid for the time spent if you take more time with those patients. The system is partly skewed this way by the current government payers...the amount that Medicare/Medicaid pays is generally used as a starting off point for the insurance companies who might agree in their contract to pay 120% of Medicaid, for example. In addition, Medicaid/Medicare really introduced the whole concept of "coding" which is how we bill and get paid now. Everything is assigned a numerical code which determines how much we can get paid. A whole industry has grown up around coding and doing it in such a way that you get paid the maximum possible. I'd love to somehow cut out the billing department, the coders, the insurance companies, etc. but it's virtually impossible in today's world.

 

Something else slightly off topic but that was brought up earlier in this thread and the other giant health care thread...why does a doctor bill $350 insurance only pays $30? And if you are self-pay you pay the whole $350. It seems completely unfair. And in many ways it is. We all have to contract with the insurance companies in order to be able to see their patients. So you buy insurance from Super Company and then they contract with us to have us be one of their providers. When we do that contract we get patients but we also have to agree to not charge their customers more than what Super Company pays. Super Company then pays on some scale (using the codes mentioned above and usually as a percentage of Medicaid reimbursement). We might not like getting that small amount but we have agreed to accept it in return for getting the patients of that company. As part of insurance law we cannot charge people different amounts based on what insurance they have. This means that legally I am not supposed to charge a self-pay person less than what someone with insurance has. What we often do is "charge" them the same and then say we are willing to write off a certain percentage of their bill. It amounts to the same thing but is technically ok, at least I think. I'm not a legal expert or a billing expert by any stretch of the imagination.

 

One big concern I have with the current bill is it seems way too complex. I started reading it and it just made my head hurt. Or maybe that was the 2 yr old screaming while I was trying to read it. :) I'm trying to go back and read it but it's just crazy complex. I'm not sure it really addresses fundamental issues and instead is a band-aid on the problem. And a really expensive band-aid at that.

Edited July 21, 2009 by Alice

[astrid]

As much for me as for you, dear reader, I thought I'd sketch out my thoughts about health care reform.

 

 

 

And I welcome reasoned and reasonable critiques.

:thumbup::cheers2::iagree::hurray::iagree::thumbup1::iagree:

[rlowetx]

Our problem is that it is NOT a free market system. I feel like Dr's are the only ones who for some reason we don't feel like we have to pay.. if I go to a lawyer or accountant, I pay them for their services.. if I go to a mechanic, I pay them to fix my car. But we feel that if we have to pay more that $30 for a co-pay for seeing a highly trained specialist, that there is a problem.. isn't insurance supposed to help reduce risk? I know I'm minimizing the issue, but I think a free market WOULD work...we don't have that.. b/c of insurance (not really acting like insurance - acting like price caps or prepayment plans), we don't shop around.. we don't pay differently for a splinter or stitches versus an EKG.. and shouldn't we? I go see our pediatrician and pay the same whether he sees me at all (the nurse gives the vaccine) or we have a 45 min consultation.. where's the free market? How is the doctor getting paid appropriately BY ME for the services they rendered? They aren't.. they code something to the insurance company (that represents 1 in 100 items on their list of items) and bill it to the insurance company who doesn't know me or my son or our needs....

I think free markets would work if insurance worked like auto-insurance or home insurance.. I pay a premium to help reduce the risk of me getting hit by a whopper (major car crash, house fire).. other than that I have to pay to keep my car and house maintained so it lasts me for a long time..and to do those things I shop around and get the best price and the best service (sometimes I pay more b/c I want better service...). Just my opinion, which no one has.. I just don't understand why the health insurance has grabbed control of our "free market" medical system...right now instead of the government in control, or you / I in control (free market), the insurance companies are in control.

[bairnmama]

Do you really see a connection?

 

 

Having the government guarantee that all citizens have access to some basic healthcare so they don't DIE is a noble goal, as far as I am concerned. Just like public schooling -- I'm not required to send my kids to a public school, but I would be uncomfortable in a society that provided NO WAY for people who could not do-it-themselves to educate their children. I have relatives who are only marginally literate, and they have children who have graduated from college. I am not certain this couldn't have happened without public schools.

 

I find the angry "pay for healthcare yourself, you lazy lout" threads to be offensive. Medical costs are simply prohibitive in this country. I have been in another country where it is possible to pay for one's own healthcare. Health insurance costs are rising at ridiculous rates, and most of us are suffering.

 

Something needs to change.

 

For the most part, :iagree:.

 

However, what I am concerned with at this point is this particular bill that congress wants to vote on so quickly! Guaranteeing that all citizens have access to some basic healthcare is a far cry from requiring that all citizens havethe exact same basic healthcare, as determined by a newly appointed commissioner, or else be subject to penalty taxes.

 

Why not prohibit outrageous malpractice lawsuits that drive up the cost of proceedures and increase unnecessary tests out of fear of being sued?

 

Why not institute welfare reform first in order to pay for health insurance credits that help people who cannot pay for their own private insurance instead of requiring businesses, many of whom are struggling and can't afford to pay for coverage for their employees as it stands now, to foot a large part of the bill? (Welfare abuse is staggering and costing the taxpayers untold number of dollars. Yes, many people need help to get back on their feet... but there should not be an incentive to decide not to go to work in order to receive "free" health care, rent, schooling, etc. And, btw, my knowledge of this comes from many the many people I know who work in the local social services and health department offices and are disgusted that their hands are tied.)

 

Why not open up large group plans to individuals sharing a common bond (like credit union membership or alumni status) for discounts on premiums and better bargaining power instead of limiting them to large corporations?

 

Why not encourage natural healing principles and prevention instead of the latest patented pill that will require more pills to combat the side effects?

 

Yes, something needs to change.... but changing for something worse simply because a change is needed is downright illogical!

 

*See my other posts on this topic to see actual quotes from this bill that illustrate why I feel this particular bill would be worse.

[Gretchen in NJ]

(f) I'm also not persuaded by anecdotal evidence about your cousin in Canada who died after waiting six months for something. On average, other countries spend half what we spend for similar or better outcomes.

This is a completely false statement since the statistics show that we have a higher cancer survival rate here in the USA over Canada.

 

• For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.

• For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

How about Natasha Richardson?

 

Quote:

Why had it taken nearly six hours for the patient to arrive at a facility capable of treating her critical needs?

 

Witnesses agree that Richardson herself repeatedly declined to be taken to a hospital. But once it became obvious that her condition required it, Quebec's antiquated medical evacuation system played a part: the region has no helicopters to move patients from the field to hospitals in Montreal – a situation that has already stirred controversy in the wake of Richardson’s death.

 

"Our system isn't set up for traumas and doesn't match what's available in other Canadian cities, let alone in the States," Tarek Razek, director of trauma services for the McGill University Health Centre in Montreal, which represents six of the city’s hospitals....

End Quote.

 

No medical helicopters in all of Quebec? How many other trauma patients have died because they were unable to medi-vac them to a trauma center? A trauma center which is not as good as what we have here in the USA. "let alone in the states," is a key phrase.

 

Canada must be keeping cost down by not having medical helicopters and fewer and not as good as USA trauma centers. How do you calculate how many patients have died or have been permanently injured due to these cost cutting measures? You can't, so people look to anecdotal evidence like Natasha Richerson and cancer statistics.

 

Could you please tell me which countries spend 1/2 of what we spend for similar or better outcomes? Also, how much more do they pay in taxes on average?