Creativity Challenge: How can we reduce health care costs in America?

[Mama Geek]

That is great that you had the money but there are many, many people who are living paycheck to paycheck and who are one disaster away from homelessness:(.

 

My share of cost would have been much lower had my dh and I handled our money differently. We had too much in assets to qualify for medicaid. We worked hard to get where we are and have taken significant risks, and made a lot of sacrifices to get to where we are. I didn't just go out to the money tree in the back yard to get it.:001_smile:

[Mrs Mungo]

If the corn syrup biz gets dulled we won't be able to get as many people on pharm meds. We all know eating sugar/corn syrup leads to poor health from horrible nutrition. Why do we still eat it? It's a cheap high. The US has addictive behavior that isn't shunned enough. A few movies about the government and pharm/farming. I will be having the Coca Cola van spying on me soon for outing this outrageous info!

http://www.foodincmovie.com/

http://www.thefutureoffood.com/

 

I drink soda and I've watched those movies. And again, I wouldn't mind a soda tax. Maybe I'm the exception? :P

 

I am not military, but having lived in the Norfolk area, I have know several people who are. (That mostly means my info is second hand.) Most of them have the opinion that military health care is not nearly as good of quality as civilian. We have an uncle who waited months for a surgery at a VA hospital only to then have it botched up. His condition was and still is life threatening and they have not handled it well at all.

 

One, the military system and the VA system are not the same thing. VA hospitals have a totally different operating budget. That's a different debate. I'm specifically talking about the insurance options we have.

 

1. We can choose Tricare Prime. You choose a network Primary Care Provider. This *can be* the military treatment facility near your location, but it doesn't have to be. My kids had a civilian pediatrician as their PCM at Fort Bragg. I paid *no* fees of any kind for them to see their PCM. My son was referred to a specialist, we chose one in network and therefore paid no fees of any kind to see him. If one chooses to see a doctor without a referral or one outside of the network, then you would pay fees for that, insurance would pay part of the bill, but not all of it.

 

2. We can choose Tricare Standard/Extra. You can see network or non-network providers. You pay 15% of the cost for network providers and 20% for non-network providers. You don't need a PCM, you don't need to go to the MTF, you don't need referrals. There are negotiated rates and allowable charges.

Edited November 6, 2010 by Mrs Mungo

[Mama Geek]

I drink soda and I've watched those movies. And again, I wouldn't mind a soda tax.

 

 

 

One, the military system and the VA system are not the same thing. VA hospitals have a totally different operating budget. That's a different debate. I'm specifically talking about the insurance options we have.

 

1. We can choose Tricare Prime. You choose a network Primary Care Provider. This *can be* the military treatment facility near your location, but it doesn't have to be. My kids had a civilian pediatrician as their PCM at Fort Bragg. I paid *no* fees of any kind for them to see their PCM. My son was referred to a specialist, we chose one in network and therefore paid no fees of any kind to see him. If one chooses to see a doctor without a referral or one outside of the network, then you would pay fees for that, insurance would pay part of the bill, but not all of it.

 

2. We can choose Tricare Standard/Extra. You can see network or non-network providers. You pay 15% of the cost for network providers and 20% for non-network providers. You don't need a PCM, you don't need to go to the MTF, you don't need referrals. There are negotiated rates and allowable charges.

 

I was trying to use to different examples. The friends we have known were and are active duty. I wasn't familiar enough with the VA to realize that it wasn't part of the same system.:001_smile:

[Mrs Mungo]

I was trying to use to different examples. The friends we have known were and are active duty.

 

But, what I'm saying is, if they were being seen at a MTF, it was by their choice. With Tricare you can choose to see a civilian doctor. That's my point. I'm talking about government-paid insurance, not socialized medicine. The MTFs and the VA are socialized medicine, while Tricare and Medicare are not, they are government-paid insurance. It is exactly the difference between socialized medicine and single-payer insurance. Do you see what I mean?

 

I wasn't familiar enough with the VA to realize that it wasn't part of the same system.:001_smile:

No problem. :) Edited November 6, 2010 by Mrs Mungo

[NoPlaceLikeHome]

My share of cost would have been much lower had my dh and I handled our money differently. We had too much in assets to qualify for medicaid. We worked hard to get where we are and have taken significant risks, and made a lot of sacrifices to get to where we are. I didn't just go out to the money tree in the back yard to get it.:001_smile:

 

:iagree: However, there are many people living paycheck to paycheck who also work hard and sacrifice as well. Yet these same people do not have any extra money to spare.I realize that there are those who make mistakes and are not careful with money to say the least (which does irritate me) but are they to be told too bad if they cannot afford healthcare due to their carelessness? People are turned down for medical care already due to a lack of money in this country.:( Of course, there should be checks in place to prevent abuses but there already are. I would be in favor of any needed strengthening of checks to prevent abuses but I still contend that there a lot of people who do not abuse the system and are barely scraping by IMHO.

 

One last thought: As humans we all make mistakes and I think it is better to have grace and help people in need which I think Medicare for all can do:)

Edited November 6, 2010 by priscilla

[Meriwether]

I've heard some concerning stories about Canada's system as well. I've heard more bad stories about England's. I think the question is how well it is funded. France has a very good, well-funded system. When it matters to citizens, it gets paid for, I guess.

 

I cannot stress how pleased we were with the care we got in France, and how inexpensive it was: $30-$40 to see a doctor, $8 for a blood test, less than $10 to have a nurse come to our apartment and remove ds's stitches. The clinics and hospitals do not look like the Ritz Carlton, but the staff was well-trained and the equipment good. To see a doctor, you may indeed enter through a door to his garage and go down a flight of stairs into a room in his basement, or go into a small waiting room off the doctor's office, which is a fairly large room attached to her apartment. But nobody seems to mind. It's the care we're going for, after all. Isn't it?

 

I'm sure you were please the the inexpensive care, but that service cost somebody. Less than $10 for a nurse to come to you? If that took anywhere close to an hour of her day, it could not be enough to pay her a living wage. Governments don't have money of their own. Somebody is paying for it.

[NoPlaceLikeHome]

I'm sure you were please the the inexpensive care, but that service cost somebody. Less than $10 for a nurse to come to you? If that took anywhere close to an hour of her day, it could not be enough to pay her a living wage. Governments don't have money of their own. Somebody is paying for it.

 

Yes but we already are paying for it to the tune of millions and millions of dollars IMHO. I think it would be more cost effective to have Medicare for all:).

[Mrs Mungo]

I'm sure you were please the the inexpensive care, but that service cost somebody. Less than $10 for a nurse to come to you? If that took anywhere close to an hour of her day, it could not be enough to pay her a living wage. Governments don't have money of their own. Somebody is paying for it.

 

Of course! That's not the debate. France does not have socialized medicine though, if that's what you're trying to argue.

 

Yes but we already are paying for it to the tune of millions and millions of dollars IMHO. I think it would be more cost effective to have Medicare for all:).

 

:iagree:

 

Here is an article on the French system for informational purposes from Businessweek:

http://www.businessweek.com/magazine/content/07_28/b4042070.htm

[Kim in Appalachia]

you either have to have a completely private system, no government programs at all, or have a single payer system, where only the government had control. The in between that we have now costs a lot, and causes discrepancy in care.

 

The cost of paperwork managing the different systems is a hidden cost of health care. We pay a lot to keep all of those different business in the black and pay even more for government bureaucracy.

 

My personal vote is for a single payer system, but that would be hard to implement with our country's legal structure. I also think people should have to be responsible for some portion of the care, like co-pays, that could be assessed on their lifestyle choices, IE smoker, heavy drinker/drugs, obesity, etc... Without personal responsibility there is no way to control costs.

 

There is a lot of health care cost tied up to extreme care and there is no easy way to deal with that. Other countries that have universal health care do not have our large or socially diverse (in values ) population. We have lots of babies born to teen age drug addicts here, and the cost of care for the infants is high. These girls would not take the birth control, even if it was free, and they don't get prenatal care, even though it is free here. There is no legal way to force a young girl off drugs and to receive care, so large amounts are spent on her drug addicted preemie.

 

There is also the issue of the elderly. We do way to many expensive procedures on those who should not have it (or even want it), but family members insist on using every means up to the very end. That's expensive.

 

There are more issues, but there is a lot of wasted money in our health care system. Unfortunately, the size of our government and overall population makes it hard to have universal health care. Our government (and I am NOT referring to any one party or current admin.) seems to make a mess out of most things. I think that's the main reason universal health care can't get past. No one trusts the government to do it well. But the current system is quickly falling a part.

[Kim in Appalachia]

Medicare/Medicaid has rampant abuse...if we had one agency (20 people would be enough) to sit and double check the largest abuses, you could save billions...stop those raping the system...

 

Tort reform...malpractice costs for physicians is outrageous not to mention for hospitals...limit the amount lawsuits can sue...there are billions going out every year...malicious malpractice is not common, but people are human, people with multiple disease conditions take to suing when it was the same physicians who prolonged their life 5-10 years....there's always a funds thirsty attorney to lead them into a malpractice suit....

 

those would be my first two starts.

 

While I'm sure there is some abuse with Medicare/Medicaid, it's no more than the abuse of funds in other large programs. Much of what is claimed to be abuse is just incorrect coding. There is abuse, but not enough to make that large of a difference.

 

And while there does need to be some tort reform the biggest reason Malpractice insurance has gone up is because the stock market has not. When the companies make less on investments they charge more. I have seen some frivolous suits, those are usually small so that they settle quickly. The threat of lawsuits is what makes docs order unnecessary tests, not the actual lawsuits. I wonder how such issues are handled in other countries? That would be interesting to compare. Another food for thought is that the insurance companies rake in big money, they don't want the threat of lawsuits gone either. They want to be needed.

[Meriwether]

Of course! That's not the debate. France does not have socialized medicine though, if that's what you're trying to argue.

 

 

 

 

 

Here is an article on the French system for informational purposes from Businessweek:

http://www.businessweek.com/magazine/content/07_28/b4042070.htm

 

 

Nope. I'm trying to agrue that "nothing is free." I read your article. There were a couple of things that struck me. This is one:

 

In 1990, 7% of health-care expenditures were financed out of general revenue taxes, and the rest came from mandatory payroll taxes. By 2003, the general revenue figure had grown to 40%, and it's still not enough.

 

 

My Dh has insurance through his work. I recently took three of my children to well-child check-ups. We were in the office with the nurse and/or doctor for less than 45 mins. total. Our bill? Close to $600 dollars plus $45 dollars in co-pay. The insurance paid the bill, but I rarely take the kids to well-child checkups, because I don't feel like Dh's insurance company should have to pay $750 dollars a year for those. That is ridiculous. I agree that there has to be a better way.

 

Too many times, though, people seem to want a valuable commodity - health care- to be free. Or at least not cost THEM money. There have been several ideas presented in this thread on reducing costs. Some of them I could support. If every person were responsible for their own health care - no government, no insurance - doctors would not be able to charge 600 dollars for less than an hour's worth of work. I'd like a system with nurse practitioners as mentioned earlier. I do have issues with anything that would raise taxes or limit freedom. In general:).

 

Emphasizing again that I dislike government programs (with the military, judicial system, and roads being my primary exceptions), it would be interesting to see how government insurance would work if you had to sign up for it and only those who received benefits were taxed for it.

 

[justamouse]

Oh hell why bother no one here deals in subtlety or nuance.

 

hey now, I understand and I love your posts ;)

 

I cannot stress how pleased we were with the care we got in France, and how inexpensive it was: $30-$40 to see a doctor, $8 for a blood test, less than $10 to have a nurse come to our apartment and remove ds's stitches. The clinics and hospitals do not look like the Ritz Carlton, but the staff was well-trained and the equipment good. To see a doctor, you may indeed enter through a door to his garage and go down a flight of stairs into a room in his basement, or go into a small waiting room off the doctor's office, which is a fairly large room attached to her apartment. But nobody seems to mind. It's the care we're going for, after all. Isn't it?

 

I've heard France's system was fantastic. I have friends with three Autistic boys who are having to move back to get their boys affordable care. They're going broke here, and her husband makes a pretty penny.

 

Yes but we already are paying for it to the tune of millions and millions of dollars IMHO. I think it would be more cost effective to have Medicare for all:).

 

:iagree::iagree:

[Mama Geek]

One question I do have is under a single payer system (the government) can you go in a pay out of pocket for a procedure?

 

I have been under the assumption that this would not be possible and that is a big reason that I don't like that idea, that, and the government doesn't get much of anything right.

 

Also aren't a lot of Dr's refusing medicare and medicaid patients now? I know more and more Dr's are getting out of medicine or going to other countries to practice and there are fewer students going into medicine. If they have to deal with the government for payment I think that will get much worse.

[treestarfae]

I think people should have thorough education about health and be able to monitor themselves with home medical supplies. I think it's outrageous to pay nurses at clinics for taking my stats. Seriously step on a scale, take a temp and blood pressure. People should know how to type or write their own symptoms. Eliminate nurses and create more doctors.

[Punchie]

W/o having read everything posted:

 

1.crack down on fraud, make it a priority intially (think of how many more ppl could have access to Medicaid if millions weren't being fraudulantly spent)

2. increase pyts to doctors for Medicaid/care (and Tricare) so more doctors would take it

3. doctor payments should be focused more on the patient's health as opposed to the "more money for more tests ordered"

4. focus on prevention

5. have more nurse practitioners / PAs to handle the routine things

Edited November 6, 2010 by Punchie

[Mrs Mungo]

One question I do have is under a single payer system (the government) can you go in a pay out of pocket for a procedure?

 

I have been under the assumption that this would not be possible and that is a big reason that I don't like that idea, that, and the government doesn't get much of anything right.

 

With single-payer, no. With a public health care option, yes. On my phone, can't address the other ? at the moment.

[BakersDozen]

I think people should have thorough education about health and be able to monitor themselves with home medical supplies. I think it's outrageous to pay nurses at clinics for taking my stats. Seriously step on a scale, take a temp and blood pressure. People should know how to type or write their own symptoms.

This is what we do, including my prenatal care. Why pay an OB to do what I can easily do at home?

 

One thing done here is those on gov't aid/welfare have to go to the ER rather than Urgent Care. That, of course, drives up costs (and increases wait times!). It makes me so angry!! I would love to see the welfare system come under closer scrutiny as a method to combat health care costs, maternity coverage especially.

[jld]

I'm sure you were please the the inexpensive care, but that service cost somebody. Less than $10 for a nurse to come to you? If that took anywhere close to an hour of her day, it could not be enough to pay her a living wage. Governments don't have money of their own. Somebody is paying for it.

 

The French have really made their system efficient (I posted about the medical card that everyone carries with their medical history on it on another thread), and that certainly helps keep down costs. Doctors do much work themselves that doctors in America have nurses and receptionists do, which also keeps costs down. And their offices are pretty modest.

 

That nurse was with us for 10 minutes, and continued on her route for the day. Dh told me the $30-40 we pay to see our doctor is the true cost of seeing her, or close to it. He said that most French people have supplemental insurance in addition to basic gov't insurance, and they are reimbursed the cost of seeing their generalist.

 

There are subsidies from the gov't to the doctors, as the article mentioned, that may contribute to keeping costs down. These come not only from income tax, according to dh, but from other revenue as well, such as the VAT tax that we pay on whatever we buy there, our lodging, meals, etc. We do benefit from the French system, however, much as foreigners who come to America benefit from the nice national park system we have, paying the same fee to get in as Americans do. They pay the same price for food products subsidized by the American taxpayer. I'm assuming people think this evens out by what these tourists are paying for being here.

 

I really would not advise going to a libertarian no gov't, no ins. system. The system here in India benefits the rich. Contrary to what stripe posted, middle class people are not likely to be able to afford private healthcare in India. If the man in charge of human resources at the factory where dh works had a son with leukemia, he would not have gone to Apollo Cancer Hospital for treatment. He would have died. The idea just sickens me, and I hope people do not fall for this gimmick.

[justamouse]

to have a Dr bring you down into his basement to treat you at his house there would have to be some serious deregulation? heck, there would have to be some serious deregulation to have nurses check you (though most nurses I know could do a great job of it, too).

[jld]

The French just can't afford to be as picky as the Americans, I guess. And the suing and all that really doesn't seem to be as big of an issue as in America. I'm not sure why. I think it's because with a big safety net, the French don't have to worry so much if something happens to them. They'll get enough money from the gov't to live if they are disabled by a doctor's mistake, so it isn't so critical to sue so you can get care and just be able to live the rest of your life.

 

You know, I know there's a big concern about using the system and gov't inefficiency and all that. I'm not saying there isn't abuse in France; many people go to the doctor for little things, like sore throats, when they could just be patient and wait for it to go away. And undoubtedly the cost to people is going to rise if the gov't can't get a hold of the deficit. But the system is good, and it is certainly fairer than the American one. The French system is based on universal coverage; we are all in this together. Dh works for a French company, and even though the salaries are pretty modest (I'm sure dh makes much less than many Americans doing equivalent jobs), every single person at that company gets health insurance, good insurance, with low co-pays and low deductibles. A representative told the company several years back that only 4 companies in our state offered as good of a plan as dh's company did. It's just normal to the French owners. As a matter of fact, I don't think they would feel like decent people if they didn't provide it. I wish American companies could share these values, instead of it being every man for himself.

 

And I still feel just sick, physically sick, by the idea of that libertarian approach to this whole thing. Ugh. Maybe you need to see people turned away for inability to pay before you can see the inhumanity of that idea. Talk about regressive. Talk about going back in time. God forbid supporters of that one ever get their way. I hope they're the ones who get cancer then discover they can't pay. My son was diagnosed with AML last year, a cancer with a 55-60% survival rate after 5 years. The only thing that kept me from feeling totally sorry for myself was knowing that at least he could get treatment. None of the middle class kids, or maybe even upper middle class kids here could. They would have just died, as the treatment, for them, would have been so expensive, and at some point it becomes awkward to keep asking the relatives for money.

 

A rich woman here in my complex told me her cousin died a few years ago from leukemia. He needed a BMT but the family had already been asking the relatives for money, and felt too ashamed to keep asking. This woman has an expensive apartment and probably at least a million in the bank. How could she have let this happen? How could she not have gone to her relatives and said, please, let me help? And you know, I wonder if she feels guilty. She certainly had a pained look on her face when she told me this. If there's any truth in her, she knows it's wrong to have so much when others have so little. It's just immoral. And I live with this all around me here. And the poverty is so overwhelming.

 

Please, we don't want to go back in time in America. That may be where we're headed with the new group coming in. Regressive, regressive, regressive.

[Stacy in NJ]

to insure against a catastrophic health episode, a major illness or injury.

 

Individuals and employers should be allowed to purchase major medical policies that DO NOT cover preventative services.

 

One reason we have experienced two decades of incredible medical services inflation is because of the expansion of the subsidy aspect of medical insurance, both private and government.

 

The health saving accounts that were eliminated under the Obama plan should be reinstated and expanded.

 

Free or reduced fee for service clinics should be federally funded for those who need them.

 

Stacy (Who spent 12 years working as a Benefits Analyst to large employers for a consulting firm and who negotiated with various state insurance departments and insurance companies)

[Stacy in NJ]

on the cost of medical insurance or services. The total amount of compensation of insurance executives is a drop in the bucket compared to the raw dollar amounts spent on medical services.

 

Limit salaries of insurance company executives.

 

http://www.forbes.com/lists/2006/12/Insurance_Rank_1.html[/

[justamouse]

The French just can't afford to be as picky as the Americans, I guess. And the suing and all that really doesn't seem to be as big of an issue as in America. I'm not sure why. I think it's because with a big safety net, the French don't have to worry so much if something happens to them. They'll get enough money from the gov't to live if they are disabled by a doctor's mistake, so it isn't so critical to sue so you can get care and just be able to live the rest of your life.

 

this is true

As a matter of fact, I don't think they would feel like decent people if they didn't provide it. I wish American companies could share these values, instead of it being every man for himself.

 

we do offer the best coverage we can (and do so because we feel the welfare of our workers is in our hands) but the expense for us, as a small business is astronomical. when it comes to tightening the belt by cutting healthcare and firing a person, we have a hard choice to make

 

And I still feel just sick, physically sick, by the idea of that libertarian approach to this whole thing.

 

i don't disagree

 

'

 

i hope they do something, I'd love to see universal care but with the political climate now....

[Snowfall]

I think the best solution for individuals, businesses, and local and state and the federal governments is single payer universal health care IMHO. This would essentially be Medicare for all:)Private health insurance companies have not been doing a good job for decades in my opinion and insurance premiums have been going up by up to 20-50% every year for decades as well while the coverage gets skimpier and skimpier:(.

 

I know some advocate high deductible plans or plans that only meet a certain subset of the populations needs but IMHO this is unfair to those who cannot afford high deductibles or who happen not to be in said subset. One person actually said in the past they did not want a plan that covered maternity services since they were man:blink: Yeah, lets leave out half of the human race in the coverage.

 

Honestly, I think healthcare is a right and we should not be kicking those who are unfortunate to the curb. Also, no one should have to go broke due to healthcare costs:(. As for paying for this, we already are paying a lot of money to say the least. I do think the Patient Protection and Affordable Care Act is a step in the right direction but it will take 4 years for all of the pieces of legislation in the act to take effect.

 

:iagree::iagree::iagree:

[Snowfall]

There is also the issue of the elderly. We do way to many expensive procedures on those who should not have it (or even want it), but family members insist on using every means up to the very end. That's expensive.

 

I agree. My grandmother's breast cancer returned just months after she was cleared (mastectomy and chemo). The stats showed that with her type of breast cancer, at her age, relapsing in that amount of time, her odds of survival were literally almost ZERO. She didn't want to do chemo again, and she didn't want to do radiation. Her children talked her into doing both. Not only that, but she had regular PET scans, MRIs, and bone scans even AFTER they knew without a doubt that she was terminal. The doctor thought it necessary for everyone to know exactly where the cancer was this month that it wasn't last month, even though they couldn't stop it, couldn't even slow it down, and couldn't even manage the pain for the last 2 months. I don't really know how long the treatments prolonged her life. I certainly don't begrudge her getting them. What I do think was totally unnecessary was all the scans. The woman was dying. Telling her what awful symptoms she might need to expect next week, based on her PET scan this week was just cruel, and it was horribly wasteful.

[Lovedtodeath]

Tort Reform! This would seriously lower malpractice insurance. It's getting to where any completely ridiculous claim against a doctor or hospital results in huge amounts of money to the plaintiff's attorney because it's cheaper than a court battle.

 

In Michigan, malpractice insurance for OBGYN's have forced huge numbers of them out of practice because we have a law on the books that allows parents to sue until a child is age 21 for anything they perceive went wrong in the delivery room. We've had doctors sued and attorneys settled out of court for things like, "I'm just certain if the doctor had not given me that epidural that I demanded, my child would not have ADHD." No joke, that's one case locally in which the parents got over $100,000.00 and who knows what the attorney received. It's ridiculous. If a child has a birth injury due to the negligence of the attending medical staff, we can safely assume it's going to show up before that kid is old enough to be graduating college.

 

Plus, by reducing malpractice and the sizes of settlements for non-life threatening/maiming/death suits, doctors would not feel to compelled to order unnecessary tests. There is a lot of "covering butts" going on out there.

 

Ask me how I know, dd just had an interesting ambulance shift and got a first hand glimpse at stupidity and wastefullness in action just so that "behinds were shielded".

 

Faith

This makes no sense to me. I have a friend who almost died and she got nothing from her doctor and was told that the only way she would was if she could prove intent or drunkeness, etc. That Dr. no longer has a license, but none of the patients my friend knows of got a penny. I have more stories than this. I know a lot of messed up diagnoses, messed up surgeries and negligence. I know no one who has gotten a dime for malpractice.

[Kim in Appalachia]

Free or reduced fee for service clinics should be federally funded for those who need them.

 

Stacy (Who spent 12 years working as a Benefits Analyst to large employers for a consulting firm and who negotiated with various state insurance departments and insurance companies)

 

 

The only problem with this is the largest cost is not the doctor but the tests and drugs. My dh works at a community health center and the largest issue is that the patients can't afford their medications and they can't afford the expensive specialists and tests that are needed.

 

At this time, more of these clinics are needed, but the issue is larger.

[Haiku]

 

There are many very wealthy people in India who seem to have no problem watching children die from illnesses they could easily pay to treat . . .

 

This happens in the country my kids were adopted from, too. The old Doc Baker-from-Little House ideal is unworkable in today's world. One of my children has a chronic, life-threatening disease for which her treatment costs many times more every year than we earn. There is no possible way we could ever pay for it, no matter how shrewdly we negotiated. It's simply not possible.

 

I do think we should do away with insurance, however, and go to single-payer care. It needn't be free. I'm happy to pay for healthcare.

 

Tara

[Mama Geek]

Several people have discussed France's model for healthcare as a good option, but isn't France now in the position that they can't pay for all the benefits that the people want and are having to cut back? Isn't that why there is lots of rioting going on in that country now? I am of the impression it is not working for them.

 

Also everything I have read indicates that medicaid is about out of money. It could be because of abuse of the system, it could be because Congress has moved the funds to pay for other things, or it could be for many other reasons. My dh and I have paid into medicare for 15+ years each. I really doubt we will ever see a penny of it.

 

I do like the ideas of the medical co-op type of things that were discussed in an earlier post. I haven't known anybody involved in one though. I am only aware of 3 that exist right now and they are all Christian based and require a statement of faith. But why couldn't something like this be organized for other groups? It is something voluntary to be a part of rather than something forced like a government funded system.

[mom2att]

I've read through all nine pages of this thread with interest. I'm fascinated by the number of calls for a government-supported, single-payer system. Admittedly, I'm clueless on many of the specifics of such a system. But I'm also curious as to why so many support this model, and here's why:

 

It’s pretty much been agreed upon the last couple of centuries that all Americans are entitled to a free education provided by the government. States continue to pour money into this system with meager at best results. Parents can opt out of the system, of course—families of means can pay additional (and sometimes exorbitant) fees to give their children a private education, in essence paying twice since their tax dollars are still supporting the public model. Parents like those on this board can opt to home educate, but again this is an option limited to those of at least moderate incomes, since in most cases it necessitates one parent staying at home to teach, and again these families are paying for the public system while subsidizing their own educational purchases. In the meantime, the U.S. spirals down when it comes to international education rankings. Schools routinely graduate kids who cannot pass grade-level competency tests. Teachers cry foul about too-large classes, tests that they have to teach too, and parents who don’t give a darn. Unions make it nearly impossible to fire incompetent teachers while asking for still more money. Administrators suspend 1st graders for bringing army men school or giving a peck on the cheek to a classmate on the playground. But hey, it’s “free!â€

 

I think many, if not most of us on this board would agree that the education system in the U.S. is broken. The fact that we, along with an untold number of Americans, have chosen to opt out of this system is telling. We can also agree that our health care system is broken. But is applying the same “free for all†solution really the answer we want? If it doesn’t work for education, why in the world do we think we will have better luck with our health?

 

Sorry for my rambling. Obviously I am not offering any solutions, as the OP who started this thread suggested should be done. Truthfully, I don’t see the health care issue as a problem to be solved. It’s merely the symptom of a much greater problem—an economy in which the government continues to spend money it can never, literally never, pay back.

[MindyD]

Here in India, if you can't pay, you don't get help. It's not just the doctors who are involved, but the hospitals and the drug companies (I'm thinking of ds's cancer treatment last year). I understand the USA is different, but do charities really come forward to pay for other people's care, in its entirety? Can they even afford to?

 

There are many very wealthy people in India who seem to have no problem watching children die from illnesses they could easily pay to treat . .

.

 

 

Yes, we do have charities for that. We Americans have our faults, but we're very giving and generous with what we have.

[MindyD]

I don't know, Mrs Mungo, I don't want reused needles. But in some places, I've been given a cotton ball and a piece of tape instead of a bandaid.

 

Deamonte Driver, 12, from Maryland, died because of a dental problem. Estimates from 2002 were that 18,000 in the US die annually due to a lack of health care; in 2009, one estimate was 45,000 annually. More here from the NY Times.

 

I have seen that autistic kids are being denied care -- I saw one family on TV that moved to the woman's home country (some Scandinavian country, I think) because they provide health care, whereas in the US, they could neither afford the treatment nor obtain insurance for their autistic son. Wherever they are living now, the child is getting excellent care.

 

Why aren't any of the seniors who get Medicare refusing it? Maybe because they like it! Interesting then that seniors are much more opposed to govt funded healthcare than young people.

 

 

LIKE IT? No, more like it's their ONLY option.

[Catherine]

Competent primary care providers, who know their patients, and have a trusting relationship with them, are very cost effective and efficient ways to deliver care. I believe that increasing specialization is a big driver in increased costs. Good and accessible primary care also prevents duplication of effort and testing. It facilitates good communication and keeps all the parties talking to each other. And even though it would be politically impossible, reducing payments for procedures, and increasing payment for talking and coordinating care, (via Medicare) would begin to change the incentives that pull more and more doctors into subspecialities and out of primary care. Anyone who is interested in the cost aspects of health care should read some of Atul Gawande's writings. He is a surgeon, but an excellent writer with a gift for illuminating the crux of a situation. The last article he wrote, on dying, hospice care, and palliative care, was excellent.

[NoPlaceLikeHome]

I've read through all nine pages of this thread with interest. I'm fascinated by the number of calls for a government-supported, single-payer system. Admittedly, I'm clueless on many of the specifics of such a system. But I'm also curious as to why so many support this model, and here's why:

 

It’s pretty much been agreed upon the last couple of centuries that all Americans are entitled to a free education provided by the government. States continue to pour money into this system with meager at best results. Parents can opt out of the system, of course—families of means can pay additional (and sometimes exorbitant) fees to give their children a private education, in essence paying twice since their tax dollars are still supporting the public model. Parents like those on this board can opt to home educate, but again this is an option limited to those of at least moderate incomes, since in most cases it necessitates one parent staying at home to teach, and again these families are paying for the public system while subsidizing their own educational purchases. In the meantime, the U.S. spirals down when it comes to international education rankings. Schools routinely graduate kids who cannot pass grade-level competency tests. Teachers cry foul about too-large classes, tests that they have to teach too, and parents who don’t give a darn. Unions make it nearly impossible to fire incompetent teachers while asking for still more money. Administrators suspend 1st graders for bringing army men school or giving a peck on the cheek to a classmate on the playground. But hey, it’s “free!”

 

I think many, if not most of us on this board would agree that the education system in the U.S. is broken. The fact that we, along with an untold number of Americans, have chosen to opt out of this system is telling. We can also agree that our health care system is broken. But is applying the same “free for all” solution really the answer we want? If it doesn’t work for education, why in the world do we think we will have better luck with our health?

 

Sorry for my rambling. Obviously I am not offering any solutions, as the OP who started this thread suggested should be done. Truthfully, I don’t see the health care issue as a problem to be solved. It’s merely the symptom of a much greater problem—an economy in which the government continues to spend money it can never, literally never, pay back.

IMHO Medicare is a success and and it is not free. We pay for it and we already pay massive amounts of money for other forms of healthcare:) I am strongly in favor of Medicare for all:)

[NoPlaceLikeHome]

LIKE IT? No, more like it's their ONLY option.

 

Actually the satisfaction rates with Medicare are quite high from poll results that I read of previously. Medicare also saved my parents lives:)

[Nestof3]

:iagree:

 

Limit salaries of insurance company executives.

 

http://www.forbes.com/lists/2006/12/Insurance_Rank_1.html

 

More 24 hour/weekend clinics to offset ER use.

[NoPlaceLikeHome]

One question I do have is under a single payer system (the government) can you go in a pay out of pocket for a procedure?

 

I have been under the assumption that this would not be possible and that is a big reason that I don't like that idea, that, and the government doesn't get much of anything right.

 

Also aren't a lot of Dr's refusing medicare and medicaid patients now? I know more and more Dr's are getting out of medicine or going to other countries to practice and there are fewer students going into medicine. If they have to deal with the government for payment I think that will get much worse.

 

If we had Medicare for all, then Medicare would be the only thing in town so to speak and they really would not have much of choice if they wanted to stay in business:) I am in favor of funding education for doctors though.

[Nestof3]

The problem is, almost everyone uses up more in Medicare than what they pay in. I think the entire social security and medicare system needs an overhaul. I think the benefits should kick in at a later age. And, I think there should be something different set up for all government retirees and the social security benefits and how much they pay in. Oh, and I think government jobs with free healthcare should have to pay some for health care. Just a little bit would help out immensely. There's just too much "take care of gov't employees" going on in our nation.

 

 

And, yes, I can say that even with my dad being retired Navy, my son going into the Marines, and my MIL being a retired state employee.

 

 

IMHO Medicare is a success and and it is not free. We pay for it and we already pay massive amounts of money for other forms of healthcare:) I am strongly in favor of Medicare for all:)

[Carol in Cal.]

Have not read the whole thing, but I think that we should extend the Medicare signup age down to 50. That would encourage entrepenourship (I can't spell it but I know what it is) because people would not have to have an employer to get health care coverage. Also, it would improve coverage opportunities for older workers who get laid off and can't find jobs, as well as cutting the cost of older workers to companies, so that they would be more likely to be retained.

 

I also think that guarenteed issue Medigap coverage should be refreshed with open enrollment every year.

[Mejane]

How about it, priscilla? And why aren't these grandparents demanding healthcare for their grandchildren? Why are they only looking after their own interests? More entitlement thinking on the part of the elderly, I guess.

 

:iagree: I recently began receiving (ahem) the AARP magazine, and I stopped reading it after a few issues because it's nothing more than a b*tchfest about how "we" have to be vigilant because the government is trying to reduce "our" precious medicare and social security. AARP has a very powerful lobby, and they're never going to allow seniors' benefits to be cut.

 

No one likes cuts, but everyone has to sacrifice across the board, imo, and that includes seniors, who use a lion's share of the healthcare dollar.

[mcconnellboys]

I would work to eliminate the vast amount of fraud and wastage. Bobby Jindal has had terrific ideas for how to do this for many years and has done some work on it, both national and at the state level for Louisiana. He has a public health policy degree from Oxford, where he studied as a Rhodes scholar. I've watched him grow up and heard about his very sound ideas for years. I'd like to see him made "health czar".

 

I do not intend for this to be a political comment of any sort whatsoever. I care not what party a person is in. I care about the soundness of their ideas for America, from my own personal perspective, of course, because that's the only way any human being can view the world....

[Haiku]

If it doesn’t work for education, why in the world do we think we will have better luck with our health?

 

 

 

I have a friend visiting from Europe even as I type. I asked him whether schools are free in Europe. He said that state schools might be free but probably have a nominal charge. He said that they have a bad reputation though. He said that in his country, Catholic schools are highly regarded and you have to pay for them, but the fee is "so low it's hardly worth mentioning." So for all practical purposes, many of the countries who are kicking our rears in education have basically free education as well. I don't think the problem is the cost (or lack thereof) as much as the attitude one takes toward it. In most of the rest of the world, free (or nearly free) education and free healthcare co-exist (and yes, I know it's not free but is paid for with taxes, as is our free education).

 

ETA: Said friend phoned his mother to find out the fees for school. His Catholic high school cost $100 a year. His Catholic university cost $400 a year. He has a degree in philosophy, speaks four languages and can read Latin, and works for the European Commission (sorry, all that's just a brag on my friend cause I think he's so fab. :001_wub: )

 

Tara

Edited November 6, 2010 by TaraTheLiberator

[NoPlaceLikeHome]

The problem is, almost everyone uses up more in Medicare than what they pay in. I think the entire social security and medicare system needs an overhaul. I think the benefits should kick in at a later age. And, I think there should be something different set up for all government retirees and the social security benefits and how much they pay in. Oh, and I think government jobs with free healthcare should have to pay some for health care. Just a little bit would help out immensely. There's just too much "take care of gov't employees" going on in our nation.

 

 

And, yes, I can say that even with my dad being retired Navy, my son going into the Marines, and my MIL being a retired state employee.

 

Just for the record, I have a family member who works for the federal government and their healthcare is far from free. They pay $199 every 2 weeks for family health insurance and $56.00 bi-weekly for dental and vision. They also have $350.00 deductible per person up to $700 per family as well as $20 to $30 co-pays and 15-35% co-insurance up to $7000.00 catastrophic per family. So no it is far from free. Now when I worked for our local county here I only paid $50/month for cadillac health insurance with $5.00 co-pays and no deductibles:glare: Honestly I think the city, county, and state government workers tend to have much, much better benefits when it comes to health care and retirements. The federal government made reforms in their benefits in the 1980's to make them much more reasonable IMHO.

 

As far as benefits kicking in at a later age, I think that is unfair to those who hold physically challenging jobs such as construction workers, nurses, etc. As an RN I am hard pressed physically at 50 and thank God that I do not have to work currently since nursing is back breaking work as well as emotionally draining. I will not be able to retire until 67 and I think raising it to 70 is a bad idea. There are ways to shore up social security without raising the age such as not capping the income for social security taxes and a generous means test. I know my dear grandfather did not need social security as all since he was very well off and I have no problem with a generous means test.

Edited November 6, 2010 by priscilla
correction of figures

[goldberry]

Just an observation, but I didn't see anyone mention that one of the reasons for the exorbitant fees at hospitals, etc, is that they are charging for all the folks who have no insurance, no cash, and will never pay.

 

As long as hospitals and ambulances provide service to everyone, everyone should be required to pay into the system (according to their means.)

 

I still don't understand the objection to mandatory participation. If a person doesn't want to pay, won't they still expect to have their appendix out when they show up at the emergency room? And yet two states just passed laws against mandatory participation.

[justamouse]

ETA: Said friend phoned his mother to find out the fees for school. His Catholic high school cost $100 a year. His Catholic university cost $400 a year. He has a degree in philosophy, speaks four languages and can read Latin, and works for the European Commission (sorry, all that's just a brag on my friend cause I think he's so fab. :001_wub: )

 

Tara

 

I'm green.

[NoPlaceLikeHome]

Just an observation, but I didn't see anyone mention that one of the reasons for the exorbitant fees at hospitals, etc, is that they are charging for all the folks who have no insurance, no cash, and will never pay.

 

As long as hospitals and ambulances provide service to everyone, everyone should be required to pay into the system (according to their means.)

 

I still don't understand the objection to mandatory participation. If a person doesn't want to pay, won't they still expect to have their appendix out when they show up at the emergency room? And yet two states just passed laws against mandatory participation.

 

Exactly, as humans there are no guarantees on our health:( In fact, it is safe to say that the overwhelming majority of us eventually need healthcare IMHO.

[Gooblink]

This is bs. I am an attorney and would like to tell you that I do not waste 30,000.00 on discovery, seeking records, taking witness statements and depositions on a frivolous case. This old story comes from the insurance lobby . There are many COYA tests requested but the insurance companies fight the MD's over this and if they will not pay there is no test. My dh's best friend does only birth injuries, those children will never, ever go to college or sit up on their own. You are shamefully misinformed. I am certain that in our state 100,000.00 "nuisance" suits are not settled, they go to trial in most cases . The burden of proof is enormous the initial investigative financial commitment is likewise and the amount of time to go through the records before during and after is astonishing. I am the daughter, grandaughter and grand niece of physicians as well so I grew up hearing a very wide range of perspectives. That said if a physician gets sued and it goes to arbitration binding or non or mediation they might in fact not have committed malpractice as not all errors are such but rather there is a range of error acceptable to the community standard that is a mistake per se but not malpractice. Oh hell why bother no one here deals in subtlety or nuance.

 

WTH? You almost had my attention.

[JennyD]

On the subject of tort reform, it seems to me that it's something of a circular problem. Rhetoric of greedy patients and lazy doctors aside, from what I've read it seems that most medical errors are just that, errors. People make mistakes. However, the problem is that being the victim of a medical mistake can be absolutely financially devastating. (I read a study a few years back that found that medical bills were the prime reason for people declaring bankruptcy.) So people sue, which is an awful process for everyone except the lawyers, and exceptionally wasteful besides.

 

There has to be a better, more systematic way of dealing with this. Maybe something along the lines of the vaccine fund for victims of medical error, coupled with more serious attention to/incentives for implementing systematic ways of reducing errors (e.g., checklists, etc.). But the tort system, with its overarching framework of blame and desert, just doesn't seem to be the right one for the task.

Edited November 6, 2010 by JennyD

[NoPlaceLikeHome]

On the subject of tort reform, it seems to me that it's something of a circular problem. Rhetoric of greedy patients and lazy doctors aside, from what I've read it seems that most medical errors are just that, errors. People make mistakes. However, the problem is that being the victim of a medical mistake can be absolutely financially devastating. (I read a study a few years back that found that medical bills were the prime reason for people declaring bankruptcy.) So people sue, which is an awful process for everyone except the lawyers, and exceptionally wasteful besides.

 

There has to be a better, more systematic way of dealing with this. Maybe something along the lines of the vaccine fund for victims of medical error, coupled with more serious attention to/incentives for implementing systematic ways of reducing errors (e.g., checklists, etc.). But the tort system, with its overarching framework of blame and desert, just doesn't seem to be the right one for the task.

 

 

I agree that often there are simply errors since medical professionals are human and medicine is more of an art IMO. OTOH as a nurse I have seen truly incompetent doctors and nurses who are allowed to practice. With doctors from what I understand, there has often been a system that allows doctors not to turn in bad doctors so to speak IMO:(. Also with drugs, I have read of multiple instances of drug companies tainting their research in favor of their drugs:glare: OTOH I realize that many good drugs (and all drugs from my experience) have listed side effects a mile long in the drug inserts but are really overall safe to take and effective.

 

 

As far as tort reform, I know in our state it is already difficult to file frivolous law suits since another doctor must attest that malpractice or negligence occurred before a lawyer can bring a law suit against a doctor. Despite these safeguards, health care expenses have been going up for decades in our state. I have also read of other states like Texas where tort reform has been instituted and yet health care expenses are still high. So I truly do not believe that tort reform is going to have a big impact on health care expenses IMHO. I am in favor of reasonable tort reform that protects patients equally whether they are poor or rich.

[Meriwether]

As far as benefits kicking in at a later age, I think that is unfair to those who hold physically challenging jobs such as construction workers, nurses, etc. As an RN I am hard pressed physically at 50 and thank God that I do not have to work currently since nursing is back breaking work as well as emotionally draining. I will not be able to retire until 67 and I think raising it to 70 is a bad idea. There are ways to shore up social security without raising the age such as not capping the income for social security taxes and a generous means test. I know my dear grandfather did not need social security as all since he was very well off and I have no problem with a generous means test.

 

Does this mean what I think it does?