Free Birth Control; Children Up to 26; Pre-Existing Conditions; Free Mammograms, etc. If these matter to you...

[Carrie12345]

Wow, that's pretty damn insulting given how much of our income we have paid not only into insurance but into actual medical expenses. You seem to be failing to understand that discounts are negotiated for group insurance as well and it is usually cash payers who cover that gap, as we have in every prior treatment. Note also endowment and private charity.

 

People wealthier than you? Maybe, maybe not. We are those tax payers who ended up priced out of our insurance and with almost no options and had to find a way to make it work for our family in the post-ACA world when we couldn't spend hundreds per week on maintaining insurance that left us unable to pay for basic treatment and care in meeting our deductible. Now we pay out of pocket for a those basics, pay into a group for catastrophic coverage, and work as individuals to manage the cost of procedures.

 

My health share covers maternity and postpartum complications like this 100%. But we went to the hospital first to see what we could do to limit our bill as much as possible. We qualified, based on income and need, for their charity, because we just exceeded the Medicaid limits and they were aimed at preemies more than sick babies in terms of length of hospital stay.

 

You can criticize and needle me as much as you want, but it says a lot more about you than me. I'm glad that after paying all but the basic 15% prompt pay discount for multiple births and treatments, this hospital was finally able to help us out a bit. First time in eleven years of living here we have qualified for their assistance.

 

Here's my bottom line:  I don't really care how your needs or your baby's needs were taken care of, just that they were.  I want you and your baby to be healthy, period.  I want my "babies" to be healthy.  I want ALL babies to be healthy, even when they're 19, 26, 45, and 82.  I don't care if they're rich, poor, the nicest person on the planet, or drug addicted prostitutes.  They're all human beings in the world of modern medicine. Our parents, our kids, our neighbors, our friends.  It's not a freaking contest.

[Carol in Cal.]

Which would be provide by the government. In other words, the government provided insurance is good enough for the super poor, the disabled, and the elderly, but no where near good enough for anyone that can pay for something different. The rich deserve better care. 

Nope, not 'good enough' but rather 'better than nothing'.  Sometimes improvements need to be incremental, unfortunately.  Please don't put words in my mouth.

[Carol in Cal.]

But end of life discussions = death squads/killing grandma.  Not allowed!

Well yeah, sometimes they do.  It's a fair concern, particularly given the frequently cited high cost of end of life car.  How would you address preventing that savings motive from being a factor in end of life decisions?

[Pawz4me]

Who needs a separate 1 hour consultation (or wants to pay for it, or wants to leave the family member to have it)?  Your family member is dying, and people come in and out all the time.  They DO talk about this stuff.   

Been there, done that. 

 

 

No they don't.

 

Been there, done that more times than I like to remember. :(

[Carol in Cal.]

Oh no, be careful! I can see people responding with ....but 99.9% own a fridge and multiple televisions and cell phones... In fact, I'm certain there's been threads saying these exact things.

Not around here.

 

Around here there are a lot of families that don't have their own kitchens.  They have shared kitchen privileges with a bunch of other families.  But yes, they probably do have cell phones, because their employers require them to be on call/available, and otherwise they would be tethered to a land line.  These tend to be food insecure families, who are using just about their entire paycheck on rent for these inferior spots.  It's really, really tough.  But if they move out of high rent areas, they can't get jobs and they don't have food/assistance/clinic care/public transportation fallbacks.  Catch 22 in spades.

 

Having said that, there are choice issues AS WELL.

 

My husband and I own a single family rental house with 4 bedrooms.  We have never used Section 8 vouchers, but one time when we advertised it for rent we got a bunch of calls from people who had those vouchers to use and wanted us to join the program.  I actually called the city to find out the requirements.  The guy I talked to was so nasty on the phone that I ruled it out.  But in the meantime there was this woman who I got to be kind of friends with on the phone as she called several times to ask about this.  She had a very young baby, maybe a year old, same as mine.  Her voucher got her the right to pay a specific percent of her earned income for a home, I think it was 30%.  Then the authorities paid the rest, up to a limit (that was below fair market value for our rental, but I digress).  

 

So we chatted about a lot of things, and traded baby stories, and where to get cheap used clothes and stuff.  It got to be Christmas time, and she was all excited because she had gotten her welfare check and was going to buy her baby all four of the talking Teletubbies that were the 'all the rage' gifts that year.  It was crazy, that was almost $400 for presents for a baby that would not even remember them.  I had been DEBATING whether I could get ONE of them for my own kid.  So yeah.  Bad choice, and one that people might sympathize with wanting but resent the actual purchase decision.

 

Both are true.  It is both the case that poor spending choices can really mess things up and also that many have no discretionary income at all.  And it is also true that people who are pinching every penny so hard that it squeaks in an effort to be responsible can have some justification for feeling like more people should do that.  Hillbilly Elegy talks wonderfully about this.  

 

But I don't see how anyone can fail to have compassion for those who face serious medical difficulties. no matter what their choices have been in the past.

[FaithManor]

No they don't.

 

Been there, done that more times than I like to remember. :(

My mother's husband is going through taxpayer money like water over a dam for constantly trying to keep him alive despite end stage lung cancer that cannot be cured or put into remission at age 72 in a male who has heart problems and only one lung, multiple health issues on top of the cancer. It is insane, and the only thing he gets for all of this is more suffering.

 

Not one word by any medical professional anywhere on the subject of end of life planning. When I bring it up, my family looks at me like I am the devil incarnate!

 

There is something seriously wrong with this.

[LMV]

Our local pediatric ER has an UC that is attached.  Unless you come in by ambulance, the triage nurses are the ones who make the call about which one you go to.  My understanding is that because it's part of the same hospital, the same rules about treatment apply, so UC can't turn people away either.  

 

I'm not sure if it actually saves on wait times, because presumably they are taking money from ER staffing to pay for UC staffing, but it does get the kids with minor contagious illnesses out of the same waiting room with the most medically fragile kids, and it keeps the two groups from comparing their wait times.  

 

Facilities which do this need to be very careful in how they are doing this or they will run afoul of EMTALA. My guess based on what you shared is that they have a fast track area of their ED which resembles an urgent care to you but is actually just another area of their ED. We considered doing something like this but ultimately decided we didn't want to add midlevel providers into our mix and currently don't have the volume to support adding another physician. We will re-evaluate in six months. If they are truly diverting from the ED to urgent care (even if that urgent care is on their hospital campus) then they will need to be in compliance with EMTALA as they do this.

[LMV]

I also wish the ER had more ability to turn people away while didn't have a true emergency and redirect them to an urgent care. We sat for hours in ER once for stitches for my DS. Another boy and his family were there waiting for Tylenol because he had a fever. They, too, waited for hours. Meanwhile, a member of the family went to the convenience store and bought bags full of snacks to eat while they waited for their "free" Tylenol.

 

EMTALA requires that all patients who present be evaluated for an emergency medical condition. If a condition exists then stablization and treatment must be provided.

 

I'm curious as to how you knew that the family was only waiting for tylenol. Our triage nurses will usually ask if they can give tylenol in triage for documented fever and if it is indicated we order it. Now tylenol isn't always indicated for fever and is truly contraindicated in some patients and clinical scenarios so we do handle this on a case by case basis but I don't think we've ever had kids in our waiting room just waiting for tylenol. 

[Miss Peregrine]

EMTALA requires that all patients who present be evaluated for an emergency medical condition. If a condition exists then stablization and treatment must be provided.

 

I'm curious as to how you knew that the family was only waiting for tylenol. Our triage nurses will usually ask if they can give tylenol in triage for documented fever and if it is indicated we order it. Now tylenol isn't always indicated for fever and is truly contraindicated in some patients and clinical scenarios so we do handle this on a case by case basis but I don't think we've ever had kids in our waiting room just waiting for tylenol. 

Because we struck up a conversation with them. They told us. 

[Frances]

Well yeah, sometimes they do. It's a fair concern, particularly given the frequently cited high cost of end of life car. How would you address preventing that savings motive from being a factor in end of life decisions?

I think programs that empower people to get the knowledge and make the decisions before they ever face the end of life are the best prevention. That way, people are not making the decisions under stressful circumstances.

 

As for rationing of care, whether by insurance companies or the government, I don't think there is any way to avoid that unless unlimited spending is allowed or someone has their own unlimited funds. But research has shown that when people are given the knowledge and facts ahead of time, most choose fewer costly interventions at the end of life, thus leaving more money for others. Research also shows this leads to better experiences for both patients and family members. I don't think using peer pressure or incentives to get people to think and talk about end of life decisions before they ever face them is a bad thing.

[FaithManor]

I think some of you are missing the point. These end of life consultations aren't ONLY for people dying in the hospital... These were also meant to be a one time, I think, meeting where the elderly are able to sit down and let their physician know what and how much they want to be told in dire situations, to understand living wills and how hospice works, what type of documents are needed, how feeding tubes work, etc. The patient does NOT need to be terminal to ask for a meeting.

It's giving people information. Who on earth would object to giving a human information about their medical choices, especially an elderly person who may not even understand there are often multiple options?

The same people who don't want poor people to have decent healthcare or women to have birth control, or SNAP, or...pretty much my neighbors who voted against a piddly $3.00 per house $50 per business millage to enhance 911 and said since they have never had to call 911 themselves nor plan to, they dang well are not paying for it for everyone else.

 

That group.

 

And there is a suprising number of them. Sigh....my brothet is one of them and his life has been saved by medics three times in the last ten years. But he'd rather die than pay another $3 to "the man".

[Laura Corin]

Came across this - I didn't see it myself, so I can't vouch for it. Supposedly these are the costs of these procedures to the UK NHS (they will be free to the patient at the point of need). A&E is the ER. NHS 111 is the remote advice service. A GP Surgery is a GP's office (normal visit, not a surgical procedure).

 

ETA those prices in US dollars are around

 

300

150

39

20

0.70

 

 

Edited January 14, 2017 by Laura Corin

[ktgrok]

Nope, not 'good enough' but rather 'better than nothing'.  Sometimes improvements need to be incremental, unfortunately.  Please don't put words in my mouth.

 

I guess what I'm trying to say is, why is government provided care okay for poor people, the disabled, the elderly, but NOT okay for everyone else? 

[Carol in Cal.]

I guess what I'm trying to say is, why is government provided care okay for poor people, the disabled, the elderly, but NOT okay for everyone else? 

It's better than nothing.  Which is what a lot of people would have lacking the assumption of a fallback government plan.  It's an incremental step that has value.  Just like high deductible plans are better than nothing.  Just like Medicare alone is better than nothing.  All of these things could be improved upon, but they are also all better than nothing.

[Frances]

It's better than nothing. Which is what a lot of people would have lacking the assumption of a fallback government plan. It's an incremental step that has value. Just like high deductible plans are better than nothing. Just like Medicare alone is better than nothing. All of these things could be improved upon, but they are also all better than nothing.

But in some cases, for all practical purposes, it amounts to nothing. If you can't find a doctor who will accept your Medicaid or you aren't poor enough to qualify in your state, Medicaid does not help you. If everyone in the country was in the same pool, we would not have these issues. If we were all in it together, then everyone would get care because it would be the only game in town, except for what extras people wanted to pay for on their own.

[Barb_]

So this topic is almost played out, but I wanted to post something I just ran across. From the article:

 

The distance between health-policy ideology and life-or-death health care narrowed to a few feet at a nationally televised town hall meeting this week when a small-business man from Arizona stood up and faced House Speaker Paul D. Ryan.

 

“Just like you, I was a Republican,†Jeff Jeans began. Standing on the stage, the Wisconsin congressman broke into a grin as Jeans said he had volunteered in two Republican presidential campaigns and opposed the Affordable Care Act so much that he'd told his wife he would close their business before complying with the health-care law.

 

But that, he said, was before he was diagnosed with a “very curable cancer†and told that, if left untreated, he had perhaps six weeks to live. Only because of an early Affordable Care Act program that offered coverage to people with preexisting medical problems, Jeans said, “I am standing here today alive.â€

 

(Snipped)

 

Just several hours after the House voted mostly along party lines Friday on a budget measure intended as the first step toward repeal, Jeans, 54, elaborated in an interview on his medical and financial crisis.

 

He had lost his health benefits, he told The Washington Post, when a company for which he had moved to Arizona filed for bankruptcy. Soon after, in early 2012, he was diagnosed with throat cancer, with a tumor on his vocal cords so large that he could not speak. He offered to pay cash for the $30,000 treatment, but a cancer center near his Sedona home said he needed to produce either an insurance card or a $1 million deposit.

 

Full article:

 

https://www.washingtonpost.com/news/to-your-health/wp/2017/01/14/cancer-survivor-who-challenged-ryan-the-aca-saved-his-life/?hpid=hp_hp-top-table-main_tyh-survivor-932am%3Ahomepage%2Fstory&utm_term=.1c9a86f2e162

[Rebecca in KY]

Yeah, I'm pretty sure that their idea of personal responsibility isn't the same as mine. ;)

 

Kind of a side topic, because I truly don't know. People, usually women, complain that they want free-to-them birth control. Now, I would far rather encourage abstinence when you're not in a position to afford a baby, but I also know that for a variety of reasons, that isn't realistic, and I would far rather birth control than abortions or neglected children. And I understand that many women don't use them for contraception but for health reasons. So about the BC costs. I gather BCPs are expensive without insurance coverage? I don't use them so I really don't know. Are the pills themselves expensive because they're expensive, or are they expensive because insurance covers them? Could we reduce costs for that sort of stuff so that the majority of women, even college students not making much, could afford to buy them themselves without insurance coverage? Like the Mylan epipen thing, is there artificial and unnecessary bloat built into the costs of BCPs (or anything else)?

[Rebecca in KY]

Sorry about the quoted post with no comment. I hit the wrong button. :)

 

As to the cost of BC: I take a typical generic pill. We joined a health share this year, so no prescription coverage. Good Rx, an online prescription discount program, quoted me $24 for a 3-month supply. My health share included a discount card through another company, and that one dropped it to $18 for 3 months. Without a discount, the price ranged from $24-$45 per MONTH.

 

I used Good Rx last year even while covered under an ACA health plan. The plan was useless and covered almost nothing. My discounted price through insurance for things like allergy nasal spray was a joke. I eventually stopped filling my prescriptions through my insurance and just used the discount cards.

[MedicMom]

Facilities which do this need to be very careful in how they are doing this or they will run afoul of EMTALA. My guess based on what you shared is that they have a fast track area of their ED which resembles an urgent care to you but is actually just another area of their ED. We considered doing something like this but ultimately decided we didn't want to add midlevel providers into our mix and currently don't have the volume to support adding another physician. We will re-evaluate in six months. If they are truly diverting from the ED to urgent care (even if that urgent care is on their hospital campus) then they will need to be in compliance with EMTALA as they do this.

Our main local hospital has a fast track staffed by mid levels. Unfortunately it hasn't seemed to fix anything, though I think it's a great idea in theory. The area is very low income and low education, and everyone seems to think they need an ambulance ride and an ER visit for their cold. It's a huge huge problem.

[ktgrok]

It's better than nothing.  Which is what a lot of people would have lacking the assumption of a fallback government plan.  It's an incremental step that has value.  Just like high deductible plans are better than nothing.  Just like Medicare alone is better than nothing.  All of these things could be improved upon, but they are also all better than nothing.

 

But why do poor people and the disabled get "better than nothing" but others get what is being argued is better? 

 

Why is it okay for care level to be decided by monetary reserves?

[Guest]

But why do poor people and the disabled get "better than nothing" but others get what is being argued is better?

 

Why is it okay for care level to be decided by monetary reserves?

I can't tell if this is rhetorical, but it is a fundamental issue in policy and civics and there are distinct schools of thought on this. Arguably none are wrong, they just have a different set of costs and benefits. I have zero interest in arguing this with any of you, it's just food for thought.

 

Everything in life, from food quality to transportation, to clothing, housing, even utility service level, is dictated by cost. Health care as well. The minimal level of service needs to be adequate but that doesn't mean more advanced therapies or accommodations aren't available.

 

Example: Our pediatrician billed us $352 for Benjamin's weight check and 2 week appointment yesterday, no cash discount. We left that practice with our other kids to get what is considered lower/substandard levels of care from the ANPs attached to the family practice of my midwives, who charge a little over $100 for well child checks. We couldn't afford to take five healthy kids to a pediatrician and walk out with a $1600-ish bill to be told they were all healthy, every year or two. So our income dictated we seek out less expensive care.

 

So we have some fundamental right to take our kids to a pediatrician instead of a generalist/family practice? Nope. And if we want the higher/more specialized level of care we must pay for it. But the basic care through the health department or through the cheapest provider we could find has been just fine. The bare minimum is good enough for us, because we aren't wealthy enough to foot the bill for more. We have to budget it in for the kid who needs the more specialized care now, but it's a stretch. If we really couldn't foot it we would have to have him seen at the health department or family practice, and potentially deal with someone not being well versed in child development and not catching something in his progression that might need therapy or treatment. Small risk, but one we would rather not take if we can afford to do better. It doesn't mean he is in imminent peril if we cannot keep paying the pediatrician though.

 

Care is tiered. Do I have a fundamental right to a different doctor if I feel like I want better? Why?

 

I'm a fan of base levels of care being sufficient - if someone cannot get an adequate health check or treatment regardless of their ability to pay that *is* a problem. The bare minimum option shouldn't be nothing, and on that we all agree. But from there yes, there is absolutely differing levels of care, especially in preventative services and non-emergent care. It gets trickier when it's palliative care or for a progressive and long term illness, and I think that's an area where the bare minimum fails in certain states and municipalities and needs addressing. But if you divorce cost from quality the result tends to be a lowering of quality for everyone, not an increase in quality across the board. There are definite ramifications to a lack of preventative care or expense associated with lifestyle that can be argued, but that's outside of what I'm talking about which is more the basic assumption that care cannot be tiered for cost/quality. That nuance is why I am such a fan of vouchering Medicare/Medicaid and offering additional incentives for individuals spending on preventive care, but there are other solutions available too. They each have tradeoffs though.

Edited January 15, 2017 by Arctic Mama

[poppy]

Sorry about the quoted post with no comment. I hit the wrong button. :)

 

As to the cost of BC: I take a typical generic pill. We joined a health share this year, so no prescription coverage. Good Rx, an online prescription discount program, quoted me $24 for a 3-month supply. My health share included a discount card through another company, and that one dropped it to $18 for 3 months. Without a discount, the price ranged from $24-$45 per MONTH.

 

I used Good Rx last year even while covered under an ACA health plan. The plan was useless and covered almost nothing. My discounted price through insurance for things like allergy nasal spray was a joke. I eventually stopped filling my prescriptions through my insurance and just used the discount cards.

 

My birth control was $80 a month (Nuvaring) *after* insurance. 

Why that one? The others made me feel ill.

Why so much? Because hormonal birth control is sold by for-profit companies.

 

Then I got an IUD. I don't know how much the IUD cost.  Thanks, Obama.

[Carol in Cal.]

But in some cases, for all practical purposes, it amounts to nothing. If you can't find a doctor who will accept your Medicaid or you aren't poor enough to qualify in your state, Medicaid does not help you. If everyone in the country was in the same pool, we would not have these issues. If we were all in it together, then everyone would get care because it would be the only game in town, except for what extras people wanted to pay for on their own.

This post contains some assumptions that I think are worth considering further.

 

There are doctors who take only a certain number of Medicaid patients.  There are also doctors who take only a certain number of Medicare patients.  Here's a popular press article from about 5 years ago documenting that:  http://usatoday30.usatoday.com/news/washington/2010-06-20-medicare_N.htm

 

I believe that most assessments of how single payer would work assume that current or similar rates of repayment as those for Medicare would be extended to everyone.  Cost controls, IOW, would be significant and would be a result of doctors being stuck with whatever the government would pay, a rate which clearly many of them have been finding both unreasonably low for a long time AND which is less than they get paid for 'regular insurance' patients.

 

So why would doctors accept that?  And wouldn't we have trouble getting enough students to become doctors if they knew that there was such serious downward pressure on pay rates?  The premise of having only one game in town is that everything else would remain the same while people would suddenly be able to find care.  But I think that that premise is flawed.  Availability of medical and even emergency care is already a growing problem in rural and even in poorish urban areas.  I believe that this would make that worse.

 

Additionally, if the government, with its known burgeoning problem with deficit spending, becomes the only provider of primary medical insurance coverage, it's not going to take long before lists of previously addressed but now 'too expensive' medical treatments are going to skyrocket.  That is what happened in Oregon when they implemented that kind of system.  In Oregon (before the ACA), medical treatments would put into a prioritized list, and then each year Oregon would assess how much money they had for this, and drew a line in the list above which things were covered, and below which things were not.  Examples of things that were not covered included treatment for sore throats, on the assumption that they would get better on their own, and aggressive treatment for advanced cancer, on the assumption that this was not usually effective.  

 

Fundamentally, I disagree with this approach.  I think that decisions about what treatments will be covered, which essentially means the difference between being able to get them and not being able to get them, should rest on the patient in consultation with her doctor.  Furthermore, once you start drawing that line based on cost, you can draw it anywhere you want.  I don't want to give any one entity that much power over patients' health care decisions.  

 

lRight now we have insurance companies AND government payers AND state insurance commissions AND individuals all mitigating each other's power over this.  If we go to a single payer, we are putting that much power in an entity that has proven itself to be untrustworthy, and that is tremendously incented to deny care, even more so than is the case now.  I wish this wasn't true, but it is.

Edited January 15, 2017 by Carol in Cal.

[Luckymama]

Here's a link to the Planet Money podcast taking about end-of-life care in La Crosse WI

 

http://www.npr.org/sections/money/2014/03/05/286126451/living-wills-are-the-talk-of-the-town-in-la-crosse-wis

[Lawana]

This post contains some assumptions that I think are worth considering further.

 

There are doctors who take only a certain number of Medicaid patients. There are also doctors who take only a certain number of Medicare patients. Here's a popular press article from about 5 years ago documenting that: http://usatoday30.usatoday.com/news/washington/2010-06medicare_N.htm

 

I believe that most assessments of how single payer would work assume that current or similar rates of repayment as those for Medicare would be extended to everyone. Cost controls, IOW, would be significant and would be a result of doctors being stuck with whatever the gomvernment would pay, a rate which clearly many of them have been finding both unreasonably low for a long time AND which is less than they get paid for 'regular insurance' patients.

 

So why would doctors accept that? And wouldn't we have trouble getting enough students to become doctors if they knew that there was such serious downward pressure on pay rates? The premise of having only one game in town is that everything else would remain the same while people would suddenly be able to find care. But I think that that premise is flawed. Availability of medical and even emergency care is already a growing problem in rural and even in poorish urban areas. I believe that this would make that worse.

 

Additionally, if the government, with its known burgeoning problem with deficit spending, becomes the only provider of primary medical insurance coverage, it's not going to take long before lists of previously addressed but now 'too expensive' medical treatments are going to skyrocket. That is what happened in Oregon when they implemented that kind of system. In Oregon (before the ACA), medical treatments would put into a prioritized list, and then each year Oregon would assess how much money they had for this, and drew a line in the list above which things were covered, and below which things were not. Examples of things that were not covered included treatment for sore throats, on the assumption that they would get better on their own, and aggressive treatment for advanced cancer, on the assumption that this was not usually effective.

 

Fundamentally, I disagree with this approach. I think that decisions about what treatments will be covered, which essentially means the difference between being able to get them and not being able to get them, should rest on the patient in consultation with her doctor. Furthermore, once you start drawing that line based on cost, you can draw it anywhere you want. I don't want to give any one entity that much power over patients' health care decisions.

 

lRight now we have insurance companies AND government payers AND state insurance commissions AND individuals all mitigating each other's power over this. If we go to a single payer, we are putting that much power in an entity that has proven itself to be untrustworthy, and that is tremendously incented to deny care, even more so than is the case now. I wish this wasn't true, but it is.

With no snark or disrespect intended, what kind of health care system would you envision as ideal?

[Carol in Cal.]

With no snark or disrespect intended, what kind of health care system would you envision as ideal?

I answered this earlier--will see if I can find it later on, but have to run for now.  Did not want you to think I was ignoring this question.  

[Slartibartfast]

This post contains some assumptions that I think are worth considering further.

 

There are doctors who take only a certain number of Medicaid patients.  There are also doctors who take only a certain number of Medicare patients.  Here's a popular press article from about 5 years ago documenting that:  http://usatoday30.usatoday.com/news/washington/2010-06-20-medicare_N.htm

 

I believe that most assessments of how single payer would work assume that current or similar rates of repayment as those for Medicare would be extended to everyone.  Cost controls, IOW, would be significant and would be a result of doctors being stuck with whatever the government would pay, a rate which clearly many of them have been finding both unreasonably low for a long time AND which is less than they get paid for 'regular insurance' patients.

 

So why would doctors accept that?  And wouldn't we have trouble getting enough students to become doctors if they knew that there was such serious downward pressure on pay rates?  The premise of having only one game in town is that everything else would remain the same while people would suddenly be able to find care.  But I think that that premise is flawed.  Availability of medical and even emergency care is already a growing problem in rural and even in poorish urban areas.  I believe that this would make that worse.

 

Additionally, if the government, with its known burgeoning problem with deficit spending, becomes the only provider of primary medical insurance coverage, it's not going to take long before lists of previously addressed but now 'too expensive' medical treatments are going to skyrocket.  That is what happened in Oregon when they implemented that kind of system.  In Oregon (before the ACA), medical treatments would put into a prioritized list, and then each year Oregon would assess how much money they had for this, and drew a line in the list above which things were covered, and below which things were not.  Examples of things that were not covered included treatment for sore throats, on the assumption that they would get better on their own, and aggressive treatment for advanced cancer, on the assumption that this was not usually effective.  

 

Fundamentally, I disagree with this approach.  I think that decisions about what treatments will be covered, which essentially means the difference between being able to get them and not being able to get them, should rest on the patient in consultation with her doctor.  Furthermore, once you start drawing that line based on cost, you can draw it anywhere you want.  I don't want to give any one entity that much power over patients' health care decisions.  

 

lRight now we have insurance companies AND government payers AND state insurance commissions AND individuals all mitigating each other's power over this.  If we go to a single payer, we are putting that much power in an entity that has proven itself to be untrustworthy, and that is tremendously incented to deny care, even more so than is the case now.  I wish this wasn't true, but it is.

But none of this solves the problem of people with pre-existing conditions unable to get care.

 

We can argue about it until we are blue in the face but meanwhile if ACA goes away there are people who will die.

 

I am not ok with that.

 

The problem with this whole issue is that there are people here who feel strongly because they have children who will die. My nephew will die.

 

So...I kinda don't care if people don't want government involved in healthcare. I do. Because I do not want people to die.

 

I get how some can look at it clinically but others cannot and this will always be an emotional topic because people, children they love will really die.

Edited January 15, 2017 by Slartibartfast

[Slartibartfast]

It's better than nothing.  Which is what a lot of people would have lacking the assumption of a fallback government plan.  It's an incremental step that has value.  Just like high deductible plans are better than nothing.  Just like Medicare alone is better than nothing.  All of these things could be improved upon, but they are also all better than nothing.

ACA is also better than nothing, which millions are now facing.

[ktgrok]

 The bare minimum is good enough for us, because we aren't wealthy enough to foot the bill for more. We have to budget it in for the kid who needs the more specialized care now, but it's a stretch. If we really couldn't foot it we would have to have him seen at the health department or family practice, and potentially deal with someone not being well versed in child development and not catching something in his progression that might need therapy or treatment.

 

See, I'm not okay with your child having to face that risk just because you have less money than someone else. Either it is good enough for everyone, or not good enough period. (yes, I realize right now you are able to afford the pediatrician, but obviously that could change, and some people can't). 

 

Needing the pediatrician should be based on medical history, not finances. 

 

I don't think a poor child's health (again, not yours, but someone who cannot budget for the pediatrician) is worth less than the health of a child whose parents can afford better. 

[FaithManor]

Slartibartfast, I tried to like your post above but sadly have squandered my likes for the day and will now slink bsck to the corner in shame.

[ChocolateReignRemix]

. It gets trickier when it's palliative care or for a progressive and long term illness, and I think that's an area where the bare minimum fails in certain states and municipalities and needs addressing. But if you divorce cost from quality the result tends to be a lowering of quality for everyone, not an increase in quality across the board. There are definite ramifications to a lack of preventative care or expense associated with lifestyle that can be argued, but that's outside of what I'm talking about which is more the basic assumption that care cannot be tiered for cost/quality. That nuance is why I am such a fan of vouchering Medicare/Medicaid and offering additional incentives for individuals spending on preventive care, but there are other solutions available too. They each have tradeoffs though.

 

Except other nations have better overall heath outcomes while spending less per capita than we do, which makes me question the bolded

[FaithManor]

See, I'm not okay with your child having to face that risk just because you have less money than someone else. Either it is good enough for everyone, or not good enough period. (yes, I realize right now you are able to afford the pediatrician, but obviously that could change, and some people can't).

 

Needing the pediatrician should be based on medical history, not finances.

 

I don't think a poor child's health (again, not yours, but someone who cannot budget for the pediatrician) is worth less than the health of a child whose parents can afford better.

I could not like this though I wanted to because sniff sniff, I have no more likes which is a lot like running out of dark chocolate sea salt carmels. It is going to be a long, bad night.

 

I do so agree and especially when it comes to children. Jesus was pretty specific. They do not ask to be brought into this world and then are at the mercy of the daft decisions of our culture and policy makers. All children desetve better, period. For those that believe in Christ, there is no pat on the back for not caring, not trying harder, not demanding solutions for the children of the world.

[Carol in Cal.]

With no snark or disrespect intended, what kind of health care system would you envision as ideal?

OK, here it is:

 

"If I were designing a system from the ground up, it would be modelled on patients making medical decisions based on their values and their doctors' advice, and insurance companies not being able to second guess this.  It would be regulated by state insurance commissions rather than federal ones.  It would be subsidized and there would be a state high risk pool similar to that for auto insurance.  When a policy said 'out of pocket limit' that would mean 'This is the maximum you will have to pay this year', no exceptions.  High deductible plans would be available and encouraged."

 

To be VERY clear--the stipulation of state high risk pools means that everyone would be able to get insurance, regardless of 'insurability' or preexisting conditions.

[goldberry]

Well yeah, sometimes they do.  It's a fair concern, particularly given the frequently cited high cost of end of life car.  How would you address preventing that savings motive from being a factor in end of life decisions?

 

It happens now, as I mentioned with my FIL's case, with greed factoring in rather than cost savings. Regarding either profit or saving interfering, is there any evidence it would happen MORE if it were an objective doctor assigned specifically for that purpose?  

 

I think a few things would address it. One, if the consultation is offered but not mandatory.  Two, ultimate decisions are still left to the family just like they are now.  Three, I think it would still be reported or dealt with if doctors were giving *false* information in these consultations (such as saying there was a 5% chance of survival rather than a 50% chance).  Of course doctors should be held accountable if they give false information to persuade the family into a decision.

Edited January 15, 2017 by goldberry

[happypamama]

But why do poor people and the disabled get "better than nothing" but others get what is being argued is better?

 

Why is it okay for care level to be decided by monetary reserves?

That depends on the area so much. Here, most places take all the state insurances. Hershey takes all of it, and so do the other top hospitals. I've not heard people complain that they had to settle for lower care because they had state insurance. That's how it should be IMO. I will happily pay more in taxes if it means that families with babies like mine can go to Hershey and not be stuck with a lesser hospital. I just wish we could make it feasible for lower income people to have that without hurting the middle class with the high premiums.

[regentrude]

Except other nations have better overall heath outcomes while spending less per capita than we do, which makes me question the bolded

 

Very detailed article with lots of statistics and graphs.

 

http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

 

 

 

 

On several measures of population health, Americans had worse outcomes than their international peers. The U.S. had the lowest life expectancy at birth of the countries studied, at 78.8 years in 2013, compared with the OECD median of 81.2 years. Additionally, the U.S. had the highest infant mortality rate among the countries studied, at 6.1 deaths per 1,000 live births in 2011; the rate in the OECD median country was 3.5 deaths.

The prevalence of chronic diseases also appeared to be higher in the U.S. The 2014 Commonwealth Fund International Health Policy Survey found that 68 percent of U.S. adults age 65 or older had at least two chronic conditions. In other countries, this figure ranged from 33 percent (U.K.) to 56 percent (Canada).

Edited January 15, 2017 by regentrude

[LucyStoner]

I guess what I'm trying to say is, why is government provided care okay for poor people, the disabled, the elderly, but NOT okay for everyone else?

The ultimate irony being that even preACA we spent more per capita in tax dollars to provide healthcare just to poor people, elderly people and congresspeople than counties like Canada and the U.K. spend per capita to provide care for ALL of their citizens. We have the money to care for everyone but we basically insist on getting fleeced.

[Carol in Cal.]

But none of this solves the problem of people with pre-existing conditions unable to get care.

 

We can argue about it until we are blue in the face but meanwhile if ACA goes away there are people who will die.

 

I am not ok with that.

 

The problem with this whole issue is that there are people here who feel strongly because they have children who will die. My nephew will die.

 

So...I kinda don't care if people don't want government involved in healthcare. I do. Because I do not want people to die.

 

I get how some can look at it clinically but others cannot and this will always be an emotional topic because people, children they love will really die.

You're not really addressing the post that you quoted.  In it I did not argue against either mandatory coverage of people with preexisting conditions or the ACA.  What I argued against was single payer.

 

I don't oppose the government being involved with healthcare.  What I oppose is one entity, ANY one entity, even the government, being entirely in charge of access to medical insurance coverage for specific conditions.  I DON'T WANT ANYONE TO DIE.  I am sorry you are in the position of having a family member who is vulnerable to this.  I'm sorry anyone does.    It's ridiculous and entirely unacceptable.

[ktgrok]

OK, here it is:

 

"If I were designing a system from the ground up, it would be modelled on patients making medical decisions based on their values and their doctors' advice, and insurance companies not being able to second guess this.  It would be regulated by state insurance commissions rather than federal ones.  It would be subsidized and there would be a state high risk pool similar to that for auto insurance.  When a policy said 'out of pocket limit' that would mean 'This is the maximum you will have to pay this year', no exceptions.  High deductible plans would be available and encouraged."

 

To be VERY clear--the stipulation of state high risk pools means that everyone would be able to get insurance, regardless of 'insurability' or preexisting conditions.

 

And for those who are unemployed, disabled, or cannot afford premiums?

[Slartibartfast]

OK, here it is:

 

"If I were designing a system from the ground up, it would be modelled on patients making medical decisions based on their values and their doctors' advice, and insurance companies not being able to second guess this.  It would be regulated by state insurance commissions rather than federal ones.  It would be subsidized and there would be a state high risk pool similar to that for auto insurance.  When a policy said 'out of pocket limit' that would mean 'This is the maximum you will have to pay this year', no exceptions.  High deductible plans would be available and encouraged."[/size]

 

To be VERY clear--the stipulation of state high risk pools means that everyone would be able to get insurance, regardless of 'insurability' or preexisting conditions.[/size]

So what do you think would be a reasonable amount for a high risk pool to insure someone who needs tens of thousands of dollars in care, a month, for the rest of their life?

 

How would someone just starting on their career afford that?

 

People with pre-existing conditions can make contributions to society but if they are trapped on medicare then they have no choices but to take min wage jobs so they do not die.

 

High risk pools won't work, it isn't a viable option for ACA. That will kill people.

Edited January 15, 2017 by Slartibartfast

[Barb_]

 

"But if you divorce cost from quality the result tends to be a lowering of quality for everyone, not an increase in quality across the board"

 

Sorry for the crappy quote--Ipad.

 

I'd like to discuss this. I'm not really following you here. Can you give me an example of this so I understand your thought process? I can't think of a single instance in any industry or country. Maybe it's something that sounds like it would be true, so you assume it would be the case?

[goldberry]

He had lost his health benefits, he told The Washington Post, when a company for which he had moved to Arizona filed for bankruptcy. Soon after, in early 2012, he was diagnosed with throat cancer, with a tumor on his vocal cords so large that he could not speak. He offered to pay cash for the $30,000 treatment, but a cancer center near his Sedona home said he needed to produce either an insurance card or a $1 million deposit.

 

Full article:

 

https://www.washingtonpost.com/news/to-your-health/wp/2017/01/14/cancer-survivor-who-challenged-ryan-the-aca-saved-his-life/?hpid=hp_hp-top-table-main_tyh-survivor-932am%3Ahomepage%2Fstory&utm_term=.1c9a86f2e162

 

And yet how many people, even on this forum, think this stuff never happens, that there are always ways to get treatment?  They think these stories are an exaggeration or a scare tactics.  No, it's happening, to real people and to real families.  It is something our country should be ashamed of.

[Slartibartfast]

You're not really addressing the post that you quoted.  In it I did not argue against either mandatory coverage of people with preexisting conditions or the ACA.  What I argued against was single payer.

 

I don't oppose the government being involved with healthcare.  What I oppose is one entity, ANY one entity, even the government, being entirely in charge of access to medical insurance coverage for specific conditions.  I DON'T WANT ANYONE TO DIE.  I am sorry you are in the position of having a family member who is vulnerable to this.  I'm sorry anyone does.    It's ridiculous and entirely unacceptable.

That is why I am in favor of single payer.

 

Leaving it up to multiple entities (the states) and Congress mucking with things that made it more affordable is why the ACA is in the state it is in.

 

And I was addressing the quote, you keep suggesting things or having arguments that don't actually address *why* people are frantic. It won't save people.

 

Something has to be done.

Edited January 15, 2017 by Slartibartfast

[Frances]

OK, here it is:

 

"If I were designing a system from the ground up, it would be modelled on patients making medical decisions based on their values and their doctors' advice, and insurance companies not being able to second guess this. It would be regulated by state insurance commissions rather than federal ones. It would be subsidized and there would be a state high risk pool similar to that for auto insurance. When a policy said 'out of pocket limit' that would mean 'This is the maximum you will have to pay this year', no exceptions. High deductible plans would be available and encouraged."

 

To be VERY clear--the stipulation of state high risk pools means that everyone would be able to get insurance, regardless of 'insurability' or preexisting conditions.

But if insurance companies have no say in what is covered, only patients and doctors, how would the premiums ever be affordable without almost unlimited subsidization? I don't understand how this is financially feasible, but maybe I'm missing something.

 

I also don't understand the high risk pool for health insurance being compared to auto insurance. People who make bad driving decisions such as DUI pay more for auto insurance or aren't allowed to drive for a reason. Those born with bad health or bad genetics need healthcare regardless of their ability to pay.

[Lang Syne Boardie]

So this topic is almost played out, but I wanted to post something I just ran across. From the article:

 

The distance between health-policy ideology and life-or-death health care narrowed to a few feet at a nationally televised town hall meeting this week when a small-business man from Arizona stood up and faced House Speaker Paul D. Ryan.

 

“Just like you, I was a Republican,†Jeff Jeans began. Standing on the stage, the Wisconsin congressman broke into a grin as Jeans said he had volunteered in two Republican presidential campaigns and opposed the Affordable Care Act so much that he'd told his wife he would close their business before complying with the health-care law.

 

But that, he said, was before he was diagnosed with a “very curable cancer†and told that, if left untreated, he had perhaps six weeks to live. Only because of an early Affordable Care Act program that offered coverage to people with preexisting medical problems, Jeans said, “I am standing here today alive.â€

 

.....

 

 

I used to be closer to (one party's) side on health care. I am now almost completely in Camp Other Party on health care.

 

The difference? A sick child who is now a young adult with a chronic health condition who requires lifelong expensive care.

 

I certainly THOUGHT that I understood about poor people and health care. Had I not been a poor person, most of my life? Had I not run the gamut of experience, from no health care as a child, to working in a Medicaid clinic as a young adult, to being a low-income parent yet with very good union benefits? Surely I had a large picture, right?

 

But no. That next level of necessary compassion did not kick in, even for me, until I understood what it meant that people's children will die without some form of universal coverage. Well, now I know. And I can't un-know.

 

I was already fully equipped with the compassion, and basic milk of human kindness, that leads me to understand my child is not more precious than your child (or your child is not less precious than mine), or my father than your father, or myself than yourself. But the part where this intrinsic belief is applied to health care in my nation -- well, like I said, now I know.

 

For anyone reading who remains unconcerned about tens of millions of Americans, including children, elderly, veterans, who may fall through the cracks unless something amazing happens, THIS is the perspective that you obviously don't have. Go find it. Don't stop seeking compassion until you obtain it...I pray to God you can learn it through observation and not experience.

Edited January 15, 2017 by Tibbie Dunbar

[Carol in Cal.]

And for those who are unemployed, disabled, or cannot afford premiums?

'subsidized' addresses that.  Which I have stipulated more than once.

[Slartibartfast]

'subsidized' addresses that.  Which I have stipulated more than once.

Subsidies for whom?

 

What would be the limit for that and how would that be better/different than the ACA?

 

The middle class cannot afford a devastating diagnosis.

Edited January 15, 2017 by Slartibartfast

[Carol in Cal.]

That is why I am in favor of single payer.

 

What make you trust the government with this?  

I've talked in detail about what makes me not do so.  I've said over and over that I'd like to.

I've indicated respect for the way the system works in Germany, which I'm fairly familiar with, and I've said why I don't think it would work here.

What makes you believe that it would?  Where is your evidence?

[Slartibartfast]

What make you trust the government with this?  

I've talked in detail about what makes me not do so.  I've said over and over that I'd like to.

I've indicated respect for the way the system works in Germany, which I'm fairly familiar with, and I've said why I don't think it would work here.

What makes you believe that it would?  Where is your evidence?

Tricare already covers nearly ten million people.

 

My nephew with CF gets Tricare now because his dad is a Vet. Once he ages out of Tricare he will have nothing unless he keeps himself poor.

Edited January 15, 2017 by Slartibartfast

[Carol in Cal.]

But if insurance companies have no say in what is covered, only patients and doctors, how would the premiums ever be affordable without almost unlimited subsidization? I don't understand how this is financially feasible, but maybe I'm missing something.

 

I also don't understand the high risk pool for health insurance being compared to auto insurance. People who make bad driving decisions such as DUI pay more for auto insurance or aren't allowed to drive for a reason. Those born with bad health or bad genetics need healthcare regardless of their ability to pay.

AFAIK high risk auto insurance is somewhat subsidized.  I might be wrong about that, but that's what I envisioned.  It's subsidized and everyone can get it--the state becomes the insurer of last resort, with the other stipulations in place.

 

Re. the first paragraph, in an ideal world, wouldn't you think that patients and their doctors would decide what treatment they need and would get?  That's how medical insurance started out, and it made sense.  What makes it not make sense now?  Isn't it the ideal that we should shoot for?