Americans want universal health coverage

[d]

If the gubmint provided catastrophic insurance ...

but this is not likely the universal health coverage the folks want, which i trust means full benefits and modest if not near zero cost.

 

[unclemick]

The illusion of a free lunch will never die.

The idea of 'somebody else' paying for it is nice.

heh heh heh

 

[Non sequitur]

The same people who constantly crow about how great the American "anything" is simultaneously find every component of it infinitely trashable. We simply can do not better... be no better.. manage no better.. produce no better than whatever their most deridabe straw man example is. But we're better than everybody. But all extant deficiencies are OK and must not be addressed or we'll be "Like Them"
(Unless I'm reading you wrong)

That's a very good observation razztazz. Recently, I noticed that too.

 

[Rich_by_the_Bay]

The illusion of a free lunch will never die.

The idea of 'somebody else' paying for it is nice.

Point well taken.

But there probably would be some true savings to a certain extent: take out the insurance company profit, even out the cost of emergency room care subsidies for those with no assets, and remove the barriers to early retirement or between-job gaps in coverage. Believe me, it is REALLY expensive when someone with no insurance defers getting their gall bladder removed ($10k total) and 6 months later it ruptures with peritonitis, etc., etc. ($250K if they survivie).

Fiscal cost aside, it would really provide value, emotional or otherwise, to know that no matter what other b*llsh*t life threw at you (laid off, family crisis, disability) at least for having paid your taxes, you had coverage for catastrophic illness.

 

[poboy]

My question , if we institute socialized medicine, where will all the Canadian doctors who migrated to the United States end up?  We have medicaid , medicare, sliding scale fee clinics.    I worked until I knew I could retire with a pension and  medical insurance. Wanted to retire five years ago but knew I could not until I reached my goal.  I have no sense of entitlement.

 

[Craig]

My goodness ... I was being very sarcastic.

We have a friend from Britain who regaled us with "impressive" stories of government health care.  People come to America from many countries for treatment they can't receive timely from their government healt care providers in their home country.

We're trashing the dollar, and we are in serious debt.  Great idea ... let's make it even worse with Hillary health care.

Frankly, I'm amazed that otherwise intelligent people would still consider government health care to be a viable option.

There might be some savings by converting from the free market (such as it is in this case) to government control?  No.  By that logic, let's have the feds take over Wal-Mart ... after all, they've driven the prices down, but gee ... if we take out all of that nasty shareholder profit, just think of how cheap everything will be. 

Doesn't work that way.

After this, we can discuss the great success of government / public schools.  But, I won't, not anymore.  This is a tiresome, useless debate.

 

[Martha]

Poboy, you seem to think that there isn't a problem and you can keep working or there is a safety net. More than 45 million don't have insurance. The safety net is small and doesn't cover everyone.

Sliding fee clinics don't pay for your insulin, your lipitor, your asthma drugs. If you don't have insurance, you pay out of pocket or go without.

Say you have a job with insurance, get cancer and are too sick to work. You can't get medicare yet--you aren't yet eligible. You can't get medicaid: you have money in a 401k, own your own home, or don't fall into one of the eligibility categories. You are disabled and lose your job. You can get COBRA for 29 months but how are you going to pay for it? You don't have a job anymore. Oh, and by the way, COBRA is a government mandate, without it there would be no insurance possibilities at all for that person.

I know a number of people that if they had a catastrophic illness they would be wiped out. I would rather pay a more in taxes than watch my friends and relatives lose their homes if they got seriously ill. Or worse, go without care.

We had a secretary in her 20s that got a brain tumor, not malignant. She had constant horrendous headaches. She ended up having to leave work. Thank goodness we have disability insurance at work, it provided her money to pay her COBRA premiums until she was eligible for medicare/social security disability. How many employers provide disability insurance for their staff?

you suggest that i have a viable alternative to the current system; i don't -- nor have i seen a convincingly viable alternative put forth elsewhere. achieving what i suspect folks want is not likely possible, and attempts to reach such an unachievable result will end as you have suggested, subject to my modifications: "less than satisfactory, relatively unreliable service at a very high cost with tons near unimaginable levels of bureaucracy and an "I dont give a crap about f**k you" attitude.

And what evidence do you base this opinion on? Doctors are still doctors, nurses still nurses. The insurance bureaucracy seems to have a goal of not covering you. I don't think European countries and Canada feel that their service is unreliable.


Charles, you attack "Hilary style" health care. What do you know about her plan? To make the plan palatable to some on the right, it mandated employer provided health insurance through regulated HMOs. I was with the left in believing that we were better off ditching the insurance model and going for a single payor system.

I find this a very serious debate and not the least bit useless.

 

[Rich_by_the_Bay]

We're trashing the dollar, and we are in serious debt. Great idea ... let's make it even worse with Hillary health care.

Frankly, I'm amazed that otherwise intelligent people would still consider government health care to be a viable option...

Doesn't work that way.

After this, we can discuss the great success of government / public schools. But, I won't, not anymore. This is a tiresome, useless debate.

Not clear what your real-world experience in this area has been but, reimbursement levels aside, Medicare reimburses more efficiently than many private carriers. Medicare covers certain things that private insurance doesn't. When MC makes a determination about whether certain services are covered or not, the private sector carriers fall into line within weeks.

My 32 years in the field suggest that each of the current payor types (MC, Medicaid, private fee-for-service, and HMOs) all have about the same level of incompetence. The motivating factors might be different (e.g. private carriers "kite" their payments to make you wait so they make more money, while MC is just bureaucratically slow), but the net result is not all that discrepant.

Given that, I'd sure feel better knowing that catastrophic coverage will never be denied to me for a fair price, and I can plan my life without having to pray that I either a) don't ever get sick or injured, or b) can plead with some carrier for individual coverage that won't cost me tens of thousands a year to get me to age 65.

I'm all for a market economy, but some services just seem to be best provided at a universal level for the "greater good." That is not just for the poor, but also for the "fairly rich" who, because of constraints on health coverage, can't retire early, can't take risks on starting a new business, and can't compete in the global market because health care costs make them noncompetitive. This is a good topic to keep an open mind about, whatever your political leanings.

On a personal level, the health insurance issue (12K/year for me and DW) is a major factor in our decision about the timing of FIRE.

 

[Martha]

Rich, pleeeeease write Sen. Ron Wyden, D-Oregon and Sen. Orrin Hatch, R-Utah, who are looking at the national health care issue, and tell them your experince with reimbursement.

Martha

 

[ShokWaveRider]

Americans want universal coverage

- As long as they don't have to pay any more taxes and that their relatively good medical coverage they now have isn't degraded.

Not true, I would pay more taxes for decent care, any type of community/group health care actually)

SWR

 

[razztazz]

Sliding fee clinics don't pay for your insulin, your lipitor, your asthma drugs

HA! Lipitor is the reason I cannot work and have been shaken down (or at least my Government provided medical policy has been shaken down) for hundreeds of thoudans of dollars. And they wouldn;t gurantee it would prevent heart attacks. BTW.. my heart scan proved I have no plaque. A wasted life, lots of money to the medica monster for as long as I live. The only "cost/benefit analysis they do is o I make money?" Anybody gets killed.. hey it's not perfect.

Ass far as Hillary care: A good comment and a bad comment.

Forst of all mentioning it anytoime there is a serious discussion on medical insurance to denegrate a free people attempting to better the world is b/s. Who needs to bring up Hillary Care? Has nothing to do with the topic at hand. Speaks to the agenda or lack of seriousness of the part of the invoker.

But alas... if it HA BEEN an medical insurance access plan maybe it would ahve bene viable. It was not. It was a veneer of "health care access" draped over a larger goovernment take-over of teh entire emdical system.

See.. too grabby. The devil was in the details and they were kept behind The Green Door. Too bad they didn't have a convenient "Pearl Harbor" like some people

 

[dory36]

Not sure how many here have Purple Hearts or service-connected disabilities, but either qualifies veterans for free or very low cost health care in VA hospitals. (Other vets can qualify with a variety of situations, but I think you have to be below some income threshold if you didn't get injured and you didn't enroll before a few years ago.)

They get a bad rap on occasion. My experience (as a recipient) is that the actual care providers are not significantly different in their care or practice than those encountered elsewhere. But management seems to matter a lot in the attitudes and so forth of the rest of the staff. At several centers I saw staff that would do any for-profit hospital proud. At another, although there were welcome exceptions here and there, I think they staffed several departments with DMV rejects. And of course they are the one close to home...  

 

[Cool Dood]

I know a number of people that if they had a catastrophic illness they would be wiped out. I would rather pay a more in taxes than watch my friends and relatives lose their homes if they got seriously ill. Or worse, go without care.

But the one doesn't necessarily follow from the other. What some people would object to is that you and many other people "would rather pay more" than watch your friends and relatives suffer, but then the proposed solution is through taxes so you're making them pay more, too (and a lot more -- Canadian health care, for instance, keeps racking up billions and billions in costs, and I'm sure the American system is similarly expensive). Why not just help out your friends and relatives with their insurance? Is there a good reason to forcibly take a good chunk of money from every working American (you're not really free to just pass up paying your taxes), when the goal is only to provide health insurance to a subset of Americans who can afford nice houses and cars and all that but won't pay for their own insurance? I can understand the reason if it's to support those who really are too poor or otherwise incapable of supplying their own health services, but that's an extremely different proposal than universal health care. Government funding can certainly do a large amount of good for people who can't look after themselves, but it won't solve the problems it's supposed to for the tens of millions of average Americans.

 

[Rich_by_the_Bay]

They get a bad rap on occasion. My experience (as a recipient) is that the actual care providers are not significantly different in their care or practice than those encountered elsewhere. But management seems to matter a lot in the attitudes and so forth of the rest of the staff. At several centers I saw staff that would do any for-profit hospital proud. At another, although there were welcome exceptions here and there, I think they staffed several departments with DMV rejects. And of course they are the one close to home...

That jives with my experience. When a VAH is affiliated with a medical school, it's attending physicians are usually on the faculty. As a rule, they work via teams of residents. The attending (supervising) physicians are comparable to those of any community teaching hospital.

My observation is that residents in VA hospitals are more frequently supervised at a "hands off" distance compared to university hospitals. Management does create a great deal of "drag" on getting things done, but this is not always the case. Their electronic medical record system, while inelegant, is quite functional and at least it works.

I do not hesitate to recommend VAH care for those who are eligible. Along with that recommendation I encourage them to be an active consumer, looking out for their own safety and better yet, having a loved one do the same; insist on speaking with the attending doctor from time to time if that is not happening. Double check all meds and procedures planned.

This is sound advice for ANY hospital, but mayber even sounder for VA care where the management sytems may be more complex. Finally, despite lots of fine doctors in the system, don't expect personalized, mature, warm and fuzzy care; you may indeed find just that, but with all the turnover and busy clinic expectations it is a rare commodity.

 

[Rich_by_the_Bay]

But the one doesn't necessarily follow from the other. ...Why not just help out your friends and relatives with their insurance?

Cool, sometimes people with preexisting illnesses truly and literally just cannot get insurance. No one will take them, or only at unreachable cost with all types of exclusions. This is commonplace and a big reason why your otherwise sensible reaction is not the whole picture.

A few safety nets exists in some states, but these are not the rule and even they are filled with problems. Mostly, you just have to spend down your nest egg, if any, until you are poor and then you qualify for Medicaid. Sometimes.

A person with several hundred thousand dollars in assets -- saved over a lifetime -- may have to spend that down before receiving coverage. Honest. It happens. Alas, you can do that pretty quickly with a coronary bypass, maybe a dose of kidney failure, vascular surgery, a bad car accident and so forth.

Society picks up the tab for charity care (taxes, often at a county or state level), providers raise their fees to recover the unreimbursed care they provide (they can't just not care for them, the way a private business can simply not sell to someone who can't pay), and the vicious circle goes on and on.

 

[Martha]

. Why not just help out your friends and relatives with their insurance? Is there a good reason to forcibly take a good chunk of money from every working American (you're not really free to just pass up paying your taxes), when the goal is only to provide health insurance to a subset of Americans who can afford nice houses and cars and all that but won't pay for their own insurance?

Now come on, when did I say these were the facts. I have many, many examples. I will give you one. I know a person who has a house bought for $75,000, with a small down payment saved that took her years to save. She earns $20,000 a year. She has two children. Divorced. She has insurance through work. Despite the low income, she even puts a little money away in her 401k. If she lost her job because of illness, she would be SOL. But at least her employer has insurance. Many small employers are dropping insurance.

Non of my stories involve people with nice houses and nice cars that chose not to get insurance. All my stories involve people who don't make much money, but still try to save. Many have health problems so they would not be able to get affordable insurance except through work. What I am saying is that you get sick enough, you can't work. Tying health insurance to jobs is a problem.

Help out with friends and relatives? Gee, why am I still working part time? I help out all the time. I walk the walk. Do you?

 

[Martha]

Dood, I will give you another story with a bad end. True story.

My cousin's friend had a job in a health food store. No benefits and no ability to buy insurance on the open market. So she had no insurance. She found a lump in her breast. Because of worries about cost she delayed going to the doctor. She went too late and now she is dead.

 

[lets-retire]

That jives with my experience. When a VAH is affiliated with a medical school, it's attending physicians are usually on the faculty. As a rule, they work via teams of residents. The attending (supervising) physicians are comparable to those of any community teaching hospital.

My observation is that residents in VA hospitals are more frequently supervised at a "hands off" distance compared to university hospitals. Management does create a great deal of "drag" on getting things done, but this is not always the case. Their electronic medical record system, while inelegant, is quite functional and at least it works.

I do not hesitate to recommend VAH care for those who are eligible. Along with that recommendation I encourage them to be an active consumer, looking out for their own safety and better yet, having a loved one do the same; insist on speaking with the attending doctor from time to time if that is not happening. Double check all meds and procedures planned.

This is sound advice for ANY hospital, but mayber even sounder for VA care where the management sytems may be more complex. Finally, despite lots of fine doctors in the system, don't expect personalized, mature, warm and fuzzy care; you may indeed find just that, but with all the turnover and busy clinic expectations it is a rare commodity.

I wish I could share your enthusiasm for the VA, but my experience is it is very bad. The last time I went, as a disabled Vet, it cost more than my current insurance for the treatment I received, and the treatment was substandard. I would go there only if my other option was dying. Similar to the CPR theory (The patient is dead don't worry about a few broken ribs).

 

[d]

i recall a local VAH celebrating its 50th anniversary.  it was noted that at its beginning it had (something like) 200 beds and an administrative staff of 20 ... 50 yrs later it had (something like) 20 beds and an administrative staff of 200.  depending on one's needs, outpatients get bussed to another hospital in one of two other states (yes, its an all-day afair), sometimes only to be told they don't have the correct paperwork, or, in at least one case, someone else's x-rays.  when our esteemed elected representatives sign-on to have their health care provided by the VA, i'll give it a second thought ... but not until then.

 

[Rich_by_the_Bay]

There apparently are deep and widespread differences among various VA facilities. Rarely do I hear rave reviews, and "war stories" abound. My experience is only with those associated with major medical schools. These tend to be high profile referral centers.

At these centers you can get standard care for common problems for free, with the likelihood that someone competent is at least theoretically overseeing your care; the residents (1-3 years out of medical school) are who you will see mostly.

Someone referred to my "enthusiasm" for the VA hospitals -- a large overstatement to say the least. I have no official connection with the VA system. Still, there are thousands getting routine care at no cost with few complaints. Plenty of room for improvement, to be sure, but a lot of good, free care, too.

I've seen more than a few kids with their legs or arms blown off who receive life-saving care, surgery and months of rehab; they have left the hospital walking and with a list of potential civilian employers. These stories don't get quite as much attention as the disastrous ones, I guess.

 

[maddythebeagle]

My proposal would be to add ANOTHER tax on cigarettes and lottery tickets and divert it ALL to pay for some form of indigent health care. For folks that can afford it, I like what astro says, getting help to be in a group plan rather than playing the individual risk game sounds reasonable.

 

[razztazz]

Astro's idea has already been addressed but was suspisciously swetp under the rug. In about teh late 1990's there was a" medical care reform" type group headed by a doctor. The upshot of this program was have teh Gov cover all claims over (I belive it was 30,000 dollars at the time, and simply getting the insurance companeis off the hook for the huge "Sunday punch" type of claims would immediately make insurance for almost everybody affordable. They even had a funding mechanism that did not include some huge income tax increase or the usual suspects. The inicdents of that type of claim was well under 1%

Sorry I no longer have that link, but that was the gist of it
'

 

[lets-retire]

razz--That sounds very similar to the promise the insurance companies gave to the state governments to require no fault insurance on all motor vehicles operated on the roads.  If I remember correctly the lower prices did not materialize.

It sounds good though. The DW recently had brain surgery. The bills submitted to insurance for just the surgery totaled about 50,000. Would the precare and after care be included in the minimum price? I could see where the Gov would say no and the insurance companies would say yes. Then in the end I'd be stuck with the bill.

 

[razztazz]

razz--That sounds very similar to the promise the insurance companies gave to the state governments to require no fault insurance on all motor vehicles operated on the roads. If I remember correctly the lower prices did not materialize.

I make no claims of omniscience like some others might. I was just relating that thing I read that sounded like what astro proposed. On paper., it works ike a Swiss watch but reality has people in it. To wit: Now as far as no-fault car insurance not doing what it was supposed to do.. prossibly a management problem. ALl thos eprivate businessmen and they still couldnt get it right. Or more likely the insurance companies had no intention of lowering prices anyway. They just used that as a ruse to sell it to the public in order to profit from a government thing.

 

[OldAgePensioner]

I have experience with 2 teaching ( Northwestern and UCSF) hospitals and both my primary doctors did/do VAH ( I suspect they get the interns a better training regimine) and if this is normal practice, the VA hospitals are well staffed.

If the US ends up with a healthcare system like England, I will **** my self. The idea of waiting months upon months to get an appointment is not what I consider healthcare.