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Re: Americans want universal health coverage
Old 06-10-2006, 10:33 AM   #61
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Re: Americans want universal health coverage

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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
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Re: Americans want universal health coverage
Old 06-10-2006, 10:36 AM   #62
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Re: Americans want universal health coverage

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... *:P

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Re: Americans want universal health coverage
Old 06-10-2006, 10:45 AM   #63
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Re: Americans want universal health coverage

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Originally Posted by Martha
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.
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Re: Americans want universal health coverage
Old 06-10-2006, 10:52 AM   #64
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Re: Americans want universal health coverage

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Originally Posted by dory36
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... :P
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.
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Re: Americans want universal health coverage
Old 06-10-2006, 11:00 AM   #65
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Re: Americans want universal health coverage

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Originally Posted by Cool Dood
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.
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Re: Americans want universal health coverage
Old 06-10-2006, 02:03 PM   #66
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Re: Americans want universal health coverage

Quote:
Originally Posted by Cool Dood
. 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?



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Re: Americans want universal health coverage
Old 06-10-2006, 02:11 PM   #67
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Re: Americans want universal health coverage

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.

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Re: Americans want universal health coverage
Old 06-10-2006, 02:49 PM   #68
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Re: Americans want universal health coverage

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Originally Posted by Rich_in_Tampa
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).
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Re: Americans want universal health coverage
Old 06-10-2006, 03:11 PM   #69
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Re: Americans want universal health coverage

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.
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Re: Americans want universal health coverage
Old 06-10-2006, 03:37 PM   #70
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Re: Americans want universal health coverage

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.
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Re: Americans want universal health coverage
Old 06-10-2006, 04:15 PM   #71
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Re: Americans want universal health coverage

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.
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Re: Americans want universal health coverage
Old 06-10-2006, 04:29 PM   #72
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Re: Americans want universal health coverage

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
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Re: Americans want universal health coverage
Old 06-10-2006, 07:10 PM   #73
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Re: Americans want universal health coverage

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.
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Re: Americans want universal health coverage
Old 06-10-2006, 07:26 PM   #74
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Re: Americans want universal health coverage

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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.
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Re: Americans want universal health coverage
Old 06-10-2006, 08:37 PM   #75
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Re: Americans want universal health coverage

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.
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Re: Americans want universal health coverage
Old 06-10-2006, 08:46 PM   #76
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Re: Americans want universal health coverage

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If the US ends up with a healthcare system like England, I will **** my self
you won't have to, the system will take care of that.*
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Re: Americans want universal health coverage
Old 06-10-2006, 09:53 PM   #77
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Re: Americans want universal health coverage

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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.
Appears there are a few coming at this from stage left ... it is a tiresome debate because of the ample evidence that government programs generally fail, especially from a service standpoint.* Employer-provided group health plans are a poor arrangement as well, ironically fostered by flawed government policy in the late 40's, when employers were limited on their private compensation policy.*

For another perspective on plans that really would work better, consider studies at http://www.cato.org/healthcare/index.html

Quote:
Not clear what your real-world experience in this area has been but, reimbursement levels aside, Medicare reimburses more efficiently than many private carriers.
I'll clear it up ... I've been on the payer side for 30 years in financial management, with 20 years as a CFO.* Analyzed and managed the installation of many plans in that time, for companies up to $1.4B in size.

We've not had a truly private system in all that time ... all group health plans, insurance companies and employers are hobbled by various regulations and tax law.* Interesting that as a physician some of your first comments in response are to recap the reimbursement policies.

The challenge for most of us is quality and cost.* Again, fairly review the reports coming out of Great Britain and Canada, to name two.* I don't hear a lot of good reports on quality from those countries, or timeliness of care.

We went very wrong when employers and insurance companies became the customers for health care ... when patients are truly the customers, seeing and paying the tab, the normal market forces can begin to work.*

Frankly, there are too many participants in the current system that prefer the lucrative situation that results from insulating the system against market forces.* To the extent anyone has tried to introduce market-based reform, the left has often successfully hobbled those efforts, and made it difficult or impossible for them to bear fruit.* Health care providers (like teachers ...) are loathe to embrace a system where their efficiency and quality are rated and broadly publicized.* And now those approaching retirement are tempted to take the AARP approach of taxing everyone to cover their health care downside.

Ironically, our current group health consultant tells me that HSA's are now starting to really blossom.* Perhaps there is some hope after all.

I'm surprised that so many successful investors on this forum, taking personal responsibility for their futures, would hold the notion that government health care is a great idea.

Take care.

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Re: Americans want universal health coverage
Old 06-11-2006, 02:15 AM   #78
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Re: Americans want universal health coverage

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Originally Posted by Martha
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,
  • The plural of anecdote is not data. I can also tell you sad personal stories, like about a friend who had an aneurysm and went in for surgery, but was put on the government waiting list and by the time her turn came up, her condition had worsened, the surgery required was far more risky, and she died. No story, however sad, is going to provide the answer to the difficult question of health care.
  • Tying health insurance to jobs may indeed be a major problem. I was discussing the theoretical issues of health care and not the U.S. system, which I don't think I'd particularly care to defend.
  • The way you describe your friends, it sounds like they couldn't afford health care and therefore, according to what I was saying, should receive it from the government -- since they weren't among those with fancy houses and all that who go without insurance. Again, I'm sure it doesn't work that way for real in the U.S., but I wouldn't want to find myself in the thankless position of defending the current U.S. health care setup.
  • Yes, I do walk the walk. I'm not exactly getting rich working for a non-profit, and I volunteer and donate quite a bit.
  • I went out drinking tonight, so this post is probably kind of incoherent. Also, that's why it's in bullet form -- easier to concentrate on.
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Re: Americans want universal health coverage
Old 06-11-2006, 03:50 AM   #79
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Re: Americans want universal health coverage

Re: "Hillary care"
Quote:
To make the plan palatable to some on the right, it mandated employer provided health insurance through regulated HMOs.
Well this made me laugh, because it's egg-ZACTly the new plan in MA which Republican governor Mitt Romney "came up with"! ...and he has an extremely pro-business background and mindset. But just put the name "Hillary" in front of anything, even anti-flag-burning, and it's instantly a non-starter.* If she's for it, they're against it.

OAP, as far as appointments are concerned, when I was paying $700+ a month to an HMO, I would usually get appointments for 4-6 weeks out. Now I can just walk down the street and drop in.

Both systems have horror stories; both systems have bureaucracy. But I'm not sure how the arrogant, punitive attitude that some posters have evidenced is going to resolve anything. Government deals with a lot of communal services that benefit everyone. Are the anti-single-payer folks also hankering for every road to be toll road? No public schooling ("I don't have kids, so why should I pay?") Police and fire assistance only if you can pay cash? ("Hey, I'M careful.. MY house isn't gonna burn down. Why should I pay for firefighters that are gonna save someone ELSE's house?"). Give me a break!

As Rich pointed out, there is a huge $ cost AND a huge social and psychological cost in the precarious system the US has now. The US is the ONLY developed country w/o a universal health care system.. but that's because everyone else in the world is "otherwise intelligent" (i.e., stupid)?* Razztazz, you are right on re. the American attitude. If it's NIH they don't wanna know about it.

Poboy, I'm glad you were able to work hard and reach your "goal" of being able to pay for health insurance. But it just doesn't sound to me like something only a few should be able to attain. You make it sound like a hard-won prize (which indeed it is) but I find something intrinsically disturbing in that being the "normal" American situation.

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Re: Americans want universal health coverage
Old 06-11-2006, 07:38 AM   #80
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Re: Americans want universal health coverage

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Originally Posted by 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
'
That was Kerry's proposal.
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