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Re: Krugman on Health Care Crisis
Old 03-06-2006, 11:29 AM   #21
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Re: Krugman on Health Care Crisis

Quote:
Originally Posted by Cute n' Fuzzy Bunny
We dont have health care. We have sick care.

And I think the health care providers ratchet up the 'standard price' so that they can offer a good discount to the insurance company negotiators when they both show up at the table.
Of course. Everyone wants a discount, with Medicare/Medicaid wanting the biggest discount of all.

Read an article a bit ago about Amish communities negotiating with their local hospitals for lower prices. They couldn't get the cash price lower than the medicare price because that may be viewed as medicare fraud.

At least the feds have now told hospitals that they can offer some discounts off the full price to the uninsured without violating medicare rules.
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 11:33 AM   #22
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Re: Krugman on Health Care Crisis

Somewhat on topic, has anyone tried out any of those 'health care cards' for medical, pharmacy and dental that appear to offer the insurance company price for the uninsured? Do they really work? The cynical slice is telling me that they have a list of doctors you have to use, all of which are like one of the two doctors on the simpsons...
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 11:40 AM   #23
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Re: Krugman on Health Care Crisis

Quote:
Originally Posted by MasterBlaster
Right now we have great medical care and can get it on demand but at very high pricescare...
It's not that easy to measure the quality of health care. We have great technology (if you have $) but after stripping away the health-consequences of a good societal infrastructure (e.g. water, sanitation, food inspection, etc.) our outcomes are probably no better than most developed countries, and maybe a bit worse.

Everyone has stories, but the life expectancy, neonatal mortality, disease outcome evidence etc. are available. Is it bad to wait 6 months for a hip replacement in Canada v. 2 weeks here? Yes, of course, but at the risk of breaking the economy, disrupting retirement plans, or making otherwise able workers postpone retirement due to obscene health insurance costs, I don't know.

Believe me, I am no radical in such matters. Our system has kernels of brilliance, but a whole lot of mud.
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 11:43 AM   #24
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Re: Krugman on Health Care Crisis

Good post Rich.
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 11:44 AM   #25
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Re: Krugman on Health Care Crisis

Quote:
Originally Posted by Cute n' Fuzzy Bunny
Somewhat on topic, has anyone tried out any of those 'health care cards' for medical, pharmacy and dental that appear to offer the insurance company price for the uninsured?* Do they really work?* The cynical slice is telling me that they have a list of doctors you have to use, all of which are like one of the two doctors on the simpsons...
http://www.simpsons-crazy.co.uk/DrNick.html

you must be thinking of dr. nick.
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 12:09 PM   #26
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Re: Krugman on Health Care Crisis

Or hibbert. Anyone who giggles inappropriately right after telling you that you've got incurable cancer isnt quite right in the head either...
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 12:57 PM   #27
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Re: Krugman on Health Care Crisis

I'm pleased with the response to this topic!* It's amazing how the Krugman article dovetailed so well with the 60 Minutes 'cost of hospital care to employed wage earners without health insurance' clip.*

I don't know if the Krugman proposal is feasible... but, I know the Health Care System we have now costs a whole lot and increasingly leaves out a sizable portion of the population.* The US govt pays for approximately half the health care in the US (in the form mainly of Medicare and Medicaid)* and yet large numbers of people are left completely out of the system.* Meanwhile, the per capita expenditure of the US is twice what other countries are paying.*

Krugman*
Quote:
The US health care system is more privatized than that of any other advanced country, but nearly half of total health care spending nonetheless comes from the government. Most of this government spending is accounted for by two great social insurance programs, Medicare and Medicaid...

...Medicaid has grown rapidly in recent years because it has been picking up the slack from the unraveling system of employer-based insurance. Between 2000 and 2004 the number of Americans covered by Medicaid rose by a remarkable eight million. Over the same period the ranks of the uninsured rose by six million. So without the growth of Medicaid, the uninsured population would have exploded, and we'd be facing a severe crisis in medical care...
...

In past HC topics in this forum we have identified several potential reasons for the US* per capita expenditures, including excess paperwork and overhead.* Krugman also discusses these in the article.

Quote:
...The cost advantage of public health insurance appears to arise from two main sources. The first is lower administrative costs. Private insurers spend large sums fighting adverse selection, trying to identify and screen out high-cost customers. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.

At the same time, the fragmentation of a system that relies largely on private insurance leads both to administrative complexity because of differences in coverage among individuals and to what is, in effect, a zero-sum struggle between different players in the system, each trying to stick others with the bill. Many estimates suggest that the paperwork imposed on health care providers by the fragmentation of the US system costs several times as much as the direct costs borne by the insurers...]...

Best regards

JohnP
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 05:45 PM   #28
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Re: Krugman on Health Care Crisis

Quote:
Originally Posted by Nords
Anyone recommending the VA as a model for nationwide healthcare must be carrying their own personal insurance.* Or else they're planning to use Bumrungrad for the big stuff.
Nords, if you go to a military hospital, your care is both paid for and delivered by the government. And TriCare has the social insurance model of Canada, Germany, etc. Which is, incidentally, the model Krugman put forth before he discusses full government provision of care with providers as employees-- same as in a military hospital like Walter Reed or Bethesda or Madigan. So you have dorect experience with these, and I assume that you are satisfied. At least satisfied enough that you are not planning to go into the individual market.

The part I canít understand is what evidence suggests that the USA, paying twice as much as France, for less care, can possibly be doing a good job for its citizens or taxpayers. It doesnít matter how you measure care- use lifespan, use number of visits, use consumer satisfaction, France is ahead. And they arenít the only country either.

Regarding VA care, my buddy has hereditary spherocytosis, a blood disease. The VA correctly diagnosed him, gave him a splenectomy, and monitors and cares for him subsequently. He has work insurance, but prefers what he gets at the VA- most of whose Docs also have academic appointments.

Quote:
Originally Posted by MasterBlaster
Right now we have great medical care and can get it on demand but at very high prices and without access for everyone in the country.

My take on government run (or single payer) medical care is that there will be high medical access for everyone but at a cost of quality and on demand service.

So those other countries trade quality and timeliness for widespread access. Maybe that's a choice we should make. But at least let everyone know the trade-offs we will be making and have an even-handed debate.

Think US Post Office like service when you think of government run or single payer medical care. It gets the job done but you may wish the service and the timeliness was better.
You must not have read Krugman's article. Every knee jerk ditto head parrots this same tired and inaccurate line: ďWe have great care, and that is why is costs so much.Ē At least read and attempt to understand the article. I am only interested here because I have some hope that people who are going to be voting will have a full range of facts, and the information to see how our current system is out of keeping with our ideals as a democracy. Democracy requires some degree of social justice, and this medical situation is a clear violation of social justice. Plus, as Krugman says, it is horribly inefficient.

We will get social insurance anyway, the meltdown of employer provided insurance will see to that. But why not do it now, and save a lot of money and heartache?

And regarding the post office - try to get 6 day a week delivery to the remote places where a fair number of us live, for 40 cents no less, from anyone else other than the post office. My mail lady bags packages that she has to leave. The clod from UPS throws them on the ground in the rain. This is spite of repeated calls to the UPS office. All in all, I'll take the post office for most things.

Ha



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Re: Krugman on Health Care Crisis
Old 03-06-2006, 06:00 PM   #29
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Re: Krugman on Health Care Crisis

What's with all this hostility ?

Are you are calling me a "knee jerk ditto" ??


Our system has alot to be desired and there is lots of room for improvement. There is a trade-off to be made here. Maybe we should have a great debate about what kind of system we want.

However if you believe that everyone can have the same level of care and pretty much immediate access then in my "knee jerk" opinion you are mistaken.



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Re: Krugman on Health Care Crisis
Old 03-06-2006, 07:19 PM   #30
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Re: Krugman on Health Care Crisis

Quote:
Originally Posted by Nords
Anyone recommending the VA as a model for nationwide healthcare must be carrying their own personal insurance.
I too wonder how many of those advocating single-payer, Canadian or European, style systems have actually experienced them first hand. Although I only have experience with the US system, I have heard many complaints from ex-pat friends about their inability to see doctors, get up to date medications or procedures, etc. etc. One friend actually waits until her periodic trips back to the states to see the doctor for routine exams.

Is there anyone here who has actually experienced both systems and has an informed opinion about the benefits / drawbacks of both?
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 07:42 PM   #31
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Re: Krugman on Health Care Crisis

Just my experience
I have Japanese national health insurance and am satisfied. I pay 150 dollars a month plus a 20% copay. The govt pays the rest. You can choose your doctors. Some doctors donít know anything and there is a lot of malpractice.* I had some problems with a doctor mistreating me for my asthma. I also had a dentist who relied on laser technology over skill. The average doctor is better in the States. But there are enough good docs that if you are careful it is fine. Now I basically choose doctors with foreign licenses. My eye doctor and dentist both graduated from top US universities. My generalist graduated from a Japanese university but he knows his stuff and I trust him.*

The insurance will pay for eye exams but not glasses, dental visits but not orthodontics. I also get a yearly check up free (that may be employee sponsored) but I would have to pay 100 dollars (?) for a more intensive check up at a hospital. It also covers drugs. An MRI is 100 dollars. It will also pay for emergency treatment when I am overseas.

I havenít gone far into the system but my experience has been basically service on demand. However, you do have to wait for good doctors. My FIL had to wait a month for his cancer surgery because he wanted to do it at Kyoto University Hospital with a specific surgeon. I had to wait 2.5 hours to see my eye doctor.

I used to wait to go back to the states to get care but as my Japanese language skills have improved and I have learned to choose my doctors, I havenít felt the need to wait.

Also, I am not sure but you probably are not going to get the most advanced treatment or procedures in Japan. I think they are more focused on bang for the buck over buck for the bang.

Mike
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Re: Krugman on Health Care Crisis
Old 03-06-2006, 08:07 PM   #32
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Re: Krugman on Health Care Crisis

I live under the US system with a "good" HMO Kaiser. I had social medicine with the Navy and when I was living in the UK and I have relatives in Canada. There are problems in each system but overall I would take Canada as the best of the lot. In the US I think we pay too much, have too much defensive medicine and far, far too many uncovered people. I think there would be a big boost to the economy if we had national medicine and small businesses as well as large ones could hire without paying for or worrying about and maybe not offering medical insurance.
Like defense I do not believe that medicine is purely a business. If it was I would vote to abolish all insurance and then the market would lower medical costs.
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Re: Krugman on Health Care Crisis
Old 03-07-2006, 07:10 AM   #33
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Re: Krugman on Health Care Crisis

In the squeeze:

My brother--a case of shock & awe:

He's a small businessman with private insurance that excludes his one prior condition,*back pain. But that was lower back pain from many years ago, and last year he developed a pinched nerve in his cervical (neck) spine and after his right arm went numb and he could barely move it, he had surgery to fix it. His surgeon and anethesiologist charged him the insured rate, but the hospital charged him $30,000 for his overnight stay (the uninsured rate). His surgeon is helping him fight this, but it doesn't look good.

Me--a case of fear:

I've put on weight and am afraid to have that on my medical record, so I'm way overdue for my physical. Sheesh! A middle class person with insurance afraid to go the doctor for fear of becoming uninsurable--now that's sad.
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Re: Krugman on Health Care Crisis
Old 03-07-2006, 07:23 AM   #34
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Re: Krugman on Health Care Crisis

Isnt that sort of like risking a 20% loss on your investments because you want to avoid a 1% sales fee?

Maybe you should consider paying out of pocket for a physical at a low cost provider where it wont land on your insurance companies medical records? It might suck if the weight gain was a 27lb tumor or something, or if the weight gain is from some medical condition thats curable with a diet change or a little pill or something. Not that I recommend little pills.

My wife told me yesterday that they had a woman in the hospital that had a 150lb tumor removed. Thats considerably more than my wife weighs. Amazing.
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Re: Krugman on Health Care Crisis
Old 03-07-2006, 07:39 AM   #35
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Re: Krugman on Health Care Crisis

Quote:
Originally Posted by Cute n' Fuzzy Bunny
Maybe you should consider paying out of pocket for a physical at a low cost provider where it wont land on your insurance companies medical records?
Not sure this is something I would want to do. If I recall the health insurance application I completed, it asks for ALL records for doctor visits going back X years, and spells out that any omissions could be grounds to terminate your coverage. It would be a tough sell if discovered to say you forgot about such a recent visit.

I say go see the doc about your weight gain. There are way too many risks in not doing so.

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Re: Krugman on Health Care Crisis
Old 03-07-2006, 07:52 AM   #36
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Re: Krugman on Health Care Crisis

Fake moustache, fake name, and when you're done with the doctor visit you can drink beer do remedial maintenance on dory's server...
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Re: Krugman on Health Care Crisis
Old 03-07-2006, 07:58 AM   #37
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Re: Krugman on Health Care Crisis

Krugman's a liberal a.h.
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Re: Krugman on Health Care Crisis
Old 03-07-2006, 10:04 AM   #38
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Re: Krugman on Health Care Crisis

Quote:
Originally Posted by HaHa
Nords, if you go to a military hospital, your care is both paid for and delivered by the government. And TriCare has the social insurance model of Canada, Germany, etc. Which is, incidentally, the model Krugman put forth before he discusses full government provision of care with providers as employees-- same as in a military hospital like Walter Reed or Bethesda or Madigan. So you have dorect experience with these, and I assume that you are satisfied. At least satisfied enough that you are not planning to go into the individual market.

Regarding VA care, my buddy has hereditary spherocytosis, a blood disease. The VA correctly diagnosed him, gave him a splenectomy, and monitors and cares for him subsequently. He has work insurance, but prefers what he gets at the VA- most of whose Docs also have academic appointments.
Let's just say that the military healthcare system has inspired me to adopt "prevention" as my primary healthcare manager.* There's a reason that the Tripler Army Medical Center is referred to as "Crippler".

As for the rest of the system, the VA does means testing and the TRICARE system is preparing to triple its annual fees.* While neither of these is worth complaining about in respect to the remaining benefits, this salami-slicing does set an uncomfortable precedent to future Medicare/Medicaid benefits.*

It may feel pretty silly fighting back when there's so much good remaining in the system, but it's too late to fight back in 20 years when all you're holding is a salami string.

Quote:
Originally Posted by 3 Yrs to Go
Is there anyone here who has actually experienced both systems and has an informed opinion about the benefits / drawbacks of both?
Aye, there's the rub. And let's remember that as much as half of the American doctors graduated in the lower 50% of their medical school class.
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Re: Krugman on Health Care Crisis
Old 03-07-2006, 10:29 AM   #39
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Re: Krugman on Health Care Crisis

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Originally Posted by bennevis
Krugman's a liberal a.h.
I wonder why you think this? Is it because of some specific information that you have not apparent from his article?

Or do you maintain that publically funded health insurance is the provence of liberal a**h***s?
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Re: Krugman on Health Care Crisis
Old 03-07-2006, 10:43 AM   #40
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Re: Krugman on Health Care Crisis

Well, he IS well known as "america's looniest liberal pundit"...

As far as the a.h., I cant comment. I'm not familiar with that particular degree.
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