Health Care Reform

[Rich_by_the_Bay]

I haven't seen a thing that prevents a person from buying care with their own $$$. I think any insurance should pay for care likely to restore health, if a person wants to pay out of pocket for care not covered by insurance (public or private) that is just fine..

If only it were true, Brat. It is actually illegal to charge a patient for services which are deemed "unnecessary" by the medicare intermediary even if you and the patient agree they would be desirable. You can do so if the service is deemed "uncovered" rather than "unnecessary" but even that requires a written waiver by the patient that they know it is likely to be denies before the fact (!?). Of course, you can spend hours arguing with the sophomores at the Medicare office to convince them they are wrong (they rarely budge and don't understand).

So, cosmetic plastic surgeons can get very wealthy fast since nothing they do is covered. Not so with internists or other cognitive specialties. It's Byzantine.

 

[samclem]

If only it were true, Brat. It is actually illegal to charge a patient for services which are deemed "unnecessary" by the medicare intermediary even if you and the patient agree they would be desirable.

Wow. If the patient wants the service and is willing to pay for it, and the provider wants to do it, and nobody submits a bill to Medicare, I wonder what rationale the government has used to make it illegal? Maybe there could be complications that Medicare would have to cover?

 

[Corato]

Rich in Tampa is correct. My father was just told that earlier this year and it was not a procedure with risk it was a diagnostic procedure. The doctor refused because he said he could loose his license even after being offered cash up front.

 

[youbet]

If only it were true, Brat. It is actually illegal to charge a patient for services which are deemed "unnecessary" by the medicare intermediary even if you and the patient agree they would be desirable. You can do so if the service is deemed "uncovered" rather than "unnecessary" but even that requires a written waiver by the patient that they know it is likely to be denies before the fact (!?). Of course, you can spend hours arguing with the sophomores at the Medicare office to convince them they are wrong (they rarely budge and don't understand).

So, cosmetic plastic surgeons can get very wealthy fast since nothing they do is covered. Not so with internists or other cognitive specialties. It's Byzantine.

Rich, Brat's post clearly referred to "uncovered" treatments but I found your comments about "unnecessary" treatments very interesting.

Were you referring only to Medicare pronouncements that a treatment is "unnecessary" or would private insurance pronouncements of "unneccesary" have the same effect?

 

[Rustic23]

I have always cautioned 'be careful what you ask for'. Remember the system Rich talks about is a U.S. Government run health care system.

 

[DblDoc]

The problem right now is the president and leaders of the house and senate want government run health care period. Anything else they say is a lie. Government run health care will be rationing period. They will let us die when we get over XX age.

Any form of health care that doesn't ration care will eventually require too much of our GDP to be sustainable. There has to be limits to the care we provide. As a society we must decide what is appropriate and how much to spend. I have not seen anything to address this issue in the discussion as it is politically unpalatable.

DD

 

[ziggy29]

Any form of health care that doesn't ration care will eventually require too much of our GDP to be sustainable. There has to be limits to the care we provide. As a society we must decide what is appropriate and how much to spend. I have not seen anything to address this issue in the discussion as it is politically unpalatable.

The problem is that what we want (for the most part) is health care that is top quality, not rationed and affordable. I don't think it's possible to have all three. At least one of these has to be sacrificed somewhat.

No matter what we do in terms of reform, we have to be reasonable enough to accept that we can't "score highly" in two of these three inputs without falling on the third.

Top quality and unrationed care is unaffordable.

Top quality and affordable care will be rationed.

Unrationed and affordable care will likely be lower-quality.

Pick any two.

 

[Texas Proud]

The problem is that what we want (for the most part) is health care that is top quality, not rationed and affordable. I don't think it's possible to have all three. At least one of these has to be sacrificed somewhat.

No matter what we do in terms of reform, we have to be reasonable enough to accept that we can't "score highly" in two of these three inputs without falling on the third.

Top quality and unrationed care is unaffordable.

Top quality and affordable care will be rationed.

Unrationed and affordable care will likely be lower-quality.

Pick any two.

And this is where some people diverge... unaffordable to whom?

For some reason people what everybody to have the same level of healthcare in the country... why?

I have better housing than most, I have two nice cars and one beater... maybe better than most, I get paid better than most... and there are many on this board that have all of them better than ME...

Why would we expect someone with minimum wage skills get the same healthcare as a multi-millionaire?

In reality, we already have a multi-tiered system... if you are on Medicaid, you do not get the same level of service... let's just bring it to the open and deal with it...

Then we can choose which of the two as a nation we want.. and the rich can pay the difference and have all three...

 

[ziggy29]

Then we can choose which of the two as a nation we want.. and the rich can pay the difference and have all three...

Well, sure -- I'm talking about on a national "universal coverage" level, not that everyone will necessarily be required by law to have the same standard of care. Something will have to give for "the masses," and those who can afford to trade in their Chevy for a Cadillac can do so if they desire.

 

[Brat]

Humm. So this only impacts insured covered by Medicare??

One issue is that trust in physicians has decreased as some have ordered tests in which they have financial interest.

Frankly I would prefer that a patient have the choice of paying for some services directly BUT I think physicians should make full disclosure of any risks, financial interests, and maybe have a peer review of the advise before the patient signs on. It is sad to say that not all physicians have only the patients interest in mind.

 

[HFWR]

Sen. Gregg throws his hat into the ring...

Op-Ed Contributor: Health reform possible without growing government - Yahoo! News

 

[mews]

Nichlos Kristof in today's New York Times has a column that, referring to an ad campaign by the insurance companies, included this phrase:

...as a plot to create a Canadian-style totalitarian nightmare, and you feel a wee bit scared.

I howled. Sorry, my Canadian relatives, but I did.

ta,
mew

 

[ziggy29]

...as a plot to create a Canadian-style totalitarian nightmare, and you feel a wee bit scared.

I howled. Sorry, my Canadian relatives, but I did.

I've always said you have to watch out for those jackbooted totalitarian Canadians.

 

[lets-retire]

If only it were true, Brat. It is actually illegal to charge a patient for services which are deemed "unnecessary" by the medicare intermediary even if you and the patient agree they would be desirable. You can do so if the service is deemed "uncovered" rather than "unnecessary" but even that requires a written waiver by the patient that they know it is likely to be denies before the fact (!?). Of course, you can spend hours arguing with the sophomores at the Medicare office to convince them they are wrong (they rarely budge and don't understand).

So, cosmetic plastic surgeons can get very wealthy fast since nothing they do is covered. Not so with internists or other cognitive specialties. It's Byzantine.

The art in bold is another of the many reasons why a nationalized plan is not a good option.

 

[mews]

I've always said you have to watch out for those jackbooted totalitarian Canadians.

"Hi, we're here to loudly and viciously impose .. oh, you're still eating breakfast. Well, we'll come back in a bit, eh?"



ta,
mew

 

[george76]

My point is that it could be much worse... and cost a lot of money that we will not pay, but make our children and grand children pay...

From my own experience having lived under both the US system and under a nationalized health care system, my answer is easy. We can't, as a nation, possibly do any worse than we are now. Have you lived under both systems? If not, what do you base your facts on?

Furthermore, if we don't do anything our children and grand children will pay far more than they would now. Our insurance premiums are going up by double digits annually! How much do you think they will be when it is time for your grand-kids to pay them?!

At a previous small company I worked for, our health insurance expenses for our employees were becoming bigger and bigger each year. It reached a point where we no longer were as competitive against international companies when it came to bidding for contracts. As a matter of fact, we lost one contract to a French company because our costs were too high, partially relating to our higher health care costs for our employees. Don't you want our companies to be able to compete against French companies?

KeithHennessey.com
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• Another 10.1 million do not fit into any of the above categories, and they have incomes more than 3X the poverty level. For a single person that means their income exceeded $30,600 in 2007, when the median income for a single male was $33,200 and for a female, $21,000. For a family of four, if your income was more than 3X the poverty level in 2007, you had $62,000 of income or more, and you were above the national median.
• Of the remaining 15.6 million uninsured, 5 million are adults between ages 18 and 34 and without kids.
• The remaining 10.6 million do not fit into any of the above categories, so they are:
  • U.S. citizens;
  • with income below 300% of poverty;
  • not on or eligible for a taxpayer-subsidized health insurance program;
  • and not a childless adult between age 18 and 34

Just because someone has access to health insurance, doesn't mean they can afford it as you are insinuating. A neighbor was laid off from his job about a year ago. With the job market tight, he saw this an opportunity to start his own business. Well, do you know why it didn't work? Health insurance for his own business would run a whopping $18,000 a year for him, his wife and four children. Insane! So, yes, I guess you are right when you stated that he had access to health insurance and thus we should not care about him. It is his own fault...

I can give you countless of other scary stories that don't show up in your neat statistics.

By the way, those statistics you quoted don't say a word about people that are insured but terrified that they will lose their job and no longer have coverage. How do you think my friend with MS feels? How do you think she will pay for her treatments for MS if she loses her job? From a friend's perspective, it is almost like she is now a slave to her job because without it there is no way she can ever pay for the MS treatments.

I have read some of the postings on this thread trying to scare the rest of us as to what will happen if we adopt a Canadian like health insurance system. Who the heck says that we need to copy their system? Why can't we take a combination of the best from the US/the French/the Canadian etc?

 

[lets-retire]

George--I too have lived with both systems. I couldn't disagree with you more. Your argument that the government couldn't do much worse is a poor argument at best. Assuming the government provides the same level of treatment for it will still be more expensive. You keep telling partial stories about how bad the system is. You conveniently forget to include specifics. I could go out right now and price insurance policies for me and my youngin (the DW has serious pre-existing conditions that would most likely preclude her from obtaining insurance on the private market) and say health insurance is too expensive. On the other hand I could just as easily go out and find a policy that is much more reasonably priced that will cover me and the son just as well, with me paying for more of the routine coverage. Two big determining factor in the prices of insurance is what is covered an the type of policy. An HMO is normally relatively inexpensive, but you have a lot of restrictions on what they will cover and which doctors you can see. On the other hand if you go with a "cadillac plan" it will be much more expensive, but you have more options for doctors and it will cover more treatments.

You keep quoting what the insurance companies have not covered, but consistently fail to mention the type of policy, the amount you are paying, whether the treatment was an accepted treatment or experimental, etc. You also quote policy prices, but fail to mention type of policy, how much flexibility the policy provides the purchaser, types of deductibles, etc. There is a reason most companies don't provide policy information online. There are riders, exclusions, etc that will change the price of the policy for the good or bad.

I was paying for Cobra a few years ago my bill was just short of $1000 per month. The company that the DW worked for that provided the insurance was not that large. The policy was decent but by no means a "cadillac plan," but it provided good coverage. Taking away the discount for the company size the policy probably should have cost maybe $1500 per month. I've had much better policies, that cost much more, and I've had much worse policies that cost less. From what I've seen, the only time I would pay for a cadillac plan is if it were provided as part of my compensation. I don't see the need for insurance to cover my routine doctor's appointments, they aren't that expensive. Just dropping that provision would result in a much lower cost. Me and the MIL work for the same entity. She opted for a policy that requires her to pay more of her medical bills, but she and her family don't have many bills. Due to the DW's medical issues if I chose that plan I'd be broke within two years, so I opted for one that covers quite a bit more. As a result of this decision I pay roughly twice what my MIL pays, but it is simply prepaying medical bills in the form of insurance payments.

 

[Texas Proud]

From my own experience having lived under both the US system and under a nationalized health care system, my answer is easy. We can't, as a nation, possibly do any worse than we are now. Have you lived under both systems? If not, what do you base your facts on?

First, I do not think you need to live under both systems to understand the systems... but for some reason you do..

I am saying that the US gvmt is saying they want to spend hundreds of billions of dollars for healthcare... to provide insurance for 'the uninsured'.... so, all that is happening is that the people I presented would go into basically our system and we would pay for it... I do not see where the is a corrisponding REDUCTION of my cost of providing insurance for MY family... so, it cost more.

Now, show me where they are going to IMPROVE the system? What rules and regulations will they pass to make it better? If there are some, just pass them and let the private sector take care of the rest... I do not want my government telling me what I can and can not do for my healthcare... at least not more than it already does...

Furthermore, if we don't do anything our children and grand children will pay far more than they would now. Our insurance premiums are going up by double digits annually! How much do you think they will be when it is time for your grand-kids to pay them?!

Something will be done before then... I just do not believe that the gvmt taking over and paying for everything is the right way to go.

As a matter of fact, we lost one contract to a French company because our costs were too high, partially relating to our higher health care costs for our employees. Don't you want our companies to be able to compete against French companies?

Yes... and they do... there was probably something else besides healthcare that lost the contract.... I can not see where someone said 'Well, we would have picked you except that your healthcare costs were to high, so we are going with the French company that has lower healthcare costs'. Your company could have been paying its CEO and top executives huge salaries... or had to many people... or who knows what...

BTW, it seems that Honda, Toyota, BMW etc. etc. thinks that it is not a big problem to pay the insurance and have their cars assembled here.. instead of Japan, Germany etc. (say, where are those French cars?)

Just because someone has access to health insurance, doesn't mean they can afford it as you are insinuating. A neighbor was laid off from his job about a year ago. With the job market tight, he saw this an opportunity to start his own business. Well, do you know why it didn't work? Health insurance for his own business would run a whopping $18,000 a year for him, his wife and four children. Insane! So, yes, I guess you are right when you stated that he had access to health insurance and thus we should not care about him. It is his own fault...

So he fits into the first of the uninsured... I pay $8,400 a year for my family... and have a $4,500 deductible policy... and yes, I think it is way to high... I still do not want my gvmt to spend 100s of billions.. when I do not know if my costs will go down or not....

I have read some of the postings on this thread trying to scare the rest of us as to what will happen if we adopt a Canadian like health insurance system. Who the heck says that we need to copy their system? Why can't we take a combination of the best from the US/the French/the Canadian etc?

OK, what are the best policies I do not think it is single payer...


OHHH... and by the way.. to answer your first question... yes, I worked in England for a bit more than a year... fortunately for me I did not have to go through their system... but I heard some horror stories about it... and did you know that back in 2000, one of the biggest new company perks that was starting to come out in England was private insurance? Seems that some of the investment banks etc. were trying to lure people by providing them with 'better' health care..

And I will give you and example... My girlfriend came over to the US and got sick... I said let's go to the doctor as she had paid for travel insurance... she said she did not have the time to wait etc... Well, we called up, went in to see a doctor... he did the tests, gave prescriptions and we were out of there in a couple of hours... She said that in England she would have to have waited a couple of days... this is rationing of service which so far we do not have for a lot of people here..

Also, have you seen their teeth? A lot of people had bad teeth... I guess this is not covered over there...

 

[Brat]

"Also, have you seen their teeth? A lot of people had bad teeth... I guess this is not covered over there..."

It's not covered here either.

 

[Gone4Good]

I guess I'm more optimistic that private businesses would offer a lot of efficiencies and enhancements to services.

And I guess I'm a little less optimistic because I haven't seen any evidence of that in NJ.

An observation: We don't have a free market today.

Completely agree.

If we fix things so that insurers are competing for the business of the public directly, there's every reason to believe they will become more responsive and that people will be happier with their health care.

But here, not so much. As with all insurance, your claim is considered a loss to the provider. The insurance industry in general has made a business practice out of delaying and not paying claims. Notwithstanding all of the advertising to the contrary, I've yet to see an insurance company (whether auto, home, health, etc) that cares about customer service when it actually comes to paying claims. And with health insurance, the company is almost always paying claims.

All of which makes me think. If an insurance company is forced to take all applicants and charge them exactly the same price, wouldn't it make sense for the company to internally segregate the profitable customers from the unprofitable ones and direct customer service resources only to its better customers? The healthy 20 year old gets gold plated service in order to keep him happy, while the cancer patient waits on hold for an hour and a half because the insurance company hopes he'll eventually get fed up and switch to another provider.

 

[Gone4Good]

Government run health care will be rationing period.

We ration health care now. Every market system controls demand by pricing some people out of the market. For example, not everyone can afford a Mercedes. And that's as it should be. But what is the health care equivalent of a Mercedes? Heart by-pass surgery? Chemotherapy?

The truth is that if we want care to be affordable, demand has to be curtailed. You can either do that with a pricing mechanism which limits care to only those who have money, or you can limit care administratively. One way or another we will, and we do, limit care. The only question is, how should it be limited.

 

[lets-retire]

Here's a thought I had. The most recent figure I saw estimated health care at 18% of the GDP of the US. Using 2007 figures that works out to 2.78 trillion dollars, or roughly 8200 per citizen in the US. This dollar amount includes elective surgeries that would not be covered by insurance anyway. The plan being floated by the administration has several price tags going as high as 1.5 trillion dollars. My thoughts are that price tag is extremely low. I've not seen too many government programs come in at or below budget, most are extremely over budget. Does anybody else think 1.5 trillion dollars is an acceptable price tag to provide health insurance for the roughly 46 million people who are not covered. When you consider many of those not covered are completely capable of providing their own insurance, but choose not to, many in the survey are not US citizens and are not in the country legally, and many in the survey are already eligible for some form of government health care, but just have not gone in and signed up for it? I think the price tag is way too high.

 

[george76]

You conveniently forget to include specifics. I could go out right now and price insurance policies for me and my youngin (the DW has serious pre-existing conditions that would most likely preclude her from obtaining insurance on the private market)

You keep quoting what the insurance companies have not covered, but consistently fail to mention the type of policy, the amount you are paying, whether the treatment was an accepted treatment

Exactly. Your DW and my friend has same the problem. Pre-existing conditions. Not covered. What more is there to stay. If you are healthy or have money, our system works great.

No, I didn't conveniently forget to include specifics. I thought I already done this. I had regular employment. The lack of coverage was not for anything experimental. As a matter of fact, the doctor was surprised they wouldn't cover it.

But it is rather interesting that you make this entire debate about my little situation. It sounds like you aren't familiar regarding how common this problem is.

The bottomline is that we are being told scary stories about how bad it will be when the government takes over with rationing etc. We already have rationing.

Take care.

 

[george76]

Yes, they had private insurance in the country I was temporarily in as well, Sweden. So, they had nationalized health care for everybody. But they also allowed for private insurance for people that wanted to skip the waiting lines. While certainly not perfect, it worked. Everybody was covered, and there were ways to get around the waiting lines. And yes, they covered your teeth.

You stated that you don't want the government telling you what you can or cannot do regarding health care. The insurance industry is already doing this. Again, I had coverage denied. My friend is a slave to her job. She can never get private health insurance because of her pre-existing condition. She is being told what to do. Unlike Europeans who can move around without having to worry about healthcare, my friend is a slave to her job.

You stated that "something will be done before then" regarding our health insurance premiums going every year? OK - Like what?

It is interesting to hear you trying to come up with reasons to why we lost our contract to the French company. We had internal reviews afterwards regarding what took place. Our cost structure was very similar to our foreign competitors. Except for our benefit program. We very competitive with US competitors but not European ones. You can believe what you want. I actually worked there and know what happened. We had to lay off 10 people as a result.

Why do you think those foreign companies want to produce cars here? The states of Alabama etc are giving them subsidies paid for for by the US taxpayer. Yes, indeed, we can't afford to pay a dime in health care to our own people but we can afford to give subsidies to foreign car manufacturers. Interesting priorities, don't you think?

This will be my last posting on this subject. There is not much to add. Let's hope that whatever happens, health care reform will happen and will be meaningful.

Take care.

 

[Gone4Good]

The plan being floated by the administration has several price tags going as high as 1.5 trillion dollars. . . . Does anybody else think 1.5 trillion dollars is an acceptable price tag to provide health insurance for the roughly 46 million people who are not covered. . . . I think the price tag is way too high.

As reported in the NYT, the assumption is $1 trillion over 10 years . . .

Mr. Obama has insisted that his plan will not add to the federal deficit, and he had already set aside in his budget what he calls a $635 billion “down payment” toward the overall 10-year cost of the overhaul, which is expected to top $1 trillion.

http://www.nytimes.com/2009/06/14/us/politics/14address.html?hp

So even using the $1.5T number, over 10 years, for 46MM people, comes out to about $3,200 per person per year.