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Old 06-08-2009, 01:36 PM   #61
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I can't speak for anybody else. But considering my own experience I don't think it is possible we can get any worse medicine than we have now

I had severe back pain a few years ago. The doctor prescribed a traction chair to help the back get better. Some bureaucrat at the insurance company refused to pay for it, so I could not use it. I still have back pain etc.

A friend of mine have MS. As an MS patient she needs to take a daily injection of a drug. She could not use the medication the doctor prescribed, because the insurance company refused to pay for it. Instead, she had to settle for a cheaper drug the insurance company allowed her to take. The doctor was not happy, but it was this second choice drug or nothing.

Whatever health care reform we get, I doubt it will be worse than what we have today. Furthermore, since this is an early retirement board, health care reform hopefully will also eliminate the issues with pre-existing conditions. It is tough to retire with a pre-existing condition as no insurance company will touch you.

Why would you think that having a single payer system would be any better... instead of some insurance company refusing to pay, some gvmt official refuses to pay... same with the drug... what is being proposed does not address the two examples that you gave (at least IMO)...


Also, my question to you (not trying to be mean about it...)... but, if you back was hurting so much, why not pay for the chair yourself? I can tell you that I would if I could get rid of back pain...
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Old 06-08-2009, 02:10 PM   #62
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The fact that we're paying twice as much as the rest of the developed nations and 47 millions american are without healthcare speaks for itself. The current system is not sustainable.

Can we all have the same type of universal coverage and pay for the same basic coverage at the same rate the French, the German and the Brit are paying (which about half what we are paying now) and let the wealthy americans purchase additional coverage if they so desire.

What is wrong with this idea?

But WHERE are the savings that you talk about... if the gvmt is going to be paying trillions of dollars, how is it cheaper...

From all the talk, I still will be paying for my current insurance, but the gvmt will pay for all that are not on the system.... to me this is HIGHER costs...

Now, if you can say for sure that as a nation, we could cut the cost of health care in half IF we had a universal system... then I could go for that... but that is not what is in the works.... nothing even close..
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Old 06-08-2009, 02:43 PM   #63
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From all the talk, I still will be paying for my current insurance, but the gvmt will pay for all that are not on the system.... to me this is HIGHER costs...
Yep, unfortunately you belong to the group that will be paying for your dinner plus the dinner of a few others. Console yourself with the knowledge that, though you are paying for everything, we're allegedly going to get a good price on the chow.

Aside from the humanitarian, do-gooder, "it's our social responsibility" yak, there is a case to be made that the US would benefit economically to a huge degree if we can find a way to deliver health care in a more efficient manner. Right now, we don't. The employer-sponsored system is crazy--it shackles people to jobs they don't like/aren't suited for and impedes worker mobility that would significantly boost productivity. It is also inefficient (ask any health care worker who deals with the admin side of our present system). If we could find a way to deliver health care more efficiently, we'd all benefit tremendously. While health care is not exactly like other consumer commodities, I believe there are still ways to harness the free market to deliver the kind of benefits it delivers in every other aspect of our economy.

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This is a scheme that can potentially achieve the same objectives as a single payer system, but the hand of government is so heavy here I'm not sure there is much difference between this and just having the government run everything. It's possible that you get some benefit from competition among insurers but the scope of those benefits will be limited by how much leeway companies are given to compete on things other than price.
I guess I'm more optimistic that private businesses would offer a lot of efficiencies and enhancements to services. Some of the package options could be HMO-style for people willing to put up with the restrictions in order to save some money--a little free choice: if you like what you could get in Canada, it's available. People who want more options, lower wait times, access to single hospital rooms, access to a particular physician could pay more. Also (though I didn't go into it here, se previous post) I see a big role for the government as an information clearinghouse that facilitates consumer choice. If people can see how satisfied/dossatified others have been with all the insurers and health care providers they can choose from, I think consumers would be in a better position to choose an insurer (using their own money or the government voucher) and I think the insurers will increase their efforts to please customers . It's more free choice than we have now (under employer plans) and much more free choice than we'd have under a government-run plan. Though the overall amount spent on medical care in countries with socialized medicine/government-run plans is lower than the US, the problems of skyrocketing government expenditures for these services is nearly universal. Maybe we can take a different approach and avoid that headache.

An observation: We don't have a free market today. One reason health insurance providers get poor ratings from patients is that the patients are not their customers--they have only an indirect motive to serve them. Their true customers are the companies for whom the patients work. The companies care most about lowering costs. 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. I don't see this dynamic coming into play if the government is running things, but that is only because I've been to the DMV and talked to the IRS.
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Old 06-08-2009, 02:51 PM   #64
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YThe employer-sponsored system is crazy--it shackles people to jobs they don't like/aren't suited for and impedes worker mobility that would significantly boost productivity.
I would go even further than that: specifically, not just that it impedes worker mobility, but it stifles the entrepreneurial spirit. It's scary enough to quit your job and follow your dream or pour your heart, sweat and guts into a new business or a new idea. Losing a sure-thing paycheck for a high-risk, high-reward venture is a big decision. And it's made that much harder by the way the employer-provided health insurance model shackles one to their employer.

I have to think the employer-insurance model has been increasingly causing a drain on the primary engines of economic growth in recent years -- entrepreneurism and small business.
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Old 06-08-2009, 02:58 PM   #65
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When a new graduate or when a doctor wants to move to and ,say, work in Vancouver, he/she has to get a billing number from the province. The province had routinely been denying those numbers in places where they deem there is an oversupply of doctors. You can get a billing number without difficulty if you want to go and work as a doctor in the Northern parts of any province, where it is extremely cold, underpopulated and underserviced, but you will have a hard time if you want to work in your profession in Vancouver,Toronto, Montreal and so on. .
atlas,
I'm not suggesting that the Canadian system is one anyone should follow. I am suggesting that some of your comments here are out of date, exaggerated or both.

The above statement was true 10 years ago in the general Vancouver area only. I don't believe it is true today. Even then, a doctor could choose to 'opt out' of medicare and bill patients directly. That is why I suggested you consult meadbh, who is a practising doctor in Canada.

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Physicians in Canada may be the only group that have no choice as to where they want to work and raise a family.
This suggests that physicians are told where they must go to practise. Even when BC stopped handing out billing numbers, this limited them to places that weren't Vancouver. While choice 1 may have been unavailable many other choices were left.

Re: malpractice
I think insurance rates are lower because (due to differences in the legal systems) doctors are sued less, win more cases when sued and awards are lower when they lose.

Once again, I'm not advocating the Canadian system. I'd be dollars ahead if I had paid for all of my family's care and not paid the portion of tax that went to fund it. The Canadian system is what it is. Let's just be accurate when we describe it.


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So you think an average combined rate of 45% for federal and top provincial tax is fine.
Actually I said the average top marginal rate and I didn't say I liked it. While I believe US rates are generally lower, I wouldn't want to pay NYC income tax.
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The maximum rate in the city limits of New York City (as of 2007[update]) is therefore 47.14%
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I do not know where your rosy number of 2 billion dollars in Canadian government deficit came from ( you said last year). For 2008 it is $50 billion and it was a record.
The number comes from here. 2009 will be a record.
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Old 06-08-2009, 03:44 PM   #66
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Like I said, this discussion is taking on a of tone about government policy and politics and may be better if it takes place in the political discussion in the other section. But at the risk of the moderator's displeasure:

I left Canada in 1990 after college and graduate school, that was the situation back then. Despite the many controls the government placed, such as billing number control and annual billing limits, there was still runaway health care cost. The draconian controls got to the point where doctors refused to take on more patients, going on rotating strikes etc. ( see articles) And many doctors left the country.

The physicians could not opt out of the government health care system at that time. Things changed somewhat in 2004 after the Canadian Supreme Court decision. But you can read from many sources ( in newspapers, McLean magazine , and on TV) that the Canadian health care system is a shadow of what it was intended to be. It is hard to compress a relatively long time line into a short paragraph and information and time may be juxtaposed. Just because some utterly unfair practices are now removed does not mean that they never existed and some did not suffer injustice. If doctors can get billing numbers in Vancouver now, it is because Canada is now facing a significant doctor shortage. Central planning often backfire and have unintended consequences. I am wondering whether we are wandering down the same road.

The way government think health care cost may be controlled is to control the industry. When it is the single and only payer, it can control the pay (and underpay) of health care professionals to cut cost. It will browbeat the hospitals and drug makers into charging what the government want them to charge. One article alluded to the doctor getting C$ 20 for the patient's visit. The average salary of doctors in France was $50,000 . Doctors, being a small group, can be soaked, just like the rich can be soaked. But despite controlling doctor's, health care cost had still skyrocketed in many countries where there are government ran health care. The bureaucracy still have to be manned and there will be a lot of government jobs for paper pushers. Just hope those workers do not all end up with lifetime government pensions.

And there will not be a lot of other savings, because a disinterested bureaucrat is not likely to dispute george76 in his claim. It would save time and effort just to rubber stamp any claim, after all it is nobody's money.
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Old 06-08-2009, 04:50 PM   #67
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Well, I'm out of this thread with the following observation. If you want to post opinion, feel free. If you want to post facts, make sure that your facts are, in fact, facts.
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Old 06-08-2009, 05:58 PM   #68
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Why would you think that having a single payer system would be any better... instead of some insurance company refusing to pay, some gvmt official refuses to pay... same with the drug... what is being proposed does not address the two examples that you gave (at least IMO)...


Also, my question to you (not trying to be mean about it...)... but, if you back was hurting so much, why not pay for the chair yourself? I can tell you that I would if I could get rid of back pain...
My posting said that the new health care reform could not be any worse than the system we have today. Yes, perhaps you would have a government bureaucrat instead of some insurance bureaucrat rejecting your doctor's proposed prescription. How is that any worse? Furthermore, everybody would have now have coverage. So, by default it would be better.

By the way, I spent a couple of years in Europe in a country with so called socialized medicine. I never had some government bureaucrat reject what the doctor had prescribed.

Why did I not pay for it myself? It would have been $4,000 or monthly payments in excess of $250 for years to come. At the time I simply couldn't afford it. I guess I could have declared bankruptcy, but that's just not me.

By the way, you raise an important issue. The vast majority of personal bankruptcies in the US is because of health care costs. Kind of like the situation I was in. Health care reform would help lower this number.
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Old 06-08-2009, 06:05 PM   #69
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I agree we shouldn't have to pay for a bridge to nowhere. The people in charge who decided to build that bridge would be the same people in charge of your health care.

The same people who are in charge that decided to build that bridge are also the same people that are making decisions about the US military.

Surely you would agree that we have a first class military? It is run by the government. Why couldn't the government also run a first class health care system?

Other countries, such as France, also have first class health care systems. Theirs is run by their government. If France can do it , why can't we?
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Old 06-08-2009, 08:48 PM   #70
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There is a lot of leeway given to a successful military campaign. Set backs that cost a lot of lives are expected. Look at our first steps in WWII. We couldn't fight our way out of a paper bag, yet we won the war. The point is that a military campaign can withstand incompetent people if there are enough competent people to make up for them. I have been in units where I would urinate on the CO if he were on fire, but I would fight tooth and nail for my peers. There is a big difference between health care and military actions. Almost anybody would fight hard if their life depended on it. It is that type of action that can carry the day, in spite of poor leadership.

I'm not willing to take the chance with my health care of having some bureaucrat in Washington tell my doctor what acceptable treatment they can or can not perform. Many people say that private health insurance already does that. As I have stated I have yet to have the insurance company refuse to pay for something that was deemed necessary by my doctor. Of course my doctors have never recommended experimental procedures.

I have decent health care. I've been subject to civilian, military, and VA health care and found the system that most bash to be the best of the three. A VA hospital I went to received very high ratings according to a person on this board. I wouldn't go to that hospital again to have my prescriptions filled. The civilian doctors I have gone to have been in all kinds of cities from very rural in Michigan to large cities in Florida and every type of town in between. Hands down the civilian doctors have been the best. They even fixed problems the military doctors said I would have to live with. I have had several co-workers tear their rotator cuff (at least that is what they said their issue was) on the weekend/after duty hours. These people had to go to a civilian doctor to be treated. To a person they were told they should undergo surgery to fix the problem. Not one went under the knife to have the muscle repaired on the military's dime. Military health care would kill us, but it sure wasn't the decent care I expect.

Their was an article a couple years ago about the exodus of wealthy French citizens. They were getting tired of being taxed through the teeth.
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Old 06-08-2009, 09:46 PM   #71
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Look at our first steps in WWII. We couldn't fight our way out of a paper bag, yet we won the war.
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Old 06-08-2009, 10:56 PM   #72
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My posting said that the new health care reform could not be any worse than the system we have today. Yes, perhaps you would have a government bureaucrat instead of some insurance bureaucrat rejecting your doctor's proposed prescription. How is that any worse? Furthermore, everybody would have now have coverage. So, by default it would be better.

By the way, I spent a couple of years in Europe in a country with so called socialized medicine. I never had some government bureaucrat reject what the doctor had prescribed.

Why did I not pay for it myself? It would have been $4,000 or monthly payments in excess of $250 for years to come. At the time I simply couldn't afford it. I guess I could have declared bankruptcy, but that's just not me.

By the way, you raise an important issue. The vast majority of personal bankruptcies in the US is because of health care costs. Kind of like the situation I was in. Health care reform would help lower this number.

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...

I don't care about the uninsured... the vast majority of them have access to health insurance but choose not to buy it (or, from my reading just signing up for it).. that is their choice..

So... who are the uninsured... I think I will go get facts as someone pointed out...

KeithHennessey.com » How many uninsured people need additional help from taxpayers?

  • There were 45.7 million uninsured people in the U.S. in 2007.
  • Of that amount, 6.4 million are the Medicaid undercount. These are people who are on one of two government health insurance programs, Medicaid or S-CHIP, but mistakenly (intentionally or not) tell the Census taker that they are uninsured. There is disagreement about the size of the Medicaid undercount. This figure is based on a 2005 analysis from the Department of Health and Human Services.
  • Another 4.3 million are eligible for free or heavily subsidized government health insurance (again, either Medcaid or SCHIP), but have not yet signed up. While these people are not pre-enrolled in a health insurance program and are therefore counted as uninsured, if they were to go to an emergency room (or a free clinic), they would be automatically enrolled in that program by the provider after receiving medical care. There’s an interesting philosophical question that I will skip about whether they are, in fact, uninsured, if technically they are protected from risk.
  • Another 9.3 million are non-citizens. I cannot break that down into documented vs. undocumented citizens.
  • 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

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Old 06-08-2009, 11:18 PM   #73
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I would go even further than that: specifically, not just that it impedes worker mobility, but it stifles the entrepreneurial spirit.
Yep, good point. And, it's not just the individual, but often the whole family that loses medical insurance. It's one thing to decide to take a risk and start a business knowing that your whole family will have to tighten their belts, skip the vacation, and eat beans for a year. It's another thing to know that if anybody gets sick there's a real chance that you won't be able to get them timely care, and that the family will be bankrupted by it.
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Old 06-10-2009, 09:29 PM   #74
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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.
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Old 06-10-2009, 09:49 PM   #75
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I haven't seen a thing that prevents a person from buying care with their own $$$. I think any insurance should pay for care likely to restore health, if a person wants to pay out of pocket for care not covered by insurance (public or private) that is just fine. As it is now private health insurance doesn't pay for all possible services, it is "rationed" through coverage limitations. When writers say that care was denied by their insurer that isn't correct, the insurer simply said that they wouldn't pay for the care requested. The patient was free to pay for it outside the policy.
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Old 06-10-2009, 10:02 PM   #76
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I haven't seen a thing that prevents a person from buying care with their own $$$. 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.
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Old 06-10-2009, 10:16 PM   #77
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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?
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Old 06-10-2009, 11:40 PM   #78
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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.
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Old 06-11-2009, 12:27 AM   #79
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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?
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Old 06-11-2009, 10:51 AM   #80
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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.
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