Healthy? Insurers don't buy it

[windsurf]

My throw-ins on this topic: Too many people are on too many drugs. I have an aunt and uncle, both with type II diabetes and now, consquently, cardiac issues who are each on over a dozen drugs. I cannot imagine that their docs know the interactive effects of all of these. Type II diabetes is a preventable epidemic that is driving up the cost of care. Smoking: I have lost a parent and a brother to lung cancer, the end stage. What proportion of cost are we non-smokers bearing to pay for preventable maladies tracable to smoking? Our government is complicit in both epidemics. The standard American diet recommendations don't do enough to warn people away from an overemphasis on refined grains and sugars and arise from intense lobbying by interest groups. You know about tobacco subsidies. Talk about government interference in health. While not insignificant, I do not think that malpractice suit costs are in any way a major factor across the board. One aspect that is not often mentioned is that the fact of malpractice also burdens the system. Brain damaged babies requiring lifetime care would be an example. This thread is raising some great points. In the meantime, I am bracing myself for the mess to get worse. The lobbying forces that conspire against rational treatment are entrenched and wealthy.

 

[lazygood4nothinbum]

they only increased premiums because i work out at the gym which throws off apparent bmi. i fully disclosed both allergies and arthritis on application and was accepted without riders or increased premiums on those.

when i went to the doctor for pain in my shoulder which i thought might be a torn rotor-cuff, he diagnosed the arthritis. i asked him what i can do about that. he said "blame your mother." i asked "is that your professional opinion?"

 

[mykidslovedogs]

This is a state law issue. Actually, we did get one company say it would quote but the quote would be so much higher than our current provider that we probably would not want to bother. This was before they obtained any health info from our group and only had age info.

Large group markets (50 + eligible to be insured) are presided over by Federal ERISA regulation, not State, and Federal law prohibits insurance carriers from declining to quote based on age, so the only thing I can think of here is that your group was declined due to the nature of business or industry. Otherwise, the carriers that declined to quote were breaking the law.

Many insurance companies abandoned the guaranteed issue/community rating market of NJ and some other eastern states, for better waters elswhere. If the whole US was guaranteed issue and community rated, the insurance companies would have to compete on price.

NY and NJ have large enough populations to test market the concept, and we have seen the results there. IMO, if we went nationwide with the concept of guaranteed issue and community rating, small carriers that can't get a good handle on risk assessment will be driven out of business, leaving us with an oligopoly of only large carriers like United HealthCare. These carriers, especially at first, will charge exhorbitant rates, until they can get a better handle on the risks associated with guaranteed issue of coverage. Lower income families will forego coverage which will result in further inflation.

You assume reduced quality without facts. You assume that HSAs will effect inflation in the industry with no facts. An HSA would do nothing for me. I still need to take certain drugs for asthma. If I was low income and only could buy an HSA plan, I may forgo getting necessary drugs. End result I would end up in the hospital. If I found a lump in my breast, I am not going to call around and find out who does the cheapest biopsy. I am going to my primary care doc and asking for referal to the best. If the lump is cancer, I am not going to shop around for the cheapest chemo provider. I want the one who gives the best result. Not Budget Chemo at the mall. According to the Kaiser foundation, half of HSAs are not even funded and the average funding is only $500.

Martha, I have a lot of confidence that HSA usage will continue to rise over the next several years. I don't think that their effects will be immediate. Of course, it will take some time before employers as well as individuals learn how to use them and understand how to use them to their advantage.

If you had an HSA under an employer-sponsored plan, your asthma drugs would be covered subject to the plan deductible, and you would be able to purchase them on a tax-deductible basis with your HSA dollars, so how can you say an HSA will do nothing for you? Oftentimes, the cost of a prescription is not much more than the copay itself. My kids take Zyrtec. If I were on a copay plan, I would pay $45 for the prescription. The retail price of the drug is $80.00. On my HSA, I pay $60.00 on a tax-deductible basis with my network discount, AND, the cost of the prescription reduces my deductible which would NOT happen on a copay plan. Many people do not take that benefit into consideration.

I had a client who owned her own business. Before she purchased her HSA through employment, she was paying about 4000/yr. in copays for prescription drugs alone. After she purchased her HSA she was receiving 100% coverage for all services including prescriptions after her 2000 deductible was met. The additional cost to the insurance carrier was offset by the number of other healthy people in the group who now have an HSA. Before the client purchased the HSA, she used only brand name drugs. After, she started purchasing the generic equivalents for some of the drugs she was taking....a HUGE savings to the insurance carrier. This is a perfect example of how consumer-driven plans can influence our buying decisions in the healthcare market. For the chronically ill and the consumers with the highest expenses, HSAs under an employer-sponsored plan are often the best solution, because the premiums are much lower, and coverage kicks in oftentimes at 100% after deductible. There are no un-ending copays or high co-insurance maximums to meet. For this particular client, the savings to her in premiums plus copays and coinsurance splits ended up being about $10,000/yr.

We have many groups that are now either offering HSAs solely to their members or offering HSAs as part of their benefit mix. As this trend continues, I truely believe that HSAs will begin to have a positive impact on consumer spending. Some employers are saving so much on their premiums, that they are able to fund almost the entire deductible into their employees HSA accounts as a BENEFIT! I think that's fantastic.

There are many ways to save on costs within the medical industry. For example...last year, my daughter needed an ultrasound. It would have cost $1000.00 at the local hospital, or $200.00 at her Drs office in Denver. Since I have an HSA, where do you suppose I decided to take her? If I had been on a copay plan, I never would have had any incentive to shop around.

Here are some facts regarding the adoption of HSAs since they began. We need to give this concept more time. So far, 31% of people who have adopted HSAs were previously uninsured and 42% were families with incomes below $50,000.

http://www.treas.gov/offices/public-affairs/hsa/pdf/fact-sheet-dramatic-growth.pdf

Martha, if asthma is your only illness, Assurant Health will take you on their HSA plan and even cover your asthma under a separate, condition-specific deductible. Humana one is also much more lenient with contolled asthma on their high-deductible healthplans. You might want to check into it. If the premium savings is enough to justify the OOP cost of your meds, it might be worthwhile for you to look into the possibility of an individual plan for yourself.

 

[ladelfina]

http://lefarkins.blogspot.com/2007/01/we-cant-afford-not-to-have-universal.html

I and others have gone into the points made above on other threads, but I thought I would highlight these two comments:

"As someone who works in the field, I can tell you that insurers' administrative costs run about 30% of premium. That's for advertising, broker fees (paying to have new customers brought in), underwriting (ie screening out really sick people), claims handling (ie trying not to pay claims due to prior existing conditions, etc), reinsurance (laying risk off onto other insurers, typically overseas). The great majority of these costs are entirely unnecessary for the delivery of health care. And this is the insurers' costs only- the costs imposed on employers, doctors and hospitals in dealing with this system are additional."

[I don't think MKLD is a shill, but while she has given us some valuable info here, she'd be crazy to support something that would give her less business.]

and, this.. eye-opening!!
"I don't even go to the doctor anymore, it's a two month wait for an appointment, makes no sense to me. I just go to the ER, pay the $50 deductible, and at least get some kind of medical record going as to the condition I am reporting."

 

[mykidslovedogs]

http://lefarkins.blogspot.com/2007/01/we-cant-afford-not-to-have-universal.html

I and others have gone into the points made above on other threads, but I thought I would highlight these two comments:

"As someone who works in the field, I can tell you that insurers' administrative costs run about 30% of premium. That's for advertising, broker fees (paying to have new customers brought in), underwriting (ie screening out really sick people), claims handling (ie trying not to pay claims due to prior existing conditions, etc), reinsurance (laying risk off onto other insurers, typically overseas). The great majority of these costs are entirely unnecessary for the delivery of health care. And this is the insurers' costs only- the costs imposed on employers, doctors and hospitals in dealing with this system are additional."

[I don't think MKLD is a shill, but while she has given us some valuable info here, she'd be crazy to support something that would give her less business.]

I have serious concerns about the effects of nationalized health insurance, regardless of what happens to my business. Administrative costs are a fact of life. If insurance companies and brokers didn't exist, the government would do the administrating, and I'd be willing to bet the level of service you demand right now wouldn't be there when you needed it (Ever try getting answers from the IRS?) ... Imagine trying to appeal a claim problem with a government entity! I realize the general consensus here is that insurance companies try their darndest not to pay claims, but being in the business, I can assure you the opposite is true! We have several hundred clients and only a few claim problems here and there. 9 times out of ten, the problem is that the doctor did not bill correctly, or the client did not interpret the explanation of benefits correctly. I have seen the insurance carriers pay out thousands, even millions in claims, saving people from financial ruin.

Here is one staggering statistic. Hmmmm.....who will innovate all of the new breakthrough prescriptions without the U.S.A leading the race?

I'm sure France is using plenty of drugs that were developed in America and reaping the benefits of all of the R&D that we insurance payers and tax payers in America have had to pay for: See below:

U.S. Leads in Development of Global Drugs
Source: Pharmaceutical Research and Manufacturers of America.
USA: 45%
France: 3%
Sweden: 4%
Belgium: 5%
Others: 6%
Japan: 7%
Germany: 7%
Switzerland: 9%
UK: 14%

How about this statistic which came straight from information published by Medicaid....Over 70% of Medicaid claims stem from illnessess related to obesity and alcoholism. I've heard others on this board comment that lifestyle issues are a drop in the bucket compared to the other problems in our healthcare industry. Seems to me that lifestyle is a very important consideration when comparing the cost of care in our country to other countries.

and, this.. eye-opening!!
"I don't even go to the doctor anymore, it's a two month wait for an appointment, makes no sense to me. I just go to the ER, pay the $50 deductible, and at least get some kind of medical record going as to the condition I am reporting."

I am curious where this quote came from. I too have had to schedule preventive exams in advance (big deal), but here in America, I have NEVER had to wait more than an hour for urgent care nor have I ever been put on the back burner for important diagnostic tests or surgery (I'll bet the same is not true in other nationalized systems). This person who is taking advantage of the ER in that way is abusing the system and is contributing to the problem of the high cost of care in our country.

 

[lets-retire]

The way I see it there are only three was national health care can be done. 1) The government accepts bids form independent insurers, 2) The government provides the insurance, similar to Medicare, or 3) the government provides the service, similar to the military or VA.

The problems as I see it from 1 are. Right now there are numerous insurers to provide benefits and competition, but as soon as the government issues the contract, even if they are bid regionally, the number of insurers will drastically decrease. The end result is lower competition. This will result in one of two things. The insurer naming their price or the government taking over the game. If the insurer names their price it will be more expensive than what we already have. Then comes the second problem since the insurance companies are mandated by the federal government and are private companies they would basically be able to tell the providers what they will receive for their services. You can guess it will be rather low after all the insurers are in the business of making money. That leaves the insurer dictating the salary of the health care provider. If the doctors don't like the pay the can simply not accept the insurance and close their doors.

The problems with number two are essentially the same as with number one. I haven't heard too many people who are pleased with Medicare, I'm sure they are out there I just haven't heard of many.

The problem with number three, as I have seen it, is the government is not a very good provider of health care. I suffered through 29 years of government health care. I wouldn't wish that on anybody. My experience has been very poor service and many incompetent doctors. It is interesting that I only receive VA disability for items supposedly fixed by military doctors. A couple items I had to have removed from the VA rating because after consulting a private sector doctor they were correctly fixed.

With no profit motive to encourage the development of new medicines or procedures most of the research would be paid for by the federal government, further increasing the costs. If you think the federal government can do anything without involving large administrative overhead then you need to seriously take a look at how this government works.

 

[Martha]

Large group markets (50 + eligible to be insured) are presided over by Federal ERISA regulation, not State, and Federal law prohibits insurance carriers from declining to quote based on age, so the only thing I can think of here is that your group was declined due to the nature of business or industry. Otherwise, the carriers that declined to quote were breaking the law.

My firm's experience was pre-HIPAA changes to ERISA. Nevertheless, I don't recall a provision requiring insurance companies to provide quotes to large groups. Yes for small, but no to large.
Do you have a cite to the contrary? State law also governs to extent not inconsistent with ERISA/HIPAA.

By the way, I couldn't help but bold your statement about my office being declined due to the nature of its business or industry. Kinda funny given that we are a bunch of lawyers.

NY and NJ have large enough populations to test market the concept, and we have seen the results there. IMO, if we went nationwide with the concept of guaranteed issue and community rating, small carriers that can't get a good handle on risk assessment will be driven out of business, leaving us with an oligopoly of only large carriers like United HealthCare. These carriers, especially at first, will charge exhorbitant rates, until they can get a better handle on the risks associated with guaranteed issue of coverage. Lower income families will forego coverage which will result in further inflation.


Martha, I have a lot of confidence that HSA usage will continue to rise over the next several years. I don't think that their effects will be immediate. Of course, it will take some time before employers as well as individuals learn how to use them and understand how to use them to their advantage.

If you had an HSA under an employer-sponsored plan, your asthma drugs would be covered subject to the plan deductible, and you would be able to purchase them on a tax-deductible basis with your HSA dollars, so how can you say an HSA will do nothing for you? Oftentimes, the cost of a prescription is not much more than the copay itself. My kids take Zyrtec. If I were on a copay plan, I would pay $45 for the prescription. The retail price of the drug is $80.00. On my HSA, I pay $60.00 on a tax-deductible basis with my network discount, AND, the cost of the prescription reduces my deductible which would NOT happen on a copay plan. Many people do not take that benefit into consideration.

I had a client who owned her own business. Before she purchased her HSA through employment, she was paying about 4000/yr. in copays for prescription drugs alone. After she purchased her HSA she was receiving 100% coverage for all services including prescriptions after her 2000 deductible was met. The additional cost to the insurance carrier was offset by the number of other healthy people in the group who now have an HSA. Before the client purchased the HSA, she used only brand name drugs. After, she started purchasing the generic equivalents for some of the drugs she was taking....a HUGE savings to the insurance carrier. This is a perfect example of how consumer-driven plans can influence our buying decisions in the healthcare market. For the chronically ill and the consumers with the highest expenses, HSAs under an employer-sponsored plan are often the best solution, because the premiums are much lower, and coverage kicks in oftentimes at 100% after deductible. There are no un-ending copays or high co-insurance maximums to meet. For this particular client, the savings to her in premiums plus copays and coinsurance splits ended up being about $10,000/yr.

We have many groups that are now either offering HSAs solely to their members or offering HSAs as part of their benefit mix. As this trend continues, I truely believe that HSAs will begin to have a positive impact on consumer spending. Some employers are saving so much on their premiums, that they are able to fund almost the entire deductible into their employees HSA accounts as a BENEFIT! I think that's fantastic.

There are many ways to save on costs within the medical industry. For example...last year, my daughter needed an ultrasound. It would have cost $1000.00 at the local hospital, or $200.00 at her Drs office in Denver. Since I have an HSA, where do you suppose I decided to take her? If I had been on a copay plan, I never would have had any incentive to shop around.

Here are some facts regarding the adoption of HSAs since they began. We need to give this concept more time. So far, 31% of people who have adopted HSAs were previously uninsured and 42% were families with incomes below $50,000.

http://www.treas.gov/offices/public-affairs/hsa/pdf/fact-sheet-dramatic-growth.pdf

Martha, if asthma is your only illness, Assurant Health will take you on their HSA plan and even cover your asthma under a separate, condition-specific deductible. Humana one is also much more lenient with contolled asthma on their high-deductible healthplans. You might want to check into it. If the premium savings is enough to justify the OOP cost of your meds, it might be worthwhile for you to look into the possibility of an individual plan for yourself.

 

[ladelfina]

Hmm.. I know a lot of people have violent feelings towards lawyers, so...?

 

[mykidslovedogs]

My firm's experience was pre-HIPAA changes to ERISA. Nevertheless, I don't recall a provision requiring insurance companies to provide quotes to large groups. Yes for small, but no to large.
Do you have a cite to the contrary? State law also governs to extent not inconsistent with ERISA/HIPAA.

By the way, I couldn't help but bold your statement about my office being declined due to the nature of its business or industry. Kinda funny given that we are a bunch of lawyers.

I've got a question into NAHU on this. I know they can decline to quote based on nature of business (not sure if lawyers fall into the category of "high risk" or not...I've never run into that before, but then again, we don't do a lot of larger sized groups, either......hee hee) and based on claims history, but I'm fairly certain they can't just decline to quote based on age. I could be wrong on that. I'll get back to you and let you know what I find out on this.

 

[califdreamer]

Here is one staggering statistic. Hmmmm.....who will innovate all of the new breakthrough prescriptions without the U.S.A leading the race?

I'm sure France is using plenty of drugs that were developed in America and reaping the benefits of all of the R&D that we insurance payers and tax payers in America have had to pay for: See below:

U.S. Leads in Development of Global Drugs
Source: Pharmaceutical Research and Manufacturers of America.
USA: 45%
France: 3%
Sweden: 4%
Belgium: 5%
Others: 6%
Japan: 7%
Germany: 7%
Switzerland: 9%
UK: 14%

So the US develops 45% of the drugs and the EU develops at least 42%? Why is this staggering?

 

[lets-retire]

So the US develops 45% of the drugs and the EU develops at least 42%? Why is this staggering?

The EU is not a single country. If you look at it that way then you could say, "At least 87% of all new medicine is developed by western nations. So Americans aren't tht important to the development of new medicines." The staggering part is that the US with it's incredibley flawed medical system developesalmost half of all new medicines.

 

[magellan_nh]

The staggering part is that the US with it's incredibley flawed medical system developesalmost half of all new medicines.

When adjusted for gdp, the US and the EU produce about the same amount of new medicines.

That means that the EU, with mostly socialized medical care, developes about the same amount of new medicine as the US.

This doesn't even get into the discussion about the fact that R&D budgets are around the same as sales and marketing budgets for most of big pharma.

Jim

 

[Rich_by_the_Bay]

When adjusted for gdp, the US and the EU produce about the same amount of new medicines.

Plus, many so-called "new drug" development is largely, of late, variations on old drugs which allow remarketing prior to the original patent expiration date. Generally speaking, Enalapril=Lisinoopril=captopril; omopeprazole-pantoprasole=esomeprazole; etc.

No doubt the American pharmaceutical manufacturing capability is impressive and I am proud of it. The irony is that all this fails to improve our health outcomes relative to many other countries.

I find the "staggering" claim to be unsupported by any reasonable interpretation of the situation, and unrelated to the health care delivery system. What's "staggering" is that the richest, most dynamic economy in the world has failed to provide basic health care access and support for over 40 million of its citizens.

 

[mykidslovedogs]

Plus, many so-called "new drug" development is largely, of late, variations on old drugs which allow remarketing prior to the original patent expiration date. Generally speaking, Enalapril=Lisinoopril=captopril; omopeprazole-pantoprasole=esomeprazole; etc.

I agree with you on this point and have mentioned it earlier in one of my earlier posts as a wasteful use of our healthcare dollars. However, Americans demand these choices, and the only way to change it is to divorce people from "rich benefits" that they are so used to, and perhaps make people more accountable for their choices ... perhaps by having health plans like HSAs, which make people think twice before using Nexium instead of Prilosec OTC, or perhaps having plans with very high copays for what I call "convenience" drugs and very low copays for "lifesaving" drugs such as anti-biotics.

No doubt the American pharmaceutical manufacturing capability is impressive and I am proud of it. The irony is that all this fails to improve our health outcomes relative to many other countries.

I keep seeing this point mentioned in earlier posts by other members of the forum. It seems that the comparison of lifestyles between the US and other countries has been minimized. I don't think we can compare apples to apples on health outcomes when we compare the lifestyles of Americans to other countries. In America, over 65% of our people are overweight. Even Medicaid has published data that over 70% of claims paid out are related to illness stemming from obesity and alcoholism. We take almost as many antidepressents as we do anti-biotics.

I
find the "staggering" claim to be unsupported by any reasonable interpretation of the situation, and unrelated to the health care delivery system. What's "staggering" is that the richest, most dynamic economy in the world has failed to provide basic health care access and support for over 40 million of its citizens.

I don't see how you can say that innovation and quality of any sort is "unrelated" to the healthcare delivery system. Yesterday, I spent some time talking to a friend of mine who is from Britain. He shared with me that the hospitals and rooms available to the general public are "dirty" and "lack privacy". Only the very rich are able to get the kind of care and quality that even the poorest American is used to here in the USA. He told me that the primary reason the medical system "survives" out there is through the investments of venture capitalists. He said if it weren't for them, the public system would fail.

If doctors had to survive only on the salaries paid to them by the Medicaid and Medicare systems, would their careers be worth the investment in the education required to become a doctor? Do we really believe that the government would fairly compensate our medical community to a point where there would be no concerns about shortages of care? How many of our young people will choose healthcare careers in a purely socialized system? Would we lose good hospitals to bankruptcy? Is it possible that a lack of good doctors and hospitals could lead to "rationing" of another sort here in America? Perhaps extreme wait times for transplants? - heart/lung surgeries? - oncology care? brain surgeries? due to lack of specialists available to handle the additional 40 million patients? Would the USA continue to be a leader in technology and innovation in pharmaceuticals, medical equipment, diagnostics, hospital facilities, etc..? These are some of the questions that really bother me.

 

[F M All]

I don't see how you can say that innovation and quality of any sort is "unrelated" to the healthcare delivery system. Yesterday, I spent some time talking to a friend of mine who is from Britain. He shared with me that the hospitals and rooms available to the general public are "dirty" and "lack privacy". Only the very rich are able to get the kind of care and quality that even the poorest American is used to here in the USA. He told me that the primary reason the medical system "survives" out there is through the investments of venture capitalists. He said if it weren't for them, the public system would fail.

Complete BS. On your own data the UK system produces proportionately more innovation than the US. Some hospitals in the UK may be old and poorly maintained but everyone in the UK (including visitors) has access to excellent urgent care - the bottom 15% are not excluded. Yes, a lot of new funding is via Private Finance Initiatives so that Gordon Brown (UK Chancellor of the Exchequer) can meet his public finance targets but this is only an alternative form of capital funding, the NHS services the debt.

Stop throwing around ill informed anecdotes to support your case, instead research some facts. The UK system is one to consider but it has many faults, look at other nations and try to develop an answer that combines the better aspects of each. The German and Dutch systems are nationalised medicine combined with private insurance for the better off, both systems are far superior to the current mess in the US. You cannot get away from the simple facts that the US system is incredibly wasteful, is a failure for a large percentage of the population, and is the most inefficient on cost per head basis. This nation is heading for a health crisis.

 

[mykidslovedogs]

Stop throwing around ill informed anecdotes to support your case, instead research some facts. The UK system is one to consider but it has many faults, look at other nations and try to develop an answer that combines the better aspects of each. The German and Dutch systems are nationalised medicine combined with private insurance for the better off, both systems are far superior to the current mess in the US. You cannot get away from the simple facts that the US system is incredibly wasteful, is a failure for a large percentage of the population, and is the most inefficient on cost per head basis. This nation is heading for a health crisis.

I have no problem with hybrid systems, with plenty of choices for those who want better or alternate choices through private policies (including tax incentives for those who choose to "buy down" from the "nationalized" plan, however, in discussing those ideas in prior threads, I was chastized by those who think it is unfair for there to be a two-tiered system with the lower-income folks getting stuck with the short end of the stick.

Some of the solutions proposed by the democratic party leave much to be desired and leave a lot of questions unanswered. (Sentator Wyden's Plan, for one - the national plan is too rich and will do nothing to prevent overutilization; It doesn't give any choices to American people to buy down if they want to, nor any tax incentives for those who want to go with higher deductible options. It doens't address the possibility that small employers may tend to cut back on employment in order to offset the additional cost of being required to provide benefits. It also doesn't take into consideration the unemployed, which I am sure make up a very large portion of the uninsured. If the purpose of the plan is to reduce or eliminate the uninsured, then the unemployed and part-time workers who are ineligible for benefits need to be addressed.)

I have also heard of other plans regarding nationwide Medicaid with premiums paid on a sliding scale. (Could work, but what kind of effect will that have on the supply of medical providers in the long run?)

I do have a problem with purely socialized systems and believe that they lead to poorer quality of service. There is no "utopian medical system". Where one system has its strengths, another system will have weaknesses in the same area. I lean towards a capitalistic solution or at the very least, a hybrid system, because I think that there is less risk of the majority of people being disadvantaged in the long run.

Right now, there is no doubt that we need some kind of reform. I have talked about the positive aspects of consumer-driven health plans and even provided factual data on some of the successes (I'll bet no-one even looked at that link), yet there hasn't been even one positive response from this board about that.

As far as antecdotes go...I was only sharing with you an actual conversation I had with a friend of mine who is from Britain. The conversation was not BS. I shared his exact thoughts and comments on the system there (no lies or exaggerations). That particular person happens to be an architectural designer for the medical industry. He has seen many hospitals in the USA as well as abroad, and his opionions were interesting to me.
Maybe my comments weren't based on some major study, but they were the legitimate opinion of someone who has lived in that country for much of his life.

 

[Peter]

Maybe my comments weren't based on some major study, but they were the legitimate opinion of someone who has lived in that country for much of his life.

Complaining about the NHS is a national sport in the UK. Doesn't mean that the system is inherently bad.

I can tell you that when my mother was hospitalized recently after a stroke, the care she received, and the hospital she was in, were both far better than my late wife had at Stanford University Medical Clinic. And now Mom is out of hospital, she gets regular home visits from her GP and also from a physiotherapist every other day.

All this for a cost per head of population that's less than half what we pay in the USA. Hmmmm ...

Peter

 

[califdreamer]

I have no problem with hybrid systems

There is no "utopian medical system". Where one system has its strengths, another system will have weaknesses in the same area.

Right now, there is no doubt that we need some kind of reform.

Yup.

 

[F M All]

Yes, Peter, good points.

Mykids, your conversation may not have been BS but your post was. I do not wish either to write an "in-nords-inately" long post or cause you to leave the board (as if I could )- I don't have the time for the first (I'm FIRE ) and I believe that within your scope of experience you have some valuable opinions for this board. Suffice to say my comments are based on being British, therefore I have long first- hand experience of the UK National Health Service, and I have also lived, worked, paid for health coverage and used the health systems in Germany, Netherlands and the US. I agree with Bernie Sanders (article on BBC website today) when he says:-

"We spend three times as much per capita on health care as the UK, and 48 million Americans have no health insurance,". "Our system is faulty and inefficient," , and the reason is clear to him: "It is designed to make money, not to provide quality health care."

 

[brewer12345]

"We spend three times as much per capita on health care as the UK, and 48 million Americans have no health insurance,". "Our system is faulty and inefficient," , and the reason is clear to him: "It is designed to make money, not to provide quality health care."

A nice summation.

Let me point out that arguing with MKLD is like trying to teach a pig to sing. He will go to absurd lengths to protect what he sees as the legitimacy of his gravy train. Don't waste your time.

 

[F M All]

Brewer,

I grew up with Pinky and Perky.

http://www.pinkyandperky.com/frames/index.htm

 

[mykidslovedogs]

Yes, Peter, good points.

Mykids, your conversation may not have been BS but your post was. I do not wish either to write an "in-nords-inately" long post or cause you to leave the board (as if I could )- I don't have the time for the first (I'm FIRE ) and I believe that within your scope of experience you have some valuable opinions for this board. Suffice to say my comments are based on being British, therefore I have long first- hand experience of the UK National Health Service, and I have also lived, worked, paid for health coverage and used the health systems in Germany, Netherlands and the US. I agree with Bernie Sanders (article on BBC website today) when he says:-

"We spend three times as much per capita on health care as the UK, and 48 million Americans have no health insurance,". "Our system is faulty and inefficient," , and the reason is clear to him: "It is designed to make money, not to provide quality health care."

It seems that both parties are in agreement that we need to reduce the cost of care.

The extreme liberals would like to fix the problem by doing a better job of cost shifting or having the evil "rich" subsidize the innocent "poor" who have no personal responsibilty for the situation they are in. IMO, these solutions will get more people covered, but they won't do much for reducing the amount of inflation in the industry...they just spread the cost around more and create heavy tax burdens on the people. In their "utopian" system, the government would just take care of us all at the taxpayers expense. This may help cut back inflation, but what sacrifices will we have to make regarding quality and innovation? I don't know the exact answer, but common sense tells me that when there are no monetary incentives such as the ability to make a profit, there is little or no incentive to compete for business, explore new technology or to make improvements and new discoveries.

The extreme conservatives would have it the other way....pure capitalism with no regard for the ones who are left by the wayside.

Niether is a good solution. There is a happy medium in there somewhere, and both sides will eventually have to make compromises. There is no doubt something needs to be done to stifle inflation in the industry.

New legislation regarding HSAs, HRAs and consumer-driven health plans are a good start at getting to the heart of the problem as 3-Way described it: inelastic demand combined with consumers who have been sheltered from the actual cost of their care for many many many years. Consumer-driven plans help make coverage more affordable to MANY more people without stifeling competition. The compromise is higher deductibles and a requirement for people to save money to take some responsibility for their own healthcare costs. Medicaid reform is also necessary. It's not right that people of particular incomes slip through the cracks. As a taxpayer, I am more than willing to help subsidize basic care for these folks. The compromise here may be higher taxes, and some inequality between lower and higher income people.

That's my opinion and I'm sticking to it!

 

[brewer12345]

See what I mean?

 

[F M All]

 

[mykidslovedogs]

A better look at the root cause of the American Healthcare Crisis:

http://doctordurante.com/Socialized_medicine.html

I thought this data was interesting and helps explain why other touted socialized healthcare systems have not yet entered crisis mode, like we here in the USA have: (The OBVIOUS solution! Looks like we all need to pay more taxes!)

Tax burdens around the world
Country Single, no kids Married, 2 kids

Australia 28.3% 16.0% Korea 17.3% 16.2%
Austria 47.4% 35.5% Luxembourg 35.3% 12.2%
Belgium 55.4% 40.3% Mexico 18.2% 18.2%
Canada 31.6% 21.5% Netherlands 38.6% 29.1%
Czech Republic 43.8% 27.1% New Zealand 20.5% 14.5%
Denmark 41.4% 29.6% Norway 37.3% 29.6%
Finland 44.6% 38.4% Poland 43.6% 42.1%
France 50.1% 41.7% Portugal 36.2% 26.6%
Germany 51.8% 35.7% Slovak Republic 38.3% 23.2%
Greece 38.8% 39.2% Spain 39.0% 33.4%
Hungary 50.5% 39.9% Sweden 47.9% 42.4%
Iceland 29.0% 11.0% Switzerland 29.5% 18.6%
Ireland 25.7% 8.1% Turkey 42.7% 42.7%
Italy 45.4% 35.2% United Kingdom 33.5% 27.1%
Japan 27.7% 24.9% United States 29.1% 11.9%

Source: OECD, 2005 data