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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 08:31 AM   #81
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Re: Is Univeral Health Care the answer?????

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I guess we could ask the doctors to work for free? That should solve the problem! After all, there's no reason why a healthcare provider should make money. Healthcare is an entitlement.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 08:42 AM   #82
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Re: Is Univeral Health Care the answer?????

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Originally Posted by FIRE'd@51
Perhaps there's an HR person at her employer, who would know how to efficiently work through the "insurance maze".
I appreciate everyone's well-meaning comments about the example I gave.

Please understand that I work in a huge and experienced referral center and all the usual resources are always brought to bear: HR, case managers, transcription department, insurance specialists, social service, financial counsellors, you name it. There is no lack of advocacy. They are old hands at this game. You win some and you lose some. You burn collossal resources in the process.

My main point is not how I should proceed with this individual patient, but rather how toxic it is for patients (and less so for their providers) to try and focus on recovery or acceptance when you are continuously peppered under the current system, ranging from treatment-threatening lack of a specific coverage, time limits on how long a service is covered (whether it's rehab, home health, etc.), how to accommodate patients with no coverage, and confusion over benefits.

The business folks complain of delayed claims payments, denial bordering on harrassment (you put an "incorrect" code modifier on one item and entire claim for thousands is delayed 90 days [who keeps the interest on the balance?] and so on.

As a cancer referral center, we do see the serious side of the issues disproportionately but at some time almost all of us face such issues, whether cancer or something else.

Regardless of your politics or whatever solution you favor, it's a mess. To deny that is a nonstarter for me.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 08:58 AM   #83
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Re: Is Univeral Health Care the answer?????

I don't think anyone disputes that it is a mess. The question, at least for me, is who should we trust to craft the health care bill. I am not convinced that our government can craft legislation that is better than my current plan. As I said before, I am happy with my health care plan.

Although, I imagine if the legislators are required to be the recipients of their own program, then they might be more inclined to create one that works. But, I am sure they will exempt themselves from their own legislation.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 09:48 AM   #84
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Re: Is Univeral Health Care the answer?????

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Although, I imagine if the legislators are required to be the recipients of their own program, then they might be more inclined to create one that works. But, I am sure they will exempt themselves from their own legislation.
They often do, when it comes to great ideas to impose on the American population.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 10:02 AM   #85
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Re: Is Univeral Health Care the answer?????

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Originally Posted by janeeyre
I don't think anyone disputes that it is a mess. The question, at least for me, is who should we trust to craft the health care bill. I am not convinced that our government can craft legislation that is better than my current plan. As I said before, I am happy with my health care plan.

Although, I imagine if the legislators are required to be the recipients of their own program, then they might be more inclined to create one that works. But, I am sure they will exempt themselves from their own legislation.
It seems to me that most people that have affordable healthcare do not have a problem with our present system. When I worked I felt exactly the same way for 34 years. However, once you see your benefits cuts and no longer have access to affordable healthcare (which is happening everyday in the US) then you will understand the dilemma.

I agree with your comment - we all should be in the same system and dealing with the same problems in our to fix our system. We spend a lot of money for mediocre (at best) care with no way of knowing who the good doctors are, the good hospitals, and from what I have seen many decisions today are based up profit not quality care.

I don't know who to blame but IMHO the insurance companies are the primary suspects. They seem to have enough lobbyists to shield themselves from scrutiny and the result is sub-par or no affordable care. The idea that you can go into a subsidized system if you don't make enough money seems criminal to me and is an example of a solution that has no risk for the healthcare businesses.

When you begin to hear talk about outsourcing healthcare then you know we have a problem - outsourcing means cutting costs and healthcare is not the issue - profit is.

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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 10:10 AM   #86
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Re: Is Univeral Health Care the answer?????

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Originally Posted by janeeyre
I don 't think anyone disputes that itis a mess. The question, at least for me, is who should we trust to craft the health care bill. I am not convinced that our government can craft legislation that is better than my current plan. As I said before, I am happy with my health care plan.
You must remember that your health care is only good as long as your are employed. If you become disabled or lose your job you lose your health insurance. Yes there is cobra. When we retired early our employer based heath insurance went form $128.00 per month to almost $1,000 per month under COBRA. You no longer get the benefit of your employers payment. A person supporting a family and losing their job can not afford $1,000 for health insurance when unemployment only pays around $1,600 a month.

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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 10:41 AM   #87
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Re: Is Univeral Health Care the answer?????

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You must remember that your health care is only good as long as your are employed. If you become disabled or lose your job you lose your health insurance. Yes there is cobra. When we retired early our employer based heath insurance went form $128.00 per month to almost $1,000 per month under COBRA. You no longer get the benefit of your employers payment. A person supporting a family and losing their job can not afford $1,000 for health insurance when unemployment only pays around $1,600 a month.

This is why I support disassociating health insurance from employment or at minimum, making it more consumer-driven with HSAs or HRAs. That way, people aren't so disassociated from the cost of their care, and it won't be such a shocker when they go out on their own. Tying health insurance to employment back in the day was a huge mistake. It made sense at the time, but it's part of why we are in such a big mess today.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 10:48 AM   #88
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Re: Is Univeral Health Care the answer?????

For those who wonder how it is that health insurance became linked to employment: it dates back to wage & price controls during WW II. Benefits were not included in wage control so employers offered health insurance when they couldn't increase the rate of pay to attract workers. Unintended consequences of govt programs.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 11:18 AM   #89
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Re: Is Univeral Health Care the answer?????

No,I have always been on my husbands health plan offered thru Boeing. When we both ER, we were able to keep the same plan. It was that health care promise that clinched our ER at 50.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 11:27 AM   #90
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Re: Is Univeral Health Care the answer?????

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No,I have always been on my husbands health plan offered thru Boeing. When we both ER, we were able to keep the same plan. It was that health care promise that clinched our ER at 50.
It is just that a promise. Ask the Ford ER or airline ER how they are dealing with the promise. A universal health care program would not be a promise. I hope!
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 11:50 AM   #91
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Re: Is Univeral Health Care the answer?????

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Originally Posted by Brat
For those who wonder how it is that health insurance became linked to employment: it dates back to wage & price controls during WW II. Benefits were not included in wage control so employers offered health insurance when they couldn't increase the rate of pay to attract workers. Unintended consequences of govt programs.
The current system is keeping many individuals in the work force that otherwise would prefere to do something else. If health care would be universal people would work for other companies (start-ups...) and companies would have better HR policies with respect to employee retention/education.
In addition as previously mentioned companies offering good health plan (read: expensive) are at a competitive disadvantage comapred to foreign companies.
Since the situation started to deteriorate it doesn't seem that the tendency toward worse benefits and higher cost can be modified without changing the system.
The system also prevent flexibility in the work force: ie. people would wnat to taje a sabbatical between highly paid jobs, ER, disabled individuals etc... It is typically when you can't be employed (ie. sick) that you need your health insurance.
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Old 05-04-2007, 11:57 AM   #92
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Re: Is Univeral Health Care the answer?????

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This is why I support disassociating health insurance from employment
We finally agree on something. There is hope yet
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 12:00 PM   #93
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Re: Is Univeral Health Care the answer?????

Seems most agree that health insurance should be unhitched from employment.

The question is then who should run the asylum: the insurance companies (fox in the hen house)? the government entirely (chaos, bureaucracy)?

Someone has to do it, and someone has to enforce the rules. If other necessary "citizen" services can be used as models, there are utilities (private with governmental oversight and access protection), and there is the post office (I think semi-private, regulated, but also with competition for those who want or need more at higher cost, yet guaranteed available for those who live where it would otherwise be unprofitable to deliver mail).

Hard to believe that in America we can't find a way to make this work.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 12:34 PM   #94
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Re: Is Univeral Health Care the answer?????

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. . .
Regardless of your politics or whatever solution you favor, it's a mess. To deny that is a nonstarter for me.
I think most Americans understand this point today. But we seem to still be struggling with how to best move forward. I hope we get past the pro-status-quo arguments "blame the victim" mentality soon.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 12:37 PM   #95
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Re: Is Univeral Health Care the answer?????

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The question is then who should run the asylum: the insurance companies (fox in the hen house)? the government entirely (chaos, bureaucracy)?

Hard to believe that in America we can't find a way to make this work.
Medicare is a government program that works good. I do not think many people would give up their Medicare insurance. Cost is something else. But Medicare only covers the elderly which in most cases are more costly than the young. Why is that the insurance companies would not cover them? They only wanted the gravy (young people). So if Medicare could cover the young it could spread its risk out over a much larger group of people and reduce the costs.

Medicare works why not just expand it to cover everyone. Under Medicare you still have your choose of medical providers. Under Medicare you can increase your benefits by buying private insurance to go along with it. But you get at least good basic coverage with it.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 12:43 PM   #96
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Re: Is Univeral Health Care the answer?????

I have never talked to an older person on Medicare who wasn't very glad that he/she had it.

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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 02:04 PM   #97
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Re: Is Univeral Health Care the answer?????

We should definitely insist that our legislators abide by the same universal plan they would impose on us.

What type of coverage do they have now? Do they have medicare at 65?
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Old 05-04-2007, 02:24 PM   #98
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Re: Is Univeral Health Care the answer?????

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Medicare is a government program that works good. I do not think many people would give up their Medicare insurance. Cost is something else. But Medicare only covers the elderly which in most cases are more costly than the young. Why is that the insurance companies would not cover them? They only wanted the gravy (young people). So if Medicare could cover the young it could spread its risk out over a much larger group of people and reduce the costs.

Medicare works why not just expand it to cover everyone. Under Medicare you still have your choose of medical providers. Under Medicare you can increase your benefits by buying private insurance to go along with it. But you get at least good basic coverage with it.
The reason Medicare works so well right now is that the healthcare providers have the private insurance industry to fall back on to charge higher prices to in order to make up for lost profits. If everyone were on Medicare or Medicaid for that matter, providers would not have anywhere to go to make up for lost profits. Instead, they would have to take huge pay cuts (Medicare pays approx 25 cents on the dollar average for every dollar billed, and the providers cannot go after their patients for the balance). What kind of service do you think you will recieve from doctors who earn half the money they earn today. How many people do you think will choose careers as physicians if they are forced to have their pay limited by the government? What do you think that will do to the level of service people recieve in the longrun?
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 02:40 PM   #99
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Re: Is Univeral Health Care the answer?????

Let's see... for every $100K of gross income, if you eliminate maybe 0.5 FTE for dealing with the morass of insurance companies and their policies and forms, that's about $17K per year of decreased expenses.

If you give me back at least $.50 on a dollar of charges for all the free care I give (uninsured, etc.) that probably another $5-10k per year recaptured. Next, I regain an hour or two a week in handling referrals and preauthorizations required by carriers and various HMOs. Believe it or not, in many areas MC pays fees far faster than private carriers, so that's a few bucks in my favor.

Yup, I'd probably make a little less under an all-Medicare system, but not that much. Then there's always that opt-in private carriage trade practice you could tap into if that was your style. I figure I'd get by.

Now, if I were an opthalmologic surgeon or invasive radiologist, or other high-paying procedure specialist, I would probably have to figure out a way to get by on $400-$500K instead of 50% more than that, but we all have to sacrifice .

In fairness, you have a point. Reimbursement needs to be set fairly or the whole system will eventually bog down from lack of providers -- it's a big deal. But I figure the market would eventually square itself up, perhaps a bit less lucratively than now, and not without some trauma.

Like the VA system, MC is far from perfect, but there are aspects of it that work very well.
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Re: Is Univeral Health Care the answer?????
Old 05-04-2007, 03:29 PM   #100
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Re: Is Univeral Health Care the answer?????

Rich -

Don't forget about the fact that you will probably have to turn lots of people away people for service, because there won't be any mechanism for controlling demand; And since there will likely be plenty of people who won't choose the career as a Dr. if they aren't going to make enough money to make it worth all of the required education and legal hassles....that's when the waiting lists begin....
Since most people can't afford private coverage now for plans with all the bells and whistles, imagine how few will be able to afford it when the masses elect the gov't system. Private prices might double or maybe even triple, and may only be accessible to the very richest of Americans...

or...will you just give pro-bono services to the people on waiting lists like you do now for the uninsured...? Remember, there will probably be at least 2-3 times as many people on waiting lists for your services than there currently are now in the uninsured population... Wait a minute...I forgot...it will probably be illegal for people to try to move up on the waiting list through pro-bono...

If I were to go back and go to school to be a doctor under a nationalized system, and if I could make, say $250,000-$300,000/yr as a primary care physician...great! That's what I'd be. Why go to school for an extra 3-5 years to become a specialist if I am only going to make MAYBE $50,000 - $100,000 more than a primary care doctor. We'll have primary care doctors out the ying-yang, and very few specialists. That scares me!
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