Next Pres. Election and Health Ins.

[maddythebeagle]

Zipper, have you ever had a serious health condition that required you to be placed on a waiting list?

Have you ever seen a grown man naked or been in a Turkish prison?

 

[Martha]

Insurance companies "ration" health care in part by limiting hospital stays. There have even been some legislative moves towards requiring at least overnight stays for mastectomies and a certain length of stay after having a baby. I have heard anecdotal accounts of people being discharged sooner than the doctor and patient would like--psychiatric care is one example someone on the board brought up today. Is this a pervasive problem or not? Being in a hospital increases risk of getting some other illness, so that cuts against longer stays.

I have heard that hospital stays in Canada tend to be longer and that you might be discharged into a rehabilitation facility, for example, if you had a bypass operation. Is this true? Anyone have any info on this issue?

 

[Rich_by_the_Bay]

Insurance companies "ration" health care in part by limiting hospital stays. ... Is this a pervasive problem or not?

Anecdotally, in my experirence in 3 different regions it is not any longer a big problem; used to be about 10-12 years ago.

A bigger problem is patients sitting in a hospital for 2-3 weeks longer than necessarily as they wait for a bed in a nursing home or rehab facility.

 

[HFWR]

I posted those links for information purposes only, and included a small quote as a teaser. I may or may not agree with the conclusions reached...

This post will self-destruct in ten seconds.

 

[tomz]

There are wait times in the US, too

LA Times article

Adults with no health insurance face waits up to a year or longer for gallbladder or hernia surgery in Los Angeles County, a backlog that community clinic doctors say has worsened since the county downsized Martin Luther King Jr.-Harbor Hospital last year.

Waiting times for specialists at seven South Los Angeles community clinics.

Cardiology: Nine months to a year

Dermatology: Six months

Ear, Nose and Throat: Six to nine months

Endocrinology/Nephrology: Six to nine months

Source: Southside Coalition of Community Health Centers, 2005

 

[mykidslovedogs]

LA Times article

Just goes to show how inefficient social programs are at getting people in to be seen in a timely manner. If there were enough money to go around to meet all of the demand, people wouldn't have to wait, but social programs, (community clinics - which are basically gov't run healthcare), always run short of funds, and thus, short of supply (providers) to do the surgery.


....I know....let's take health insurance away from everyone....that way, things will be more equal, and then, we can ALL have long wait times for hernia surgery.

 

[Brat]

...
A bigger problem is patients sitting in a hospital for 2-3 weeks longer than necessarily as they wait for a bed in a nursing home or rehab facility.

I have had both parents discharged from a hospital to ltc facilities, what a nightmare. After it happened for the first time we were much better prepared.

It is difficult for any physician to tell their patents (or their family members) to visit care facilities in ADVANCE of immediate need so that they can make informed choices.

Discharge planners probably have facility lists, maybe they could put together questionnaires to guide the process along for family members. Facilities have only a limited number of beds for a given care level and that the inventory changes daily, families need to have several on their 'druther list BEFORE admission to the hospital if possible. Often, if the family has visited the preferred care facility in advance and praised their efforts the admissions person will move mountains to admit the patient.

 

[tomz]

Just goes to show how inefficient social programs are at getting people in to be seen in a timely manner. If there were enough money to go around to meet all of the demand, people wouldn't have to wait, but social programs, (community clinics - which are basically gov't run healthcare), always run short of funds, and thus, short of supply (providers) to do the surgery.

Where else can these people go? They can't afford insurance. These clinics are the only place these people can go other than the ERs, which are already overcrowded. Did you read the whole article? Without these social programs, the 18,000 uninsured who die because they don't have insurance would be a much larger number.

On another note, wait times for hip replacement surgery are shorter in the US than they are for Canada. Guess what, the vast majority of hip replacements in the US are done for people on Medicare, which, I believe, is a government program. There are other approaches to universal healthcare than Canada and England. France, Germany, and Holland have pretty good systems and their wait times are better than the US in most cases.

 

[Meadbh]

She's Canadian, and like me would not trade our system for yours in a heartbeat.

Thanks Zipper for clearing that up. Like CFB, I have put MKLD on my ignore list, so I didn't see or respond to the comment.

 

[cute fuzzy bunny]

It IS sort of fun to see people going nuts without seeing the original ridiculous claims and arguments.

Four billion people in the US, no wonder the supermarket was so crowded earlier. I thought it was saturday for a minute there.

 

[eridanus]

This was a very good figure to throw out there. It shows that America does, indeed, already have a hybrid system. The gov't spends 1/2 the healthcare dollars, but they can only afford to pay for about 1/4 of provider's salaries. If we go to a fully gov't controlled system, with all else being equal, providers would have willingly agree to lose 1/2 of their pay.

How much profit do the insurance carriers make each year?

I have this funny feeling that only those who directly benefit from the system, namely insurance companies and their salesforce, still support it.

 

[Meadbh]

Insurance companies "ration" health care in part by limiting hospital stays. There have even been some legislative moves towards requiring at least overnight stays for mastectomies and a certain length of stay after having a baby.

True. Too early discharge of babies who hadn't learnt how to feed was associated with increased readmissions for jaundice, dehydration and even kernicterus (brain damage due to severe jaundice). I believe it was during the Clinton era that legislation was passed in your country to mandate a certain minimum stay after delivery, e.g. 24 hours.

I have heard anecdotal accounts of people being discharged sooner than the doctor and patient would like--psychiatric care is one example someone on the board brought up today. Is this a pervasive problem or not? Being in a hospital increases risk of getting some other illness, so that cuts against longer stays.

Being in hospital is positively dangerous to your health. In fact it's just as dangerous as bungee jumping, in terms of the probability that something bad might happen to you. (That's called an Adverse Event.) There was, for a time, a period when it was discharge at any cost, but I think the pendulum has swung back a bit now towards a realization that people actually need some time to recover before they can safely look after themselves. Community supports are great when they are there.

I have heard that hospital stays in Canada tend to be longer and that you might be discharged into a rehabilitation facility, for example, if you had a bypass operation. Is this true? Anyone have any info on this issue?

Lean thinking hit the US first and certainly at that time lengths of stay tended to be shortest in the US. I don't have good current comparative data, but I can certainly state with confidence that the pressure to keep the process moving is intense. I do not see people being discharged to rehab facilities following bypass surgery, unless they also need rehab. Problem is, as the population ages, there are more and more elderly people needing major help with daily living, e.g. after strokes. These people often need long term care. As Rich mentioned, these people, who often are unable to live independently, need more long term care spaces than are often available. This means they may stay longer in hospital than is desirable. Solving a problam like this requires large system planning and resource allocation at the population level. It's also an opportunity for investors in long term care facilities!

 

[mykidslovedogs]

Where else can these people go? They can't afford insurance.

I'm not knocking the clinics for picking up where health insurance leaves off. I thought you were complaining about the wait times. I'm just pointing out that wait times are what you get with social programs - it's just the way it is. The only reason medicare succeeds (without long wait times) is because providers have the private insurance market to fall back on for lost profits, so because of that, we don't have to worry about shortages. Once we go to an all gov't system, the shortages will start to happen.

 

[mykidslovedogs]

How much profit do the insurance carriers make each year?

I have this funny feeling that only those who directly benefit from the system, namely insurance companies and their salesforce, still support it.

I'm sure they do pretty well. I don't see profit as an evil. I see it as a means to an end. I believe that people should be rewarded for their hard work, particularly doctors and healthcare providers, and scientists. If they want to give away their services for free - more power to them...but they should not be held hostage to government salary caps. They should be allowed to charge whatever the market will bear for their expertise.

When we move to a single-payor system, I will still be one of the haves, so I don't support the current system, just because I work in it. I have lots of marketable skills and will still be well off enough to purchase private healthcare (if it is not outlawed). Who I feel really bad for are the people that will eventually get stuck in waiting queues when they are really, really sick. In a single payor system, when you are in a queue and you don't have the means to jump it, you're stuck. No one's going to be able to bail you out or shift your cost of care to someone else, like we can currently do here in the USA.

In this industry, I have seen the success stories. I see many, many - everyday! But no-one wants to hear the positive stories. I've seen the system pay out millions to people who would've gone bankrupt without it. I've had clients who have been fortunate enough to get knee surgery from one of the best of the best sports medicine facilities in the world and boast success. I've seen a client debilitated by a serious neck injury receive timely surgery from a well-known orthopedic doctor in Steamboat, Colorado and be fortunate enough to have a complete recovery. I've had many, many clients who have already saved their deductibles many times over in a personal health savings account (they are now covered 100% for any future health problems with no future out of pocket expenses to worry about.) As a team, DH and I have even helped nearly all of our small business clients to find ways to continue to offer affordable benefits to their employees.

 

[FinallyRetired]

Soon - this is exactly the kind of plan that frieks me out. Here's a quote from the article:

"18,000 people die every year in Ameica because of no health insurance. We must act NOW! Please help..."

Has anyone done any research to find out exactly how many people within single payor systems die while on a waiting list or suffer needlessly? ...

I can't give you the figures for single payer systems. But I can give you an upper bound based on the U.S. proxy: 18,000/ 301,139,947 (not 4 billion).

According to Business Week, "as several surveys and numerous anecdotes show, waiting times in the U.S. are often as bad or worse as those in other industrialized nations -- despite the fact that the U.S. spends considerably more per capita on health care than any other country."

So, just take the deaths in the U.S. waiting list as an upper bound, single payer systems will be no worse, and probably much less.

In this industry, I have seen the success stories. I see many, many - everyday! But no-one wants to hear the positive stories...

No doubt, I'm sure you do good work within the current broken system. Just like rescuers saved many lives during Katrina. Doesn't make the needless deaths go away, or the levee design good.

 

[mykidslovedogs]

According to Business Week, "as several surveys and numerous anecdotes show, waiting times in the U.S. are often as bad or worse as those in other industrialized nations -- despite the fact that the U.S. spends considerably more per capita on health care than any other country."

My feeling on business weeks opinions is that they are referring more to waiting times for PCP and ER services, which is not of much concern to me, because these aren't necessarily the kind of services that I'm worried about when I'm really, really, chronically SICK. We DO have a problem with PCP wait times, because Medicare and Medicaid don't pay enough for those kinds of careers, so young, new talent choose specialist careers instead....therefore, we are starting to experience shortages in those fields...not as a result of a failed private sector, but as a result of a failing Medicare/Medicaid system.

What I'd really like to see are clear, side by side comparisons on wait times for diagnostics and treatments of the more serious, but fairly common, health conditions that I have brought up before. (cancer, cardiac problems, severe arthritis, parkinsons, alzheimers, glaucoma, cataracts, non-emergent joint problems involving the knee or hip, etc.)

 

[eridanus]

nm

edit: removed my snarky comment

 

[bpp3]

My feeling on business weeks opinions is that they are referring more to waiting times for PCP[...]

They're handing out Angel Dust in the hospitals now? That would seem to be the problem with your system right there.

 

[mikex]

Wow! This thing really took off.

I keep telling everyone at work I'm going to leave in a couple of years so I'll be paying for my own Health Ins., I hope I can afford it. Looks like I can, but I think someone who excersises like I recently started to do (running a few times a week) should definitely get some kind of discount. Do they do that? I had an idea that if they gave a person a security-sealed pedometer (only if you wanted a discount) and you could download the distance monthly to a website, it would be a way of at least proving in some regard how active you were. But it would only be voluntary for people that wanted to prove they excersised regularly. I don't know how else you could prove it. But a person who excersises is going to require less health care than a fat couch potato (well, unless you break a leg or a car runs into you while running, hmmmmm).

 

[cute fuzzy bunny]

I'm unaware of any policy that charges you less if you're in better than average shape or exercise a lot. That'd sure be a good motivator for some people to get off the couch.

Anyone else know of an insurer that indexes their rates this way?

 

[mikex]

Never mind - I just realized how you could cheat using my idea, just sit on the couch and shake it, duh. Well it would prove you excersised your wrist though.

 

[mykidslovedogs]

Wow! This thing really took off.

I keep telling everyone at work I'm going to leave in a couple of years so I'll be paying for my own Health Ins., I hope I can afford it. Looks like I can, but I think someone who excersises like I recently started to do (running a few times a week) should definitely get some kind of discount. Do they do that? I had an idea that if they gave a person a security-sealed pedometer (only if you wanted a discount) and you could download the distance monthly to a website, it would be a way of at least proving in some regard how active you were. But it would only be voluntary for people that wanted to prove they excersised regularly. I don't know how else you could prove it. But a person who excersises is going to require less health care than a fat couch potato (well, unless you break a leg or a car runs into you while running, hmmmmm).

You can't get discounts, because the quoted rates are already the "super preferred" rates. They rate-up if there are any pre-existing conditions. Some carriers can also exclude pre-existing conditions, or any individual carrier can decline unhealthy people altogether.

Anthem BCBS has a new, Lumenos HIA plan that will give you credits in an account to use towards medical expenses when you use their health programs or complete their health questionnaires. It's the only plan of it's kind that I know of. Still, the Lumenos HSA (where you put away your own money towards the deductible) ends up being a better price when you take into consideration the tax savings.

 

[eridanus]

I'm sure they do pretty well. I don't see profit as an evil. I see it as a means to an end. I believe that people should be rewarded for their hard work, particularly doctors and healthcare providers, and scientists. If they want to give away their services for free - more power to them...but they should not be held hostage to government salary caps. They should be allowed to charge whatever the market will bear for their expertise.

You didn't answer the question. How much profit do insurance carriers make?

 

[Webzter]

You didn't answer the question. How much profit do insurance carriers make?

I've got a friend that works fairly high up in the IT organization at Kaiser. Kaiser has this problem where they're not allowed to make too much per year.. when they do then the state comes after them to complain about price gouging and other member groups come after them looking for a piece of that profit pie.

So, my friend has told me that he's had to come up with creative ways to spend even more money to help keep profits low; buying software / hardware they don't need, buying extra licenses, etc.

The story could be apocryphal but I'm inclined to believe it. Ancedotally, I used to work for a consulting company. The local phone utility hired several of our guys for a project. When they showed up on their first day, they were shown where they would be sitting and then told that they wouldn't have computers, none were expected, and to feel free to bring in books or something to pass the time. Basically, the utility needed a legitimate way to burn down profit so that it didn't look so bad.

To sum it up, I don't have a lot to add to the thread but I do have some pretty boring stories.

 

[mikex]

I've got a friend that works fairly high up in the IT organization at Kaiser. Kaiser has this problem where they're not allowed to make too much per year.. when they do then the state comes after them to complain about price gouging and other member groups come after them looking for a piece of that profit pie.

So, my friend has told me that he's had to come up with creative ways to spend even more money to help keep profits low; buying software / hardware they don't need, buying extra licenses

I guess I'll ask the obvious question - why not refund part of the premiums to the customers?