Universal Health Care - what are we waiting for?

[obgyn65]

My views on this topic are well known. But each time I say anything on this topic, these views are shot down in flames by some. Therefore, I am done discussing this or even helping those who have medical questions. Just waiting for these types of threads to be closed....

We pay way more, for inferior results (vs top 30+ developed countries) and leave 17% of our population without access to health care (unlike almost all other developed countries).

 

[youbet]

I mean people with HSA policies who have been able to shop around for, or negotiate, prices before treatment is rendered. I haven't had any success doing that - even for completely discretionary services.

.

You're changing subjects from my original comments to Midpack. I was talking about having access to medical care if you can private pay or utilize free clinics, Medicaid, charitable groups, etc. I really wasn't commenting on our system being "shoppable." I agree with you that it would be tough to competitive shop for medical services. But that's different than being "denied access."

Again, I'm not speaking up for our current medical system or the people who work within its confines. But I don't like to make my case for improvement by overstating the situation. We don't "deny access" to the 17% of our citizens who don't have medical insurance policies. But many of them certainly have an inferior situation unless they are wealthy.

 

[donheff]

Yes, don't know what came over me. Actually I've been reading The Healing of America by TR Reid today, the same guy who did Sick Around The World on PBS, and the book has me stirred up again.

Even though I'm a lifelong conservative, free markets are not going to provide (universal) access to quality health care at anything near competitive prices. Until there is a serious groundswell from all us regular peeps, the special interests will make sure "our" elected officials maintain the [-]gravy train[/-] status quo in health care. Hope springs eternal...

Hooray for Midpack. You may make a conservative out of me.

 

[haha]

I'd love to hear success stories on this, maybe I'm just not doing it right. But my experience has been that health care providers don't even know the price of their services. I've probably asked a dozen times for how much a specific test or procedure cost and have never been given an answer up front. It's a huge failure of the whole HSA scheme IMO.

When I had a very high deductible I would sometime say, I'm not sure how this will shake out with insurance, but if you give me the Blue Shield rate I'll pay green cash on the day of the procedure. Sometimes I would say this on the day of treatment. Often it worked, but it did require carrying a fair amount of money. If it seemed too high, I'd just say so. Often doctors consider themselves to be above commerce, a big lie if there ever was one.

Ha

 

[JOHNNIE36]

• Don't forget something like 17% of the population does not have access to health care unless it's an outright emergency.
• Reportedly 18,000 people per year die for lack of health care in the US, some reports suggest it's much higher.
• And we're the only developed country where people go bankrupt over medical care costs.
• While paying 50-100% more than other countries.

Once I finish the book I'm reading, I'll probably calm down again, then again maybe not...

I hear that also, but don't believe for a minute that you can't get health care (your 17%) if you need it. This is the biggest give away country in the world. I've know and have seen people on Medicade that only have it because they are too lazy to do anything about it. They are just milking the system. Don't tell me I'm wrong because this has happened within my own family. I've been around the biggest milkers in the world. You know as well as I do, there are people that know they can get by without working by preying on social services for food and shelter. And there are people out there that just can't wait to give it to them.

 

[travelover]

My views on this topic are well known. But each time I say anything on this topic, these views are shot down in flames by some. Therefore, I am done discussing this or even helping those who have medical questions. Just waiting for these types of threads to be closed....

Well then, have you heard from the Kardashians?

 

[ERD50]

Midpack, it is frustrating when your thread follows a path different than the one you intended. ...

When a poster starts a thread on an extremely complex topic, and claims a single graphic 'sorta says it all', and includes distortions in the little bit he does say ('without access') well, I'd fully expect that it would trigger a diverse stream of comments. Was the 'intended path' to have everyone agree with him? Gee, we don't need discussion forums for that, we all have mirrors in our house. Or one could start a blog and disable comments.

Right now we're waiting on the Supreme Court. If that goes poorly, ...

By 'if that goes poorly', do you mean 'if the Supreme Court fails to do their job and interpret the Constitution to the best of their ability'? Whatever the outcome, I do hope the SC does their job, which could be different from whatever outcome you or I may prefer or expect.

-ERD50

 

[obgyn65]

No - and I don't even care who does their paps. How about this for a thread highhack ?

Well then, have you heard from the Kardashians?

 

[MichaelB]

When a poster starts a thread on an extremely complex topic, and claims a single graphic 'sorta says it all', and includes distortions in the little bit he does say ('without access') well, I'd fully expect that it would trigger a diverse stream of comments. Was the 'intended path' to have everyone agree with him? Gee, we don't need discussion forums for that, we all have mirrors in our house. Or one could start a blog and disable comments.

I was just sharing a thought with Midpack. No need to make an issue out of it.

 

[ERD50]

I was just sharing a thought with Midpack. No need to make an issue out of it.

Issue?

It just appeared to me that you were making an 'issue' of other posters input. And I commented on it, as I didn't understand what the problem was with such an open-ended OP.

-ERD50

 

[MichaelB]

Issue?

It just appeared to me that you were making an 'issue' of other posters input. And I commented on it, as I didn't understand what the problem was with such an open-ended OP.

-ERD50

As you wish.

 

[haha]

Map sorta says it all...note Iraq & Afghanistan!

We pay way more, for inferior results (vs top 30+ developed countries) and leave 17% of our population without access to health care (unlike almost all other developed countries).

An interesting thing is that we are not exactly a developed country. We have an large unskilled and in some cases non-working, poorly educated or completely uneducated lower class, a barely adequate industrial infrastructure, and some very skilled workers, engineers, managers and high class operating companies floating above all this. We also have quality hospitals and universities but extremely spotty primary and secondary education. All decisions are made by greasing the biggest wheels rather than producing the best results for the nation.

Rather than spend an enormous amount on healthcare and various forms of healthcare industry waste, we should rebuild our infrastructure and make it again financially attractive to do something in the US other than tweet one another all day, or sell paper back and forth on Wall Street. Much of which actually lowers the quality of life and the economy.

Ha

 

[Texas Proud]

My views on this topic are well known. But each time I say anything on this topic, these views are shot down in flames by some. Therefore, I am done discussing this or even helping those who have medical questions. Just waiting for these types of threads to be closed....

Even though some might disagree with you (and I am probably one), that does not mean we do not enjoy reading your posts...

And why not help with medical questions I do not see the connection....

 

[obgyn65]

Did you see this thread http://www.early-retirement.org/forums/f38/high-cholesterol-problem-59917.html where I gave some basic advice ? One poster questioned my credententials. Another one questioned basic guidelines. Another poster came to my rescue saying "Some of you are brutal . Have you noticed that rarely do medical people get in these discussions . Its because they are beaten up and spit out . If you really want opinions from the front line not just articles with a bias treat the medical people with the respect they deserve ."

Since then I guess I have tried to stay away from any healthcare-related question, whether Obamacare or clinical questions. It's not a problem, since I joined this board to discuss FIRE anyway...

Even though some might disagree with you (and I am probably one), that does not mean we do not enjoy reading your posts...

And why not help with medical questions I do not see the connection....

 

[seraphim]

Universal Health Care - what are we waiting for?

Someone else to pay fot it.

 

[justplainbll]

I used to be against universal health care but recent dealings with the system make me wonder what we are doing as a country. To site the case of DW's bout with the norovirus recantly. Taken to the emergency room at our local hospital on 3-12 because whe was dehydrated. Discharged 3-6.
Total hospital bill $29215. This does not include doctors charges. I'll break it down for you (large amounts only).
$5247 the room in 2 East
$1409 pharmacy
$932 intervenous therapy
$10075 CT scan (can you believe that?)
$592 radiology
$7579 laboratory
$3086 emergency room
$300 some misc charges

$29215 Total. My part was $912 but discounted $228 for paying on the spot. Doctors and specialists billed separately but covered by insurance plan. All bills not in yet. We have a Medicare Advantage plan where we pay only our Medicare premium. We have copays but I don't think $684 is bad for all the treatment she got. This is the part I don't understand and take exception with our system. Of the billed amount by the hospital of
$29215, the insurance company only allowed $3947 and paid $3092. The balance was my copay which was discounted.

Now, does any of that make sense? The billed amount? The allowed amount? What happens to the difference? This is what I have against our system. The individual just can't relate to the charges. One of DW's regular medications, which we buy for $6 for a 90 day supply, was charged on the bill at $67 every day. This whole system is bulls**t!!!

+ 1

 

[Gone4Good]

You're changing subjects from my original comments to Midpack.

That's probably true, but you also said we should ask people with high deductible policies about getting health care for cash. Even with a high deductible policy, where I know I'm paying 100% out of pocket, I still don't pay cash. Mostly because they charge people without insurance multiple times the insured rate, but also because nobody can tell me what anything costs. So while it is probably technically true that you can get care in the normal health care system by paying cash, I'm not really sure how that works in practice.

 

[MichaelB]

That's probably true, but you also said we should ask people with high deductible policies about getting health care for cash. Even with a high deductible policy, where I know I'm paying 100% out of pocket, I still don't pay cash. Mostly because they charge people without insurance multiple times the insured rate.

You can't pay cash with a high deductible policy. You must let the service provider charge your insurance company, let them determine the negotiated price and the amount you are responsible to pay. They will advise the service provider who will then bill you and also "credit" toward your annual deductible the amount you owe. If you pay cash upfront the insurance company never hears about the charge and your deductible remains completely unmet.

 

[Gone4Good]

If you pay cash upfront the insurance company never hears about the charge and your deductible remains completely unmet.

I understand that the cost of the proceedure wouldn't be applied to my deductible, but I might be willing to do that for cash savings up front. I don't expect to hit my deductible anyway, most folks with HSAs don't.

It seems like I should be able to get a considerable discount off the insured price so the doctor's office doesn't have to do all the paperwork, but they usually can't even tell me what the insured price is.

 

[Khufu]

The stark difference between the US and other rich countries that have effective health care systems is that the vested interests have got control of legislative process here. When you hear German legislators, for example, explain that unemployed people have to be assured of continued access to health care because their health is at greater risk, you realize that no one here, even a Democrat Congressman, would dare being heard to say such a thing. I think it comes down to this: when the health care industry has managed to sequester 17% of the GDP, as they have in the US, they are adequately financed to defend their stake from fundamental reform.

 

[travelover]

No - and I don't even care who does their paps. How about this for a thread highjack ?

Sorry, obgyn, I shouldn't have pulled you into my private joke.

I've become disillusioned about any meaningful healthcare reform. It is a highly complex, interconnected issue, which I honestly don't think the public has the capacity nor the patience to ever understand. Thus the Kardashian connection.

Forces that stand to benefit from the status quo have unleashed literal armies of lobbyists on congress to derail any meaningful change that might jeopardize profits. Radio pundits have turned the whole issue into a sound bite distortion of grandmothers being euthanized and big government running our lives. Any real in depth discussion quickly causes glazed eyes and lost advertising dollars.

I do however believe in equilibrium, and at some point the golden goose will kill itself.

 

[MichaelB]

I understand that the cost of the proceedure wouldn't be applied to my deductible, but I might be willing to do that for cash savings up front. I don't expect to hit my deductible anyway, most folks with HSAs don't.

It seems like I should be able to get a considerable discount off the insured price so the doctor's office doesn't have to do all the paperwork, but they usually can't even tell me what the insured price is.

I see your logic. The differences between list and negotiated price are so great I can't imagine getting a better deal with cash. The fact that cash upfront is such a better deal for the provider yet they can't even make that deal just shows how dysfunctional this whole thing is.

 

[ERD50]

I've become disillusioned about any meaningful healthcare reform. It is a highly complex, interconnected issue, which I honestly don't think the public has the capacity nor the patience to ever understand. ...

Forces that stand to benefit from the status quo have unleashed literal armies of lobbyists on congress to derail any meaningful change that might jeopardize profits. .... Any real in depth discussion quickly causes glazed eyes and lost advertising dollars.

What you say is true of many issues these days - substitute 'energy policy', 'pollution controls', 'immigration', or 'tax reform' for 'health care' , and it's the same thing. I skipped over the partisan comments you included, as those could be countered with distortions from the other side, but why go there?

While I don't expect it either - I think the proper route would be small, bite-sized bills that attack HC issues, and keep building on that. Yes, some problems like adverse selection require some wide-reach, but there are many things that could come before that.

The stark difference between the US and other rich countries that have effective health care systems is that the vested interests have got control of legislative process here. .... I think it comes down to this: when the health care industry has managed to sequester 17% of the GDP, as they have in the US, they are adequately financed to defend their stake from fundamental reform.

Again, true of many issues. One of the reasons that 'health care industry has managed to sequester 17% of the GDP' is because Congress put laws in place favoring them (tax benefits for companies providing HI). But that was probably done to 'help' people, not industry, and it back-fired big time.

-ERD50

 

[Midpack]

I'm not arguing against the need for a better medical system here in the USA. But your statement is just not accurate. Why not say something like 17% of the population does not have insurance and must either pay for services themselves or, if indigent, find charitable or gov't provided free services (which is going to be tough).

I picked it up the 17% in reading, coincides with the 45 million uninsured that you often hear. But fair point, and here's another POV that indeed calls the 17% into question (from Sen James E. Risch, Idaho). Remains that we can do much better and still cover everyone at lower cost, there are more than 30 active examples for us to benchmark from public to private and every combination in between.

However, is this acceptable/necessary?

A Harvard Study estimates 45,000 people a year die because they lack access to affordable health care.

Although people die because they have no health insurance, a hospital cannot turn away anyone with a life threatening condition so in theory nobody should die because they do not have health insurance. However, many people choose not to see a physician because they do not have a way to pay once the treatment has been provided. However, often by the time they get to a hospital, their life threatening condition is too far advanced to be saved. Also, life saving treatment of some prescription drugs or certain medical procedures (such as dialysis or transplant operations) may not be affordable and are thus the patient is denied a life saving drug or operation.

 

[Chuckanut]

When you hear German legislators, for example, explain that unemployed people have to be assured of continued access to health care because their health is at greater risk, you realize that no one here, even a Democrat Congressman, would dare being heard to say such a thing.

Another reason for the difference, IMHO, is the attitude towards Freedom.

Most Europeans seek "Freedom From", while many Americans seek "Freedom To".