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Old 09-11-2014, 02:32 PM   #21
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My answer is NO based on the information and ideas that are usually presented with regard to universal health care. If I was forced to "vote" on the adoption of universal health care I would go with something like the Swiss system. However, even the Swiss approach leaves something to be desired in my mind.

I strongly believe ever-increasing health care costs are due in large part because many users have little (or no) "skin in the game." Until a system evolves that puts the user/patient in charge of spending the money it seems to me costs will continue to rise because we are spending other people's money. Spending OPM is much easier to do than spending your own money. When a person thinks a doctor visit is free or costs $5 or $20 it's the OPM mentality. Sure, I don't mind going to the doctor it only costs me $X.

So... if a universal system could evolve in which user/patients are allotted money and they spend it as they see fit for their situation then I think we'd be on to something. Yes, this would require additional controls and I'm not suggesting we simply leave people by the wayside if they've used all their money but there must be consequences to doctor visits, hospital stays, poor decisions, etc. when it comes to paying for healthcare. As users/patients we need to shop around when possible, understand who provides the best service for the least amount of money. Choose a doctor who provides realistic, practical treatment rather than a doctor who simply prescribes another pill or runs another test.
Although I think that it would help if people have some "skin in the game", if you've ever used health care for something like cancer, you really have little or no control over the cost of the care. It is usually extremely expensive. So for the most part I disagree with your assessment of putting a limit on coverage. Someone like me can go for 55 years with little or no health care usage but then all of a sudden get diagnosed with cancer. I should not be penalized for doing everything right for 55 years and then then having bad luck, get cancer.

I think the bigger problem is that health care is so expensive because doctors, hospitals and drug companies in the US can charge what the market will bear and that tends to be much higher than the rest of the world because there is little or no negotiations for many health care products and services. I take one pill daily to keep my cancer in remission and it costs about $460 per pill (close to $13,000 every 28 days). With the cancer I have, this drug is by far the most effective in keeping my cancer in remission, so there is not really an alternative treatment unless I want to die sooner. So in my opinion your solution of giving a certain allotment of money per person is NOT the answer.
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Old 09-11-2014, 04:05 PM   #22
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If it is like the Canadian system, in a heartbeat. This is the ONLY thing that will pull me away from Sunny Florida. My wife still works so we can get healthcare that is affordable, ACA or no ACA.

Fortunately we are both Canadian Citizens and have a choice, so it is OK. Pitty it is so cold up there for the most part otherwise we would already be living there in retirement. I am not a 2 house person.
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Old 09-11-2014, 04:22 PM   #23
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As an MD and consumer in the Canadian system - I think it's among the best in the world. As an MD in the American system (now years ago) - not so much!
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Old 09-11-2014, 05:09 PM   #24
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There is more than one price; the price is progressive with respect to AGI. The premia paid for Part B and part D coverages goes up stepwise from the base rate to progressively higher rates which in the case of Part B irrc top out at about 4x the base rate.

I sold some stock and popped up 2 steps, which will increase my Medicare B and D fees a fair amount in the 2016 tax year. This has happened to me before also.

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Good point, and one that I think detracts from Medicare as a model for universal health care.
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Old 09-11-2014, 05:26 PM   #25
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The biggest obstacle that I see to universal healthcare in the US is the multi-billion dollar insurance industry and the seemingly inherent American fear of their government.
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Old 09-11-2014, 05:40 PM   #26
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The biggest obstacle that I see to universal healthcare in the US is the multi-billion dollar insurance industry and the seemingly inherent American fear of their government.
+1
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Old 09-11-2014, 05:50 PM   #27
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The biggest obstacle that I see to universal healthcare in the US is .... the seemingly inherent American fear of their government.
+1 I think that between medicare, medicaid and the VA systems troubles that many are very skeptical that the government could pull it off without it being an unmitigated disaster, especially in this partisan age. And of course, the botched roll-out of healthcare,gov didn't help either.
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Old 09-11-2014, 06:28 PM   #28
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[QUOTE=DallasGuy;1492474]Although I think that it would help if people have some "skin in the game".....

I think the bigger problem is that health care is so expensive because doctors, hospitals and drug companies in the US can charge what the market will bear and that tends to be much higher than the rest of the world because there is little or no negotiations for many health care products and services. I take one pill daily to keep my cancer in remission and it costs about $460 per pill (close to $13,000 every 28 days).... /QUOTE]

Agree 100% that people ("consumers") should have some "skin in the game", at least with US public attitudes that "more is always better". IMHO This is critical to folks not abusing the HC system as well as using market forces (consumers) to encourage some serious cost containment. Clearly US "consuming" vast HC resources ($$$) has not paid off in better health (on ave) than other developed nations which spend far less.

Also agree that Big Pharma (& most medical device makers) have largely been able to set their own prices. Often Big Pharma keeps raising prices even after the drugs' R&D costs have been recouped &/or partially funded by others (e.g. philanthropy, gov't). As one former Big Pharma exec put it recently, “Everyone is engaging in extreme prices because they can get away with it.”.
Why Prescription Drug Prices Keep Rising Higher - Businessweek
Not surprising that drug costs in US are much higher for same meds than in other countries, a fact even the US gov't has admitted for many years.
Cost of Prescription Drugs

OTOH- Most US docs & hospitals have long been subject to price negotiations. And most US docs are now HC system employees anyway, so not negotiating their own fees like in traditional fee-for-service private practice.
http://www.nytimes.com/2010/03/26/he...anted=all&_r=0

Interesting to look at recent industry net profit margins (public financial data, publicly traded firms):

Big Pharma 20.8%
Medical instruments/suppliers 12.8%
Other Pharma (mostly generics) 11%
Hospital Systems 3.8%
Health Plans (HI carriers) 3.2%
Industry Browser - Yahoo! Finance - Full Industry List
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Old 09-11-2014, 06:29 PM   #29
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Imagine car insurance if your employer provided it to you via a group policy. Imagine car insurance if the government paid for it. Health insurance should be no different.
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Old 09-11-2014, 06:35 PM   #30
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I would like to see health insurance divorced from employment - it was a bad idea to begin with (and was the unintended consequence of a different government intervention).

Many aspects of ACA are heading in the right direction in my opinion. I think everyone should be required to have health insurance so people can't freeload off the system. I think that health insurance should be subsidized if someone's income is low and it is unaffordable and ACA does that. I like mandating that a limited number of maintenance services are included in coverage "free" so people don't have an incentive to ignore health issues.

Where I would diverge with proponents of universal health care is that I think health insurance should remain in the private sector and not be subsumed by the government like in Canada and the UK.

The bottom line is that health insurance and health care is expensive and each person needs to be personally responsible for their healthcare which means that health care for people with health issues will end up paying more than those who rate healthy.
Considering the very ample dole given from taxpayers to far from impoverished people to allow them to buy these allegedly private insurances, I question whether this isn't just a mechanism to transfer money from those unfortunate enough to still be taxpayers, to all kinds of medical crony monopolies.

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Old 09-11-2014, 06:41 PM   #31
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Imagine car insurance if the government paid for it.
Actually I experienced this in Manitoba. It was pretty good! Rates were very competitive and when someone T-boned my car on an icy street, I was properly compensated pretty quickly.

Manitoba Public Insurance
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Old 09-11-2014, 08:14 PM   #32
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And bear in mind that the government doesn't pay for it. Citizens pay for it. The government just cuts out all the middle men with their fingers in the pie and is able to negotiate costs with caregivers, drug companies, hospitals, etc. One can go online in Ontario (and I am guessing most Canadian provinces) and find out exactly what a doctor is paid for a consultation, visit or procedure and with only a little bit more effort (looking up a phone number and calling the hospital) you can find out how much a stay will be with reasonable accuracy.
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Old 09-11-2014, 08:22 PM   #33
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And bear in mind that the government doesn't pay for it. Citizens pay for it.
Well if it were in America, to be more accurate something around 45% of the citizens would pay for it, their own, and the other 55% ers share too. And since taxpayers tend to be more prudent in other areas of life, including health and hygiene, the 55%ers likely would make a bigger draw per capita from the system. Great system if you are a booze-hound slacker

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Old 09-11-2014, 08:25 PM   #34
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Although I think that it would help if people have some "skin in the game", if you've ever used health care for something like cancer, you really have little or no control over the cost of the care. It is usually extremely expensive. So for the most part I disagree with your assessment of putting a limit on coverage. Someone like me can go for 55 years with little or no health care usage but then all of a sudden get diagnosed with cancer. I should not be penalized for doing everything right for 55 years and then then having bad luck, get cancer.
+1000

ACA attempts to move in this direction and should help IF you can find a policy that includes your doctors in the network and perhaps more importantly, has the drugs you need on its formulary.
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Old 09-11-2014, 08:54 PM   #35
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Well if it were in America, to be more accurate something around 45% of the citizens would pay for it, their own, and the other 55% ers share too. And since taxpayers tend to be more prudent in other areas of life, including health and hygiene, the 55%ers likely would make a bigger draw per capita from the system. Great system if you are a booze-hound slackerHa
That's only because the system does an inadequate job of distributing the wealth. As long as the system is rigged to mal-distibute wealth into as few hands as possible yeah, you're gonna have that pucking froblem.

As far as dissolute behavior... Ok Kill 'em. There's more than one way to round people up and kill 'em. The Havers engage in all that behavior and then some but they do not suffer anywhere near the deleterious effects because they have the money to cover for it and they run far far less risk of losing everything so they don't look like slackers and boozers even though they are.

And then there's my case. I was quite healthy and indestructible.... until I let doctors try to treat me for diseases I didn't have. Cholesterol and an alleged subclinical infection that was not detectable by any test but he swore I had one. Them, complete denial of the unfortunate sequalae that progressively destroyed any remaining quality of life. Over several yrs spent hundreds of thousand on medical bills tax payers actually as I am retired military).

I finally stopped doing everything they said and my health started to improve. I still need a prescription for the rest of my life and surgery that I do not trust any doctor to do. Should I be penalized for pissing away resources? Should we do what the Doctor says? Do it then blame the victim? I am lucky" in that I did not have to worry about losing my job even tho I was left unable to work. And I had solid med insurance to pay the doctor for destroying my health and keep me from living in a dumpster.

And we all know I am not the only one.
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Old 09-11-2014, 11:13 PM   #36
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It seems ironic to me that on early retirement sites and financial sites (like Bogleheads) that health care is such a taboo topic given that the only way things will ever change is via (or at least the strong support of) a grassroots movement of financially literate people who recognize the implications of an every man/woman for themselves approach. I can retire early because I have worked hard/saved diligently/invested wisely (been very lucky/blah/blah) but also (and more importantly) because I have no significant worry about my healthcare costs or those of DW, our children or our extended family. In the US the leading cause of bankruptcy is medical expenses and it seems that people stay in jobs because they can't afford not to from a health insurance perspective. The truth is that in the US, all but the top few percentile of the population is at risk of financial catastrophe due to medical problems and despite spending far more per capita on healthcare than any other country, the US indicators for healthcare are pretty poor (and perhaps poor is a bit of an understatement). At any rate, there are issues of which all are aware, hopefully one day solutions will be found and implemented to the benefit of all.
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Old 09-12-2014, 12:53 AM   #37
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I cannot imagine living in a country without universal health care.

For us it means the provision of quality health care regardless of employer benefits. After all, why on earth does something basic like the provision of health services be linked to an employer It is no different to us than the provision of police and fire service, or clean water from the tap.

For us, it means early retirement at 57/58 with absolutely no concern for the cost /availability of health insurance insurance policies until we reach 65.

For us it means that medical costs are not the largest reason for personal bankruptcies. Becoming ill without insurance is not a reason to loose all of the assets that we have accumulated over our working years.

We pay higher taxes and there are challenges to the system. We see some US politicians claim that our system is not good. The fact is there are some issues but the hard reality..backed by 20 plus years of annual polling shows that 80 plus percent of the population like it and demand it.

We could not imagine not having it.
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Old 09-12-2014, 03:56 AM   #38
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Old 09-12-2014, 05:06 AM   #39
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I have lived in Switzerland for about 5 years now and like the Swiss model.

It is "universal" in the sense that it is compulsory for everyone in the country who is here for more than 3 months. However it is not a single payer plan and is not connected to employment, which makes it portable. Individuals pay for it and do so all of their lives. If you cannot pay the whole premium, your canton (=state) will assist you based on your income. But you own the policy/contract.

There are no pre-existing conditions exclusions and your premiums cannot go up due to your own medical experience -- they are tied to your age group.
My premiums have gone up 1 or 2% each year at most. One year they did not go up at all. It was a shock.

For the basic insurance plan, which is compulsory, the government (or a governament commission, not sure) determines what illnesses are covered and publishes a drug formulary; but it is very comprehensive. It's like the US Blue Cross/Blue Shield used to be. There is no hassle with getting health services (you can go to a general practitioner or directly to a specialist). You show your insurance card and they bill the insurer.

The basic plan is reasonably priced and includes medications and even spa treatments if these are prescribed by a doctor for physical ailments or stress/burnout. Also if you are physically unable to care for yourself or your home due to an illness, you can receive home help until you are better. Some alternative medicines are covered as is acupuncture, for example. So you get doctor visits, lab stuff, medications/equipment, and hospitalization.

What you do not get is a private room in a hospital (only semi-private) or the ability to go outside your canton for treatment. If you want that, you buy a supplemental policy, which about 20-30% of Swiss residents do. It allows for some other benefits as well. Most people are okay with the basic plan. You can never be dumped by your insurer and you can change once a year to another if you would like. The medical staff are well trained and often speak very good English. My wife had a small procedure at our local hospital and was kept in hospital for most of a week (!) to be sure she was okay, and then we had help with house stuff for two weeks following.

There are about 60 nonprofit companies which offer insurance plans, competing on some aspects of price and service.

So in summary, I like that it is not connected to my j*b, making it portable. It is compulsory, so the healthy youngsters are in the pool as well. It covers things like medications and is generally form-free and has the bonus of no hassles/gamesmanship. The companies pay the bills and we are almost never on the 'phone with them as we constantly were when we lived in the US.

One small worry. Switzerland is a true direct democracy. This means citizens can change laws based on majority vote. There is a nationwide referendum this month to switch out the current system with a single-payer government system supported by taxes. I cannot believe this will be better for us; but I don't have a vote here.

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Old 09-12-2014, 06:24 AM   #40
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That sounds like a sensible system to me other than the restriction to be treated in your own canton. Is there some provision for people who travel or do you need to buy a supplemental policy if you travel?
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