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Re: Why does health insurance vary state to state
Old 04-17-2007, 04:54 PM   #81
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Re: Why does health insurance vary state to state

Just doin' the math..It's fascinating to me that people are very quick to discount my opinions, but when I genuinely ask for "unbiased" information that might influence my opinions to the other side, no one seems willing or able to provide it.
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Re: Why does health insurance vary state to state
Old 04-17-2007, 07:38 PM   #82
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Re: Why does health insurance vary state to state

MKLD has brought up wait times as an argument against universal healthcare. The Commonwealth Fund has several studies based on survey information from 2002 and 2005 looking at various healthcare issues in the US, UK, Australia, Canada, New Zealand and Germany. A summary can be found here on the 2005 work: http://www.cmwf.org/publications/pub...?doc_id=313012

From the summary:

There were wide and significant variations in access and waiting times on multiple dimensions across the six countries. Respondents in Canada and the U.S. were significantly less likely than those in other countries to report same-day access and more likely to wait six days or longer for an appointment. At the same time, majorities of patients in New Zealand (58%) and Germany (56%), and nearly half in Australia (49%) and the U.K. (45%), were able to get same-day appointments. Waiting times for elective surgery or specialists were shortest in Germany and the U.S., with the majority of patients in both countries reporting rapid access

Although I can't find a link to it now, one big issue with wait times in the US is emergency room wait times, which in some cities can run 8 hours or more. Interestingly, the Commonwealth Fund summary says: Relative to the U.S. and Canada, the four countries reporting comparatively rapid access to physicians—Australia, Germany, New Zealand, and the U.K.—also had significantly lower rates of emergency room use. Maybe having everyone covered would strengthen our primary care system and get our emergency rooms out of that business?







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Re: Why does health insurance vary state to state
Old 04-17-2007, 08:55 PM   #83
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Re: Why does health insurance vary state to state

Martha,

Thanks for the post. I read through the article, but I haven't yet had a chance to go through the whole site in detail yet. I will bookmark it. I am specifically wondering about wait times for high tech services such as MRI, CAT, PET scans, as well as complicated surgeries. Wait times for routine office visits and preventive care don't concern me as much, since these services are not necessarily as "urgent", and also, we can pretty much compare these apples to apples with other "universal" systems, since our primary care system is inundated by Medicare and Medicaid patients, which, IMO, is what has really led to the shortage of physicians in that area (reimbursement is too low and doctors don't get paid enough for primary care, so they don't choose those careers). ER wait times are a whole different issue, which, IMO, requires a lot more analysis. I don't think ER wait times are totally because a system is socialistic vs. private...there is more to it than that....

In the USA, it seems to me that we have a shortage of primary care physicians, probably because the goverment isn't reimbursing them enough for Medicare and Medicaid patients, so they are choosing careers in a specialty where they can make more money, and don't have to deal as much with government programs. Because of the lack of primary care physicians, you then have greater wait times in the ER, since people who might have gone to a PM end up going to the ER for services. In the USA, there is really no disincentive to going to the ER, because copays are low, so that's where they go for the treatment. Americans don't like to wait, and they aren't informed about using services like triage nurses to assess the true urgency of their situation. I think ER wait times are more of a function of large cities where you have higher populations of poverty and uninsured's who use the ER as primary care. To get a real feel for actual ER wait times, I think you really would have to take a survey from a wide variety of different cities, states, and populations. Results would be skewed if you just used NY or Los Angeles as your sample.

Universal systems are not going to have as much of a shortage of primary care doctors, because primary care doctors are probably paid similarly as specialists. Why would someone choose a more difficult career if they aren't going to make that much more money? Therefore, you have less of a problem with primary care in universalized systems, but more of a problem with specialty care in universalized systems. IMO, it's the other way around in hybrid systems like the USA, because doctors have incentive to opt out of primary care and choose better paying positions than primary care. We do have a hybrid system. Half of the spending comes from Medicare and Medicaid, and the other half comes from private.

I am really trying to be open minded here, but on the article you posted, the graph was about medication errors across countries...I am curious as to whether the commonwealth first took into consideration that the USA, as the primary innovator and developer of prescription drugs, is likely to have a lot more types of prescriptions and a lot more "blockbuster" prescriptions available to patients, which could skew the results. I am often amazed at the combinations of multiples of prescriptions that our clients take, which usually include a myriad of "blockbuster" drugs for treating depression, cholesterol, elevated blood pressure, pain, diabetes, etc. With the USA having access to so many more choices of drugs than other countries, isn't it a given that more errors can occur? To me, that doesn't mean that the other systems are better...it just means that there is less chance for an error to occur there, because there is less selection.
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Re: Why does health insurance vary state to state
Old 04-17-2007, 09:13 PM   #84
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Re: Why does health insurance vary state to state

Usually the type of post I'm about to put up is handled via the moderator's board and PMs. However I'll throw this out for feedback from all those who've read his posts:

Am I the only one here noticing a scary similarity between MKLD's posts/logic/focus and that of H0cus?
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Re: Why does health insurance vary state to state
Old 04-18-2007, 04:11 AM   #85
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Re: Why does health insurance vary state to state

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Re: Why does health insurance vary state to state
Old 04-18-2007, 07:34 AM   #86
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by Nords
Am I the only one here noticing a scary similarity between MKLD's posts/logic/focus and that of H0cus?
Oh yeah, definately. Although to use the word "logic" in that sentence defies reason.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 08:19 AM   #87
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Re: Why does health insurance vary state to state

At the risk of baiting anybody.. I had put together some answers for MKLD and anyone else who is curious:
-------------------

The system in Italy is far from perfect. A good basic overview of the structure is here:

http://www.ess-europe.de/en/italy.htm

I was struck by MKLD's inclusion of plastic surgery and Lasik..!! How bizarre.. of course the government would not pay for that, nor would any private insurer that I know of... perhaps you know differently?

Just as someone can pay out of pocket and go to Mayo.. an Italian could travel less distance and still go to Switzerland or any other European country for private care if they didn't like the public or private options in Italy. My defense of the Italian system, even with all its faults, is that everyone -- upper- middle- and low-income people are covered for basic health care and emergencies. That is not available in the US except to the destitute. Since I have money, of course in the US I was able to "choose" a $9000/year HMO for two healthy 35 y.o. adults.. What if I didn't have that $9000/year? If I'm insured through my employer, the company "chooses" for me.. so what "choice" is that?

A definitive tax rate is just as difficult to establish here as in the US; it depends on your income, property tax, consumption, deductions, etc. There's a 20% VAT on everything you buy (some food items are less, at 10% and 4%). I think I have gone into this before.. Income tax rates can be found here:
http://www.worldwide-tax.com/italy/italy_tax.asp
This I got by typing "italy tax rates" into Google.

Taxes are of course higher than the US, but difficult to compare across the board, since there is a level of std. deduction and their deduction schemes beyond that are a bit different. I don't file in Italy since I only have US income; I file in the US. The average salaries here are roughly 1/2 or even less for equivalent jobs, so income tax still yields less $ per capita than would an equivalent, or even lower, US tax rate.

Again, I think I've gone into this elsewhere.. be aware that it would be false to assume that the increased taxes Italians bear go solely to cover health expenses. They obviously have other huge public subsidies that are higher than in the US.. let's say public transportation for one. They also choose to maintain a very big overall bureaucracy on the backs of the taxpayers. There are a lot of problems in Italy, but health care (problematic as it is) is one of the least among them.

Quote:
Also, just curious....if someone had to have a cornea transplant, cataract surgery, spinal surgery, brain surgery, plastic surgery, or hip replacement in Italy, is there any kind of waiting time?
My MIL had cataract surgery with a wait time of a month or two, I think. Obviously not life-threatening, but she was hot to get her driver's license renewal at 81! Wait times depend on the region and on the hospital you choose. MIL also had two separate knee-replacement surgeries with wait-time maybe a couple months each once she put her name on the list. Again not life-threatening... Same thing with a friend who had a hip replacement in the South of Italy. I don't think the wait time was any longer than a month or two.. but he wanted to put it off as long as possible, so.. hard to tell. I'm more curious what the wait times would be in the US for knee replacement.. do they just do it at the drop of a hat?

My husband is waiting on lithotripsy and it is taking months.. but that's his choice to wait because he wants to go to a heavily-used center in Rome, when he could go to a private clinic in Perugia that is "convenzionata" (i.e., they have a deal with the government to take public patients as well as private). The Rome center is undergoing renovations that won't be done until the fall, and they have a new machine sitting under wraps waiting for the new space to be ready; he wants to wait for the new machine and the trusted technician that treated him several years ago. Years back, for the same procedure he waited a long time (like more than a year) at another hospital that never got back to him; he contacted a second hospital and got in in a couple months. Again, it's not perfect.. you have to put this in the context of a country where it is not out of the question to go to the Post Office and find they have no stamps, or to ask the clerk how much it costs to send a letter to the US and they say "how should I know?". America can do better.

Fortunately among our family and close associates we haven't come across the need for any urgent procedures.

One interesting thing I noticed is that the Italian health service will pick up the tab for services abroad (like an organ transplant) if the doctor presents documentation that either the waiting list is too long, or that the patient needs a special procedure.


Totalip (prescribed for DH) is Atorvastatin, the same as Lipitor, and he got it "free". The others I don't know.. Looking up Advair.. it is of course available in Italy under the name "Seretide" (we're not a third-world country); whether this is free or with a co-payment depends on the doctor's dx, and your income level or something like that.. I don't have time right now to research the others.

Life-saving or essential medicines are labeled "Class A" and are always "free". Class "B" are things like hormone treatments, antacids and certain painkillers, (Advair would prob. fall into this group too) and for these some people pay some kind of "ticket" (co-payment). Class "C" for which everyone pays full price are things like cough drops, aspirin (unless with an Rx), dermatological creams.. This is just a brief idea and not an exhaustive list.

Now that Italy has "de-volved" many health care decisions onto the 20-22 regions (fans of federalism rejoice).. some regions have established co-payments on prescriptions.. You can be exempt from the co-payment, though, if you show you have a low income. Hence it's not the same for very region or every patient. However, the "ticket" ranges from €1 to €4 per prescription.. hardly prohibitive.

As far as private ins. rates go, I'm not sure.. there is some info here indicating it's €1300-2000/year for a family of four.
http://www.justlanded.com/english/it...alth_insurance

In closing.. I don't see how it could hurt to try a single-payer universal care scenario, with the option to purchase extra insurance if one wanted. It doesn't have to mean the government runs everything.

Look at it this way:
In Italy, all the major highways are toll roads, whereas in the US the interstates are "free" (meaning everyone pays for them through taxes). But in Italy basic health care for everyone is "free" (paid for via taxes), while in the US there is a hodgepodge of incomprehensible health care "tolls", many out of reach of a sigificant number of people.

It's just a different political choice. In the US we want free roads but take a "I've got mine/screw everybody else" approach to health care. In Italy, it's the reverse. There's nothing that says roads or hospitals or insurance or pension schemes have to be "bad" just because they are public. We can do better if there is the will to change.


This is an interesting report:
http://www.rand.org/pubs/corporate_p...ND_CP484.1.pdf
Go to page 16 to see an informative chart.
The second paragraph below the chart:
Quote:
The United States is spending more on health care per capita than any other country, but its use
of medical services—measured by, for example, hospital days and physician visits per capita—is
below the Organisation for Economic Co-operation and Development (OECD) median.
Pay more.. get less.. sounds good to me! :P

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Re: Why does health insurance vary state to state
Old 04-20-2007, 08:35 AM   #88
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by ladelfina
My defense of the Italian system, even with all its faults, is that everyone -- upper- middle- and low-income people are covered for basic health care and emergencies.
That's a very interesting and insightful report. I believe a near-perfect system is unattainable and the more I learn of other countries' systems, the more I am convinced that it is all a series of trade-offs.

FWIW, I'd be content with just what you describe: basic health care and emergencies covered for everyone through taxes, sound, evidence-based utilization control, and streamlining, with optional buy-in for convenience care, cosmetics, out-of-country care and other nonessentials. Waiting a month for a joint replacement, cataract, etc. is undesirable but not a show-stopper for me.

As to how we get there or implement it, well, that's the hard part. But not having to worry about access to insurance, portability, underwriting for conditions out of your control, inability to retire early due to health care costs -- what a relief that would be.

Thanks for describing the Italian system.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 09:04 AM   #89
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Re: Why does health insurance vary state to state

Ladelfina,

Thank you for the detailed report. I like to collect as much information about other countries as I can through the eyes of an actual user of the system. It's interesting to me that you don't have to pay into the tax system, yet you are able to take advantage of all of the services. What a bargain!

I wanted to mention to you that I included plastic surgery and Lasik because there is coverage for such things on a limited basis here in the USA. In fact, insurance companies are starting to warm up to Lasik coverage on vision plans, and I think VSP even now has a couple of plans that cover it! If someone has a disfiguring ailment that required plastic surgery, such as a cleft palate, that also affects the ability to have a normal life, insurance carriers do cover such things, and I believe the wait time here is quite short for such needs. Cleft palate and hand surgery come to mind. We also have new technology here for cataract surgery that not only corrects cataracts, but also corrects "old age eye" at the same time, and that is now covered by insurance carriers and Medicare with little or no wait time.

I'll see what I can do to collect wait times here in the USA for high tech services, complicated surgeries, etc.

I guess I would argue that the USA does already provide basic care such as preventive and emergency services for all...albeit, for the uninsured, the rest of us pick up the tab, but, that's how it would be in a socialized system anyways.

Bureau of Primary Health Care - This government run web site will help you find a local clinic that will give you medical care, even if you have no medical insurance or money.

Insure Kids Now - Now, you may have one less thing to worry about. Your state, and every state in the nation, has a health insurance program for infants, children and teens.

I wonder if anyone here has ever thought of a voucher system to allow anyone who can't afford insurance to be subsidized to purchase a personal policy?

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Re: Why does health insurance vary state to state
Old 04-20-2007, 09:41 AM   #90
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Re: Why does health insurance vary state to state

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I guess I would argue that the USA does already provide basic care such as preventive and emergency services for all...
Horsesiht! Ever tried to get service when uninsured? Basic care for all in the US - haaaaahahahaha! That's a good one. Pull the other one: its got bells on.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 09:46 AM   #91
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Re: Why does health insurance vary state to state

Quote:
I guess I would argue that the USA does already provide basic care such as preventive and emergency services for all...albeit, for the uninsured, the rest of us pick up the tab
oops Brewer beat me to it.. I was just about to say.. "The uninsured" (if you read the Rand report) have an average income of something like 200% of the 'poverty level'. You have to be either destitute or well-off to get access to care. A big chunk of people (like 20% or so of employed Americans) fall in-between.

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Re: Why does health insurance vary state to state
Old 04-20-2007, 09:56 AM   #92
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Re: Why does health insurance vary state to state

A little off the main topic of this discussion, but still relevant...

In our area, and I think across the country, grocery stores and pharmacies are putting in clinics with PA's that charge a minimum amount and take care of minor health problems such as ear infections, etc. They will send the patient to a doctor only if necessary.

When my kids were young and we were at the pediatrician's for what seemed like every week for minor problems like ear infections, strep etc., I often thought that it would be so much easier and cheaper to have PA's that could just dispense antibiotics, etc. if necessary. Doctors are very expensive and should be used for real problems, IMHO. I think we would save a lot of money in the health care system if we could have a less expensive means of treating "everyday" problems. In fact, my own GP said that 80% of his office visits are for easily treatable conditions. Why use an expensive doctor for those situations? Just have inexpensive clinics set up in pharmacies, grocery stores etc that folks could use whether or not they had insurance. IIRC they charge about $10.

We need to find less expensive solutions than doctors' offices and emergency rooms.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 09:59 AM   #93
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Re: Why does health insurance vary state to state

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I wanted to mention to you that I included plastic surgery and Lasik because there is coverage for such things on a limited basis here in the USA. In fact, insurance companies are starting to warm up to Lasik coverage on vision plans, and I think VSP even now has a couple of plans that cover it!
I think LASIK is an example of something people should pay for out of their own pockets. Won't that raise insurance premiums for everyone, just so people with a couple of diopters of correction can get "cosmetic" surgery? Also, what about all the costs to people who have complications from LASIK? Who pays for that?

It seems to me that there are a lot of things we should be doing with regard to expanding insurance access to more people before we consider covering LASIK.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:05 AM   #94
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by ladelfina
oops Brewer beat me to it.. I was just about to say.. "The uninsured" (if you read the Rand report) have an average income of something like 200% of the 'poverty level'. You have to be either destitute or well-off to get access to care. A big chunk of people (like 20% or so of employed Americans) fall in-between.

Well, I posted these links, but they must have been ignored.. Take another look. ANYONE can get service at these clinics on a sliding scale:

http://www.ask.hrsa.gov/pc/

http://www.insurekidsnow.gov/

Plus, anyone can go to an ER, and the ER must provide service regardless of whether you are insured or not. I agree, the tab is picked up by the insured, but, if it weren't for that, then the tab would be picked up by the taxpayers in a universal system anyway.

Again, not saying our system is perfect. And I'm not saying that everyone should agree with me either. I just don't think I would be willing to give up the level of service (for high tech and complicated issues) that we have here in the USA for another type of system.

I also mentioned before....I wonder if anyone has ever considered a voucher type system where anyone who cannot afford insurance could be subsidized on a private policy? Perhaps the govt could define a "Basic" plan that all insureres must offer on a guaranteed basis, and then the gov't could subsidize that plan or even a "buyup" plan if the applicant wanted. A voucher system on a sliding scale wouldn't leave anyone out.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:07 AM   #95
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Re: Why does health insurance vary state to state

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Originally Posted by FIRE'd@51
I think LASIK is an example of something people should pay for out of their own pockets. Won't that raise insurance premiums for everyone, just so people with a couple of diopters of correction can get "cosmetic" surgery? Also, what about all the costs to people who have complications from LASIK? Who pays for that?

It seems to me that there are a lot of things we should be doing with regard to expanding insurance access to more people before we consider covering LASIK.
My point here is that America spends more GDP than other countries BECAUSE WE CAN and we CHOOSE TO. Whoever doesn't want Lasik included in their policy can buy a policy that doesn't have that kind of coverage, but in universalized systems, you don't even get that kind of choice.

LASIK is not necessarily just cosmetic. I actually had lasik 10 yrs ago and paid for it out of my own pocket. My vision was 20/400. I could barely see my hand in front of my face. I couldn't swim with contacts/glasses or ski with them without complications. I couldn't even go camping and have a good time without waking up blind as a bat in the morning. With Lasik, I can now enjoy sports and vacations without a second thought, and my morning routine is a whole lot simpler. I also have not had to visit the eyedoctor every single year for new glasses or contact lenses. In other countries, there's no way this technology would have been readily available with no waiting period 10 years ago.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:16 AM   #96
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Re: Why does health insurance vary state to state

To MKLD about plastic surgery.. I was thinking about boob jobs and the like (duh!)

For a cleft palate I found the protocol here (you can kind of figure it out):
http://www.ospedalebambinogesu.it/po...=2365&idon=128


Is this the America you want to live in, though.. when it's MORE important for ME to be able to insure my self for LASIK surgery.. than for MILLIONS of people to have any insurance at all!!!??

The solution in a "universalized" system would be a no-brainer: I pay $5000/year instead of $10,000.. I pocket the difference and purchase my own damn Lasik surgery or buy a private insurance that will cover it. Done!


Barbara Anne.. there are some good ideas there.. I thought many practices used PAs quite a bit anyway.

In Italy, when there are office hours, the waiting room is usually just chock-full of oldsters. I get the impression that it's a chance for them to talk to someone about their aches & pains. They also need to focus on rationing care differently here (like charging a small fee for office visits) and use the extra time and manpower to reduce wait times for non-emergency surgeries and the like. I think there would be big pockets of resistance, though, since people are used to walking in and getting seen for nothing.

They are starting in some places with fees for non-emergency ER visits.. €35 w/o tests.. €50 with tests.. woo hoo.. that's gonna break the bank! Of course there are a dozen or more "exemptions": kids under 6, seniors over 65, blind and deaf people, war veterans, the unemployed, concentration camp survivors, victims of terrorism and of organized crime (I am not kidding-these are actual categories for exemptions).. etc. etc. etc.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:24 AM   #97
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by mykidslovedogs
Plus, anyone can go to an ER, and the ER must provide service regardless of whether you are insured or not. I agree, the tab is picked up by the insured, but, if it weren't for that, then the tab would be picked up by the taxpayers in a universal system anyway.
You are missing the point. Not insured at an emergency room or clinic? Go to the back of the line, and when you are finally treated, you will be hit with dunning letters (and collection agency calls, etc.) for months trying to charge multiples of teh prices charged to insured patients.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:24 AM   #98
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Re: Why does health insurance vary state to state

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Whoever doesn't want Lasik included in their policy can buy a policy that doesn't have that kind of coverage, but in universalized systems, you don't even get that kind of choice.
Doesn't that mean the only people who would sign up for that coverage are those who consider themselves potential LASIK candidates? Certainly, no one with normal vision would want to pay extra for it. So where is the benefit unless it's forced upon everyone through regular insurance.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:26 AM   #99
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Re: Why does health insurance vary state to state

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Originally Posted by ladelfina
Is this the America you want to live in, though.. when it's MORE important for ME to be able to insure my self for LASIK surgery.. than for MILLIONS of people to have any insurance at all!!!??
Actually, it's NOT the kind of America I want (me, me, me). But I do want people to have the choices too WITHOUT the long waiting times for high tech. I understand in England that if you are at serious risk to have a heart attack, you still have to wait for your surgery. The only way you get in immediately is if you are actually having the heart attack right now.

That's why I posted the links above to prove that America does take care of it's people for basic care. Did you even look at them? These clinics do a wonderful job of helping out the working poor.

http://www.ask.hrsa.gov/pc/

http://www.insurekidsnow.gov/

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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:34 AM   #100
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Re: Why does health insurance vary state to state

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when you are finally treated, you will be hit with dunning letters (and collection agency calls, etc.) for months trying to charge multiples of the prices charged to insured patients.
brewer, do you remember a film called "The Hospital" with George C. Scott?
There's a bit this reminds me of.. where some guy is being wheeled in moaning on a stretcher.. and there's a nurse/administrator lady with '60s "cat"-style glasses whining.."Sir.. sir... do you have Blue Cross?.. Sir, do you remember your Blue Cross number?.. sir.."

(At least that's how I remember it).

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