Wow, what do people do who don't have health insurance?!

[MasterBlaster]

The problem is, you can't tax people enough for government healthcare. If we were continually taxed to pay for the government programs, eventually, we would be taxed far in excess of what the cost of private insurance costs.

And it's not just government healthcare programs. It's everything that the government does. The programs grow year after year, and the poor taxpayers are then subject to pay it. So who works for who ?

When the economy is good they increase spending on all of the programs.

When the economy is bad they just increase the taxes to pay for those now increased programs.

 

[ziggy29]

Pray for continued good health.

 

[ziggy29]

Was talking to my RE agent last night. Sad story of a couple trying to "go bare". In the middle of selling their home, huge medical problem came up. At the end of it all, they lost all their money, and their house. Then some more lien holders showed up at the last minute and the real estate agents involved in the home sale had to kick in some money out of their commissions to resolve all the financial demands.

Penniless, no home, smashed credit. Very sad.

That is sad. Too bad they don't live here in Texas. It's virtually impossible for a creditor or legal judgment to take your homesteaded primary residence (or retirement accounts) here. Asset protection laws for the primary residence are as strong in Texas as any state in the union.

 

[ladelfina]

Just ask OJ!

----------
No, seriously.. this is a terrible issue. it's only from outside the US that I see how hard it is to navigate, especiallly between states/regions. I have no problem paying for what I get. But the system now seems completely arbitrary .. depending on what insurance co. you have (or more likely what insurance co. your employer allows you access to).. plus completely different experiences also from one state to the next. Fairness and human decency not part of the equation, much less the free market!!!

If DH and I ever come back to the US, we'll enter the dreaded "uncovered for more than X days" zone(despite having been covered). We'll pay a pretty price. Which would be ok if it were comprehensible. It's not. TAXES are more comprehensible and more fairly levied, and that's not saying much.

I just saw a fifty-something ER poster talking about a $185/mo. premium.
How is that possible, even with a high deductible?

We accept the inequities because we accept the spin-the-wheel-and-the-winner-takes-all LUCK paradigm. Hey! CFB's RE agent made a dime off the next guy's misery.. why not us!? We favor the chances of the (potential) winners in the system; the losers fend for themselves until they hit rock bottom, whereupon we (taxpayers) pick up the tab, funnel it back into the game, and spin the wheel once again. Errrgh.

 

[eridanus]

And it's not just government healthcare programs. It's everything that the government does.

Yeah, private health insurance companies are gonna straighten it out anytime now. :

I have this crazy idea about where we can get $150 billion a year for health care....

 

[ziggy29]

I have this crazy idea about where we can get $150 billion a year for health care....

And will that $150 billion "revenue source" avoid consistently growing faster than inflation and population growth? Our experience with Medicare should indicate otherwise.

As long as health care continues to eat an ever-increasing percentage of the GDP, creating a new revenue source to meet needs NOW will not create a good long-term solution. Like Social Security and Medicare, you can only raise taxes to keep them "solvent" so many times before they become an unacceptably large drag on the economy.

So let's consider ways to keep health care costs from spiraling out of control in the future. Do any of them avoid restricting the availability ("rationed care") or reducing the quality and technology available?

There is the crux of the problem.

 

[eridanus]

And will that $150 billion "revenue source" avoid consistently growing faster than inflation and population growth? Our experience with Medicare should indicate otherwise.

As long as health care continues to eat an ever-increasing percentage of the GDP, creating a new revenue source to meet needs NOW will not create a good long-term solution. Like Social Security and Medicare, you can only raise taxes to keep them "solvent" so many times before they become an unacceptably large drag on the economy.

So let's consider ways to keep health care costs from spiraling out of control in the future. Do any of them avoid restricting the availability ("rationed care") or reducing the quality and technology available?

There is the crux of the problem.

The "revenue source" would've been diverted from one of our "spend like a drunken Democrat" President's budget line items.

Anyway, you're right. We need to figure out how to reduce spiraling costs, and the solutions will have to kill a few sacred cows. Making bills more transparent and making hospitals more e-capable will only take us so far.

 

[ladelfina]

They do this: they croak!

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.

By the time Deamonte's own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George's County boy died.

Deamonte's death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

The issue isn't this one kid. The issue is a system wherein short-term gains are preferable to (theoretical) long-term losses. Even when the losses include human lives.


$80 sounds better than $250k. Unless you're the entity on the hook for the $80.. and couldn't give 2 s*** about who is going to pick up the $250k .. or not.

 

[lets-retire]

medical bills--I feel lucky I've had to take my wife to two hospitals in two entirely different states and both bills were in short hand. I've had to go to two different hospitals, one in the same state my wife went to the other in a different state, and again the bills were short hand English. The total is four different hospitals in three different states. When I do eventually receive a bill with nothing but codes on it, you can bet I will either be on the phone with the billing department or in their office until I receive and adequate explanation for what I was billed.

Medical rationing-- We have it now and any solution we will have it. The main difference is currently health care is rationed by the patients ability to pay for non-emergency procedures. The solution is rationing will be for everyone. My preference is not to take a benefit for those who have worked hard or are still working hard to afford insurance. For those of you who have retired early (before Medicare eligible) and now complain that the cost of health insurance is unacceptably high, my position is, it sounds like you are not really able to afford to retire. Go back to work (heresy, I know), even a part timer should be able to afford most insurance policies when all of the other bills are paid form another source.

The only way for the government to "fix" health care is to take it over. Anything short of that will eventually lead to taking it over. I recognize the current system is screwed up, but not as bad as letting the government run it. What program has the government run that is accomplishing all of it's goals well, while staying within budget? I can't think of any. Why would they be able to do it with national health care? If your financial planner kept losing you money would you trust them with more money? They aren't doing what you are paying them to do.

 

[eridanus]

Medical rationing-- We have it now and any solution we will have it. The main difference is currently health care is rationed by the patients ability to pay for non-emergency procedures. The solution is rationing will be for everyone.
<snip>

The only way for the government to "fix" health care is to take it over. Anything short of that will eventually lead to taking it over. I recognize the current system is screwed up, but not as bad as letting the government run it. What program has the government run that is accomplishing all of it's goals well, while staying within budget? I can't think of any.

So your solution is for the insurance companies to voluntarily ration more fairly? And the companies will do this why?

 

[lets-retire]

My point is our system will not cover everyone. The government controlling health care is not a good solution, and I think is worse than the beast we already know. I'd rather stay with the beast I currently know than the one I've known in the past to be more flawed than the private sector.

 

[mykidslovedogs]

Here's a good example of rationing in a universalized system:

Canada is able to buy prescription drugs at a discount from the USA ONLY because the pharamaceutical companies figure they can afford to sell LIMITED amounts of prescription drugs to Canada (and other poorer countries) by separating markets and cost-shifting higher prices to Americans who are willing to pay more for their prescriptions in the form of health insurance premiums. This is wonderful for Canadians, right? (but not for us, because we pay the higher prices to compensate...)

Canadian pharmacies figured out that they can profit from their discounted prices by selling their drugs back to Americans in the free market at a premium, through illegal reimportation. This is good for Americans. But who ends up with the short end of the stick?....

Canadians are now experiencing SHORTAGES of certain prescription drugs such as Lipitor, and Canadian pharmacies are now LIMITING patients to 30 day supplies in order to compensate. RATIONING. Ultimately, it is the ONLY solution for universalized systems. They can't make up for the shortages with production from their own pharmaceutical firms, because the technology just isn't there. Their socialized system has stifled development of prescription drugs in their own country. Thus, they have to depend on the USA for their supplies of prescription drugs.

Is this how we want America to end up? Think about it. Because, if we universalize and force price controls on our pharmaceutical companies, it will work for a while, but in the LONGRUN....Americans will begin see shortages of prescription drugs, just like the Canadians are now beginning to face.

 

[Common Sense]

Re: They do this: they croak!

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html

The issue isn't this one kid. The issue is a system wherein short-term gains are preferable to (theoretical) long-term losses. Even when the losses include human lives.


$80 sounds better than $250k. Unless you're the entity on the hook for the $80.. and couldn't give 2 s*** about who is going to pick up the $250k .. or not.

Shouldn't it be everyones personal responsibility to take care of their own teeth? A simple tooth brush, floss, and toothpaste for $4.00 would probably have prevented this problem. Maybe we need socialized dentistry as well as socialized medicine to provide care for people who are too lazy or ignorant to provide for themselves.

 

[Martha]

I've been "on break" from the healthcare discussions, but I would hesitate to assume that a 12 year old's tooth abscess was caused by failure to brush and floss. And no matter what, a 12 year old shouldn't be dying because of a tooth abscess.

 

[Martha]

Here's a good example of rationing in a universalized system:

Canada is able to buy prescription drugs at a discount from the USA ONLY because the pharamaceutical companies figure they can afford to sell LIMITED amounts of prescription drugs to Canada (and other poorer countries) by separating markets and cost-shifting higher prices to Americans who are willing to pay more for their prescriptions in the form of health insurance premiums. This is wonderful for Canadians, right? (but not for us, because we pay the higher prices to compensate...)

Canadian pharmacies figured out that they can profit from their discounted prices by selling their drugs back to Americans in the free market at a premium, through illegal reimportation. This is good for Americans. But who ends up with the short end of the stick?....

Canadians are now experiencing SHORTAGES of certain prescription drugs such as Lipitor, and Canadian pharmacies are now LIMITING patients to 30 day supplies in order to compensate. RATIONING. Ultimately, it is the ONLY solution for universalized systems. They can't make up for the shortages with production from their own pharmaceutical firms, because the technology just isn't there. Their socialized system has stifled development of prescription drugs in their own country. Thus, they have to depend on the USA for their supplies of prescription drugs.

Is this how we want America to end up? Think about it. Because, if we universalize and force price controls on our pharmaceutical companies, it will work for a while, but in the LONGRUN....Americans will begin see shortages of prescription drugs, just like the Canadians are now beginning to face.

Our insurance company used to limit us to 30 day supplies. Now it has been up to a 90 day order at once. I am surprised at how frequently we cannot get our entire order filled at once because of shortages.

 

[Martha]

So let's consider ways to keep health care costs from spiraling out of control in the future. Do any of them avoid restricting the availability ("rationed care") or reducing the quality and technology available?

There is the crux of the problem.

Depends on what you think "rationing" means.

I have read a number of articles on reducing health care costs, but the folder with all my info is not easily assessable right now. A few things come to mind. One is finding a way for insurance companies (if we are going to keep them) to compete more on price and less by way of underwriting. On the delivery end, our primary care system is weak as compared to some other countries. Doctors see too many patients and spend too much time on paperwork. If we could strengthen that system, higher cost specialists may not be needed as often and patient comliance may be better, ending up in reducing costs. Health promotion at work (see a recent Business Week article) seems to result in savings. Carrots and sticks for compliance make a difference. Chronic diseases use up a lot of money; education in self management can result in savings. There are many many more things we can do to reduce costs. I am just tossing out a few.

Besides chronic diseases, end of life care is very expensive. Tough nut to crack. One thing that seems to reduce end of life care cost is simply having discussions about end of life care with everyone involved and not have families close their eyes to what is going on. Rich_in_tampa could speak more to this than I ever could.

 

[eridanus]

Financial Times has an new article on US Healthcare. Interesting read.

----------
Symptoms of an unsustainable system

By Jacob Weisberg

Viewed as a whole, the American system is inefficient, expensive and
possibly unsustainable. It consumes 16 per cent of gross domestic
product and is growing 6.4 per cent a year. Europe provides
universal, high-quality care for half as much per capita.
Employer-based coverage is a drag on the economy, tethering workers
to jobs they would otherwise leave and adding to the cost of goods.
Healthcare spending is everywhere a budget wrecker. Yet, for all that
the US spends, 16 per cent of the population, including 8m children,
must make do at the system's charitable margins.

 

[ziggy29]

Besides chronic diseases, end of life care is very expensive. Tough nut to crack. One thing that seems to reduce end of life care cost is simply having discussions about end of life care with everyone involved and not have families close their eyes to what is going on. Rich_in_tampa could speak more to this than I ever could.

Very true. Dealing with end-of-life care is a medical hot potato, a real ethical dilemma. On one hand, we are loathe to give up our loved ones to a death sentence, but for some situations the cost of trying to cure *one* almost certainly hopeless situation and maybe add a couple of low-quality months to someone's life could probably pay for routine and preventative care for hundreds of uninsured and underinsured individuals.

My dad succumbed to cancer in November 2005. He basically learned he was terminal a couple months prior to his passing. He specifically opted for home hospice care with strict medical directives in place, including a DNR and a signed document stating that the ONLY medications he was to be given were to keep him comfortable and feeling as well and pain-free as possible -- not for any attempts at life-prolonging "miracle cures".

Not to say this makes my dad a hero over other people, but I have to imagine a LOT of health care dollars would be saved if a lot more people made these end-of-life choices (preferably voluntarily). I guess some end-of-life situations have more "hope" than others, so that would be another factor to consider.

 

[mykidslovedogs]

Financial Times has an new article on US Healthcare. Interesting read.

----------
Symptoms of an unsustainable system

By Jacob Weisberg

Viewed as a whole, the American system is inefficient, expensive and
possibly unsustainable. It consumes 16 per cent of gross domestic
product and is growing 6.4 per cent a year. Europe provides
universal, high-quality care for half as much per capita.
Employer-based coverage is a drag on the economy, tethering workers
to jobs they would otherwise leave and adding to the cost of goods.
Healthcare spending is everywhere a budget wrecker. Yet, for all that
the US spends, 16 per cent of the population, including 8m children,
must make do at the system's charitable margins.

This is one of the arguments I always hear for universalized care, but one thing that is never explained is that our "total healthcare spending" includes the cost of coverage that we pay for people from other nations who come to the USA for care because they can't get it in their countries, yet, those people are not counted in the population when determining the "per capita" figuers. Also, those figures are skewed because of cost-shifting to the American people for prescription drugs (poor countries purchase their prescriptions at much lower prices than America does, because the pharmaceutical firms are able to make up for it by charging higher prices to the American people since our markets can sustain the higher prices).

Also, did you know that Immigrants accounted for a third of the increase in the uninsured population from 1994 to 1998 and from 1998-2003 immigrants accounted for 86% of the growth of the uninsured according to a report by the Employee Benefit Research Institute?

 

[mykidslovedogs]

I've been "on break" from the healthcare discussions, but I would hesitate to assume that a 12 year old's tooth abscess was caused by failure to brush and floss. And no matter what, a 12 year old shouldn't be dying because of a tooth abscess.

You are right! If the mother or father had been paying close attention to the child and had taken him/her into the ER in a timely manner, the death could have been prevented. If the mother or the father had taken the child to the dentist for preventive care, and worked out a financial arrangement, the death could have been prevented. I am sure that no dentist would turn down a child in excrutiating pain just because the parents can't pay the bill in full at the time of service.

Just because someone else wasn't there to pay for the child's dental care is no excuse. There are plenty of charitable organizations that could have advised the parents where to go to take care of the problem had they just taken the initiative to ask. My guess is that there is more to the story than what is being told. Perhaps the parents were neglectful, resulting in the child's demise. The USA healthcare system should not be blamed for such a tragedy.

 

[Rich_by_the_Bay]

This is one of the arguments I always hear for universalized care, but one thing that is never explained is that our "total healthcare spending" includes the cost of coverage that we pay for people from other nations who come to the USA for care because they can't get it in their countries, yet, those people are not counted in the population when determining the "per capita" figuers.

No doubt that occurs, but I've never seen anything to suggest that it's anything more than a minor contributor to the gigantic overall problem. Lots of uninsured immigrants, but also lots of insured immigrants and tons of others to dilute the effect.

I'd have guessed it's a trivial factor (in the relative sense) but if you have something to the contrary, I'm educable.

 

[mykidslovedogs]

Read through this paper. Page 14 has some interesting information on Healthcare Spending in the USA, and gives another picture than what we typically see from proponents of universal coverage.

http://www.wpri.org/Reports/Volume19/Vol19no10.pdf

 

[Empty Pockets]

Back to the original question, what do people do who don't have health insurance ?

I don't mean this as a smart answer, but it used to be - they died.

My parents tell of people who didn't have any money in the 30's and when they got sick, they stayed home and fought it with home remedies the best they could and they either lived or died.

I realize times have changed and this wouldn't happen today. But it does keep things in perspective, I don't like paying these high prices for medical care and I think something has to change, but I am glad that there is care available if my family or I need it.

 

[unclemick]

I really hesitate to remind the old timers here but I went 12 years without health insurance - that or go back to work.

I was in the 'get well or die camp' given the prices availible to me when I lived in LA. 10k deductible BCBS outta Kansas City and 12 yrs of portfolio growth post Katrina.

I DO NOT RECOMMEND THIS!!!!

heh heh heh - everyone depending on me had insurance and finances were arranged should sickness bust my portfolio to zero.

 

[eridanus]

Read through this paper. Page 14 has some interesting information on Healthcare Spending in the USA, and gives another picture than what we typically see from proponents of universal coverage.

http://www.wpri.org/Reports/Volume19/Vol19no10.pdf

Do those US numbers include government subsidies for employer-bought insurance?

If you're getting a government subsidy, you're a socialist!

(Only 10m Americans have completely non-subsidized health insurance.)