Should we return to prior healthcare system

[DeborahB]

Yes, people are dying because they have no insurance. They can go to the ER to be STABILIZED for urgent life-threatening issues (assuming they live near and can get to an ER). But there is no mandate that says continuing care happens.

We absolutely (currently) have no mandate for preventive care that keeps people healthy enough to not need ER type care.

There are many people in this country who have to choose between much-needed medicine, and food or utility bills. Or - who have no money for any of the above. The food banks are seeing many more people in the past 2 years.

If you are a diabetic and can't afford insulin, or have a heart condition and can't afford whatever meds you need... You've got a big problem with the current system if you are uninsured.

Or if you have SOME assets and develop cancer - your entire life savings (assuming you have some) can go in a second with no insurance. And then if you need more care, with no more money, you can die. It's just that simple.

As far as I'm concerned the USA is living in the dark ages when it comes to health care. And our health statistics are dismal. We have excellent health care... IF you can afford it or have good insurance...

If not, you are SOL.

 

[DeborahB]

In my view we cannot afford to overturn Obamacare and start over. Too many people are dying every year because of lack of healthcare insurance.

+1

 

[MichaelB]

Yes, but doesn't Medicaid kick in? I'm not commenting about how good/bad Medicaid is, but this was in response to the comment:

Medicaid is means tested for both assets and income. Eligibility is a lengthy and onerous process. It is not a reasonable option for an uninsured individual needing medical care in the short term.

Again, people may be going bankrupt because they don't have or can't get ins, but are they dying because of it?

-ERD50

Study links 45,000 U.S. deaths to lack of insurance | Reuters

(Reuters) - Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.
"We're losing more Americans every day because of inaction ... than drunk driving and homicide combined," Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.
Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.

 

[DeborahB]

Medicaid is means tested for both assets and income. Eligibility is a lengthy and onerous process. It is not a reasonable option for an uninsured individual needing medical care in the short term.


Study links 45,000 U.S. deaths to lack of insurance | Reuters

Exactly.

 

[M Paquette]

There are limits for Medicaid. Not everyone, even those living in poverty, can get care through Medicaid. In California, for example, Medicaid is run through the Medi-Cal program.

Find Out if I Qualify

If someone can't get into one of the eligible channels, they won't have care. In Mendocino County, some of the folks I mentioned before did eventually get into end-of-life care through Phoenix Hospice out of Willits, which was covered as a Medi-Cal program.

In general, it would be preferable to address medical care issues prior to the patient entering terminal care, though. What we currently have is a bit of a patchwork of employer care, individual policies for those who qualify and can afford them, high risk pools for those who can afford that, Medicare for those 65 and older with 40 eligible quarters of work experience or cash to pay the premiums, Medicaid for others over 65, or in eligible care channels, and some charitable organizations.

There's some more information on Medicaid and the uninsured here:
www.kff.org/uninsured/upload/7613.pdf

 

[dex]

Medicaid is means tested for both assets and income. Eligibility is a lengthy and onerous process. It is not a reasonable option for an uninsured individual needing medical care in the short term.


Study links 45,000 U.S. deaths to lack of insurance | Reuters

About 2.5 million people die each year in the USA. If 45,000 die due to lack of health insurance then 2.45 million die who have health insurance die. It doesn't look like health insurance is doing much good.

The headline should read: "2.45 Million Die Each Year In Spite of Paying High Health Insurance Cost"

 

[M Paquette]

About 2.5 million people die each year in the USA. If 45,000 die due to lack of health insurance then 2.45 million die who have health insurance die. It doesn't look like health insurance is doing much good.

The headline should read: "2.45 Million Die Each Year In Spite of Paying High Health Insurance Cost"

*SIGH*

In other news, 100% of the current population will eventually die, with or without health insurance. So, why would anyone want this stuff?

 

[Martha]

In my view we cannot afford to overturn Obamacare and start over. Too many people are dying every year because of lack of healthcare insurance.

I agree. We can work to improve the current plan if we want to keep health insurance in the mix. If we just junk it the odds of doing something to replace it in the immediate future are next to nothing.

There is no political will for a government run program.

I would like our time spend on trying to figure out how to reduce costs, or at least stop the huge inflation in costs. Parts of the health care plan put in place mechanisms to study the cost issues. Let's do that.

 

[Texas Proud]

I have to mention.... I am not sure if it was 60 minutes or some other program (now I think it was Nightline).....


They were showing some clips from a program in the UK... people come it with some strange malady and show it to the viewers... then the docs go about 'fixing' it... now, the ones I saw were very ugly problems... and this in a country that is supposed to have national health care....

They said they saved the life of one 9 YO girl... so it seems that there are problems with a system that sick people will not even go to the doc for free!! Not saying they would go if they were paying for insurance, but when all you got to do is go in.... strange....

 

[MichaelB]

I agree. We can work to improve the current plan if we want to keep health insurance in the mix. If we just junk it the odds of doing something to replace it in the immediate future are next to nothing.

Also agree. Start again is mostly code for leave it the way it was...it worked alright for me.

There is no political will for a government run program.

But don't touch Medicare or Tricare.

I would like our time spend on trying to figure out how to reduce costs, or at least stop the huge inflation in costs. Parts of the health care plan put in place mechanisms to study the cost issues. Let's do that.

Yeah. Maybe we could also figure out how to do away with the abusive price gouging for people with no insurance.

 

[ERD50]

*SIGH*

In other news, 100% of the current population will eventually die, with or without health insurance. So, why would anyone want this stuff?

Well, I think the headline is certainly questionable. I think dex was just trying to point out the false logic there. If people w/o ins are claimed to have a higher mortality rate, it doesn't necessarily follow that covering those people would dramatically reduce the mortality rate of that group.

Take the one quote:

Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.

It's pretty easy to see that there are other factors. People w/o insurance are probably more likely to die because of the same factors that lead them to not have insurance. On average, that group is probably poorer, probably make some poor choices, probably have a lower level of employment (hence no employee coverage), and a slew of factors that would probably correlate with higher mortality. There may be as much 'effect' as there is 'cause' there.

I'm not trying to hold Medicaid up as any great solution, and there are certainly problems that need to be fixed. But claiming that many tens of thousands die each year due to lack of coverage strikes me as a kind of 'bumper sticker slogan' approach to the issue.

-ERD50

 

[ERD50]

Also agree. Start again is mostly code for leave it the way it was...it worked alright for me.

Repeating it doesn't make it true.

Show me the posts on this forum where people are saying we don't need any changes to the system. That claim was earlier applied to samclem, and that's certainly not true.

I could turn that around around and say that your statement is code for 'I won't listen to any criticism of the reforms (which are now the new 'status quo')'.

-ERD50

 

[MichaelB]

ERD & Dex: This study is referring to premature deaths due to preventable causes.

"For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health care is supposed to prevent," said Woolhandler, a professor of medicine at Harvard and a primary care physician in Cambridge, Massachusetts.

Not a bumper sticker or a slogan, but instead a summary of a Harvard Medical School study.

 

[obgyn65]

ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.

People w/o insurance are probably more likely to die because of the same factors that lead them to not have insurance. On average, that group is probably poorer, probably make some poor choices, probably have a lower level of employment (hence no employee coverage), and a slew of factors that would probably correlate with higher mortality. There may be as much 'effect' as there is 'cause' there.


-ERD50

 

[dex]

ERD & Dex: This study is referring to premature deaths due to preventable causes.
Not a bumper sticker or a slogan, but instead a summary of a Harvard Medical School study.

A couple of key point is missing from the article:

1. What are the reasons for not having health ins?

2. Perspective - what are the over/under % of death for people with and without insurance for other variables - e.g. education level, income, type of job - manual or office worker, immigration status.

 

[Texas Proud]

ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.

I don't know the answer to your question.... just like you do not know the answer to mine.... how much should society pay to keep someone alive who has abused alcohol and drugs their whole life... has never in their life kept a job... in fact has not worked in many years...

Do we spend $1 mill, $10 mill, $1 billion I really want to know the answer to this question... how much should we pay to keep someone alive? And then, how long are they going to live IF we do something to keep them alive...


As has been pointed out in this thread... 100% of us will die sometime... it is just a matter of when... and then there is the cost to keep someone alive for a short time... or a long time... also... will that cost be a one time cost or a cost for lifetime


so you quote "One death due to the lack of healthcare is one death too many." IMO does not look at reality of costs and benefits...


Since you are an OBGen... you know that there are babies that are born without a brain... they are alive... but we just put them aside and wait for them to die... is this right This is 'one death'... is it to much? Do YOU do this?

 

[dex]

how much should society pay to keep someone alive who has abused alcohol and drugs their whole life... has never in their life kept a job... in fact has not worked in many years...

Add food to the list.

Rising obesity will cost U.S. health care $344 billion a year - USATODAY.com

If Americans continue to pack on pounds, obesity will cost the USA about $344 billion in medical-related expenses by 2018, eating up about 21% of health-care spending, says the first analysis to estimate the future medical costs of excess weight.
+++++++++

 

[ziggy29]

Rising obesity will cost U.S. health care $344 billion a year - USATODAY.com

If Americans continue to pack on pounds, obesity will cost the USA about $344 billion in medical-related expenses by 2018, eating up about 21% of health-care spending, says the first analysis to estimate the future medical costs of excess weight.

If one wants to talk strictly about the public costs of lifestyle decisions, IMO it's not complete (or intellectually honest) unless they offset these costs with the SAVINGS that come from the same people (on average) collecting SS and public pensions for several fewer years.

I don't advocate obesity, smoking and alcohol abuse for saving taxpayer money on SS and pensions, BUT if people are going to use the "cost to the taxpayer" argument against bad lifestyle decisions, it's only fair to consider BOTH sides of that ledger. If we should tax people more (or have government charge them more) for health care if they smoke, drink, eat crappy food or weigh too much, shouldn't those same people pay less in SS taxes or receive more of a pension because they'll collect public benefits for 5-7 fewer years on average? That would be the intellectually consistent thing to do.

 

[dex]

If one wants to talk strictly about the public costs of lifestyle decisions, IMO it's not complete (or intellectually honest) unless they offset these costs with the SAVINGS that come from the same people (on average) collecting SS and public pensions for several fewer years.

I don't advocate obesity, smoking and alcohol abuse for saving taxpayer money on SS and pensions, BUT if people are going to use the "cost to the taxpayer" argument against bad lifestyle decisions, it's only fair to consider BOTH sides of that ledger. If we should tax people more (or have government charge them more) for health care if they smoke, drink, eat crappy food or weigh too much, shouldn't those same people pay less in SS taxes or receive more of a pension because they'll collect public benefits for 5-7 fewer years on average? That would be the intellectually consistent thing to do.

Your basic assumption of 'public costs' is what is being discussed. Should those lifestyle choices and their impact be a public costs.

But not all the causes or earlier than normal death are a lifestyle choice. For example, life expectancy for the black community who descended from slavery is lower than whites. That is a result of slavery, segregation and racism, not a lifestyle choice. If that issue is to be addressed it should be on racial justice grounds and not heath ins.

 

[DeborahB]

ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.

And to add to that, it's not only bad choices that make you seriously ill, it can just be bad luck. I survived cancer. I was fortunate that I had health insurance. I was lucky I lived. There was nothing about my health history that indicated this cancer, nothing I could have done differently.

Had I not had insurance, and had a more virulant form of the cancer, I might have died, like many other people I know. Had I not lived near an ER, I might have died when I went into shock... it was a near thing.

Health care is just as vital a need for people as other public services.

 

[samclem]

For example, life expectancy for the black community who descended from slavery is lower than whites. That is a result of slavery, segregation and racism, not a lifestyle choice. If that issue is to be addressed it should be on racial justice grounds and not heath ins.

Not to get too far afield of the topic, but there are many reasons black Americans have lower life expectancy than white Americans. Smoking rates and diet are important factors, and I think it's entirely fair to say that what you put into your mouth (food and/or tobacco products) is a matter of personal choice.
And, yes, poor black Americans have shorter lifespans than Americans of average income. So do poor white Americans. There's no need to go down the unproductive "racial justice" rabbit hole if we deal with the important things that are relevant today--poverty, economic opportunity, and the importance of making good choices. Black Americans aren't dying younger because their forebears were slaves, they are dying younger because they are poor and their families have been torn up--partially by government policies designed to help them. They can't afford another generation of government "help" like they've had.

 

[Martha]

I'm not trying to hold Medicaid up as any great solution, and there are certainly problems that need to be fixed. But claiming that many tens of thousands die each year due to lack of coverage strikes me as a kind of 'bumper sticker slogan' approach to the issue.

-ERD50

If you recall, several times I have posted links to studies which show the number of people whose deaths are attributable to lack of access to health care due to lack of insurance. The numbers are increasing. It is a claim that is well supported and not merely a "bumper sticker slogan."

 

[BigNick]

They said they saved the life of one 9 YO girl... so it seems that there are problems with a system that sick people will not even go to the doc for free!! Not saying they would go if they were paying for insurance, but when all you got to do is go in.... strange....

The whole point of that show is to get people to go to the doctor, especially if their condition is embarrassing.

Believe it or not, lots of people simply will not go to the doctor, whatever their insurance status, whatever their country's health system, whatever the perceived quality of care. Lots of Americans with 100% insurance will not go. Really. Talk to medical people who know.

I appreciate that you're trying to make a political point here ("free health care must really suck if people with conditions that turn out to be life-threatening don't take it up"), but please understand, things are a lot more complicated than that. The UK's health system is not the world's best by a long way, but it's one plausible OK way of running things, and with no up-front bills to pay, it means that nobody turns down care because they don't have cash in their pocket.

Every other major European country has a different system, many of them with surprisingly little direct government involvement. And most of them outrank the US according to every measure of outcome (other than dollars spent per insured person). Portraying countries which don't have US-style health care as if they're some kind of third-world setup with no antibiotics or anaesthetic, as certain US media outlets like to do, doesn't quite square with life expectancy figures for those countries, but it makes for a good story for consumers of the "all government is by definition evil at all times" narrative.

 

[MichaelB]

Repeating it doesn't make it true.

Show me the posts on this forum where people are saying we don't need any changes to the system. That claim was earlier applied to samclem, and that's certainly not true.

I could turn that around around and say that your statement is code for 'I won't listen to any criticism of the reforms (which are now the new 'status quo')'.

-ERD50

Fair enough. I’ll retract my earlier statement. Now, you advocate scrapping the reform and starting again. What specific healthcare regulatory improvements do you suggest that are both credible and feasible in our current political environment?

A couple of key point is missing from the article:

1. What are the reasons for not having health ins?

2. Perspective - what are the over/under % of death for people with and without insurance for other variables - e.g. education level, income, type of job - manual or office worker, immigration status.

Well, I think the headline is certainly questionable. I think dex was just trying to point out the false logic there. If people w/o ins are claimed to have a higher mortality rate, it doesn't necessarily follow that covering those people would dramatically reduce the mortality rate of that group. -ERD50

Wait a minute. You asked if people were dying due to lack of health insurance. You got the answer and the reference to the study. It doesn’t support your view so you challenge the conclusions? Here’s a link http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf

In the model adjusted only for age and gender, lack of health insurance was significantly associated with mortality (hazard ratio

---

=1.80; 95% CI=1.44, 2.26). In subsequent models adjusted for gender, age, race/ethnicity, poverty income ratio, education, unemployment, smoking, regular alcohol use, self-rated health, physician-rated health, and BMI, lack of health insurance significantly increased the risk of mortality (HR=1.40; 95%CI=1.06,1.84; Table 2). We detected no significant interactions between lack of health insurance and any other variables. Our sensitivity analyses yielded substantially similar estimates.

---

Keep in mind - this study estimates premature death from preventable causes due to lack of insurance coverage. Hardship and illness are not covered. The actual cost to the US is far greater.

Folks that suggest "starting again". What specifically do you propose that is realistic and credible in our current political environment and has a significant effect on access to health care and insurance?

 

[dex]

Black Americans aren't dying younger because their forebears were slaves, they are dying younger because they are poor and their families have been torn up--partially by government policies designed to help them. They can't afford another generation of government "help" like they've had.

They are poor as a result of slavery, segregation, racism and the 'good intentions' of government.