Sorry I couldn't get to this sooner. We had to do a border run to Burma/Myanmar and it took the whole day.
Martha:
Akaisha, I think healthcare is more about relationships and trust than about shopping. You develop a relationship with a primary care doctor. Primary care doctors are not terribly expensive in and of themselves. You develop a health condition and your doctor makes recommendations. You may ask for a second opinion, but no matter what you want what is best for you, not necessarily the cheapest solution.
You have made some good points, Martha. Everyone's approach to healthcare is different, there is no doubt. I haven't had a primary care physician since I was a child living at home with my parents. I moved across country when I was 21, and although I had insurance, I don't remember having a primary care physician. When we bought our restaurant I was 27. In the decade we owned the restaurant, I could count on one hand how many shifts I missed due to illness. I think stress is what held me together.
When Billy worked for Dean Witter, a health care policy was provided - and I went to a medical clinic in our town for this or that -- and some of the doctors were kind, some were cold. There was nothing even nearing a 'relationship' with any doctor... Of course I appreciated the kinder ones more, but what I wanted was a professional opinion. I had friends for relationships... I don't mean that to sound cold, so please take that in the manner in which I am offering it.
When I am hiring someone, I am hiring a service -- you know what I mean? I want new eyeballs looking at the facts, and someone who can assess a situation. If I have 7 minutes in a doctor's office I do not want to spend 5 of those minutes talking about how my cucumbers are growing in my garden or how my dog is doing. It is entirely possible that since I was never given the "Leave it to Beaver" life - I could be jealous of those who have..? so I have a different approach to the providing of healthcare.
When I mention shopping around for a health care policy, I mean 'value' not necessarily the cheapest. And when I need medical care, I discuss my options with the doctor, and we decide together what we do. If he suggests a test or procedure, I ask him why, and I ask him what result or information he is expecting to get from it. I also ask if he thinks it is necessary, and then we discuss it a little more. I don't go for the cheapest, I go for value for money spent. I also do not hold the belief that everything under the sun should be done to save me from dying.
Martha:
With respect to insurance, as I mentioned, if you are perfectly healthy or employed by an employer that offers insurance you will have a pretty easy time of buying health insurance....Trapping people in unwanted jobs is not good for anyone. Also, many states allow insurance premiums to increase after you become ill or as you age. This can price people right out of the market. Again, they have no bargaining power.
I understand. This is so annyoying about health insurance companies. Having health insurance for the healthy seems a bit silly. The moment one becomes ill and actually uses his health insurance, rates go up or one can find they are no longer insurable. It doesn't matter if you have had no claims, if you cross over a certain age barrier, your rates can go up. Trapping people in unwanted jobs because of a health care policy is more exploitation by the health care insurance companies. Also, to demand that an employer supply HCInsurance is much of the same. We are all being held hostage to this one issue. There is no freedom of movement or freedom of choice.
On the other hand, I don't believe the state should be dictating prices. That is price control, and is a very slippery slope..
Martha:
I question whether universal coverage would increase cost for everyone, given cost comparisons with countries that provide national healthcare...But I refuse to acknowledge it would be more expensive without some real evidence of that fact. I also refuse to buy arguments that the care would not be as good unless I am presented with real evidence of that fact.
This reminds me of the old saw "Is the glass half-full or half-empty?" The same evidence is there but people 'see' it differently. You can ask, 'is it half - empty?' and someone will say, yes, of course. You can ask 'is it half-full?' and someone will say yes, of course.
If socialized medicine was doing so great, there wouldn't be the need for those private care clinics and hospitals opening up in Canada (see above article I mentioned previously). More and more Canadians are becoming disenchanted with their system. When there are guaranteed payments, there is no incentive to provide better service at a better price, and more efficiently. 8)
You see, the same evidence is there for the both of us, but our premises are different. This is why I wonder if the Health Care Issue will ever truly be 'solved' . If our premise is so different - how can we get to a common solution?
Martha:
Minnesota has done pretty well with using the insurance model and subsidizing health insurance for the low income and those with preexisting conditions. However, one problem with the model is that when money gets tight, there always is talk of cutting the subsidized insurance to the poor. States are doing that now with medicaid.
Putting the distribution of health care into the government's hands will simply tie us to them, and prevents us from having any say about it. Politicians sell their promises of health care to voters in order to get elected, and voters sell their votes for the promise of 'free' health care. Isn't Medicare insolvent? Don't we already have problems with Social Security? The Welfare program has had terrible difficulties over the years... These government programs aren't the answer, in my opinion.
Sure we can all use a safety net. But there has to be defined limits to it... (IMO)
Also, most human beings over the age of 36 have "pre-existing conditions" or a propensity to one.. what's the point? The insurers only want to insure healthy people who can guarantee they will stay healthy? It is aggravating..
Martha:
This is one of the reasons I am coming to the conclusion that an insurance model is not going to work. Insurance companies are not going to cover at reasonable cost the poor and unhealthy without subsidies. If subsidies are viewed not as an entitlement, then they will be subject to political whims and risks of cuts when state budgets are tight. So, I am coming to the conclusion that it is time to take on the insurance lobby and have national healthcare.
Yes, you see, our premises are different. I do not see this as an entitlement issue. In fact, I have a hard time with the attitude of "I'm entitled to something, you pay for it." I think that is part of the problem. I have no trouble with a defined and limited safety net. The government is notoriously inefficient. How could this dispensing of health care by the government ever be effective? And if someone else pays for the healthcare, then shouldn't they also decide the parameters? Why would they want to pay for health care for someone who smokes, or is overweight, or eats meat, or doesn't exercise, or drinks heavily, or uses drugs.... I simply do not see it as a panacea.
Rich_in_Tampa
In my experience, people who are prosperous, have enjoyed great health and have avoided chronic illness find the market-driven system to be fine. When faced with chronic illness, job loss in the face of illness, or even (sometimes) a desire or need to retire, they often change the way they feel.
Often, but not always. You have a point Rich, yet one that could still be debated.
Rich:
Understandable change of heart, after being beaten down time after time after time by a Kafka-esque and failed system - the 25 y.o insurance company phone receptionist telling them their last drug or procedure wasn't covered, the $125 aspirin in the hospital (to make up for the $2500 MRI scan they had to do for free on the penniless ER patient), the pretty wealthy 75 y.o. scrambling to sell everything so her husband's nursing home bills don't impoverish her, and on and on.
Yes we can't allow ourselves to be charged $125 for an aspirin, and there is no doubt our system is broken. I believe it is our responsibility to check the bills we receive and make noise about over charges.
I have done this many times. Also, I have brought in kleenex, vasoline, towellettes, and personal meds when appropriate so that my family member isn't charged like that. It stinks, but we can no longer go into these situations like sheep, believing that the hospital and doctors have our best financial and personal care in mind. This is an illusion, and has been one for a very long time.
It sounds like you are angry and cynical about this, Rich...
You have certainly painted an inflammatory picture here. BTW, just because a doctor recommends an MRI doesn't mean I buy one. (I hope that "penniless ER patient wasn't a reference to me...)
Rich:
Not any easy problem but the first step is to recognize it exists.
I agree. That is what we are all doing here, is it not?
Rich:
Like it or not, your turn will come (unless you are "lucky" enough to meet a sudden demise after a life of good health).
Well, again, you have a way of writing that is inflammatory. I don't want to get hooked into the picture you have painted, because it is fear-based, and I don't find that to be productive. None of us know how or when we will die. None of us know the future at all. And -- you are assuming that I have had no experience with ill health, or severe financial threats, and that is how I am basing my opinion.
No doubt, this whole subject is fearful, and it is easy to get angry and demanding about it. It's easy to slip into the idea that we are 'entitled' to be taken care of. Life is often terrifying.
Rich:
I remember Medical Society meetings where even a hint of support for a national level catastrophic care policy would get you shunned.
Well, you can't worry about being 'shunned'.
This happens on both sides of the aisle, wouldn't you agree? Do they walk away from the water cooler when you arrive? Do they no longer respect your professional opinion? Are you no longer invited to their parties or BBQ? I know it's disappointing when colleagues don't respond with support for an idea we have proposed. -- Have the courage of your convictions, Rich, and may the best ideas 'win.'
Rich:
Now the shunners are in their 70s, and lobbying for broader Medicare coverage. Live goes in circles, they say.
I personally don't have experience of this particular example, so I will take your word for it.
unclemick2
Don't know what will emerge - but expect a lot of screaming and yelling and nashing of teeth - before something workable happens.
That's what is happening now, no doubt!
Unclelmick:
40% of all medical cost in the U.S. is on the taxpayers nickel in some form right now
Is that true?
Akaisha
Author,
The Adventurer's Guide to Early Retirement
