Is Univeral Health Care the answer?????

[Mwsinron]

Not if its done like Europe or Canada.

 

[perinova]

Not if its done like Europe or Canada.

I guess that would me No.

 

[janeeyre]

I have heard horror stories about VA hospitals since I was a kid.



I'm sure like anything else there are quality ones and then....

http://www.cnn.com/CNN/Programs/and.../03/va-hospital-turned-away-suicidal-vet.html

I guess any dramatic story can mask reality.

 

[VoyT]

I don't want governmental policies to dictate my options.

As opposed to having an insurer's polices dictate your options?

 

[Rich_by_the_Bay]

Saw a patient today who seriously needed daily injections of a powerful blood thinner to prevent potentially fatal pulmonary blood clots. For various reasons, she was not a candidate for the usual pill form of blood thinner (warfarin or 'coumadin').

This will be a 6 month course, possibly lifelong. The injections cost around $70 per day. Insurance covers 15 days. They can't afford it on their own, period.

We are now faced with putting her on warfarin against medical recommendations, having her simply not accept treatment (50% mortality risk), or having them go $12,000 in debt every 5-6 months at a minimum through a home equity loan they can ill afford. She wants the pills and I am torn since I know it will expose her to serious excess risk.

I face these daily. It is very painful and often futile to fix. Regardless of its ultimate structure, a system which covers legitimate, evidence-based treatment within reasonable boundaries is morally necessary.

This is a 55 year old woman, worked and paid for health insurance (plus employer payments) for decades, and basically played by the rules. She's screwed.

The system needs to protect such people. A safety net at $10K or obliging insurers to pay for the legitimate and accepted medical duration of treatment, whatever. This is what it has come to, and your turn may well arise.

Personally, I favor a tax-supported, Medicare-like system covering all Americans with catastrophic coverage over $10K adjusted for inflation, and private or out-of-pocket coverage for the first $10k/y per person, perhaps adjusted for means.

The winners in the current scenario: pharma, insurers. Everyone else loses.

 

[sgeeeee]

. . . I do not believe I would have the same opportunities under a Universal Plan. . .

If your concern is about having opportunities, then why not simply keep your eye on the various proposals and make sure you only back those that preserve those opportunities? I don't see anything fundamental to the concept of Universal Health Care that requires elimination of options.

 

[ERD50]

I don't know what the answer is, but the current system of getting insurance through your employer is a broken one.

As far as I am from the socialist side of the scale, I would like to see some form of catastrophic coverage for all, and some basic preventative coverage for all at minimal rates. Catastrophic coverage just seems like the right thing to do, preventative/proactive care might actually provide a cost savings overall. Maybe tie in an incentive - take steps to stay healthy and premiums are lower?

I think people may be confusing having 'options' with having competition. I think it could be possible to have a system where the govt is administering, but people have a choice of which doctor to see.

I'm skeptical though.

-ERD50

 

[LKH]

I think there are a lot of good ideas for solving the healthcare crisis. I think that we probably need to adopt some combination of several. Here are some I've seen that I think have some merit:

1) Simplify. The medical community complains that a typical doctor spends some 40% of his or her time and resources just filling out all the paperwork for insurance companies, Medicare/Medicaid, etc. Let's get to work and come up with one uniform, simple set of forms that can be used for all purposes.

Ditto the FDA. It currently costs $900 million to get the average drug past all the FDA's requirements and on the shelves - even if the drug has already been approved in other countries and even if it's been used for ages overseas. Obviously, the bureaucratic bloat goes a long way to explain why drugs here are so much more expensive.

2) Healthy choices: Safeway says they dropped their health insurance rates by 15% simply by offering lower premiums to employees who enrolled in programs that helped them make healthy lifestyle changes, e.g. keeping up with preventative care and screenings, quitting smoking, losing weight, etc.

3) Cafeteria insurance. It used to be that insurance was only for catastrophic care. People expected to pay out of pocket for routine care, seeing the doctor for annual physicals, etc. Obviously, even routine care is more costly today, since we're advised to have regular screenings that cost good money. But most insurance plans today cover just everything - including things that most patients will never use, like acupuncture, chiropractic, etc. Maybe we should offer a basic plan for routine care and catastrophic coverage, then allow people to opt in for supplements that cover all the various options they personally would use.

4) Universal catastrophic and preventative coverage for those who can't afford insurance. Just the basics.

5) Malpractice reform. Doctors and hospitals make mistakes, and sometimes the mistakes hurt people. It's one thing to require that they pay to make the person whole (or as whole as possible). It's another to require them to make the patient a millionaire. We need to decide just how deep our doctors' pockets have to be, so that they can stop paying so much for malpractice insurance.

 

[donheff]

We need some sort of universal coverage. I would prefer single payer but expect I will have to settle for something inferior that retains the existing bureaucracy of insurers. What we have today is a travesty.

 

[teejayevans]

I think there are a lot of good ideas for solving the healthcare crisis. I think that we probably need to adopt some combination of several. Here are some I've seen that I think have some merit:

1) Simplify. The medical community complains that a typical doctor spends some 40% of his or her time and resources just filling out all the paperwork for insurance companies,
Ditto the FDA.

2) Healthy choices: Safeway says they dropped their health insurance rates by 15% simply by offering lower premiums to employees who enrolled in programs that helped them make healthy lifestyle changes, e.g. keeping up with preventative care and screenings, quitting smoking, losing weight, etc.

3) Cafeteria insurance. Maybe we should offer a basic plan for routine care and catastrophic coverage, then allow people to opt in for supplements that cover all the various options they personally would use.

4) Universal catastrophic and preventative coverage for those who can't afford insurance. Just the basics.

5) Malpractice reform.

1. doctors don't do it, their assistants do it, I think that number if overblown in this age
of computers.
2. agreed, I think insurance should be based on your fitness level, I don't want
to pay for the smokers, drinkers, drug users, for people a 1/2lb cheeseburger with
bacon and mayo is health food.
3/4. how about routine care, and basic medical care that covers 99% of the population,
then allow people to opt for catastrophic insurance in case of transplants, AIDS, etc
Also everybody has a deductible of some sort, with the exception of preventive
treatments (exams, flu shots, etc).
5. Agreed, if drug gets FDA approval and there is no fraud, the drug companies are not
liable. Tort reform is badly needed, no question, but since most of the politicians are
lawyers....here is a scary thought: President John Edwards, yikes!
6. Remove all advertising of prescription drugs, I'm tired of seeing the "ask your doctor
if you need our-overpriced-drug today!"

TJ

 

[Martha]

This will be a 6 month course, possibly lifelong. The injections cost around $70 per day. Insurance covers 15 days. They can't afford it on their own, period.

How many of us here know if our insurance policies would cover this? Shopping is impossible and "choice" is meaningless to this person. I brought up the changes in the VA in part because they are now doing things that can reduce cost and yet provide better care. So they follow up with the patients who have chronic problems to help them do what they need to do to address the problems. Because patients are with them for life, the VA has a vested interest in keeping them healthy. They also practice evidence based medicine that Rich often mentions. Right now we are doing a lot wrong and the reasons are in part systematic.

I favor a Medicare type system rather than a for profit insurance company based system.

 

[brewer12345]

So is MKLD dead? Hard to believe she would not chime in here at length by now...

 

[LKH]

1. doctors don't do it, their assistants do it, I think that number if overblown in this age of computers.

One reason some doctors won't take Medicare patients si because the bureaucracy costs them more money than they make. And if they can shovel it off to assistants, great, but WE pay for those assistants. Simplify the paperwork, and it will cost less.

3/4. how about routine care, and basic medical care that covers 99% of the population, then allow people to opt for catastrophic insurance in case of transplants, AIDS, etc Also everybody has a deductible of some sort, with the exception of preventive treatments (exams, flu shots, etc).

There was a time when insurance was simply catastrophic care. What you want is coverage for the occasions when healthcare gets too expensive to afford. You need insurance to assure you that if you get cancer or something, you won't be bankrupted trying to get healthy again. So I wouldn't agree to an "opt-in" for catastrophic care. I think CC should be universal, as should preventative care. If you want to pay out of pocket for sick visits and other non-routine but typically less expensive care, then that makes sense. Same for mental health care, physical therapy, etc. (though I think there's a risk there. YOu don't opt in for physical therapy, and then you have an injury and they deny coverage when you try to opt in because it's a pre-existing condition).

5. Agreed, if drug gets FDA approval and there is no fraud, the drug companies are not liable. Tort reform is badly needed, no question, but since most of the politicians are lawyers....here is a scary thought: President John Edwards, yikes!

Careful. You'll give me nightmares. Still, better than President Hillary. I think I could live with President Obama if I had to.

Actually, I'm not so sure about tort reform for drugs. If we cut out the FDA process, then the idea of crazy lawsuits would at least motivate pharmaceutical companies to make sure they test their product adequately. And unlike doctors, who usually have $100k student loans to pay off and other expenses that mean they don't net as much as you'd think, pharmaceutical companies DO have deep pockets. I'd be all for curtailing frivolous lawsuits, and also refusing suits where the patient was informed of a potential side effect and chose to assume the risk. But I wouldn't limit damages for drug companies when a drug caused harm and it can be shown that the company failed to adequately test it, or failed to make public some known side effects.

6. Remove all advertising of prescription drugs, I'm tired of seeing the "ask your doctor if you need our-overpriced-drug today!"

Good point!

 

[mykidslovedogs]

Saw a patient today who seriously needed daily injections of a powerful blood thinner to prevent potentially fatal pulmonary blood clots. For various reasons, she was not a candidate for the usual pill form of blood thinner (warfarin or 'coumadin').

This will be a 6 month course, possibly lifelong. The injections cost around $70 per day. Insurance covers 15 days. They can't afford it on their own, period.

We are now faced with putting her on warfarin against medical recommendations, having her simply not accept treatment (50% mortality risk), or having them go $12,000 in debt every 5-6 months at a minimum through a home equity loan they can ill afford. She wants the pills and I am torn since I know it will expose her to serious excess risk.

I face these daily. It is very painful and often futile to fix. Regardless of its ultimate structure, a system which covers legitimate, evidence-based treatment within reasonable boundaries is morally necessary.

This is a 55 year old woman, worked and paid for health insurance (plus employer payments) for decades, and basically played by the rules. She's screwed.

This is a very unfortunate situation. Having spent a lot of time appealing claims for clients, I would be willing to bet that this person's injection claims could be appealed and authorized, and perhaps even approved for the lifetime injections. A simple letter written by the doctor and sent into the insurance carrier through THE PROPER CHANNELS, would be the way to begin the appeal process....(I would not try to call customer service in a case like this other than to ask for the proper address for filing a FORMAL appeal.) If the person has a broker that can assist her, that would be even better, because a lot of times, brokers have contacts that can walk these things through the process in a quicker fashion. This just happens to be a unique situation that can't always be defined in a contract. Also, to move the claim through appeals in a timely manner, it is extremely important that the MEMBER, write a cover note, requesting the appeal based on her doctor's synopsis as attached. If the request is not signed by the member, it will be ignored, due to PRIVACY regulations.

A lot of times, insurance carriers put limits on things like blood thinners and other potentially dangerous drugs such as narcotics, to protect people from potential danger. A formal appeal in this situation and others like it is well worth it, and you, as her doctor could be of great assistance by providing a well-written letter explaining the situation in detail for her to use in the appeal process.

 

[teejayevans]

. Tort reform is badly needed, no question

Speaking of tort reform being needed: Washington DC JUDGE is suing a
dry cleaners for losing his pants, for ....drum roll please...
$65,000,000.
It goes to trial next month, in my world he would be in order:
1. disbarred
2. pay all fees of the cleaners plus $650,000 (my 1% rule)
3. be prevented from being a party of any lawsuit for rest of his life.

http://www.washingtonpost.com/wp-dyn/content/article/2007/04/25/AR2007042502763_pf.html
TJ

 

[Rich_by_the_Bay]

Washington DC JUDGE is suing a
dry cleaners for losing his pants, for ....drum roll please...
$65,000,000.

I'd love to see those pants. Must be really nice!

 

[brewer12345]

A simple letter written by the doctor and sent into the insurance carrier through THE PROPER CHANNELS...

Am I the only one that read this insulting bit of nonsense as "Rich, your patient will have to suffer because YOU did not bother to take simple steps that EVERYONE knows would get her insurer to pay for the medication" ?

[moderator edit]

 

[lets-retire]

After beating this horse dead several times, I'm leaving my comments as an answer to the topic.

NO!!!

 

[Rich_by_the_Bay]

Am I the only one that read this insulting bit of nonsense as "Rich, your patient will have to suffer because YOU did not bother to take simple steps that EVERYONE knows would get her insurer to pay for the medication" ?

Ahh... she's just trolling, .

 

[haha]

A lot of times, insurance carriers put limits on things like blood thinners and other potentially dangerous drugs such as narcotics, to protect people from potential danger.

Yes, it's a little known fact that the heroic and highly trained clerk at a private health insurance company is often the only thing standing between a typically derelict Doctor and his helpless patient.

They deserve a much larger cut of the health care dollar, and should publicize this important additional duty that they perform.

NOT

Ha

 

[tomz]

Regarding catastrophic insurance:

That's where most of the costs are in our current system. 20% of patients account for 80% of the costs. (give or take a few %) This 20% includes chronic conditions, end of life issues, premature infants, etc. ; i.e., all the things that we consider catastrophic. In the big picture, things like tort reform and high deductibles for routine stuff are a drop in the bucket.

There are a number of studies/books available that document this. Tort reform and the horror stories that accompany it get people upset. However, the real issues lie elsewhere.

 

[sgeeeee]

Am I the only one that read this insulting bit of nonsense as "Rich, your patient will have to suffer because YOU did not bother to take simple steps that EVERYONE knows would get her insurer to pay for the medication" ?

[moderator edit]

Sorry, Brewer. I just quit reading the nonsense before I got that far. I was insulted before getting to that statement.

 

[Rich_by_the_Bay]

Yes, it's a little known fact that the heroic and highly trained clerk at a private health insurance company is often the only thing standing between a typically derelict Doctor and his helpless patient.

They deserve a much larger cut of the health care dollar, and should publicize this important additional duty that they perform.

NOT

 

[Trek]

Just thought I'd share how the Health Care system works here in Estonia. It does seem that when most people think about universal or national health care, it means all the private doctors and hospitals will cease to exist. That isn't the case at all. Here in Estonia you can also buy private medical insurance and visit your doctor/medical facility of choice. There are plenty of private practices if that's your thing.

In any case, I'm not showing this as a model for the U.S., I just thought some people might enjoy seeing how other countries approach their health care needs.

Outline of the Estonian Health Care System
http://www.haigekassa.ee/eng/health/outline/

 

[tomz]

Thanks for the info, Trek. It is useful to know how the rest of the civilized world provides healthcare to all its citizens. I have a question. What is the taxable amount referred to in the following:

The employers are required by the law to pay social tax for all persons employed, whereby the rate of this tax is 33 % of the taxable amount, and of which 20 % is allocated for pension insurance and 13 % for health insurance.