Next Pres. Election and Health Ins.

[mykidslovedogs]

Well, now, you've introduced an interesting though, supply and demand. Why is our health care cost continuing to rise well above inflation, and above people's abilities to pay? Because demand increases while supply stays the same or even deceases. IMO, there's several factors for this: an aging population, increased stress, increases in treatment options (ironically -- there was no MRI waiting list before there were MRIs), and a limited supply of physicians. We can't control many of these factors, but we can take steps to increase the supply of hospitals, equipment, and physicians. Since the private sector doesn't seem able to do this, there will be increasing pressure for the public sector to do it.

How many hospitals could be built with the money saved from reducing admin overhead from 30% (the private HMO number) to 3-5% (the Medicare number)?

Let me explain why we have a lack of supply of primary care physicians in our country. It's not because the private sector isn't cutting the mustard. It's BECAUSE the Medicare/Medicaid systems don't pay them enough, so they don't choose those kind of careers. Instead, they go for the specialist careers where they can make a lot more MONEY! Combine that with an aging population and rediculously expensive malpractice insurance and overhead costs of equipment, staff, etc...and what do you get? (a SHORTAGE of PCPs created by the PUBLIC health system).

To answer your second question. The administrative costs of Medicare/Medicaid are kept in check because the gov't caps the amount of money going towards service...try getting timely and efficient service from a Medicare Administrative representative. Additionally, the time/costs that Doctors and practioners incur filing paperwork, etc...are not included in the published numbers. Yes, the numbers may be lower than in the private sector, but not as much as they are made out to be. No-one is including the time/cost that brokers like me spend helping people figure out which Medicare Part D plan to buy. Sometimes, I'll spend hours sifting through all of the plan choices for my clients, filing the application, and following up on it...all for a measly $5/mo commission. (I guarantee you my time is worth more than that!) Right now, I offer assistance with Medicare Part D as a value added benefit to my clients, but, if it keeps going the way it's going, I may have to send people off on their own to do the research...

 

[mykidslovedogs]

If we were in a trial, I would have to object to most things you say as assuming facts not in evidence.

I move for a mistrial.

I am so sorry, judge! The last time I checked, my PCP would not give me an MRI on my brain. Is yours different? Take a look here:

Long Wait for MRIs in Canada

Did you watch the video?

On The Fence Films :: Movies (A Short Course in Brain Surgery).

Would you declare a mistrial on Michael Moore too? I'll bet not!

 

[FinallyRetired]

Let me explain why we have a lack of supply of primary care physicians in our country... ? (a SHORTAGE of PCPs created by the PUBLIC health system).

OK, if a Martian were to land in the US and read your arguments, they would conclude that we have the leading health system in the world, but our gummint keeps trying to screw it up. And the rest of western democracies must have decaying health systems with patients dying while waiting for procedures. Why, we must be guarding our very borders to keep out foreigners fleeing their health systems in order to take advantage of ours. And their poor governments must be about to topple from their people demanding a US style health system. That's the case, right?

Funny thing, when I lived in Holland I was very happy with their national system, as well all of my Dutch friends. In fact, some of my expat friends were so happy with it they chose Dutch hospitals and doctors even though they had the choice to return to the states for treatment. We must have been hoodwinked. My only complaint was difficulty in getting a lot of drugs, they emphasize prevention over overdrugging. And you know what, they certainly looked fit in comparison with Americans.

 

[mykidslovedogs]

OK, if a Martian were to land in the US and read your arguments, they would conclude that we have the leading health system in the world, but our gummint keeps trying to screw it up. And the rest of western democracies must have decaying health systems with patients dying while waiting for procedures. Why, we must be guarding our very borders to keep out foreigners fleeing their health systems in order to take advantage of ours. And their poor governments must be about to topple from their people demanding a US style health system. That's the case, right?

Not exactly, I DON'T think our system is perfect, but I do think it alienates fewer people than other systems, ESPECIALLY when it comes to complicated health issues. I will always prefer capitalistic solutions and tax incentives over gov't mandates. Did you happen to watch a few of those videos I posted links to?

FYI - I just had a client call who raved about the wonderful service she received on her new HSA plan with UHC. She had to have a unique surgery, and she said it all went through without a hitch. NOT a single problem with the insurance. Her HSA payed 100% after deductible just as planned, and she had already saved her deductible.

I posted a success story of my own on Michal Moore's SICKO website, and guess what? He or his moderators decided NOT to post my story. (He's got a place on his site where people can comment on their opinions about their healthcare/health insurance.) This did not come as much of a surprise to me. He isn't going to post anything GOOD about our healthcare system on his site, even if visitors want to make some good comments.

 

[FinallyRetired]

I posted a success story of my own on Michal Moore's SICKO website, and guess what? He or his moderators decided NOT to post my story. (He's got a place on his site where people can comment on their opinions about their healthcare/health insurance.) This did not come as much of a surprise to me. He isn't going to post anything GOOD about our healthcare system on his site, even if visitors want to make some good comments.

There's plenty good about our health system -- for those who are insured and whose insurance allows the procedures and have affordable deductibles. And I'm sure you have plenty of success stories. Whenever services are unequally distributed those who qualify for the services are treated very well. I'm sure there are excellent doctors in Zimbabwe who treat the people at the top. We're much better than Zimbabwe in treating the majority of Americans but we suck at treating the bottom 20-40M.

How many success stories do you have to share from those at the bottom? I saw the videos. Still didn't answer the question about medical care in the US for those at the bottom. Why are you so set against extending medical care to those who can't afford it?

By the way the link you have about MRI waiting times in Canada has false information. It starts with "In Canada there is a 7-9 month wait for MRI's." I posted a previous link with data on waiting times by province, you might want to look at it.

 

[Meadbh]

If we were in a trial, I would have to object to most things you say as assuming facts not in evidence.

I move for a mistrial.

 

[Rich_by_the_Bay]

How many success stories do you have to share from those at the bottom?

Oh, Lord! I've spent a meaningful chunk of my career caring for those at the bottom of society (probably numbering in the thousands), often due to mental illness, addictions, alcoholism plus the occasional freeloader.

Success stores? Give me some time...I may be able to come up with one or two. A few times I've been able to game the system creatively to benefit a patient here and there, but otherwise... naaah, sorry, can't come up with many succes stories.

Major university teaching hospitals have a proud heritage of caring for the poor because the faculty physicians were often on salary and had little directly at stake for non-payment. But that has been changing, and not for the better; there is more emphasis on "productivity" every year.

 

[maddythebeagle]

What Canada lacks is the extraordinary deep pockets of successful private investors. We don't have a Mayo Clinic for the same reasons that we don't have a Harvard, Yale or Stanford. This has nothing to do with government. The US is way ahead of Canada in tapping private benefactors for their "public" institutions. We are starting to get some momentum from the founders of eBay, RIM, and Celestica (Onyx). But we are way behind.

In fact, a major reason that my hospital, Vancouver General, has only 2 month lead times for major surgery is that the Pattison and Diamond families among others have been very generous.

ding ding ding....I have been to the Mayo Clinic several times for treatment...private benefactors are a big part of it...Certainly, it is the way they do things and history that generates the interest in giving....although, I see a lot of Canadian lic. plates in the parking garages, but hey MN is close to Canada, right...

 

[cute fuzzy bunny]

Jeez louise, the insurance troll is on my ignore list and I *still* have to hit the page down key about 12 times between these galtian strings of posts.

Regarding supply and demand...hmm...we've apparently got way more supply than they have in canada, what with all these world class medical institutions, wading hip deep in MRI machines and so forth.

So our health care should cost less per capita than canada's, what with their long waiting lines and apparent dearth of quality optional and probably unnecessary care.

Hey...waitaminit...all this ridiculous supply and quality of supply in evidence at every turn, yet the costs keep rising?!?

Where is all the money going...

Oh yeah, I forgot. Canada doesnt have to pay insurance companies.

 

[FinallyRetired]

Oh, Lord! I've spent a meaningful chunk of my career caring for those at the bottom of society (probably numbering in the thousands), often due to mental illness, addictions, alcoholism plus the occasional freeloader.

I know you didn't intend this meaning, but that really is a "meaning-full" part of a career. Not to get religious, but you may yet receive pretty good pay for treating those at the bottom of society.

Success stores? Give me some time...I may be able to come up with one or two. A few times I've been able to game the system creatively to benefit a patient here and there, but otherwise... naaah, sorry, can't come up with many succes stories.

Major university teaching hospitals have a proud heritage of caring for the poor because the faculty physicians were often on salary and had little directly at stake for non-payment. But that has been changing, and not for the better; there is more emphasis on "productivity" every year.

So we have a microcosm of a universal health care system within teaching hospitals, because the physicians don't have to depend on the patient's financial means for their salaries. And they have a proud heritage of caring for the poor. Sounds like they can provide the medical service that attracted them to the profession in the first place. Service is a word that is not often used in these debates. I'm not a physician, but I always considered my military career as a service. Lord knows the pay alone didn't begin to make the family separations and frequent moves worthwhile. And even if a budding medical student is looking forward to a good salary, I have to believe that without the call of service they will either not make a good physician or decide there are easier ways to make a buck.

So, Rich, I'll tell you something I often hear around military people -- thanks for your service!

 

[Rich_by_the_Bay]

Thanks, Soon.

You're correct about the rewards being proportional to the altruism one is committed to. In a way, those like myself have been subsidized by taxes and contributions to enable us to care for the indigent without personal penalty so it's not all as charitable as it might have sounded. And there are plenty in private practice who render no-pay care to the poor in limited amounts.

Anyhow, care for all segments can be done well and should be done universally in my view. The current system is shameful and embarrassing.

 

[mykidslovedogs]

Oh, Lord! I've spent a meaningful chunk of my career caring for those at the bottom of society (probably numbering in the thousands), often due to mental illness, addictions, alcoholism plus the occasional freeloader.

Success stores? Give me some time...I may be able to come up with one or two. A few times I've been able to game the system creatively to benefit a patient here and there, but otherwise... naaah, sorry, can't come up with many succes stories.

Major university teaching hospitals have a proud heritage of caring for the poor because the faculty physicians were often on salary and had little directly at stake for non-payment. But that has been changing, and not for the better; there is more emphasis on "productivity" every year.

Rich - you have made my point for me. In America, philanthropic physicians such as yourself will still care for the poor even if they have no means. However, in countries where people are placed on waiting lists, they are unable to "jump the queue" unless they have lots of money and can come to America for services that they do not want to wait for. Even if the physician wants to help, if there is no room at the hospital or no funded rooms, the charitable physicians hands are tied. At least, in America, people can turn to charity for help, even if they can't afford services. In other countries, it's just to bad if you don't have the means to jump out of the waiting queue (I guess....unless they can find a charitable organization that will give them the money to come to America for services).....but once America adopts a single payor system and we start experiencing shortages and waiting queues, then where will people go?

This is for soon to retire... soon - I have no objections to providing coverage for those who slip through the cracks....major medical coverage..or bankruptcy protection (with some personal responsibility for deductibles and pre-deductible expenses. Medicare for all (Canadian system), IMO, is not a good solution.

 

[Beststash]

Healthcare for all is not about you or I, it is about coverage for everyone in this country. There is no reason that the citizens of this country should be held hostage by the insurance companies. We can afford and we should provide healthcare for everyone - it is the moral and decent thing to do.

There are more important things in life than profit or capitalism.

Peace

 

[samclem]

Luckily, it looks like Wisconsin has it all figured out.

OpinionJournal - Featured Article

In part . . .

[FONT=Verdana, Times]"This exercise is especially instructive, because it reveals where the "single-payer," universal coverage folks end up. Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker (emphasis added)."

Obviously, the answer is to not be a worker. Or, if you are a worker, to leave Wisconsin.

[/FONT]

 

[mykidslovedogs]

Healthcare for all is not about you or I, it is about coverage for everyone in this country. There is no reason that the citizens of this country should be held hostage by the insurance companies. We can afford and we should provide healthcare for everyone - it is the moral and decent thing to do.

There are more important things in life than profit or capitalism.

Peace

Bestash - I am in 100% agreement with you. There are more important things in life than capitalism or profit. In a perfect world NO ONE should ever suffer. That's how I would like to see things happen too, but that would be idealistic and also unrealistic! The question is...IMO....by which means will the least amount of people suffer? In a single payor system, IMO, waiting queues will HURT more people (particularly people suffering from chronic, painful, apparently "non-emergent" illnesses than in a for-profit system where access and quality are always there - somewhere (whether it be through paying on your own, insurance or charity).

In one of the videos I posted, a woman was suffering from a bladder probelm. She needed somekind of electrode placed on her bladder to help her empty it regularly. The single payor system called the surgery "elective", because it was non-emergent. The waiting time for the surgery was 3 years. The surgeon told her he could only do 12 of these surgeries per year, and his hands were tied. He couldn't help her earlier even if he wanted to. She did not have enough money to "opt out" of the system. The woman suffered from so much pain and infections, that the condition became emergent, and she had to have her bladder removed. Now she has a hole in her abdomen and a bag. This kind of thing is unheard of in America. In America, even if she were poor, she would have been able to get treatment, most likely through charity or pro-bono.

This is a true story. I've got a good friend who has lots of relatives that live in England. He tells me that, in the public clinics and primary care facilities, at the end of the day, the physician will literally walk out of his office, look at his watch, and then look at the people in the waiting room. He'll say, "I'm sorry, I've met my quota for the day, and cannot take any more patients".. Then, he'll just walk out....leaving people who had appointments to come back another day, EVEN IF THEY ARE SICK. Mind you, these are people who had appointments. This is just ONE of the consequences of a single payor system. If these people don't have access to private care or can't afford it, then, they just have to wait.

 

[FinallyRetired]

Luckily, it looks like Wisconsin has it all figured out.
[FONT=Verdana, Times]It represents an average of $510 a month in higher taxes for every Wisconsin worker (emphasis added)."[/FONT]

Let's take a family with a single wage earner. $510/month is $6120 per year. The average health insurance cost for a family in the US is $11,000 per year. So the average single earner family saves $4880 per year. Double earner families, assuming they each pay the same, would pay $12240 a year, or $103 per month more to provide health care for everyone. Doesn't sound like a reason to quit work or leave the state. And by the way, that $103 per month extra will likely be equalized after one more year of health insurance increase.

 

[FinallyRetired]

This is for soon to retire... soon - I have no objections to providing coverage for those who slip through the cracks....major medical coverage..or bankruptcy protection (with some personal responsibility for deductibles and pre-deductible expenses. Medicare for all (Canadian system), IMO, is not a good solution.

Well, that's a start. Could we do a little better than rely on pro bono or the "family and friends" plan? I've said before, I don't know what the answer is, and I am not advocating single payer one way or the other. All I'm saying is, give health care a chance.

As far as the endless waiting times you keep bringing up, I don't want those. If those are a problem in Canada or anywhere else, we can do better. We don't have to copy another system's problems, we should learn what works and what doesn't, and as someone else said, leapfrog to the best system in the world. Used to be a time we had the confidence to think we could do better than anyone else. Now we seem to be in the mode of gee, wish we could do what those other guys do, if only we had the money or the profits. That's bullcrap and I'm not buying it.

BTW, the US military health system services over 100,000 patient visits per day. It is free, has little or no deductibles, and has enough doctors and hospitals that waiting times are not an issue. I wait maybe 1-2 weeks to see a doctor, 2-3 weeks to have a test (sooner if urgent), and maybe 2-3 months for elective surgery. Urgent cases are seen the same day or in days. Can we use that as an example instead of these horror anectdotes that you bring up about Canada?

Is the military health system perfect? Far from it, we had a thread on it in this forum not too long ago. But it works. And when a wheel squeaks, as in the recent Walter Reed case, it gets oiled, people get reassigned, and the problem gets fixed. After every visit with a specialist I get asked to fill out an anonymous survey as to the quality of care. And if I need to I can pick up the phone to complain to an ombudsman, to the hospital commander, or to my congressman. In 40 years of using this system I've had to make maybe 2 calls to complain.

And you know what? That is a system operated by the US Gummint paid for by US taxpayers.

 

[HFWR]

Luckily, it looks like Wisconsin has it all figured out.

OpinionJournal - Featured Article

In part . . .

[FONT=Verdana, Times]"This exercise is especially instructive, because it reveals where the "single-payer," universal coverage folks end up. Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker (emphasis added)."[/FONT]

[FONT=Verdana, Times]Obviously, the answer is to not be a worker. Or, if you are a worker, to leave Wisconsin.[/FONT]

Not necessarily defending the Wisconsin plan, but if the money now spent by corporations and individuals for insurance premiums is eliminated/shifted, maybe the extra tax bill is somewhat of a wash...

 

[maddythebeagle]

Agreed that the WSJ article is little light on info...I really dont think health care reform on the state level is really going to do much...WI has had problems with indigent from other states moving in because of higher welfare payments in the past....What are people supposed to do during the 1 year "waiting period"....and these payroll proposals dont help business....It should be up to the business what they want/can afford to pay in benefits...

There are also competing proposals in WI for a more HSA type insurance for most people....and a subsidy for the "poor"....

Also, it is MUCH more complicated to say what each person's share of the cost is....right now there is budget shifting of medicaid (with hidden taxes on stuff like landfill tipping going to medicaid in our state)

 

[gozzie]

Healthcare

We're going to have to grow up as a nation before real changes are made in the healthcare system. What we have experienced in the post WWII period is cost-shifting, which accellerated after Medicare in 1966. Everyone want the best healthcare but they want someone else (government, employers) to bear the cost. For heaven sakes, the auto workers get exercised if they have to pay a dime out of pocket. The change will come when big business puts its foot down. We're seeing GM, Ford, Chrysler say that they can pay health benefits and compete. We going to all have to realize that we will have to pay for what we want and not expect someone else to do it.
A one size fits all system won't work here. We need to realize that healthcare is both a right and a commodity. A certain level of healthcare will always be available to everyone-it justs needs to be provided in better places than emergency rooms. But for those who have the money and are willing to pay, they will get direct access to a physician of their choice, sophisticated tests and procedures, etc. That part of the system will be more consumer driven. HG

 

[Martha]

Luckily, it looks like Wisconsin has it all figured out.

OpinionJournal - Featured Article

In part . . .

[FONT=Verdana, Times]"This exercise is especially instructive, because it reveals where the "single-payer," universal coverage folks end up. Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker (emphasis added)."

Obviously, the answer is to not be a worker. Or, if you are a worker, to leave Wisconsin.

[/FONT]

Keep in mind this is just an opinion from the WSJ opinion page. There are a number of proposals being floated around in Wisconsin, none of which are likely to be passed. There is plenty to dislike about the proposed plan, but there is also plenty to like. Some analysis shows that the cost is a wash. It is all academic because the chance of this plan passing is nil.

 

[mykidslovedogs]

Let's take a family with a single wage earner. $510/month is $6120 per year. The average health insurance cost for a family in the US is $11,000 per year. So the average single earner family saves $4880 per year. Double earner families, assuming they each pay the same, would pay $12240 a year, or $103 per month more to provide health care for everyone. Doesn't sound like a reason to quit work or leave the state. And by the way, that $103 per month extra will likely be equalized after one more year of health insurance increase.

Yes, the average cost is $11,000/yr, but for most people (approx 95% of working americans, the large majority of that cost is paid for by their employer. So, if they have to pay the extra taxes, they are going to feel it!

The point of most of my posts is that if you implement a single payor system, you eventually end up with waiting queues. Theres no way around it. One way or another rationing will occur. It occurs in America via the free market (the haves and the have nots). In other countries, it occurs because of shortages (of money, suppliers of care, etc.). So, basic economics shows us that on either extreme, there are major problems.

In the middle, there HAS to be some kind of cutoff point for people to get gov't aid. In America's hybrid system, politicians keep trying to figure out where that cutoff point needs to be, but there are always a certain number of people who can't qualify for Medicaid and also either can't afford health insurance or lack the financial smarts to figure out how to work the cost of healthcare into their budget.

On the other hand, if you implement a single payor system with the ability to "opt out" into a private system, most people will not be able to afford private care, so you still end up with inequality (the haves get better service, and the have nots get to wait their turn).....not the kind of solution that most who lean to the left would agree to.....two-tiered systems don't sit well on that side of the fence.

For some reason, the majority of Americans think that the grass is greener on the other side...proably because of all of the negative media attention about our system and all of the hype about Michael Moore's SICKO movie....notice that the media give ZERO attention to the problems with the other kind of systems.....because of the hype, I truly fear that Americans will elect a congress/president that will be heavily in favor of a single payor type system. Even if we elect a moderate President, the camel's nose will already be under the tent, and, IMO, it will only be a matter of time before we implement a single payor system. I think America will probably always have some kind of private system available (unless the extremists eventually outlaw that, like in Canada, to prevent the haves from getting something more than the have nots), but in all likeliehood, even if we do keep a private system in place, the majority of people would not be able to afford to "opt out".

 

[Martha]

Yes, the average cost is $11,000/yr, but for most people (approx 95% of working americans, the large majority of that cost is paid for by their employer. So, if they have to pay the extra taxes, they are going to feel it!

As a former employer who provided health insurance for employees, I would take the savings from having to pay those big premiums and see that the employee came out even by increasing their pay.

However, the big problem is with employers who do not offer health insurance. In that case there is no savings to pass along to employees.

I would prefer to finance health care through the income tax system or similar system and not through a payroll tax where the burden fall just on employers/employees.

 

[FinallyRetired]

However, the big problem is with employers who do not offer health insurance. In that case there is no savings to pass along to employees.

Ding ding ding...
And that's an increasing number. As much as 30% in some cities.

 

[Martha]

An the increasing number is almost entirely from small employers, who are less able to afford increasing taxes.