Health care?

[explanade]

And what are these statements, facts or opinions?

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There is pretty good competition in this sector that prevents consumers from the "raw deal". Also, the returns of healthcare companies have been in the mid-teens, good but not outrageous. The reason for the push towards high deductible plans is because the HMO, PPO etc plans were costing employers too much and were unsustainable. The HDHP puts some of the responsibility for the cost of health care back on the individual, which is the way it has historically been in this country.

[modhatter]

I think it only stands to reason that the only people who can get buy with a "high deductible", limited coverage policy are those people of means and a healthy savings account, who prefer to take their chances. The middle class worker or lower wage earners will do very poorly with these policies and in a lot of cases not get treatment when they need it.

[nun]

High deductible plans are just a way to paper over the basic issues with US health care; it's is too expensive and doesn't cover nearly enough people. Reducing benefits and shuffling numbers won't solve the problems. There has to be systemic change. It can happen in an ordered way if we start now or in a catastrophic way if we leave things as they are now.

[Sirka]

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Originally Posted by nun I have an MA state health plan that costs me $100 a month with no- deductible and very low co-pays. So US healthcare is great for me and UK almost as good.

I don't know of other states that offer such great deal, so one state does not US make. Does any one in California pay so little?
Hopefully it will get better with Obama Care.

[nun]

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Originally Posted by Sirka I don't know of other states that offer such great deal, so one state does not US make. Does any one in California pay so little? Hopefully it will get better with Obama Care.

I work for MA and state workers get access to good plans. If I lost my job I'd have to buy one of the health insurance plans that's mandated by MA under RomneyCare. At least you cannot be refused coverage. As a 51 year old male my premiums would be $350 a month for a high deductible $2k/$5k plan with 20% co-insurance. $610 would get me a $0/$0 plan with no co-insurance.

MA does well in coverage, but healthcare is still expensive.

[Brat]

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Originally Posted by nun I work for MA and state workers get access to good plans. If I lost my job I'd have to buy one of the health insurance plans that's mandated by MA under RomneyCare. At least you cannot be refused coverage. As a 51 year old male my premiums would be $350 a month for a high deductible $2k/$5k plan with 20% co-insurance. $610 would get me a $0/$0 plan with no co-insurance. MA does well in coverage, but healthcare is still expensive.

Actually that isn't all that expensive. The 20% co-insurance would be at the insurer's negotiated rate and there are many a 51 yo who would be delighted with $610/mo plan. Let's put that in context for a young woman: the cost of the common generic family planning med Loryna 3 MG-0.02 MG Tab at Costco is more than 10% of your $0/$0 plan per month. If you want the brand name for the same medication is more than 15%, again at Costco.

[nun]

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Originally Posted by Brat Actually that isn't all that expensive. The 20% co-insurance would be at the insurer's negotiated rate and there are many a 51 yo who would be delighted with $610/mo plan. Let's put that in context for a young woman: the cost of the common generic family planning med Loryna 3 MG-0.02 MG Tab at Costco is more than 10% of your $0/$0 plan per month. If you want the brand name for the same medication is more than 15%, again at Costco.

When you have paid such high prices for health care for so long I can understand that those costs might not be shocking.

[Mulligan]

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Originally Posted by explanade Quick search turned up a bunch of articles: High Deductible Health Insurance Plays Russian Roulette With Our Health As Insurers Rack Up Record Profits - Forbes I remember when the Cigna executive turned whistleblower first started doing interviews, he mentioned these kinds of plans as manna for the insurers. Found this just now: Insurance industry whistleblower predicted new front group "Vermonters For Healthcare Freedom" | Facebook

In my individual situation, I dont see HD plan as playing russian roulette, I see it as a logical choice for me and am thrilled I have it. I could have stayed on my group plan at $500 a month , $1000 deductible, with $25 office visits and prescription co- pays. But I preferred to go into the individual market and $72 a month and have a $5 k deductible, 0 copay on everything after that. I fund my $3k yearly HSA and pocket the tax savings which in effect pays completely for my premium. After 20 months of retirement, I have $6100 in an HSA, and my premiums have been more than covered by 2 years of tax deductions. If I had stayed on the group plan, all I would have to show for it is $10,000 in premium receipts. If the insurance company is making more off me from an HD, and Im saving more also, I have no problem with it. But that is just me and of course YMMV. I am not suggesting this is a better system than what other countries have, Im just saying working within the constaints of our current model, I prefer the HD HSA route.

[MDJO]

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Originally Posted by Nords You would think that with all the wildly successful single-payer systems in the world then at least one of them would catch on here and spread uncontrollably. Or possibly they're not as wildly successful as we're led to believe.

Amen Nords.

Ever see the hospital parking lots in US cities along the Canadian border? Lots of Canadian plates.

[Midpack]

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Originally Posted by MDJO Amen Nords. Ever see the hospital parking lots in US cities along the Canadian border? Lots of Canadian plates.

By all means, let's base our views on ancient sound bites, it's much easier to preserve the expensive, middling results, many uninsured status quo.

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A tip without an iceberg? It is frequently claimed, by critics of single-payer public health insurance on both sides of the border, that such use is large and that it reflects Canadian patients’ dissatisfaction with their inadequate health care system. All of the evidence we have, however, indicates that the anecdotal reports of Medicare refugees from Canada are not the tip of a southbound iceberg but a small number of scattered cubes. The cross-border flow of care-seeking patients appears to be very small. These findings from U.S. data are supported by responses to a large population-based health survey, the NPHS, in Canada undertaken during our study period (1996). As noted above, 0.5 percent of respondents indicated that they had received health care in the United States in the prior year, but only 0.11 percent (20 of 18,000 respondents) said that they had gone there for the purpose of obtaining any type of health care, whether or not covered by the public plans. Why is cross-border care seeking so low? Our results should probably not, on reflection, be surprising. Prices for U.S. health care services are extraordinarily high, compared with those in all other countries, and this financial barrier is magnified by the extraordinary strength of the U.S. dollar. Private insurance for elective services, being subject to very strong adverse selection, is, not surprisingly, nonexistent. Discussions with key informants in the Canadian private insurance industry indicated that carriers correspondingly confine themselves to the coincidental services market. Furthermore, provincial governments have been lowering their rates of reimbursement and tightening preapproval criteria for cross-border care. In the absence of either source of health insurance coverage, it would be somewhat surprising if large numbers of Canadians were choosing to head south and pay out of pocket for care. In fact, one recent survey found that Canadians were not even prepared to pay out of pocket in their own country to reduce their own waits.

http://content.healthaffairs.org/content/21/3/19.full. Just one link, of many. I'd love to see one that shows any significant numbers of Canadians or other nationalities that seek US health care. Every one I've seen suggests it's an exception...

[modhatter]

As usual Midpack. You nailed it. Can always count on you to come back with the facts, supporting your argument.

Since we have Canadians on this board, I'd like to hear them speak for themselves as well. It's so great when we can hear from those who have lived in the UK, or Canada or Norway. My mom is from Norway, and most of my relatives live there. They find it very difficult to understand the resistance to a universal health care system here in the US.

[oldtrig]

Just think how many older workers would leave the work force if health care was not expensive? That would make way for others to get the jobs and therefore people start spending money again. If our government would start something now that would fix this large problem then our grandchildren would live in the land of the free again. Let's start with fraud. I know so many people that are on disability who are healthy as a horse. Lawyers advertise it on TV. When you get say 50 and loose your job then fake a disability. People keep talking but the same people keep getting elected. Something had better be done now or the future for this country is not so very bright. Nothing in life should be free but health care does not need to be this expensive. oldtrig

[NW-Bound]

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Originally Posted by Alan Socialized medicine does not necessarily mean there are no private clinics and hospitals providing services for those that can afford it.

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Originally Posted by nun All emergency care is free in the UK, no matter what your status. I have US friends who had an issue with a pregnancy while visiting the UK and they went to the ER, had a load of scans and it was all no charge because it was deemed an emergency. If you are not UK resident you are supposed to pay for non-emergency treatment. Also your citizenship or whether you are a tax payer has nothing to do with eligibility for NHS treatment, you just have to be a resident or in an emergency.

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Originally Posted by Aruba50 In Canada, there is no such thing as supplemental insurance that will get you to the front of the line. The system is based on the principle of universal access. Some provinces have been pushing the envelope by allowing some private, for profit services such as MRi scans but even this is limited. Orthopaedic surgery is one of the worst areas in the system. Wait times can be very long. It's not clear to me why this is other than the fact that generally, no one will die waiting for a knee operation. If your friend was "on call" it was because she was wait listed for her surgery, meaning that they wanted to get her in ASAP and so she had to be available in the event of a spot opening up in the surgical schedule. This was not a result of her not having bought some sort of insurance.

Because Americans highly value their personal freedom, a system like Canada would be a non-starter here. A system where individuals can purchase additional private coverage, such as the British, the French, or some other European systems would make more sense.

I look at it this way. Two persons of the same means may have different values; one may want a big house and fancy cars, the other may want to spend money on travel. Similarly, one can wait for his turn for a non-life threatening treatment, while the other is willing to forgo that bathroom remodel to get a knee replacement ASAP. What is wrong with that?

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Originally Posted by pb4uski The problem is that too many people have a warped view that health insurance should pay for every little thing, but at the same time they wouldn't think that car insurance should pay for oil changes or tires or brakes... Just thinking how it could be better without having the government totally takeover.

From what I have read here from posters, it appears the Canadian government has taken over completely, while European systems still allow supplemental private health care. The latter makes a lot more sense to me.

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Originally Posted by modhatter ...The other side of that coin in controlling costs is individuals having some skin in the game. I see myself - people on medicare and private insurance (paid for by their employer), not being at all concerned with costs and therefore either agreeing or opting for things they might not if they had to pay a portion of it themselves. My GP, who I know well was complaining about the excessive appointments his medicare patients were making when there was really nothing wrong with them. He said he would like to see a $25 copay instituted and he thinks these frivolous visits would decrease dramatically. There of course would probably have to be a reduced fee for people very low income patients (say $10), or the doctor could have the option to waive it if he so chose. Doctors are of the same mentality sometimes. When I saw a specialist a couple of years ago, he suggested I have an expensive test to see if my condition had worsened. I asked him, if it has, is there anything he can do to make it better? He said, "not really". So I said, "then why go through the expense of the test?" His answer to me was: "What do you care, medicare will pay for it." So, I politely told him, I did care because someone was paying for it. That is a true story. It is a real Catch 22 if there ever was one - when it comes to medicine. We know that making people incur some costs might greatly reduce unnecessary procedures and tests. On the other hand, it might discourage people from seeing a doctor and getting treatment they need. We know that some doctors are quick to recommend operations and procedures that patients might not need and would not really improve their condition enough if at all to warrant such an expense...

I have seen plenty of the above examples myself, with my own elderly relatives who are on Medicare.

Have you ever seen plates with excessive food being thrown away in "all-you-can-eat" buffets? Well, in healthcare, it is not so obvious to the patients that the excessive or nebulous treatments they demand are just the same as the wasted food in the buffets, but the results are just as egregious. Now, imagine that the buffet owners are guaranteed to be reimbursed by a 3rd party!

[nun]

The Canadian system mostly uses Government funds to pay for private medical services. Some provinces also have private insurance. All the countries we are talking about are capitalist economies that deliver health care to their entire populations with a mix of Government and private funding/insurance. The UK is the most socialized and obviously not a model that could be implemented throughout the USA, but having a single payer system does not preclude the operation of other systems in parallel

[pb4uski]

What is the difference between "single payer" and centralized claims administration?

From what I have heard of single payer, economic risk is centralized as well (ie; no competition, like Medicare Parts A and B).

[Buckeye]

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Originally Posted by modhatter Read Wendell Potters book. He was a CEO at Cigna, I believe. He explains this new trend by insurance companies and explains how they are pushing these policies because they make a lot of money on them. They are high deductible (lower costing) policies that have lots of exclusions in them. He explains how insurance companies are relieving themselves of cost obligations in these policies and giving it to the policy holder, rendering them highly under insured. He has testified in Congress as to the current practices of insurance companies. My sister has one of these high deductible policies, because she can't afford anything else. She has a problem with her foot and is in constant pain walking on it. She finally did go to a doctor, who said he needed her to get a MRI. As she would be a private payer of this scan, it was double what an insurance company would pay. She can not afford this, so she lives with the pain and remains in the dark as to the cause. This is wrong on so many levels.

If she has one of the high deductible policies (not just catastrophic coverage, but a true high deductible policy) she should be getting the negotiated MRI rate. She probably has to pay 100% of the negotiated rate as she will not have met her deductibe, but at least it's a negotiated rate.

[Buckeye]

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Originally Posted by oldtrig Just think how many older workers would leave the work force if health care was not expensive?

Cost is part of the issue but being able to get coverage at ANY price is another issue. There are many who have pre-existing conditions and are uninsurable. I bet there's a fair sized group of people willing to pay relatively high premiums if they were just able to buy a policy!

[nun]

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Originally Posted by pb4uski From what I have heard of single payer, economic risk is centralized as well (ie; no competition, like Medicare Parts A and B).

All US healthcare is expensive, however it is run. Other countries deliver more coverage at a lower per capita cost whether they are the socialized system of the UK or more based on private insurance like in Switzerland. There are undoubted inefficiencies and duplication of effort inherent in the administration of US healthcare, but IMHO most of the excessive cost comes from the way medicine is practiced and consumed in the US. This produces an expensive system that covers an increasingly smaller %age of the population and (on average) produces poorer health outcomes when compared to many other countries. The only people that should be satisfied with US healthcare are the vested interests, patients get a pretty raw deal.

[nun]

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Originally Posted by Buckeye Cost is part of the issue but being able to get coverage at ANY price is another issue. There are many who have pre-existing conditions and are uninsurable. I bet there's a fair sized group of people willing to pay relatively high premiums if they were just able to buy a policy!

My Plan B ER scenario involves returning to the UK where I will be covered under the NHS. No out of pocket costs and obviously no worries about getting coverage. The reason that isn't Plan A is that I live in MA where we have RomneyCare so I am guaranteed coverage whatever my health. You can choose form a high deductible plan ($350/month and $2k/$5k 20% co-insurance) or one that costs almost twice as much that covers everything.

Most systems outside the US are built on the assumption that everyone will be covered irrespective of their finances or health. They work back from that. The MA system (and a few other states) and Medicare also make that assumption, or dictate depending on your outlook, and they achieve universal coverage. But the costs are still high so Plan B is looking increasingly attractive to me.

[Midpack]

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Originally Posted by nun The Canadian system mostly uses Government funds to pay for private medical services. Some provinces also have private insurance. All the countries we are talking about are capitalist economies that deliver health care to their entire populations with a mix of Government and private funding/insurance. The UK is the most socialized and obviously not a model that could be implemented throughout the USA, but having a single payer system does not preclude the operation of other systems in parallel

Posted earlier in this thread. Note the US private health care system already spends more public funds than most countries! And then a staggering amount of private funds as well to bring out total spending to more than double the average cost per capita, and far more than the 2nd highest, without commensurate results.

And it's not clear the UK is "the most socialized" but it is clear we're the costly outlier.

We can do better, if we quit defending the status quo and look at models all around us. But between special interests and most of all, apathetic citizens who don't realize how much they're already paying (the full amount below!), I'm not optimistic - yet. While we aren't going to change wholesale, it would be nice to make progress in reducing monumental waste to reduce cost, increase coverage and improve results.