Poll: Whos is in favor of a single payer Health Care System?

[Grizz]

I've only ever lived with universal health care (Canada) and as such am wholly unqualified to comment on the cost or care effectiveness of the current American system. What I have noticed though is reading thread after thread about the ins and outs of budgeting for American health insurance in retirement. Of course not everything is "free" under our system but I feel fortunate that the healthcare cost variable is largely a non issue in my FIRE plans and even more so since DW has recently been diagnosed with a neurological disease that can easily cost $50K+ per yr in drugs alone.

 

[meierlde]

Processed foods may be worse though, because the agricultural subsidies encourage unhealthy ingredients like fructose corn syrup and more processed foods, though I think in general, poorer people everywhere are more susceptible to bad diets.

Note that sugar is 50% glucose and 50% fructose, while High fructose corn syrup is either 55% fructose 43% glucose or 42% fructose and 53% glucose. Chemically they are about all the same (there is a 90% fructose version but it is primarily a blending ingredent to make the 42% fructose version into the 53% version).
So the only reason it is used is it is 3x cheaper than sugar in softdrinks for essentially the same effect. (Facts from Wikipedia on High Fructose Corn Syrup)

 

[modhatter]

NW Bound,

Yes, I agree about the co-pay in certain situations. But my point too, was that I all ready had that procedure done in the hospital. The specialist had the report from the test in his hands. Yet he was more than eager to give me the test again in his office. For what purpose?. Would not have done me any good. But would certainly enrich the doctor's pockets. I'm guessing with that big machine and all those needles, we could be looking at a test in excess of $1,000.

This is another argument for electronic records. If that doctor wanted to give me that same test again, then he should be make to enter this test (everything has a code associated with it) in the medicare data base under my social, and it should come back blinking in bright Red flashing warning signs, that this procedure was all ready performed on such and such a date, and would not be paid by medicare unless the doctor could substantiate it's medical need (in which the patient would have to sign off on as well, as well as make at least a $50 co-pay.) Problem solved.

 

[samclem]

This is another argument for electronic records. If that doctor wanted to give me that same test again, then he should be make to enter this test (everything has a code associated with it) in the medicare data base under my social, and it should come back blinking in bright Red flashing warning signs, that this procedure was all ready performed on such and such a date, and would not be paid by medicare unless the doctor could substantiate it's medical need (in which the patient would have to sign off on as well, as well as make at least a $50 co-pay.) Problem solved.

My doctors use electronic records. Well, we seldom see "doctors", but the PAs and NPs are there. Trust me--they don't read them. There's not enough time between patients for them to review the records. And no second-guesser at Medicare, or Humana, or anywhere else will be as effective as a patient (making a co-pay, and with the flexibility to find a new doctor if he/she is dissatisfied) asking "didn't I just pay for this test? Go back and look at my records. If you still want to do it, explain the value to me."

 

[NW-Bound]

Again, I am surprised that ACA healthcare will not be in force until 1/1/2014, and people already want something else. Yes, we will need cost containment, which has not really been addressed, but preexisting conditions are now a no-problem. One is free to chose a plan suitable for his own conditions, and can jump from plan to plan every year. Yet, some people are still not happy. As I said before, they probably believe it should be all free.

Free as in no new taxes to pay for this. And no, high cost of living as in Europe would not work, as we Americans would not like it, and no such things as US$8 per gallon like they pay. What do they know, driving Smartcars, while we drive big SUVs and 2-ton pickups over here? They are skinny, while we need big vehicles because we are, well, big. Lots of time, we want big just because. It's a birthright.

I have always thought that while the European standard of living is not for me, I respect their choices. I am not going to criticize them for what they want. But as an American, I am not sure that some Americans know what we would have to give up to get something.

The other day, my brother, a highly-paid high-tech worker, asked that how poor people (and presumably ignorant) would know to buy the right insurance, then to choose a doctor. The implication is that the government should do all this for these "idiots". I did not have time to ask him what he had in mind. Should the government do all this for everybody too? Or should the government run public hospitals with doctors and nurses being public servants. I know some Canadians want this as they think their system does not go far enough. Then, we should disallow private care providers, because if they exist, doctors would not work in public hospitals. These doggone doctors, who think they can chose where they work, just like engineers, programmers, book keepers, or auto mechanics do. Damned doctors and nurses! Lock them up, throw in a bone every time they can prove they save somebody.

Oh boy, I can now envision old Soviet-style healthcare! Did my brother know what he was asking for?

It's getting scarier.

 

[haha]

I'm not so sure that Americans lead less healthy lifestyles than people in other developed nations.

For one thing, I think Americans smoke a lot less. Not sure about alcohol, one war or another.

Processed foods may be worse though, because the agricultural subsidies encourage unhealthy ingredients like fructose corn syrup and more processed foods, though I think in general, poorer people everywhere are more susceptible to bad diets.

I agree with this. Smoking is the number 1 definite lifestyle problem to health, and America's rate is low and falling. Exercise? There are blocks near me with two gyms, all seem to be full with guys pumping iron and young to almost young very fit looking woman tearing along on the treadmills or elliptical trainers. Plenty 60 year old women shopping in Trader Joe with their tight knitted pants who look like they could be 20 until you see their faces. I do think suburban life and long commutes contribute to poor health, as perhaps does American weather. If a suburbanite works, has children, lives in one of our euphemistically called four season climates, and cannot afford the money or time for frequent gym he or she is going to have a hard time staying in good health.

Personally since we almost all must live within some budget, I give myself a better shot at getting adequate good food in America than anywhere else I know of.

All these things apply to professional class people, but less so to others.

Ha

 

[NW-Bound]

NW Bound,

Yes, I agree about the co-pay in certain situations. But my point too, was that I all ready had that procedure done in the hospital. The specialist had the report from the test in his hands. Yet he was more than eager to give me the test again in his office. For what purpose?. Would not have done me any good. But would certainly enrich the doctor's pockets. I'm guessing with that big machine and all those needles, we could be looking at a test in excess of $1,000.

This is another argument for electronic records. If that doctor wanted to give me that same test again, then he should be make to enter this test (everything has a code associated with it) in the medicare data base under my social, and it should come back blinking in bright Red flashing warning signs, that this procedure was all ready performed on such and such a date, and would not be paid by medicare unless the doctor could substantiate it's medical need (in which the patient would have to sign off on as well, as well as make at least a $50 co-pay.) Problem solved.

You were describing Medicare and its patients. And we know Medicare is going broke prior to SS. And yet, people point to the stats that Medicare's overhead is low, as in the percentage that it pays out vs. what it collects in taxes. That sounds good, but what about its payout being for unnecessary procedures like you yourself and my elderly relatives experienced?

In my case with my private insurer, we both know about the procedures and tests. My insurer knows the competitive prices, I would hope, because I don't know the technical reason for a test to cost more than another. And no way my insurer would miss a duplicate test even if I do, and I don't!

Both the insurer and myself know AND care about each test and procedure, because some cost big money, like $2K-3K. When it comes to making someone cares about something, there's nothing that makes a person care like hitting him in the pocketbook. Anyone who says differently, well...

My specialists and their clinic must justify any test or procedure to the insurance, and I myself want to know for my own good. What are they looking for in this test? I ask about interpretation of the results, and also research on the Web for what I can. I am no medical person, but I can apply some basic knowledge.

When it comes to your own health, particularly when it impacts your longevity AND also your money, you will be really paying attention to make sure that you get effective treatment with your money, because the latter is limited.

 

[NW-Bound]

Talk about electronic records, let me relate a personal story.

I have a PPO policy, and can go see a specialist without a referral from my general practitioner. So I did, when I had reasons to.

I had had a recent physical exam with the GP, and had a blood test. I had a copy of that record, and brought it with me to the specialist's appointment.

In the initial consultation, he asked me about any recent exam that I had. When I told him, he left the exam room for a few minutes, and came back with his own copy, before I could offer my own copy. He apparently obtained it directly from either the lab, or from my GP. I did not ask. Darn, I love all this electronic record. The medical field finally catches up with every other industry, and probably with other developed countries.

 

[NW-Bound]

I forgot to make a comment about your "do nothing" 4-week stay in the hospital that was fully paid by Medicare.

... something else that I did notice, especially since they kept me there 30 days and really didn't administer any real treatment except some minimal physical therapy at the gym for a couple of hours over a ten day period, and a shot in my belly twice a day (that I gave myself) But I had LOTS of doctors dropping in my room to say Hi, How are you doing, at a charge of god knows what per doctor, (I must have had at least six drop in a day, and had no clue who they were or what they were there for) and the nurses coming in every couple of hours to try and push pain pills (which I did not want or need) or anything else they could push on me to take (that I did not need) Even so, that 4 week hiatus came to $129,000, and this is not including any cancer treatment or radiation, which I got out patient back home. I am not casting any aspersions on MD Anderson. I think it is a fine hospital. I am just saying, I think that things are pushed in the hospital to rack up the big bills. I did not have to be there for 30 days, I could have easily been out of there in two weeks.

I'm one of the nut jobs who cares about what Medicare is being charged. I can remember going to a Neurologist sometime after my treatment, and him suggesting to me I take an expensive test. When I asked him, what good would taking the test be? Would it improve my condition at all? He answered no, it wouldn't. So I said, then why take the test? His answer to me, and this is 100% true. "What do you care, your not paying the cost, Medicare is." It's stuff like that, that is costing us dearly.

I do not know all the circumstances regarding your admittance to the hospital, but I do not think my private insurance would let them keep me for that long without doing much. Heck, I had pretty darn major and scary surgeries, and I was out of there after 5 nights both times (I've got big multiple scars to show for it; well no, I do not want to show them).

Well, my health was also very good pre-op, so that could be a factor, but my surgeon checked on me in person every morning to see how I was doing. He also called in the evening to talk to my nurse to see what was happening with me since his morning visit. This 40-ish young doctor always greets me with "How are you doing my friend?", and we do feel like friends. I have been to his clinic for many visits for different things, so that is a factor.

So, back on Medicare, I know that the agency does have some cost control measures, as I learned from my late father's expensive, lengthy, and repeated stays in the hospital. However, I am sure Medicare case workers are not going to be aggressive with the hospital like a private insurer would be.

Meanwhile, the patients who do not have to pay anything would cringe at any cost control, thinking that it would mean a lower quality of care.

We are already diving to the ground with Medicare, and people now want Obamacare to become an extension of Medicare for everybody. We are doomed!

 

[imoldernu]

Some passive thoughts:

Impossible for free market economies to reduce costs through competition as long as regulations can be affected by political influence. As long as corporations can pay to influence legislators to enact laws that restrict competition:
-a hospital bed that costs $7000 AND "MUST" be used because the regulations were propagated to exclude competition.
-protection for brand name drugs beyond thecopyright period through minor changes formulation.
-AMA restrictions on the number of doctors allowed in the limited number of approved medical schools.
-unrealistic requirements for medical professions where specialization does not require high evels of education.

We could add thousands of inequities, but the fact remains that as long as money can buy legislation, there will be no free market influence. A conundrum.

my opinion only.

 

[NW-Bound]

About my own experience with my surgeries, when I received copies of the bills that my insurer sent, I was surprised at what my surgeon got. It was certainly quite less than I would expect. In addition, I cannot read the hospital charge code, but his charge was only a single line. All the daily visits, the phone calls to the hospital at night, the post-op follow-ups at his own clinic were on that single line.

Was it a package deal that the insurer made with him? I do not know, but it was cheap for the care that I got from this surgeon. One heck of a deal! If other charges are like this, hell, I could be self-insured and still have money left over for travel, from all the previous decades that I paid for insurance and did not use healthcare.

PS. Compared to modhatter's experience, I was visited only by my surgeon during my hospital stay, post-op. No other mysterious doctors. Perhaps my medical condition was good and did not require extra medical attention. Would a Medicare patient in my condition automatically get "extra care"? I would not know.

 

[scrabbler1]

I worked in the actuarial field for 23 years, specializing in personal auto insurance. Some comparisons to the personal auto insurance system work well, but others do not.

All states have some sort of mandatory insurance law (for third party liability coverage), akin to the health insurance's individual mandate. This counteracts or at least attempts to minimize the problem of "free riders" and "adverse selection." From my review of data over my years of work, most drivers have "clean" driving records with regard to accidents and serious traffic violations the insurance companies are allowed to surcharge on the driver's premiums. It is the premiums collected from these good drivers which help keep premiums down for everyone.

From my work on pricing changes to premiums due to the strengthening of mandatory insurance laws, they tended to drive down the rates for uninsured motorists (UM) coverage, the "price" insured drivers pay to protect themselves in case they have an accident with an uninsured driver.

Those who buy auto insurance are classified by far more rating variables than those who buy health insurance, however. Bad drivers pay more, as do young drivers (under 25). Drivers who take accident prevention courses receive a discount. We have territorial rating, now being done in a more refined way by zip code. Gender and marital status are also used for rating within some age groups. For some coverages, the car itself is a rating variable.

Both a single payer and an individual mandate bring everyone into the health insurance system, paying something (unless they are too poor to be able to afford it). With the ACA, the penalty for not buying insurance at least gets some money from those who choose to be "free riders" because we don't deny a minimal amount of health insurance if someone has a heart attack on the sidewalk and lacks insurance.

I prefer a single payer, "Medicare-for-all" type of system. Raise the Medicare tax and have more income (MAGI?) subject to it so everyone, working or not, is paying into it, while everyone is eligible for coverage. Insurance companies can sell additional, higher levels of optional coverage. This takes most of the profit and overhead out of the insurance system.

 

[NW-Bound]

I prefer a single payer, "Medicare-for-all" type of system. Raise the Medicare tax and have more income (MAGI?) subject to it so everyone, working or not, is paying into it, while everyone is eligible for coverage. Insurance companies can sell additional, higher levels of optional coverage. This takes most of the profit and overhead out of the insurance system.

Not the Medicare as we have it today. We do not know how to fund Medicare as it is now, let alone extending to more people.

Without cost control, we will need more taxes like VAT or asset tax to pay for it (in case ER's think they will get a freebie). All other countries have cost control measures. Ask if any of them would allow a month-long do-nothing hospital pay costing $129K. We could have sent modhatter on a month-long cruise instead. She would enjoy it more, and I save money as a taxpayer.

PS. A report on the Web said that the Republicans claim Medicare will run out of money in 2016, while the Democrats said 2024.

 

[Gatordoc50]

About my own experience with my surgeries, when I received copies of the bills that my insurer sent, I was surprised at what my surgeon got. It was certainly quite less than I would expect. In addition, I cannot read the hospital charge code, but his charge was only a single line. All the daily visits, the phone calls to the hospital at night, the post-op follow-ups at his own clinic were on that single line.

Was it a package deal that the insurer made with him? I do not know, but it was cheap for the care that I got from this surgeon. One heck of a deal! If other charges are like this, hell, I could be self-insured and still have money left over for travel, from all the previous decades that I paid for insurance and did not use healthcare.

PS. Compared to modhatter's experience, I was visited only by my surgeon during my hospital stay, post-op. No other mysterious doctors. Perhaps my medical condition was good and did not require extra medical attention. Would a Medicare patient in my condition automatically get "extra care"? I would not know.

Nobody wants to hear that doctors make less than policemen when accounting for total hours worked, overtime, education, pensions, sick and holiday pay, retirement benefits, health benefits, years worked, etc., etc. And as far as I know, the private healthcare system is debt and deficit free and has cost taxpayers nothing. So, as you can see, when you expand the expensive public health system and shrink the self sustaining private system, costs are gonna rise. As far as socialist countries costs, who really knows who much they spend on healthcare. They spend way less on care, get superior results,? In addition, they spend way less on education and get superior results? In addition, they spend nothing on defense? And yet, they're broke and their entire economies are dependent on our economic health.. Sounds like some pretty fuzzy accounting.

 

[HFWR]

I'm amazed that a majority of the members of this forum (or at least a majority of those who have voted so far) favor a single payer system. This group tilts very heavily towards a philosophy of self-responsibility, self-reliance and independent thinking. I can't reconcile how such a group would be willing to hand over responsibility for their health care to our federal government!!

Though, at present, our insurance system is controlled by employers, insurance companies, AND the government, which often works well on a case-by-case basis, but in the aggregate is apparently not working so well.

 

[Betty Noir]

.

...Everyone would get the same level of coverage.... .

Except, of course, for those who will simply purchase a different level of care.

In Single-payer systems, there remain two classes: the rich and the poor.

 

[NW-Bound]

... As far as socialist countries costs, who really knows who much they spend on healthcare. They spend way less on care, get superior results,? In addition, they spend way less on education and get superior results? In addition, they spend nothing on defense? And yet, they're broke and their entire economies are dependent on our economic health.. Sounds like some pretty fuzzy accounting.

Very good points, as we have often looked at just one area, and not at the entire economy.

When we stand back, we will wonder if the American way, with some warts as it is, may have something right after all. Foreigners coming here are often amazed at the low cost of living, compared to what they are paying at home. Many come here to call home. And often, the foreign retirees who do not need to work like it enough to spend the winter here.

Our food is cheap, but that's bad? As frugal people, we do not shop at Whole Food, but we stay away from soda pops loaded with sugar (of whatever kind), and find plenty of cheap produce to buy for healthy meals. Why can't Americans exercise self-control and make better choices? Is the only way to control something is to raise taxes to make it expensive so people will not get it?

Here's one last thing that I remember. I doubt that I would be able to save this much money and to retire early if I lived in another Western country. As I worked in a megacorp with many emigrants (legal) from many countries, I heard of their stories.

And in one case, there was this American engineer who decided to emigrate to Germany, for a change in pace I guess. He came back after a few years. He said that he was not able to save anything. When he was there, he married a Polish girl. His wife was religious, and wanted to have a proper wedding in a church. They tried to save money for that, and saw that they were not getting anywhere. He promised his wife that she could have that after they got back to the US.

So, fellow ER's, think harder about the little stash that you have saved, or trying to save to retire early. And what could have happened to it, can happen to it, or may happen to it in the future.


PS. I have made many posts on this thread, while in the past I was not active in the healthcare debate. Why? It's because of my recent experience with extensive healthcare, and I now know more about it. Just one person's viewpoint, but I know a lot more now, compared to other people, like my siblings, my friends who have not spent a single night in a hospital.

 

[ShokWaveRider]

I think the results of this poll prove that there is still some hope for a "Proper" health care system for ALL Americans. Shame we cannot push it. I could never understand why the public option was removed. I would select it.

 

[MichaelB]

The poll is now closed. Thanks for an interesting discussion

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