Originally Posted By RoadTrip Well, it looks like Admin shut us down on the Lutz thread. I don't know why... I think a discussion of lousy health care and Lutz go together just fine. At any rate... I think health care in the United States is extremely good. I think the health insurance industry is extremely poor and what adds a massive amount of cost to health care. Whenever you look at a list of the highest paid executives in America there are always a few on the list from health plans. I would like to see health insurance limited to major medical. All routine health care should be paid for by the consumer. This would eliminate a huge amount of insurance company overhead and would provide incentive for health care providers to reduce costs. At present most people don't give a rip about what health care costs. All they ever pay is a co-pay or a relatively small percentage of the total cost. If people had to pay for their own health care they would make decisions more carefully when deciding whether or not they should run to the doctor with that runny nose. How would this be funded? With insurance limited to major medical, companies with health plans would save a bundle on employee health plans. They would replace that expenditure with a deposit into an individual's health care account which could be used to pay for routine health care. Individuals would also contribute to this account on a pre-tax basis as they presently can do. Until the consumer of the services gets 'closer to the bill' health care cost will never be controlled. Government provided health care would not make the situation better; it would make it worse.
Originally Posted By davewasbaloo I understand your hypothesis and think it is very interesting, but I do not think it is the best model at all. Currently an ER episode costs on average in the UK $100,000 per episode. This does not include post care requirements. A preventative approach (which many of these situations are) costs much, much less. Now well I have given ammunition to your arguement in your favor, it is here where my debate differs. Most people would not pay those small amounts for preventative measures - they would rather spend there money on essentials or fun things (we see this with housing maintenance all the time). Then when it is too late and an acute episode crops up, then there is an economic drain, or the insurance would kick in. Either way it is a lose-lose all around. With Socialised medicine, you get the preventative model kicking in, and it is a much more economic way to deliver services. I really like Australia's socialised medicine model where it is means tested. The kids, elderly and disabled are free. The moderate incomes pay a small amount, the wealthy pay a greater amount. That seems to be the most fair model to me. But I will reassert, the US standard of care is excellent if you can afford it. But if you can't, it's tough luck. I cannot live with that, it feels immoral to me. Government provides Military services, education, road maintenance, protection services etc., why not social medicine? It is proven that healthy societies are often more prosperous societies. Then again, I am also a fan of national compulsury services by the young too. But maybe that is for a different thread.
Originally Posted By Kar2oonMan >>At present most people don't give a rip about what health care costs.<< Wha? Millions of people certainly care about what it costs, but cannot afford the insurance premiums whatsoever, let alone the walk-in rates at a doctor's office or ER. The problem with your plan RT is that often times, "major medical" becomes necessary due to a lack of preventative care and regular checkups to catch things when they're easier to treat. Leaving people to pay their own way for all the tests, x-rays, check-ups, follow ups and meds won't be much different than the system many are now shut out of. It isn't the consumer's fault that the costs are so high. Your plan seems to punish regular folks in an effort to "teach a lesson" rather than helping. Your plan assumes that people are overusing health care services in a frivilous way. I'm sure that happens, but not to the extent that it jacks up rates.
Originally Posted By Dabob2 <They would replace that expenditure with a deposit into an individual's health care account which could be used to pay for routine health care.> There's no guarantee of that, of course. And what of people who are unemployed? What of a new hire? How does the company "replace" the expenditure on an employee they previously didn't have? Would the government mandate that all employers have to contribute something to an individual's health care account? They don't mandate that any company provide health insurance now. <Government provided health care would not make the situation better; it would make it worse.> I disagree. Single-payer systems like nearly the whole industrialized world have (except us) are not perfect; however, IMO they outrank ours. The fact that you have a single payer simplifies things tremendously, thus reducing costs better than any other thing you could do. We already have government insurance for the two most expensive groups of people to insure: the elderly and the very poor. Adding the rest of us into that "pool" creates a more rational (and lower cost) pool. Canadians, to take one example, overwhelmingly say they would not trade their system for ours, even knowing first hand the imperfections of their own (which any system will have).
Originally Posted By JohnS1 I would like to see some patient education which informs people not to run to the doctor for every tiny little malady, but some segments of society haven't seemed to get that message. Part of it is the fact that they think it's free, as you point it out, but part of the problem is that in this illness of the month society we live in, we are surrounde by advertising that tells us every ache or pain is COPD, SIF, GPTY, or a host of other acronyms that make us feel wanted and part of a group - granted, even a sick group! We are so hungry for attention in this society that even recognition for being part of a group with an illness or disease offers that 15 minutes of fame we are all supposedly seeking. A public service campaign needs to be launched that says, "Hey, 90 percent of the time, that asilment you have isn't going to be fatal, or even long lasting. Stay home, stay in bed, and no more going to the emergency room for hang nails.
Originally Posted By Kar2oonMan By the way, many years ago my wife's grandfather was transferred from kaiser to a private hospital for heart surgery. Looking at the details of the bill, they were charging $8 for a Q-tip. Seriously. Because they were billing his care to Kaiser, they added all kinds of stuff like that, like one of those $500 toilet seats the government pays military contractors for.
Originally Posted By Dabob2 #2 and #3 make excellent points about preventative care that I should have.
Originally Posted By JohnS1 PS - DavewasBaloo - the word is preventive. There is no such word as preventative. (Just my little bit for the preservation of grammar in the word!) You may now all go back to what you were doing.
Originally Posted By davewasbaloo JohnS1 - in the UK, the term is preventative medicine, perventive is considered poor grammer here (just like normalcy and normalicy). See, two countries devided by a common language.
Originally Posted By davewasbaloo And I don't want to be snotty - but currently I am working on an international project into preventative approaches to supporting Long Term Conditions Management to try to reduce the costs of care delivery (In the UK it is estimated expenditure will go from $10bn to $24bn in 20 years due to demographic shifts) - we do not use the term preventive.
Originally Posted By RoadTrip Why would companies contribute to an individual's health care account? Why do they (most companies) contribute towards insurance premiums? They need to do it to remain competitive when recruiting employees. I also think the government could provide tax credits to businesses and individuals for contributions to the account. What about a new employee? They should have money in their account from the previous employer. What if it is a person's first job? Well, they are probably 18 and pretty darned healthy. They would be covered by major medical in case of really serious problems. Other than that... how much does a routine office visit cost? The person's health care account will soon have enough to pay for routine care.
Originally Posted By Dabob2 Re: #6. That's similar to something that happened to me, and the Q-tip made me think of it. Back in the 80's I had a really sore throat that just wouldn't go away. I was in the process of moving, which was occupying all my time and attention. When I got to my new place, I didn't know any doctors, so I went to a walk-in place. The doctor took one look at my throat, knew what to do, and took this really long wooden Q-tip, dipped it in this purple stuff, and swabbed my throat with it. Sure enough, the next day I was all better. When I went to pay, the desk told me it would be $80. Expensive enough, I thought (this was over 20 years ago). She assumed I didn't have insurance, I guess because most people who came there didn't, or because I was young, or both. But I did have insurance, and told her so. I saw that she then charged the insurance company $380 for this (literally) 2 minute diagnosis and treatment. Doctors and clinics and hospitals do this routinely - inflate charges to insurance companies, because they can - or, they'd tell you, to make up the difference for people who can't pay. This is another nutso consequence of some people having insurance, and other people not. On the other hand, often people who can't pay, yet do not qualify for Medicaid, pay MORE for hospital services than those with insurance, depending on the deal a particular insurance company has with a particular hospital. In other words, those least able to pay are charged the most sometimes. The system is completely irrational and is not serving us well. This doesn't even get into the problems that "Sicko" pointed out, with people who THINK they're well covered getting sick and finding out their insurance companies won't pay. I know I've told my (so far only upsetting rather than life-threatening - I think, knock wood) horror story of my current insurance company refusing to pay for a pancreatic scan every six months as my doctor wants. The tumor on my pancreas SEEMS benign now, but if it starts growing, that's the sort of thing you want to know AS SOON AS POSSIBLE, not possibly 11 months after you scanned it last. Pancreatic cancer is aggressive and MUST be caught early for you to have any chance. But some bureaucrat in Buffalo (or Bangalore) has decided he knows better than my doctor, and it's once-a-year for you, bub.
Originally Posted By Kar2oonMan >>Heather Foxman was trying to be the health-care bargain shopper backers of increasingly popular consumer-driven insurance plans say Americans should become. The pregnant woman, who has a high-deductible health plan, wanted to know how much she would pay for an ultrasound. After being tossed between clinical and billing departments at Meriter Hospital, St. Mary's Hospital and Dean Health System, she got three similar quotes. She went to Dean, the lowest bidder at $510. Then the bill came — for $942. Foxman is among many pioneers in the consumer-driven health movement who are bumping up against a complicated billing system that has just started trying to become more transparent. "Why can't you get a written estimate like you do from a car mechanic or somebody working on your home?" asked Foxman, 35. "We'd like to be empowered as health-care consumers, but it seems like we can't be."<< <a href="http://www.madison.com/wsj/topstories/index.php?ntid=257762" target="_blank">http://www.madison.com/wsj/top stories/index.php?ntid=257762</a>
Originally Posted By Dabob2 <Why would companies contribute to an individual's health care account? Why do they (most companies) contribute towards insurance premiums? They need to do it to remain competitive when recruiting employees.> I'm sure you realize, more and more companies aren't offering it at all. Would companies that currently don't be mandated to do so? If not, more will simply opt to stop doing it, as they are now. Also, I'm sure you realize that health care costs are rising much faster than either inflation or real wages. I think you're being awfully optimistic to think that this employer scheme would work for most people.
Originally Posted By Kar2oonMan I know I've told my (so far only upsetting rather than life-threatening - I think, knock wood) horror story of my current insurance company refusing to pay for a pancreatic scan every six months as my doctor wants. The tumor on my pancreas SEEMS benign now, but if it starts growing, that's the sort of thing you want to know AS SOON AS POSSIBLE, not possibly 11 months after you scanned it last. Pancreatic cancer is aggressive and MUST be caught early for you to have any chance. But some bureaucrat in Buffalo (or Bangalore) has decided he knows better than my doctor, and it's once-a-year for you, bub.<< No, I hadn't heard about that! That is ridiculous they want you to check only once a year!
Originally Posted By u k fan You say preventive - I say preventative. Let's call the whole thing off!!!
Originally Posted By davewasbaloo Let's also add the psychology factor to this equation here. If you have a condition that can be exascerbated by stress - heart disease, BP, Mental Health issues etc. and you are worrying about whether you will get treatment, or feed the kids, there is no doubt health will deteriorate. That has a major impact. Or energy that could be dedicated to getting better and improving quality of life is spent "shopping around" that will not help either. Also, who will ensure treatment is honest and fair if it becomes wholly market driven? Also, my gut says the current economic medical model used in the US has been a huge contributor to sue happy America. You see, if you have something medically go wrong, and you have paid for it, or will have to pay more to sort it out, you are more likely to sue. But if you have a situation arise and you know you will be treated, you may be less likely to sue. There are very few law suits against medical practices in socialised countries, and I think it is because it is dealt with as a consumer business, but as a public service. The thrust in community ethos contributes to a greater common will. Something that seems to be eroding at pace in the US.
Originally Posted By ecdc I'm just at a loss as to why people in the U.S. are so opposed to something that clearly works in other countries. People are quick to point out the problems, but I'd say being among the worst of the industrialized nations for things like infant mortality, life expectancy, etc. is a much bigger problem. I think this in large part goes back to what John Edwards says: There are two Americas. The ones with good health care don't know the ones that don't have good health care even exist. It won't be them whose child dies during childbirth, so why change the system?
Originally Posted By Dabob2 <No, I hadn't heard about that! That is ridiculous they want you to check only once a year!> Yes, I agree. All I'm asking for is a simple scan twice a year, AS IS THE ACCEPTED PROTOCOL FOR PANCREATIC TUMORS, and as my doctor wants. I don't think that's asking too much, but apparently some functionary in a cubicle whose bonus may depend on how many people he turns down, thinks it is.
