Good. Illegals don't have a SS (US) or SIN (Canada), which means they don't pay taxes. If you're not paying taxes, you should not receive tax-funded benefits. It seems like a very simple concept.mheslep said:That right there would prevent insurance reaching several million of the of the US 46million uninsured figure that is so often quoted. A large portion of that figure are illegal aliens and hence would not be covered under Canadian rules.
mgb_phys said:The problem in America is that insurance outside work is incredibly expensive - if small companies don't have much bargaining power, how much does an individual have. Especially since individuals with no insurance are bundled in with all the un-insurable. In Canda even without benefits you are basically just paying the extra bit of tax ( $50/month for me in BC) yourself instead of through the payroll.
It is interesting that British doctors were the main campaigners against the NHS in the 40s, then in Canda they went on strike in the 50s to prevent an NHS there - now it seems American doctors have learned from history.
ShawnD said:Good. Illegals don't have a SS (US) or SIN (Canada), which means they don't pay taxes.
drankin said:What do you call expensive? I insure my whole family outside of my work offered insurance for $250/mo. It's part of the new HSA system we have in the US. The reason it is low is because my deductible is high. Since it is high I can put my pretaxed income into a HSA savings account with my bank where it can collect tax free interest. I can use that money towards any health needs when I have them, including dental and vision. If I have a medical emergency I pay the first $5000 (using my savings) my insurance pays the rest up to 1 million dollars (or maybe it's 2). I love the program because I no longer pay a high premium for insurance I never use but if I have a major emergency I'm only out a few grand that I have in my tax shelter. It's new, simple, and I have control of where I want to spend my money on medical needs. I'm not restricted by my insurance as to where I get my health care and I'm insured for the kind of care needed that can be financially devestating. I can build my savings as quickly or slowly as I want and it isn't taxable. It depends on how much of a medical needs consumer you are but if you are like most families, you don't use as much as you would typically pay in premiums.
quadraphonics said:Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.
edward said:Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.
Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.
That is exactly the point where your plan won't look so good anymore.
drankin said:That $5000 is good for an entire year and then they reset your deductible. I can save up as much as I want in my HSA and the beats traditional insurance. My money stays mine, not to an insurance company. If I'd had started this 20 years ago it would still be there collecting interest because I haven't had any medical emergencies for that long. To think of all that money I was throwing at insurance companies in the past.
If I had a bunch of emergencies and didn't have to pay for it because of socialized health care, then my fellow tax payers would have to pick up the tab. Someone has to pay for it, I think it's only right that I pay my way and determine where I get my medical care.
edward said:True to some extent, but when it comes to medical care they are sucking the life out of Arizona's medical system. The money they pay into the federal government never makes it back to the individual states.
These HSA plans can be just as good or bad as you want them to be. That is, given a first class cover-everything PPO Blue Cross Blue Shield plan, one can get the exact same HSA plan from BCBS except you pay the high deductible.edward said:Your plan looks good because you haven't used it yet. You don't get much medical care for $5,000 these days. The 5g's wouldn't even pay for an outpatient appendectomy. Then you would have to start worrying that another illness or injury may strike the family before the $5000 is replaced.
Testing labs and imaging centers expect the co-pays up front. All of them accept credit cards and a lot of people are having to use them.
That is exactly the point where your plan won't look so good anymore.
True, for the legit jobs & employers that do withholding.quadraphonics said:Not true. In order to work, you have to supply a Social Security number, which is then used to withhold taxes from your paycheck. Illegal immigrants simply supply a false Social Security number,
False, as a great deal of illegal alien income is off the books.and so pay the same taxes as everyone else (actually, they tend to pay even more, as they are typically too afraid of being found out to file for refunds).
This is highly debatable as the evidence is hard to collect. Illegals send children to public schools, use emergency rooms for medical care under the EMTALA law, criminal aliens make up a large share of the prison population, and so on.Also, illegal immigrants tend to consume much less public services than citizens/legal immigrants with the same income (again, fear of being caught and deported but also because they can't ever collect Social Security). All of which adds up to them being a much lower burden on tax-funded services than comparable legal workers.
Note that I say "comparable legal workers," as it is the case that pretty much everyone in the bottom income brackets consumes more in government services than they pay in taxes. In all cases, it's people in higher tax brackets who are ultimately paying for most of the services that everyone uses, and illegal workers are actually less of a burden than legal workers with comparable incomes.
Note that most all of the former socialist health care countries are rapidly increasing the use of private/market based medical care - Canada, France, Netherlands, etc.devil-fire said:in socialized health care systems the cost of care is always cheaper then in the USA due in part because the system isn't trying to suck a profit out of sick people and the administrative costs are much lower.
Yes, exactly right. Doesn't make economic sense to use 'insurance' to cover the chronically ill, as is.the current American health care system is inefficient at providing care for the unhealthy.
mheslep said:And BTW, $5000 will get you a great deal of medical care if you tell the provider that you are paying out of pocket and you care what they charge you. If you just hand them an insurance card then, yes, it gets you very little and that's no surprise.
mheslep said:True, for the legit jobs & employers that do withholding.
False, as a great deal of illegal alien income is off the books.
mheslep said:Illegals send children to public schools, use emergency rooms for medical care under the EMTALA law, criminal aliens make up a large share of the prison population, and so on.
edward said:Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.
I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.
Don't waste your time on the folksy T.R. Reid video. Read the interviews by the experts.devil-fire said:Frontline just did a show on the health care systems in other countries, http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Reinhardt: Well, if I were to do a balance sheet of the system, the good things are that we[the US] have an extremely well-trained labor force, particularly physicians; I don't think any nation trains doctors better. We have the latest technology, simply because we throw so much money [at it]. ... We are really technology-hungry in this country. That's a good thing.
More and more, our system treats patients like customers, which is actually a good thing; that it's very, in general, customer-friendly -- not always, particularly if you're poor, which is a different story, but that is, by and large, a good thing.
And it's very innovative, both in the products we use, in the techniques we use and the organizational structures we use. Those are all very good things, highly competitive.
Not long ago urban governments around the world considered housing 'a right' and used rent controls to provide it creating a housing disaster. Now that's all gone.Americans generally pay too much for too little of something many other countries consider to be a basic human right.
I'm skeptical of how 'small' the income tax evasion is. The statistics are hard to get, but we know at least that the IRS estimates tax evasion done by everybody in the US is 1http://www.npr.org/templates/story/story.php?storyId=15111003" of 'independent contractors' report no income. Thats a lot of guys standing on the corner working for cash.quadraphonics said:Only a small percentage is off the books (and mostly consists of people hiring day-labor to clean their houses or help with yardwork). Meanwhile, every restaurant, hotel and farm in the United States is withholding taxes from the paychecks of illegal aliens.
edward said:Actually the insurance companies as well as Medicare have a set amount that they will pay for any given treatment or procedure. As far as I know individuals don't have the option to bargain for a lower price at for profit medical facilities.
I had a Kidney CAT scan last week and I saw a woman with no insurance trying to bargain for a lower price. The office manager could only suggest that the woman use her credit card.
Kellerman's article is the best yet that I've seen in sizing up the current economic model for US health - Tony Soprano Care:...Several years ago, I suffered a sports injury that necessitated an MRI. The "fee" for a 20-minute procedure was over $3,000. My insurance company refused to pay, so I informed the radiologist that I'd be footing the bill myself. Immediately, the "fee" was cut by two thirds. And the doctor was tickled to get it...
So hopefully soon the US can break free of big Tony's 'protection' racket. And BTW, this is not a reason for a federal takeover, any more than ridding the garbage business of organized crime was a reason the nationalized garbage service....The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of "protection." But even the Mafia doesn't stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional "cost of doing business" increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service...
I would be interested in knowing how many lives MRI has saved?We are really technology-hungry in this country. That's a good thing.
I expect the wins aremgb_phys said:I would be interested in knowing how many lives MRI has saved?
As far as I can see the possible scenarios are:
1, We thought it was a minor injury and the MRI confirmed = no save
2, We thought it was serious and we are treating it = no save
3, We thought it was minor but it's really serious AND we can treat it = save
I believe there is little or no market system in play due the government's intervention in the system via the employer based health care tax exemption, and regulations that restrict nationwide portable insurance.
After reading Adrenaline's post and the physicians study I believe that what physicians really want is all of the billers, coders, filers and other expensive time wasters time to go away; its ancillary that many believe Universal Care is the way to make this happen.
Do you have an opinion on the proposed application of anti trust law to hospitals and doctors? By this I mean anti trust remedies to these current practicees. -mergers among hospitals that lead to very high concentrations of market power.
-The practice of doctors and hospitals colluding to boycott patients and their health plans to obtain anticompetitive concessions .
-The barrier to entry of new physicians by the Accreditation Council for Graduate Medical Education (ACGME). ACGME enjoys complete control over the number of residency programs and residents
Because the total number of residents funded by Medicare has been fixed by the Balanced Budget Act since 1997, a particular hospital or specialty that wants more residents of a given sort must either pilfer some of the slots of another specialty—a difficult trick—or find outside funding for them
Did not know there was a barrier when their official goal is to create positions by expanding existing class sizes and creating new medical schools.-The barrier to new medical schools created by the AAMC. As Adrenaline mentioned med. school costs I am particularly interested in opinions
I come from a poor family. If had had my first choice ( georgetown university) i would have owed half a million dollars in student loans with interest over the course of the loan payback. I was lucky enough that one of the ivey leauges gave me a $ 80,000 dollar grant. I still had to borrow but it was less than it could have been ( I still lived on $7,000 a year as a student in 1990s which was just astounding ...I learned to bike 15-20 miles quickly since i did not have a car )AMSA agrees that the proposed AAMC strategy of expanding the physician workforce through both the expansion of existing schools and the creation of new allopathic medical schoolsis the most effective way to quickly and economically address the significant shortage of physicians expected early in this century.
Quite right. I'm talking about agreement among competitors/peers to set prices and ... well, collude.adrenaline said:I boycotted a private insurance that did not pay me a dime for providing 500 of their members with medical care for three years.That is not collusion.
I didn't know Medicare was responsible for all US residency positions. How was that done before Medicare?This is mute. Due to the following...so many residency slots no longer get filled, Internal medicine residencies, general surgery and other surgical specialites are almost 50% unfilled. Only select high competative slots like dermatolgy aand radiology ( which there is no shortage of doctors for these fields ) have filled their slots.
http://www.insurancenewsnet.com/article.asp?n=1&innID=398236378
Also, almost all the residency training slots are funded by medicare, and medicare has not expanded it's budget for this . Without the funding, new residency positions cannot be created, ( unless you want private pharmaceuticals/biotech companies to sponsor them which brings up some ethical dilemmas).
Abstract
Non-primary care physicians earn considerably more than primary care physicians in the United States. I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating a shortage of non-primary care physicians. Entry barriers exist due to cartel behavior by residency review committees, regulation that until recently required residents in all specialties to receive the same wage, and/or scarcity of teaching material. I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents’ salary of $34,000. In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated $0.6 to $1.0 billion per year in labor costs.
mheslep said:Thanks for your thoughtful response
Quite right. I'm talking about agreement among competitors/peers to set prices and ... well, collude.
I didn't know Medicare was responsible for all US residency positions. How was that done before Medicare?
That last bit - mandating physician participation - seems especially politically inept. What did the public plan people expect the doctors to say in response to that?NYT said:WASHINGTON — As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan
...
While committed to the goal of affordable health insurance for all, the association had said in a general statement of principles that health services should be “provided through private markets, as they are currently.” It is now reacting, for the first time, to specific legislative proposals being drafted by Congress.
...
But in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”
...
If private insurers are pushed out of the market, the group said, “the corresponding surge in public plan participation would likely lead to an explosion of costs that would need to be absorbed by taxpayers.”
...
The medical association said it “cannot support any plan design that mandates physician participation.” For one thing, it said, “many physicians and providers may not have the capability to accept the influx of new patients that could result from such a mandate.”
“In addition,” the A.M.A. said, “federal programs traditionally have never required physician or other provider participation, but rather such participation has been on a voluntary basis.”
My first suggestion for the rural physician shortage is to break the lock the medical associations and industry have on medical schools and residencies. The cost of medical training is so high that I imagine new physicians can't help but pursue higher wages in metropolitan areas to cover the debts.Moonbear said:...
So, yes, lack of insurance is an obstacle to health care, but it's the second obstacle, not the first. The first is simply having a health care provider nearby. That problem needs to be addressed before offering insurance is going to help.
http://www.ftc.gov/be/workshops/heal...olsonpaper.pdfAbstract
Non-primary care physicians earn considerably more than primary care physicians in the United States. I examine a number of explanations for the persistent high rates of return to medical specialization and conclude that barriers to entry may be creating a shortage of non-primary care physicians. Entry barriers exist due to cartel behavior by residency review committees, regulation that until recently required residents in all specialties to receive the same wage, and/or scarcity of teaching material. I estimate that medical students would be willing to pay teaching hospitals to obtain residency positions in dermatology, general surgery, orthopedic surgery, and radiology rather than receiving the mean residents’ salary of $34,000. In the simulation, the quantity of residents in these four specialties would increase by an estimated six to 30 percent, rates of return would fall substantially, and teaching hospitals would save an estimated $0.6 to $1.0 billion per year in labor costs.
When will people learn that having insurance does NOT equate to having health care? Insurance companies like to take your money, but then are stingy when it comes time to pay up. Why are insurance companies dictating which procedure/medicines/doctors people can and can not have?What's worse—being diagnosed with cancer or discovering that your health insurance won't go the distance in covering your treatment? These days, with earlier detection and better therapies, cancer isn't the death sentence it once often was. But treating it is expensive, and employers and health plans are increasingly placing caps on the maximum benefits they will pay, as well as other restrictions on coverage that hit cancer patients particularly hard. If the tumor doesn't kill you, it seems, the medical bills just might.
The policy limits on coverage typically apply to all illnesses, not just cancer. But experts say that cancer patients are particularly likely to bump into annual caps on doctor visits or drugs, say, because the disease often requires intensive treatments—including surgery, chemotherapy, and radiation—in the months after diagnosis. Even if patients avoid the initial pitfall, they may eventually run afoul of lifetime benefit caps.
jal said:HEALTH CARE IS TOO EXPENSIVE
So what do you do?
Option #1
You save money
As an individual, you place some of your extra income into savings for that eventual day.
If your savings are not sufficient, then the banks will lend you money to pay for it.
If you cannot save and you cannot get a loan then you do without the medical service.
Option #2
You pay for an insurance.
It’s a pooling of surplus income/money from a large number of people who are putting their money in a “trust” for the day when they will need to cover medical expenses. If the individual has not put in enough money to cover his medical expense then the shortfall will come from the other contributors. Everyone will eventually get sick. Therefore, when you need medical help you will get financial help to pay for it.
If you cannot pay for an insurance and you cannot get a loan then you do without the medical service.
Option #3
You pay the government, (a tax), to administer the pool of money.
The government will pay for the specified medical expenses for everyone and collect money from those who are above a determined minimum level of income.
If you wish to take out more “coverage” then you save/pay a private insurer to administer that pool of money and to payout when you get sick for the specific medical treatment that you are paying for.
If it is too expensive for the individual then it will be too expensive for the government.
If you cannot pay for medical treatment then you do without.
---------
Can the cost of medical treatment be lowered?
NO! Not without a bloody battle with losers from the medical, (and legal), establishment.
The present systems have too many interlocking monopolies.
The systems need to remove intermediaries and break the monopolies that have set up “fee schedules”.
Since there are a growing number of people who must do without medical services because of the cost, those medical service providers have concluded that they must get the government to collect money for them so that they can continue operating without loosing any advantages.
Jal
Those figures are way off a4mula and easy to look up: US defense spending is ~$516B/yr (2009), Medicaid+Medicare ~ $630B/ yr (2009), though health spending is increasing at a much faster rate than defense. There are other government health programs like Veterans care, but they are minuscule in comparison. Thus govt health spending is roughly 5% of US GDP ($14 trillion). The total of _all_ health care related spending in the US economy, both private and public, is about 17% of GDP (1/6th).a4mula said:...As it stands the government drops over 17pct of our gdp on healthcare. That still represents less than 20pct of the total cost. For all the complaints we have about defense spending, the government spends 4 times as much on medicaid and medicare. ...