Most US doctors now support a national health plan

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  • #26
In talking with physicians about this story, it seems it's not really as clear-cut as the survey and headlines would like people to think. It's not about simply having a national health care plan, but the form it takes and who is running it. A patient with an insurance plan that refuses to pay for care the doctor deems necessary or that gives the patient no choice to change doctors if they are uncomfortable with their current provider is no better off than one with no insurance at all.
Well that's a bad system, in most countries you have the right to change doctors, for whatever reason you see fit, even practices, if you're not happy with a Dr then you can just go somewhere else. Problem solved, health insurance or not, you can go private, you can go to another HS provider.
 
  • #27
Moonbear
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Well that's a bad system, in most countries you have the right to change doctors, for whatever reason you see fit, even practices, if you're not happy with a Dr then you can just go somewhere else. Problem solved, health insurance or not, you can go private, you can go to another HS provider.
In the US, you can run the gamut from excellent health insurance with low co-pays (or no co-pays for preventative care) and the flexibility to go to any provider you like, to HMOs where you're locked into a provider network and can have long waits to see providers and might have costly co-pays, to medicare where you're stuck with whatever one physician is willing to take you on a plan that seems to go out of it's way to deny claims based on incomprehensible coding systems that turns into more charity on the part of the physician than an actual healthcare plan. Of those, medicare is the one that's currently government run, so not a lot of people with decent health insurance think switching to something like medicare is a good plan, including the physicians.

Basically, until someone proposing national health care spells out some details of how it will function, it's really hard to know whether it's going to be on the good end of the spectrum where patients will get the care they need and doctors will get paid for providing that care with minimal hassle, or if it'll be on the bad end of the spectrum where patients will get stuck with physicians they don't like or won't get the care they need while physicians fill out mounds of government paperwork just to be told the claims are denied because they forgot to check box 26b-a-2 on page 37 of the form.

You have to keep in mind that we're a nation of people who don't trust government, somewhat by design, so while there are good models of nationalized healthcare in the world, we tend not to trust our politicians very much to choose one of those or implement it correctly, especially when they have probably never experienced the hassles of bad insurance plans or not having the money to pay for something out of pocket if they wanted/needed it.
 
  • #28
Indeed I'm looking at it from the perspective of a NHS looking back. And of course the US is different. But I think on a state by state basis, ie try it out see if it works given each individual states needs, it might work? Slowly and progressively to see what works and what doesn't. Obviously centralised by the government is not going to work. I don't think anyone is going to trust that, your country is too large to have one single system work.

That said your system seems very confusing. If it was centralised on a state by state basis, I guess the only people who lose out are those companies that aren't nationalised, but of course no one is talking about making the system solely nationalised, that is not what works in practice. Combination of both, seems to be better than one or the other. Those who want to pay above and beyond get above and beyond, those who can't or wont pay are covered by taxes. Now that sounds horrible, but when you're paying twice what any other country in the world is by GDP or close to, you're already paying more in taxes than the cost of a private healthcare plan. You just don't feel it because it comes out of your stealth taxes.
 
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  • #29
Moonbear
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Indeed I'm looking at it from the perspective of a NHS looking back. And of course the US is different. But I think on a state by state basis, ie try it out see if it works given each individual states needs, it might work? Slowly and progressively to see what works and what doesn't. Obviously centralised by the government is not going to work. I don't think anyone is going to trust that, your country is too large to have one single system work.
Yes, it might have more of a chance at a state level than a national level to begin implementation. Thinking about that, predominantly rural states would probably be good starting points. Afterall, you can't really make the choice of providers any worse than what's already offered (not that providers are necessarily bad, but that they are few and far between, so people don't have much choice regardless), the populations are poorer so can't really afford out-of-pocket expenses if they don't have insurance, etc. It would probably not take so well starting out in states with large urban populations...while the urban poor would benefit, the suburban rich would fight it tooth and nail.
 
  • #30
ShawnD
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There's no blanket 'are covered' by the UHC. They can be, if your Ca. Medicare people send you to one.
There isn't 1 clinic in my entire country that is unwilling to accept payment from UHC, because they would go out of business immediately. If one clinic asks for your health card and charges you nothing, and the one next door only accepts cash/credit and charges $130 per visit (that's what visiting Americans are charged), guess which one goes out of business the fastest. Non-UHC clinics in Canada are comparable to finding a Walmart that will only accept cash; no credit or debit. They simply do not exist.

Yes, it might have more of a chance at a state level than a national level to begin implementation.
Not only that, but having it vary from state to state allows people to vote for the system they want. 50 states with 50 different systems, at least somebody will be happy somewhere. 1 country with only 1 system is just asking for trouble.
 
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  • #31
mgb_phys
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That does pose the problem of 'health tourism' unless you are going to insist on a minimum residency requirement in each state before you get benefits (which Canada does).
 
  • #32
mheslep
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That does pose the problem of 'health tourism' unless you are going to insist on a minimum residency requirement in each state before you get benefits (which Canada does).
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.
 
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  • #33
mheslep
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so while there are good models of nationalized healthcare in the world,
Where do you have in mind?
 
  • #34
mheslep
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There isn't 1 clinic in my entire country that is unwilling to accept payment from UHC, because they would go out of business immediately. If one clinic asks for your health card and charges you nothing, and the one next door only accepts cash/credit and charges $130 per visit (that's what visiting Americans are charged), guess which one goes out of business the fastest. Non-UHC clinics in Canada are comparable to finding a Walmart that will only accept cash; no credit or debit. They simply do not exist.
Thats not the issue. Of course private clinics will take payment from anyone or any source. The issue is whether or not CHC agrees to pay the clinic for you, or not.
 
  • #35
devil-fire
  • #36
ShawnD
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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.
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.


Thanks for the Frontline link.
 
  • #37
drankin
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 learnt from history.
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.
 
  • #38
quadraphonics
Good. Illegals don't have a SS (US) or SIN (Canada), which means they don't pay taxes.
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, 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). 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.
 
  • #39
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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.
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.
 
  • #40
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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.
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.
 
  • #41
drankin
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.
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.
 
  • #42
devil-fire
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.
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. the current American health care system is inefficient at providing care for the unhealthy.

a quote from the frontline report- "...but heres the thing. these capitalist countries don't trust health care entirely to the free market. they all impose limits. There are three big ones. First, insurance companies must accept everyone and can't make a profit on basic care. Second everyone is mandated to buy insurance and the government pays the premium for the poor. Third, doctors and hospitals have to accept one standard set of fixed prices. Can Americans accept ideas like that? Well the fact is that these foreign health care ideas arn't really so foreign to us. For American veterans we're just like Britain's NHS, for seniors on Medicare we're like Taiwan, for working Americans with insurance we're Germany and for the tens of millions without health insurance we're just another poor country"
 
  • #43
quadraphonics
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.
Well, they pay state taxes as well, both in paycheck withholdings, sales taxes, property taxes and so on. But it does bear mentioning that the issue is concentrated in certain states, those on the border obviously being the most impacted. And the federal government should probably compensate border states for this in some way. My point was simply that the tax burden of wealthy Arizonans would be even *worse* if they had a similar population of legal workers. No matter which way you slice it, a bottom-heavy workforce is a drain on government benefits, which in turn have to be funded by wealthier workers. The strains are a product of the demographics of the state, not the illegal status of whatever segment of the workforce (again, that they're illegal means they're *less* of a burden than a comparable legal worker).
 
  • #44
mheslep
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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.
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.

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 thats no surprise.
 
  • #45
mheslep
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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,
True, for the legit jobs & employers that do withholding.

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).
False, as a great deal of illegal alien income is off the books.
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.
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.
 
  • #46
mheslep
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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.
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.
the current American health care system is inefficient at providing care for the unhealthy.
Yes, exactly right. Doesn't make economic sense to use 'insurance' to cover the chronically ill, as is.
 
  • #47
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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 thats no surprise.
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.
 
  • #48
quadraphonics
True, for the legit jobs & employers that do withholding.

False, as a great deal of illegal alien income is off the books.
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. And there's no way for them to avoid sales and property taxes (you know, the ones that actually pay for those schools and roads?), regardless of where their income comes from.

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.
All those statements are equally true of American high-school drop-outs. Like I said, "comparable American workers."
 
  • #49
drankin
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.
Usually there is more than one hospital to chose from. But, if you are already in one then you are pretty much stuck with that unless you want to manage a transfer to another. Not something you are in the position to do in an emergency. We definately need some changes to where everyone can be insured, kind of like everyone needs car insurance. Someone told me Ron Paul had a well thought up plan something like this.
 
  • #50
mheslep
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Frontline just did a show on the health care systems in other countries, http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Don't waste your time on the folksy T.R. Reid video. Read the interviews by the experts.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/
A for instance, not found in the video:
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.
Better yet see M. Tanner's
The Grass Is Not Always Greener
A Look at National Health Care Systems Around the World

http://www.cato.org/pub_display.php?pub_id=9272

I believe you'll find in general that a) if you get sick and have access the US is the best bet in the world, b)the US system is too expensive and drops many through the cracks.

Americans generally pay too much for too little of something many other countries consider to be a basic human right.
Not long ago urban governments around the world considered housing 'a right' and used rent controls to provide it creating a housing disaster. Now thats all gone.
 
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