News The US has the best health care in the world?

[mheslep]

The free market has not been given much of chance to work in US health care. Some states have only one insurance company left, and they're protected from the competing firm in other states. Patients for the most part have no idea of the cost incurred; they pay their copay or deductible and walk. In some other related businesses with no insurance model, like Lasik eye surgery, or Veterinary medicine* the costs have remained flat or even dropped while the state of the art has advanced.

*per pet. $120 each pet in 2001, $127 in 2007
http://www.cms.hhs.gov/NationalHealthExpendData/downloads/tables.pdf
http://www.avma.org/reference/marketstats/ownership.asp

Edit: In case of the high technology medicine is driving costs up argument:
http://www.petsdx.com/"

 

[WheelsRCool]

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

Those against things like socialized medicine and universal health insurance (I know government-run healthcare and government health insurance are not necessarily the same thing), are not saying the healthcare system does not need reform. But to switch from the current system to a government model seems like trading one set of problems for another.

Right now, U.S. healthcare is not really free-market. It is about 50% government (Medicare and Medicaid) and the private insurance sector I believe is very highly regulated by the states, some so heavily that it is nearly impossible for them to function in the states they're in. It isn't really a free-market in the normal sense. Healthcare seems like a double-edged sword. With the private health insurance sector, you have corporate bureaucrats making decisions. With government, you have government bureaucrats.

For-profit health insurance companies will try to do everything as efficiently and cheaply as possible, which can mean denying care, while government-run health insurance companies waste money and are very inefficient.

For example, Medicare and Medicaid I believe are government-run health insurance companies, and they are monuments to waste, fraud, corruption, etc...

Since hospitals and so forth (I believe) have a ceiling on what price they can charge to people with Medicare or Medicaid, the healthcare businesses would pass those costs onto those with private insurance.

I would imagine that since Medicare and Medicaid's costs have ballooned way beyond what they were ever intended to, that this contributes to the rising costs of the private sector healthcare. Lawsuits I also think are a contributing factor.

Then there's regulations, for example, in my state of New York here, I remember during the Congressional elections, there was a radio commercial in which some candidate criticized his opponent for refusing to sign a bill that would prevent health insurance companies from raising the price on X service for customers.

If health insurance companies cannot charge higher prices for Medicare and Medicaid people, and cannot raise prices for certain services in the private sector either, what do people think will happen? The only option left is to flat-out deny said service (i.e. ration).

I think it is all these things combined (various price controls, lawsuits, Medicare and Medicaid costs), throughout the states (I believe health insurance companies are regulated by the states), that contribute to rising healthcare costs.

In theory, that would mean one way to begin to control healthcare costs in the private sector is to get Medicare and Medicaid under control.

But that also leads to the other parts I don't get: Medicare and Medicaid are both government-run. And both have ballooned way out of control cost-wise. So wouldn't the logical thing be to figure out how to get them both under control first, before creating a whole new government health program?

We also have the example of the Massachusettes universal care experiment, which was supposed to not balloon out of control cost-wise, yet that is what has happened. And the fears that creation of a public option would be a Trojan horse to destroy the private insurance industry to eventually push the country onto a single-payer system.

 

[Al68]

...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

It's less evil because no one is using force against their fellow man to coerce them. Or are you just pretending to not understand what is meant by the term "socialist" when used by those opposed to this proposal?

And the tax penalty isn't for not wanting to buy medical insurance, it's for not participating in the government system. But I assume you knew that already.

And as far as the "grandfather" clause, while it would temporarily allow some existing private policies, it will immediately eliminate the ability of consumers to shop around for a private policy that isn't in the "exchange".

 

[Al68]

Right now, U.S. healthcare is not really free-market. It is about 50% government (Medicare and Medicaid) and the private insurance sector I believe is very highly regulated by the states, some so heavily that it is nearly impossible for them to function in the states they're in. It isn't really a free-market in the normal sense.

This is a good point. We have seen decades of government regulation repeatedly being used to correct problems caused by previous regulation. Then each time regulation causes more problems, they are blamed on capitalism, and the solution is more regulation. And now after decades of ever increasing regulation causing increasing problems, we're told that the solution is, guess what: government regulation.

 

[wildman]

http://www.care2.com/causes/health-...practice-of-canceling-insurance-for-the-sick/

Probably my biggest reason for some sort of health care reform from the goverenment is the continued practrice of "rescinding" health care policies that is happening at a more alarming rate with my privately insured patients. I am right now struggeling with a 42 year old I diagnosed with burkitts lymphoma. I have been his doc for 11 years and his insurance carrier told him his diagnosis was a preexisting condition based on some fatigue complaints he expressed to a nurse practioner 4 years ago. ( at the time he was working second shift and was diagnosed with shift work disorder and improved when he was able to get first shift duty). His physicals year after year did not relieve any lymphadenoapthy until his last one. They dropped him. He can't obtain private insurance, I have had him put all his assets in his exwifes name and soon he will qualify for medicaid which will pick up all his treatment 100% this was a man who worked full time since he was 17 for this paint production factory.

Though not an example of rescinding I had a 41 year old diagnosed with cutaneous t cell lymphoma, two years into her treatment ( full body radiations, sepsis from repeated pseudomonas infections etc.) she reached her one million dollar lifetime maximum and was essentially going to have to pay 100% of any future medical costs and treatments. her employer did not offer her any other type of plan. I put her on disabilty and now medicare and medicaid secondary has stepped up to the plate and has been paying for her treatments for the last 9 years. ( she is now 50).

If you think the government rations care, think again...when a government plan forgoes say an expensive 35,000 dollar defibrillator in a 95 year old it is socialism, if a private insurance plan "rescinds" it is less evil since free market forces have dictated their actions.

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with, but if you don't think we are paying already then I got a bridge to sell you (cheap!).

 

[mheslep]

...Let's not forget, the best avante garde basic medical research is done by NIH, government funded, ( socialized) without profit motive. ...

drug companies are resorting to "me too" drugs or slight modifications of existing drugs ( ie: nexium from prilosec, lexapro from celexa) for the quick profit turn around.

No doubt NIH research has produced countless nobel prizes. It's a national resource for basic research, especially from what little I know about the reported cancer, heart disease, and of course genome research there. But it's hardly the beginning and end of day to day medical advances in this country as I read the history. In that line, a couple years ago Health Affairs published a survey of internists on the top 10 most useful high tech medical innovations world wide, and I can't find NIH footprints on any of them.

* MRI/CT
* ACE inhibitors
* Balloon angiography
* Statins
* Mammography
* Coronary Artery Bypass Graft surgery
* H2-receptor antagonists
* Selective serotonin reuptake inhibitors (SSRIs)
* Cataract extraction and lens implants
* Hip and knee replacements
http://healthaff.highwire.org/cgi/reprint/20/5/30

NIH certainly had no fundamental role in the development of the MRI. Some of the rest:

• Statins come from the work of Japanese biochemist Akira Endo while working at Sankyo, with later work by Merck to isolate a statin from Endo's fungus.
• Captopril, the first available ACE Inhibitor, was developed by Bristol Meyers Squib scientists, based on the fundamental work of English scientists K. K. F. Ng & J. R. Vane.
• Angiography was invented by radiologist Charles Dotter out of the University of Oregon and the first devices made by entrepreneur Bill Cook.
• The first CABG was done at the Albert Einstein college of medicine by US Drs. Goetz, Rohman, Haller, Dee. The first five SSRIs (antidepressants) came out of five different drug companies: Lundbeck, Solvay, Eli Lilly, SmithKline-Beecham, and Pfizer.
• Modern cataract surgery was enabled by the invention of phacoemulsification by US Opthamologist Charles Kelman.
• The MRI was developed by P. Lauterbur of the University of Illinois at Urbana-Champaign and P. Mansfield of the University of Nottingham, Nobel prize winners for their work.

Sorry if this is pedantic, but the above comment is not the first on the 'who needs industry, government/academia does it all anyway' line. There's some notable academic pushing that concept recently, against what seems to me a mountain of evidence to the contrary.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=101126
http://www.preskorn.com/books/ssri_s2.html
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/article/articleDetail.jsp?id=98075

 

[Al68]

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with...

That seems like asking someone with a tumor what he would replace it with. The answer is just to get rid of it, not replace it. That's what I'd say about socialist policies in the U.S. They don't need to be replaced, just eliminated. And certainly not expanded even more.

 

[WhoWee]

The way the bill is written, it completely bans private policies in one section - but in the next, it allows them again, through a new mechanism. It merely changes the way they are sold, instead of banning them. But the law has to be written all legal-like. This is typical legal crap.

If you go read the bill, you see the language in Title I referred to in this article, and you see that it contains an exception. That exception is Title II, which allows PRIVATE insurers to offer PRIVATE plans through a new mechanism called a Health Insurance Exchange. I don't know the details yet, but it looks like it's basically one-stop shopping for health insurance, to make it easier for people to compare plans. They could choose a private plan, the government's plan, or Medicare, etc. if they qualify. I think it also makes it possible to choose a plan from any state, nationalizing the health insurance market and making more competition possible. It has some kind of tax benefits too. I found this article praising the idea, from a CONSERVATIVE think tank:

http://www.heritage.org/research/healthcare/wm1230.cfm





Personally, as a small business owner who spends an exorbitant amount of my overhead on health insurance premiums this "stock exchange" set up for when I shop around for health insurance can be very appealing.

As a doctor, it sucks, because that means many more players to deal with and it does not streamline my adminstrative work and overhead.

I'd like to elaborate on the heritage.org piece:
"As a vehicle for a defined-contribution approach to health care financing, an exchange would expand coverage and choice. Rather than have to decide whether to pay for full coverage or not, employers could make defined contributions of any size to the exchange. Moreover, employers could also enable employees, including those working part-time and on contract, to buy health insurance with pre-tax dollars. Under a Section 125 plan, any premium payments made by workers, even part-time workers or contract employees, would be 100 percent tax-free. This is especially important for workers in firms that require them to pay part of the health insurance premium. Employees, not employers, would buy the health care coverage with pre-tax dollars, would own their own health plans, and would take them from job to job without the loss of the generous tax benefits of conventional employer-based coverage. This is a revolutionary change in the health insurance market."

An example of a "Cafeteria" section 125 qualified plan is an Aflac accident policy. Another example is a "flex-spending account". Basically, pre-tax dollars are used to pay premiums.

To qualify, a business needs to register and implement a qualified plan. Assume the business is a light manufacturing company with 100 workers - and the workers earn from $10 to $30 per hour. The Aflac policies will typically cost less than $50 per month and will be paid by the employees that decide to participate.

The direct benefits to the employer are as follows.
1.) The $50 cost is deducted from the employees gross wages - if $15/hour @ 40 hours = $600 per week - $50 Aflac = $550 gross. The employer now pays matching taxes on the lower amount.
2.) With an accident policy in place, a worker is less likely to use a workers compensation plan if injured during non-working hours - this means lower workers comp costs in the long term.
3.) A lower gross also means lower FICA contributions for the employee.

For anyone interested in learning more, this is worth a look
http://www.mathematica-mpr.com/publications/PDFs/section125brief.pdf

 

[adrenaline]

Healthcare seems like a double-edged sword. With the private health insurance sector, you have corporate bureaucrats making decisions. With government, you have government bureaucrats.

we both agree. At the same time, no other nation would tolerate a system that consumes one-third of insurance premiums on insurance functions.

For example, Medicare and Medicaid I believe are government-run health insurance companies, and they are monuments to waste, fraud, corruption, etc...

The private sector did no better and had more waste ( and most likely fraud as well) in the failed experiment called medicare advantage plans. ( They deny paying the first three days of hosptialization, deny rehab care over three days and still cost more!)

Lawsuits I also think are a contributing factor.

in the form of defensive medicine we both agree. that is one glaring defect of the obama plan, no real call for tort reform.

In theory, that would mean one way to begin to control healthcare costs in the private sector is to get Medicare and Medicaid under control.

All other industrialized nations have universal programs whether through government ownership, single payer insurance programs etc. and have been more successful at slowing the rate of health care inflation, spending much less than we do, while providing care for everyone. We need to engage in an active dialogue and learn from them rather than the general consensus of ignoring them. I believe the government would not make allowances for the 80 percent of research that is designed simply to restart the patent clock.

As for fixing medicare, let's start with overuse of high-tech, specialized services that provide no health care benefit which have characterized much of our system. For example, drug eluting stents cost two to 5 times more than bare metal stents, though they have lower early restenosis rates, they have much higher late restenosis rates ( one year out) so these patients have to take plavix, 300 dolllar a month drug, much longer due to fear of this. A single payer system would have much better information resources to help realign incentives to promote more optimal use of the technologically-advanced products and services. I believe obama's plan calls for such an ovesite board to evaluate effectiveness of different therapeutic options.

Private plans have not been innovators in cost management but have merely followed the government’s lead through measures such as private, managed care price fixining. When I was chief of medicine, many of our quality initiatives in the hospital ( prevention of readmission rates etc.) and efficiency was driven soley by medicare mandates, not private health plans. For instance, medicare does not pay the hospital if the patient is readmitted within 24-48 hours after discharge for the same diagnosis. Otherwise, what was to prevent us doctors from booting out a patient too early and getting paid to readmit them ( admission payments are high) the next day? Thus, there was great incentive to provide for post hospital followup ( home health), predischarge planning ( education about disease) , and keeping them in the hosptial long enough to ensure that the chief medical problem has been resolved adequetly? ( we still need work on that by the way)

We also have the example of the Massachusettes universal care experiment, which was supposed to not balloon out of control cost-wise, yet that is what has happened. And the fears that creation of a public option would be a Trojan horse to destroy the private insurance industry to eventually push the country onto a single-payer system.

let's not forget our media conveniently ignore's taiwan's single payor success story. Right now, the current environment rewards practioners in highly lucriative fields, interventional radiology etc, and has created a shortage of primary care practioners. ( afterall, a family practioner owes as much as a future radiologist when they come out of medical school.) ( Another reason why the massachessets plan failed but that is another long discussion. ) A strong primary care infrastructure provides higher quality care at lower costs. Our primary care system is rapidly deteriorating. A single payer could realign incentives to strengthen our primary care base. Our costs would be lower, and everyone would have access to the quality provided by a medical home of their choice. Right now, primary care docs, paid at the bottom of private and medicare reimbursements must hire the most administrative personell to deal with all the insurance rules and regulations.

 

[adrenaline]

It's less evil because no one is using force against their fellow man to coerce them. .

They are coerced, if you cite lack of choice.

Most of my patients have no options regarding the plan their employer provides.

The woman with t cell lymphoma did not have an option from her employer for a higher lifetime limit plan.( past the million dollars.) Instead, the private plans dumps her after they have spent too much money on her and our tax dollars now have to take care of her ( despite 15 years having wages suppressed and garnished paying the premiums). The man with burkits lymphoma did not have a choice in a company plan that practices rescinding more than others.

I myself can only offer my employees humana ppo or hmo, nothing else. WHen two of my nurses developed breast cancer I could not afford to change insurance carriers.

 

[WhoWee]

adrenaline,
It might help if you explain how the Government indirectly sets the payment standards for insurance companies through Medicare fee schedules.
http://www.cms.hhs.gov/FeeScheduleGenInfo/

 

[adrenaline]

No doubt NIH research has produced countless nobel prizes. It's a national resource for basic research, especially from what little I know about the reported cancer, heart disease, and of course genome research there. But it's hardly the beginning and end of day to day medical advances in this country as I read the history. In that line, a couple years ago Health Affairs published a survey of internists on the top 10 most useful high tech medical innovations world wide, and I can't find NIH footprints on any of them.

* MRI/CT
* ACE inhibitors
* Balloon angiography
* Statins
* Mammography
* Coronary Artery Bypass Graft surgery
* H2-receptor antagonists
* Selective serotonin reuptake inhibitors (SSRIs)
* Cataract extraction and lens implants
* Hip and knee replacements
http://healthaff.highwire.org/cgi/reprint/20/5/30

NIH certainly had no fundamental role in the development of the MRI. Some of the rest:

• Statins come from the work of Japanese biochemist Akira Endo while working at Sankyo, with later work by Merck to isolate a statin from Endo's fungus.
• Captopril, the first available ACE Inhibitor, was developed by Bristol Meyers Squib scientists, based on the fundamental work of English scientists K. K. F. Ng & J. R. Vane.
• Angiography was invented by radiologist Charles Dotter out of the University of Oregon and the first devices made by entrepreneur Bill Cook.
• The first CABG was done at the Albert Einstein college of medicine by US Drs. Goetz, Rohman, Haller, Dee. The first five SSRIs (antidepressants) came out of five different drug companies: Lundbeck, Solvay, Eli Lilly, SmithKline-Beecham, and Pfizer.
• Modern cataract surgery was enabled by the invention of phacoemulsification by US Opthamologist Charles Kelman.
• The MRI was developed by P. Lauterbur of the University of Illinois at Urbana-Champaign and P. Mansfield of the University of Nottingham, Nobel prize winners for their work.

Sorry if this is pedantic, but the above comment is not the first on the 'who needs industry, government/academia does it all anyway' line. There's some notable academic pushing that concept recently, against what seems to me a mountain of evidence to the contrary.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=101126
http://www.preskorn.com/books/ssri_s2.html
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/article/articleDetail.jsp?id=98075

all true in the past, but the current environment of quick profit turnovers now force the "innovative "drug companies to spend 80 percent of their research dollars "extending" patents on on say left handed isomers on old racemic drugs, new "drug delivery" encapsulation for the same drug etc...

My point was that there is healthy biomedical research going on in these other counteries. Not denying our own accomplishments. Of course, it would be unfair to use embryonic stem cell research advances in these countries since the religious whackos tied our county's hands for many years under Bush.

 

[Al68]

They are coerced, if you cite lack of choice.

Most of my patients have no options regarding the plan their employer provides.

The woman with t cell lymphoma did not have an option from her employer for a higher lifetime limit plan.( past the million dollars.) Instead, the private plans dumps her after they have spent too much money on her and our tax dollars now have to take care of her ( despite 15 years having wages suppressed and garnished paying the premiums). The man with burkits lymphoma did not have a choice in a company plan that practices rescinding more than others.

I myself can only offer my employees humana ppo or hmo, nothing else. WHen two of my nurses developed breast cancer I could not afford to change insurance carriers.

No, they are not being coerced by force. They have the insurance they chose. Just claiming someone has no choice doesn't make it true. Claiming someone has no choice because their employer only offers one plan is absurd. That's like claiming I have no choice about what kind of food to eat because a hot dog cart only offers hot dogs.

That kind of logic only works for people incapable of thinking for themselves.

Gee, most people have no options regarding what kind of food the local hot dog cart offers. So they're "coerced" into eating a hot dog. Silly, huh?

 

[adrenaline]

No, they are not being coerced by force. They have the insurance they chose. Just claiming someone has no choice doesn't make it true. Claiming someone has no choice because their employer only offers one plan is absurd. That's like claiming I have no choice about what kind of food to eat because the hot dog cart only offers hot dogs.

That kind of logic only works for people incapable of thinking for themselves.

Gee, most people have no options regarding what kind of food the local hot dog cart offers. So they're "coerced" into eating a hot dog. Silly, huh?

So your suggest they change jobs, for the sake of health insurance benefits? That is equally absured especially in this economic climate.

My 62 year old ATT worker who found out his family lifetime limit decreased from 5 million to one million can't just up and change jobs ( His wife has had a prior history of lymphoma and there is a chance it will come back). Who hires a 62 year old? Second, The man with burkits had no idea the plan he had since he was 17 practiced such abusive practices,( afterall, they did not give him grief over his yearly physicals and occassional shoulder bursal injections.) do you know if your does? ( I'll give you a hint, his is a top three insurance carrier) The woman with t cell lymphoma had no idea she was going to use up her lifetime limit when she was diagnosed with the cancer. When she did, she tried to get the health insurance carrier to extend the lifetime limit, even if it meant paying an extra thousand dollars a month, ( she was willing)

Your statements make no sense with both examples I used.

And let's not forget that both examples I used, the government did not ration care, it saved them. The private insurance carriers did the most ultimate and cruel form of rationing, cut them off when they were needed the most.

 

[mheslep]

all true in the past, but the current environment of quick profit turnovers now force the "innovative "drug companies to spend 80 percent of their research dollars "extending" patents on on say left handed isomers on old racemic drugs, new "drug delivery" encapsulation for the same drug etc...

My point was that there is healthy biomedical research going on in these other counteries. Not denying our own accomplishments...

I'm unable to speak to the more recent innovations, except to say that if the US has had all these accomplishments in the past (majority of the 10 were US based), then what's changed now? I don't buy that its all or even mostly on industry - that today's industry is all about quick profits but somehow that twenty, thirty years ago they were not. I'd be more inclined to open up the hood on the today's FDA imposed costs of developing truly new medicines/procedures measured against the government imposed costs of that era, or perhaps the coupling behind today's big pharma and today's FDA that prevents new smaller players from entering.

 

[adrenaline]

adrenaline,
It might help if you explain how the Government indirectly sets the payment standards for insurance companies through Medicare fee schedules.
http://www.cms.hhs.gov/FeeScheduleGenInfo/

all i know is private insurances follow medicare fee schedules. some pay less ( I fire those plans when I review their contract and see they are paying us less than medicare set fees)

 

[adrenaline]

I'm unable to speak to the more recent innovations, except to say that if the US has had all these accomplishments in the past (majority of the 10 were US based), then what's changed now? I don't buy that its all or even mostly on industry - that today's industry is all about quick profits but somehow that twenty, thirty years ago they were not. I'd be more inclined to open up the hood on the today's FDA's imposed costs of developing truly new medicines/procedures measured against the government imposed costs of that era, or perhaps the coupling behind today's big pharma and today's FDA that prevents new smaller players from entering.

I blame the growing wave of any advanced scientific research, not just biomedical, being done in most other countries to the hemmohraging pool of foreign basic scientists and engineers returning to their country of origin. That in itself is multfactorial ( china and India's living standards are better so more advanced degreed chinese and indian scientists and engineers voluntarily return to their countries rather than stay with a company here.) When I look at journals and look at many of the medical directors of the academic medical facilities,they are now mostly foreigners ( at least by name). I am assuming since they are the ones pursuing the advanced research degrees. I'm sure that is another whole discussion.

My short lived career as a chemist, I remember being one of few Americans in my classes as well as the workplace.

 

[Al68]

So your suggest they change jobs, for the sake of health insurance benefits?

No, I'm suggesting that they can choose their own medical insurance like I do.

A hot dog cart choosing to only offer hot dogs isn't "coercion" simply because I "needed" to buy one today for practical reasons. Having limited practical choices is not the definition of coercion.

Your statements make no sense with both examples I used.

That's because you gave no examples of coercion.

I will say I very much dislike employer based health insurance, partly for the reasons you state, and that is a problem caused by government intervention (preferential tax treatment). People (like me) who shop around for private insurance tend to know a lot more about the policy they buy.

 

[adrenaline]

This is what I mean when I say we already have socialism. The problem is that it is an uncontrolled crazy form of socialism. It is far more expensive (if you figure in emergency room costs that are spread over all the insured, medicare and medicaid) than the more rational forms of socialism in other countries. It is literally driving us bankrupt. I am not sure what we should replace it with, but if you don't think we are paying already then I got a bridge to sell you (cheap!).

True, part of the reasons hospitals charge medicare and insured patients more is to try to recover the cost of treating the uninsured. Our private insurance premiums have been shown to be higher because of the uninsured. And this is also something to keep in mind, the uninsured are more likely to sue a hospital or doctor in an attempt to recover and recopu costs, that drives up everyone's cost...

And let's also remember 60% of all medical bankruptcies are due to medical costs, anywhere from a half to 3/4 were insured before bankruptcy ( many of them lost insurance after losing their jobs due to illness, went past their 18 month cobra, or reached their lifetime limit). Having health insurance does not protect you from medical bankruptcy!http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/index.html?eref=rss_health

 

[adrenaline]

No, I'm suggesting that they can choose their own medical insurance like I do.

A hot dog cart choosing to only offer hot dogs isn't "coercion" simply because I "needed" to buy one today for practical reasons. Having limited practical choices is not the definition of coercion.

The 62 year old whose wife had a prior history of lymphoma would have had to pay close to 3,000 a month to insure his family ( he also had multiple basal cell cancers.) on a private plan. He had no choice.Now, I have 3,000 a month extra to boot the bill but I bet 99 % of the posters here cannot suddenly afford 3,000 dollars a month to insure their family because they don't like their insurance. Before his wife was diagnosed, it made no sense to insure his family on his own since only 32 dollars a months was being garnished from his wages to insure him, his wife and three kids. do you know how expensive it is to insure all those together?

The man with burkits lymphoma had no choice because he had no idea his plan was going to rescind him, at that point he was no longer "insurable" due to his preexisting.

Do you know what your lifetime limit is on your insurance plan? Remember, if you get a leukemia and need a bone marrow transplant you will eat up a million within the first 12 months.

Perhaps I shouldn't have called it coercion, more like "no options" when a perfect storm of events outside their control came together so that they had no other opition... the only option was a public one for two of them, privided by medicare/ medicaid but only if one quit her job to qualify for disability despite wanting to work and another had to give up all his assets to a exwife.

got to go, the hosptal just called me in for tonight.

 

[WhoWee]

I think we should all thank adrenaline for sharing so much with us. These are the type of details our elected representatives should be considering.

For every legislative action - there (might be?) equal (or compounded?) consequences?

The point is we shouldn't jump to conclusions - health care reform is very complicated.

 

[Al68]

Perhaps I shouldn't have called it coercion, more like "no options"...

Then I might have agreed, at least "no practical options". And again, government intervention (preferential tax treatment for employer based insurance) is the biggest cause of the problems you mention. People who choose their own insurance policy will naturally know a lot more about it.

And yes, I know the lifetime maximum for my policy because I chose the policy. I know the deductibles, what it does and doesn't cover, and lots of other things that everyone should know instead of blaming some imaginary "system" for their lack of knowledge.

The range of choices in private policies might surprise most people, and are limited only by government intervention.

 

[wildman]

That seems like asking someone with a tumor what he would replace it with. The answer is just to get rid of it, not replace it. That's what I'd say about socialist policies in the U.S. They don't need to be replaced, just eliminated. And certainly not expanded even more.

What do you propose? Do you wish to just let the people without insurance just die or do you have another workable idea? Actually, politically, just letting people die probably isn't politically possible since if you did that, most people in the country would be on the death list and you know this is a democracy...

 

[Al68]

What do you propose? Do you wish to just let the people without insurance just die or do you have another workable idea? Actually, politically, just letting people die probably isn't politically possible since if you did that, most people in the country would be on the death list and you know this is a democracy...

Do you seriously believe "most people" would be completely helpless without a nanny government? That most people "need" socialist policy?

This reminds me of a famous quote by Ben Franklin: "Necessity is the cry of tyrants and the creed of slaves."

And the U.S. is not a "democracy" in the absolute sense you imply (tyranny of the majority). It's only a democracy within the broader definition that includes any republican form of government.

As far as "wishing to just let the people without insurance to just die", that's not exactly conducive to honest debate, it's just blatant socialist hate mongering. And overuse of the word "just".

 

[wildman]

Do you seriously believe "most people" would be completely helpless without a nanny government? That most people "need" socialist policy?

This reminds me of a famous quote by Ben Franklin: "Necessity is the cry of tyrants and the creed of slaves."

And the U.S. is not a "democracy" in the absolute sense you imply (tyranny of the majority). It's only a democracy within the broader definition that includes any republican form of government.

As far as "wishing to just let the people without insurance to just die", that's not exactly conducive to honest debate, it's just blatant socialist hate mongering.

I have lived in a Third World country and yes without the nanny government people just die and infectious disease runs wild. It is not fear mongering. It is my experience. Health care is very expensive and someone has to pay for it. A lot of people don't have money to pay for it and yes they are helpless. Charity can only go so far. What do you propose to do? You didn't answer my question.

As far as democracy goes... What I am saying is if you disenfranchise enough people you run into political problems. You can't just wave your hands and just make that go away. I'm not pushing socialized medicine or anything else, I just want to know what you propose to do.

Basically, the present system is running out of control as far as cost goes. It is socialized medicine without cost control. But if we take the people who are now on government care off of it, you run into political problems. It is a catch-22 without many solutions. So what do you propose to do?

 

[WheelsRCool]

Of course, it would be unfair to use embryonic stem cell research advances in these countries since the religious whackos tied our county's hands for many years under Bush.

Well being cautious of embryonic stem cell research isn't because of religion (per se, there are religious whackos in it), it is because many view it as tied in with the old eugenics movement. Also there are no restrictions on performing embryonic stem cell research in the United States, the use of Federal money for it is what was restricted.

 

[adrenaline]

Well being cautious of embryonic stem cell research isn't because of religion (per se, there are religious whackos in it), it is because many view it as tied in with the old eugenics movement. Also there are no restrictions on performing embryonic stem cell research in the United States, the use of Federal money for it is what was restricted.

true, but once again, I trust research from the NIH (goevernment )more than I trust research from private corporations.

In my field , of course, I have to discern pharmaceutical company sponsered drug trials ( which are prevalent) and bear in mind that there has been a history where negative or neutrals results do not seem to get published , ( example paxil in teenagers http://healthfully.org/index/id9.html). I am more inclined to believe the NIH sponsored trial that showed benefit of zocor statin in preventing heart disease in normal lipid diabetics than one sponsored by zocor . As a whole, physicians trust NIH sponsored data more.

The same can be argued about any benefits of embryonic stem cell research and its application to medicine.

Embryonic stem cell research and its immediate application is still in such an infantile stage, it's probably not a beneficial line of resource allocation in R and D for most private companies, at such a basic scientific reasearch level, I think government funding provides the "fuel" that allows it to grow exponentially in its knowledge base and therefore future application.I believe, Israel, a powerhouse in this line of research is almost 100% funded by the government, especially the science and technology ministry and the Ministry of industry, trade and labor.

 

[noblegas]

IMO if the american middle class family is able to pay for two cars that probably costs together, $8000-16000 , depending on what section of the middle class income strata you fall under, why can't you pay a measily $4000-5000 dollars in comparison for healthcare insurance? Shouldn't sacrifices be made on your end rather than the insurance companies to make healthcare insurance affordable for you? Does a family really need to buy two cars, nay three if you have children who want cars, not to mentioned a host of other expenses not essential for living like a two story house, college education, $2000 white picket fence ; Americans should really look at the expenses on their list of things that they bought over the years before they can say they cannot afford health insurance;

 

[WhoWee]

I think we can all agree on these few items. The one thing Government is very good at doing is spending money. Politicians love large projects. They are very bad in the areas of management (the US Post Office is PLANNING to lose $7,000,000,000 per year) and downright anal about details (think about $600 toilet seats, the DMV, building permits - all of those people need to justify all of those jobs). (Has anyone been through a SOX audit?) Hence, everything they oversee has waste and in-efficiency built-in.

As a manager, coach, and father, I've learned to look at the task at hand, look at the individual capabilities of my team and our resources, then devise a strategy that matches CAPABILITY to TASK and identifies weak areas to resolve.

The Government already spends enormous sums of money on health care. The programs are already in big trouble - it's a political "hot potato". The Government plans need to be reformed first.

This should save money and improve care. However, this will take too long and there is NO SIZZLE for the politicians to sell at home. It's hard to hang your name on this type of reform.

If the problems in the existing Government programs are not addressed, they will most likely get worse. By doing another "Patchwork" repair, they will only disguise the current problems and possibly create additional ones.

Politicians want to spend money, the Government is good at spending money, and the health care industry runs on money. Government and health care should be a good match.

(This is the 3rd time I've posted these ideas - sorry if it's the 3rd time you've read it.)

1.) Government investment into facilities, equipment and research would be terrific.
2.) Government investment into high risk insurance pools (to allow access to private insurance to people with pre-existing conditions) would be terrific.
3.) Government built wellness clinics (part of #1), staffed (part time) by experienced doctors (paid with tax (REDUCTION) credits) would provide basic care to everyone and reduce the strain on emergency rooms. The doctors would use the Reduction credits to keep more of their earnings. A reduction is a dollar for dollar tax credit - not a deduction from income.

Now a few new things

4.) Standardization of health insurance. Much of the waste in the insurance industry is dealing with the 52+ Masters - Federal and state governments plus D.C., etc.

Each insurance company, each insurance policy, and each insurance agent must be approved and licensed with each individual state. The costs to consumers is enormous - but hidden.

5.) As others have pointed out, insurance is designed for protection against catastrophic loss.

If you have homeowners insurance, you don't file a claim to have it power washed, painted, re-shingled, or to cut the grass. Instead, you save for those situations and pay out of pocket. If a tree falls on your roof, you call the insurance company.

High deductible ($10,000 to $25,000 deductible) policies and HMO's have grown in popularity the past few years. The owner of the policy saves money in their own personal bank account to use for routine doctor visits and tests (up to the deductible) and only uses the insurance for large events - like hospital stays and surgery. The premiums on these high deductible plans are MUCH lower and often provide greater lifetime maximums and 100% coverage once the deductible is met.

The large employer paid or "Cadillac" plans allow for unlimited doctor visits, tests, medicine, teeth cleanings, eye exams, glasses, etc., etc., etc. Some of these plans were negotiated by unions, some corporations used their massive buying power to negotiate, others are used by business to attract and retain top talent (like the one Evo described).

Most individuals do not have access to and cannot afford these "Cadillac" plans. Small employers often purchase their own private personal insurance, then form a Section 125 Cafeteria plan, with supplemental and accident plans paid by the employees, but nothing else. Mandated coverage of minimum wage and part time workers will certainly guarantee loss of jobs and closing of many struggling businesses. These workers (the working poor) don't have many choices. They make too much to be included in welfare programs and too little for private insurance.

I like the idea of reforming Government waste. Re-allocating the "stimulus" money to fund new hospitals, clinics, and research. Re-allocation of "TARP" funds into a high risk insurance pool to allow access for pre-existing conditions, providing tax incentives to doctors for volunteer work (they are one of the few professions that can actually utilize tax credits) and keeping Government out of the management of health care.

The Government has a role (investment) - it's not the day to day management of health care. Let doctors and the medical professionals run health care. Let insurance companies offer standardized plans and insure against catastrophic events.

We need to step back, use common sense, and remove politics from the debate.

 

[mheslep]

...Do you know what your lifetime limit is on your insurance plan? Remember, if you get a leukemia and need a bone marrow transplant you will eat up a million within the first 12 months.

Aside: I have a good friend with exactly those conditions just now - leukemia + transplant required; he's located donors and yes one million is indeed the cost he tells me. My question: does it really need to cost that much? There seems to be an assumption in health care discussions that the cost of these procedures has a fixed value, now and forever, like a 1000 ounces of gold. The computing and telecommunications power in my cellphone used to require a million dollar device not that many years ago. The economics of the free market were required to make that capability affordable to me, not simply basic research.