Moonbear said:People WITH insurance don't seek preventative treatment either. This is more a social/lifestyle issue than an affordability issue.
I don't know of any state that doesn't have a program to provide childhood vaccines for free, especially those required to enter school.
Uninsurance poses a threat to the control of communicable disease by delaying the detection, treatment, and reporting of infectious disease outbreaks, which may include emerging infectious agents such as SARS and perhaps someday those linked to bioterrorism. Hospital emergency departments and health departments play critical roles both in infectious disease surveillance and in caring for low-income populations, who are more likely to be uninsured. When high rates of uninsurance make emergency department crowding worse, the capacity of the emergency care system to handle a sudden influx of patients from a natural disaster or terrorist strike is compromised. To meet the burden of caring for the uninsured, health departments may be forced to shift scarce resources from traditional population-based public health activities, such as monitoring water quality and restaurant inspections to the delivery of personal health services to uninsured persons. This can weaken the ability of local health departments to contain outbreaks of infectious disease and other public health threats.
Despite high vaccination coverage
and low incidence rates of most vaccinepreventable
diseases,3,4 anecdotal reports
from state policy makers and clinicians
suggest that the US vaccine
financing system is under increasing
strain. Childhood vaccines in the United
States are financed by a patchwork of
public and private sources.5 Children
who are privately insured often have insurance
coverage for vaccines (BOX).
However, some children are enrolled in
private health insurance plans that do
not cover the cost of vaccines and they
are considered underinsured for immunization.
In 2000, it was estimated
that 14% of children aged 0 to 17 years
were underinsured in the United States,
requiring families to either pay out-ofpocket
for the cost of vaccines not covered
or forgo receiving vaccines.
Among clinical preventive services,
childhood immunization has been
ranked at the top in terms of health impact
and cost-effectiveness by the National
Commission of Prevention Priorities.
15 Despite the benefits of
childhood vaccination and the high coverage
rates achieved with older childhood
vaccines,3 our study demonstrated
gaps in the financing of new
vaccines for children who are underinsured
with respect to vaccination. Assuming
14% of children are underinsured
in the United States, we estimate
that 2.3 million children are unable to
receive state-purchased meningococcal
conjugate vaccine in the private sector,
and 1.2 million children are unable
to receive this vaccine even if they
are referred to the public sector. Due
to lack of funds to purchase newer vaccines
for children who are not VFC eligible,
many states have adopted more
restrictive policies for provision of publicly
purchased vaccines since 2004.
The lack of sufficient section 317 funding
and state funding for vaccine purchase
has led some states to provide vaccine
to VFC-eligible children but not
to underinsured children. Disparities
among states are worse for the most expensive
and newest vaccines, including
pneumococcal conjugate, meningococcal
conjugate, and hepatitis A
vaccines.
The public sector safety net for offering
vaccine to underinsured children
seems to be under considerable
strain. Past studies have suggested that
many private clinicians refer underinsured
children to public health clinics
for vaccination.16,17 Unfortunately, a
growing number of states are no longer
able to provide expensive vaccines, such
as the meningococcal conjugate vaccine,
to underinsured children in the
public sector. Furthermore, the proportion
of vulnerable US children
whose insurance plans either do not
cover vaccines or require families to pay
out-of-pocket for preventive care is
likely to grow. A recent article by the
American Academy of Pediatrics found
that 20% of employers are offering catastrophic
health insurance plans (highdeductible
health plans), up from only
5% in 2003, and only 30% of these plans
covered preventive care before the deductible
was met.18,19 These trends are
of concern because inadequate insurance
coverage has been associated with
forgone health care among families who
lack resources.20
And when is the last time you heard of this happening in the US?
Flareau is most concerned about diseases that are preventable because of vaccines. Small outbreaks of measles, pertussis and other once-common diseases keep cropping up because people, often those who aren't insured, don't get vaccinated.
Having seen how government agencies and public institutions operate, I suspect it would be much more inefficient. And, without any choice, if the government says they won't cover the cost of a procedure, you don't even have an option to change insurance carriers if government provided all the medical coverage. Or else, you'll still need to pay for private insurance for supplemental coverage beyond what the government plan pays.
I'm not saying the way the insurance industry runs things is great, I just don't have any reason to think government red tape would improve upon it, not the way our government is run.
Federal investigators have found that a handful of companies account for a growing share of the health insurance policies sold to small businesses in most states, leaving consumers with fewer options and higher costs.
Yes but as suggested up thread they don't actually eat the cost. You do, via $10 hospital tissue boxes.CaptainQuasar said:A friend of mine was a paramedic in New York state. She said that the EMS providers / ambulance companies there frequently simply had to eat the cost of transporting people and caring for them because the laws required them to answer calls and transport people but didn't guarantee any way for them to get paid.⚛
The US does not have a free market health care system in any sense that's its normally seen. At least 50% of all health care spending is by the government already, and in the rest of it the buyer is not the recipient. In a market the recipient must freely negotiate w/ the providerGravenworld said:Our "free market" health care system...
mheslep said:Yes but as suggested up thread they don't actually eat the cost. You do, via $10 hospital tissue boxes.
mheslep said:The US does not have a free market health care system in any sense that's its normally seen. At least 50% of all health care spending is by the government already, and in the rest of it the buyer is not the recipient. In a market the recipient must freely negotiate w/ the provider
Here and abroad I believe its in large part because health care is so perfectly suited to the pandering of politicians: "elect me and I will get you more covered procedures, its your right!". This goes on and on until health care is 100% run by government at which point government can only control costs by limiting supply (queues).gravenewworld said:Exactly, that is what the US health care system has evolved into. You have a very few huge conglomerates controlling the vast majority of health care for the population. Even the government itself finds that this is leading to more and more higher costs and less choice for patients. Do you see it going away anytime soon if nothing is changed? I don't think so. Where is the efficiency in the system we have now? NO COUNTRY IN THE WORLD with the best of health care has a free market health care system. Why?
mheslep said:Here and abroad I believe its in large part because health care is so perfectly suited to the pandering of politicians: "elect me and I will get you more covered procedures, its your right!". This goes on and on until health care is 100% run by government at which point government can only control costs by limiting supply (queues).
There are plenty of examples of small free markets in play in the US and elsewhere. http://healthcare-economist.com/2006/04/25/markets-at-work-lasik/" , as its not covered by insurers, is a famous one. It now has the highest patient satisfaction of any surgery. 1998 price was $2200, now its $1350. But remain vigilant. Soon some politco will start yelling its your right to see as well as the next man in this society, we all must have it; Lasik will get mandated onto insurance plans. Then one day, our Original Poster will return to our forum and query: "...John Smith is uninsured, has terrible vision, gets a $100K lasik eye job ... who pays?"
mheslep said:Here and abroad I believe its in large part because health care is so perfectly suited to the pandering of politicians: "elect me and I will get you more covered procedures, its your right!". This goes on and on until health care is 100% run by government at which point government can only control costs by limiting supply (queues).
Lumping all those countries together and saying they all have 'universal coverage' is grossly imprecise. I'm only familiar with a 2 or 3 other countries shown there and of the ones I know only England (the topic of the report) has real 'universal' care: doctors, hospitals, everything run and paid for by the government. As you can see the waiting time is >six months. Other countries are moving away from failing universal plans and opening up free market health care. Government care is just another 3rd party payer system, it doesn't work either. There is no way around supply and demand.gravenewworld said:Really? See pg 3 of the OECD report.
http://www.oecd.org/dataoecd/5/27/26781192.pdf
So how is it that places like Japan spend less % of their GDP on health care, have universal coverage, and have waiting times just as long as we do in the US for health care?
gravenewworld said:LOL exactly. The first and hardest step for millions of Americans is getting insurance in the first place. On top of that, having insurance here in the US doesn't guarantee affordable health care for an individual at all.
You seem to agree w/ the premise of the Lasik example I posted but in the next post I gather that rather you believe that only an insurance system would inflate Lasik costs, but that if it were provided under a universal government program this would not be the case. http://www.hoover.org/publications/digest/3459466.html" . The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.gravenewworld said:Really? See pg 3 of the OECD report.
http://www.oecd.org/dataoecd/5/27/26781192.pdf
So how is it that places like Japan spend less % of their GDP on health care, have universal coverage, and have waiting times just as long as we do in the US for health care?
mheslep said:Lumping all those countries together and saying they all have 'universal coverage' is grossly imprecise. I'm only familiar with a 2 or 3 other countries shown there and of the ones I know only England (the topic of the report) has real 'universal' care: doctors, hospitals, everything run and paid for by the government. As you can see the waiting time is >six months. Other countries are moving away from failing universal plans and opening up free market health care. Government care is just another 3rd party payer system, it doesn't work either. There is no way around supply and demand.
THERE WILL BE NO PERFECT SYSTEM FOR HEALTH CARE. I find it extremely ethically wrong that yes here in the US we may not have to wait long for health care, but one of the main reasons why is simply because we deny 45 million of our citizens health coverage. That is not efficiency, that is simply lunacy. Also, when private insurance companies enter the market, it kills universal systems of health. I believe it is in the UK, where if you have private insurance you get to be placed ahead of people that have UH on waiting lists. This in turn motivates more and more people to buy private insurance which in the end (if enough people buy into private insurance) will increase costs and leave a big chunk of people who get 2nd rate health care service.Japan's health care system is characterized by universal coverage, free choice of health care providers by patients, a multi-payer, employment-based system of financing, and a predominant role for private hospitals and fee-for-service practice.
Virtually all residents of Japan are covered without regard to any medical problems they may have (so-called predisposing conditions) or to their actuarial risk of succumbing to illness. Premiums are based on income and ability to pay. Although there is strong government regulation of health care financing and the operation of health insurance, control of the delivery of care is left largely to medical professionals and there appears to be no public concern about health care rationing.
Like the Australian, Canadian and many European health care systems, Japan's national health insurance program is compulsory. But Japan surpasses all 24 member countries of the Organization for Economic Cooperation and Development (OECD) in life expectancy at birth and also has the lowest infant mortality rate (Appendix 1, Table 1).1 It achieves these successes at a cost of only 6.6 percent of gross domestic product, $1,267 per capita - half that of the United States (Table 1) .
Japanese-style national health insurance raises a fascinating question: how has Japan reduced financial barriers of access to medical care and achieved a No. 1 ranking on health status at a cost that is among the lowest of wealthy industrialized nations?2 In addressing this question, we begin with a comparative analysis of health care resources and the use of medical care in Japan, the United States and other OECD countries. Next, we review the financing and organization of medical care in Japan, evaluate some strengths and weaknesses of the health care system, and explore possible lessons for health care reform in the United States.
For some reason you seem to assume that supply always will remains stagnant. This is how Japan is able to control their health care costs and waiting times-by having much better supplies (per capita wise) of medical technology and hospital beds available.You seem to agree w/ the premise of the Lasik example I posted but in the next post I gather that rather you believe that only an insurance system would inflate Lasik costs, but that if it were provided under a universal government program this would not be the case. I ask you to reconsider. The real cost of producing any handout will always increase rapidly as the demand increases without check. It matters not who the 3rd party payer may be. If the 3rd party (insurer/government) stops paying the increase, the supplier will inevitably start limiting the quality of the service or good.
The post said "places like Japan". Ok to advance the discussion, please define with a little detail what you mean when you say 'Universal Coverage' so we can have some common ground. Who pays, for what services , limitations to the services, allowance for alternative coverage, etc.gravenewworld said:Where did I lump them together? I pointed out Japan as an example.
mheslep said:The post said "places like Japan". Ok to advance the discussion, please define with a little detail what you mean when you say 'Universal Coverage' so we can have some common ground. Who pays, for what services , limitations to the services, allowance for alternative coverage, etc.
The
dominance of for-profit insurance
and pharmaceutical companies,
a new wave of investorowned
specialty hospitals, and
profit-maximizing behavior even
by nonprofit players raise costs
and distort resource allocation.
Profits, billing, marketing, and the
gratuitous costs of private bureaucracies
siphon off $400 billion to
$500 billion of the $2.1 trillion
spent, but the more serious and
less appreciated syndrome is the
set of perverse incentives produced
by commercial dominance
of the system.
We're not getting anywhere as this post is a non-sequitur. Up thread I posted, and you agreed twice ala 'LOL, exactly': 1) the US health system fails, 2) the US health system is not a free market, its a 3rd party payer system. Then you reply w/ this aha! post that 1) says the US health system fails and 2) says nothing about my assertion that other countries may be allowing more private alternatives in addition to their government run systems (they are, e.g. Ireland, Canada, Netherlands).gravenewworld said:I will respond to this later after I get home from work.
So many places are now switching to a more free market based approach to health care?
Chew on this-
http://content.nejm.org/cgi/content/full/358/6/549
"Market-Based Failure — A Second Opinion on U.S. Health Care Costs"
Moonbear said:I'm not saying the way the insurance industry runs things is great, I just don't have any reason to think government red tape would improve upon it, not the way our government is run.
Thanks, Jason. People who have never worked in the medical field have no idea how much friction and waste insurance companies cause in the delivery and cost of medical treatment. Doctors spend a LOT of time and money deciding which insurance plans to participate with, and their staff have to learn the ins and out of each plan, including which procedure codes are acceptable and covered under each plan and which are not. People who fear a single-payer system of universal health coverage have no idea how much fragmented private insurance coverage costs.JasonRox said:Good post turbo-1. (The first one.)
Baxwax: perhaps you can help with filling in the story on the http://en.wikipedia.org/wiki/Medicare_(Canada)#The_Parallel_Private_Debate" AFAIK there's a huge private system in place in parallel to the government system that, though not banned by the CHA, the provinces can and do ban private care but its practiced massively w/ a wink and nod regardless? More importantly this would be real free market care, not 3rd payer insured, that is one walks in pays the good doc. directly.baywax said:I can tell you, as a Canadian, that government collected taxes when used to paid for universal health care works great...
mheslep said:Baxwax: perhaps you can help with filling in the story on the http://en.wikipedia.org/wiki/Medicare_(Canada)#The_Parallel_Private_Debate" AFAIK there's a huge private system in place in parallel to the government system, though not banned by the CHA the provinces can and do ban private care but its done massively w/ a wink and nod regardless? More importantly this would be real free market care, not 3rd payer insured where one walks in pays the good doc. directly.
It's all computerized now. When my doctor needs to prescribe something, what my plan pays for pops up and he asks me which option I want.turbo-1 said:Thanks, Jason. People who have never worked in the medical field have no idea how much friction and waste insurance companies cause in the delivery and cost of medical treatment. Doctors spend a LOT of time and money deciding which insurance plans to participate with, and their staff have to learn the ins and out of each plan, including which procedure codes are acceptable and covered under each plan and which are not. People who fear a single-payer system of universal health coverage have no idea how much fragmented private insurance coverage costs.
When you need specialized diagnostics and specific treatments/procedures, your insurance program may refuse to pay for your treatment for any number of reasons. They may say that you weren't pre-approved to receive the treatment, or that a lesser treatment should have been offered, or that the diagnosis and/or procedure coding did not meet their guidelines. When I was the network administrator for a VERY large (for Maine) Ophthalmic practice that was growing aggressively, they needed to borrow against their receivables to purchase or lease new treatment facilities, hire new staff, buy new equipment, etc. The major impediment to their growth was the banks' reluctance to lend money against receivables that were being stalled repeatedly by the insurance companies' refusal to pay for covered services, based on technicalities.Evo said:It's all computerized now. When my doctor needs to prescribe something, what my plan pays for pops up and he asks me which option I want.
So you don't have to wait http://www.fraserinstitute.org/commerce.web/newsrelease.aspx?nID=4967" to get surgery?baywax said:Its gotten weird in response to what was all over the media as a "failing health care system"... (wonder who paid for those media hypes...??). Since then we have private clinics setting up that bill the government for patients with the HC card. Others may or may not be using their private insurer. But, why bother when the govt. costs 117 dollars a month for 4 kids and two adults being covered?
mheslep said:The post said "places like Japan". Ok to advance the discussion, please define with a little detail what you mean when you say 'Universal Coverage' so we can have some common ground. Who pays, for what services , limitations to the services, allowance for alternative coverage, etc.