1950 hospital maternity bill

[Mitchell Andrus]

My mother-in-law's bill for my sister-in-law's birth.

This the TOTAL bill from the hospital. (She never throws anything away)

.

[Mike Cutler]

$125.00 for a girl!! I wonder how much boys cost back then?:D,;)

Quite a change in the last sixty years.
That's pretty cool Mitch.

[Larry Browning]

$125.00 for a girl!! I wonder how much boys cost back then?:D,;)

Quite a change in the last sixty years.
That's pretty cool Mitch.
I must agree that this is a bargain, but my math gets me $276. I wonder what that is in today's dollars? I'd bet it would still be a bargain compared to what they charge now.

Today they would have sent them home after one day, or maybe even the same day.

[Steve Rozmiarek]

My oldest daughters bill was $42,000, and my youngest was $14,000. My, how the times change. I guess that my oldest would most likely have not made it in a 1950 hospital, and the same for mom on the youngest. Count me as not grumbling too much about the prices!

Of course, there is the matter of that $1200 xray....

[Jason Roehl]

I must agree that this is a bargain, but my math gets me $276. I wonder what that is in today's dollars? I'd bet it would still be a bargain compared to what they charge now.

Today they would have sent them home after one day, or maybe even the same day.

Looking up the CPI for 1950, I get 24.10, 215.30 for 2009 (100 for 1982), and your calculation of $276 for the total bill, that would come to $2,465.68 in today's dollars.

I think health care is a little ahead of the CPI, but then again, I bet $276 invested wisely 59 years ago would net you much more than $2500 today. If you got a 10% average annual rate of return, you could have over $76,000.

The moral of the story? Twenty-somethings should put away a few hundred bucks for the birth of their grandkids.

[Greg Peterson]

I heard an older gentlemen describe recently that in 1946 he went to his dentist for a tooth extraction. Upon completion the bill was $2.00. This gentlemen said that the average wage was forty to sixty cents per hour. It took him four hours to pay off the bill.

Latest rate is roughly $1,000. At $15.hr, it would take a person over sixty hours (before taxes) to pay off this charge.

4 hours versus 66.6 hours? A sixteen fold increase.

There's just something wrong with that.

And yes, hospitals can't get new mothers out of their doors fast enough. Shameful.

[Jason Roehl]

And yes, hospitals can't get new mothers out of their doors fast enough. Shameful.

That's why some of us support the recent trend towards midwifery. Our first was born in our living room, but being 5-6 weeks early, the midwife made the call to transport her to the hospital about an hour after birth. The two boys followed suit with being that early, and were born in the hospital, though the same midwife was with us for the second as well. She had come to check my wife and said, "You're 8cm, and I don't have my kit with me--we're going to the hospital NOW!" All 3 stayed in the NICU for about a week to the tune of $12-18k

IMO, pregnancies have been treated as an illness for far too long, and a hospital (where a bunch of ill people are) is the last place I want my wife and newborn if I can at all avoid it.

I should add, I had a wisdom tooth pulled a little over a year ago, and the total bill, including x-rays and drugs (an antibiotic and some Vicodin) was about $250.

[Greg Peterson]

IMO, pregnancies have been treated as an illness for far too long, and a hospital (where a bunch of ill people are) is the last place I want my wife and newborn if I can at all avoid it.

No one goes to the hospital because they are healthy or trying to get healthy that's for sure. But a maternity ward should be a place where the process of birth affords the mother (and father) some basic comforts that a regular hospital room is not equipped to offer.

Our priorities are skewed when we treat newborns as a drain on medical resources. Perhaps this explains in part why the US is so poorly ranked in the world in the infant mortality rate (29th out of 37 developed nations).

[Rod Sheridan]

My children were born in 1985 and 1987.

The youngest was born in a birthing suite, rather than the "operating " type room the older child was born in.

The birthing suite was nice, furniture similar to a bedroom, with a large TV on the wall, and you didn't have to wear a gown/mask etc.

I don't remember any cost for the first one, the second child was under $20 for some incidental expenses that weren't covered by healthcare. She had jaundice and had to stay an extra 3 days so that may have been the issue.

Regards, Rod.

[Glenn Clabo]

Deaths per 1,000 births in 1950 = 29
Deaths per 1,000 births in 1950 = 44 (if black)
Deaths per 1,000 births in 2003 = 7
Deaths per 1,000 births in 2003 = 13 (if black)
The US is still 29th out of 37 developed nations.
In 1950, 2,960 women died in childbirth. In 1998, 281.

[Steve Rozmiarek]

My children were born in 1985 and 1987.

The youngest was born in a birthing suite, rather than the "operating " type room the older child was born in.

The birthing suite was nice, furniture similar to a bedroom, with a large TV on the wall, and you didn't have to wear a gown/mask etc.

I don't remember any cost for the first one, the second child was under $20 for some incidental expenses that weren't covered by healthcare. She had jaundice and had to stay an extra 3 days so that may have been the issue.

Regards, Rod.

Rod, I don't want to get political, I'm just curious how the health care system is funded up there? I just read that some folks will be taxed at 55% in the States if the health care bill goes through here. How does that compare to Canada?

[Greg Peterson]

55% of what? Source?

Americans spend far more of our GDP than any other nation that has universal health care. In the key indexes used to measure the effectiveness of health care systems, the US is way down the list in every category.

Most nations have a health care system. We have a health insurance system.

[Mike Henderson]

IMO, any health care system has to have incentives against utilization. That is, it should cost the user something to use the system. If there's no incentives against utilization, the utilization just goes off the chart.

The cost to the user can be modest, just big enough to make them think before using the system, but small enough that they can use it when they judge it's necessary. For major issues, catastrophic coverage would kick in to avoid bankrupting the user.

Mike

[Greg Peterson]

Well stated Mike. I'm curious however as to what percentage of of patients in universal health care systems abuse the system?

That said, even with the abuses factored in, every one else is paying less for health care than we are in the US. Their life expectancies are higher, their quality of life in later years is better and the infant mortality rates are lower than here.

I suspect that once people got use to the idea of being able to seek health care when they were getting ill or injured, we would see a reduction in overall costs. Treating symptoms rather than full blown illness or injuries. It's cheaper to provide physical therapy to alleviate a problem at an early stage rather than let the condition persist for years and ultimately result in a costly surgery. Meanwhile, the patient unnecessarily suffers.

[Steve Rozmiarek]

55% of what? Source?

Americans spend far more of our GDP than any other nation that has universal health care. In the key indexes used to measure the effectiveness of health care systems, the US is way down the list in every category.

Most nations have a health care system. We have a health insurance system.


No, that would be the tax bracket that they are in.

Just to put my bias in the open, I have a problem working my tail off to pay for my family's health care, plus someone elses. I can take the responsibilty for my own bills, they can too. I won't disagree that the system seems a "little" broke, but as one of those looking at a tax bracket of 50% or so, I have to wonder if it is even worth it anymore. Why work so darned hard? Why should I take all the risk to have a business and carry so much more tax liability? Isn't the risk that comes with being an employeer enough?

Honestly, I don't want to get political, but I'm seriously considering doing something else for a living that requires paying way less taxes. I doubt I'm the only one, then who is going to pay? I hear the "rich". I'm not rich, not even close, but every now and then everything works, and the IRS gets a big check from me. What is the reward anymore? Why should I stick my neck out for a society that gives nothing back to me?

Sorry for the rant...

[Rich Engelhardt]

Hello,

I suspect that once people got use to the idea of being able to seek health care when they were getting ill or injured, we would see a reduction in overall costs

My wife works for the county, so needless to say our coverage is both great and reasonable - compared to what the private sector has to suffer with.

My problem however has nothing to do with the actual cost and/or availability of services.
I'm in somewhat the same boat (or wagon if you prefer) as Steve.
I'm also one of those "pulling more than my share" of the loaded wagon, while others ride.
I simply can't afford to take time off to seek out treatment for anything short of a major "chest grabbing and flopping around like a fish out of water" type of thing.

My SIL's unemployed boyfriend? Oh yeah, every little twinge and he's off running to the ER. Same w/her two nephews, her niece who's on the .gov dole, all their kids....the list is a long one.:mad:

[Mitchell Andrus]

IMO, any health care system has to have incentives against utilization. That is, it should cost the user something to use the system. If there's no incentives against utilization, the utilization just goes off the chart.

Mike

All-you-can-eat restaurants come to mind. If the patrons over eat, the restaurant goes belly-up.
.

[Rod Sheridan]

Rod, I don't want to get political, I'm just curious how the health care system is funded up there? I just read that some folks will be taxed at 55% in the States if the health care bill goes through here. How does that compare to Canada?

Hi Steve, the per capita cost of healthcare in Canada is aproximately 60% of that in the USA, for universal coverage.

(Healthcare is based upon residency in the province. If you live in the province for 3 months, you're covered. If you move from one province to another, you're covered by your previous province for the 3 months that you don't have coverage in your new province.)

This means that if you retire and move to Canada, you have health coverage, even though you're not a Canadian citizen.

Universal healthcare was fought against by many doctors, with claims that you wouldn't be able to pick your doctor, that it was communist etc.

The Canadian system doesn't involve the government (except for paying), you pick your doctor, vist them as required, no government "approval" required etc.

Almost all the services are privately delivered, my doctor is self employed, labs are private enterprises, as are hospitals, clinics etc.

Wait times are far shorter than the occasional sensationalised news story, my family experiences have been extremely positive.

Canada as you know, has a greater land mass, with maybe 10% of the population of the USA, which increases costs due to lower density.

I would expect that the USA could come up with a good system that would save you substantial money, and deliver a premium product.

Regards, Rod.

[Orion Henderson]

Our priorities are skewed when we treat newborns as a drain on medical resources.


Well said.

[Brian Kent]

The top federal tax rate is 35% for income over $372,950. The number being considered in some of the many proposals going around is a 1/2% to 1% surtax on income over $350,000. This is not the rate on the whole amount, but on the part of the income that is over $372,950 or $350,000. Not all of the many bills being put forward have this tax increase proposed.

[Brent Leonard]

Honestly, I don't want to get political, but I'm seriously considering doing something else for a living that requires paying way less taxes. I doubt I'm the only one, then who is going to pay? I hear the "rich". I'm not rich, not even close, but every now and then everything works, and the IRS gets a big check from me. What is the reward anymore? Why should I stick my neck out for a society that gives nothing back to me?



wow.........

[Jeff Wright]

IMO, any health care system has to have incentives against utilization. That is, it should cost the user something to use the system. If there's no incentives against utilization, the utilization just goes off the chart.

The cost to the user can be modest, just big enough to make them think before using the system, but small enough that they can use it when they judge it's necessary. For major issues, catastrophic coverage would kick in to avoid bankrupting the user.

Mike

I would add that there should be a cost penalty for electing NOT to live a healthy life. My wife and I spend at least an hour and a half each day exercising. I don't always like doing it, but it's what it takes (for us) to keep our weight in the recommended zone. Hopefully it will reduce our chances of getting diabetes and minimize heart issues. What I find upsetting is my paying (in my insurance premium) a component towards those unwilling to make the effort and dedicate some time each day to stay healthy. We are both in our 60s and believe living a healthy life is part of our financial planning. If we can minimize our personal healthcare costs, we can live a "wealthier" life AND a healthier life.

I still recall as a six-year-old going to the family physician for a shot when sick and my mother taking out a five or ten dollar bill to pay for the visit. No insurance hassles or complications . . . for us OR the doctor. Why can't we go back to people paying cash for their normal visits and buying only catastrophic coverage?

[Greg Peterson]

We are already paying for 'deadbeats' using the emergency room as their primary care provider. It is less expensive to provide a system of care accessible to all.

There are a couple of cultural biases at play. One, that we don't have or can not afford the time to see a doctor unless we are in severe distress. This is both foolish and costly.

A co-worker complained of having a rash for over a week. Finally at the urging of several of his peers he went to his doctor. Turns out he had a staph infection. Aggressive antibiotics were prescribed and the symptoms of the infection abated. It can take up to a year for the infection to completely go away and even now he still has soreness in his back. Shortly after being diagnosed with the staph infection his infant grandson (that is on kidney dialysis) and daughter moved in. Had he not be diagnosed and begun treatment one has to wonder would could have happened.

This co-worker 'did not have time' to go see a doctor.

I have plenty of my own stories of avoiding the doctor. One of which resulted in a serious illness that impacted me for a year. Had I gone to the doctor early on, I could have avoided the physical pain and damage my body suffered. I 'did not have time' to see the doctor though.

The second bias is 'I got mine, you get yours'. We all know people that do not contribute to the system (i.e. pay their fair share). My effective tax rate is right around 33%. I do not have the luxury of tax loopholes, writing something off as a business expense or investing money elsewhere for the sole purpose of tax avoidance.

I have a problem with a tax system that penalizes people that get up and go to work everyday and rewards those that make their fortunes moving money. Warren Buffet has famously said that his secretary pays a higher percentage of her income in taxes than he does.

Is it so wrong to ask the same level of health care our government workers are provided?

There are so many health care models in the world these days, surely we can take the best of the best and develop a template that fits our needs.

There is nothing wrong with a profit motive in health care. It is necessary. But what is wrong with private insurance is the grossly over compensated executives. Nearly 20% of premium payments go towards overhead. Medicare is roughly 3%. I'm not particularly interested in providing the corporate elite with private jets and gold plated china.

Rod - I have indeed heard horror stories ( as most of us have) about long lines and waiting lists for health care abroad. I've seen absolutely zero evidence of this being common or standard practice in any universal system. If I want to see my doctor it takes several weeks to months to get in. And when I do go the appointment, I plan on waiting one to two hours past my appointment time before he comes into the exam room.

Our health care is already severely rationed. And should someone be so unfortunate as to contract a major disease or chronic ailment, good luck finding a policy that will cover that should one ever be required to change insurance plans.

If someone is ill or in need of treatment, why should they have to be troubled with the emotional drain of fighting the insurance company over denied claims?

[Glenn Clabo]

Rod,
Thank you for posting this. I can't tell you how much propaganda flying around the internets hurts the efforts to get through real facts here in the states.

My parents are getting up there in age and as someone who is married to a Canadian who's parents are near their end of life I constantly see the differences in real terms. I've also had first hand experience with the US system as I lost my first wife to cancer while going more than $250,000.00 in debt. People who make claims of wanting to deal with their own problems really can't understand how horrible it is to see a loved one being treated based on cost as you go into debt trying to keep them alive. It simply doesn't happen in other civilized countries...like yours.

[Ken Fitzgerald]

GLenn,

Talk about rumors flying around the internet and wanting to get the facts out.

Got to FWW. There a Canadian first name Stu.

Check out a couple of threads he started recently. One concering his cousin in BC and getting medical attention. One thread concerning Stu's wife getting medical attention. Both in "universal or socialized medical systems" in two different countries.

Nobody can make a statement that covers every instance, every case.

Don't take my word for it......check out Stu's threads.

[Greg Peterson]

I am impressed with the fact that the mods have not had to issue any warnings.

Perhaps this issues reputation for divisivness is unwarranted?

[Ken Fitzgerald]

I am impressed with the fact that the mods have not had to issue any warnings.

Perhaps this issues reputation for divisivness is unwarranted?

We are too busy disagreeing and being at each other's throats to do anythng else!:eek:

[Jeff Wright]

The Canadian system doesn't involve the government (except for paying), you pick your doctor, vist them as required, no government "approval" required etc.



Rod, by saying the government is not involved other than paying for services do you mean that the government is the one who ADMINISTERS the program? If so, I think our great fear is the potential for our government to drop the ball in the administration end of things.

[Glenn Clabo]

Ken,
Remember Ken...My wife is a nurse who has worked in both the Canadian and US systems. She doesn't base her opinion on hearsay...she bases it on facts and factual evidence. One of her most requested presentations involves the comparisons of the US system vs. other countries...based on facts...not feelings. The facts are hard for people to swallow but everyone walks away from those presentations with a different view.

I read those posts from Stu...and all I can say is what you are reading is one case that comes second/third hand from a family member who doesn't understand what speed of treatment has to do with outcomes...only that they know a loved one is sick and everything must happen yesterday...which is very understandable...But in fact that’s not realistic nor does it result in better outcomes... it only costs more. The fact that someone can pay to get something done quicker has no relationship to successful outcomes. In fact...Canada has one of the highest successful outcome rates in the world and the US is much lower even though we in the U.S. spend much more on health care than Canada, both on a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in the U.S. was US$6,714; in Canada, US$3,678.

His wife’s situation and their health care "system" have no relationship. It's about her doctor and their relationship. Someone once said that there really is a "worst doctor in the world...and the scary part of that is...someone has an appointment with him/her." While counseling men who are dealing with spouse’s health issues I find that most of them tend to blame the system vs. taking on the responsibility to confront the doctor or his boss. Most wouldn't tolerate a mechanic treating their spouses badly...but just bitch about how a doctor is without doing anything.

Remember also...I lost my first wife to cancer. At the time I was very ignorant about most things medical. I was one of those spouses who thought nothing happened fast enough...or whatever was being done wasn't enough. I have to live with the fact that what was demanded by us may actually have ended her life earlier than if we had taken our time and listened.

Besides ALL that...I'm very close to the proposals being worked right now...nobody is proposing ""universal or socialized medical systems"...only the availability of insurance.

[Greg Peterson]

Ken - I see very little disagreement.

Jeff - I would not opposed to crediting those of us who are proactive in their health. I do not know by what standard you would measure and monitor such a program, but alas people do need to take personal responsibility for their health. Plenty of illnesses, injuries, conditions are the result of people not taking care of themselves and the rest of us in the insurance pool are required to pay for their irresponsibility.

Going to the gym isn't always the easiest thing to do, especially when you know what's in store (I loathe the long and boring cardio workout). There are two kinds of autonomy. The kind money buys and the other money can not buy. We each are able to ensure that we have ample autonomy when it comes to our health. Money, well that's a whole other matter.

While the Canadian government administers the payment of medical bills, I took Glenn's comment to mean that the doctors decide the best course of treatment. In other words the government does not have a list of disallowed procedures, unlike many if not most of our private plans.

The quality of care and results in Canada's system are high and the cost is low. And they do not have a pre-existing condition exemption.

[Steve Clardy]

1967, I clipped the end off of my small finger in a drill press incident.
Doc sewed on some skin from my leg, over night stay in the hospital, then I was released.
I remember my folks talking about that $103.00 or so bill, and worrying about how they were going to pay for it.

[Scott Shepherd]

Someone's got to pay for any new plans coming down the pike. Do that at the expense of small business owners and you'll find the unemployment rate heading in one direction......up.

[Ken Fitzgerald]

Glenn,

With the utmost respect for your wife, her professional credentials and expertise, it is just one person's opinion.

I'll bet I can get some of the doctors I work with to disagree immensly. BTW we have doctors from Canada practicing locally.

I'll disagree with you on Stu's problems. Delayed final diagnosis due to a lack of equipment is a problem caused by the system. Delayed treatment due to the delayed diagnosis is also a problem with the system.

His wifes' problem.....again systemic. Based on Stu's posting without paying thousands of dollars monthly out of their own pocket they can't see another specialist unless referred by her current doctor. Again....problem caused by the system IMHO.

I will also repeat and this was told to my face. A gentleman from Calgary in a motel in Coeur d'Alene, ID telling me how on Saturday nights people use the ER as a baby sitting service while they party. He also mentioned that the tour bus he was on had a good probability of stopping in Spokane the next morning when somebody aboard had a "heart attack" due to delayed treatment in Canada. Again Glenn...this gentleman told me to my face.

Explain to me the difference between socialized medicine and making insurance available? If someone else is footing the bill, and it's available to everyone what is the difference?

Medicare, in some cases, doesn't even reimburse the cost of performing certain exams and procedures. As a result, hospitals end up charging more for the same exam, so they can recoop their losses from those of us lucky enough to have insurance. If you pay a co-ay like I do, I'm helping pay for those Medicare exams.

I know fully well the problem with aging parents. I've been dealing with the financials of that for quite a few years.

As you are aware, my delayed retirement is going to happen due to dental expenses and I have dental insurance.:mad:

Here's my take on this.

The problem is not black and white but is truly complex.

You can't make a direct comparison between Canada and the US BECAUSE of the population differences.

Don't give me "Let's do something now and we'll iron out the details later". California did that and look at their financial crisis now.

While the goal of having medical treatment available for everyone is commendable, it is complex. I really don't think our politicians are capable making a good honest effort to solve the problems because of political pressures by too many special interest groups.

Do something is better than doing nothing? NOT.

Either take time to develop a well thoughtout financially viable solution or handle things on the local level using donations and fund raising.

[Rod Sheridan]

Rod, by saying the government is not involved other than paying for services do you mean that the government is the one who ADMINISTERS the program? If so, I think our great fear is the potential for our government to drop the ball in the administration end of things.

Jeff, I find it hard to believe that your government is either worse than, or better than ours.

When you need medical attention, you go to the doctor/hospital etc and they send the bill to the government agency responsible for healthcare.

That's as complicated as it gets from a user perspective.

I'm sure there's more to it than that, however as the user all I do is go for a doctors visit or go to the hospital or to emergency if it's a serious injury or after hours.

For example, my mother is in the final stage of terminal cancer. She's in the hospital, there are no financial considerations for the family.

Two years ago when she was diagnosed, she received chemotherapy and radiation treatment which gave her a good quality of life for an additional two years. There was no possibility of a cure.

Our only outside expense was for parking at the hospital while taking her for her daily treatment.

Regards, Rod.

[Glenn Clabo]

Ken,
"With the utmost respect for your wife, her professional credentials and expertise, it is just one person's opinion." She is not in a position to base her statements on subjective evidence. She states objective facts. When you present the evidence...doctors back down from "feelings". I've seen it happen time and time again.

"His wifes' problem" ... Okay...if you are telling me they can't get a second opinion under their system...I agree...it's a stupid system.

"Explain to me the difference between socialized medicine and making insurance available?" Socialized medicine is medicine that is controlled and fudnded by the government. Making insurance available to everyone is using the power of numbers to reduce the costs and make sure everyone can have it so those who do don't have to pay for those who don't have it. (just read this again...yipes!)

"dental insurance" ... Trust me...I understand.

"I know fully well the problem with aging parents." My point is...Her parents who are from VERY humble means...will never go bankrupt for healthcare reasons...unlike my parents who probably will.

"the rest of your comments" I agree.

Now...are you ready for another round of Lienie's...I'm buying.

[Greg Peterson]

Someone's got to pay for any new plans coming down the pike. Do that at the expense of small business owners and you'll find the unemployment rate heading in one direction......up.

I find it hard to believe that corporate America would be against a reduction in employee benefits.

It was all that long ago that the auto makers were complaining about the cost of health insurance ($1,900 per vehicle). Sure these are legacy costs based on contracts signed years ago. But even small companies would benefit from a work force that was insured.

I guess a parallel would be public education. Everyone benefits from our public educatin system, including employers.

The simple fact is that we are not receiving any where near the return on our investment that other countries with a unifersal plan are experiencing.

I could provide plenty of stories about how OUR health insurance system has devasted families and left people to die because something wasn't covered.

And frankly, if someone is recovering from a major medical incident, wouldn't their energies be better spent getting well rather than rifling through the endless medical bills, statements and fighting the insurance companies denial of services?

When it comes to reproductive rights folks have little qualms about letting a beaurocrat get between a patient and their doctor. But when it comes to private industry generating gross, inhumane derived profits, then it is somehow a bad thing, as if a universal program is somehow managed by thte government.

[Scott Shepherd]

I find it hard to believe that corporate America would be against a reduction in employee benefits.

If corporate America isn't going to pay for it, who is? Hint- you and me.

If you think it'll reduce employee benefit costs, you should read what's being proposed. Mandatory pay into the system. Last time I checked, the government hasn't run a single program that did what it was supposed to for the amount it was sold to the public.

I really don't want anything run by the people that run the IRS or Department of Motor Vehicles. Does anyone actually believe these morons we send to Washington are capable of putting together a plan that works on anything? If so, you have more faith in them than I do.

What they should be doing is studying the life's work of Dr. Deming and understanding how to apply his processes to the health care system. They tried it in education with outstanding results (of course we don't use it because that would make sense).

The solution to everything isn't handing over power and money. We've been dumping money into education by the truck fulls since I was a kid. Every election year, all you hear is "we need more money for education". Does anyone actually believe our kids are smarter today? I have a relative that just graduated high school. I mention someone being Cambodian. They said "Is that real, or did you just make that up?".

Money's nothing the problem, it's the method. Fix the method and all else will resolve itself.

[Steve Rozmiarek]

Rod, thanks for posting that.

I guess the thing that worries me the most about the current push to change the health care system in the USA, (besides the higher taxes) is the governments time honored ability to mess up anything that it touches. I know this current system works, and honestly, how many people that are being targeted for this new insurance, don't have Medicare or Medicad right now?

As Rod mentioned about the Canadian system, if all that the government does is pay, that might work here, but thats not what is being proposed, correct?

[Ken Fitzgerald]

Glenn,

It will require a change to our society that I don't think most will be willing to make.

Our health system needs change. I will not argue that.

I don't want to see a quick, poorly planned resolution just for the sake of speed.

But..... there is greed everywhere and health care is just one area that is at the forefront right now.

Everyone can find reason to fault the other guy's bonanza. Few want to weedout the problems within their own backyard.

Whether you call it "buying insurance" or "paying for treatment"...the only difference is a middle man. If someone else is paying for it..it's socialized. Call it what it is.....

No Leinies, locally. I'll have a Bud Light. My name is Ken!

[Rod Sheridan]

Hi Steve, my only experience with the American system was in 2007 when I had to go to emergency in North Carolina while on vacation.

Once the hospital found that I had full coverage, I was treated like their best customer.

It was a bit of a change from when I first walked in wearing my riding suit, carrying my helmet in my hand:D.

I don't know what's being proposed in the US, however if the insurance companies are making money under the present system, if all you did was remove their profit, you must be able to save something.

You should be able to pay the people who do the administration just like the insurance companies do, for the same price, and remove the profit.

I know that the "universal" aspect of the Canadian system is sometimes viewed in a negative light, as being a socialist creation, so it may not be the system that many Americans would embrace.

Regards, Rod.

[Carlos Alden]

Hey all:

Nice discussion on healthcare. I haven't heard any yelling or screaming yet, and so far no one has invoked the name of a radio talk show host, so we're doing great. :) Thanks for keeping things civil.

Seriously, this issue needs to be discussed and aired out, and no matter which side on is on right now we all need to hear possible changes and options.

Carlos

[Greg Peterson]

My employer provides health insurance. I have to pay a portion of it. Were a universal plan available, my employer would drop the private plan, I would not have to pay a portion out of pocket, and my employer could pay me at least a portion of what would have gone to the insurance plan. Sure my taxes would go up, but I'm already paying a fair sum each month as it is and I'm sure my employer would at least split the difference with me. They get to keep half of their savings, I get the other half.

Dropping an insurance plan free's up an employers capital to pay their employers a higher wage.

[Scott Shepherd]

Anyone that thinks this is going to reduce costs or be "free" to everyone should take the time to read the bill (unlike the congress that vote on bills before they are finished being written).

Name me one thing the government has done under budget and that's worked well and efficient.

Post office? Nope.
DMV? Nope.
IRS? Nope.
Fanny Mae and Freddie Mac? Nope.
Treasury? Nope.
Military? Nope. (most advanced in the world, but by no means efficient behind the scenes)


The definition of insanity is doing the same thing and expecting a different result. Thinking those bozos can figure a well oiled machine out that will save all of us money is a thought that doesn't enter my head.

There is a growing unrest amongst small business owners that are going to have to deal with much higher costs for this. They are starting to get vocal and speak out on the facts of the plans and how those impact their businesses.

[Ken Fitzgerald]

I will caution everyone......

No politics. I know it's hard but this can be discussed without getting into politics.


Greg and Scott....

Greg....to think your employer will drop your insurance and pay employees more.....well I wouldn' bet my house or even my next pay check on it.


Scott,

The trouble with the theoretical "capitalism" in today's worlkd is that it seldom is recognizeable in practice because of the "X-factor" called man...and his disease called "greed".

In business today words your never hear mentioned "Fair" "Reasonable" applied to profit. It is not used. You hear the words "WHAT THE MARKET WILL BEAR".....big grandiose ......it means if it comes down to making a smaller margin and a larger market or larger margin and smaller market....the latter will be taken. Business and the stock market have a real credibility problem with the American public right now. AIG....GM......Made-off...isn't that the name with 150 year reservation at the US Federal resort?......then was it worldcom?...the CEO from Mississippi?....Enron......Then there are the smaller investment managers..the guy who crashed his plane to fake his own death? A couple of days later another was found to have left his car at an airport in FL....then the next week the 2 guys in California with the $80 million Ponzi scheme.....

Don't bet your employer will give you the difference. There is plenty of greed to go around.

Everbody has tunnel vision. They look out for themselves with little regard to what's fair and reasonable.

[Greg Peterson]

Post office actually does a pretty good job. They are not a federally funded agency, at least since 1970.

DMV is a state agency.

IRS does a real good job of getting their money. Ask anyone that ran afoul of the IRS.

Treasury? You mean the privately owned Federal Reserve?

Military - $900 hammer back in the 80's? Yeah, that was courtesy a private contractor. Plenty of examples of skyrocketing costs thanks to privatization of the military.

[Scott Shepherd]

Ken, I agree. I also know that money is like water and electricity. It takes the path of least resistance. If you decide it's a great idea to take more money from the rich in the USA, once you sign it into law, I don't believe for one minute everyone that's rich will sit around and say "Aren't I great, I'm helping save someone else". My educated guess is they will be googling "Cheapest place in the world for taxes" and then the next search will be "Property in cheapest tax rate in the world". The money will leave the USA for good, taking all our "Sugar Daddy's" from us, leaving less Sugar Daddy's to pay the bills. If it's less of them, and more of us, their share will go up again. It will either cause them to go broke or to leave as well. Eventually, the burden will come back upon us, as individuals and we'll have to pay more.

People with money won't sit and let it get taken from them without their permission. I know if I were rich, I certainly wouldn't.

[Jason Roehl]

But, Ken, that's how the free market works. Maybe Scott's employer doesn't give him the difference. It only takes one other employer to dangle that offer, though... Employees are not forbidden from voting with their feet.

One thing I almost NEVER hear mentioned is that if everyone in this country has health care coverage, it's no longer insurance. Insurance, by definition, leaves out the highest-cost/highest-risk segment of the population, or escalates their costs dramatically to be in line with their probable use of their policy.

Glenn mentioned that we spend something like $6700 per capita on health care in this country. If I had to pay that for my household of 5, I'd be ticked. For one, that would be a major portion of my income, and two, I don't use anywhere near that amount of health care services each year (so far). Not even close. Last year, I spent about $300 on a dentist (stupid wisdom tooth), and that was it. This year, nothing so far. I don't run to the doc for every little sniffle--I have to have something pretty wrong with me before I go--and I try to stay fit and eat healthy.

[Scott Shepherd]

Wow, the post office does a good job? You mean the post office that's going broke?

Military is efficient? You mean the military that just spent billions of dollars bringing the F-22 out, only to have the Pentagon say it's outdated and they don't need it now? BILLIONS of dollars. Remember when we used to talk Millions? Now it's BILLIONS on one project?

You mean the stealth ship that got scrubbed after BILLIONS invested? That Military is efficient? It's not the men and women of the military that are inefficient, it's the system.

DMV? State, local, it's all the same. Their hand in my pocket and giving me poor service.

IRS is efficient? Another WOW! Have you seen the tax code? Have you called the IRS for help? I have. I've been told "I don't know" by their people because it was too complex for them to have an answer for me.

Wow, if you think those operations are efficient, I'd strongly suggest you read up on Dr. Deming's work. It's a great read and he was one of the smartest people this country ever saw. And he wasn't a politician! He was a manufacturing guy.

[Scott Shepherd]

Just for those interested, I think reading this could shed some light into other things. I think if you apply this to our current situation, you'll see we're taking the wrong approaches on many levels. Everywhere these techniques have been applied, they have worked amazing results. It really is an amazing thing to witness and be part of, and it really does work.

This is from wikipedia, but it's all accurate information, directly from his publications :

Deming philosophy synopsis

The philosophy of W. Edwards Deming has been summarized as follows:
"Dr. W. Edwards Deming taught that by adopting appropriate principles of management, organizations can increase quality and simultaneously reduce costs (by reducing waste, rework, staff attrition and litigation while increasing customer loyalty). The key is to practice continual improvement and think of manufacturing as a system, not as bits and pieces."[20] (http://en.wikipedia.org/wiki/W._Edwards_Deming#cite_note-19) In the 1970s, Dr. Deming's philosophy was summarized by some of his Japanese proponents with the following 'a'-versus-'b' comparison:
(a) When people and organizations focus primarily on quality, defined by the following ratio, http://upload.wikimedia.org/math/b/6/f/b6f3f7155ac7e9f1911289bcd0e60088.png quality tends to increase and costs fall over time. (b) However, when people and organizations focus primarily on costs, costs tend to rise and quality declines over time.
[edit (http://en.wikipedia.org/w/index.php?title=W._Edwards_Deming&action=edit&section=7)] The Deming System of Profound Knowledge

"The prevailing style of management must undergo transformation. A system cannot understand itself. The transformation requires a view from outside. The aim of this chapter is to provide an outside view—a lens—that I call a system of profound knowledge. It provides a map of theory by which to understand the organizations that we work in.
"The first step is transformation of the individual. This transformation is discontinuous. It comes from understanding of the system of profound knowledge. The individual, transformed, will perceive new meaning to his life, to events, to numbers, to interactions between people.
"Once the individual understands the system of profound knowledge, he will apply its principles in every kind of relationship with other people. He will have a basis for judgment of his own decisions and for transformation of the organizations that he belongs to. The individual, once transformed, will:


Set an example;
Be a good listener, but will not compromise;
Continually teach other people; and
Help people to pull away from their current practices and beliefs and move into the new philosophy without a feeling of guilt about the past."

Deming advocated that all managers need to have what he called a System of Profound Knowledge, consisting of four parts:


Appreciation of a system: understanding the overall processes involving suppliers, producers, and customers (or recipients) of goods and services (explained below);
Knowledge of variation: the range and causes of variation in quality, and use of statistical sampling in measurements;
Theory of knowledge: the concepts explaining knowledge and the limits of what can be known (see also: epistemology (http://en.wikipedia.org/wiki/Epistemology));
Knowledge of psychology: concepts of human nature.

Deming explained, "One need not be eminent in any part nor in all four parts in order to understand it and to apply it. The 14 points for management in industry, education, and government follow naturally as application of this outside knowledge, for transformation from the present style of Western management to one of optimization."
"The various segments of the system of profound knowledge proposed here cannot be separated. They interact with each other. Thus, knowledge of psychology is incomplete without knowledge of variation.
"A manager of people needs to understand that all people are different. This is not ranking people. He needs to understand that the performance of anyone is governed largely by the system that he works in, the responsibility of management. A psychologist that possesses even a crude understanding of variation as will be learned in the experiment with the Red Beads (Ch. 7) could no longer participate in refinement of a plan for ranking people."[21] (http://en.wikipedia.org/wiki/W._Edwards_Deming#cite_note-new-20)
The Appreciation of a system involves understanding how interactions (i.e. feedback) between the elements of a system can result in internal restrictions that force the system to behave as a single organism that automatically seeks a steady state (http://en.wikipedia.org/wiki/Steady_state). It is this steady state that determines the output of the system rather than the individual elements. Thus it is the structure of the organization rather than the employees, alone, which holds the key to improving the quality of output.
The Knowledge of variation involves understanding that everything measured consists of both "normal" variation due to the flexibility of the system and of "special causes" that create defects. Quality involves recognizing the difference in order to eliminate "special causes" while controlling normal variation. Deming taught that making changes in response to "normal" variation would only make the system perform worse. Understanding variation includes the mathematical certainty that variation will normally occur within six standard deviations (http://en.wikipedia.org/wiki/Standard_deviation) of the mean.
The System of Profound Knowledge is the basis for application of Deming's famous 14 Points for Management, described below.

[edit (http://en.wikipedia.org/w/index.php?title=W._Edwards_Deming&action=edit&section=8)] Dr. W. Edward Deming's 14 points

Deming offered fourteen key principles for management (http://en.wikipedia.org/wiki/Management) for transforming business effectiveness. The points were first presented in his book Out of the Crisis. (p. 23-24)[22] (http://en.wikipedia.org/wiki/W._Edwards_Deming#cite_note-crisis-21)


Create constancy of purpose toward improvement of product and service, with the aim to become competitive and stay in business, and to provide jobs.
Adopt the new philosophy. We are in a new economic age. Western management must awaken to the challenge, must learn their responsibilities, and take on leadership for change.
Cease dependence on inspection to achieve quality. Eliminate the need for inspection on a mass basis by building quality into the product in the first place.
End the practice of awarding business on the basis of price tag. Instead, minimize total cost. Move towards a single supplier for any one item, on a long-term relationship of loyalty and trust.
Improve constantly and forever the system of production and service, to improve quality and productivity, and thus constantly decrease costs.
Institute training on the job.
Institute leadership (see Point 12 and Ch. 8 of "Out of the Crisis"). The aim of supervision should be to help people and machines and gadgets to do a better job. Supervision of management is in need of overhaul, as well as supervision of production workers.
Drive out fear, so that everyone may work effectively for the company. (See Ch. 3 of "Out of the Crisis")
Break down barriers between departments. People in research, design, sales, and production must work as a team, to foresee problems of production and in use that may be encountered with the product or service.
Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Such exhortations only create adversarial relationships, as the bulk of the causes of low quality and low productivity belong to the system and thus lie beyond the power of the work force.
a. Eliminate work standards (quotas) on the factory floor. Substitute leadership.
b. Eliminate management by objective. Eliminate management by numbers, numerical goals. Substitute leadership.
a. Remove barriers that rob the hourly worker of his right to pride of workmanship. The responsibility of supervisors must be changed from sheer numbers to quality.
b. Remove barriers that rob people in management and in engineering of their right to pride of workmanship. This means, inter alia," abolishment of the annual or merit rating and of management by objective (See Ch. 3 of "Out of the Crisis").
Institute a vigorous program of education and self-improvement.
Put everybody in the company to work to accomplish the transformation. The transformation is everybody's job.

"Massive training is required to instill the courage to break with tradition. Every activity and every job is a part of the process." [23] (http://en.wikipedia.org/wiki/W._Edwards_Deming#cite_note-22)

[edit (http://en.wikipedia.org/w/index.php?title=W._Edwards_Deming&action=edit&section=9)] Seven Deadly Diseases

The "Seven Deadly Diseases" include


Lack of constancy of purpose
Emphasis on short-term profits
Evaluation by performance, merit rating, or annual review of performance
Mobility of management
Running a company on visible figures alone
Excessive medical costs
Excessive costs of warranty, fueled by lawyers who work for contingency fees

"A Lesser Category of Obstacles" includes


Neglecting long-range planning
Relying on technology to solve problems
Seeking examples to follow rather than developing solutions
Excuses, such as "Our problems are different"

Deming's advocacy of the Plan-Do-Check-Act cycle, his 14 Points, and Seven Deadly Diseases have had tremendous influence outside of manufacturing and have been applied in other arenas, such as in the relatively new field of sales process engineering. (http://en.wikipedia.org/wiki/Sales_process_engineering)

[Ken Fitzgerald]

Ah ideology!

Perfect in theory.....has absolutley nothing to do with practical application....

[Scott Shepherd]

Ah ideology!

Perfect in theory.....has absolutley nothing to do with practical application....

Ken, Deming was one of the most successful people in the history of manufacturing. His principles are responsible for Toyota and Honda in the 50's, 60's and 70's when they were producing amazing quality. The Toyota Production System (Possibly the most successful system in manufacturing in the world) is based on Deming's work. The USA wouldn't listen to him, the Japanese thought he was brilliant. They invited him to Japan, he taught and spoke and changed their entire economy and world.

Deming was one of the most brilliant people manufacturing ever saw. His ideas, principles, and work speak for themselves. There's no where it's been applied that it didn't create astounding results. Having worked in places that followed Deming's principles, I can tell you that it's something very special and amazing. The problem is getting senior management to get their head out their behind and get with the program.

If you don't know anything about Deming, take the time to study him. His principles have been applied to failing school systems, and those schools turned into very successful school systems. Everywhere it's been applied, it's changed the places and industries for the positive.

I think that's a long way from "theory". He had about 70 years in manufacturing and changing processes in all sorts of operations. He lived more "practical application" than you or I ever will. His systems work. Can you say that about our current system? I can't.

[Ken Fitzgerald]

Scott,

His theory as you presented it here might work well with the Japanese society. Their society has a totally different attitude than the US society.

I agree in principle with a lot of what you presented here. The trouble arises when you suggest that someone in business administration give up control by tearing down walls between departments......quit worrying about short term profits...... Long range planning? What is that? Let's just worry about this months numbers.....and of course we have to have the "flavor of the month number" to worry about. The list of things he suggests that current American business administrators would fight is endless....

There is a difference between administering a business plan and managing people and circumstances. There are far too many administrators and damn few managers.


As it would take courage on the part of our govenment leaders to pass a well researched, planned, and financially viable health care system...it would take the same kind of courage to make changes as you suggest in businesses. I'm getting old and am quite skeptical. Neither is going to happen in my lifetime. Instead, business leaders will keep playing climb the ladder...change ladders .....reach for higher pay.....don't be on the same rung when the short term decisions fail and you could be held accountable.... and the politicians will hurriedly pass something that will be an abomination but they'll find a way to weasel out of being held responsible for the outcome or at least a way to look the public in the eye and say "It wasn't me.....yes I voted for it.....but I didn't mean to".


...Yup old and skeptical. that's me.

[Eric Larsen]

My mother-in-law's bill for my sister-in-law's birth.

This the TOTAL bill from the hospital. (She never throws anything away)

.

My mother still has my 1968 bill. I was born on a Navy base and the total cost was $8. It would have been $2 less if I didn't have that Y-chromosome.

[Jeff Wright]

If corporate America isn't going to pay for it, who is? Hint- you and me.

If you think it'll reduce employee benefit costs, you should read what's being proposed. Mandatory pay into the system. Last time I checked, the government hasn't run a single program that did what it was supposed to for the amount it was sold to the public.

I really don't want anything run by the people that run the IRS or Department of Motor Vehicles. Does anyone actually believe these morons we send to Washington are capable of putting together a plan that works on anything? If so, you have more faith in them than I do.

What they should be doing is studying the life's work of Dr. Deming and understanding how to apply his processes to the health care system. They tried it in education with outstanding results (of course we don't use it because that would make sense).

The solution to everything isn't handing over power and money. We've been dumping money into education by the truck fulls since I was a kid. Every election year, all you hear is "we need more money for education". Does anyone actually believe our kids are smarter today? I have a relative that just graduated high school. I mention someone being Cambodian. They said "Is that real, or did you just make that up?".

Money's nothing the problem, it's the method. Fix the method and all else will resolve itself.

Scott, it's nice to find another fan of Deming and his 11 Points to Process/Quality Improvement. I still believe today's current Quality Improvement Processes are warmed-over Deming foundational ideas (Six Sigma, etc.). The man was still teaching five-day per-week classes the day he died at age 100.

[Greg Peterson]

The AMA is throwing their support behind H.R. 3200. They like it.

Now lets see what the senate crafts, and then lets see what happens after that.

[Mitchell Andrus]

My mother still has my 1968 bill. I was born on a Navy base and the total cost was $8. It would have been $2 less if I didn't have that Y-chromosome.

I don't want to know what the $2.00 was for.
.

[Mike Henderson]

I'm a little late to the discussion but the problem I find in today's health insurance system is that it prices people out of the system.

Example: You work many years and always have health insurance, paid either by you or your employer. While you're employed, you have some health issue - the worse for insurance is some cancer, even if the cancer is something easily treated, like skin cancer. Then you lose your job and run out your COBRA and have to apply for an individual policy.

I can just about guarantee you that no company will accept you, at any price. And if by some miracle you were able to find a policy, the price would be so high you probably couldn't afford it.

So my proposal is that as long as you maintain health insurance, you would be guaranteed to be issued a policy at a single rate. That is everyone of a certain age pays the same amount, no matter what your health history. But that's only if you maintained your health insurance continuously from the time you started working (maybe 20-22 years of age). If you don't require continuous coverage, people will select against the system by only buying coverage when they get sick.

Second, there must be an incentive against utilization. That is, it must cost something to use medical care. It can be adjusted for family means (income) but everyone must pay something. If you don't do that, people will not think before using health care. For very serious illnesses, the amount the family pays would be limited. You don't want to destroy a family, you want to get the "average" family to think before consuming health care.

I'm neutral about having a government plan. Medicare works well (except there's no incentive against utilization) and it's a 100% government plan.

Mike

[Eric Larsen]

I'm neutral about having a government plan. Medicare works well (except there's no incentive against utilization) and it's a 100% government plan.



I've experienced emergency care in Europe (1980s). What would have cost thousands here was free there. (They literally laughed at me when I whipped out my credit card to pay the bill.)

Without getting too political, I think we should all enjoy the same health care as our senators.

[Ken Fitzgerald]

I've experienced emergency care in Europe (1980s). What would have cost thousands here was free there. (They literally laughed at me when I whipped out my credit card to pay the bill.)

Without getting too political, I think we should all enjoy the same health care as our senators.


That will never happen!

[Eric Larsen]

That will never happen!

"Some men see things as they are and say why - I dream things that never were and say why not." -- George Bernard Shaw


Frankly, we deserve it. We've been protecting the free world for generations. Why should we not have the same level of health care that Canada, Norway or Germany enjoys?

[Greg Peterson]

Eric - Because we'd rather cut our nose off in spite of our face. We care more about taking care of maintaining the status quo than we do above teh 'general welfare' of the citizens of this nation.

I'm sure there were similar arguments when a public education program was first discussed.

I'd settle for a health care plan that delivered the same level of service and outcome for the same cost as our neighbors to the north of us.

[Mike Henderson]

The major issue is how to pay for "universal health care". And it's must be paid for by someone - there's no free health care.

I'd like to see it paid for by the citizens. That is, everyone should be part of the "health insurance pool" and there should be only one pool. It would be as if everyone worked for the same company and were part of that company's health insurance plan.

So each person would pay a premium. If you work for a company, perhaps that company would pay the premium for you. But one way or another, everybody pays. For those too poor to pay the premium, there would be assistance, same as we provide welfare.

By putting everyone into the same risk pool, the expenses of the the pool are distributed over the largest group of people, which means premiums are as low as possible.

Since everyone is paying, everyone has an interest in reducing the cost of health care. And in my plan, everyone has to pay something when they actually use health care - just enough to make them think about whether they really need to see the doctor. The payment would be adjusted based on the individual or family's income. The purpose of this payment is not to raise money, but to make health care more market oriented. One problem with Medicare, for example, is that it doesn't cost anything to actually see the doctor or have any service. You pay a fixed fee each month whether you use medical care or not. So no one thinks twice about whether they really need to see a doctor, or if they need that test, or anything else that costs money. In fact, since the payment is fixed each month, there's a perverse incentive to use as much as you can.

Medicare part D has been a success in getting people to search for the lowest cost drugs. We need something like that for doctor's visits, hospital stays, and medical tests.

So that's my idea. What's yours?

Mike

[Scott Shepherd]

Scott,

His theory as you presented it here might work well with the Japanese society. Their society has a totally different attitude than the US society.



Ken, before you prejudge it based on culture, you should know there are 10's of thousands of USA companies following his principles. It's not a geographic culture issue at all. It's fine to be cynical, but at some point, one has to actually look at facts, and the facts are that this has worked in the USA for 4 decades now and is still working.

[Larry Edgerton]

$125.00 for a girl!! I wonder how much boys cost back then?:D,;)

Quite a change in the last sixty years.


That's pretty cool Mitch.

I was the last on purpose home delivery in my county, and the doctor bill was $35 in 1957.

I may have my faults, but what do you expect for $35?

One question that has to be brought up at some point with ever increasing tech advances and and the associated costs spiraling out of control, what is a human life worth?

[Glenn Clabo]

Actually many large corporations have better healthcare benefits than those working in the federal government...which includes senators. I am not complaining…in any form…because I would have been bankrupted a few times in my life if I didn’t have the insurance…but I think many people would be surprised to know that as someone who has the same benefits...I went a quarter of million dollars into debt while my wife was sick. I also had to pay almost $20K out of pocket to get a tumor removed from my jaw. I get $20 towards a dentist visit, etc. I pay more than $200.00 every other week toward my healthcare provider fee...ie insurance company. I really don’t know what the government pays…but I’m sure it’s more than I do.
Again I’m not complaining about me…I think everyone should have at least what I have. I’m trying to support those who have less…or no insurance…and those who are coming to the end of their life and finding that death or going bankrupt is the only way out.

[Neal Clayton]

The major issue is how to pay for "universal health care". And it's must be paid for by someone - there's no free health care.

I'd like to see it paid for by the citizens. That is, everyone should be part of the "health insurance pool" and there should be only one pool. It would be as if everyone worked for the same company and were part of that company's health insurance plan.

So each person would pay a premium. If you work for a company, perhaps that company would pay the premium for you. But one way or another, everybody pays. For those too poor to pay the premium, there would be assistance, same as we provide welfare.

By putting everyone into the same risk pool, the expenses of the the pool are distributed over the largest group of people, which means premiums are as low as possible.

Since everyone is paying, everyone has an interest in reducing the cost of health care. And in my plan, everyone has to pay something when they actually use health care - just enough to make them think about whether they really need to see the doctor. The payment would be adjusted based on the individual or family's income. The purpose of this payment is not to raise money, but to make health care more market oriented. One problem with Medicare, for example, is that it doesn't cost anything to actually see the doctor or have any service. You pay a fixed fee each month whether you use medical care or not. So no one thinks twice about whether they really need to see a doctor, or if they need that test, or anything else that costs money. In fact, since the payment is fixed each month, there's a perverse incentive to use as much as you can.

Medicare part D has been a success in getting people to search for the lowest cost drugs. We need something like that for doctor's visits, hospital stays, and medical tests.

So that's my idea. What's yours?

Mike

the problems run so deep at this point that i don't see solutions.

a) medicare and medicaid are ripe with blatant theft. yes, everyone, your doctor and hospital are screwing the rest of us. this has been apparent for some time. see bobby jindals' investigations in louisiana a few years ago. he actually jailed quite a few hospital administrators and doctors for fraud. and i highly doubt louisiana is an isolated case.

b) my grandmother wound up in the hospital with pneumonia a year ago. she was 87 at the time. they kept her up for 18 hours without sleep running MRIs, CAT scans, multiple new sets of X rays, blood pressure tests, diabetic tests, you name it. they were so busy running up a tab for medicare that they forgot to start her on the antibiotics for the pneumonia. this is a woman who was working in her yard a week before, she's abnormally strong for her age, and takes very little medication. only threat of lawsuit from my mother was able to get them away from the walking, coughing ATM they had lying in the bed in front of them.

the best idea i can come up with is turning control of medicare/medicaid over to the university systems and having them regulate standards, by placing hard caps on what can be billed per patient without pre-existing conditions. the bottom line is hospitals and doctors need to earn less, and there's no need whatsoever for insurance companies to be middle men for profit. but no politician will look a camera in the eye and say this so i don't expect it to change any time soon.

[Brent Leonard]

I'm glad someone in the government has the cojones and is finally hellbent on doing something about the problem, even if it may be his political undoing. It has never made sense to me to think that doing nothing about a problem is a solution.

I believe any plan, even a very well devised plan, always requires later modifications to make perfect. This will be no different, and I don't subscribe to the thinking that a national program of whatever form will destroy us. Too many other countries have done it with major success.

[Ken Fitzgerald]

Brent with all due respect, no other country tried to do for 300 million people. You can't compare parking a 16 foot bass boat with parking an air craft carrier. Like wise you can't compare creating a system that handles healthcare for 20 million to a system that will have to handle 300 million.

To rush a program could very well lead to financial problems just like the State of California.....they meant well but sooner or later someone's got to pay the piper. And who are they coming to pay the bill?

NO to a quick fix. Take the time to think it out.

While having the courage to do it is one thing, the big long term question is do they have the brains to do it right?

[Mike Henderson]

The 300 million people problem doesn't worry me that much. Most people already have health insurance - the issue is how to cover the people without insurance.

But I agree with Brent. Do something and get started. Then make changes as needed. No matter how much thinking we do, there will be problems. And lots of people have done lots of thinking about "universal health care" for a lot of years. There have been proposals made long before the Clinton effort and that was about mid 1990's if I remember correctly.

Mike

[Bonnie Campbell]

One thing people can do on their own (basically) to cut back on outrageous bills is to check over the itemized statement of care given/provided. Example... LOML had been using a nebulizer and the medicine for at least a few years. After he passed I got another Medicare statement saying they had paid the medicine supplier for the month of December. He never GOT medicine in December. This wasn't the first time that company lied. I dealt with it before. They had before claimed more supplies were sent than were.... Anyway, I told Medicare THEY could deal with it, it was up to them to straighten it out. I had to 'file' an official complaint against the company, which just amounted to telling the person I spoke to I wanted it done. Lo and behold, three months later I get SIX large envelopes of copies of denial of payment to that company. Because of their shoddy record keeping THEY had to pay all moneys back to the government. So figure approximately $500 a month over all them years. I bet they start keeping better records after that. So, if the government (we) need to save money we ALL need to be watching for stuff like that.

[Ken Fitzgerald]

To start something without finding a viable way to pay for it is IRRESPONSIBLE.


Period.

There are no free rides in this world. Sooner or later you have to pay your bill or your IOU's aren't any good anymore.

Wake up!

HELLO!

[Ed Hazel]

I think the biggest problem is not insurance it is the cost of health care. Health care providers know how to get the most out of the insurance companies, most people that have health care insurance don't car what the cost is.

You should be able to "shop around" for many of the services like a MIR or ultrasound, my daughter needed an ultrasound when I called to set up an appointment I ask what would it cost an they had no idea what it would cost and were actually annoyed that I would ask such a thing.

Several years ago I elected to have a procedure done the doctor I went to advertised this as a specialty and he would do it for I think 300.00 dollars when I went in for the consultation he suggested that I would be comfortable doing this in a hospital he said my insurance would cover it in the hospital based on his recommendation. Well the 300.00 procedure ended up close to 10,000 this is the kind of activity that needs to stop.

I once had a doctors office try to bill my insurance company for a 350.00 office call for a post operation follow up, the doctor spent less than 5 minutes in the room, ($4,200.00 per hour) he asked if everything was ok? no pain? everything looks good, shedual another appointment for 2 weeks from now(I didn't). My insurance company declined payment and they sent the bill to me now for 175.00 I called and explained to them that this what is wrong with the amercan health system and they dropped the charges.

I knew a retired doctor who worked several days a month just doing consultations for a doctors office he never saw a patient he just looked over files so the office could charge a consultation fee.

It is a vicious cycle the health care industry milks the insurance companies and the insurance companies pass the costs on the health care providers make more money the insurance compies make more money and we all pay and pay.

[Mike Henderson]

To start something without finding a viable way to pay for it is IRRESPONSIBLE.


Period.

There are no free rides in this world. Sooner or later you have to pay your bill or your IOU's aren't any good anymore.

Wake up!

HELLO!
No one is advocating doing anything without being able to pay for it. What I'm advocating is to choose a path and get going (that includes how to pay for it). There may be problems that turn up after we get going and we should make the appropriate changes as we see the need.

But no one (especially me) is advocating doing anything without figuring out how to pay for it.

Mike

[Mike Henderson]

I think the biggest problem is not insurance it is the cost of health care. Health care providers know how to get the most out of the insurance companies, most people that have health care insurance don't car what the cost is.

You should be able to "shop around" for many of the services like a MIR or ultrasound, my daughter needed an ultrasound when I called to set up an appointment I ask what would it cost an they had no idea what it would cost and were actually annoyed that I would ask such a thing.

Several years ago I elected to have a procedure done the doctor I went to advertised this as a specialty and he would do it for I think 300.00 dollars when I went in for the consultation he suggested that I would be comfortable doing this in a hospital he said my insurance would cover it in the hospital based on his recommendation. Well the 300.00 procedure ended up close to 10,000 this is the kind of activity that needs to stop.

I once had a doctors office try to bill my insurance company for a 350.00 office call for a post operation follow up, the doctor spent less than 5 minutes in the room, ($4,200.00 per hour) he asked if everything was ok? no pain? everything looks good, shedual another appointment for 2 weeks from now(I didn't). My insurance company declined payment and they sent the bill to me now for 175.00 I called and explained to them that this what is wrong with the amercan health system and they dropped the charges.

I knew a retired doctor who worked several days a month just doing consultations for a doctors office he never saw a patient he just looked over files so the office could charge a consultation fee.

It is a vicious cycle the health care industry milks the insurance companies and the insurance companies pass the costs on the health care providers make more money the insurance compies make more money and we all pay and pay.
It's one thing to complain and another to propose viable solutions. I have a number of friends who are doctors. The primary care doctors are not making a killing. The do okay (about $100K/yr) but when you consider the amount of training and the investment in equipment in their office, it's not excessive. That's why medical students won't go into primary care - it just doesn't pay enough. And rural areas are having real problems finding primary care doctors to serve their area.

As one doctor said to me recently, "Every year my expenses go up maybe 5% but the amount I'm paid by Medicare and the insurance companies goes down by 5%. And my malpractice insurance goes up every year."

So don't think you can take a lot of cost out of the system by reducing payment to "greedy" doctors, especially not primary care doctors.

As I said earlier, rather than complain, propose a viable solution.

Mike

[Mike Henderson]

One thing people can do on their own (basically) to cut back on outrageous bills is to check over the itemized statement of care given/provided. Example... LOML had been using a nebulizer and the medicine for at least a few years. After he passed I got another Medicare statement saying they had paid the medicine supplier for the month of December. He never GOT medicine in December. This wasn't the first time that company lied. I dealt with it before. They had before claimed more supplies were sent than were.... Anyway, I told Medicare THEY could deal with it, it was up to them to straighten it out. I had to 'file' an official complaint against the company, which just amounted to telling the person I spoke to I wanted it done. Lo and behold, three months later I get SIX large envelopes of copies of denial of payment to that company. Because of their shoddy record keeping THEY had to pay all moneys back to the government. So figure approximately $500 a month over all them years. I bet they start keeping better records after that. So, if the government (we) need to save money we ALL need to be watching for stuff like that.

Your story illustrates why I believe that people should have to pay a portion of their medical bills. If you don't have to pay anything, many people just wash their hands and say "Let the insurance companies and doctors work this out." But if some of the money is coming out of your pocket, you get interested and watch what's charged. And also seek out lower cost care.

Part D proved that this technique works. People seek out the lowest cost drugs, whether it be generics or just places that charge less.

Mike

[Dan Karachio]

My mother-in-law's bill for my sister-in-law's birth.

This the TOTAL bill from the hospital. (She never throws anything away)

.

That's great. Just add two 00 to all the prices and you might just about get it for today, but that 10 day hospital stay? Forget it. They would kick her out in a day or two tops now. Yep, progress, gotta love it.

[Mitchell Andrus]

That's great. Just add two 00 to all the prices and you might just about get it for today, but that 10 day hospital stay? Forget it. They would kick her out in a day or two tops now. Yep, progress, gotta love it.

It was a C-section, hence the O.R. bill.
.

[Jason Roehl]

It was a C-section, hence the O.R. bill.
.

Ah, yes, back when c-sections were done only when necessary. Unlike today, when they may be done so that a doctor can make his tee-time or go on vacation as planned. :rolleyes:

[Steve Rozmiarek]

I haven't read all the most recent posts, so if this is redundant, I apologize. According to this author, the healthcare bill will mandate employers providing and paying for healthcare, as well as a 5.4% surtax on adjusted gross income, which would certainly hit my company hard. Yikes!

Read it if you like;

http://www.foxnews.com/opinion/2009/07/15/eye-popping-cost-obamacare/

[Ken Fitzgerald]

Steve,

Anything reported or endorsed by Fox News...CNN.....MSNBC.....NBC...ABC...CBS.....well it's tainted....slanted and usually inaccurate. Sadly all the news media have become part of the political process and therefore have little credibility in my world.

[Brent Leonard]

Steve,

Anything reported or endorsed by Fox News...CNN.....MSNBC.....NBC...ABC...CBS.....well it's tainted....slanted and usually inaccurate. Sadly all the news media have become part of the political process and therefore have little credibility in my world.

LOL!!
Bet ya didn't know you share opinion with Noam Chomsky! (disclaimer:this is not a political statement)

I agree with your statement. Most "news" is simple commentary.

[Steve Rozmiarek]

Ken, Brent, that piece from fox was in the editorial section, and is plainly marketed as opinion, not news. It is good to have something like that clearly labeled, rather then being pushed as unbiased news. I forget who the author is affiliated with, but he is biased. That being said, the very idea that he could be right worries me, and here is why.

The congressional budget office, manned by the "D" party came out yesterday with the estimated price of this bill, at 1 to 1.2 trillion. Somebody has to pay that bill.... Whats 1.2 trillion divided by roughly 500 million people? 1,000,000,000,000/500,000,000=$2,000, (or $2,400 if the bill is 1.2 trillion) for every man woman and child in the USA. Now, there are 47,000,000 uninsured, according to the CBO. The cost of insuring them with this bill will be, assuming the lower price (yea right), $21,276 per covered person. That buys a pretty plush policy with Blue Cross!!!

How many of the roughly 500,000,000 people in America actually pay taxes? How are any of us, or our kids going to avoid getting a huge bill for this? What happens to the economy if every person in America gets a bill for $2,000?

The math in that is mine, so it is probably a bit suspect....

[Jason Roehl]

Re-do the math, it's worse than that--there are right around 300 million people in the U.S.

[Scott Shepherd]

there are right around 300 million people in the U.S.

Legally :D

[Steve Rozmiarek]

Legally :D

LOL!

Anyway you count us, my kids are in debt already...

[Belinda Barfield]

Abuse of the system? It's going to happen. Come visit the deep South. My state tax dollars are paying for women to give birth to multiple children they can't afford, typically six to eight, that they then collect monthly payments for up to the age of 18.

Georgia is, I believe, ranked #12 in the nation for obesity. Diabetes, hypertension, and kidney disease are rampant. All diseases that are a drain on they Medicare and Medicaid systems. In any plan I believe, as others have stated, there needs to be a focus on personal responsibility for one's health, and a personal cost to obtain care.

Years ago I was the insurance clerk for a home health agency. I dealt mostly with Medicare and Medicaid and back then the amount of paperwork required to get a claim paid was ridiculous. A clean claim was paid in 30 to 60 days. This is one reason many doctors do not accept Medicare and Medicaid patients.

Hopefully someone can answer this question. What happens with malpractice cases? If the government runs the system, and you can't sue the government, will doctors have to continue to pay astronomical rates for malpractice insurance? If not, that would definitely help decrease the cost of health care.

[Mitchell Andrus]

What happens to the economy if every person in America gets a bill for $2,000?



A tax increase of ($2,000.00 x 2) $4,000.00 to my household is more than offset if I can cut my $9,600.00 health insurance bill down to just a grand or two, or eliminate it entirely. Sign me up.
.

[Darius Ferlas]

How many of the roughly 500,000,000 people in America actually pay taxes? How are any of us, or our kids going to avoid getting a huge bill for this? What happens to the economy if every person in America gets a bill for $2,000?

The math in that is mine, so it is probably a bit suspect....
Steve,

things have to be put in perspective, hence my math is a little different. It starts with the true cost of the medical care. Why is it so expensive in the US? Under US pharmaceutical business pressure the Canadian government had t issue a ban on Internet sales of prescription drugs to the US.

The main two reasons, IMO, for the US to be slaughtered in the area of the ridiculous health care costs are two things:

lawyers
pharmaceutical companies

How come American retirees would come to canada on prescription drug tours? The same prescription drugs, from the same manufacturer and yet in Canada they cost between 60% and 95% less than they do in the US.

And I'm pretty sure this is just the tip of the iceberg.
If the French can have what is considered the best health care system in the world then why can't the richest country on Earth have at least the same?

The issue seems to be pointing in the direction of first reducing the costs, which doesn't mean the level of service would be suffer. In fact the US health care system has quite a bit of catching up to do with quite a few countries.

There are other factors that increase the cost of medical care but various lobbies, and unfortunately, people's habits are too strong. We are fighting with cigarette smoking but we sell junk food in our schools. An average kid in a US school is on its merry way to becoming a more than chubby person, soon to face coronary issues, diabetes and a host of accompanying conditions.

Things are not as simple as dividing one number by another. A lot is involved. Old habits and, often meaningless, slogans ("do we want socialized medicine") are among those too. How do people know they don't want what they called socialized medicine? Have they tried it? They seem to like socialized highways system and socialized military forces.

[Frank Hagan]

I've looked at this issue from a couple of viewpoints. One thing I've found is that the stats are often, well, questionable.

The US does have the longest survival rates from many diseases, including cancer. The people still die, but they live 20 - 25% longer for some diseases. That doesn't show in the "mortality" rates. Infant mortality rates are skewed by how the individual countries report the stats; some countries don't count premature births. Others count preemies only if they are a certain number of weeks old. Early spontaneous abortions are rarely counted in the stats.

To get another view, that you don't see often in the mainstream media, check out http://healthcare.cato.org Cato is a libertarian think tank, and they have several experts that have been studying healthcare policy for decades.

[Ken Fitzgerald]

Folks,


A friendly reminder.

NO POLITICS.....that means no snide remarks......don't try to slip one by us....

We will close this thread down in a flash and will prevent this subject from being discussed IF you can't keep the politics out of it.

[Phil Thien]

So that's my idea. What's yours?

Mike

(1) If we can do nothing else, I suggest we eliminate pooling.

If you're 20 years old now, and purchase insurance, you're quoted a low rate and stuck in a new pool. As the pool ages, and some people get sick, the costs go up. The insurance company raises the rates it charges that pool to cover costs and provide a profit.

New applicants are stuck in new pools with lower costs. And some people in the pool with rapidly escalating rates jump ship to reapply to the same company, or a different company, to jump into a new pool with fewer sick people (and lower rates).

But the people that are in the original pool that were unfortunate enough to get ill can no longer find insurance elsewhere. They're doomed to stay within that original poor w/ rapidly escalating rates.

If we're just tell insurance companies that every one of their customers pays the same rate, we wouldn't have that problem. Sure, add a component for age or sex, I guess. The cost to the 20-year olds would go up slightly, but the cost to the sick and elderly would drop substantially.

I don't think insurance companies would even object, as the only reason pooling started in the first place was to offer a competitive tool (so you can offer lower rates to attract new customers). But if nobody is allowed to pool, then they haven't really lost anything.

So maybe we can all agree on that.

(2) Next is a bracketed ("progressive") system for how much you PAY the insurance company (like your taxes). Make six figures, you pay more. Make low five figures with two kids, you pay less. This is obviously income redistribution and not so easy to get people to agree with. But it is short of nationalizing health care, so maybe more agreeable to some in light of the alternative.

[Steve Rozmiarek]

lawyers
pharmaceutical companies

.

Darius, I certainly can't find fault with your reasons for the higer cost here.

What about taking drugs off patent protection sooner? That may hurt development I suppose. I sure there is a way to continue drug development, but provide a capitalistic price capping mechanism. Maybe change the patent laws so that the inventor companies get income off licensed production, but for a longer period of time, so they have a way to turn a profit on the R&D cost.

Lawyers are a tougher issue. A lawyer needs clients, and there are no shortage of greedy, ambulance chasing victims, and I doubt there is any cure for that.

[Steve Rozmiarek]

A tax increase of ($2,000.00 x 2) $4,000.00 to my household is more than offset if I can cut my $9,600.00 health insurance bill down to just a grand or two, or eliminate it entirely. Sign me up.
.

But your bill would be $4,000, plus the $9,600, because as you already have insurance, you're not one of the 47,000,000 uninsured that the CBO says that the bill targets. This is a good illustration of how the estimates, no matter whos, are impossible to make into more then just wild guesses. How many people would say the same thing? Heck, I'm reletively young, but $2,000 is cheaper for me. Problem is, say another 100,000,000 people want in, it's not going to be $2,000 any more.

This is an impossibly complicated subject, and for a bit of levity, check this link out. It has some interesting graphic illustrations of how much a trillion is. http://www.mint.com/blog/finance-core/visualizing-one-trillion-dollars/

[Andrew Rogove]

It is with great interest that I read this discussion. Many interesting voices from all around the country. First off I'll disclose that I am a physician and will naturally have a biased view in this debate. However, this is an important subject for all, most of all patients and how care will be affected depending on what gets passed in DC. I'd like to make a few points/comments on things as I see them.

First off, every one has access to emergency health care, not every one is insured. Anyone can walk into an ER and receive care, they will also receive a bill which they may or may not pay. The number of 47 million uninsured is staggering, but any one of them can walk into my ER and I will/ am legally obligated to treat them without regard to getting paid for my services. (Thank goodness for the 250 million insured). As pointed out earlier, this is a large part of why health care costs are so high.

Second, currently there is a great shortage of docs in many areas. Asking these docs to see more people for less money just won't work. I do not live in one of these areas and will have to accept less for more work, if I don't somebody else will.

Third, assuming that I am correct in stating that in many areas there is a doctor shortage that is taking care of the 250 million insured, in their office, not the ER, who will take care of the 47 million newly insured. We will need more docs. Try to tell a smart 22 year old kid, graduating college, deciding between med school, law school and business school that they'll spend the next 7-10 years in med school/residency/fellowship and make less that their predecessors, but still have 300-400K in loans (assuming private schools). What choice will they make?

Fourth, as stated before lawyers are a problem. They are making policy, as most of our elected officials, including our President, are lawyers. I doubt they have everyone's best interest at heart. They are the ones that enable people to file frivolous lawsuits, (I have no problem with docs being punished for true malpractice), that lead to high malpractice rates and higher health care costs in the form of defensive medicine. Health care reform should include something regarding tort reform and control of malpractice (and hence defensive approaches) costs. My understanding is that the current bill in Congress does not address this issue.

Fifth, also as stated before pharmaceutical companies must be held responsible to lower costs. They should be commended for the generous patient assistance programs already in place, many of my patients get a $20k/yr med for free, but they need to reign in costs. Perhaps tax breaks for those companies that prove that a certain percentage of profits are going into R&D as opposed to bonuses and salaries.

Sixth, insurance companies need to be controlled. I am fighting more and more to get my patients care they need, be it medicines not on formulary, an MRI or CT or even physical therapy. My patients co-pays are rising continuously. I don't think that their premiums are decreasing however. I don't think that the health insurance company execs bonuses or salaries are decreasing, nor are their profits shrinking.

A few final thoughts about this bill before congress- the AMA supports it, but please don't think that all physicians think that it is the best way to run the health care system. Spending 1+trillion dollars and insuring the majority of the currently uninsured is not reform, not an overhaul of the current health care system. It just adds money to things, that might be better spent elsewhere in our health care system that would allow greater/better access for all Americans. It will be interesting to see how this issue turns out during the summer and fall. Clearly something needs to be done with our health care delivery system, there is just too much unnecessary waste currently. In my opinion true reform would address these issues instead of throwing an inordinate amount of money at a sub-par solution.

I just hope that the solution that is finally reached does not drive out experienced physicians, ones who have enough money to retire and don't want to work more for less no matter how caring they are. We are already "outsourcing" our physician supply in many areas, I hope for all patients that this is not going to be a growing necessity to replace a mass exodus of experienced physicians from their practices.

Thanks for allowing me to rant a bit, this is a matter near and dear to my heart without any easy answers. I wish our Congresspeople would read this thread as I think there are many opinions expressed here of which they should be aware prior to voting on any bills.

[Rod Upfold]

Wow - how do you afford hospital stays.

My kids when they were born didn't cost me a cent.

My son is growing his forth brain tumour and is on chemo ($3000.00 for a weeks worth of chemo pills) and all the other pills. He has spent time in the hospital (2 weeks after the third operation) for an infection in his brain and they raced to the hospital (60 miles) in a ambulance. Then a month ago he spent time (1 week) in the local hospital for brain swelling. He gets a VON nurse, speech therapist, physical theraipist (there is one more but I can't think what it is) and then he gets a walker and wheel chair (rentals) leg support and a cane.

None of the three brain operation has cost a cent..nor the followup or the monthly MRI's

We get millage and parking for taking him down to London (60 miles).

How do you afford a hospital or followup charges in the states - it hasn't cost my son or me a cent.


Rod

[Scott Shepherd]

Thank you Dr. Rogove, very well said! And thanks for your service to all of us normal people :)

[Bonnie Campbell]

Wow - how do you afford hospital stays.....

....
How do you afford a hospital or followup charges in the states - it hasn't cost my son or me a cent.


Rod

Sorry to hear of your sons health problem. I'll send up some prayers for him, if you don't mind.

That's the problem Rod, a lot can't afford it. Even with health insurance at times I hear of people losing their homes to pay the bills.

Bills are outrageous. Hubby got hauled from a doctors office across the street (literally!) to the hospital by ambulance. The ambulance cost $800! Then two days in the hospital so they could monitor him cost $6000. There went the savings account! BUT, since we could pay cash to the hospital, they knocked off 1/3 of the bill. Hmmm, tell me why they said $6,000 if $4,000 would do in cash?

That being said, and me NOT having any insurance, I still don't know if I agree with universal coverage. What I have seen is they need more 'general' doctors. There are so many specialists (and few locally anyway) that you don't even know who to try getting an appointment with. Hospitals need to set up clinics to cover the people that haul their kids into the ER for a cold. Not have them taking up space in the ER itself and tying up staff that decides not to prioritize because they've got a ranting mother that demands their child with a cold be seen NOW.

I just don't see the inept government fixing the health care situation. You know darned well the politicians will still have better care available to them, as they do now. There is plenty of politics in the health care profession itself.

Okay, done ranting :rolleyes:

[Rod Upfold]

Sorry to hear of your sons health problem. I'll send up some prayers for him, if you don't mind.

The ambulance cost $800! :rolleyes:


Thank you for the prayers...we will find out on Monday if this brand of chemo is working - if not there are two other types that they can use.

The only time we pay for an ambulance is when you take one to the hospital and your not kept overnight. They do this to stop people from using ambulance for useless reasons. The ambulance cost $75.00.


Rod

[Frank Hagan]

I suspect many of you are not quoting the actual amounts the hospital gets. Because of our insurance system, hospitals "overbill" and then the negotiated rate kicks in.

My wife's recent surgery was $54,000 (hospital portion only, but that included the anesthesiologist). From diagnosis to surgery was 4 weeks. Aetna's negotiated rate with the hospital was $13,000. We pay 20% of that.

She is participating on a forum with Canadian participants as well. They are waiting weeks for treatment. They are worried their cancer will change, and metastasize unexpectedly, as it sometimes does. One of the participants was able to "jump the line" because of a cancellation ... but it was the fifth time she did not eat after 6 pm and waited at the hospital for an opening. She is a nurse.

Belinda Stronic, a member of Parliment who opposed opening up the Canadian system to private health care, was diagnosed with breast cancer in June of 2007. She did what many Canadians do ... rather than wait for the Canadian system, she flew to UCLA and had her surgery here. Canadians have an 'escape valve' to their south, and the provinces can airlift people to the US when their facilities are full. We don't have that luxury.

Sally Pipes is the executive director of the Pacific Research Institute in San Francisco. Her mother lived in Canada, and called her .... she thought she might have colon cancer. Her doctor said she didn't, but didn't perform the gold-standard test, a colonoscopy. She was too old. They took an x-ray. You don't see cancer on an xray very often. A year later, her mother called back and said she was sure she had colon cancer; she was bleeding. The doctor told them to be sure and have an ambulance deliver her to the hospital, because she would wait too long in admitting otherwise. She spent two days in the ER, and they stabilized her, and then she spent two days in the "transit lounge" waiting for a bed. She got her colonoscopy after that, but it was too late; the cancer was well advanced and she died two days later.

She had free medical care right up until the time she died. It just wasn't GOOD medical care.

[Scott Shepherd]

What bothers me is that someone else is making me do something I don't want to do. We are a free society, we should be able to make our own decisions. If I decide I want a premium plan, I can pick that. If I don't want any care at all, I can pick that too. If I want a $20,000 a year policy and I make $30,000 in salary, perhaps I should try and figure out how to better my situation where I can get to that point. Some people can't make those choices, I understand that, and I agree, as a society, we need to step in and help those that cannot help themselves. However, it's not the majority that doesn't have healthcare, it's the minority. So we're changing EVERYONE's policies.

However, in order to help them, why do I have to lose my right to choice? So to help them, the majority have no say so. If I don't want health care, I'll be fined. Since when, in this country, has anyone had the right to fine me for doing something I don't want to do, that's not illegal. That's my right. If I pay my taxes, then I should be able to make the decisions I want to and live me life how I want to, not how it's mandated to me by some suit.

If we go get lunch and we're sitting in a restaurant, and we have plates of food we paid for and someone comes in that can't pay and wants food, would it be their right to take your food and feed the person that couldn't pay? You wouldn't tolerate that in your dining experience, or anything else in life, but you get in line to have that happen to your HEALTH care? I don't get it. Never will.

It's all well and good, and the cause is noble, but not at the cost of losing our freedoms.

Just my opinion.

[Ken Fitzgerald]

Everyone.....a friendly reminder about keeping politics out of this discussion.......... Please!


Scott,

Unfortunately you wouldn't recognize the US if you had total freedom to do what you want. There are laws restricting what you can and cannot do in about everything. Some people choose to disregard or disobey those laws and pay the penalty.

Should I have the freedom or choice to drive drunk?

Should I have the freedom to shoot you because we have a disagreement?

You might think these are extreme examples of restrictive laws but those are just a few of many I can provide.

I'm so glad a doctor jumped into the thread. A couple of things we need to realize and he pointed them out. I'll tell you what I know from personal experience.

There is a tremendous shortage of doctors in general and primary care physicians in particular ....they used to be GPs and probably called Family Practioners today? Why? Typically they don't make the same kind of money a surgeon, neurosurgeon, orthopaedic surgeon.....the specialty physicians do.

I have a younger sister who is a Family Nurse Practioner. She works in the coal mining country of eastern Kentucky. She and 4 other FNPs run 5 clinics, do rounds in a hospital and teach at the oldest midwifery school in this country. My sister is one dedicated, intelligent, hardworking woman and I'm proud to call her "Sis"! Why does she and the other FNPs work so hard? They can't get enough primary care physicians to move to the area. Most people there don't have or can't afford health insurance. My sister tells me she spends a huge amount of her time looking for over the counter meds that she can recommend to her patients because they can't afford and won't fill a prescription if she writes one. Primary care physicians don't make the mega-bucks other specialty physicians do.

Explain to me why we have the drug buses as pointed out by someone else where people are going to Canada to buy the same prescription medication they can get here in the US? Why does a drug manufactured by drug company "A" cost more here than there. I suggest that it is another case of either drug company A is using the "What the market will bear" attitude and the US consumer is bearing it, OR they are willing to sell at a lessor margin of profit there...... Regardless, something stinks about that!


Scott,

You saw Glenn Clabo and I going at it earlier in this thread. Glenn finally tried to soften the conversation by suggesting we each go have a Leinie. The point being, Glenn and I often disagree as we often approach things from a different direction. Glenn would proabably tell you I'm too conservative. I'll probably make the opposite statement about Glenn. The truth is we have both encountered extemely profound medical expenses. I was the lucky one. My wife had an extremely deadly form of cancer nearly 17 years ago and required 7 hours of surgery by 5 surgeons at the University of Washington Medical Center, Seattle. Was it expensive? You bet it was and damn well worth it.

I work for large corporation and made friends with a co-worker from another country while we were students together attending a company school. A few years later he called me at home and offered me a job as he is the lead engineer in his area. I considered getting the company to write me a 4 year contract to work there and then bringing me back to Idaho for the last 2 years before I retire. Then I found out what they pay in taxes there! It would have nearly doubled what I pay here in the US. Why? They have semi-socialized medicine. If you can't afford insurance, you medical is paid for you. If you can afford insurance, you have to buy it. As my employer provides a large part of our health insurance and we pay the rest, I would have had to do both....pay for insurance and pay incredibly increased taxes. I turned down the opportunity but later visited him.

I only hope if this country is going to a nationalized health system that they don't rush just to get it done. Do it intelligently and find a way to pay for it.

[Mike Henderson]

What bothers me is that someone else is making me do something I don't want to do. We are a free society, we should be able to make our own decisions. If I decide I want a premium plan, I can pick that. If I don't want any care at all, I can pick that too. If I want a $20,000 a year policy and I make $30,000 in salary, perhaps I should try and figure out how to better my situation where I can get to that point. Some people can't make those choices, I understand that, and I agree, as a society, we need to step in and help those that cannot help themselves. However, it's not the majority that doesn't have healthcare, it's the minority. So we're changing EVERYONE's policies.

However, in order to help them, why do I have to lose my right to choice? So to help them, the majority have no say so. If I don't want health care, I'll be fined. Since when, in this country, has anyone had the right to fine me for doing something I don't want to do, that's not illegal. That's my right. If I pay my taxes, then I should be able to make the decisions I want to and live me life how I want to, not how it's mandated to me by some suit.

If we go get lunch and we're sitting in a restaurant, and we have plates of food we paid for and someone comes in that can't pay and wants food, would it be their right to take your food and feed the person that couldn't pay? You wouldn't tolerate that in your dining experience, or anything else in life, but you get in line to have that happen to your HEALTH care? I don't get it. Never will.

It's all well and good, and the cause is noble, but not at the cost of losing our freedoms.

Just my opinion.
Of course, we don't know exactly what any plan will look like yet, but I would expect it to be something like liability insurance on your car. The state mandates that you carry some minimum level of insurance. If you want to carry more, that's up to you.

But just like auto insurance, you have to have some. If people are not required to carry health insurance, we're right back where we are today with 47 million people uninsured because "nothing's going to happen to me" or "I'm too young to have health problems" or "I have other things to spend my money on." Of course, when you do have problems, you'll be right there looking for someone else to pay for your care.

Mike

[Phil Thien]

There is a tremendous shortage of doctors in general and primary care physicians in particular ....they used to be GPs and probably called Family Practioners today? Why? Typically they don't make the same kind of money a surgeon, neurosurgeon, orthopaedic surgeon.....the specialty physicians do.


Another thing that would probably help is more physicians assistants and nurse-practitioners. No need to waste a good diagnosticians time for simple things (sinus infection, rash, etc.). We have several local quick clinics that are quite reasonably priced, and do great triage.

Rather than giant changes to what we have now, I'd prefer fine-tuning it. We can make private insurance work by limiting the stratification of rates by eliminating pools. We can crack-down on pharma. We can create regional pools where hospitals have to compete for the opportunity to add beds/new diagnostic equipment (to eliminate duplication).

There are so many things we can do that don't require throwing the baby out with the bathwater.

[Steve Rozmiarek]

Another thing that would probably help is more physicians assistants and nurse-practitioners. No need to waste a good diagnosticians time for simple things (sinus infection, rash, etc.). We have several local quick clinics that are quite reasonably priced, and do great triage.

Rather than giant changes to what we have now, I'd prefer fine-tuning it. We can make private insurance work by limiting the stratification of rates by eliminating pools. We can crack-down on pharma. We can create regional pools where hospitals have to compete for the opportunity to add beds/new diagnostic equipment (to eliminate duplication).

There are so many things we can do that don't require throwing the baby out with the bathwater.

Phil, your last few posts have been really intriguing, IMHO. I think you have some really good ideas.

[Greg Peterson]

Recently released CBO report states that the house plan as it stand now is budget nuetral.

Perhaps were we to provide a college education and training for doctors we could entice our brighter students into becoming GP's and serving a small communnity for a defined period (ten years?). Other countries do this.

There are many, many great idea's out there, there are many examples of both good systems and bad systems. I don't see why we can't apply the better idea's and come up with a system that serves our best interests.

The current system will simply imploded under its own weight. To many people, through no fault of their own, and the number continues to grow, are falling into ever expanding gaps in coverage. Financial ruination is the least of these persons problems. At times the very medicine and/or procedures are simply beyond their means.

[Scott Shepherd]

Unfortunately you wouldn't recognize the US if you had total freedom to do what you want. There are laws restricting what you can and cannot do in about everything. Some people choose to disregard or disobey those laws and pay the penalty.

Should I have the freedom or choice to drive drunk?

Should I have the freedom to shoot you because we have a disagreement?

You might think these are extreme examples of restrictive laws but those are just a few of many I can provide.



Those aren't examples of a lack of freedom at all. You have the freedom to drive drunk all you want. However, it is illegal and you will pay the price by going to jail.

You have the freedom to shoot whoever you want. Do it and you'll go to jail.

I really don't think I should go to jail if I don't want to buy what you're forcing me to buy and I have no say so in it.

Both of your examples are examples of things that are against the law. Do you really believe that it should be against the law for me to not have health insurance? Perhaps my beliefs are in Chinese Medicine and I have a personal belief that you should treat the body with natural ingredients only. That might be my belief. So now I have to pay for something I don't believe in or want. It should be my right to chose.

I do not believe it should be criminal to opt out of the program. If we're trying to cover the people who want and can't afford coverage, then why do you force me to change what I already have and want?

I don't trust the government to fill a pothole, much less tell me how to take care of my medical issues. Medicaid and Medicare are both going broke and are both run by the government. Yeah, there's a great track record, you're batting 0 for 2 in health care and you want me to get in line to sign up for this? No thanks.

[Andrew Rogove]

IAs pointed out, in many areas NPs and PAs are critical in providing care, especially primary care. These "physician extenders" as some call them can multiply the productivity of one physician and an experienced NP/PA can provide more than just basic care. I believe that the health care bill, and Obama himself supports the utilization of NP/PA's. However, for this to become reality, and truly lower costs, people must get used top seeing them. I have had many patients switch to me because the competing practice in my area utilizes NPs and PAs and patients want to see "the doctor" even for maintenance checkups with no new problems. Also the system must be fine tuned/changed so that these "mid-level" practitioners are not forced to practice defensive medicine, order unnecessary tests and consultation with specialists. BTW, the AMA and most state medical societies actively work to limit the scope of practice of these health care providers- self-preservation I guess.

In my opinion, and I agree with many here, the health care system in the US does need change, but not a major overhaul in the time frame proposed. Fine tweaking here and there can improve efficiency and save money. We did not get into this problem over one summer, so why do we need to rush and fix it with an all encompassing bill that "must" be passed before summer session ends?

[Mitchell Andrus]

100!

This is my first thread to top 100 posts. There's a prize, right?

[Scott Shepherd]

100!

This is my first thread to top 100 posts. There's a prize, right?

Yeah, "free" healthcare. All you want. I'll pick up the tab, don't worry about the cost :D

[Phil Thien]

Do you really believe that it should be against the law for me to not have health insurance?


When taxpayers are the insurer of last resort, it is understandable that they would want people with the means to pay for insurance to be forced to do so.

I had a buddy give me the same "What if I would never go to the hospital due to my belief system" argument. But the answer is akin to "there are no atheists in fox holes." Shatter an ankle in seven ways, or get a gash to an arm that turns into a massive blood infection, and even the naysayers are headed for the hospital. I suppose in the very rarest of exceptions some people will refuse medical treatment and instead prefer death. In those cases, I say we happily reimburse their estates of all the fees they paid for insurance, plus interest. I'm confident it will be a very rare occurrence.

[Scott Shepherd]

Phil, it's not about being a rare occurrence, it's about my right to have a choice. It seems choice is favored in one particular medical issue we won't discuss, but it's not okay for me to have a choice. So choice seems to be good, unless you don't want choice, at which time everyone else that wants a choice, loses their ability to have a choice.

I'm just trying to figure out the logic. Choice is good for them on "Subject A", but choice is bad for me on "Subject B".

[Mike Henderson]

I do not believe it should be criminal to opt out of the program.
I think Phil answered your question pretty well, but I'll add to it. Let's suppose we allowed people to "opt out". Then, you have some medical issue. If we, as a society, were willing to leave you out on the street to die, it would work. You would suffer the consequences of your decision.

But that's not the kind of society we are. You will receive treatment, and you didn't have any insurance.

So the only thing that works is to require everyone to be part of the pool. That doesn't mean you can't get your own insurance, just like automobile insurance. But you have to carry it.

Seems pretty reasonable to me.

Mike

[Andrew Rogove]

100!

This is my first thread to top 100 posts. There's a prize, right?

Yes, but did you ever think that a copy of a nearly 60 year old hospital bill would start a debate on health care reform?

[Greg Peterson]

How many of the roughly 500,000,000 people in America actually pay taxes?

There are roughly 300,000,000 people in America.

I've heard pundits complain that roughly 40% of Americans don't pay taxes. That is an alarming figure if you acept it at face value. But once you reveal the slight of hand and remove the false frame you discover that the folks that fall into this group are actually Americans that don't earn enough to pay federal income taxes. the working poor.

No one, even the homeless or street people are able to avoid paying taxes. Whether through direct payroll deduction or consumer goods everyone pays taxes. To claim that 40% of Americans don't pay 'taxes' is beyond irresponsible and has little difference from shouting Fire in a movie theater.

[Mitchell Andrus]

Yes, but did you ever think that a copy of a nearly 60 year old hospital bill would start a debate on health care reform?

Well, start talking about health care with the nearly 60 year old who generated the bill and..... duck for cover!
.

[Frank Hagan]

Recently released CBO report states that the house plan as it stand now is budget nuetral.


Really? The last I heard, late last week, the head of the CBO was saying the House plan would cost nearly a trillion dollars. I can't find any "revenue neutral" statement except from politicians.

[Scott Shepherd]

I think Phil answered your question pretty well, but I'll add to it. Let's suppose we allowed people to "opt out". Then, you have some medical issue. If we, as a society, were willing to leave you out on the street to die, it would work. You would suffer the consequences of your decision.

But that's not the kind of society we are. You will receive treatment, and you didn't have any insurance.

So the only thing that works is to require everyone to be part of the pool. That doesn't mean you can't get your own insurance, just like automobile insurance. But you have to carry it.

Seems pretty reasonable to me.

Mike

So I'm supposed to pay for an alcoholic that's drank himself 1/2 to death, knowing that what he was doing is harmful? I'm suppose to pay for the smoker who's known for 30 years that smoking is bad for them? So I'm supposed to pay for the person who weighs 400 pounds because they refuse to get a job, eat healthy, or exercise? So I'm supposed to pay for the drug addict that doesn't want to get clean, but needs health care?

Yeah, that sounds really reasonable to me.

[Frank Hagan]

I think Phil answered your question pretty well, but I'll add to it. Let's suppose we allowed people to "opt out". Then, you have some medical issue. If we, as a society, were willing to leave you out on the street to die, it would work. You would suffer the consequences of your decision.

But that's not the kind of society we are. You will receive treatment, and you didn't have any insurance.

So the only thing that works is to require everyone to be part of the pool. That doesn't mean you can't get your own insurance, just like automobile insurance. But you have to carry it.

Seems pretty reasonable to me.


Why is health insurance treated any differently than life insurance?

Society has a cost if any of us die and our loved ones are left to struggle on their own. Many times orphans and widows end up on welfare. Should we mandate that everyone, no matter the age, take out government life insurance? After all, its those young people with many years until they die that are NOT buying and increasing the rates for those of us in our later years. They should help subsidize us.

Speaking of "subsidies", the reason the Canadians pay less for medicine is that we pay more. Canada, a country with a population less than 10% of the US, negotiates with our drug companies for cut rate prices. Pharma also has other programs to help the indigent get drugs, and it amounts to about the same subsidy given to keep business in Canada. Big pharma is made up of mostly public companies, so you can see their rate of return reflected in their quarterly 10-Q reports, freely available. None of them are "robber barons"; they have a good rate of return for their investors (mostly retirement funds of public employees and school teachers).

The shortage of doctors could be because of the AMA's efforts to prevent new medical schools from opening. Allowing more medical schools, as well as associated schools such as Osteopathy, would provide more doctors.

The "50+ million" uninsured are made up of various groups. The largest is unemployed people who have lost their health insurance with their jobs. They typically stay unemployed for a few weeks to a few months, and then have insurance again. The estimates I've heard are that there are about 6 million people who fall into the gap between existing state programs and having resources to afford their own. Surveys show that those that have medical insurance are generally happy with it.

All legislation carries unintended consequences. The unintended consequence of the proposals being considered today will be the transfer of up to 100 million people from employer sponsored plans to the "public option". That's because employers would rather pay a static, established fine than deal with variable health care insurance costs. The costs for this program will skyrocket. And then the cost cutting will come in.

All of us engage in an inherently dangerous hobby. Some 60,000 emergency room visits per year are due to powered saws, most of those from home hobbyists. What right do we have to clog up the ER and increase costs for all of the rest of society because we want to engage in this hobby?

Just like the unanimous bill addressing lead in children's toys resulted in the outlawing of the sale of youth motorcycles (and even bicycles), any comprehensive health care reform from the feds will be a frankenstein's monster. It is better handled on the state level, where the "laboratories of democracy" will fine tune plans that work. After all, our states are huge governments, with several of them about the size of Canada in terms of population.

[Steve Rozmiarek]

There are roughly 300,000,000 people in America.

I've heard pundits complain that roughly 40% of Americans don't pay taxes. That is an alarming figure if you acept it at face value. But once you reveal the slight of hand and remove the false frame you discover that the folks that fall into this group are actually Americans that don't earn enough to pay federal income taxes. the working poor.

No one, even the homeless or street people are able to avoid paying taxes. Whether through direct payroll deduction or consumer goods everyone pays taxes. To claim that 40% of Americans don't pay 'taxes' is beyond irresponsible and has little difference from shouting Fire in a movie theater.

Greg, you're not the first to point out my wrong guestimate on the population of the US, I appear to be wrong on that. The latest Congressional Budget Office report states that this bill will cost at least 1 trillion dollars. I can dig up the link if you want.

As for the tax payers, I guess it's what you consider "paying" taxes. My personal definition is if you end up paying more then the any refunds, you pay taxes.

I have a couple young children, and am around their peer's parents for school functions. Taxes always become a ticket for conversation around April 15th, as do "what are you spending your refund on?", subjects. With further prodding, its easy to see that a good portion of these folks do not pay in as much as they get out. Simple answer EIC, and minimum AGI. Ok, these folks will eventually earn more maybe, and start paying taxes, but when will they actually pay more then they have taken out?

I've heard these folks called the "working poor" before. That label bothers me I guess, but as this conversation is about health care, not income tax, we'll leave that for another day.

Bottom line is, the top 5% pay 90% of the taxes. The bottom 60% of wage earners get net more then they pay. This info is from the Tax Foundation.

[Andrew Rogove]

Well, start talking about health care with the nearly 60 year old who generated the bill and..... duck for cover!
.

I guess you'd better make sure that you have health insurance before starting that conversation:eek:

[Mike Henderson]

So I'm supposed to pay for an alcoholic that's drank himself 1/2 to death, knowing that what he was doing is harmful? I'm suppose to pay for the smoker who's known for 30 years that smoking is bad for them? So I'm supposed to pay for the person who weighs 400 pounds because they refuse to get a job, eat healthy, or exercise? So I'm supposed to pay for the drug addict that doesn't want to get clean, but needs health care?

Yeah, that sounds really reasonable to me.
Well, assuming those people have health insurance, you're already paying for them because they're in the same pool with you. And if they don't have insurance, you still pay through taxes. Health care for those people is not free - someone pays for it and guess who it is? You and me.

Unless we, as a society, are willing to leave those people on the street to die, someone has to pay.

But you do raise the issue of "further down the line". Let's assume everyone is put into the same pool and the cost of health care for the people in the pool are distributed across the members of the pool (using some kind of fair method). Eventually, the members of the pool will begin to demand that people who have unhealthy habits change their ways so that the cost of health care is less for everyone. Alternately, people with unhealthy habits might be charged more for their health insurance, just like today.

Mike

[Mike Henderson]

Why is health insurance treated any differently than life insurance?
Because health insurance is different than life insurance.

For example, if you're young and single and you die, it will not be a financial burden on anyone. If no one is dependent on you for their livelihood, it will not be a financial burden to anyone if you die. And we do have government insurance for survivors if they are destitute - it's called welfare.

Mike

[Mitchell Andrus]

So I'm supposed to pay for an alcoholic that's drank himself 1/2 to death, knowing that what he was doing is harmful? I'm suppose to pay for the smoker who's known for 30 years that smoking is bad for them? So I'm supposed to pay for the person who weighs 400 pounds because they refuse to get a job, eat healthy, or exercise? So I'm supposed to pay for the drug addict that doesn't want to get clean, but needs health care?

Yeah, that sounds really reasonable to me.

.
That's an unreasonably harsh tone. Assuming you REALLY mean this, you'll stop collecting social security when you've gotten ONLY the money that you've put in. You'll also stop your medical care when you've exhausted ONLY the money you've put in as premiums.

So,,, to flip your examples of fat, lazy drug addicted smokers over.... You'd also be paying for the healthy child who falls and breaks his arm, but who will likely not need another dime in care until he is well into his 50's and who will pay into the system towards the day when he MAY need a doctor again. The bad ones drive costs up, the good ones drive costs down. There are far, far more healthy people who won't see a doctor for years than there are drug addicts and heart by-pass candidates.

Tell the kid to set his own arm if his parents are not able to pay for insurance, right?

Shared costs make the paved roads we all drive on possible. But.... let's close the roads to anyone who lost their job and isn't paying taxes anymore. Jeesh!
.

[Ken Fitzgerald]

I'll guarrantee you will win fewer convertees to your side of this debate by being venomous!

Let's keep it civil and non-political, please.

[Frank Hagan]

Because health insurance is different than life insurance.

For example, if you're young and single and you die, it will not be a financial burden on anyone. If no one is dependent on you for their livelihood, it will not be a financial burden to anyone if you die. And we do have government insurance for survivors if they are destitute - it's called welfare.

Mike

So would you exempt young people who are not married from health care insurance? They rarely use the benefit.

I've head various statistics, but many of the uninsured are people with incomes over $70,000 a year. They probably don't have life insurance either, making life insurance for me more costly. Its the same argument.

One of the alternate plans floated is to require at least a catastrophic insurance policy, one that could be underwritten by a national company without regard to the patchwork of 50 state insurance board laws. This is really a tax on young healthy people for being, well, young and healthy. Maybe they should take up smoking.

One of the House proposals requires people to go into the "public option" when they change jobs or lose their insurance, and they can't go back to private insurance. The government intends to force doctors to take Medicare reimbursement for these people, which means that many doctors will either refuse to take them (as they do Medicaid patients now) or just quit. If you think we have a shortage of doctors now, wait until this frankenstein medical healthcare fiasco passes.

Our legislators are not smart enough to make this work.

[Scott Shepherd]

I'll guarrantee you will win fewer convertees to your side of this debate by being venomous!

Let's keep it civil and non-political, please.

Ken, I'm not sure where you read venomous in my words, but what I said was never intended that way. We are having a discussion, not a debate (well, at least I am). A debate is a contest to see who wins. A discussion is back and forth conversation to express different points of view, with no one being declared a winner. In my context, I'm not trying to convert anyone, I'm just trying to show not everyone is ready to go stand in line and sign on the dotted line, and perhaps, it's not the best path to make me go sign up against my will.

I respect others are ready to sign up. I support their rights to do so. I hope they support my rights to not sign up.

If you go back to my original postings about it all, I still stand by the fact that this is not a "Health Care" problem, it's a process problem. Everything we do is a process. Dialing the phone, making a sandwich, performing open heart surgery, going to the moon. Everything has a process. I firmly believe this, at it's core, is a process problem within the health care system. Process problems are relatively easy to map out and correct. I believe changing the process could yield very positive results. I stand by that belief.

Also, I'm already paying for the crack head who gets free health care, so going to a new system wouldn't change that fact at all. If you read what the good Doctor said in a previous post, NO ONE is being denied health care. People can't afford INSURANCE. It's not a health CARE issue, it's a health care INSURANCE issue. We can fix that.

[Mike Henderson]

So would you exempt young people who are not married from health care insurance? They rarely use the benefit.

I've heard various statistics, but many of the uninsured are people with incomes over $70,000 a year. They probably don't have life insurance either, making life insurance for me more costly. Its the same argument.

One of the alternate plans floated is to require at least a catastrophic insurance policy, one that could be underwritten by a national company without regard to the patchwork of 50 state insurance board laws. This is really a tax on young healthy people for being, well, young and healthy. Maybe they should take up smoking.

One of the House proposals requires people to go into the "public option" when they change jobs or lose their insurance, and they can't go back to private insurance. The government intends to force doctors to take Medicare reimbursement for these people, which means that many doctors will either refuse to take them (as they do Medicaid patients now) or just quit. If you think we have a shortage of doctors now, wait until this frankenstein medical healthcare fiasco passes.

Our legislators are not smart enough to make this work.
Frank, I don't know how you read such things into my words. As I said, life insurance is different than health insurance. A young person doesn't need life insurance because they don't have anyone dependent upon them.

But a young person may need medical care, either from accidents (which young men, especially, are prone to) or illness, including catastrophic things like cancer.

If someone else does not have life insurance, your life insurance payment is completely unaffected because the uninsured person won't collect anything. So, no payment, no expense for the life insurance company, no change in your premiums.

And regarding requiring all citizens to carry medical insurance, it is only by having a large pool that insurance becomes affordable. We already have the situation you describe today. You have a pool and allow all the young, healthy people to opt out. That leaves only the sicker people in the pool, and that drives up the premiums. Soon the insurance is too expensive for the people left.

By having only one pool, and requiring everyone to participate, the sicker people can afford the insurance. And when the younger people get older, or sicker, they will have medical insurance available to them because the new younger people are participating.

Otherwise, you have a "pool" of one, where the rates are set based on the health history of the individual. That's not insurance. That's paying for your health care yourself, because the insurance company will charge you what they expect you to cost them. So try to buy an individual policy and that's what you face - a pool of one.

But rather than complain, propose a solution that you'd prefer.

Mike

[Let me add that while I support the concept of a single pool for health insurance, I also strongly support the idea that medical services should cost people something. That is, there should be an incentive against utilization. The "incentive" should be adjusted so that it's about equal for all levels of income (it should vary depending on your income). Whenever things are free, we have the problem of the "tragedy of the commons" where everyone has an incentive to use as much as possible.]

[Ken Fitzgerald]

Scott,

I don't remember singling you out with that statement.

I was making a generalized statement.

Whether discussing or debating, people who come across harsh and venemous will turn off more people than they win over. As a result, whether it's a discussion or a debate, they will not get the same support they might have gotten with a more civil tone.

Just a statement......just an observation.....JMHO.

[Greg Peterson]

So I'm supposed to pay for an alcoholic that's drank himself 1/2 to death, knowing that what he was doing is harmful? I'm suppose to pay for the smoker who's known for 30 years that smoking is bad for them? So I'm supposed to pay for the person who weighs 400 pounds because they refuse to get a job, eat healthy, or exercise? So I'm supposed to pay for the drug addict that doesn't want to get clean, but needs health care?

In short, yes. This is the current arrangement. It is the very nature of insurance. Whether it is paid by federal dollars or private dollars is irrelevent.

[Darius Ferlas]

What about taking drugs off patent protection sooner? That may hurt development I suppose. I sure there is a way to continue drug development, but provide a capitalistic price capping mechanism. Maybe change the patent laws so that the inventor companies get income off licensed production, but for a longer period of time, so they have a way to turn a profit on the R&D cost.

The issue for sure isn't as simple as I presented, but as for R&D, it's the usual thing big pharma throws back when people complain about the cost of drugs.

It turns out the pharmaceutical industry spends almost as much on advertising (24.4%) as they do on R&D (13.4%). I'd say keep them R&D dollars intact and get rid of the advertising. Every little bit would help.

[Greg Peterson]

As for the tax payers, I guess it's what you consider "paying" taxes. My personal definition is if you end up paying more then the any refunds, you pay taxes.
...
Bottom line is, the top 5% pay 90% of the taxes. The bottom 60% of wage earners get net more then they pay. This info is from the Tax Foundation.

I hardly know where to even begin. Suffice it to say we will have to disagree on some fundemental areas. I won't defend the rich. They've get everything they want and they're getting more every year.

We're just trying to figure out how to keep our fellow citizens, and potentially ourselves, from losing everything should they contract a serious illness or injury.

[Art Mulder]

Folks, this is a fascinating thread to read. I appreciate how it has stayed civil and thoughtful, and all the interesting thoughts and stories being shared.

One thing that I notice that does seem to be universal among the comments here by Americans is unhappiness (or at least dissatisfaction) with the current health care system.

...art
(Happy to be Canadian...)

[Ken Fitzgerald]

Folks, this is a fascinating thread to read. I appreciate how it has stayed civil and thoughtful, and all the interesting thoughts and stories being shared.

One thing that I notice that does seem to be universal among the comments here by Americans is unhappiness (or at least dissatisfaction) with the current health care system.

...art
(Happy to be Canadian...)

Well it was civil until this little barb got slung!:eek::rolleyes:

[Frank Hagan]

Folks, this is a fascinating thread to read. I appreciate how it has stayed civil and thoughtful, and all the interesting thoughts and stories being shared.

One thing that I notice that does seem to be universal among the comments here by Americans is unhappiness (or at least dissatisfaction) with the current health care system.


As one of my Aussie friends told me, Americans are natural complainers ... about America. We'll wax eloquent about how we must be understanding of other cultures that subjugate women and children, while objecting strenously about invasions of privacy (our government tried to get the right to look at our library cards, for heaven's sake!) We fret and wring our hands at our imperfections all the time. I think its part of our Puritan heritage.

Studies show that Americans ... even an estimated 70% of the Americans who make up the "47 million uninsured" ... are happy about their health care. Those 47 million are more like Canadians in their overall opinions than the 240 million who do have health insurance (who are much happier than Canadians):



Abstract:
The debate over government-provided insurance for Americans frequently makes two assumptions: that the uninsured are unsatisfied with the health care they receive and that government health insurance would improve the quality of care for the uninsured. This paper finds that the vast majority of uninsured Americans are satisfied with their health care. Indeed, only 2.3 percent of Americans are both uninsured and very dissatisfied with the quality of the medical care that they receive. The paper finds that Canadians are much closer to uninsured Americans than to insured Americans in their satisfaction with their health care. There is also little difference in the level of Americans' satisfaction with their health care based upon race, marital status, educational attainment, income, or political views. There is some difference in satisfaction based on age and between the most extreme levels of educational attainment.

University of Maryland study (http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1395928)by John Lott

When they survey people, they are overwhelmingly happy about their own health insurance. We are unhappy not with our insurance, but with the fact that we cannot provide health insurance even for those that don't want it.

All must be saved and enter the gates of heaven, you see. We are Americans, and we worry a whole heck of a lot.

[Frank Hagan]

But rather than complain, propose a solution that you'd prefer.


It seems to me it is those proposing a massive overhaul of our health care system should come up with the solutions that (A) won't cost billions of dollars and (B) eventually lead to a single payer plan and rationing. So far, the legislators have failed, mainly because they cannot solve the problem with 1,000 pages of legislation. Or 20,000. They just aren't smart enough.

But I'll bite. There is actually very little that needs to be done if you only look at fixing the actual problems (instead of just building a legacy). Let's expand welfare to include the roughly 6 million people who fall between the Medicaid and employer-covered plans if we want. This can be done with a mandate to the states, who will determine eligibility, and block grants to pay for it. The cost of doing this will be a fraction of the cost of the proposed plans.

We can encourage national catastrophic illness plans that supersede the state regulators. Not an ideal solution in my view, because the states should be able to regulate the companies in their jurisdiction. But nation wide catastrophic illness plans would be much cheaper if companies like Aflac didn't have to figure out how to meet the requirements of 50 different insurance regulators. It would be cheaper than COBRA, and would be a good option for those between jobs. It could even be subsidized through the state's unemployment insurance plans for those between jobs (who are the majority of the "47 million").

All that needs to be done could be done with three or four individual bills that maintain our freedom to choose. We don't need to rush a bill through in the next 14 days, that no one will read, and that no one will understand, to make it to the President's desk before the next set of jobless numbers comes out.

[Phil Thien]

The issue for sure isn't as simple as I presented, but as for R&D, it's the usual thing big pharma throws back when people complain about the cost of drugs.

It turns out the pharmaceutical industry spends almost as much on advertising (24.4%) as they do on R&D (13.4%). I'd say keep them R&D dollars intact and get rid of the advertising. Every little bit would help.

Yes, kill the pharma advertising. And let's get rid of the personal injury advertising while we're at it.

[Steve Rozmiarek]

The issue for sure isn't as simple as I presented, but as for R&D, it's the usual thing big pharma throws back when people complain about the cost of drugs.

It turns out the pharmaceutical industry spends almost as much on advertising (24.4%) as they do on R&D (13.4%). I'd say keep them R&D dollars intact and get rid of the advertising. Every little bit would help.


Plus, getting those commercials off the air would be nice!

[Ken Fitzgerald]

Those commericials would just be replaced by commercials for "Sham Wow!". Which you rather watch (Are you watching cameraman?).:rolleyes:

[Glenn Clabo]

Another fact that pharms like to keep from the public (somehow being kept from public eyes since 1995)...55% of R&D for drugs comes from the government.

Also...some more interesting data...
http://www.oliverwillis.com/img/ZZ0262A7E0.jpg


Graduated Surcharge Starting at AGI > $350k,
Impact in 2011 in the U.S.
Income Group Average Average Share of Income
Lowest 20%
$ 11,427 $ —

Second 20%

25,994 —

Middle 20%



43,396 —

Fourth 20%



69,347 —

Next 15%



119,539 0

Next 4%



267,646 69

Top 1%



1,497,730 32,656




Source: ITEP Microsimulation Model, July 2009
http://www.ctj.org/itep/model.htm

[Ken Fitzgerald]

So who generated the data Glenn?

What was their bias beforehand?

Data can be biased. I want to know who gathered the data, who paid for it and what was the data gather's bias beforehand.

I can gather data that will justify my stance on a subject.

[Darius Ferlas]

On the second thought, if the Viagra commercials go then there will be little else to watch on TV ;)

A few years ago, when I still watched TV (I quit the habit 2 years ago and I'm TV free) I watched some business news, on CNN I believe. A lady was reporting on some pharmaceutical company that just released a new drug for some chronic condition. Not a treatment, but something mitigating the symptoms. The concluded that the company is now in a good financial situation since that drug was a first.

She said "that's nice because once someone starts using the drug they have to use it for the rest of their lives as the illness is not curable. That will give the company a steady stream of revenue". This is an actual quote, although a little paraphrased. I don't remember the company name, the drug or the condition the drug is for.

Business is business, but still, I felt disgusted with the approach.

Back to the original topic,i.e.
In 1989 in NYC it was $3200.

[Mike Henderson]

It seems to me it is those proposing a massive overhaul of our health care system should come up with the solutions that (A) won't cost billions of dollars and (B) eventually lead to a single payer plan and rationing. So far, the legislators have failed, mainly because they cannot solve the problem with 1,000 pages of legislation. Or 20,000. They just aren't smart enough.

But I'll bite. There is actually very little that needs to be done if you only look at fixing the actual problems (instead of just building a legacy). Let's expand welfare to include the roughly 6 million people who fall between the Medicaid and employer-covered plans if we want. This can be done with a mandate to the states, who will determine eligibility, and block grants to pay for it. The cost of doing this will be a fraction of the cost of the proposed plans.

We can encourage national catastrophic illness plans that supersede the state regulators. Not an ideal solution in my view, because the states should be able to regulate the companies in their jurisdiction. But nation wide catastrophic illness plans would be much cheaper if companies like Aflac didn't have to figure out how to meet the requirements of 50 different insurance regulators. It would be cheaper than COBRA, and would be a good option for those between jobs. It could even be subsidized through the state's unemployment insurance plans for those between jobs (who are the majority of the "47 million").

All that needs to be done could be done with three or four individual bills that maintain our freedom to choose. We don't need to rush a bill through in the next 14 days, that no one will read, and that no one will understand, to make it to the President's desk before the next set of jobless numbers comes out.
I understand your proposal, Frank. One thing that seems to come out in your posting is that you think universal health care will eliminate some of the choices you have today. I don't know the exact proposals making their way through congress, but it certainly does not have to.

In my mind, the goal of universal health care is to create a single pool, or a limited number of large pools, which anyone can join as long as they've had insurance in the past. This will give us the lowest cost for medical insurance. The single pool concept will also prevent the problem we see today where someone is laid off, uses up their COBRA and then cannot get insurance because of pre-existing conditions.

Today, even if you've been covered by medical insurance all your life, when you go to buy a health insurance policy, you're "rated" without regard to prior coverage. I'd like to see insurance be a continuous event. That is, as long as you've had insurance immediately prior, you can switch companies and get a standard rate.

The way I understand your proposal, it would not address these problems in the existing system.

Also, a universal health care system does not have to lead to a single payer system, although that might be good, nor does it have to lead to rationing. As I noted earlier, I believe that every medical procedure should cost the user something. My belief is that if costs are applied (which costs would be prohibited from being covered by insurance), people will think twice about utilization and rationing will not be necessary. My belief is that rationing comes about when there's no cost to medical care, which leads to excessive usage.

Thanks for your thoughtful proposal. It is from examining many good ideas that we'll (as a nation) come up with the best solution.

Mike

[Greg Peterson]

So who generated the data Glenn?

What was their bias beforehand?

Data can be biased. I want to know who gathered the data, who paid for it and what was the data gather's bias beforehand.

I can gather data that will justify my stance on a subject.

The income to expense ratio (Medical insurance, utilities, food, shelter, taxes,.../income) favors the affluent. Not saying it is right or wrong, just a simple fact.

The aggregation of wealth in this country has been steadily climbing. In 1972, the top 5% accounted for 8.7% of total income. In 2006 the top 5% accounted for nearly 20% of total income. I'd have to say the tax codes over the past thirty seven years have not been a hindrance to building wealth. At least for a select few.

[Steve Rozmiarek]

Glenn, I suspect that the ITEP is a very biased organization. Check out the lisk of links to media that they post:

Directory of U.S. Newspapers by State (http://www.usnpl.com/)

ABC News (http://abcnews.go.com/)

CBS News (http://www.cbsnews.com/)

The Christian Science Monitor (http://www.csmonitor.com/)

CNN On-line (http://www.cnn.com/)

MSNBC News (http://www.msnbc.com/news/default.asp)

The New York Times (http://www.nyt.com/)

Tax Analysts Tax Information Online (http://www.tax.org/)

The Wall Street Journal (http://www.wsj.com/)

The Washington Post (http://www.washingtonpost.com/)


Ummmmm, where is Fox News? Lots of people associate Fox with one ideology, but it is the largest single news source now, seems odd that it should not be on the list...

One of the members of the Board of Directors is Robert Reich, who if my memory serves me correctly, was a hugely partisan member of President Clintons cabinet.

They claim to be nonpartisan, but...

More board info:

President Richard Pomp - Democratic appointee to Californias Commision on 21st Centuary Economy
VP Robert Kuttner - Writter/Economist, "The American Prospect, an authourotative magazine of liberal ideas"
Howard Chernish - Institute for Research of Poverty, US Dept of Health and Human Services

I need to get back to work, but with just starting at the top of the list, I'm not seeing much representation of both liberal and conservative ideals.

[Glenn Clabo]

Ken...It doesn't matter anymore. No matter what one group says...another finds some opposite view point based on someone finding a person who is connected to some side.

I quit...after working to defend this country for 38 years...I'll just take advantage of what I got.

ps...I won't do what just said. I REALLY am only concerned with those that don"t have insurance...and those that are at the end of their life trying to figure out how to pay the bill.

[Ken Fitzgerald]

Glenn,

It does matter.

I just want unbiased information/data so I can make an intelligent decision.

There have been too many instances where a person or group has a belief and then finds the data to defend or justify their belief.
To me........providing biased data is just being dishonest.

And no offense Steve, some people may find Fox News as their single biggest point of news information but it is so heavily biased. "Fair and balanced" it ain't.

[Greg Peterson]

Ummmmm, where is Fox News? Lots of people associate Fox with one ideology, but it is the largest single news source now, seems odd that it should not be on the list...

Fox doesn't do news. They offer pundits and on air talk fests. If any news is reported by Fox News it is purely accidental.

For being the so-called largest news channel it is curious they did not recieve one Emmy nomination this year. Walter Cronkite received so many he lost count.

Here are the categories Fox News was unable to compete in:

OUTSTANDING COVERAGE OF A BREAKING NEWS STORY IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING FEATURE STORY IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING CONTINUING COVERAGE OF A NEWS STORY IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING INVESTIGATIVE JOURNALISM IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING COVERAGE OF A BREAKING NEWS STORY IN A NEWS MAGAZINE

OUTSTANDING CONTINUING COVERAGE OF A NEWS STORY IN A NEWS MAGAZINE

OUTSTANDING FEATURE STORY IN A NEWS MAGAZINE

OUTSTANDING INVESTIGATIVE JOURNALISM IN A NEWS MAGAZINE

OUTSTANDING LIVE COVERAGE OF A BREAKING NEWS STORY‑‑LONG FORM

OUTSTANDING CONTINUING COVERAGE OF A NEWS STORY‑‑LONG FORM

OUTSTANDING INVESTIGATIVE JOURNALISM‑‑LONG FORM

OUTSTANDING INFORMATIONAL PROGRAMMING ‑ LONG FORM

OUTSTANDING HISTORICAL PROGRAMMING ‑ LONG FORM

OUTSTANDING INTERVIEW

OUTSTANDING ARTS & CULTURE PROGRAMMING

The list goes on.

The folks that complain the most about media bias are the ones that watch Fox News. Apparently the irony is lost on them.

[Ken Fitzgerald]

Greg,

I stated earlier...I find that all of the major networks news shows are biased in one direction or the other. I don't watch any of them with any regularity.

I find my local paper is as accurate or more accurate than the television news media. The paper isn't generally in a hurry to beat the other networks to get a story on the air. But alas, even the paper is biased.

[Frank Hagan]

I understand your proposal, Frank. One thing that seems to come out in your posting is that you think universal health care will eliminate some of the choices you have today. I don't know the exact proposals making their way through congress, but it certainly does not have to.


The proposals now being floated absolutely will limit choice. Investor's Business Daily ran an editorial regarding language on page 16 of the bill recently released by the House:


When we first saw the paragraph Tuesday, just after the 1,018-page document was released, we thought we surely must be misreading it. So we sought help from the House Ways and Means Committee.


It turns out we were right: The provision would indeed outlaw individual private coverage. Under the Orwellian header of "Protecting The Choice To Keep Current Coverage," the "Limitation On New Enrollment" section of the bill clearly states:


"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.


So we can all keep our coverage, just as promised — with, of course, exceptions: Those who currently have private individual coverage won't be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers.


From Investor's Business Daily Editorial (http://www.ibdeditorials.com/IBDArticles.aspx?id=332548165656854)



THIS is what is being proposed. A phase out of private insurance. You have to listen very carefully to our politicians because they lie by omission. You can "keep" your insurance, but when you change jobs or your employer cancels coverage, you MUST go with the government option.

On a lighter note, comedian Steven Crowder, raised in Quebec, recently returned to do a little investigation of the Canadian health care system:

http://www.youtube.com/watch?v=q2jijuj1ysw

[Mike Henderson]

There's no way any such provision will make it into the final bill, Frank. There's absolutely no way we're going to destroy the existing medical insurance companies, such as Blue Cross, Blue Shield, United Healthcare, etc. If such a proposal had *any* possibility of becoming law, those companies would have ads on TV decrying the law. When in reality, most of the insurance companies support the concept of universal health care.

Mike

[Steve Rozmiarek]

Fox doesn't do news. They offer pundits and on air talk fests. If any news is reported by Fox News it is purely accidental.

For being the so-called largest news channel it is curious they did not recieve one Emmy nomination this year. Walter Cronkite received so many he lost count.

Here are the categories Fox News was unable to compete in:

OUTSTANDING COVERAGE OF A BREAKING NEWS STORY IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING FEATURE STORY IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING CONTINUING COVERAGE OF A NEWS STORY IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING INVESTIGATIVE JOURNALISM IN A REGULARLY SCHEDULED NEWSCAST

OUTSTANDING COVERAGE OF A BREAKING NEWS STORY IN A NEWS MAGAZINE

OUTSTANDING CONTINUING COVERAGE OF A NEWS STORY IN A NEWS MAGAZINE

OUTSTANDING FEATURE STORY IN A NEWS MAGAZINE

OUTSTANDING INVESTIGATIVE JOURNALISM IN A NEWS MAGAZINE

OUTSTANDING LIVE COVERAGE OF A BREAKING NEWS STORY‑‑LONG FORM

OUTSTANDING CONTINUING COVERAGE OF A NEWS STORY‑‑LONG FORM

OUTSTANDING INVESTIGATIVE JOURNALISM‑‑LONG FORM

OUTSTANDING INFORMATIONAL PROGRAMMING ‑ LONG FORM

OUTSTANDING HISTORICAL PROGRAMMING ‑ LONG FORM

OUTSTANDING INTERVIEW

OUTSTANDING ARTS & CULTURE PROGRAMMING

The list goes on.

The folks that complain the most about media bias are the ones that watch Fox News. Apparently the irony is lost on them.

Gregg, I had no idea that they gave out Emmys for news. How is news a rewardable situation? The people reporting should just do that, report, anything added to achieve an award might just be done for entertainment. The people that the news is about deserve the Emmys, not some talking head. Guess we'll have to agree to disagree on news sources. A lot of people agree with me though, and like it or not, there is another viewpoint.

Back on topic, Glenn, I didn't post that to try to hurt your position in the conversation, only to show that there is bias everywhere. We all have it, it's impossible to escape. It's not nessecarily a bad thing, unless we blindly follow bias without asking why. I agree with you about the need to help needy folks out in this mess. By boucing ideas about in millions of conversations similar to this one, real progress will be made. You have a unique perspective on life that no one else can express, and even though your side may not win any one particular argument, the fact that you stood up for what you believe, influences many people.

I think that we'd all agree that what this country does not need, is a hastily thrown together bill that does not address the concerns of the nation, just to have a bill by the end of July or whatever the "date" is. Lets talk this out, talk to our representatives in government, and fix the problem right. We owe it to our kids.

[Tom Godley]

The idea that somehow we are going to both increase coverage and expand the number of people being insured all the while decreasing overall costs per person and final costs for the whole system is well .... impossible.

That being said -- And I work in this industry -- We need an improved system.

I am not sure how you educate people to be better consumers of what goes into the shopping cart at the food store and what they consume in health care but people want a full cart at both -- and they want no responsibility for either.

HMO's did two things ... they began the idea that some oversight needed to be introduced into the system but low copays removed the incentive for self limitation.

Some beginnings

1. Move to where SOME of the costs of health care consumption are carried by the individual. This or we will have to limit consumption some other way - in order to make rational use of our health care system.

2. We need universal coverage but everyone must recognize that they now must pay into the system continually. That includes a huge portion of those under 30 and others who "feel" health care is too expensive but can currently afford it.

3. Health care can not be tax free for some and taxed for others - nor can policies cost less for IBM then an individual. Same on the invoicing side for the same service at the same facility.

4. We must find a solution to litigation in the system - it can not be denied.

5. The ability to innovate and develop must be maintained -


Over the last 50 years we have created a income tax where upwards of half the individuals in the USA do not pay into the federal system and we wonder why it is a mess - same for the way people look at health care - we have insulated many and it can not work that way.


My mother is in an independent living facility - at almost 90 - she moved when the house and steps became too much. I am thankful that she recognized the timing of this and also to the end of her driving. When I discussed the costs of this move to my contemporaries they were horrified and indicated an inability for this being a solution for them. I pointed out my mothers age and that she was using the proceeds of her house sale to fund this - I was shocked at how many were expecting the house to pass to them!!!

We have expectations that have to change.


I hope the above is not felt to be political.

[Ken Fitzgerald]

Tom,

I don't see anything political.

Thanks for your viewpoint and opinion.

[Scott Shepherd]

There's no way any such provision will make it into the final bill, Frank. There's absolutely no way we're going to destroy the existing medical insurance companies, such as Blue Cross, Blue Shield, United Healthcare, etc. If such a proposal had *any* possibility of becoming law, those companies would have ads on TV decrying the law. When in reality, most of the insurance companies support the concept of universal health care.

Mike

So why is it there Mike? That's the type of wording that sets off people like me and others, while other ignore it and say "oh, it won't be in there, don't worry". Well, I do worry and it IS in there. When it's removed, then I'll not be so worried. For now, the bill in congress does take away the right to choose your own healthcare provider. If you are in a plan now, you can keep it, but if you change jobs, you cannot. If you have private insurance with one company and want to change companies for cost savings on your own, you, under the CURRENT bill, will NOT be allowed to do that. To me, that's taking away my choice, which several people in this thread keep saying isn't going to happen.

If it's not going to happen, then call your congressmen or women and get it removed from the bill.

[Mike Henderson]

So why is it there Mike? That's the type of wording that sets off people like me and others, while other ignore it and say "oh, it won't be in there, don't worry". Well, I do worry and it IS in there. When it's removed, then I'll not be so worried. For now, the bill in congress does take away the right to choose your own healthcare provider. If you are in a plan now, you can keep it, but if you change jobs, you cannot. If you have private insurance with one company and want to change companies for cost savings on your own, you, under the CURRENT bill, will NOT be allowed to do that. To me, that's taking away my choice, which several people in this thread keep saying isn't going to happen.

If it's not going to happen, then call your congressmen or women and get it removed from the bill.
Because politics is the art of the possible.

But you're certainly correct to be "set off". People, including politicians, do crazy things sometimes and we all need to be vigilant. But the people who will be most vigilant will be those most directly affected by such a law change, which is the medical insurance companies. Such a change will put them out of business. I would expect to hear howls from those people if such a change was really possible.

Put yourself in their place. First, you'd be in there with your lobbyist monitoring the process and trying to affect the outcome. Second, you'd have plans in place to rally your supporters if things were really going against you. If your very existence was threatened you'd spend some real money to affect the outcome.

Third, how could any politician go back home for re-election if s/he supported legislation that killed one of the companies in their district and put people out of work. Any congressperson who has a big medical insurance company facility in their district would be howling right now. They'd be on every TV show possible decrying the present proposal. In fact, that's their job as a congressperson, democrat or republican.

You're absolutely correct to be vigilant and to not depend upon the politicians to be logical, but destroying some major companies would not be in their best interest. So to paraphrase Reagan, "Trust politicians to do what's best for them, but verify."

Mike

[Brian Elfert]

There's no way any such provision will make it into the final bill, Frank. There's absolutely no way we're going to destroy the existing medical insurance companies, such as Blue Cross, Blue Shield, United Healthcare, etc. If such a proposal had *any* possibility of becoming law, those companies would have ads on TV decrying the law. When in reality, most of the insurance companies support the concept of universal health care.


The insurance companies are only going to support universal health care if it isn't single payer through the government like other countries. Single payer could mean companies like United Healthcare shrinking or going away completely at some point.

They'll make even more money if everybody in the USA by law has to buy health insurance.

[Greg Peterson]

Gregg, I had no idea that they gave out Emmys for news. How is news a rewardable situation?

I have to admit I was surprised to see there were Emmy's for broadcast news too. But when I started looking at the categories, and past recipients, it became clear that the award is based on professional merit and excellence.

I'll agree that news media, the so-called fourth estate, has long since abandoned its role as an effective foil to the powerful elite, whether they be politics or industry. And I would wager that the main reason this is so is because the media is owned and operated by the very class of people it was meant to hold accountable.

Fox is obviously one of the biggest media companies in the world. Cable, broadcast network, news print, radio..., they provide a powerful and loud platform to express their opinions. They are a less than honest broker when it comes to providing information. No outlet gets it right all the time, but none exceed Rupert Murdoch's empire when it comes to eliminating inconvenient facts.

Perhaps were the media in general more interested in providing information, we might be better able to have a healthy and robust debate about many things, including health care.

[Scott Shepherd]

Third, how could any politician go back home for re-election if s/he supported legislation that killed one of the companies in their district and put people out of work. Any congressperson who has a big medical insurance company facility in their district would be howling right now. They'd be on every TV show possible decrying the present proposal. In fact, that's their job as a congressperson, democrat or republican.

Anthem (Blue Cross/Blue Shield) has a major headquarters here. It's about 3/4 of a mile from where I am sitting. HMC is in the building next door from me. Haven't heard anything but support for the new bill from our congressional reps.

It's like asking us to read and sign a contract which states "This will take all your cars away" with the argument being "Well, you know they won't really take your cars away, right?". It's just crazy. What's more crazy to me is that people get in line to sign up for this when, if people actually read what's in the bill, they would be outraged.

I'll stand side by side with anyone to help those that cannot help themselves. I'll do whatever I can to help. I'll donate product, time, services to raise money to help pay for anything anyone needs that I can possibly do. I'll gladly help on my own. But the second the government tells me that they are in charge now and they reach their hand into my pocket without me having any say so, is where I draw the line.

[Ken Fitzgerald]

Folks,

If it gets political I will shut this thread down.

[Mike Henderson]

Anthem (Blue Cross/Blue Shield) has a major headquarters here. It's about 3/4 of a mile from where I am sitting. HMC is in the building next door from me. Haven't heard anything but support for the new bill from our congressional reps.
I don't want to put words in your congressperson's mouth, but I can't imagine them supporting the bill if it would put Blue Cross/Blue Shield out of business. All politics is local. If they voted for a bill that put BC/BS out of business, they'd never make it in the next election. And they come up every two years for re-election.

Contact them, but I'll bet they know the bill would never put BC/BS out of business.

Mike

[Just an added comment: not everything proposed gets enacted into law. Sometimes a politician will propose a law that they are completely opposed to - it the bill ever came up for a vote, they'd vote against their own bill. So why do they do that? Because they know other lawmakers will kill the bill (or amendment). But this allows them to go back home and tell their constituents (who would support such a law) that they tried to get it enacted but were voted down.]

[Frank Hagan]

There's no way any such provision will make it into the final bill, Frank. There's absolutely no way we're going to destroy the existing medical insurance companies, such as Blue Cross, Blue Shield, United Healthcare, etc. If such a proposal had *any* possibility of becoming law, those companies would have ads on TV decrying the law. When in reality, most of the insurance companies support the concept of universal health care.


"Concept" and reality are two different things. A lot of things look great in 'concept', like communism and the CPSIA.

The details JUST became available with the draft of the bill being released in the last few days. You will start to see the opposition now.

Remember that not one of our elected representatives read the stimulus bill. Not one. It was an emergency, and they had to rush it through. The push to get this bill done before the August recess now looks like it will fail. Nervous congressmen are realizing they better read this one. If they had hidden that provision on page 864 of the bill, they might have gotten it through.

The insurance companies will come out now, as other groups are starting to. The insurance companies have a PR problem, as populist sentiment is against them. They have to be very careful to not create a backlash that will allow the move to a single payer system to go through as people might think they are just protecting their turf.

The fact is that any plan with a "public option" will cause the private health insurance industry to dry up and die. By design.

[Mike Henderson]

Well, last I heard there were at least three proposals being worked on. We'll have to see, but I'd be willing to bet that whatever passes will rely on the existing medical insurance companies, and will not be structured to put them out of business.

You can be a lot more successful working with people (and companies) - and allowing them to succeed - than in trying to "destroy" them.

Mike

[Darius Ferlas]

So I'm supposed to pay for an alcoholic that's drank himself 1/2 to death, knowing that what he was doing is harmful? I'm suppose to pay for the smoker who's known for 30 years that smoking is bad for them? So I'm supposed to pay for the person who weighs 400 pounds because they refuse to get a job, eat healthy, or exercise? So I'm supposed to pay for the drug addict that doesn't want to get clean, but needs health care?

Yeah, that sounds really reasonable to me.
It may seem unreasonable indeed but yes, the way the societies are organized your are supposed to pay indeed.
You are also supposed to pay to the war here and the war there, regardless of what your opionion on those wars is, you are supposed to pay a share of a few hundred thousand dollars it takes to rescue passengers of a leisure boat if they come across a storm, or a few brave skiers who venture where they really shouldn't have ventured. You also have to pay your share of school taxes and presidential expenses whether you voted for him or not. You also have to pay for the military upkeep, even if you wear orange dresses and sing hari krishna at airports.

Every single item paid for by tax dollars could be easily excluded from a personal income tax statement based on a simple statement: "I don't need that so I ain't paying".

Some things are more easily quantified than others. I'd put nation's health on par with it's physical security taken care by the military which, again, is paid for by all.

[Ken Fitzgerald]

Folks,

Last warning.....No politics. It violates the Terms Of Service of SawMillCreek.

You can "discuss" or "debate" without politics.

I will close this thread.

[Darius Ferlas]

Rod, I don't want to get political, I'm just curious how the health care system is funded up there? I just read that some folks will be taxed at 55% in the States if the health care bill goes through here. How does that compare to Canada?

For 2007, in Ontario, the highest tax bracket that exists in Canada is 46.41% for income over $120,888.

[Mitchell Andrus]

Folks,

Last warning.....No politics. It violates the Terms Of Service of SawMillCreek.

You can "discuss" or "debate" without politics.

I will close this thread.

Nooooo.... I'm going for 200!!!
.

[Ken Fitzgerald]

Mitch...it's the same old story....quantity or quality?

[Brian Elfert]

Well, last I heard there were at least three proposals being worked on. We'll have to see, but I'd be willing to bet that whatever passes will rely on the existing medical insurance companies, and will not be structured to put them out of business.

You can be a lot more successful working with people (and companies) - and allowing them to succeed - than in trying to "destroy" them.


Insurance companies are a lot of the problem in the current system. they create a whole huge layer of costs. Every extra layer means another layer to make a profit.

There is probably at least one administrative person to deal with insurance companies and billing for every doctor employed in the USA.

Doctors run all sorts of extra tests so they won't get sued and have their malpractice insurance costs go even higher.

[Brian Elfert]

My health insurance has been cut to the point of being basically worthless. It is mostly because the costs keep going up by 8% to 10% or more every year.

With today's economy I can hardly afford to go see a doctor. My insurance requires me to pay 20% of all costs and I have a $250 deductible. The only good thing, if you can call it that, is a $3750 max per year that I have to pay.

Right now, I don't go to the doctor unless I'm on my death bed which could require more care than if I went to a doctor earlier. Even when I had a $10 or $20 co-pay I wasn't going to the doctor for every little thing.

I started at my job in 2001. Back then my co-pay was $10 I think with no deductible. I have no idea what my yearly max was because I would have to have been hospitalized at least 10 times in a year to spend $3,000. Now days one hospitalization could put me over my max for the year. I pay $95 a month for healthcare now and I was only paying around $60 a month in 2001.

Unless I am injured in a serious accident or have a serious illness my health insurance is pretty much worthless now days. I would probably get better coverage if I was 66 years old and on Medicare.

[Greg Peterson]

I remember when HMO's came into the market. They were going to reel in costs by 'rationing' care. They got the rationing part down but the cost part has continued to grow exponentially over the years.

Medicare runs at about 3% overhead while private insurance runs at about 20% overhead. I've never met anyone that would begrudge a company making a profit, but there really is no contest as to which model provides the biggest return on investment.

I don't think the expenditure of resources at the doctors office can be discounted. How much time do doctors spend going head to head with an insurance company to get a procedure approved? How much insurance paper work is involved in treating a patient?

Not to mention, when a patient is trying to recover from a major illness or injury, they have the added burden of deciphering the insurance and hospital billing and then having to try to get denied charges reversed.

I don't see how one fifth of every dollar I pay into a private plan is a good investment.

[Belinda Barfield]

I don't think the expenditure of resources at the doctors office can be discounted. How much time do doctors spend going head to head with an insurance company to get a procedure approved? How much insurance paper work is involved in treating a patient?

Not to mention, when a patient is trying to recover from a major illness or injury, they have the added burden of deciphering the insurance and hospital billing and then having to try to get denied charges reversed.


Greg,

It is not unusual for a nurse or administrator to spend half a day with phone calls and faxes trying to get a surgical procedure or test pre-approved, and that is with a private insurer.

Have you every tried to decipher a Medicare EOB (explantation of benefits)?

Take a look at the Federal Income Tax code and tell me that the "company" responsible for that is going to require less paperwork than what is currently required by private insurers, and that the billing any payment processes will be easier and more efficient.

[Mitchell Andrus]

Greg,

It is not unusual for a nurse or administrator to spend half a day with phone calls and faxes trying to get a surgical procedure or test pre-approved, and that is with a private insurer.


I've no doubt that would shrink to about zero once ONE SINGLE on-line process was enacted. I know a doctor's assistant who's only job is to approve patient care with dozens on insurers, each with it's own process(es).

I'm pretty sure doctor-shopping/hoping for drugs will end too, (M.J. and Anna Nichole Smith come to mind) once an on-line system tracked patient care and drugs dispensed.
.

[Belinda Barfield]

I'm pretty sure doctor-shopping/hoping for drugs will end too, (M.J. and Anna Nichole Smith come to mind) once an on-line system tracked patient care and drugs dispensed.


Where there's a will, there's a way Mitchell.

Personally, I'm not in favor of having my medical care and history "tracked" on line. If I am a diabetic and I confess to my caregiver that I ate a piece of birthday cake, which resulted in a spike in my blood sugar, which resulted in a doctor's visit that could have been prevented, will I be penalized in some way once that information is tracked?

Yes, different insurers have different requirements for pre-approval. Why not streamline the process by standardizing the pre-approval process for all insurers, rather than going to a single insurer system? A system that will, BTW, be overwhelmed from day one.

[Greg Peterson]

Belinda, I can appreciate your concerns about privacy. But the real truth is that there exists far more information about you, freely available, than you are likely aware of. Or maybe not. The detail of information that is out there is staggering. All it takes is for someone or some agency to take an interest in you and the data mining begins.

Under the current arrangement people who do stupid or irresponsible things are not penalized. How many broken bones and worn out joints are the result of skate boarding, skiing, rock climbing, running, weekend warrior sprots (football, basketball, softball...)? Yet these people are not refused coverage because the accident was avoidable.

Many people refuse to take proper care of themselves yet expect the health insurance system to treat ailments directly related to the abuses they have brought upon themselves of their own free will.

How many morbidly obese people end up with hip replacements? How many smokers end up with COPD? Just naming a couple real world examples.

Respectfully,
G

[Brian Elfert]

I've no doubt that would shrink to about zero once ONE SINGLE on-line process was enacted. I know a doctor's assistant who's only job is to approve patient care with dozens on insurers, each with it's own process(es).


I am guessing you are being sarcastic here, but if medical providers only had to deal with one payer the number of staff required just to deal with billing and insurance would decrease.

[Mitchell Andrus]

Where there's a will, there's a way Mitchell.

Personally, I'm not in favor of having my medical care and history "tracked" on line. If I am a diabetic and I confess to my caregiver that I ate a piece of birthday cake, which resulted in a spike in my blood sugar, which resulted in a doctor's visit that could have been prevented, will I be penalized in some way once that information is tracked?

Yes, different insurers have different requirements for pre-approval. Why not streamline the process by standardizing the pre-approval process for all insurers, rather than going to a single insurer system? A system that will, BTW, be overwhelmed from day one.

My driving experience and car ownership is tracked, and because I'm a good driver and replace my cars at 100K miles, I get better rates than the unwashed masses - as it should be.

My work and income history is known to the Social Security Admin. and to my mortgage/loan officer.

That doctors I've never met in Montana and New Jersey or anywhere else can see that I'm in good health (or perhaps in need of a heart valve) is to my benefit should I get hurt water skiing.

I get good rates because I don't smoke, drink (never had a drink, btw) and never wrecked a car. I would hope someone who has DUIs, lung problems due to smoking and can't hold a job would pay higher rates (all relative as taxes are based on income).

I have no problem with my information being known by someone from whom I expect information-based services.
.

[Mitchell Andrus]

, but if medical providers only had to deal with one payer the number of staff required just to deal with billing and insurance would decrease.


Yes. This is only one way to realize a decrease in health care costs and the employees released from these duties could take jobs that increase our GDP instead of being a drain on our resources. Doctors in France and Canada have about 2/3 the support staff as ours in the US.

Just imagine if a paper-pusher in the doctor's office didn't have to fight with the paper-pusher in the insurance office anymore....
.

[Ken Fitzgerald]

My driving experience and car ownership is tracked, and because I'm a good driver and replace my cars at 100K miles, I get better rates than the unwashed masses - as it should be.

My work and income history is known to the Social Security Admin. and to my mortgage/loan officer.

That doctors I've never met in Montana and New Jersey or anywhere else can see that I'm in good health (or perhaps in need of a heart valve) is to my benefit should I get hurt water skiing.

I get good rates because I don't smoke, drink (never had a drink, btw) and never wrecked a car. I would hope someone who has DUIs, lung problems due to smoking and can't hold a job would pay higher rates (all relative as taxes are based on income).

I have no problem with my information being known by someone from whom I expect information-based services.
.

But do you really want your information available for hacking? What if it's determined that you are genetically prone to heart disease and periodontal disease. Do you want that information available for some hacker to get to it and sell it to the life insurance company who you want to buy a policy from so your son can buy that twin engine jet private plane when you die from heart disease?


And....since you fly with your son, shouldn't you have to pay more since you take bigger risks.....knowingly...just like smokers and drinkers....?

And....if those who have unhealthy lifestyles are charged more....how in the world will it be cheaper and available to everyone and if that's the case....and it's more expensive.........WHAT is the advantage and why are we putting ourselves through this anyway? Is this just an exercise to raise everyone's blood pressure......and have a few more deaths from the resultant heartattacks?

[Darius Ferlas]

And....since you fly with your son, shouldn't you have to pay more since you take bigger risks.....knowingly...just like smokers and drinkers....?

Excellent point.
And it all depends on the interpretation of what constitutes increased risk interpretation. For example, to me all persons watching TV news should pay higher health insurance premiums as the news are mostly bad, and depressing (if it bleeds it leads). This poses a risk of a cardiac arrest, cerebral haemorrhage and such. It can also reflect on the general mood condition and can cause irritability which greatly influence the physical well being.

I stopped watching TV over 6 months ago and the health benefits to me are great. I quit watching TV as a favor to the society though, since health care in Canada is free anyway ;)

[Greg Peterson]

The main point, I think, is that the configuration of our current health insurance system(s) is too expensive and costs are not coming down in the foreseeable future.

Lets wait another ten years and look at the percentage of GDP that will be dedicated to health insurance. Few reasonable arguments can be waged that would support not doing anything.

In the plainest terms, what is required is a system that reduces cost. If it be single payer or a level playing field for private insurers, then so be it. But we can no longer afford to pay twice what any other industrialized nation pays and then be satisfied the the poor returns on this investment.

The private sector has demonstrated their unwillingness or inability to regulate costs. It is time for us to tell them if they are unable to fix the system, then let us how we can help them through legislation. If they are unwilling to fix the system, then we need to just tell them how how it is going to be.

[Mitchell Andrus]

And....since you fly with your son, shouldn't you have to pay more since you take bigger risks.....knowingly...just like smokers and drinkers....?



I don't smoke or drink, so I balance the scale this way. :)

There are pilots in Canada and France and they don't seem to be worse for the exposure. Out of all my hours on this rock last year, a teeny-tiny percentage of them were spent coming in for a landing. You calculate the add'l premium... I'll pay it.

More people are injured/killed in accidents on the way to/from airports and stadiums than in a plane, or water skiing, playing/watching football games in person....... I'd bet that spectators are (collectively) at higher risk of injury than the race car drivers/players on the field.

Perhaps a surcharge per mile driven too? Don't drive?.... you get a rebate. This line of thinking could get VERY cumbersome.

'sides, at the rate we're going there will be more couch potatoes in need of add'l care because they DON'T get off their butts than those who go outside and play - and yes..... break a wrist once in a while.
.

[Mitchell Andrus]

The private sector has demonstrated their unwillingness or inability to regulate costs.

They will have to control costs AFTER our banks are empty, our cards are maxed out and our homes are all mortgaged to the hilt. Once we've been bled dry they'll.......

Oh.... I get it. Now we can have reform.
.

[Mike Henderson]

I agree with those who say that we have a "system" problem. In general, for most people with insurance, there's no incentive to use less medical care, or to shop for prices. And for the "pay per fee" doctor, there's no incentive to reduce the number of tests and procedures.

Most people think of health insurance as something that makes health care "free", and that's the attitude we need to change. Health care should cost something so that the consumer (patient) seeks only the care that's necessary and, as much as possible, seeks lower cost care.

To reduce the cost of health care, we must make the patient care what it costs, and the only way to do that is to have the patient pay some of the costs on a per-procedure basis.

Mike

[Belinda Barfield]

But do you really want your information available for hacking? What if it's determined that you are genetically prone to heart disease and periodontal disease. Do you want that information available for some hacker to get to it and sell it to the life insurance company who you want to buy a policy from so your son can buy that twin engine jet private plane when you die from heart disease?

And....if those who have unhealthy lifestyles are charged more....how in the world will it be cheaper and available to everyone and if that's the case....and it's more expensive.........WHAT is the advantage and why are we putting ourselves through this anyway? Is this just an exercise to raise everyone's blood pressure......and have a few more deaths from the resultant heartattacks?

Thanks Ken for making the point I was trying to make. The fact is that I expect my medical information to be kept confidential as it is now. My doctor cannot release information to an insurer without my consent. With rationing of health care those who are non compliant may not receive adequate care if the single payer has access to the physician's records.

Does anyone know if one is allowed to sue for malpractice in Canada, or France, or Great Britain. I'm just curious about this because, as stated previously, malpractice insurance is a huge drain on finances and time with the current system.

With the current shortage of medical personnel I don't see how we can suddenly dump so many more patients into the system. No one has explained yet this will work. With the increased work load health care professionals are very likely to leave the field and seek other employment, causing an even greater shortage of providers.

[Mike Henderson]

Regarding digital medical records, they are wonderful! Both UCLA and Hoag Hospital (locally) have gone fully digital.

So when you go to one of their doctors, they can see your complete medical record. If you had an X-ray, that's in your digital chart, along with the radiologist reading. All your previous lab work is there so the doc can compare today's labs with your earlier results.

I certainly want control of those records, but if I'm in an automobile accident in some remote place, I want to be able to give permission to the docs to access my records to see my history, prescriptions, notes from other doctors, etc.

And regarding insurance, the only way you're going to get insurance is to give permission for the insurance company to access your medical records (in today's medical system).

Mike

[Belinda Barfield]

Regarding digital medical records, they are wonderful! Both UCLA and Hoag Hospital (locally) have gone fully digital.

So when you go to one of their doctors, they can see your complete medical record. If you had an X-ray, that's in your digital chart, along with the radiologist reading. All your previous lab work is there so the doc can compare today's labs with your earlier results.

I certainly want control of those records, but if I'm in an automobile accident in some remote place, I want to be able to give permission to the docs to access my records to see my history, prescriptions, notes from other doctors, etc.

And regarding insurance, the only way you're going to get insurance is to give permission for the insurance company to access your medical records (in today's medical system).

Mike

I agree, Mike, with the use of digital records. And yes, I realize that the only way to get insurance is to give permission for access to my records. However, I don't want Big Brother to have access to my medical records, and I fear that is where we are headed.

I do some work as a medical transcriptionist. All dictations are accessible on line, and completed reports are transmitted online. It's a great system that allows me to work from home, or just about anywhere else for that matter. I'm not opposed to ease of access, just who has access.

[Glenn Clabo]

The extra cost of malpractice lawsuits are relatively insignificant proportions of health spending in both the U.S. (0.46%) and Canada (0.27%). [/URL]Average payouts to American plaintiffs were $265,103, while payouts to Canadian plaintiffs were somewhat higher, averaging $309,417. (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_note-pmid16136632-81) However, malpractice suits are far more common in the U.S., with 350% more suits filed each year per person. (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_note-pmid16136632-81)While malpractice costs are significantly higher in the U.S., they make up only a small proportion of total medical spending. The total cost of defending and settling malpractice lawsuits in the U.S. in 2001 was approximately $6.5 billion, or 0.46% of total health spending. (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_note-pmid16136632-81)Critics say that defensive medicine consumes up to 9% of American healthcare expenses. (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_note-83)In the same year in Canada, the total burden of malpractice suits was $237 million, or 0.27% of total health spending.[URL="http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_note-pmid16136632-81"] (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_note-84)


^ a (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_ref-pmid16136632_81-0) b (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_ref-pmid16136632_81-1) c (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_ref-pmid16136632_81-2) d (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_ref-pmid16136632_81-3) Anderson GF, Hussey PS, Frogner BK, Waters HR (2005). "Health spending in the United States and the rest of the industrialized world". Health affairs (Project Hope) 24 (4): 903–14. doi (http://en.wikipedia.org/wiki/Digital_object_identifier):10.1377/hlthaff.24.4.903 (http://dx.doi.org/10.1377%2Fhlthaff.24.4.903). PMID 16136632 (http://www.ncbi.nlm.nih.gov/pubmed/16136632).
^ (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_ref-82) USA Spends More Per Capita on Health Care Than Other Nations, Study Finds (http://www.medicalnewstoday.com/medicalnews.php?newsid=27348)
^ (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_ref-83) Testimony of Mark McClellan, MD, Ph.D., Administrator, Centers for Medicare & Medicaid Services, (http://jec.senate.gov/Documents/Hearings/mcclellantestimony28april2005.pdf) before the Joint Economic Committee Hearing on Malpractice Liability Reform, April 28, 2005
^ (http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared #cite_ref-84) Kessler, Daniel and Mark McClellan. "Do Doctors Practice Defense Medicine?," Quarterly Journal of Economics, 1996, v111(2,May), 353-390. Towards a More Effective Monetary Policy, Kuroda, Twao, ed.,: Macmillan, 1997, pp. 137-164. (http://ideas.repec.org/p/nbr/nberwo/5466.html)

[Belinda Barfield]

Thanks for the stats Glenn. My concern still is the cost of malpractice insurance to physicians, and the number of tests done to try to prevent the possibility of a lawsuit. Is malpractice insurance as expensive outside of the U.S.

Another consideration with being treated by NPs and PAs, they are not required to carry malpractice insurance (unless the laws have changed) as they are covered under the insurance of the supervisory physician. A number of years ago a nurse at a VA hospital gave a patient a blood transfusion of the wrong blood type. The patient died, the nurse kept her job, and the supervising physician took the heat. Because the hospital was a VA hospital, and the physician was employed by the VA, no lawsuit could be filed. So that takes me back to my question posted earlier, does anyone know what the policy will be regarding malpractice suits under a government run system?

[Mitchell Andrus]

To reduce the cost of health care, we must make the patient care what it costs, and the only way to do that is to have the patient pay some of the costs on a per-procedure basis.

Mike

Like car insurance. If I choose to roll the dice, I can ellect to pay a higher deductible and reduce my rates. As long as when a catastrophic problem emerges... I'm covered.

A flu visit will cost me the first (for example) $150.00. The first visit for cancer treatments will also cost $150.00.

Neither will bankrupt me if coverage is set up correctly. As it is now, people are spending their life's savings to save their lives.
.

[Mitchell Andrus]

With the current shortage of medical personnel I don't see how we can suddenly dump so many more patients into the system. No one has explained yet this will work.

No more patients... the uninsured are being cared for today and the states and counties are footing the bill as they walk into emergency rooms - where they have to be seen regardless of ability to pay. It'll be much cheaper to have them walk into a doctor's office or the hospital's walk-in clinics instead.
.

[Belinda Barfield]

No more patients... the uninsured are being cared for today and the states and counties are footing the bill as they walk into emergency rooms - where they have to be seen regardless of ability to pay. It'll be much cheaper to have them walk into a doctor's office or the hospital's walk-in clinics instead.
.

No, Mitchell, all of the uninsured are not currently receiving care in emergency rooms. Only the sick or injured are being treated in this manner. Insure everyone and the system will be overwhelmed almost immediately by those individuals who were uninsured, but now can receive care because they are insured. And every one will want a full battery of tests to find out whether or not they are sick. It won't be cheaper to have them walk into a doctor's or office or clinic. In the ER, only the immediate problem is treated.

Having said all that, everyone should receive the medical care they need. But don't be misled into thinking that everyone out there about to be insured is being taken care of currently by ERs. Go to one. See any well people there?

Bottom line, LOTs more patients, fewer care givers. Any physician I have spoken to regarding this, that is able to retire or work in some other field, is planning to leave medicine if a federally funded system is put in place.

Oh, and I'm guessing R & D will fall by the wayside under the system as well since funding won't be available to find that cure for cancer.

[Mike Henderson]

Like car insurance. If I choose to roll the dice, I can ellect to pay a higher deductible and reduce my rates. As long as when a catastrophic problem emerges... I'm covered.

A flu visit will cost me the first (for example) $150.00. The first visit for cancer treatments will also cost $150.00.

Neither will bankrupt me if coverage is set up correctly. As it is now, people are spending their life's savings to save their lives.
.
I absolutely agree with you. There should definitely be catastrophic coverage. We do not want to bankrupt people because of illness or accident - just make them think about the ordinary care.

Mike

[Mitchell Andrus]

Bottom line, LOTs more patients, fewer care givers.

I'm thinking we're not all going to suddenly get ill or break a bone and need a doctor.

My sister is dual USA/Canadian. She's lived in Nova Scotia, BC and Toronto for 32 years and gave birth to 2 kids. Each kid cost her about $100.00 in fees. No lines, no doctor shortage. One day wait for a cat scan - cost, $0.00. Treatment for a fractured arm (brother in law) was immediate. X-ray in about an hour. Cost about $35.00. Show your card at the door.

Hey... and guess what? Nobody's paranoid about sharing their medical history with a care provider!!!!

Throwing everyone in the pool and divying up the costs based on thier individual ability to pay (progressive tax) works so well in so many ways. Kinda like the way we all get to share each other's roads, parks, schools, power grid, water supplies, sewers, police depts.....

Speaking of police.... Why shouldn't societal protections of our health be provided on-par with the protections we expect for our homes and property? We all collectively fund the police and CDC, don't we? And the FBI, Secret Service, military.

Isn't catching my cancer as important as catching the guy stealing my car?

Isn't it just ASSUMED that we'll call the police only when needed?
.

[Art Mulder]

My sister is dual USA/Canadian. She's lived in Nova Scotia, BC and Toronto for 32 years and gave birth to 2 kids. Each kid cost her about $100.00 in fees. No lines, no doctor shortage. One day wait for a cat scan - cost, $0.00. Treatment for a fractured arm (brother in law) was immediate. X-ray in about an hour. Cost about $35.00.

Well actually there are family doctor shortages in certain parts of the country. Here in London (southwest Ontario) it can be tough to find a family doctor. However, there are also walk-in clinics around the city that people without doctors can visit. It's not as nice as a dedicated family doctor but still better than going to ER for minor things. Actually those are our own fallback when our own family doctor is away on vacation or just unavailable (doctors get sick also...)

Healthcare is also a provincial responsibility, so there are minor differences between the provinces. My x-ray 2 years ago cost me Zero. Ditto for the CT scan last year, and the ultrasound this year. (all ordered by my family doctor)

We also have had home births for our kids here in Ontario, which has full midwife coverage, so that cost us ... nothing also. Not sure why your sister would have been charged $100.

Midwifes have not always been covered. That is one way that the Canadian system has improved even in the last 10 years. Midwives and home births (for healthy people) are simpler and cheaper than hospital births, but it still took a long time to change the system, even in that one small way. I can only imagine how hard it'll be to change a system the size of the US.

...art

ps: Doing my bit to help you hit 200, Mitchell.... :p

[Greg Peterson]

Art, the loudest voices proclaim that free markets are the answer to everything. In theory perhaps, but like so many many things that look good on paper, free markets don't translate to the real world without some problems.

Chief among the biggest faults of free markets is the failure to account for greed and hubris. Our only true metric is the dollar. Everything is measured against this. Whoa to anyone or anything that can not be assigned a monetary value.

I consider this to be one of our cultures biggest flaws. How does one put a monetary value on not having to worry about fighting the insurance company? The value of a sunset? Or living in the same house your children were born in?

Todays profits derived from health insurance reflect our values. At the very least no one voices concern, which amounts to a tactic consent.

[Ken Fitzgerald]

Greg,

You find the same ills and others with socialism, too.

Our problems are societal in my view.

[Greg Peterson]

Greg,

You find the same ills and others with socialism, too.

Our problems are societal in my view.

I agree that greed is universal. But under the guise of free markets, greed is given fertile ground.

Free markets are fine, but fair markets are much more equitable.

[Ken Fitzgerald]

Here's the problem with "fair markets".


I want to decide what's fair for "your fair market" but you can't touch mine.

Our society is greedy, selfish and tunnel visioned.

The words "reasonable or fair" are no longer found in our daily language.

Whether it's discussing politics or what's a fair profit. It's what the market will bear and the words reasonable ....fair...what's that? Who cares?

We have become a sad state of "my way or the highway" vulgar loud obnoxious extemists...whether it's politics or economics.....my way or the highway....I'll get my way...or I will hit the highway.

Fair market?

And that is my point.....we can all see problems with the other guy's business but don't tell me what to do with mine........

selfish.......greedy........ Yup...that pretty well describes a large portion of our society

I always keep in mind that a dollar bill has no conscience and neither do those who worship it.

[Greg Peterson]

Markets are amoral. Those that participate in the markets are not.

As investors (401k), we have shortened our horizons to extend no more than one quarter. And CEO's are all to aware of quarterly reports having to show not just a profit, but a significant profit so as to keep the investors happy and content.

This doesn't excuse the gross compensation packages being handed out like halloween candy, but it does provide some definition to the problem.

I've no quarel with capitalism. It has its place. But not when it comes to making life and death decisions. Or quality of life decisions. Health care could, and should be considered part of the commons. Air, water, airwaves, highways, sidewalks, police, firemen... are taken for granted. Imagine a society where someone feeling ill doesn't have to choose between shorting the heating bill or paying for the doctor bill.

No one thinks twice about the cost of calling the police or breathing clean air. Why should health care be any different?

[Ken Fitzgerald]

As investors (401k), we have shortened our horizons to extend no more than one quarter. And CEO's are all to aware of quarterly reports having to show not just a profit, but a significant profit so as to keep the investors happy and content.

This doesn't excuse the gross compensation packages being handed out like halloween candy, but it does provide some definition to the problem.

I've no quarel with capitalism. It has its place. But not when it comes to making life and death decisions. Or quality of life decisions. Health care could, and should be considered part of the commons. Air, water, airwaves, highways, sidewalks, police, firemen... are taken for granted. Imagine a society where someone feeling ill doesn't have to choose between shorting the heating bill or paying for the doctor bill.

No one thinks twice about the cost of calling the police or breathing clean air. Why should health care be any different?


Considering where my 401K is right now, my horizons are greatly shortened.......:( In fact....I will probably end up working a couple more years that I didn't plan on working.

[Frank Hagan]

Well, last I heard there were at least three proposals being worked on. We'll have to see, but I'd be willing to bet that whatever passes will rely on the existing medical insurance companies, and will not be structured to put them out of business.

You can be a lot more successful working with people (and companies) - and allowing them to succeed - than in trying to "destroy" them.

Mike

Its a myth that large corporations are against government regulation; they usually favor them. The reason? They benefit, because the regulations are surmountable for them, but provide a barrier to entry for smaller firms. Its why Walmart is supporting a government mandate forcing all businesses to buy health insurance for their employees. Their competition ... the small, Main Street shops ... cannot compete with them very well now, and increasing the independent's cost exponentially will result in more consolidation. The largest insurance companies will gain from a government plan, while the non-profits and innovative smaller companies will be squeezed out.

If you think "customer service" suffers from your health insurance company now, just wait until they are the underwriter for the official government plan.

[Frank Hagan]

Under the current arrangement people who do stupid or irresponsible things are not penalized. How many broken bones and worn out joints are the result of skate boarding, skiing, rock climbing, running, weekend warrior sprots (football, basketball, softball...)? Yet these people are not refused coverage because the accident was avoidable.


Table saw accidents are avoidable.

The purpose of insurance is to spread the risk among a larger pool of people, and people who take out insurance don't do so because they plan to be injured or get sick. They do so because they recognize the unpredictable nature of life itself. Something they have done for 12 years ... like playing softball in the local league ... suddenly results in an injury for them.

[Frank Hagan]

In the plainest terms, what is required is a system that reduces cost. If it be single payer or a level playing field for private insurers, then so be it. But we can no longer afford to pay twice what any other industrialized nation pays and then be satisfied the the poor returns on this investment.

The private sector has demonstrated their unwillingness or inability to regulate costs. It is time for us to tell them if they are unable to fix the system, then let us how we can help them through legislation. If they are unwilling to fix the system, then we need to just tell them how how it is going to be.

There are ways to lower costs.

One is to cap liability, removing the need for "defensive medicine" and the extra tests that entails. Limiting malpractice to actual damages (loss of wages, future medical costs, etc.) and eliminating "punitive damages" would help. There are no plans to cap liability in any of the bills now working their way through Congress. The trial lawyers are too important a group for the politicians to entertain nicking their gravy train.

Paperwork reduction won't eliminate enough costs to sneeze at; any plan, single payer or not, will have the same paperwork costs as doctors try to get care for their patients. Removing the extra layer between the insurance company and the doctor would help.

What they really mean by "controlling costs" is rationing care, or put another way, letting people die. Its why cancer survival rates are so far behind the US in countries with single payer (Canada) or primarily government plans (Britain, which allows private care). Delay care long enough and the problem goes away.

Families now make the decision when to quit giving medical care, and let their loved one die. Having been through it, its gut wrenching. But I know I would rather have my daughters make that decision for me, in consultation with my doctors, than an "Comparative Effectiveness Board" mandated by the federal government.

Rather than overhaul the entire system, why not identify those areas that need attention, and address them?

Let's provide insurance for the 6 million people who fall between Medicaid and employer sponsored plans. Let's talk about the 8 to 12 million undocumented workers we may need to insure, and while we're at it, we can discuss again if we want insurance to pay for voluntary abortions, sex change operations and cosmetic surgery.

Let's make insurance "portable" so rather than paying high Cobra rates, a person can choose a plan that would follow them from employer to employer, with a fund established by mandatory payroll deductions for that would pay the premiums for up to 16 months coverage during unemployment.

And we don't need to rush it through before the next set of jobless numbers come out. This is too serious an issue to push through like the bank bailouts and stimulus bill. Our congresscritters should actually read this one.

[Mitchell Andrus]

200! So, I get one of the stuffed animals on the second shelf now?

[Belinda Barfield]

Ditto what Frank said.

Anyone wish to comment on the portion of the bill that requires the "elderly" to undergo mandatory counseling every five years regarding "end of life alternatives"? If I am deemed a drain on the system will assisted suicide be an alternative to assisted living?

May I should watch Soylent Green again. :rolleyes:

[Mitchell Andrus]

Anyone wish to comment on the portion of the bill that requires the "elderly" to undergo mandatory counseling every five years regarding "end of life alternatives"? :rolleyes:

Brenda... Please.... .Soylent Green? Really? (One of my favorite movies, BTW)

I wish both of my in-laws had professional guidance in this area. Instead, these discussions were and are clumsily held with their daughters and me. FIL died with Alzhiemers 10 years ago and despite everyone being college educated, nobody fully understood how to discuss this topic and make really great, yet painful, decisions. Now that my MIL has Alzhiemers, we are better prepared but will soon be seeking some proper (professional) guidance.

Laws change, emotions run high and deep. Outside help is welcome if for no other reason than to cut through the discomfort.

Walk in these shoes and you'll see how innocent - and helpful - this provision really is... especially for those without upper-middle class access to solid, non-emotional advise.
.

[Belinda Barfield]

Brenda... Please.... .Soylent Green? Really? (One of my favorite movies, BTW)

I wish both of my in-laws had professional guidance in this area. Instead, these discussions were and are clumsily held with their daughters and me. FIL died with Alzhiemers 10 years ago and despite everyone being college educated, nobody fully understood how to discuss this topic and make really great, yet painful, decisions. Now that my MIL has Alzhiemers, we are better prepared but will soon be seeking some proper (professional) guidance.

Laws change, emotions run high and deep. Outside help is welcome if for no other reason than to cut through the discomfort.

Walk in these shoes and you'll see how innocent - and helpful - this provision really is... especially for those without upper-middle class access to solid, non-emotional advise.
.

Of course not really on Soylent Green. I was joking about that. I don't believe we are headed in that direction. (at least for a good while) ;)

I agree that it is helpful it is to have guidance with end of life issues. Again, it's that "mandatory" issue that really disturbs me.

[Ken Fitzgerald]

I'm telling you right now,

"end of life" alternatives......that is and could get political quickly.

[Belinda Barfield]

I'm telling you right now,

"end of life" alternatives......that is and could get political quickly.

Not my intention Ken.

We don't know what is in this bill that is being forced down our collective throats. IMHO, many who are in favor of government funded health care for all are not going to like the mandatory counseling when that time comes around.

Here's an example for you (sorry, I don't have any playground anecdotes). Many patients with diabetes and hypertension ultimately have end organ damage that is very difficult to treat. Renal failure is one type. The only treatment for renal failure is dialysis. Without dialysis, the patient dies a painful death. Dialysis is very expensive. If my mother is 85 and on dialysis, is it realistic to think that she won't be counseled to end her long life by giving up dialysis so that someone younger and in better health can benefit from dialysis, and save the system some money at the same time?

[Darius Ferlas]

Euthanasia (let's not be afraid to use the proper terms) is a very potent issue. While I understand the need (wifey works with cancer patients) I also realize that the idea opens a lot of room for interpretation, pressure and foul play.

The issue is politically, spiritually and religiously loaded so I won't go there. Instead I quote a little something from about 2400 years ago:

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion. (Hippokrates of Kos)

Just a reflection on how much times have changed.

[Belinda Barfield]

[QUOTE=Darius Ferlas;1180228]Euthanasia (let's not be afraid to use the proper terms) is a very potent issue. QUOTE]

Euthanasia: the act or practice of killing or permitting the death of hopelessly sick or injured individuals (as persons or domestic animals) in a relatively painless way for reasons of mercy

IMHO euthansia and assisted suicide are two different methods. With the former the decision can be made FOR me if it is deemed merciful, in the latter the decision is made BY me.

Agreed that this is a very sensitve subject.

[Darius Ferlas]

[

IMHO euthansia and assisted suicide are two different methods.
They are indeed but my point was that there is a pretty thin line between the two because of interpretations, social pressures, mistakes etc.

It's just a tough one that I hope I will never have to face in regards to my loved ones.

The other day you asked about malpractice in CA, FR and UK.
Canada - much like the US
France - people can sue but they payer is the medical system, not an individual doctor
UK - no idea.

[Ken Fitzgerald]

I would suggest before anymore "alternative methods" are discussed read the bill to see if this is even a problem.

This is one of the hottest topics that will go against peoples religious and/or moral beliefs and is too political to be discussed here in my humble opinion.

Provide evidence that this is being discussed in the legislation. Otherwise this could become a heated issue and all for naught!

[Belinda Barfield]

I would suggest before anymore "alternative methods" are discussed read the bill to see if this is even a problem.

This is one of the hottest topics that will go against peoples religious and/or moral beliefs and is too political to be discussed here in my humble opinion.

Provide evidence that this is being discussed in the legislation. Otherwise this could become a heated issue and all for naught!

I don't have a copy of the bill before me Ken, but I believe mandatory end of life counseling every five years for anyone over 60 is outlined on pages 425 and 426.

Not proof, but the first site Google lists. Just do a search on "mandatory end of life counseling".

http://www.wnd.com/index.php?fa=PAGE.view&pageId=104719

[Mitchell Andrus]

I would suggest before anymore "alternative methods" are discussed read the bill to see if this is even a problem.




Relevant language from the bill:

Such consultation shall include the following: ‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to. (B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses. (C) An explanation by the practitioner of the role and responsibilities of a health care proxy. (D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965). (E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

Doesn't sound like "pull the plug" advise to me. Will there be discussions about terminal care and options concerning feeding and artificial support? I hope so!


ANYHOW..... This language may not show up in the final version once it leaves committee. So, let's not throw out the car because we don't like the ashtrays.
.

[Scott Shepherd]

I think this is the clip that might have caused some concern, where it's stated that as you get older, it might not make sense to give certain treatments, and it might make more sense to just give pain treatments to help through the end of life rather than do things that could cost more.

From ABC news....

http://www.youtube.com/watch?v=U-dQfb8WQvo

[Ken Fitzgerald]

Just for the record,

as long as we can discuss healthcare and the pros and cons of a universal healthcare system, I'd like to see the discussion continue.

End of life....euthanasia....assisted death.......they are very personal issues and can become extremely emotional because of religious and personal moral values.

In my own family recently, "no extreme measures" papers had to be signed by family members. It is, indeed, personal and emotional. I don't want to see emotional discussions surrounding these types of issues to cause this thread to have to be closed.

We can all learn alot, I believe, if we can discuss this without emotions and/or politics.

[Glenn Clabo]

"Not proof, but the first site Google lists. Just do a search on "mandatory end of life counseling".

Yes Belinda...what you quoted is not proof...in fact it's wrong. If fact it's what's really wrong with this whole issue. People tell you what you should think by playing with words. Here are the exact words...cut and pasted from the the most current bill...


the term ‘advance care planning consultation’ means a con sultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:....



Even better...look for yourself...it starts on page 424 here...
http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-BillText-071409.pdf


Do you see where "mandatory end of life counseling every five years for anyone over 60" is?


If healthcare is important to you...please read the bill (yes I have and will continue to read every change) not the interpretation of it by someone who is just trying to stike fear into your heart.

(ps...I just read what I sent...it comes off a little tough...which REALLY wasn't my intent. I'm just frustrated with the lies being spread and have some real personel life experiences that make it aggravating.)

[Greg Peterson]

The highest costs associated with caring for the elderly is in the final stages of care.

I don't see a problem with a professional discussing the options available for end of life treatments. Inform the patient of their options, and then they are able to make an informed decision.

Perhaps some, or many, do not realize the stress and complications they force on their family by not making a decision. It is a responsible person that makes arrangements in advance of such situations, thus preventing family to have to make an agonizing decision they should not have had to make. I don't want anyone deciding for me, I'll decide for myself thank you very much!

My personal experience with the issue is that knowing what the loved one wants didn't make it any easier, but I know we did what they wanted.

[Belinda Barfield]

Thanks for setting me straight Glenn.

[Ken Fitzgerald]

Glenn,

While I don't want to be told lies to strike fear into my heart...likewise, I don't want to be told lies to be "conned" into something we as a country can't afford........today or in the long term. Sooner or later somebody has to pay the bills.

And I don't want to be lied to or misled about who is going to pay the bills.

The often used term "we'll make provisions to make adjustments as the plan evolves" is just whitewashing the fact that some politicians are not willing to take the time to thoughtfully work out the details. Instead, they want to hastily pass the legislation. That to me is another example of legislative financial irresponsibility.

This is an important enough subject that giving the facts without any politcal bias is of the most importance.....

[Greg Peterson]

....giving the facts without any politcal bias is of the most importance.....

Like that's going to happen any time soon.

I looked at Belinda's link and the first thing I saw was Obamacare. Now I'm not a journalist, and heck, plenty of people will vouch for me when I say I'm not a rocket scientist either, but that headline told me that any content on the page was being served up in a manner that would reinforce a bias.

It was an opinion piece and not a particularly honest one at that. Which begs the question as to what is the authors motive to be intentionally misleading?

I hear pundits name calling, so-called news reporters or personalities clearly using daily published political memos as an actual report (used to be call plagiarism but now it passes for 'reporting'), and less than credible guests on air crying foul or doomsday.

I hear a lot of hyperbole but few reasoned, measured, modulation voices willing to ask the tough questions and break through the thin veneer of the knee jerk rabble rousers. Bill Moyer's has done an excellent job of asking the tough questions without resorting to inflaming passions, thus allowing the audience to actually think about both the question and the detailed and articulated anwer that follows.

[Ken Fitzgerald]

Greg,

It's important to note that politics are not subject for discussion.

I can't think of any reporter that is truly unbiased...including Bill Moyer and Lou Dobbs.

There can be as much bias in the question asked as in the resultant answer. You can ask a question and if you ask the right questions, you lead the conversation to a known result that is biased.

I personally don't rely on any one reporter, news agency, television netork or channel.

I know of none that "reports.....fair and balanced" and let's me decide.

[Belinda Barfield]

I looked at Belinda's link and the first thing I saw was Obamacare. Now I'm not a journalist, and heck, plenty of people will vouch for me when I say I'm not a rocket scientist either, but that headline told me that any content on the page was being served up in a manner that would reinforce a bias.

It was an opinion piece and not a particularly honest one at that. Which begs the question as to what is the authors motive to be intentionally misleading?

I hear pundits name calling, so-called news reporters or personalities clearly using daily published political memos as an actual report (used to be call plagiarism but now it passes for 'reporting'), and less than credible guests on air crying foul or doomsday.

I hear a lot of hyperbole but few reasoned, measured, modulation voices willing to ask the tough questions and break through the thin veneer of the knee jerk rabble rousers. Bill Moyer's has done an excellent job of asking the tough questions without resorting to inflaming passions, thus allowing the audience to actually think about both the question and the detailed and articulated anwer that follows.

And as I stated, Greg, that was in no way offered up as proof or truth. It was just the first thing that popped up on Google, not the end all be all source for information I'm sure we will all agree.

I have to ask, have there been that many detailed and articulated answers that followed the questions? Maybe I just missed them, or I'm not intelligent enough to understand them.

[Mitchell Andrus]

Nicely stated.

More often than not these days, the "news" plays to a hot button rather than presenting the facts.

[Greg Peterson]

And as I stated, Greg, that was in no way offered up as proof or truth. It was just the first thing that popped up on Google, not the end all be all source for information I'm sure we will all agree.


Sorry if it seemed I was singling you out. Your link was just an example of the kind of discourse our media engages these days. The tone of the article is such that one would either be inclined to agree 100% with it or disagree 100%.

Either way, divide and conquer.

Ken - Who, what, when and where are pretty objective questions and at the very least should be the starting point of any report. The 'why' question however is a little slipperier. There usually isn't one 'why' question to ask, and the answer could be anything from stone cold hard fact to speculation.

Jim Leher and Bill Moyers are a style of reporting that I enjoy. Sure they may not always ask the question that I'm dying to ask, but they usually ask questions infinitely more interesting and revealing.

Moyers did a great interview last week with Wendell Potter. Potter served as the chief corporate spokeman for CIGNA corporation for 15 years. He had many interesting thoughts, perspectives and insights into the fourth largest health insurance company in the country.

From 2002 to 2006, the health insurance industries profits rose from $1.3 billion in 2002 to $15.39 billion in 2006.

Healthy for someone. Not us though.

[Mitchell Andrus]

From 2002 to 2006, the health insurance industries profits rose from $1.3 billion in 2002 to $15.39 billion in 2006.

Healthy for someone. Not us though.

$15 billion buys a lot of care, or reduces a lot of premiums.
.

[Ken Fitzgerald]

Sorry if it seemed I was singling you out. Your link was just an example of the kind of discourse our media engages these days. The tone of the article is such that one would either be inclined to agree 100% with it or disagree 100%.

Either way, divide and conquer.

Ken - Who, what, when and where are pretty objective questions and at the very least should be the starting point of any report. The 'why' question however is a little slipperier. There usually isn't one 'why' question to ask, and the answer could be anything from stone cold hard fact to speculation.

Jim Leher and Bill Moyers are a style of reporting that I enjoy. Sure they may not always ask the question that I'm dying to ask, but they usually ask questions infinitely more interesting and revealing.

Moyers did a great interview last week with Wendell Potter. Potter served as the chief corporate spokeman for CIGNA corporation for 15 years. He had many interesting thoughts, perspectives and insights into the fourth largest health insurance company in the country.

From 2002 to 2006, the health insurance industries profits rose from $1.3 billion in 2002 to $15.39 billion in 2006.

Healthy for someone. Not us though.

Greg,

Style is just the icing. My point was that if you are prejudiced or biased towards or against a subject, you will and can ask the questions that leads to the result you want. Moyers and Laird both are liberally biased. They are as much commentators as O'Reilly and Limbaugh but at the opposite end of the spectrum.

I trust nobody in the news media today.They all have an axe to grind. It burns me up that the media have an axe to grind because obviously when they feel they have to filter the information for us, they are insulting the public's intelligence.

I stated earlier that a large part of the problems here are societal. Just like you and I are sitting at home typing on computers. Today, we interact with people less due to TV, computers, internet, etc. That change IMHO has made it so that we tend to "hang" with those with whom we agree. Thus we don't see a broad spectrum of ideas and views and when we do a lot of folks go off loudly, venemously and shoving our point of view down their throats.

Every ideology, every political flavor, every economic form in theory are 100% correct and perfect. In practical application, however, you may not recognize them.

I prefer to read the bill for myself and draw my own conclusions, Thank You!

[Frank Hagan]

Of course not really on Soylent Green. I was joking about that. I don't believe we are headed in that direction. (at least for a good while) ;)

I agree that it is helpful it is to have guidance with end of life issues. Again, it's that "mandatory" issue that really disturbs me.

The problem is that its a government mandated commission, and the advice is likely to be politicized as well.

During my father's slow descent and eventual death, we sought and received plenty of advice. There wasn't a health care professional that wasn't open and helpful, from his cardiologist to his general practitioner. There is plenty of help for those who need it within the system. These really aren't the "problems" we should be solving.

The real problems are the illegal aliens who have no health care (8 to 12 million), the working poor without employer sponsored plans (another 6 to 8 million), and those between jobs that lose their healthcare temporarily (about a third of the remaining people without insurance ... the rest don't want it).

Let's solve those problems, then we can start talking about "reducing costs in Medicare" by letting older people get "palliative care" instead of expensive drugs and procedures that extend their lives "only by a few months."

[Frank Hagan]

One of the largest inconsistencies in the arguments is the idea that more government control of the health care system will cause a reduction in costs. Its hard to see any example where that's the case elsewhere. Government intervention causes costs to go up, not down.

You can't add 47 million people to a system and lower costs.

An example: the mandatory counseling for certain people is a paperwork nightmare. Just like the HIPPA laws, requiring you to fill out those "privacy notifications" every time you go to the doctor, a federal law telling every doctor that they must counsel people in a particular way will result in less consumer understanding of the issues, not more. And increased costs in the doctor's office, not less.

Anyone here familiar with HIPPA? Did it reduce your costs, or increase it?

How many of you have signed mortgage documents? Most of the language in the dozens of pages is required boilerplate by your state and the federal government. The required medical counseling will be much the same, as layer upon layer of requirements are put on the relationship between you and your doctor. This will be worse than worthless, because it will prevent people from seeking the appropriate help ... they have a stack of federally approved papers with language written by the same guys that write the tax code to refer to.

[Greg Peterson]

Frank, Medicare operates at ~3% overhead. Private health insurance companies operate at ~20% overhead.

You tell me which one does more with the dollar.

I see no problem whatsoever in the doctor talking with his elderly patient about end of life situations. It's a conversation that likely doesn't come up around the dinner table, and the doctors office is a good place to have this talk.

Ken, Leher and Moyers are nothing like the pundits you compared them to. They don't have a 'patriot or pinhead' segment, they are not openly dismissive or hostile to guests that offer a different opinion, they don't engage in inflammatory rhetoric, and above all else they are civil.

If I want to see a clown, I'll go to a circus.

[Ken Fitzgerald]

Greg,

That is your opinion.

I never said they were as far left as the others were right...but their liberal views show through.

Here's my requirement for truth in reporting:

Give me the information. Keep your personal views to yourself.

If you are going to ask questions, ask questions that approach the subject from all points of view.

Work your butt off to keep your personal view out of it.

If that doesn't happen then it isn't reporting, it's commentary. And you are insulting my intelligience by feeding me what you think I can't determine for myself.

It's kinda like Hollywood movies based on factual happenings.....you sometimes don't see the facts for Hollywood hooplah.

PBS and those associated with it are not known for their objectivity any more than Fox News is "Fair and balanced. We report your decide." Right!

AND NOW........let's get off the politics. I'd hate to have to close a thread because I got political.:rolleyes::o

[Ken Fitzgerald]

Back to the subject at hand...

Medicare in some cases doesn't even pay the cost a hospital incurrs when it performs a procedure. As a result, hospitals raise their rates, so those of us with insurance are paying for the negatvie caused by Medicare.

Medicare is not a good example of something being operated perfectly.

[Greg Peterson]

Didn't claim Medicare was operated perfectly. No system is going to be perfect. Medicare may refuse to cover an expense incurred by the privately owned hospital, but a private insurance company would just pass that bill onto the patient. Medicare can't do that.

I've heard of instances that were originally cleared by an insurance company, the patient has the procedure performed and then the insurance company denies the claim.

[Ken Fitzgerald]

So the hospital is supposed to bite the bullet?

Why should the hospital be financially responsible and lose money?

[Greg Peterson]

So the hospital is supposed to bite the bullet?

Why should the hospital be financially responsible and lose money?

The hospital shouldn't. And they don't. They pass that expense onto the consumer. $10 asprin is one over simplified example.

I think most of us just want affordable health care and have some sort of safety net that will prevent us from losing everything we've worked to gain (retirement fund, home and the like). How we bridge this gap is important, but we can not let it divide us further.

[Ken Fitzgerald]

Greg,

For the most part, I'll agree with what you just said.

I will add one stipulation. We must find a way to fund it. You can look at the current situation with the State of California to see a beautiful example of the results of an irresponsible legislature. They had noble intentions but irresponsible actions and results. Sooner or later someone has to pay the piper.

Most Americans can take it on the chin. We want the truth. We can deal with bad news. We can pull together for a common cause. The trouble arises when you start showing any type of favoritism to one group or another. Immediately, people get jacked because they are being picked on.....

[Frank Hagan]

Frank, Medicare operates at ~3% overhead. Private health insurance companies operate at ~20% overhead.

You tell me which one does more with the dollar.


These stats leave much to be desired. One is wrong, the other misleading. And the conclusion is not what it would seem.

To get Medicare's "overhead" at 2 - 3%, you have to divide the number of dollars spent by Medicare by their administrative budget. That's not a true picture of overhead by generally accepted accounting principles (oh wait, the government doesn't use GAAP. They exempt themselves. But let's continue on.)

The low percentage doesn't account for the HIGHER spending per enrollee that Medicare has. If you calculate Medicare's costs on a per enrollee basis you close the gap by about half to the true number for private companies (7 - 8%). That still sounds a lot better, right?

While one reason Medicare has higher cost per enrollee is that it is for older people, who need more medical care. But they have also been roundly criticized for not going after waste, fraud and abuse by the GAO ... if they did, they could lower that cost per enrollee but it would raise administrative costs. There's a disincentive for them to ferret out the waste, fraud and abuse.

When comparing costs, remember that private companies have to use generally accepted accounting principles, comply with SOX and other regulations in how they calculate things like overhead, and government agencies do not.

[Jason Roehl]

Good points, Frank.

Someone mentioned that private health insurance ran a profit of ~$15B. That is a drop in the bucket compared to the total amount spent on health care in this country, ~$2.5T.

Here's a link to some numbers and charts:

http://hspm.sph.sc.edu/Courses/Econ/Classes/nhe00/

There are some interesting trends there.

[Mitchell Andrus]

Greg,


I will add one stipulation. We must find a way to fund it. You can look at the current situation with the State of California to see a beautiful example of the results of an irresponsible legislature. They had noble intentions but irresponsible actions and results.

Bad example.

"They" are the voters, not the pols. Unfunded wish-lists voted into law by voters is at the root of California's problem.

Other county's systems are the models to follow, not California's.
.

[Ken Fitzgerald]

I will disagree wth you Mitch.

Who passes the budget?

Regardless of whether the voters or the legislature, California's current budget crisis was caused by irresponsible legislation. It is irresponsible to spend more than you are earning.

We don't want that to happen with a nationial healthcare program.

As stated by one other Canadian poster here....do we want 47% taxes? And who is going to pay those taxes? What income bracket?

Give the American voters the details. Unbiased details.....

[Andrew Rogove]

Regarding end of life decisions brought up by many. These are personal choices indeed some of the most personal choices to be made. I personally encourage all of my patients to think about this and discuss it with their family. There is no reason to set an arbitrary age, 60 for example, to discuss these issues. Young people also end up on life support for many reasons, and I personally see that in a family where end of life decisions were previously discussed and made known, the difficulty of choices is made a bit easier because the family is now expressing their loved ones wishes, not making the decisions. A subtle, but sometimes comforting distinction. This is not a "end of life alternative," (hat is a totally different politically charged animal) but the discussion is important and should be done by all physicians, maybe not mandated, but good medical practice in my opinion.

As far as hospital costs, I have not seen it discussed here, but hospitals are paid on DRG codes per diagnosis for many cases, no matter how much or little care is provided. Often times pressure is put on docs to slightly change the diagnosis, without comitting out right fraud, because one diagnosis pays more than the next (an example would be urinary tract infection vs. urosepsis). This may causes hospitals to itemize for extras where they can and cahrge a ridiculous amount for aspirin (as the previous example stated.

As debated here and everywhere else in the US for that matter, there is much to be done for health care reform in this country. Hopefully, a well thought out solid plan will be implemented for all of our sakes.

Andrew

[Greg Peterson]

So far there have been some very good points brought up from various perspectives.

It seems that few would disagree that the system as it is configured today is sustainable or equitable.

I agree with Frank that Medicare needs to ferret out and eliminate the waste and fraud that is almost systemic in that system.

I've no problem with the insurance industry earning $15.39 billion in profits in 2006. But if one compares the trend in profits to the trend in ever rising premiums there is a correlation. And how much longer can small business continue to absorb or even shoulder the majority of the expense of health insurance?

When we went to an HMO system in the 90's, my employer covered the premiums 100%. They still cover the lions share, but my share of the cost exceed the premiums that were in place when we originally went into the HMO. And my deductible and co-pay is higher.

At least I have insurance. But I think many people are nervous about the fact that anyone is no more than a pre-existing condition away from not being eligible or able to afford an insurance policy should they change jobs or get laid off.

Lets hear from the single business owner/operator. I've heard horror stories about trying to get health insurance for themselves and or one or two employees.

I've little to no concern for large corporations interests in this battle. They'll ultimately get what they want if for no other reason they are to big to fail, which means to me that they should not have been allowed to become so big in the first place.

The blue collar worker and small business's are the disenfranchised stake holders in this debate, and it is this group that should have a seat, front and center, at the debate.

[Mitchell Andrus]

I will disagree wth you Mitch.


As stated by one other Canadian poster here....do we want 47% taxes? And who is going to pay those taxes? What income bracket?



Per Wikipedia, Canadian tax brackets:

$0 - $10,320 - 0%
$10,321 - $40,726 - 15%
$40,727 - $81,452 - 22%
$81,453 - $126,264 - 26%
over $126,264 - 29%

Add to that the high sales tax (17%, roughly 10% more than most states) and you get over 22 - 29% annualized, granted.

But - take an American family making $45,000.00, paying income taxes, sales taxes and THEN ADDING the cost of private health care costs and I'll bet you still aren't close to your 47% 'taxes' claim.

I'll gladly pay another 4% in income taxes (pushing me to Canada's top bracket of 29%) if I can get rid of the $8-9,000.00 insurance costs I'm paying, and stop paying the co-pays and deductibles.

Assuming a household income of $55,000.00 and a reasonable guess of $4,500.00 in insurance costs for a no-frills policy, another $1,000.00 out of pocket for co-pays and deductibles and you're adding 12% to this family's costs as a hidden 'tax' before getting to the 1040 in April.
.

[Scott Shepherd]

I'll gladly pay another 4% in income taxes (pushing me to Canada's top bracket of 29%) if I can get rid of the $8-9,000.00 insurance costs I'm paying, and stop paying the co-pays and deductibles.

So basically, you'll gladly pay more to have someone else pick up the tab for all your current costs? I'd prefer to earn my own healthcare insurance, not require someone else to pay for mine with the fruits of their labor.

Also, I've not seen much at all on here about the Lawyer's role in all of this. I would venture to guess that a huge part of all of these increases across the board are due to lawsuits. Let's fix the legal system while we're at.

[Andrew Rogove]

Also, I've not seen much at all on here about the Lawyer's role in all of this. I would venture to guess that a huge part of all of these increases across the board are due to lawsuits. Let's fix the legal system while we're at.

Amen to that. Tort reform is a big big issue with practicing physicians and must be part of any true health care reform, not restructure.

[Greg Peterson]

Tort reform is a lot like throwing the baby out with the bath water.

While there are abuses of the legal system, I'm not convinced that I want to reduce, remove or otherwise eliminate a patients only recourse in the event a doctor was willfully negligent.

Based on the number of prisoners we have in our society it seems reasonable that we like to hold people accountable for their actions. Why would we want to exempt an entire category of people from accountability?

There are ways of fixing the problem without impinging on MY rights to sue a doctor that was willfully negligent. As was stated in this thread by Andrew, "Often times pressure is put on docs to slightly change the diagnosis, without committing out right fraud, because one diagnosis pays more than the next (an example would be urinary tract infection vs. urosepsis)".

This qualifies as willfully negligent in my book. The severity of intentionally changing the diagnosis can be debated, but the bottom line is that the information recorded in the patients records is false.

There needs to be a standard the defines frivolous lawsuits. This would be a good place to start. But we don't want to limit or otherwise eliminate our only means of recourse and accountability in the event a mistake is made.

[Art Mulder]

Per Wikipedia, Canadian tax brackets:
...
Add to that the high sales tax (17%, roughly 10% more than most states)


Mitchell, you're making a mistake here. Misread the wiki entry (http://en.wikipedia.org/wiki/Taxation_in_Canada#Sales_taxes) perhaps, since it is clearly written there.

Sales taxes vary from province to province.
We have the federal GST -- goods and services tax, a VAT -- and we have provincial sales taxes. We do NOT have local city sales taxes, which I understand you do have in various parts of the US.

Added together, our sales taxes vary from a low of 5% in Alberta (which so far has no provincial sales tax, the lone hold-out.) to a high of 13%.

Actually, most provinces are around the 13% point.

[Mitchell Andrus]

So basically, you'll gladly pay more to have someone else pick up the tab for all your current costs?

I'd be swapping my insurance payments for tax payments, as they do in most other non-third world countries.

I don't mind paying for other's health and welfare. This is not an evil thing to ask of a population, I don't know why it seems to be sold as such. We all protect each other when a policeman is hired, a teacher, county clerk, road maintenance crew, soldier. The CDC is tax funded... as is the FBI, CIA NASA. Why not our hospitals, doctors and nurses? I feel protecting the health of all of our citizens is at least as important as protecting the cars and houses of all of our citizens via police and fire depts. NO? Isn't the health of my uncle, un-able to afford his own insurance and care as important as his car and the road in front of his house?

Of course I'm willing to open the umbrella a bit further, as long as I get to get under it too.

We already pay to care for others un-insured and poor. My county and state taxes are used to fund hospital and doctor care for the uninsured.

It's time to care for each other as we do our roads and bridges, else it seems that our priorities will be forever skewed.
.

[Glenn Clabo]

Hey...don't forget the "Internets"...