Universal Healthcare...

[FrantzM]

Hi

Let's at least accept that there is a problem with the cost structure. I am not sure there is much argument there. The problem thus becomes to determine where we can cut cost without cutting the patient ..err .. the quality of care ... I would for example like to understand why an MRI cost up to $8,000. What is the cost of an MRI machine and how much does it really cost to operate it? when such a routine and common procedure cost that much, it is no wonder that it is very, very difficult to finance Universal Health Care. The question remain however: What do we do with the increasing number of people who can't afford health care because of circumstances most often lack of work or lack of coverage? The people with lower revenues and with jobs that don't provide coverage are especially at risk. They can lose their jobs in a hurry because of health concerns and of course can't address these. It is especially difficult for lower income families, even with their best efforts to take a preventive approach to their health care, i-e better nutrition and exercise. IOW they eat what is less expensive which iare, of course the healthy foods and they become sick or sicker and ... where does it stop? Isn't it necessary to provide some care to those (not charity) Care, Organized care, to those people, a safety net, not a mass grave?

 

[Gregadd]

BTW Greg, you state that lawyers never never have problems extracting money from insurance companies. To me it only goes to show that lawyers don't work for free.....only the doctors

Ironically lawyers seem to be the only group able to get money from them

.

Steve- I was being facetious. We do have trouble getting money from insurance companies. That's why we have to sue. I think we (attorneys) have a proud history of pro bono representation. Just for example do you think all these prisoners released based on DNA tests went out and retained counsel?. Cheif Justice Earl Warren, as the folk lore goes, used to get handwritten appeals from inmates. He would appoint someone like Archibald Cox. Do you think WIlliam Kunstler was getting fat retainers from the pathetic defendants he represented?

I understand that lawyers and doctors are like cats and dogs. They are natural enemies. But they both have good qualities.

 

[Steve Williams]

I understand that lawyers and doctors are like cats and dogs. They are natural enemies. But they both have good qualities.

My mother used to tell me that a lawyer was a Jewish boy who couldn't stand the site of blood

 

[Gregadd]

My mother used to tell me that a lawyer was a Jewish boy who couldn't stand the site of blood

Or couldn't pass organic chemistry.

 

[Steve Williams]

nah...organic chemistry was fun and easy

 

[amirm]

Some companies have the notion of rotation where they take an employee and force him to work in every department. Nothing brings a sense of reality like that!

When I left Microsoft I kept my Cobra for 18 months and then it ran out. My own start-up hadn't come to fruition yet and here I was, with no insurance. I am telling you, no matter what your net worth, you worry about catastrophic illness wiping it out and then some. My wife was worried every day she woke up. Every doctor visit had anxiety of being told there was something seriously wrong with us. And the notion that insurance companies could turn you away for pre-existing conditions was terrifying. I did start my company and learned another lesson: crappy insurance at huge cost. Spoiled like you would not believe with Microsoft plan where everything was free no matter what you did, it was eye opening. First year premium for a handful of employees was $70K or so. Then the next year it jumped to $85K or so because we hired "older" people. So we had to go to a worse insurance plan to save some of that back.

The premiums are the same as the salaries of 20% of our workforce!

Needless to say, after 30 years of working for corporations and taking availability of group health care for granted, it was an eye opening experience to play other roles.

My suggestion to Greg is this: work in a doctor's office for a while. My suggestion to Steve is this: work in an insurance or law! There is a point of view all around. The combination is all wrong of course but integrating all points of view and keeping just the good is a hard challenging I would think.

 

[Steve Williams]

I can't disagree with you Amir.

My biggest gripe with insurance companies is the exclusion of preexisting conditions. As far as the insurance company goes they hire idiots with minimal education as underwriters who can either one fell swoop destroy any persons chance of getting coverage. I can't tell you how often I had patients come to me asking me to write a letter to their insurance about recent pap smears which were slightly abnormal not from cancer but rather from an easily treatable infection which caused the Pap to revert to normal. In spite of this they were either denied all coverage or had riders placed on their policy excluding any and all gynecological conditions

 

[Phelonious Ponk]

Some companies have the notion of rotation where they take an employee and force him to work in every department. Nothing brings a sense of reality like that!

When I left Microsoft I kept my Cobra for 18 months and then it ran out. My own start-up hadn't come to fruition yet and here I was, with no insurance. I am telling you, no matter what your net worth, you worry about catastrophic illness wiping it out and then some. My wife was worried every day she woke up. Every doctor visit had anxiety of being told there was something seriously wrong with us. And the notion that insurance companies could turn you away for pre-existing conditions was terrifying. I did start my company and learned another lesson: crappy insurance at huge cost. Spoiled like you would not believe with Microsoft plan where everything was free no matter what you did, it was eye opening. First year premium for a handful of employees was $70K or so. Then the next year it jumped to $85K or so because we hired "older" people. So we had to go to a worse insurance plan to save some of that back.

The premiums are the same as the salaries of 20% of our workforce!

Needless to say, after 30 years of working for corporations and taking availability of group health care for granted, it was an eye opening experience to play other roles.

My suggestion to Greg is this: work in a doctor's office for a while. My suggestion to Steve is this: work in an insurance or law! There is a point of view all around. The combination is all wrong of course but integrating all points of view and keeping just the good is a hard challenging I would think.

Back before health care reform, if you lost your job or left to start a business as Amir did and as I did, if you didn't have any pre-existing conditions too risky for the insurance companies, you could buy insurance on your own, although at a pretty horrible price. The catch was that insurance would cover your first heart attack, but when renewal rolled around at the end of the current policy period, they would drop you like a rock. If you had a serious illness or an expensive chronic problem, you really had no choice but to get yourself a corporate job with group coverage, stay put, and pray you didn't get laid off. It immobilized big chunks of the workforce, locked people into dead-end jobs they didn't care about...it couldn't have been good for productivity. Obamacare is a miserable dog's breakfast of a piece of legislation that has left unaccomplished the overwhelming majority of its promise, but it did get that much done. Let's hope it lasts. There are strong forces in American politics that would love to take even that back.

Tim

 

[RBFC]

Ultimately, that's the problem Tim. We got pre-existing conditions, but also got a pile of other stuff. This is a favored tactic: put an attractive piece of legislation in a bill, use it as a headliner, and pack a bunch of agenda-driven stuff quietly behind it.

Did you know that the TARP bill set aside millions for the Office of Medical Technology? This is the entity that will allow government monitoring of your local healthcare. This was set up long before the 2010 Health Care bill was passed. In the same bill, the committee of doctors who will decide on actuarial probabilities for treatment options was nominated. And this was a "bail-out"? They're working on gun control "quietly" according to the President. The convolutions of the legislative political process have increased geometrically, all driven by the desire to pass legislation without actually disclosing what it contains. Remember the President's comment, "Let's vote on it and then see what's in it." (2010 Health Care bill)

I'm going to have to refrain from entering these threads a bit if I don't want to invoke my healthcare services.

Lee

 

[Gregadd]

I think the term OBAMACARE is disrespectful and inaccurate. It may be a great campaign slogan, but has no place in intelligent discourse on health care. I wish he had gotten his way on the issue. Health care was an issue he ran on and was elected by an overwhelming margin.

 

[Ron Party]

Well stated.

 

[Phelonious Ponk]

Ultimately, that's the problem Tim. We got pre-existing conditions, but also got a pile of other stuff. This is a favored tactic: put an attractive piece of legislation in a bill, use it as a headliner, and pack a bunch of agenda-driven stuff quietly behind it.

Did you know that the TARP bill set aside millions for the Office of Medical Technology? This is the entity that will allow government monitoring of your local healthcare. This was set up long before Obamacare was passed. In the same bill, the committee of doctors who will decide on actuarial probabilities for treatment options was nominated. And this was a "bail-out"? They're working on gun control "quietly" according to the President. The convolutions of the legislative political process have increased geometrically, all driven by the desire to pass legislation without actually disclosing what it contains. Remember the President's comment, "Let's vote on it and then see what's in it." (Obamacare)

I'm going to have to refrain from entering these threads a bit if I don't want to invoke my healthcare services.

Lee

I hear you, Lee. Riders and tag-alongs are one of the many things wrong with out political process. But in this case, it's what didn't get through that is the real tragedy. We had an opportunity to truly address the healthcare problem in America - to extend decent care to everyone, to end the predatory practices of the insurance and drug companies, to bring the cost in line with the rest of the industrialized world. It would have been good for our health, good for our productivity and competitiveness and good for business all around.

All we got was an end to the worst of the predatory practices of the insurance industry.

Greg, sorry about the use of "Obamacare." I was being lazy. I wish he had gotten what he wanted as well. It wasn't quite good enough, but it was a hell of a lot better than what we ended up with.

Tim

 

[RBFC]

I think the term OBAMACARE is disrespectful and inaccurate. It may be a great campaign slogan, but has no place in intelligent discourse on health care. I wish he had gotten his way on the issue. Health care was an issue he ran on and was elected by an overwhelming margin.

With all the major news agencies and many internet reporting agencies using the term, I'm surprised that you feel that way. However, I have no problem editing it.

Lee

 

[docvale]

... No one has stated how much they are willing to pay in taxes for such a system. ...

My boss pays 30.6% on top of my gross salary for my health insurance. That money could be a component of my gross salary, if health care were "socialized". I doubt I would spend so much in taxes for health care...

Clearly, a tax-supported health care would reduce a lot the margin of negotiation of the doctors' salaries within the hypothetical public hospitals (e.g., in Italy, base salaries in public hospitals are standardized). Otherwise, the costs would have no limits... This is something that most of the MDs would probably don't like, despite the possibility to pair private practice to the public one would allow to increase the margin of earnings of the doctors. In Italy lots of doctors do both private and public practice and I've never heard complains about money from them...

A couple of years ago, when the US health care reform was debated, a girl in my lab said that she was against the extension of health coverage to all the citizens, because if everyone would have accessed treatments the lines to obtain treatments would have been longer. Honestly, here people can speak about numbers, lawyers, doctors, cost of malpractice and so on; but if I had to hear again that the restriction of health care is good for the timing of medical access, I would just be terrified again...

 

[Phelonious Ponk]

So she wanted some people to go without care so it would be more convenient for her? Nice.

Tim

 

[RBFC]

So she wanted some people to go without care so it would be more convenient for her? Nice.

Tim

This is a very sticky situation. IF you had a serious heart condition which necessitated surgery, you would have a hard time waiting a year or more for your turn. Also, you may simply be denied the service due to your age and other actuarial considerations. Examine the wait times and acceptance criteria for foreign countries with universal healthcare provisions. Either way, there's something that doesn't seem fair, and there are parties willing to argue for either side.

Lee

 

[Phelonious Ponk]

This is a very sticky situation. IF you had a serious heart condition which necessitated surgery, you would have a hard time waiting a year or more for your turn. Also, you may simply be denied the service due to your age and other actuarial considerations. Examine the wait times and acceptance criteria for foreign countries with universal healthcare provisions. Either way, there's something that doesn't seem fair, and there are parties willing to argue for either side.

Lee

Perhaps those are issues somewhere, Lee, but they're not the conditions in America, and nothing proposed in healthcare reform here would create such conditions.

Tim

 

[docvale]

This is a very sticky situation. IF you had a serious heart condition which necessitated surgery, you would have a hard time waiting a year or more for your turn. Also, you may simply be denied the service due to your age and other actuarial considerations. Examine the wait times and acceptance criteria for foreign countries with universal healthcare provisions. Either way, there's something that doesn't seem fair, and there are parties willing to argue for either side.

Lee

C'mon...
In country like UK, France or Italy, if you're in an emergency condition, you're treated as the emergency recommends. And you will never be denied because of age of "too much" serious condition!
Long lists are created if people want to be examined as periodical checks rather than for a situation. And time goes by because all the people that are in serious conditions come before, as the good sense would recommend.

 

[jazdoc]

Health Insurance

Well if we are going to understand how we got here and we are going, it's helpful to know how we got here. Meghan McArdle did an excellent job summarizing the development of private health care insurance in her 2009 Atlantic article "How American Health Care Killed My Father":

“Health insurance is different from every other type of insurance. Health insurance is the primary payment mechanism not just for expenses that are unexpected and large, but for nearly all health-care expenses. We’ve become so used to health insurance that we don’t realize how absurd that is. We can’t imagine paying for gas with our auto-insurance policy, or for our electric bills with our homeowners insurance, but we all assume that our regular checkups and dental cleanings will be covered at least partially by insurance.

Comprehensive health insurance is such an ingrained element of our thinking, we forget that its rise to dominance is relatively recent. Modern group health insurance was introduced in 1929, and employer-based insurance began to blossom during World War II, when wage freezes prompted employers to expand other benefits as a way of attracting workers. Still, as late as 1954, only a minority of Americans had health insurance. That’s when Congress passed a law making employer contributions to employee health plans tax-deductible without making the resulting benefits taxable to employees. This seemingly minor tax benefit not only encouraged the spread of catastrophic insurance, but had the accidental effect of making employer-funded health insurance the most affordable option (after taxes) for financing pretty much any type of health care. There was nothing natural or inevitable about the way our system developed: employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago.

We all believe we need comprehensive health insurance because the cost of care—even routine care—appears too high to bear on our own. But the use of insurance to fund virtually all care is itself a major cause of health care’s high expense.”

So our current employer based system is a (well-intentioned) accident of government tinkering with the tax code. This results in the following structural issues:
*Insurance is tied to the employer, not the individual consumer. This limits choice and flexibility while exacerbating the difficult issue of pre-existing conditions.
*The consumer is disconnected from the provider. The decline in out of pocket payment for services is summarized below:

*The above leads to increased costs. Insurance at Microsoft was not "free". Microsoft self-insures its employees, a form of compensation for which Microsoft receives a tax benefit. The insurance company (in this case Aetna) simply administers the plan. Imagine if your 'copay' for fill ups was $10 -- would you care about fuel efficiency?

Another misconception is that for profit health insurance companies (FPHI) make unseemly profits. Health insurers typically generate a 3-5% profit margin. This ranks in the middle of US industry and FPHI has several factors reducing profits and raising costs. Most obviously, FPHI is heavily regulated by the states. Indeed, there are 50 individual monopolies for FPI because purchase across state lines is prohibited by most states. If a FPHI in Indiana offers a low cost policy that suits my needs, I'm not allowed to purchase it in Washington. This limits consumer choice. Washington state has only four major FPHIs. Each state requires FPHI to conform to specific mandates -- services that an insurer must provide in order to offer product in each state. As of 2008 Washington State had 53! mandated services including podiatry, naturopaths and acupuncture. Each mandated service has its legislative advocates/lobbyists insisting that each is cost effective, but add them up and it probably adds 20-240%. "Mandating benefits is like saying to someone in the market for a new car, if you can't afford a Lexus loaded with options, you have to walk. Having that Lexus would be nice, as would having a health insurance policy that covers everything one might want, but drivers with less money can find many other affordable options; whereas when the price of health insurance soars, few other options exist."

Finally, less than market rates for Medicare and Medicaid reimbursement result in cost shifting to FPHI. We will explore Medicare and Medicaid next....

 

[RBFC]

Perhaps those are issues somewhere, Lee, but they're not the conditions in America, and nothing proposed in healthcare reform here would create such conditions.

Tim

Decreasing physicians' salaries, with many specialties being paid the same as family practitioners, coupled with decreased Medicare reimbursement are already changing the picture, and these are proposals included in the healthcare reform package. Add to this the millions of new patients created by their inclusion in the program. Look at medical school enrollment data to see the effect the reform (and proposed earnings reductions) is having upon interest in going to medical school.

I hope you understand that "implied" provisions of the bill are just as important as the literal ones. Please feel free to research the items I mentioned. I live in this world of medicine and see these effects on a daily basis.

Lee