A glimpse into government health care

[Don Quixote]

Great post! I don't think the Americans who want a totally government-run health-care system really know what they're getting themselves into. It would decrease the quality of health care and it wouldn't really make the current system any better. We'd end up with "medical tourism," where people who have a little $$ will travel for decent care. Your proposal that the companies set up a fund for the poor seems moderate and reasonable; my only concern is that the government will "raid" it and use it for other purposes.

And ... best of luck for your friend's mother.

[Emanuel20]

"Great post! I don't think the Americans who want a totally government-run health-care system really know what they're getting themselves into. It would decrease the quality of health care and it wouldn't really make the current system any better. We'd end up with "medical tourism," where people who have a little $$ will travel for decent care. Your proposal that the companies set up a fund for the poor seems moderate and reasonable; my only concern is that the government will "raid" it and use it for other purposes.
And ... best of luck for your friend's mother."

Thanks

"my only concern is that the government will "raid" it and use it for other purposes."

To decrease corruption, the organization responsible for the fund should not correlate different gov't interests.

[ElNono]

My biggest beef with the current system is the overinflated prices for everything. Have you looked at your insurance reports? A standard procedure that is billed for $2000, the insuance pays $300. The reality is that the procedure really costs 300 bucks, but if doctors don't bill $2000 then they wouldn't even be able to cover their costs, and make a little profit on top.
The big, huge issue with this is that if you don't have insurance, or your insurance does not cover that particular procedure, you will be billed for $2000, even tough it really costs $300.
And this is really terrible even for middle class families.
The other thing I don't like is that Insurance companies will go to any extent, exploit any hole, turn every stone in order to avoid complying with state mandated coverage for certain procedures.
I've personally had to go through this here in Jersey, where our Insurance company classifies the company as self-insured, so they can avoid covering state mandated coverage procedures.
I ended up having to pay $700+ for a medicine that an Insurance Co pays only $100 bucks.
I'm still pissed off about that .

[Wild Cobra]

Health Care is an important issue regarding United States as well as the rest of the world.

From reading the arguments being raised in this thread, I think that the solution would have to combine private insurance market and a little gov’t intervention in the insurance sector. For example, USA needs to keep its thriving insurance market however a couple changes would improve it.

Yes. Tort reform would help allot.

Currently, most of the middle, upper middle, and high class can afford health insurance at the concurrent rates. The problem would be people at the poor class and lower middle class which are individuals that have more health problems and therefore would receive higher premiums. Here is where the gov’t can help the lower class by making a threshold of income and if the income is lower than the threshold the gov’t can help the struggling family with their insurance premiums. For example, some families might be making 50-55,000 a year, which would enable them to pay a portion of their premium and the other one can be covered by the pool mentioned below. If both parents combined are making 30,000 a year; they can’t afford health insurance; however the gov’t can insure them through the Pool (explained below).

What makes you think someone making $50k cannot pay all the premium? It would be about $600 I think without other changes. Implement some tort reform and educe some regulations, that number should be half or less.

Therefore the government can start by passing a bill that requires every insurance company to pay a certain percent of its premiums, contribution, and transfer them to a CRL pool that would be used to cover the lower class population that is unable to purchase insurance. To make up for the fees contributed to the pool, insurance companies can invest their regular amount + the percent charged by the government; which would only contribute to a small amount of loss. Also, the pool’s assets can be invested so that insurance companies would have to pay lower percentage as the pools’ assets cover the risk of the lower class's health claims.

How about taking all tax liabilities off of insurance companies which would reduce the amount they have to charge to make a profit?

I don't know what a CRL pool is, but how do you keep the people being subsidized from all favoring one company over another. Wouldn't insurance companies have to ration how many people they can subsidize?

I would like to see everyone get health care but I have lived in a socialized heath care environment in Europe and I did not like it. Currently, my friend’s mother in Europe is waiting for a tumor surgery and if not operated within 4 weeks, she would not be able to recover. Her scheduled date is 2 month from now…..What the is she supposed to do? Wait….
Of course, she is going to another country to receive the surgery.

Yep... The elitists here keep pushing that idea on us. They don't care because they can go outside the system. What these socialized ideas do is cover everyone as "the least common denominator." Insurance in the USA started as an incentive to stay for a company, as a benefit over increasing wages. There is no right to free health care.

Also, the service you would receive in socialized health care is horrible…I’d rather work two jobs to pay for a quality health care! Also, there is a higher percentage of people that have died due to medical mistakes in a socialized heath care environment than in the private environment.

Yep, I agree. I have worked two jobs at times myself. Myself an my family have normally been covered by insurance through my various employer. Right now, I pay a little over $100/month to cover myself and family for my selected health plan. My employer pays something like 85%(?) of the full cost, so it really costs about $700/month. This is a cost that I choose not to pay when I had jobs without insurance because doctor visits are as low as $35, lab tests for my daughters chronic condition are about $100, etc. All you have to do is shop around for doctors who are fair. They normally give a huge discount for customers who pay as they go. They normally don't have to spend time billing insurance companies or try to collect money from patients. Her normal medical maintenance is only about $450/year including medication. She has hypothyroidism.

My biggest beef with the current system is the overinflated prices for everything. Have you looked at your insurance reports? A standard procedure that is billed for $2000, the insuance pays $300. The reality is that the procedure really costs 300 bucks, but if doctors don't bill $2000 then they wouldn't even be able to cover their costs, and make a little profit on top.

I don't believe that. There can be discounts, but not that much. What you are talking about might be the bill for just one aspect of the whole visit. Often, at hospitals, the doctors bill separately from the hospitals. I've see this on out of pocket payment when too large to pay in full.

The big, huge issue with this is that if you don't have insurance, or your insurance does not cover that particular procedure, you will be billed for $2000, even tough it really costs $300.

Depends on the place you deal with. What you describe is one reason the health care system costs so much. People cannot be turned down for emergency procedures, then the health care providers often don't get paid. That's why huge profits are built into insured coverage costs. This is why a good hospital or clinic will charge far less with payments in full.

And this is really terrible even for middle class families.
The other thing I don't like is that Insurance companies will go to any extent, exploit any hole, turn every stone in order to avoid complying with state mandated coverage for certain procedures.

Some do. That's why you shop around. If you know where to go before having to make a last minute decision, it can cost half or less. When the consumer is informed, the market responds. As long as places can get away with high profits, what incentive do they have to reduce prices? Their standard pricing keeps them from going bankrupt.

I've personally had to go through this here in Jersey, where our Insurance company classifies the company as self-insured, so they can avoid covering state mandated coverage procedures.
I ended up having to pay $700+ for a medicine that an Insurance Co pays only $100 bucks.
I'm still pissed off about that .

Different health plans are different. This might be one where the consumer pays the first $1000 or so before coverage picks up the majority of costs. There are free market plans like this out there. They are primarily meant to cover only excessive expenditures, keeping people from financial hardship. These are among the cheapest options I can get through my employer.

Bet you have no monthly premiums to pay, or they are lower than they would be else wise.

[Purple & Gold]

that's not true. the girl i knew had no job, thus no healtcare...

When was this? Because it had always been, and from what I understand that everybody is covered including the unemployed. Not saying that what you are saying is not true, but the unemployed have always been covered. Of course things may have changed, but I doubt it.

[Purple & Gold]

Why would the top ten percent want to opt out if
it is such a good health system. Strange that the
well to do can go the private route.

Like Teddy, reckon he could run off down to
North Carolina, was it, for the best doctor for his
condition was located to get treated under
Universal Health Care? Well he could, but could
you?

Of course the top 10% can always get better coverage. You get what you pay for, but not everybody can afford the best care. When you cover everybody something has to give. At least everybody gets health care, which is the main issue. And it's good coverage, sometimes better than coverage in the U.S. sometimes Mexico has better doctors then the U.S.

[xrayzebra]

Of course the top 10% can always get better coverage. You get what you pay for, but not everybody can afford the best care. When you cover everybody something has to give. At least everybody gets health care, which is the main issue. And it's good coverage, sometimes better than coverage in the U.S. sometimes Mexico has better doctors then the U.S.

Where is the equality in that? And no one in the U.S. is denied health care. No hospital can turn anyone away by law. Also, I don't know where you are from, but here in San Antonio, we pay a pretty hefty hospital tax that operates a county hopital, named, University Hospital, that provides health service for anyone, including illegals, that shows up on their door steps. University has made it abundantly clear they will never question anyone's citizenship.

Oh, as a little side note. Mexico, I believe has some form of universal health care. But Mexican citizens on the border will come to the American side to have their children so they are citizens of this country and for other procedures. Which has/is causing a monetary crunch on these hospitals because they cant/refuse to pay.

[Purple & Gold]

Health Care is an important issue regarding United States as well as the rest of the world.

From reading the arguments being raised in this thread, I think that the solution would have to combine private insurance market and a little gov’t intervention in the insurance sector. For example, USA needs to keep its thriving insurance market however a couple changes would improve it.

Currently, most of the middle, upper middle, and high class can afford health insurance at the concurrent rates. The problem would be people at the poor class and lower middle class which are individuals that have more health problems and therefore would receive higher premiums. Here is where the gov’t can help the lower class by making a threshold of income and if the income is lower than the threshold the gov’t can help the struggling family with their insurance premiums. For example, some families might be making 50-55,000 a year, which would enable them to pay a portion of their premium and the other one can be covered by the pool mentioned below. If both parents combined are making 30,000 a year; they can’t afford health insurance; however the gov’t can insure them through the Pool (explained below).

Therefore the government can start by passing a bill that requires every insurance company to pay a certain percent of its premiums, contribution, and transfer them to a CRL pool that would be used to cover the lower class population that is unable to purchase insurance. To make up for the fees contributed to the pool, insurance companies can invest their regular amount + the percent charged by the government; which would only contribute to a small amount of loss. Also, the pool’s assets can be invested so that insurance companies would have to pay lower percentage as the pools’ assets cover the risk of the lower class's health claims.

I would like to see everyone get health care but I have lived in a socialized heath care environment in Europe and I did not like it. Currently, my friend’s mother in Europe is waiting for a tumor surgery and if not operated within 4 weeks, she would not be able to recover. Her scheduled date is 2 month from now…..What the is she supposed to do? Wait….
Of course, she is going to another country to receive the surgery.

Also, the service you would receive in socialized health care is horrible…I’d rather work two jobs to pay for a quality health care! Also, there is a higher percentage of people that have died due to medical mistakes in a socialized heath care environment than in the private environment.

I'm sorry to hear about your friends mother, but keeping the U.S.'s thriving insurance market is not the way to go about things. I'm not saying scrap all health insurances, but there is a reason why they are "thriving". They are making huge $'s off of the sick and elderly that have no choice but to go to them. They are making huge profits and half the time will not care for somebody if they have any preexisting conditions. Kaiser just had to pay a large settlement for wrongly terminating policies because of misinformation and preexisting conditions. Not to mention the power the pharmaceutical companies have with insurance companies. All should be covered and it's as simple as that. Nobody should have to go into debt because they got sick or got in an accident that was beyond their control.

My cousin who got sick at 18 now is straddled with a monthly bill to cover her hospital stay. At 18 already paying over $200's a month because you got sick. Doesn't anybody see anything wrong with this?? Now she can't even go to school because between gas, her hospital bill, rent, food, etc. there just isn't enough money to go around. She has to work 2 jobs, which doesn't allow college, which in turn will severely impact her future. Hospitals making big bucks off of people that have no options is just immoral.

While socialized health care is not always the best and sometimes people and cases do fall through the cracks, it is much better than the U.S. model. In the U.S. model people are made to go through hoops all the time, being made to fill out all types of paperwork and being rejected time and time again is many times an insurance companies "policy" before they are given care. Not only in socialized countries do people have to go out of the country to get health care. It happens in the U.S. as well. I've been to both types of doctors and the U.S. versions service is not much better. Sometimes it is just as bad if not worse. There will always be cases on both sides that will paint each side as horrible or great, but when dealing with such large numbers of people the whole is what needs to be looked at.

[Purple & Gold]

Where is the equality in that? And no one in the U.S. is denied health care. No hospital can turn anyone away by law. Also, I don't know where you are from, but here in San Antonio, we pay a pretty hefty hospital tax that operates a county hopital, named, University Hospital, that provides health service for anyone, including illegals, that shows up on their door steps. University has made it abundantly clear they will never question anyone's citizenship.

Oh, as a little side note. Mexico, I believe has some form of universal health care. But Mexican citizens on the border will come to the American side to have their children so they are citizens of this country and for other procedures. Which has/is causing a monetary crunch on these hospitals because they cant/refuse to pay.

Are you saying it's equal now?? Nothing will ever be equal, it's about getting the best care to the most people. In the U.S. you will not be denied coverage, but you will sure be sent a bill. If you can't cover it then it goes to creditors, etc. This will affect a persons future greatly.

The thing is that if people were able to go to the doctor for regular care, than many of these late night emergency room visits will not be needed. This not only helps the patient, but the taxpayer as well. A little bit of prevention (doctors visits) will stop little problems from turning into grave sicknesses. Of course the hospitals don't care because they charge more for emergency rooms, ambulances, etc. It's all profit to them.

As for Mexico, it is one of the most corrupt governments in the world. I don't really think I need to tell you why people would want their children to be U.S. citizens. This is the only place in the world were a 1st world country borders a 3rd world country. With that comes special issues and cases that pertain only to us and the region we are in.

[Purple & Gold]

My biggest beef with the current system is the overinflated prices for everything. Have you looked at your insurance reports? A standard procedure that is billed for $2000, the insuance pays $300. The reality is that the procedure really costs 300 bucks, but if doctors don't bill $2000 then they wouldn't even be able to cover their costs, and make a little profit on top.
The big, huge issue with this is that if you don't have insurance, or your insurance does not cover that particular procedure, you will be billed for $2000, even tough it really costs $300.
And this is really terrible even for middle class families.
The other thing I don't like is that Insurance companies will go to any extent, exploit any hole, turn every stone in order to avoid complying with state mandated coverage for certain procedures.
I've personally had to go through this here in Jersey, where our Insurance company classifies the company as self-insured, so they can avoid covering state mandated coverage procedures.
I ended up having to pay $700+ for a medicine that an Insurance Co pays only $100 bucks.
I'm still pissed off about that .

Insurance companies are s and anybody that tells you to just shop around doesn't live in the real world or could really just care less.

[xrayzebra]

Insurance companies are s and anybody that tells you to just shop around doesn't live in the real world or could really just care less.

Yeah, until you need them and they pay the bill.
You want cheaper insurance and full payments of
most charges....go the HMO route.....

Yeah they have rules, but so does everyone.

[ElNono]

I don't believe that. There can be discounts, but not that much. What you are talking about might be the bill for just one aspect of the whole visit. Often, at hospitals, the doctors bill separately from the hospitals. I've see this on out of pocket payment when too large to pay in full.

Wish I could show you the bills.
Surgery: billed $7000, insurance paid $1200.
Lab Work: billed $350, insurance paid $60

and the list goes on...

Some do. That's why you shop around. If you know where to go before having to make a last minute decision, it can cost half or less. When the consumer is informed, the market responds. As long as places can get away with high profits, what incentive do they have to reduce prices? Their standard pricing keeps them from going bankrupt.

Shop around for what? My wife's job offers only a single plan. Take it or leave it. I only have insurance through her, since we don't make enough money at my job to have insurance.

Different health plans are different. This might be one where the consumer pays the first $1000 or so before coverage picks up the majority of costs. There are free market plans like this out there. They are primarily meant to cover only excessive expenditures, keeping people from financial hardship. These are among the cheapest options I can get through my employer. Bet you have no monthly premiums to pay, or they are lower than they would be else wise.

The plan we have has no premium. They'll cover 100% of in-network visits, and 80% of out of network. Thing is, they're only in Jersey. We used to go see a specialist in Philly, and now we can't anymore. We have to go see the Jersey dude, and he sucks. But what are you gonna do?
What pisses me off mostly is that they exploit a hole in the law to deny coverage of state mandated procedures, and like I said, 90% of the time they only pay 10%-30% of the billed amount.
This is the sad state of business here in Jersey.

[bresilhac]

Yeah, until you need them and they pay the bill.
You want cheaper insurance and full payments of
most charges....go the HMO route.....

Yeah they have rules, but so does everyone.

I cannot believe you would actually try to defend those greedy, profit-driven insurance companies for any reason. The insurance business is an obscene fraud and most people don't even realize it as such. Insurance companies take the money they rake in via "premiums" and invest it all in the markets to make lots of cash for themselves and their stakeholders.

And if they have to reluctantly pay on a few of their rigged policies it's like pulling an impacted molar. They'll fight you every step of the way to try and get out of paying for anything. Fact is there is nothing benevolent or altruistic about an insurance company contrary to what they would like you to believe.

In fact, insurance companies are shining examples of how capitalism actually works. Screw as many "customers" out of as much money as you can while paying out as little in benefits as you can while simultaneously paying the least taxes as you can. Man do I wish I was the CEO of Kaiser or MetLife.

[xrayzebra]

I cannot believe you would actually try to defend those greedy, profit-driven insurance companies for any reason. The insurance business is an obscene fraud and most people don't even realize it as such. Insurance companies take the money they rake in via "premiums" and invest it all in the markets to make lots of cash for themselves and their stakeholders.

And if they have to reluctantly pay on a few of their rigged policies it's like pulling an impacted molar. They'll fight you every step of the way to try and get out of paying for anything. Fact is there is nothing benevolent or altruistic about an insurance company contrary to what they would like you to believe.

In fact, insurance companies are shining examples of how capitalism actually works. Screw as many "customers" out of as much money as you can while paying out as little in benefits as you can while simultaneously paying the least taxes as you can. Man do I wish I was the CEO of Kaiser or MetLife.

Hey, you don't like insurance companies, screw them, don't take out any. It is a free country, you know.

But I'll just bet you think it is right for the Government to require all drivers have car insurance. Right.

And for government to furnish flood insurance for folks who live in flood prone areas. And to help folks on the coast who don't have hurricane insurance. Yeah I bet you think that is great for YOU and me to pay out through our taxes. Yep, help those people to rebuild in the same area so we can do it all over again in a few years. You know like New Orleans, which is below sea level. Is America great or what.

Cause you don't like those damn captialist, which built the country you live in. Give me a break.

[TDMVPDPOY]

medicare/free health cover for underprivilege only works when ppl who uses it, doesnt abuse the system and putting burden on it.....another problem also is baby boomers

[Emanuel20]

What makes you think someone making $50k cannot pay all the premium? It would be about $600 I think without other changes. Implement some tort reform and educe some regulations, that number should be half or less.

-Well, the 78% of families of 4 that make under $50K in GA struggle to pay insurance premiums if they have any.

How about taking all tax liabilities off of insurance companies which would reduce the amount they have to charge to make a profit?

-Insurance companies make their profits from accurate estimation and they charge premiums based on claims (in healthcare) and previous medical conditions and the likeliness of future medical conditions. The decrease of tax liabilities will not have a significant impact of their profit trend.

I don't know what a CRL pool is, but how do you keep the people being subsidized from all favoring one company over another. Wouldn't insurance companies have to ration how many people they can subsidize?

-Well, every insurance company would be allowed a percentage of the Pool based on participation of lower class. (They would have some limit). Therefore, you will have a balanced participation of the lower class covered by different insurance companies.

[boutons_]

"would be about $600"

The avg family of four pays $12K/year for premiums, then $3K outta pocket.

[Emanuel20]

"would be about $600"

The avg family of four pays $12K/year for premiums, then $3K outta pocket.

Depending on what kind of insurance coverage you have.
Here in GA, we did a survey and found out that the average family of 4 pays about $500-$600 monthly (combination of HMO, Indemnity, PPO). I guess this is only for GA, but still when you generalize it, this is not more than 7,200 annually. But I have a feeling that if you take United States as a whole and draw the stats, 12K annually would not be far from the truth (maybe a little less ).

[RandomGuy]

NEW YORK - Employer health care costs are poised to rise almost 10 percent in 2008 — more than double the annual inflation rate — and nearly that much again in 2009, according to an industry report released Tuesday.

The study by PriceWaterhouseCoopers predicts that medical costs will increase 9.9 percent in 2008 and an additional 9.6 percent in 2009.

"Health care providers, insurers and employers will have to monitor medical costs carefully if we are to avoid a resurgence of the double-digit annual increases seen in the past," said Dr. David Chin, leader of the Health Research Ins ute at PriceWaterhouseCoopers.

The report identified two factors driving the increase:

_A hospital building boom, as hospitals replace facilities and add private rooms and centers for outpatient treatment.

_An increase in the expenses those with insurance are paying for those without. Cost-shifting from the uninsured, Medicare and Medicaid will account for nearly one in every five dollars spent by private insurers in 2009, according to the study, as the federal government underfunds public insurance programs and the number of people with private insurance continues to decrease.

One of the things employers are doing in response is increasing wellness, prevention and disease management programs, which they say not only keeps employees healthy but also raises productivity.

PriceWaterhouseCoopers surveyed more than 500 employers and health plans, with total coverage of more than 11 million people, for the report.

Linky dinky doo

Read it and deal with it. This is exactly what I and other progressives have said would happen over time, based on the available economic data.

I seriously would LOVE to see the conservative "solution" to this problem, other than the patently immoral "let people without health insurance just die" bit already expressed here.

[RandomGuy]

Like it or not government subsidizing or regulation of health care is coming.

The ONLY way to avoid this is to abolish the laws that require emergency rooms to accept and treat all patients who show up without insurance. If you can't/won't do that, then stop ing, and give me a solution.

I see three basic choices.

1) We can either have the conservative, grab-asstic, "do-nothing" solution that will simply accelerate this trend, and probably cause some sort of systemic collapse.

OR

2) We can do something akin to a single-payor system with the government playing the role of a massive insurer.

OR

3) We can let the government run health-care lock stock and barrel, about as grab-asstic as the first solution.

Anyone else have any bright ideas, do tell.

[RandomGuy]

people die while on a waiting list to even see a doctor for a diagnosis like what happens over in Europe with their socialized health care

Source?

Statistics?

I call bull . Put up or shut up.

The only data I have seen is that Europeans are healthier in general than Americans.

Hardly indicative of people dying in the streets, is it?

[Wild Cobra]

Source?

Statistics?

I call bull . Put up or shut up.

The only data I have seen is that Europeans are healthier in general than Americans.

Hardly indicative of people dying in the streets, is it?

Don't ask me for a link either. I'm not looking it up. I am shocked that people get into this single payer idea without looking at the bad aspects themselves. It works this way. Patients who get cancer do not get treated right away. Too many end up on waiting lists to be seen. By the time they get seen and treated, many who could have survived now become terminally ill because of the progression of cancer from a controllable cancer, to uncontrollable.

There are other situations that do occur. I'm not an expert here, I just know things like this happen regularly.

[boutons_]

"By the time they get seen and treated, many who could have survived now become terminally ill because of the progression of cancer from a controllable cancer, to uncontrollable."

This already happens, right now in your ever so lovely USA, to 1000s of un/under-insured people who wait as long as they can before going to dubya's emergency room. Now their disease is 10x or 100x more expensive, longer lasting that early treatment. The ER/hospital sends the bills to govt and/or simply raises all the hospital's billing to patients who can pay.

Another aspect of the US system is that many people don't buy their prescription drugs because the ever increasing co-pays, because of dubya's donut hole, so they get sicker rather than spend the money. Especially true for retired people on fixed incomes.

Remember that dubya's health bill made it illegal for the US govt to negotiate prices with BigPharma.

CBO says the Medicare/Medicaid system is solvent until the 2040s, and some say that's too pessimistic.

[xrayzebra]

Source?

Statistics?

I call bull . Put up or shut up.

The only data I have seen is that Europeans are healthier in general than Americans.

Hardly indicative of people dying in the streets, is it?

RG I think most of us could only give antidotical
instances. I don't know how they would start to generate the statistical information needed to show how many people are dead or dying from non-treatment. I not sure the government would if it could. It certainly wouldn't look good on them, would it?

I suppose we could (I could) do like a lot of single payer (universal health care) supporters and pull some figures out of the air. Like 100,000 and call it a crisis. But I wont

[RandomGuy]

Yes. Tort reform would help allot.

Not according to the PriceWaterHouseCoopers white paper.

Tort reform= hollow ideological solution lacking data that makes people "feel good"

Tort reform would do a bit, but not as much as its advocates claim, and certainly not much in the long run.