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Public/Private Health Insurance vs Single Payer

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May 12, 2009 – Comments (27)

In his post explaining that a public health insurance program will inevitably lead to mandatory death sentences as in the "Logans Run" movie, and suggesting a private for profit insurance model will avoid that, even under the same pressures, uclayoda86 asked me this question;

 Do you really believe that a single payer would provide good services for everyone and cost $2 Trillion less?

Which is a fair question for me, having voiced my support for H.R 676, a bill which would provide Single Payer and eliminate the $350,000,000,000 dollars wasted through the inefficiency of the private for-profit, multiple payer system now in place.

The question however, was do I really believe that the expected savings from a Single Payer system will actually materialize.

According to the Nationmaster database:

The United States has a 2008 population of 300,000,000, of which 50,000,000 are uninsured. In 2004 the United States spent $1,847,088,000,000 on healthcare.

The total 2008 population of Germany, France, the U.K, Canada, Swizerland and Denmark is also 250 million, and represents a variety of "socialized, government run, healthcare" systems.

In 2004 Germany spent $288,722,000,000, France spent $211,304,000,000. U.K. spent $173,904,000,000. Canada spent $100,221,000,000. Swizerland spent $50,139,000,000 and Denmark spent $19,480,000,000.

Total combined spending in 2004 is $843,770,000,000.

One Trillion less in 2004 than the USA spent to insure a comparable number of people.

Even if you decide that the US spending covers 300mil people through free walk in emergency rooms, and add that 20% additional spending to the Government run systems, you still spend $830billion less each year.

Is it possible we pay Doctors and Nurses, 80% better in the United States than in the compared Countries? I suppose it is. Is it also possible, as the Doctors and Nurses of www.pnhp.org claim that the excessive beaurocratic paperwork of the private insurers wastes $350bil each year. I suppose it is. This clue from the Herzing online University suggests it is;

 Medical Billing and Insurance Coding — Career Outlook

Medical Records and Health Information employment will continue to grow at a rate of 18% through 2016—much faster than the average for all occupations, according to the US Department of Labor. Technicians with a strong background in medical coding will especially be in demand.

Medical Billing and Insurance Coding — Career Paths

Properly trained Medical Billing and Insurance Coding professionals are in very high demand across the health care industry. Positions exists in all areas of health care including doctors’ offices, insurance companies, hospitals, clinics, assisted living facilities, or any other health care provider. Examples of career paths for Herzing University graduates include:

Medical Coder Insurance Claims Analyst Coding Specialist Abstractor Medical Office Assistant Coding Technician Medical Billing Specialist Medical Clerk Health Information Specialist

Graduates of the Herzing University Medical Billing and Insurance Coding programs will be positioned to work as either a Medical Biller or Medical Coder. They may also choose to incorporate both career paths as some employers seek one person who is capable of performing both functions.

Starting pay is fully three times the cost of a health insurance policy.

You can reach your Congressman and voice support for H.R.676 at 202-224-3121.

Sometimes the smartest investment is not an equity.

Single Payers detractors suggest that a Single Payer system will result in long waits and denial of services. Single Payers supporters say the private insurers already cause that. Single Payers detractors say Government interference is the problem. Single Payers supporters say using Private Insurers to run medicaid/medicare programs is the problem. Single Payers detractors say people should make better choices and earn more money so they deserve healthcare. Single Payers supporters tell their stories.

Here is Trisha's story:

TrishaSomewhere between Flint and Detroit, MIHeathcare Status: Employer Insured

I finally obtained a job where the employer provided the insurance they promised. It felt good to have insurance, finally, after years of either going without or having to "ride the system". What an accomplishment! Being a newlywed, I got surprised with a little blessing shortly into my new job. From the moment I found out I was pregnant, my experience with Aetna and the medical community has been nothing short of hell on earth.

My first OBBYN wanted me to sign a statement saying I'd pay $3200+ for "general prenatal care and delivery charges" on top of pre billing Aetna the maximum amount. I got one ultrasound done there and went to a new OBGYN. The ultrasound was denied by Aetna, since "it was coded incorrectly, Aetna labeled it experimental" and isn't obligated to pay it. The Dr.'s office assures me it is labeled correctly "Aetna is just like that". The debt collector told me to quit trying to commit insurance fraud by getting the Dr. office to recode it properly and resend it. Oy.

Long story short, Aetna has denied E-V-E-R-Y single bill submitted for one excuse or another. I call, and they say, "oh, I see what the problem is...I'll fix it and send it back through." Then they don't. And this is only for having a baby! I can't imagine had I have actually gotten ill or had a larger health issue! And the dental? It's a joke. I quit paying my dental with Aenta and went back to paying cash out of pocket for my dental care because it was cheaper that way.

So here I sit, with my newborn babe, fully insured and THOUSANDS of dollars in the hole while others around me get State insurance and never see a bill. It sucks to feel like you're getting punished for trying to be a responsible contributor to this wreck of a society we belong to.

27 Comments – Post Your Own

#1) On May 12, 2009 at 11:36 AM, Mary953 (71.96) wrote:

Your story at the end is not a condemnation of the multi-payer system, but a condemnation of Aetna.  I suggest that this is a case of doing your job so badly that you don't have to be bothered to do it at all.

Has Trisha tried going up the chain past the customer service rep, to supervisors, and further?

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#2) On May 12, 2009 at 11:36 AM, Mary953 (71.96) wrote:

Your story at the end is not a condemnation of the multi-payer system, but a condemnation of Aetna.  I suggest that this is a case of doing your job so badly that you don't have to be bothered to do it at all.

Has Trisha tried going up the chain past the customer service rep, to supervisors, and further?

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#3) On May 12, 2009 at 11:39 AM, OleDrippy (35.99) wrote:

I honestly feel this is the single biggest issue facing our country today. How many would-be entrepreneurs never get started due to health care costs? How many tests and treatments are denied or overcharged in the third party payor system? We either need to fully privatize healthcare and let supply and demand do its thing (Yes, doctors used to charge what people could PAY, not what they could get form the insurance company), or completely socialize.. This bastardized middle-ground that we find ourselves in is an embarrassment.

 Oh.. And we need more doctors and PAs.. How the AMA can continue to rig the system by bottle-necking the medical school system is beyond me.

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#4) On May 12, 2009 at 11:42 AM, ByrneShill (71.87) wrote:

I'm canadian. We pay half what you guys pay for healtcare (per capita) and the 1 year of life expectancy we got over you is widely known to be because of our universal healthcare system.

I'd rather have a better system for half the price. But maybe I'm crazy.

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#5) On May 12, 2009 at 12:58 PM, uclayoda87 (29.22) wrote:

Before making your decision, it might be worth while to listen to someone who has lived in a Universal Health Care system:

Daniel Hannan, a member of the European Parliament, the one who roasted Gordon Brown.

http://www.youtube.com/watch?v=qD-gkXANZ_Q

http://www.youtube.com/watch?v=-sifofmgRBo&feature=related

http://www.youtube.com/watch?v=94lW6Y4tBXs&feature=related

 

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#6) On May 12, 2009 at 1:00 PM, wrparks (59.34) wrote:

Bryne Shill,

Was that supposed to be sarcasm, or are you serious?

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#7) On May 12, 2009 at 1:57 PM, Ewok82 (29.25) wrote:

Are there statistics looking at how much money comes into the US from foreigner seeking health care in the US?  I'm not talking about uncompensated care provided in the ERs, which won't go away in either system, but people who travel to the US and buy health care here.  I'm especially interested in how many people come from Canada and the UK, which are most like us and have easy access to the US.

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#8) On May 12, 2009 at 5:25 PM, devoish (98.42) wrote:

Mary953,

You are correct. Trisha's situation could easily be one knucklehead employee. Trisha might even be that derilect trying to game the system. On the other hand there certainly seem to be a lot of "Trisha's" and both Wellpoint and UNH have paid hefty fines for denying treatment that should have been covered, and fined for delaying payments to Doctors, or refusing payments entirely that should have been paid. My experience of buying a plan with a $20 drug copay, only to have my insurer decide my doctors 90 day prescription had to come in 3, 30 day purchases tripled my copay for a drug my wife will be taking for at least five years. Information concerning their right to overrule my doctor is probably buried on page 87 of the plan. But that is what they did.

On a seperate subject, your posts have been helpful to me especially about how to skip to the top and bottom of some really long threads. Thanks.

uclayoda,

I am shocked Hannity (a former politician) could find a guy to come on television with concurring opinions to his own. He could have called Dare too. I have come to believe the claims about waiting to die in a an emergency room are more real for the American population than the UK. That farce about beaurocrats deciding what is covered under Single Payer H.R.676 is true about private insurers and untrue about Single Payer where a team of doctors would decide what is covered. If you are sophisticated enough to know you want additional coverage for whatever experimental and possibly dangerous drug was not approved by the UK for cancer treatment, you can buy additional coverage for it. You will not have to buy additional coverage for what is covered, because it is covered.

Ewok,

I know of no statistics for people coming to the USA for treatment.

 Investigate the phrase Medical Tourism and you will find Americans going to Mexico and South America, and Europeans going to Turkey. In the case of the Europeans, they are going for treatments not yet available or not approved in Europe such as Davinci Robotic surgery (disclosure: I own ISRG) which is spreading from the USA (and so became available here first) to Europe and elswhere. You cannot automatically expect it here, but it is more available. Americans are not going for what they believe are "better" treatment. They are going because they cannot get treated here at all due to a lack of insurance.

 

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#9) On May 12, 2009 at 6:01 PM, devoish (98.42) wrote:

wrparks,

I don't think he is being sarcastic. I did not invent the numbers I posted.

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#10) On May 12, 2009 at 8:46 PM, uclayoda87 (29.22) wrote:

I will agree to disagree.  I have practiced medicine since 1987 in many different environments, University Hospitals (UCLA), VA hospitals (Wadsworth and Long Beach VA), county hospitals (Harbor/UCLA hospital), free clinics (Venice Family Clinic), private hospitals (Scripps-LaJolla, Tricities - Oceanside, Memorial - Yakima) as well as in two private practice groups.  For me personally, I don't worry about my own health because of who I know.  I will always be able to find a good physician, who I know is good.  I also understand that many sound physician groups are in trouble financially, they see their employee and other costs go up, but their revenue stay flat.  A family physician friend of mine chose to close his practice and return to the military, because it paid better and he didn't have to worry about trying to keep his practice viable any more.  I am hopefully within 5 years of my planned retirement, or at least cutting back to just teaching.  Unfortunately, I don't have your  confidence that a team of doctors will always make good rules on who gets treated, bacause frequently definitive answers on what it the best treatment is not clear.  In cardiology, we are lucky and have ACC/AHA guidelines for many disease states in cardiovascular medicine.  But these are only guidelines. The authors realize good information on every disease state is not always available.  Prepackaged ER protocols for chest pain evaluation and treatment can sometimes cause serious harm and sometimes death.  These plans were developed by expert panels with good intentions, but that doesn't prevent therapeutic misadventures.  Ask yourself if you would be willing to deny potentially life extending treatment, because it was not proven to extend survival?  Then be told that there are actually few treatments that actually have "proven" benefit.  You are then back to expert opinion for policy decisions.  But as we know from the history of medicine, what is believed to be contraindicated today may be the standard of care tomorrow.

I don't care for the financial 3rd party payment system that we have today, but I believe that universal health care will not deliver the promise of good health care for all.

I don't have any well thought out plan to replace our current system, but if the goal is to reduce health care costs, without concern for political correctness, I would propose the following:

1.  Government catastrophic medical coverage for bills over $50,000 up to $250,000.  This would include cancer treatments, approved "live saving" treatment, but would not cover elective surgery or complications related to elective treatments/surgery.

2.  Do away with all health care insurance and medical prescription insurance.

3.  Make all medications available over the counter (without perscription) and allow drug companies to market these meds on the internet and TV with FDA approved messages.

4.  Limit malpractice claims to cost of the current treatment, which must go to binding arbitration only.  Maximum limit:  $250,000.

5.  Limit ER visits to 4 per year per person if unable to pay.  Exceeding this is paid by 1 week of jail time or community service (trash crews).  If you are able to pay, go as often as you like, you would be paying for the visit, just like a regular doctor's appointment, except this would be much more expensive.

 Well this this not the complete list, but the idea is that health care is not a right without responsibilities.  If society made people pay for their own health care, then they may choose to live a healthier lifestyle so that they could spend their money on something else.  If they choose to ignore their health, it's their own fault and they would be forced to live with their decisions.

Eagles - Get Over It.

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#11) On May 12, 2009 at 10:46 PM, ByrneShill (71.87) wrote:

@wrparks:

I'm serious. Admittedly I don't check life expectancy and healthcare spendings per capita every day, but last time I checked canadians had 1 more year to live on this planet and our healthcare bill (per capita) is half yours.

That, and our doctors never have to tell parents that their kids will die because they can't afford that 250k heart surgery.

And also, it seems our universal drug insurance is pushing prices down a lot on isured drugs (not all drugs are insured, for example, viagra isn't). Some clever bus companies organizes trips for elders to come to drugstores to Canada to buy their medications. I know this sounds far fetched but it's true.

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#12) On May 12, 2009 at 11:03 PM, devoish (98.42) wrote:

uclayoda87,

Great reply, thank you.

First about "good healthcare for all". There are a certain percentage of people that will never have good healthcare just because of their own lack of participation, drug habits, smoking weight, etc.

But this group is not everybody that cannot afford insurance today. Many people who are hardworking and "deserving" are just not paid enough.

It has to bother you that Stephen Hemsley, ceo of UNH and their lowest paid ceo of the last ten years gets 10mil, in a bad year when your friend who actually delivers the product cannot make a viable living. UNH was heavily fined for delaying payments and denying payment to Doctors. And he is just one executive at the company. When they tell President Obama they will reduce costs, what are they going to do?

1 and 2 is H.R 676, with you as the "beaurocrat" deciding what is covered by Government and how much. I am  not sure why you start at 50k. Many Doctors will  be dissatisfied with your decisions, you will be dissatisfied with many of theirs. Such is the world, but I generally I think I prefer people who have faced the patients in good and bad results making those decisions.

With H.R.676, #2 is allowed to cover for things that are not covered or someone could just pay cash if a person feels they can make those decisions.

Right now I am supposed to sift through 17,000 different available plans and try to choose the one that will have what I don't know I am going to need.

3) I cannot go there. Addictive drugs, dangerous ones. Teenagers. sorry.

4) I agree. malpractice does not have to be millions of dollars. First, no matter what happened that is or is not malpractice, my medical costs are covered whether a surgeon hacked off the wrong leg or I lost it in a car accident. Second, if you combine that with a strong enough SSI that can keep me in decent house or apartment if I am unable to work then I don't believe there should be any "pain and suffering". Accidents happen, people lose their incomes for all sorts of reasons mostly unintentional. If there is a Doctor or anesthesiologist with an exceptionally high "incident" rate, that needs to be addressed by retraining, job change, but not financial devastation. Keep in mind that insureres are here also, charging enough to ensure a comfortable profit.

5) I could go here also as long as consideration is made for people who cannot work, people who work 70-80 hours and still struggle to pay modest bills (and I know some).

The part about people choosing a healthier lifestyle is tricky. I agree that I should, but some of my choice is restricted by the asbestos that used to be in brake shoes. There is also the issue that cigarette companies were able to assure us that smoking is harmless decades after the truth was known. And someone will still come on here and post "my grandma's 90 and she smokes" as thought that refutes all the dead people.

What you say about evolving medical treatments is true. But who should decide if not Doctors? You can look at the advice from a drug company, it can be reviewed by the FDA, and still mistakes are made and sometimes it seems data that casts doubt on a drug is removed. Thes things are true whether Beaurocrats, Doctors, or Actuaries make the call. Right now you already choose from a pre-selected set of options.

Truly, thanks for the honest reply, even if we disagree. It is tiresome to hear "its socialism" as though that matters at all.

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#13) On May 13, 2009 at 8:17 AM, Bojac3728 (21.54) wrote:

I don't know what the answer to health care is, but I do know that there is no free lunch. Perhaps everyone should be given a $5,000 tax credit so they could shop around and purchase their own policy. If I remember correctly this was a Republican idea that was rejected by Obama.

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#14) On May 13, 2009 at 10:48 AM, wrparks (59.34) wrote:

Bryne Shill,

Sorry, I was referring to the claim of an extra year of life being attributed to your healtcare system.  That's the part that I hoped was sarcasm.  People often say such things, but there is zero evidence for it.  Cultural differences have far more to do with it.  

I have no issue with what you said about the "costs half as much" part, since that is objectyively verifiable.  

Devoish,

I know you believe in the tragedy of the commons as it applies to the environment.  You have said as much in the past, and I agree.

Why doesn't it apply to healthcare?  When you remove the costs of the service from those who incur the cost and spread it around to those who do not incur the cost, there is zero incentive to properly utilize the resource.  Something as simple as reaising copays for doctors visits would have a huge affect.  Just as there is no incentive for the factory to clean the waste before dumping it into the stream without the rule of law, there is no incentive for individuals to properly assess their utilization of medical care when they don't have to directly pay for it.

Why not try regulated competion before a single payer system?  Our current system can be fixed, all it would take is to create a system that encourages competition for insurance carriers. We have a system that works for car insurance where the "uninsurable" pay into a high risk pool that is government supported.  Why not set up something along those lines?

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#15) On May 13, 2009 at 12:38 PM, devoish (98.42) wrote:

I don't know what the answer to health care is, but I do know that there is no free lunch. Perhaps everyone should be given a $5,000 tax credit so they could shop around and purchase their own policy. If I remember correctly this was a Republican idea that was rejected by Obama.

I agree there is no free lunch, but right now we are getting hot dogs for the price of steak. As to the 5k tax credit. That applied to a "family" and would help "families" earning $37,000/year or more. Every family earning less than that would would receive less than a $5k tax credit and get less help. The money transfers from  the tax coffers to the insurers and they choose to increase benefits, increase pay to Doctors or increase profit margins. Nobody who is an executive at an insurer is screaming to get out. They have to be forced out. Margin increases increase pay to the executives, it is structured into incentive pay.

Curiously, Mccain picked a number, $5000, that would benefit almost exactly 60% of familys, enough to get elected, and transfer tax dollars directly to the insurance arm of the financial industry.

McCain did not figure that plan out on his own. He took advise from his economic advisors.

 

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#16) On May 13, 2009 at 12:56 PM, devoish (98.42) wrote:

wrparks,

Who can afford copays? People who cannot afford insurance to begin with?

When you say "properly utilize the resource" do you mean sick people overusing it by following their Doctors advice or insurers underusing it by restricting needed service? Right now the first is less the problem than the second. Some people do run to the Doctor with every sniffle, the vast majority do not. They come to work sick, send their kids to school sick, etc. Not taking a sick day is incentive enough. I disagree that your scenario exists to any large degree except among those not working by choice.

Why not try regulated competion before a single payer system?  Our current system can be fixed, all it would take is to create a system that encourages competition for insurance carriers. We have a system that works for car insurance where the "uninsurable" pay into a high risk pool that is government supported.  Why not set up something along those lines?

Why Health Insurance Doesn't Work Like Any Other

Despite the wreckage caused by the economic crisis, the Obama Administration is still focused on health care reform, and not without good reason: the sharp increase in personal insecurity, plus the reduction in debt headroom, have made health care reform increasing important. Today the President is calling in representatives of the health care industry to pledge to reduce costs voluntarily; tomorrow the Senate Finance Committee is discussing comprehensive health care reform.

As the debate begins, I wanted to touch on a couple of basic concepts.

The health care debate seems particularly hampered by confusion over labels. Uwe Reinhardt has a useful article describing different systems that focuses on how care is provided and how it is paid for. He distinguishes between: social insurance, where contributions are made on an ability-to-pay basis (taxes, for example); private insurance, where contributions are based on an individual's expected costs (more on that later); and no health insurance, where you pay the full cost of treatment.

I would go a step further and say that part of the confusion is over the terms "health care" and "health insurance." People who think there is a problem with the current system usually say that everyone should have "health insurance," and leave it at that. If pressed, they would probably say that this "insurance" should be provided by private-sector insurers (this is America, after all). I know something about insurance (I co-founded a company that makes software for property and casualty insurers), and I don't think this is makes sense.

Try this article for the answer:

The basic idea of insurance is that risks are shared across a pool of people so that each person is protected against unlikely events. In a free-market homeowner's insurance system, insurers charge premiums to each homeowner, and only make payments to the ones who have their houses burn down. (I'm simplifying for ease of exposition.) For this system to work, though, the insurer has to charge each person the expected cost of providing the insurance - that is, the value of his house times the likelihood of his house burning down. Most people would agree that this system is fair to homeowners, and usually affordable - if you can't afford the premium, don't buy such a big house.

The analog in health insurance, however, quickly becomes unsupportable. Unfortunately, sick people (and, to a lesser extent, old people) have much higher expected health care costs than young, healthy people. In an actuarially fair health care system, their annual premiums should equal their expected annual health care costs. For someone with a serious illness, those expected costs would easily dwarf his expected income. There is no way to "buy a smaller house." So in an actuarially fair, free market system, he would be unable to get health insurance, would be unable to afford health care, and would . . . die.

Put another way, from the perspective of the insurer, the rational thing to do is charge people more than their expected health care costs, and the efficient outcome is to not insure very sick people. When we say that anyone should be able to get health insurance, we are saying that someone should be forced to lose money insuring sick people.

Same thing with cars, everybody might need a mercedes, not a used chevette. You have no control (limited control by whether you eat right,smoke,excersize) over your risk profile.

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#17) On May 13, 2009 at 1:51 PM, wrparks (59.34) wrote:

If the tragedy of the commons does not apply, then why do we hear about waiting lists for surgery in Canada & the UK? Why do ambulances in the U.K. park ouside major hospitals, with patients inside the ambulance, because the law says there is a limit on the amount of time a patient can sit in a waiting room? 

I actually prefer the system in Switzerland.  They set a minimum of standards that all insurers must provide, but insurers compete on price and service for customers.  Essentially,it's the opposite of what we have.  That is how we could take our current system and fix it without placing the burden of financing on the government (yes, they subsidize those with low income, but still the gov't pays a far smaller share).

But, I wouldn't make it compulsory like Switzerland.  You have the option not to purchase insurance, but you must pay for all services upfront if you are uninsured by choice.  That is funcional competition.  I admit, there are parts of their system I dislike, but I think it is on the right track.

Implementing single payer in the U.S. now is like putting a bandaid on a snake bite.  Sure, your not bleeding, but you're still going to die.  Costs will outstrip payments, and the gov't will not have the cajones to raise costs for consumers.

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#18) On May 13, 2009 at 3:56 PM, AbstractMotion (53.95) wrote:

I'd be in favor to something similar to wrparks is talking about with Switzerland, with a few catches.  First of all just standardize classes of plans that provide similar coverage and payment options, this should streamline things immensily.  Automate the records system, it'll reduce errors in treatment and increase productivity.  Seperate big pharma and health insurers from the doctors, there's way too much overlap here and pressure from these organizations to either spend too much money or too little depending on the situation.  Doctors need to be able to operate with the best needs of their paitent in mind, this means minimal pressure from either government or the insurance industry.  People who fail to pay for emergency treatment should be given a court date which they are required to appear in court to decide on a public aid plan, send them into treatment/prison if it's crime related, or deport them if they're here illegally.

 

Medicare needs to be reformed in general, too much money goes into this system for the services it provides and it inflates healthcare costs for everyone else.  This beast has expanded past the point of just covering treatment for seniors.  I know just about everyone here has seen the commercials they run for power chairs, diabetes tests, home oxygen systems and so forth.  Likewise retirement communities should go through stricter screening at the state and local levels to make sure that the areas they're built in have adequate hospital space to support them.  We've had 3 such complexs built around here and the difference in any medical plaza has become very visible.  I don't have anything against seniors, but every statistic shows they put a huge strain on the medical system and we aren't going to deal with this problem without dealing with that fact.

 

I'd also like to see the wages for nursing related roles rise, as our healthcare system is also essentially short staffed especially at the primary physician level.  I'd be fine with the federal government offering low or interest free loans and scholarships for people interested in going into the field of medical care like they do in many other countries.

 

When it comes to malpractice and lawsuits I'd agree with capping the compensation at something reasonable such as actual damages or the revoking of licenses where appropriate.  Unless there's a real case for flat out disregard for someone's safety or attempts to misrepresent serious risks I can't see handing out millions and millions of dollars for something that has gone through rigorous testing.  Likewise the number of these should be reduced with a better records system.

 

 

 

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#19) On May 13, 2009 at 4:26 PM, devoish (98.42) wrote:

The tragedy of the commons does not apply because healthcare is not a resource like water with an absolutely limited supply. The healthcare resource is easily increased by getting the insurers out of skimming and into actually delivering healthcare.

In my last post you point out that the french system is 9bil in the red as though that is a black mark against their system as compared to ours. If our expense matched theirs, plus 9bil in the red we would save 40%.

As to the Switzerland system that includes insurers. If the Gov't is setting a minimum standard and doing the work of deciding what is covered, what are the insurers doing? Figuring out what to add in? Let the H.R.676 doctors decide what is covered, then let the private insurers offer coverage for anything that is missing.

I consider anything but Single Payer a bandaid on a snake bite. As long as resources are diverted from healthcare, to paperwork and executive pay, then healthcare its practicioners and patients are the losers.

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#20) On May 14, 2009 at 12:32 PM, wrparks (59.34) wrote:

Healthcare is a limited resource, just like any other.  Just saying it is not doesn't make it so.  If it was unlimited, there would be no such thing as a line at a doctors office.  When you hear that there are too many doctors and nurses and not enough jobs, you may be right, but we are far from that level.

Besides, limited vs unlimited has nothing to do with the tragedy of the commons.  Air is essentially in unlimited supply, but air pollution is certainly applicable.

Besides, by your standards, patients will always be the losers, because there will always be paperwork and executives.  Do you think somebody will volunteer to head up this new system?  The best way to minimize overhead would be a straight no insurance system where you have a single doctor that oversees all your care and maintains all your records, but I think we all agree that is a bad idea. Where there is a middle man, there are always inefficiencies, and nobody has proposed a system without a middle man.

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#21) On May 14, 2009 at 2:18 PM, ByrneShill (71.87) wrote:

@wrparks: You need to get yourself informed better on Canada's and UK's healthcare system before you can judge. Those "waiting lists" as you call them are mostly filled with people who can wait for their surgeries without too much problem. The only difference between the US and Canadian waiting lists is that Canadian's are prioritized solely by order of importance for the patient's health, while the US's list are in order of importance and size of bank account. A healthy hypocondriac might very well see a doctor before a sick guy if he's richer. Couldn't happen in the frozen north. In any case, the amount of canadians denied health care services that they need is extremely small, to the point of being in the margin of error statisticly. You can't say the same about the US.

As for the "the government will waste money" argument, it is backed neither by logic nor by facts. The fact is that healthcare spendings per capita in US is 2X what it is in canada, but the services are of lower quality/quantity (as per the life expectancy). The logical explanation is that both services providers (hospitals and clinics) and insurers each have a boatload of paperwork to fill, waste money marketing their products, and at FY end, they need to make a profit. So if you count for each level a 15% paperwork overhead, 10% net margins and 15% marketing expenses (numbers from the top of my head, but in the right ballpark), you'll find out the govt doesn't waste as much as you'd like to think.

But anyway, you're the one paying 2X as much for slightly less services. We pay 2X as much for brokerage commissions and cell phone services, so I guess we're even.

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#22) On May 14, 2009 at 4:01 PM, devoish (98.42) wrote:

Healthcare is a limited resource, just like any other.  Just saying it is not doesn't make it so.  If it was unlimited, there would be no such thing as a line at a doctors office.  When you hear that there are too many doctors and nurses and not enough jobs, you may be right, but we are far from that level.

If you can get more drinkable water onto the planet, let me know. H.R.676 can get more healthcare providers by retraining the insurance employees.

Besides, limited vs unlimited has nothing to do with the tragedy of the commons.  Air is essentially in unlimited supply, but air pollution is certainly applicable.

Yes it does. limited is what it the TOC is all about.

Besides, by your standards, patients will always be the losers, because there will always be paperwork and executives.  Do you think somebody will volunteer to head up this new system?

Nope. But I can hire a "head of the CDC" equivalent at an equivalent $200k salary.  I don't need a Hemsley at 10mil. There is no reason for "overhead" to equal production costs, and that's what the problem is. There is just too much money going to the relatively easy work of filling out forms than the much more difficult work of being a provider.

  The best way to minimize overhead would be a straight no insurance system where you have a single doctor that oversees all your care and maintains all your records, but I think we all agree that is a bad idea. Where there is a middle man, there are always inefficiencies, and nobody has proposed a system without a middle man.

There is no need to overpay the middleman and give him authority over delivery and collections. You could not have pointed out the problem any better.

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#23) On May 14, 2009 at 4:42 PM, wrparks (59.34) wrote:

I know that is the problem.  I was pointing out that your solution doesn't fix what you just acknowledged as the problem.  It may decrease it temporarily, but are we really after temporary fixes?

The bill will not increase the number of healtcare providers, but it probably will shift tons of insurance company employees to the government payroll.  Do you really think that the average insurance company paper pusher has any interest, or even the capacity, to work in the much more difficult medical industry that requires a vastly different set of skills?  What makes you think the government will manage things better?

TOC does not require limited resources, per se, though limited resources were cited in the Hardin paper most are familiar with.  Again, the air we breath is effectively unlimited, yet air pollution is an example because the costs of an activity are not born by the pollutor.  All the TOC requires is for costs to be born by someone other than the person incurring the cost. Economists call them externalities.

 

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#24) On May 14, 2009 at 7:57 PM, devoish (98.42) wrote:

The bill will not increase the number of healtcare providers

H.R.676 provides funding for the retraining of insurance employees into provider professions such as nursing, anesthesiologists, etc.

Do you really think that the average insurance company paper pusher has any interest, or even the capacity, to work in the much more difficult medical industry that requires a vastly different set of skills?

Many of the company paper pushers were nurses before they switched to the insurance industry. If funding is provided to train nurses, nurses will be trained. If the "paper pushers" aren't up to the task, they will get the jobs vacated wherever the nurses came from.

What makes you think the government will manage things better?

Are you going with "great job, insurer?" The Government does a better job of most things as compared to the FIRE indistries. With the Gov't the waste gets spread out among the lowest earners, with business it concentrates in the hands of a few. Contrary to popular opinion, money concentrated in the hands of the wealthy is not only invested, it is also lost. In the hands of the poorest it is spent, and works over and over.

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#25) On May 14, 2009 at 8:54 PM, wrparks (59.34) wrote:

How is this for waiting lists for those whose conditions can "wait".

 http://www.guardian.co.uk/society/2008/feb/17/health.nhs

Sure, it's anecdotal.  Sure, it happens in the U.S. as well.  But don't blow smoke up my butt and tell me you have the solution when your solution has equally daunting problems.

" Contrary to popular opinion, money concentrated in the hands of the wealthy is not only invested, it is also lost. In the hands of the poorest it is spent, and works over and over."

That is a very poor arguement for any health care system, but a great argument for Keynesian economics.  Unfortunatley, it helps your case here zero. Besides, waste is waste is waste and there is no evidence that gov't waste goes to the poor moreso than anyone else.

How about the idea that the higher prices we as americans pay is simply subsidizing the care in other countries?  The high costs we pay could be funding research for new mediciens and surgical techniques.  Now, the government has to pay for the research on top of the other costs.  Suddenly costs are rising more and more.

Look, I don't argue our system is bad.  But, the US gov't already spends approximately 40 cents of every healtcare dollar spent.  Why is moving that to 100 cents of every dollar going to make things better?   The level of care to the currently underserved will likely increase.  If that is all you are after, admit it and move on, and I can agree that it is a lofty, worthy goal, even if I think your method of attaining it is flawed.  But don't try to pretend that it will save money in the long run without some kind of economic price signal to the end user of the service.  

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#26) On May 15, 2009 at 1:02 PM, devoish (98.42) wrote:

How about the idea that the higher prices we as americans pay is simply subsidizing the care in other countries?  The high costs we pay could be funding research for new mediciens and surgical techniques.  Now, the government has to pay for the research on top of the other costs.  Suddenly costs are rising more and more.

Ok? Argue that we need to pay higher prices for drugs. Don't argue we need a mark-up to insurers. If its true. Find ourt what Government spent on drug research, and what the pharma industrie spent and get back to me.

Your article says in the UK there were 43,500 ambulance trips that took one hour or more from call, to pick-up, to arrival at a hospital, to the ambulance being released back into service. There were 7,200,000 calls for ambulance service so this represents .006% of all calls.

Here in the US we cannot even collect such statistics unless you want to be the person who compiles the data from every city in the union. One example from your article is of the December statistics is being overloaded at Christmastime, when the English have the same problem with office parties and celebrations we have here. Macys can get extra help at Xmas time and show them where the cash register is. In ambulance care you cannot find trained EMT's at a moments notice. So the business model can hire as neccessary if they are Macys. Either model, private or H.R.676 has to have enough people and ambulances for the peak times and be willing to pay them to sit idle at other times.

In the case of the U.K. you need to take whatever percentage of your care is ambulance service/emergency room service and increase it by probably less gthan 5% and your problem is solved. In America we would have to do the same thing, but we would have to pursuade private companys to do it with increased payments, trust them not to overcharge, audit them to be sure, wait two years for data to see if we were succesful and then beg them again.

In the U.K they would know if they had made an improvement within months.

The last example was a very extreme case of the specific people involved not being clear enough or understood clearly enough, until the second phone call.  It is not representative of thiose other 43,500 one hour trips were probably just transporting patients from the hospital to home or to a different hospital a function that happens everywhere.

And for the record, it is misleading to compare their round trip statistics to our reponse time statistics if you decide to go down that path.

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#27) On July 02, 2009 at 2:27 PM, uclayoda87 (29.22) wrote:

WSJ OPINION


JUNE 30, 2009


How Other Countries Judge Malpractice

 

The health-care systems Democrats want to emulate don't allow contingency fees or large jury awards.

 

 

By RICHARD A. EPSTEIN

 

In his recent speech to the American Medical Association, President Barack Obama held out the tantalizing possibility of reforming medical malpractice law as part of a comprehensive overhaul of the U.S. health-care system. As usual, he hedged his bets by declining to endorse the only medical malpractice reform with real bite -- a national cap on damages for pain and suffering, such as the ones enacted in more than 30 states.

These caps are usually set between $250,000 to $500,000, and they can make a substantial difference. Other reforms, such as rules that limit contingency fees, shorten statutes of limitation, or confine each defendant's tort exposure to his proportionate share of the harm, have small and uncertain effects.

Medical malpractice, of course, is not just an American issue. And now that the U.S. is considering universal health-care systems similar to those found elsewhere, it's worth a quick peek at their medical malpractice systems -- which usually attract far less controversy, and are far less expensive, than our own. ...

 Too bad we don't hear about this type of health care reform from the administration.

 

WSJ LIFE & STYLE

JULY 1, 2009, 11:46 P.M. ET

The Doctor Will Text You Now

 

Patients Visit With Their Physicians Online as More Insurers Begin Paying for Digital Diagnoses

 


  By ANNA WILDE MATHEWS

 

Jane Rust woke up early one day last year and discovered that her left eye was red, swollen and itchy. So she logged on to her family doctor’s Web site and typed a message describing her symptoms and asking what to do.

By mid-morning, the 61-year-old homemaker received an online response from her doctor with a diagnosis—conjunctivitis, or pink eye, probably contracted from a child in her Sunday-school class—and a prescription to pick up at the pharmacy. “I didn’t have to disrupt my day,” says Ms. Rust, who lives in Readyville, Tenn. “It’s much more efficient.” ...

This may be the future of health care as Doctor's stop providing free after hours phone consultations and begin charging patient's for answers to written questions by e-mail.  The cost for these written responses will likely be in the $100 to $200/question range for specialists and would not include Rx, since I believe that many prescription drugs will become available over the counter.

As an alternative, patients may try to Google the answer to their problem on the internet.  It's basically "Do it yourself" vs. "Pay to have it repaired".

 

 

 

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