Questions on health insurance?

You have put your finger on the nexus of reasons for health care reform. Because the private insurance companies have to make money as opposed to a single payer system (the government).

Because we have fee-for-service, independent private facilities, too much money on end of life, not enough on preventative medicine, because insurance companies are vultures, same for pharmaceutical companies, because they profit and patients lose yet there are no alternatives.

Because…because….We’re ‘mercans! What about my freedom? Why should I spend any money on somebody else? I got mine, so keep your mitts off! COMMUNISM! NAZIS! SOCIALISTS! TRIAL LAWYERS! WELFARE MOTHERS! BOOGETY BOOGETY BOOGETY AAARRRRGGHHHHH!!!!! droooooollllllllllll.

@Snarp ….aaaaaand then they realize they have Stage IV liver disease needing immediate tx which their ‘super awesome’ private insurance only covers 80% and they have to pay $400 each time they come in plus same for booster shots and all of a sudden years of savings go ‘poof’ and they realize what a mess we’re in with these prices, these drug companies and with private insurance…they always realize when it’s too late…I’ve had hundreds of patients telling me this every month

@Snarp That made me laugh.

The reason why our life expectancy is low despite what we pay is that there is no incentive for insurance companies to pay for preventive care. Any money saved is not likely to be seen until years in the future, and shareholders want to see profit now.

I wish the anti-national health people would go and visit countries that have national health care and see how nice it is to live in a country that sees health care as a basic human right and not a privilege for the wealthy. But sometimes, I think the US system might be too broken to fix when I read things in the news or watch movies on TV about the family who couldn’t afford the pills or surgery to save their child… it just seem so…. third world and unexplainable. Running so many hospitals as profit driven corporations seems… um… unethical.

sean, you are not fooling anyone. you welshboy you

The reason our life expectancy is low is none of us want to do what we need to do to be healthy. The finnish diet is much healthier than ours and they are better about regular exercise than we are.

One thing we all have to remember part of what we pay for in the US is choice in health care. We want to decide which doctor to see and when to see them. We want to be able to get our tests done now and not wait. We want to have all of our health care covered. We don’t want to pay for checkups, or medicines or anything really. We don’t want to know that we are having to pay for our own choices and they the impact our individual health. Yes some are predisposed to disease, but all the more reason to take on some SELF prevention.

Because the insured pay for care for the uninsured, so their premiums go up.
Because many young people do not buy insurance, so the the patient pool tends to be older and more sick
Because most Americans have pre paid medical plans (very expensive) instead of true insurance (less expensive)
Because Americans generally believe that what they are getting is health care, which has a seductive and reassuring sound to it. Actually, it is sick care, and some sick people are sick because they do not pursue health as a goal.
Etc.

Our tort laws is what drives a huge part of this cost.

@sleepdoc
In the US you can only go to doctors that your insurer allows you to go to.
Here in Germany, I can go to any doctor I want.
Your waiting times are no better than in countries with nationalised health care.
You do not have all of your healthcare covered. The insurer pays about 80% and makes you pay the rest upfront.

@sleepdoc I live in socialised medicine. I can change my doc until I feel comfortable with one. I get my tests done quickly. I can show up at the emergency room and have done for gall stones. I went right threw when they saw my pain and had pain meds immediately and an ultra sound within the hour. I needed a Nose Ear and Throat specialist and waited only 3 months, it was non-urgent, otherwise I could have seen the specialist at the hospital.
Looking after everyone makes more sense.

@sleepdoc I love the notion that we’re paying for choice and for not waiting. Most people have to choose a doctor in their plan’s network, which is no more restrictive of choice than a government plan would be. And unless you need emergency care, you’re going to wait, just like everywhere else. So Americans are paying for a myth.

@ragingloli I didn’t say that those things were fact. I said that is what people want. The other thing to realize is that when the US makes something government regulated it by nature becomes less efficient. Just the way it happens. I am not knocking other health care systems. I am just saying that what people here want is not compatible with what a health care system can provide.

@Snarp Have you ever been part of a government regulated health care system? Say for example the VA or Tricare for the military? Wait until you spend all day on the phone to get a referral to be seen because you are traveling and then still get the bill anyway.

One thing we all have to remember part of what we pay for in the US is choice in health care. We want to decide which doctor to see and when to see them

Why is it so important to you that we shovel money into insurance and drug companies instead of actual health care? If you don’t fear being educated, read up on French health care.

From the right-leaning magazines Business Week and Reason:
“France’s infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.”

“65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents. And France spends just 10.7% of its gross domestic product on health care, while the U.S. lays out 16%, more than any other nation.”
http://www.businessweek.com/magazine/content/07_28/b4042070.htm

“In France, by contrast, you walk to the corner pharmacist, get either a prescription or over-the-counter medication right away, shell out a dozen or so euros, and you’re done. If you need a doctor, it’s not hard to get an appointment within a day or three, you make payments for everything (including X-rays) on the spot, and the amounts are routinely less than the co-payments for U.S. doctor visits. I’ve had back X-rays, detailed ear examinations, even minor oral surgery, and never have I paid more than maybe €300 for any one procedure. ”
http://reason.com/archives/2009/12/07/why-prefer-french-health-care

@sleepdoc And you think these kinds of problems don’t happen with private insurers?

Several major issues:

The cost of drugs. Like anything else, when you buy in volume, you should get a better price point. In other countries the national health plans negotiate with corporate pharm for reasonable prices. We have passed a law that insures Medicare will pay whatever the Drug companies want.

Fear of litigation requires unnecessary expensive procedures. Americans’ expectations send us to a lawyer every time we don’t get a perfect result (as sometimes happens in nature). The cost of Dr visits are higher to cover malpractice insurance. In other countries they have quality control procedures but if your surgery didn’t cure your condition, you don’t automatically win the lottery.

If medical care is not for profit, you immediately save 40–50% that goes to shareholders and the bureaucracy that is needed to block claims.

In order to reduce expenses, the health care systems in other countries provide and encourage preventative medicine.

There are also standards for end of life decisions like not keeping an acephalic baby on life support for 5 years until it dies from infection or giving a 90 yo Alzheimer’s patient prostate surgery.

@sleepdoc
I do not know about snarp, but I do.
When I had a wart on my head, I did not want to go to my family doctor so I looked up one in the phonebook for one and went there next day. No need to check with insurance if they support him(her actually), because as being publicly insured, they do. No paperwork, no exorbitant fees. Just a quick swipe with my insurance card.
She then referred me to a surgeon in town. Got my surgery withing a week, hasslefree, no additional costs.
It is fantastic.

@Snarp I am not saying that the system isn’t broken. But I am also saying that people have grown accustomed to a certain standard. The money isn’t there to maintain that standard and make sure everyone is covered.

@sleepdoc Actully my supervisor always talks about this study she read about which determined that if patients and doctors and administrators didn’t spend SO much time fighting with/ calling/ negoatiang with insurance companies every day, the money saved could cover everyone in the U.S.

@Simone_De_Beauvoir I am sure there a lots of ways to fix this. I for one agree that health insurance companies should not make profits from the premiums their clients pay. How to get there is another question entirely!

@ragingloli Did the Dr. tell you that wart WAS your head? HA HA HAHAHAHAAHAA!!

@sleepdoc At one time, up until 92 or 93, adults in America under a certain income level actually did qualify for Medicade. I did, and I received the exact same kind of care I got when I was insured through a private company, only it was all much less expensive. They canceled it all of a sudden in 93….

I really wish the anti-nationalized medicine people would pay attention to what the people who actually live in nationalized health care countries are saying. I have yet to hear one person complain about the care that they receive, but in spite of this that anti care people just keep pulling out the same old tired BS about “wait times,” and “getting to see who you want,” and blah blah blah. Can’t they read?

Also, per seeing who you want: Private insurance has restrictions on who you can and can’t see. PPO’s and non PPO’s.

@Val123 I will tell you that much of what I know comes from people who lived in Canada and tell me what they feel. I am not against health care reform. I just don’t think the current US government can put together and administer a plan that will work.

@sleepdoc Perhaps you could invite some of them here, and have them share their experiences.

I think America CAN administer a plan that will work, if they’d all quit fighting like a bunch of two year olds. It’s embarrassing.

The only reason we can’t put together a plan that will work is because we are weighted down with the detritus of a system build up over years of accrual of bits and pieces of junk from here and there and never trimmed of dead wood. We are stuck with a massive system that doesn’t work and that has too many people too tied up in it’s structures to allow politicians to do away with it. Basically when it became necessary to create a health insurance system, we bet wrong and the rest of the world bet right, and we’re stuck with our mistake. Of course the reason we bet wrong is putting free market ideology and corporate interests above the promoting the general welfare of the people, a problem that our politicians still have.

The US gov’t already administers a plan that works. It’s called Medicare and it is very, very popular.

While medicare works for those who receive it…. I am not sure it would be feasible to use as a plan for an entire country.

@sleepdoc Medicare is free. My understanding of the new plan is that there will be reasonable premiums for those who can afford it, which is only fair.

@sleepdoc
The US actually has it easier than the rest of the world to create a successful public healthcare/insurance system.
When Bismarck (a conservative, btw) created public health insurance at the end of the 19th century, there was nothing like it on the planet to draw experience from. Yet it worked and still works today.
The US can look at the successful systems from all over the world to draw experience from and create their own system. You also have medicare and medicaid, the VA, the health care system in Hawaii, all already successful inhouse systems.
You have all the references and data you need to create an excellent nationwide public system. The only thing that stops you is childish political bickering and fearmongering.

@ragingloli Spot on again!

@ragingloli There are examples, but as may know. They won’t do that. They will have to come up with something of their own invention. And by the way I wouldn’t call the VA system a total succes.

@sleepdoc The VA has actually been doing pretty well, especially since it was divided into over 20 regions. It’s not perfect (what system is?), but I’ve been able to refer my patients to subspecialists and get them medications for a copay of $8/month. Not bad.

I want to mention that Medicare on its own is not what you should be after. It only covers (like private insurance) 80% of chemotherapy or radiation, for example. These poor elderly people here in Brooklyn now have to pay (besides paying for some Medicare plans a portion of their pathetic as if SSI) to get a supplemental plan (run by the same effed up private insurances) so that they can get 100% coverage or even afford a medication that they need.

@sleepdoc Va docs are salaried (which saves money) and happier because they don’t have to feel as if a million tongues are breathing down their necks all the live long day to see more patients, write up more procedures. And that, in itself, makes the VA system one to emulate.

@Dr_Dredd It may be improving, but it is not a full health care system. There is little if any pediatrics there are embarassingly few women’s services.

@Simone_De_Beauvoir Just so you know my commentary here has nothing to do with physicians salaries. I am a doctor and see the inside of the system. There is way more to fix than people know.

@sleepdoc
They can still do that. But it would be stupidity not to look to the lessons learned from other systems, take the parts that work, dispose of the ones that do not, and create a wholly new system.
If I were to design a supercar, I would not start to design an engine from scratch, or transmission, or springs, or brakes. I would buy an already developed and tested high performance engine from AMG, Brembo brakes, suspension components that have already proven effective and reliable and get a transmission from a specialist.
Developing everything from scratch without even looking at already existing solutions, even just for reference, would be infinitely stupid, prohibitively expensive (unless you already are a global car supercorporation like VW), and success would be questionable even after the problem of money had been ruled out.
I can still have my own unique supercar by having an exciting design, my own chassis, custom made interior, etc.

@ragingloli You don’t have to preach to me about this. If you just look at what has been done historically to include what is currently being debated, this is not what is happening.

@sleepdoc Well, of course. I talk to physicians daily about their struggles, as well and the pressures they face. But not all docs care, they don’t mind the profitability of their.eh..business

@sleepdoc Not true about women’s health services. Every VA now has a women’s health coordinator, and most have one or two clinicians dedicated to women’s health. There are also women’s health centers of excellence. I believe the Pittsburgh VA is one of them.

As for pediatrics, it’s true that there are no pediatric services, but that doesn’t mean they can’t be incorporated into a system that mirrors the VA.

@Val123 No way is medicare free. The taxpayers pay for it, and many doctors refuse to accept medicare patients at all.

@YARNLADY In my case, it was. I had absolutely no problem finding a doctor. Had some trouble finding a dentist, though.

@Val123 Free to you, maybe, but the taxpayers provide the funds.

@YARNLADY I understand that.

@Val123 : – ) OK, just want to make sure every future reader of this question gets the full picture.