Cala, do you not realize that  Mr. Alter was making fun of evryone from the other side? He was deliberately being over the top, to show how ridiculous the anti health care people are!

Uhm, yes, Gilbert, I did get that.

And I cannot imagine a living, breathing human being with an I.Q. over 50 NOT getting it, no matter what their political persuasion.

That's why I said "PASS IT ON." This is about ALL of us. ONE country. One RICH country. And it's about how we need to cover everyone in our country with healthcare NOW.

sorry, carla! I was just so angry about these ridiculous iterruptors at healthcare townhalls.

carla, again, that's not true! it would go into affect immediately! that's why the right wing and the lobbyists are fighting against it!

Gilbert: Read it. Go to thomas.gov and put HR3200 in the search field. Just read the 1,000 page thing. OR ask Tim Foley for the pertinent timeline page. Almost NOTHING goes into effect immediately.

As for the right wing and the lobbyists, if you sneeze and call it healthcare reform, they will fight it to the death. Just don't pay them any mind at all.

The only fight worth fighting on this issue is among Democrats. Better make sure you get on the correct side of it.

I think with the way TARP and the bailouts have gone the lobbyists will be just fine in a democrat congress.  Besides most large insurance companies and Wal-Mart are behind nationalized healthcare, what could possibly go wrong?!?!  Oh wait, Wal-Mart pays their employees so poorly most are on government healthcare and the large health insurance companies are behind this to squeeze out smaller companies.  Yeah glad we are gunna be on the right side of that. 

 I so agree with Clara. I personally do not want to be fighting this battle for the next ten years. I think sometimes it is used as a distraction. They should have gone for single payer. And if the Republicans get in again they will just dismantle it.( they confess everyday that they are too ignorant to run the government.)
  They Democrats should have gone out with teams of doctors into poor neighborhoods and outside of unempolyment offices and then wrote a health care bill.
  My goal is getting the robber barrons out of health care. I will not go along with a MANDATORY plan that includes handing over a captive public into the private corporate protection rackets.

Only in America.

My wife went to the doctor for stomach ulcers.  The Doctor knew there was a family history of colon problems and decided that a colonoscopy might be a good idea after the diagnosis of stomach ulcers was confirmed.  He discovered 5 palups that would have turned cancerous.  My wife was 22.  Under any socialized healthcare in the world my wife would have had to wait until the cancer had manifested symptoms before getting treatment.  By then it would have most likely been too late. 

For every tragic story there are stories of success and of people cured by the wonderful doctors we have in this country.  Doctors that are finding their hands tied by insurance companies and their practices starved both by rising malpractice insurance and decreasing receipts from government health care programs. 

Wake up, health care isn't the problem, Government and corporate bureaucracy have turned health care into a minefield and fewer and fewer people are willing to walk through it for a public that is more likely to sue them than thank them.

Seth, I am deeply sorry for the pain your wife and your family went through.

I will note that Australia, a a socialized health care system, has better 5-year survival rates for colon cancer as the U.S. (Australia:  59% to 93%, depending on the stage when diagnosed;  44 to 85% for the U.S., throwing out stage 4 as an outlier in the U.S.)

If the plan in Congress passes, it will be similar to the structures of Japan, Switzerland and the Netherlands.  Japan has the best colon cancer rates in the world (72-93%).

Sources:

http://coloncancer.about.com/od/stagesandsurvivalrate1/a/CCSurvivalCount.htm

http://coloncancer.about.com/od/cancerstatistics/a/AU_Survival_CC.htm

http://www.ncc.go.jp/en/statistics/1999/figures/f10-2.html

I think you misunderstand, we are thankful.  We didn't have to go through that at that particular point in our lives.  Both my parents did go thorough cancer treatment though, both are alive and cancer-free and living healthy lives now because of modern medicine developed in the united states under our current system.  This is not to say that it is a perfect system or that it is a system that cannot be improved on but there is a reason most cutting edge technology is developed here.   One must recognize that although our system is flawed throwing the baby out with the bathwater is not the best way to approach our current dilemma.

Seth,

Before you get too involved with malpractice costs, keep in mind that they occupy about 2% of medical costs. The premiums charged doctors are methods the insurance companies use to recover some of the medical costs paid out. The threat of malpractice yields profit to insurers.

As to decreasing receipts, providers can only be paid what people can afford to pay. As costs for services rise in one area, costs for others must be brought down because the available funds aren't there. This is as true for an individual as it is for those socially insured. Do we want care limited or denied because of higher charges? What is more important, income or healthcare?

If doctors want to charge higher fees (and I think most PCPs deserve it), they need to join the fight for reform against those insurers and hospitals they contract with, the testing centers they overuse, over-specialization, pharmaceutical ad campaigns and salespitches. Many of the doctors ready and willing to do this are single-payer advocates.

Healthcare is already being sold on Wall Street. Do you propose eliminating both insurance and government funding? Without some sort of resource pooling, poorer people who find themselves in the same need as your wife would be without recourse for treatment.

What would reform look like to you?

Funny you should ask, I actually can tell you exactly what it would look like.  My wife and I were unemployed, living with family and just about out of funding.  We suffered a physical and emotional loss that entailed my wife having to under go one of several procedures.  We didn't have insurance and on paper we would be the last people likely to pay for our medical bill.  Never once did the doctor or the hospital staff bring up the ability to pay.  Never once were we pushed to a decision.  The procedure we chose was more expensive that other options but was the best for our psychological health.  My wife had excellent pre and post operative care and money never came into the picture.  The hospital worked out a fee that we believe to be fair for the excellent care we received.  We are now paying back what we can afford now that we have jobs and are able to get our heads above water.

You can say this is an isolated incident but the treatment is the same at the hospital I now work at (thanks in part to the experience I had at a hospital in what was the single lowest point in my life).  The procedure wasn't free but it was fair.  We had excellent health care professionals who deserve to be compensated for their work.  If I have to pay back the debt over the course of my life I will still consider myself fortunate that there was such a fine facility that treated my family so well in this low point in my life.  It gave me strength to get to a better place and eventually to accept a job in a pediatric oncology unit.

To me reform looks much like my experience.  No government official telling me what is in my best interest, no insurance company telling we what they will and won't cover with the money that they have collected from me over the years.  I believe that the government should play a limited roll in the health care process and that is to protect the patient against negligent acts.  I don't believe that you should be able to sue the hospital because the nurse couldn't find a vein (and yes this is something hospitals are sued over).  You should see some of the cases that my wife (who now works in the health field as well) sees.  You should be able to sue if your doctor causes injury because of negligence, but negligence should be decided by other doctors and not government bureaucrats or corporate insurance lawyers.  I simply believe that if you go to bed with the government you end up with the same diseases.   I agree that money shouldn't come between the individual and health care, it has been my experience that for the most part money is more of an issue for lawyers and politicians than most health care professionals.  Doctors do pro bono work all the time.  When was the last time an insurance company did pro bono work, or a politician did a job that didn't advance his career with a photo op when he had the chance.  I'm not saying that this system would be prefect, no system is, but I think it would be a lot more honest and simple.  In engineering a complex system is more unstable than a simple system and I believe the same is true of social systems.  Keep the lines of responsibility and communication clear and open and I think we will have a much better system than a corporate or government option could offer. 

I,too, have used the $10/ month or whatever I could afford to fill voids in past coverage. When it was for a couple thousand$, there was no problem. I'm young, have many years of work ahead of me.

You're fortunate in several regards:

1) You have enough years in you and a low enough cost to work the debt off in a lifetime and a job that allows you to do it.

2) You did not have income enough to cover rent, mortgage - otherwise you may have found yourself unable to find extra for the payments.

3) Providers were willing to accept a lower value for the procedure as the payments you make over time are not equal to the value of the treatment (money decreases in value).

But what if you had a job and bills with no income to spare? what if you were older or treatments stretched beyond your ability to earn over your remaining career? what if the required treatments were critical and couldn't wait for evaluation or take much time to make the decision and the hospital wanted something up front? This does happen in some places where regulations are weaker or charity care is available but only accepted in certain hospitals.

Do you not know that the costs for the care you're paying off were externalized on other patients? I can guaranatee they were. What are your plans to pay them back? Do you even know or care who they are and what it cost them? or do you think that the whole situation was a narrow relationship between you and the provider? That would be as naive as it is incorrect.

This was a solution for you at the time but it isn't for everyone at every time. If it happens to you, again, and the costs are higher and you have only a few years of earning left in you, what will you do?

Beyond that, it indicates that there would have to be a myraid of individual approaches to find models which fit every person and that system is about as complex as one can make it. Single-payer is simple. Go wherever you want, get the care you need, get well. No bureaucracy. even the threat of bureaucratization is a scare tactic by opponents to avoid confronting single-payer. Service is performed, provider gets paid whatever is available to be paid, providers make less money off illness and injury, this acts as incentive to keep people well or face long, uncompensated hours fixing the problems.

Seth it already is and continues to be. What do you think Medicare and Medicaid is?

I'm not going to argue the fact that I was fortunate to be in a situation that made it possible to ay off my health care debts.  As for the particulars of the bill my wife and I did go over the bill and there was nothing in the bill that was not preformed.  As far as hospital losses being monetized in the bill... well that is something that happens if you use insurance, government programs, or pay out of pocket.

I believe I said that the system I'm talking about isn't perfect (far from it) but you asked my opinion.  I think that if every individual was given the money out of their paychecks to put toward health care (similar to a Health Savings Account) instead of to insurance and social security we would see real reform.  If I am paying out of my pocket you know I am checking my bill like a hawk.  Did you know that if you go to one pharmacy you can spend vastly differing amounts for prescriptions?  Most people don't even think about this when they go to pick up medications.  They simply swipe their co-pay and are on the way.  When a medication is $35 at one location and $180 at another you get to know where that $35 location is real quick when you don't have insurance.  It's simply a case of ignorant consumers that allow this to happen.  The answer to this isn't to have the government tell companies what the price for a medication should be.  Drug companies are already in bed with politicians and I don't want my choices in medication based on who helped the current candidate to get re-elected.  Let the government require price sheets to be posted so consumers can shop for the best deal for their money, that is how government can help.

Again you were asking me what my idea of a working system is, not of a roadmap for the nation to be executed over the next 3-10 years.  I accept not everyone is as willing to take responsibility for their own health care as I am.  I believe in ones power to live as he or she wishes, and that includes making bad decisions.  I want to be able to have full control over my care and I am willing to put some work into it to make sure that I receive a level of care that I choose, not one that is chosen for me.  Like it or not under ANY system in which you are not the sole provider of your health care your choices are limited to the locations and procedures that the administrator approves. 

I want to key in on the idea of a "One size fits all" approach.  I don't believe such a system can exist that is truly fair.  We are all individuals and to cram everyone into the same system will discriminate against one group for the sake of another.  Every system that promotes homogony over individualism does.  I'm not going to argue that for the poor with catastrophic illnesses this is not a viable option.  I believe that what we are really talking about here is charity and I don't think the Government should be in the charity business.  I'm all for government incentives for businesses to give to legitimate charities, but as for the administration of those charities, leave it to the charity as to where that money is best spent.  As far as government is concerned I'm not big into the "carrot or the stick" approach when it comes to government for one reason, I don't trust the government with sticks. 

Umm, It's against the law for a Hospital to refuse treatment for someone based on their ability to repay.  I don't know where this cut-and-paste response came from but few hospitals exist for profit.  Where a lot of the end up loosing hundreds of thousands of dollars are in the governments under-paying and refusing to pay Medicare claims.  If you want more of that you can have it.  I want my doctor, not a monstrosity that cuts benefits to the mentally disturbed (because they of course don't vote) and the infirm, who develop opportunistic infections (they probably don't make it to the polls too often either).  The hospitals treat them even though they will NEVER be compensated for it.  Thank your government for that.  More of the same? I'll pass thank you.

Seth--

You made such a good case for checking sources, I know you'll appreciate that actually, hundreds of hospitals exist for profit (although last year was a bad one for the hospital industry):

http://www.reuters.com/article/healthNews/idUSTRE5216G320090302

In addition to their poor return on investments (them and the rest of the country) in 2008, hospitals have another major financial drag -- uncompensated care, to the tune of $42.7 billion.

Of course, this number increases during a recession, which is not good for the nerves of investors in for-profit hospitals:  "Moody's Investor's Service is nervous about what the next few quarters will bring for investor-owned hospitals. In a recent report, it noted that such companies could take a serious hit to their income statements if uninsured patient volume increases or collections decrease."

Read more: http://www.fiercehealthfinance.com/story/moodys-leery-uncompensated-care-backlash/2009-06-30#ixzz0NN3qiVWc

Funny thing -- these articles don't seem to mention Medicaid or Medicare compensation as a major factor...

I would need to look up the definition as the article uses the term but I understand "uncompensated care" as services rendered to the patient that the hospital isn't compensate for.  In this case you would have individuals who choose not to pay, individuals who cannot pay, and organizations that refuse to pay or pay less than the services rendered cost to perform.

With Medicaid if an individual develops a condition while in the hospital the hospital is not compensated for ANY services rendered to the patient, even if the condition is unavoidable (i.e. 80-year old patient develops a bed sore after 3 months on bed rest).  The article is not specific but I know hospitals loose a lot of money because of this and the definition falls rather squarely into the category of uncompensated care.

I'm not saying that insurance is the way to go and I'm definitely not saying that the status quo is the way to go.  What I am saying is that if our choice is a bureaucrat or an accountant I would rather have an option that puts my care in the hands of my doctor and doesn't tie my hands.  I don't see either side putting forth an option that meets that criteria.

Here's the American Hospital Association's definition: 

"Uncompensated care is an overall measure of hospital care provided for which no payment  was received from the patient or insurer.  It is the sum of a hospital's "bad debt" and the charity  care it provides.   Charity care is care for which hospitals never expected to be reimbursed.  A  hospital incurs bad debt when it cannot obtain reimbursement for care provided.  This happens when patients are unable to pay their bills, but did not apply for charity care, or are unwilling to  pay their bills.  Uncompensated care excludes other unfunded costs of care, such as underpayment from Medicaid and Medicare." (emphasis mine)

http://www.aha.org/aha/content/2007/pdf/07-uncompensated-care.pdf

In that case it would be interesting to see the extent to which the number would grow when the costs of government under funding costs are added, because like anything else someone has to pay for it.  I would also find it hard to estimate this number in the first place because there is such a complex system between providers and insurers.  In the end the point still remains, the current system is flawed, private and US Government run.  What is missing is a third option, and option that gives power back to the individual and his doctor to choose what is best for him or her.  We also need a reality check.  Free health care is never free and you get what you pay for.  There s no way to do a universal plan within our current legal structure and have the system be solvent without significant tax increases in a continually strained economy. 

Seth,

I disagree. We are already paying, out of pocket, Medicare taxes to support a pay-as-you-go system, we are paying huge insurance premiums, deductibles and copays, we are subsidizing Medicaid. Cut out the insurance company overhead and the combined outlays for all of these will be near sufficient to pay for all medical costs incurred. We could divert the funds we pay, from their current sources and work out the care and cost reforms afterward; spread the burdens more equitably later on. We can even re-allocate TARP money not taken by the financial sector to bail docotrs out of student debt (PCPs could easily be considered a troubled asset) and underwrite public malpractice policy.We have many means at our disposal without new levies. We spend money in so many foolish directions.

The criminal shame of it all is that with all that we pay, we get healthcare inferior to 36 other nations who pay far less. Their care is not solely market-based, leaves choices to physicians and patients, AND is government subsidized. Are you saying we cannot accomplish what other nations have accomplished? That we cannot use our government for our benefit?

If we need additional funding, there's always the possibility of raising regressively flat Medicare tax which taxes the rich the same as the working class. We can do this without affecting 90% of the population. That's not a significant tax increase. The top 10% of earners wouldn't even notice a change in their lives.

You don't think that anything should come between doctors and patients. I think that should include money. Inability to pay is not a medical problem and it shouldn't be made into one.

Where did you get that statistic?  I recommend you check your sources.  would you get this in Berkley S.F.  probably.  As a whole over the populace of the United States I think not.

How about going with a more impartial statistic that includes validity (this is a statistical term, if you don't know what it means look it up).

I recommend reading "How to Lie with Statistics" You see it on the news every night, statistics can be manipulated to tell whatever story you like.  Without raw data and information on populations polled, statistical significance, and confidence intervals you are just reading what the author wants you to believe.  Think for yourself, get educated and don't fall for that crap.

You are absolutely correct Kendra. The federal aw says that they have to treat you but if its life and death that only includes stabilizing you and then moving you to the county hospital. Sure you or your kids might be seen by a doctor for an earache but what about the prescription for the antibiotic that is needed? You pay